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Concept: Eyelid



PURPOSE: To compare nylon monofilament suture with polytetrafluoroethylene sheet for frontalis suspension surgery to treat eyes with congenital ptosis. DESIGN: Retrospective, nonrandomized, comparative, interventional case series. METHODS: We reviewed the medical records of 49 patients who had undergone 79 eyelid frontalis suspension surgeries to treat congenital ptosis. All of the patients were younger than 16 years and had congenital ptosis with poor levator muscle function. They were treated with frontalis suspension surgery with either a nylon suture or a polytetrafluoroethylene sheet and were followed up for at least 1 year. A single rhomboid loop sling was used for the nylon suture surgery. For the polytetrafluoroethylene sheet, an incision was made in the eyelid crease, and one end of the sheet was fixed to the tarsus and the other was fixed to the frontalis muscle. The main outcome measures were postoperative recurrences and complications. RESULTS: We evaluated 37 eyelids of 25 patients after nylon suture surgery and 42 eyelids of 31 patients after polytetrafluoroethylene sheet surgery. Among these, 9 eyelids of 7 patients were included in both groups. The median postoperative follow-up period was 32 months in both groups. The recurrence rates were 62.2% for the nylon suture group and 0% for the polytetrafluoroethylene sheet group (P < .001). The postoperative complication rates were 0% for the nylon suture group and 7.1% for the polytetrafluoroethylene sheet group (P > .05). CONCLUSIONS: Frontalis suspension using a polytetrafluoroethylene sheet with direct tarsus and frontalis muscle fixation is a reasonable technique with low rates of recurrences and complications.

Concepts: Comparison, Surgery, Eye, Eyelid, Ptosis, Tarsus, Levator palpebrae superioris muscle, Dermatochalasis


We report an unusual case of bilateral eyelid erythema caused by eyelash glue. A 22-year-old woman presented with a 3-day history of bilateral eyelid dermatitis after attaching false eyelashes by using latex-containing glue. Slit-lamp examination revealed erythema and swelling of the upper lids of both eyes. The skin prick test was positive for eyelash glue and her total tear IgE score was high. To the best of our knowledge, this is the first report of bilateral eyelid dermatitis caused by eyelash glue.

Concepts: Allergy, Eye, Skin, Greatest hits, Skin allergy test, Eyelid, Eyelash


Upper-eyelid blepharoplasty is a very common procedure in aesthetic plastic surgery. Among all the literature in favor of orbicularis muscle resection, there are no commentaries associated with orbicularis muscle suture and its convenience. This article discusses a new approach: independent resection of the orbicularis oculi muscle similar in size to the resected skin and the subsequent suture of the orbicularis muscle after its resection. This results in a fine reconstruction of the upper-eyelid crease, achieves a good definition of this anatomical structure, and allows correction of asymmetries with the contralateral upper eyelid. The results obtained (98 % of patients satisfied) and no complications with this procedure make it a safe alternative for upper blepharoplasty. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

Concepts: Evidence-based medicine, Anatomy, Alternative medicine, Eyelid, Blepharoplasty, Orbicularis oculi muscle, Levator palpebrae superioris muscle, Orbicularis oris muscle


PURPOSE:: To describe a modified Fasanella-Servat procedure and nomogram for the correction of minimal amounts of ptosis. METHODS:: Retrospective review of this modified Fasanella-Servat procedure was performed on 118 eyelids in 86 consecutive patients over 2, 4-year periods by 1 surgeon (S.C.D.). The amount of tarsectomy was based on the amount of ptosis. RESULTS:: Mean pre- and postoperative margin-to-reflex distance 1 were +0.7 mm and +2.4mm, respectively. One hundred and twelve eyelids (95%) had satisfactory results with postoperative margin-to-reflex distance 1 ≥ 1.5 mm. Eyelid symmetry was achieved in 92% of eyelids to within 0.5 mm. There was no incidence of overcorrection, tarsal buckling, or corneal abrasion. One eyelid had a contour deficit. Tarsectomy amount ranged from 2 mm to 5 mm. Average amount of tarsectomy to eyelid elevation was 2.4:1. CONCLUSION:: The modified Fasanella-Servat procedure is technically easy, time-efficient, and has a low complication rate for the treatment of minimal blepharoptosis (< 2.5 mm) with good levator function and negative phenylephrine test. In the authors' hands, the ratio of tarsectomy to eyelid elevation is approximately 2:1. In addition to other techniques such as levator advancement and Müller's muscle conjunctival resection, the modified Fasanella-Servat technique is a useful adjunct to the modern ptosis surgeon's armamentarium.

