Tawfik, Hatem A. M.D.; Abdulhafez, Mohamed H. F.R.C.S.; Fouad, Yousef A. M.B.B.S.; Dutton, Jonathan J. M.D., Ph.D., F.A.C.S.
Purpose: To review the recent data about eyelid morphogenesis, and outline a timeline for eyelid development from the very early stages during embryonic life till final maturation of the eyelid late in fetal life.
Methods: The authors extensively review major studies detailing human embryologic and fetal eyelid morphogenesis. These studies span almost a century and include some more recent cadaver studies. Numerous studies in the murine model have helped to better understand the molecular signals that govern eyelid embryogenesis. The authors summarize the current findings in molecular biology, and highlight the most significant studies in mice regarding the multiple and interacting signaling pathways involved in regulating normal eyelid morphogenesis.
Results: Eyelid morphogenesis involves a succession of subtle yet strictly regulated morphogenetic episodes of tissue folding, proliferation, contraction, and even migration, which may occur simultaneously or in succession.
Conclusions: Understanding the extraordinary process of building eyelid tissue in embryonic life, and deciphering its underlying signaling machinery has far reaching clinical implications beyond understanding the developmental abnormalities involving the eyelids, and may pave the way for achieving scar-reducing therapies in adult mammalian wounds, or control the spread of malignancies.
Meisha L. Raven, DO, Roman I. Krivochenitser, MD, Mark J. Lucarelli, MD
A 42-year-old man presented with a left medial commissure lesion that progressed in size and pigmentation over 8 years (Fig 1, arrow). Clinically, the lesion appeared gray in color and mild telangiectatic vessels were seen. Histopathology revealed a large apocrine hidrocystoma with a circumscribed nodule composed of variably sized tubules adjacent to the cyst wall (Fig 2). The cells displayed abundant eosinophilic cytoplasm, uniform round nuclei, and apocrine snouting (Fig 3). Tubular apocrine adenomas are rare benign tumors with a predominance in females (2:1), and are most commonly seen on the scalp, cheek, axilla, and breast.
Stephen J. Goldie, Scott K. Lyons
Surgical excision of non-melanoma skin cancers is the mainstay of treatment, and a common procedure performed by clinicians from various backgrounds and training levels. Despite efforts to excise squamous cell carcinomas (SCCs) with a margin of normal tissue, some tumours are incompletely excised or cells are “seeded” into the wound allowing local recurrence. Following surgical oncology procedures many operators irrigate wounds or body cavities with water rather than saline. The logic being that water will induce an osmotic shift of fluid into the cells, causing them to lyse.
Shaheen Hasmat, Nigel H. Lovell, Gregg J. Suaning, Tsu-Hui (Hubert) Low, Jonathan Clark
The most devastating outcome of facial nerve paralysis is the inability to completely close the eye as it can lead to corneal ulceration and loss of vision. Gravity-assisted eye closure with upper lid loading is commonly used; however it is limited in replicating physiological eye closure to adequately lubricate the cornea. Superior results can be obtained using more advanced reconstructive approaches, however they depend on nerve regrowth which may be unpredictable and prolonged. This report describes a novel technique for creating an active eye closure using an implantable actuator. A generated magnetic field creates lateral movement in an electromagnet that is translated to the eyelid through a sling design. The device is powered wirelessly through a transcutaneous induction link and can be hermetically encapsulated for patient safety. The initial phase of device development is presented including data of a fully functioning prototype and the results of its application in animal and human cadavers.
Kyle J. Godfrey, MD, Michael Kinori, MD, Johnathan H. Lin, MD, Vivian S. Snyder, DO, David B. Granet, MD, Christopher W. Heichel, MD, Shira L. Robbins, MD
Benign hemangiomas are rare vascular tumors of the conjunctiva that typically present clinically in the first few weeks of life and resolve spontaneously. De novo presentation later in childhood has not been well documented. We present the unusual case of an 11-year-old boy with a rapidly growing benign de novo conjunctival hemangioma that was treated with surgical excision.