Concepts: Ratio, Eye, Conjunctiva, Eyelid, Lacrimal nerve, Ptosis, Levator palpebrae superioris muscle, Dermatochalasis


OBJECTIVE: To present a novel, minimally invasive technique for everted third eyelid cartilage correction in dogs that employs the use of low-energy cautery to remodel the cartilage. PROCEDURES: Twelve eyes of ten dogs had cautery performed under general anesthesia to correct everted third eyelid cartilage. The tip of a handheld cautery unit or an electrocautery handpiece was applied to the bulbar conjunctival surface of the third eyelid at the central location of cartilage convexity and treated to effect. This resulted in gradual conjunctival contraction and cartilage softening that remodeled the third eyelid to return to a more normal, physiologic position. When the tips of the cartilage bar were also curled, cautery was briefly applied to the convex surface to straighten the cartilage in a similar manner. RESULTS: Blanching of the conjunctiva at the site of treatment occurred. Char was sometimes present and was gently removed with a scalpel blade to improve postoperative patient comfort. Mild conjunctival hyperemia was noted in a few patients for 1-2 days after surgery, but there were no signs of discomfort or eyelid swelling. All dogs had good results in terms of cartilage correction with no recurrence; however, one of the Great Danes that had concurrent third eyelid gland prolapse required gland replacement surgery. CONCLUSIONS: Thermal cautery is a simple, inexpensive means of correcting third eyelid cartilage eversion in dogs with a high rate of success that preserves normal tissue while restoring function.

Concepts: Surgery, Eye, Anesthesia, Conjunctiva, Eyelid, Lacrimal nerve, Conjunctivitis, Scalpel


Effective lower eyelid blepharoplasty is possible in a virtually closed fashion without either an anterior subciliary skin incision or a transconjunctival incision, both of which put the patient at risk for lower lid retraction.

Concepts: Patient, Eyelid, Blepharoplasty


To describe a simple technique to correct tarsal lower eyelid ectropion with or without marked eyelid laxity (The Leicester Modified Suture technique).

Concepts: Surgical suture, Eyelid, Ectropion, Entropion


Abstract A 34-year-old African-American man was referred for eyelid swelling and ocular discomfort. He was found to have floppy hypertrophic eyelids and marked bilateral mechanical ptosis that was present since childhood. Systemic examination was significant for furrows on his forehead and scalp, coarse facial features, and enlarged hands and feet with clubbing of the fingers and toes. Radiographic imaging of the long bones demonstrated periostosis, and MRI of the head revealed a pituitary macroadenoma. Pituitary and thyroid hormone levels were normal. The patient was diagnosed with pachydermoperiostosis and a non-secreting pituitary macroadenoma. Bilateral upper lid tightening via wedge resection was followed by bilateral external levator advancement ptosis repair in a staged manner. The patient achieved symptom relief and improved lid position postoperatively.

Concepts: Head and neck, Medical terms, Pituitary adenoma, Thyroid, Eyelid, Ptosis, Levator palpebrae superioris muscle, Dermatochalasis


Abstract Prolapse of the lacrimal gland is an unusual condition. An appearance of bilateral dermatochalasis was observed in the medical examination of a 30-year-old female patient with bilateral upper eyelid edema.The patient underwent bilateral blepharopylasty. During the surgery, it was noticed that in the temporal portions of the eyelids, there was a prolabed tissue-like lacrimal gland. We did incisional biopsy from the prolabed tissue that was thought to be orbital lobe of the lacrimal gland and carried out reposition of the orbital rim with 5-0 polyester suture and closed the orbital septum. Lacrimal gland reposition is a procedure which entails the separation of such anatomic structures as orbital septum, adipose tissue, and levator complex. However, failure to recognize a prolapsed lacrimal gland may mistreat by simple excision, and will lead to important alterations in ocular lubrication. In our case, repositioning of the glands was successfully performed during upper-lid blepharoplasty.

Concepts: Conjunctiva, Eyelid, Lacrimal nerve, Tears, Tarsus, Blepharoplasty, Dermatochalasis, Lateral palpebral arteries