Lora R. Dagi Glass, MD, Alexandra T. Elliott, MD
Current techniques for repairing large eyelid colobomas require preparation of other tissue sites and occasionally more than one procedure. We present a technique that requires only one procedure and is limited to the colobomatous eyelid; in addition, it is specifically designed to help avoid postoperative astigmatic and obstructive amblyopia. Outcomes are demonstrated in 3 cases of hemifacial microsomia. Large colobomas on the upper eyelid can be successfully and aesthetically repaired with only one procedure, incising only the congenitally abnormal eyelid.
Vijay Kumar Wagh, Ki Crystal Lam, A.M Susana Morley
A 36-year-old woman of Afro-Caribbean descent was referred to our clinic with a history of painless swelling of the right upper eyelid for a few months. She had suffered intermittent right upper eyelid swelling for 10 years and had been seen in many hospitals. She had been given various diagnoses, most commonly allergic eyelid edema, but had also been treated for blepharitis and dry eyes. The swelling often resolved spontaneously or with the use of topical or oral steroids. A few months before review with us, she had developed a severe episode of persistent right upper eyelid swelling that partially resolved with systemic steroids.
Lally, Sara E.
Purpose of review:The purpose of this article is to review the recent published literature in 2015 on lymphatic malformation and provide updated information on the disease. Specifically, this article will describe recent advances in identifying and managing lymphatic malformations.
Recent findings:All articles discussed in this article emphasize the difficulty in treating lymphatic malformations. Most patients have long complicated histories with multiple recurrences. Studies are trying to identify which lesions will be successful treated by certain therapeutic modality. Treatment includes nonsurgical and surgical therapies.
Summary:Lymphatic malformations are difficult lesions to treat because they do not respect tissue planes. The use of sclerosing agents shows great promise for treating macrocysts. More knowledge is needed in the development of the disease process. Hopefully, antilymphangiogenic agent can provide targeted treatment.
Adel H Alsuhaibani, Yasser H Al-Faky
Purpose: To report a unique technique to repair lower eyelid retraction using resorbable polydioxanone implants. Patients and Methods: This was a retrospective, consecutive, nonrandomized interventional case series. Patients with lower eyelid retraction after trauma repaired facial fracture, thyroid eye disease, lower eyelid blepharoplasty, and long-standing facial palsy were treated with middle lamellar spacer using absorbable polydioxanone implant. All patients were recruited from the King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Only patients with minimum follow-up of 12 months were included in the study. Results: Eight patients (4 males and 4 females) underwent lower eyelid retraction repair using absorbable polydioxanone implant. The mean age was 43 years (range, 23-63 years). All patients noted improved ocular surface symptoms. The improvement in eyelid retraction ranged from 1.5 to 4 mm with an average of 2.7 mm postoperatively. The implant was well tolerated with no major complications. Conclusions: Several options for spacer materials are available. Absorbable polydioxanone implants seem to be an effective middle lamellar spacer that is a good alternative for repairing middle lamella related lower eyelid retraction and lower eyelid support.
Raffaele Piscopo MD, Mary Romano MD, Alessandra Di Maria MD, Riccardo Vinciguerra MD & Paolo Vinciguerra MD
Introduction: Paraneoplastic clinical signs are characterized by a large and heterogeneous variety of manifestations due to several possible underlying neoplasms. Paraneoplastic pemphigus (PNP) is a particular paraneoplastic variety that usually primarily affects the dermic and/or oral mucosa and is characterized by a high rate of mortality (90%). Therefore, it is important to recognize its possible signs early. This report describes a case of ocular paraneoplastic pemphigus (PNP) presenting with recalcitrant eyelid ulceration and hyperemic conjunctivitis caused by an undiagnosed prostate cancer.
Methods: A 77-year-old man was admitted to our department because of recalcitrant hyperemic conjunctivitis in both eyes, complicated with large ulceration of both upper eyelids in spite of topical therapy. After 3 weeks, oral mucositis and bullous dermatitis on the chest and arms developed.
Results: Complete slit lamp ocular study, conjunctival swabs, routine hematologic tests, serum neoplasm markers, indirect immunofluorescence study, immunoblotting, and oral mucose biopsy with direct immunofluorescence were performed under the hypothesis of a paraneoplastic sign. Total body computed tomography scan and ultrasound-guided needle prostate biopsy completed the diagnostic process and confirmed the diagnosis of prostate PNP. Complete remission of ocular clinical signs was achieved by treatment of the prostate malignancy with systemic immunosuppressive therapy and chemotherapy.