Management of Entropion and Trichiasis

2011 ◽  
Author(s):  
David H. Verity ◽  
Geoffrey E. Rose
Keyword(s):  
Ocular Surface ◽  
Lower Eyelid ◽  
Complete Loss ◽  
Secondary Effects ◽  
Orbicularis Muscle ◽  
Eyelid Margin ◽  
Ocular Irritation ◽  
Age Related ◽  
Causative Factors ◽  
Gentle Traction

Entropion is a posterior rotation of the upper or lower lid margin against the globe; the causes include involutional changes within the eyelid tissues or cicatricial shortening of the posterior lamella of the eyelid. Congenital lower lid entropion is rare and results from an excess of skin and orbicularis oculi muscle being only loosely attached to the eyelid retractors. The symptoms of entropion—which include ocular irritation, lid spasm, pain, redness, and watering—are worse in the presence of a keratinized lid margin (occurring in cicatricial disease) and where the ocular surface is compromised. Discomfort may lead to secondary blepharospasm, which exacerbates the entropion by causing the preseptal part of the orbicularis muscle to override the pretarsal component. The eyelids and globe should be examined to identify underlying causative factors—in particular the degree and position of tissue laxity, the position of the eyelid margin and lashes, and the thickness of the tarsus. Any secondary effects of entropion, both within the lid and on the ocular surface, should also be noted. 7-1-1 Tissue Laxity. Aging of collagen and the force of gravity leads to eyelid laxity and an excess of tissues, particularly the anterior lamella of the lid. Stretching of the orbicularis muscle and canthal tendons results in horizontal laxity, and eyelid stability is further compromised by enophthalmos due to age-related fat atrophy. Where there is a relative dissociation between the anterior and posterior lamellae, the preseptal orbicularis muscle overrides the pretarsal muscle, leading to eyelid inversion, and this effect is exacerbated both by laxity of the lower lid retractors and age-related tarsal atrophy. Tissue laxity in the absence of orbicularis overriding tends to cause ectropion; with complete loss of retractor action, this can result in complete eversion of the tarsus (“shelf ectropion”). Horizontal laxity of the eyelid tissues is assessed by grasping the lid skin and applying gentle traction in the appropriate direction. The overall horizontal laxity is judged by the extent to which the eyelid can be parted from the globe—greater than about 6 mm is abnormal for a lower eyelid—and by the speed with which the retracted lid returns to the surface of the globe (the “spring-back” test).

scholarly journals Pseudoexfoliation syndrome and ocular adnexa

2016 ◽  
Vol 9 (3) ◽  
pp. 15-21 ◽  
Author(s):  
Vitaly V. Potemkin ◽  
Vyacheslav V. Rakhmanov ◽  
Elena V. Ageeva ◽  
Aisa S. Alchinova ◽  
Elena V. Meshveliani
Keyword(s):  
Muscle Tone ◽  
Lower Eyelid ◽  
Levator Muscle ◽  
Pseudoexfoliation Syndrome ◽  
Orbicularis Muscle ◽  
Upper Eyelid ◽  
Ocular Adnexa ◽  
Related Disease ◽  
Age Related ◽  
And Function

Pseudoexfoliation syndrome (PEX) is a relatively widespread generalized age-related disease of connective tissue. It seems reasonable to evaluate the condition of ocular adnexa in patients with PEX. Purpose. To evaluate the condition of ocular adnexal tissue in PEX. Methods. 132 eyes of 66 patients with PEX syndrome and 128 eyes of 64 patients without it were enrolled in the prospective study. We evaluated function of upper eyelid levator muscle, lower eyelid retractors, horizontal lid laxity (HLL), canthal integrity, degree of retractors disinsertion and tone of orbicularis muscle. Results. HLL, degree of retractors disinsertion, laxity of medial canthal tendon were statistically significantly more expressed in patients with PEX (p < 0,05). The tone of orbicularis muscle and function of lower eyelid retractors were statistically lower in patients with PEX (p < 0,05). The function of eyelids levator muscle, tone of lateral canthal tendon and degree of ptosis were similar in both groups. Conclusion. Signs of atonic changes of ocular adnexa are relatively more common in patients with PEX (p < 0,05).

scholarly journals Application of Kuhnt–Szymanowski Procedure to Lower Eyelid Margin Defect after Tumor Resection

2017 ◽  
Vol 5 (2) ◽  
pp. e1230 ◽  
Author(s):  
Ayato Hayashi ◽  
Mariko Mochizuki ◽  
Tomoki Kamimori ◽  
Masatoshi Horiguchi ◽  
Rica Tanaka ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Lower Eyelid ◽  
Eyelid Margin

Age-related ocular surface modifications assessment combining thermal infrared and deep learning approach

2021 ◽  
Author(s):  
Chiara Filippini ◽  
Antonio Maria Chiarelli ◽  
Daniela Cardone ◽  
David Perpetuini ◽  
Lorenza Brescia ◽  
...  
Keyword(s):  
Deep Learning ◽  
Ocular Surface ◽  
Surface Modifications ◽  
Thermal Infrared ◽  
Learning Approach ◽  
Age Related

scholarly journals The microbiome and ophthalmic disease

2018 ◽  
Vol 244 (6) ◽  
pp. 419-429 ◽  
Author(s):  
Adam D Baim ◽  
Asadolah Movahedan ◽  
Asim V Farooq ◽  
Dimitra Skondra
Keyword(s):  
Ocular Surface ◽  
Open Angle Glaucoma ◽  
Age Related Macular Degeneration ◽  
Therapeutic Interventions ◽  
Gastrointestinal Microbiota ◽  
Treatment And Prevention ◽  
Age Related ◽  
Microbiome Research ◽  
Ophthalmic Diseases ◽  
Ophthalmic Disease

Progress in microbiome research has accelerated in recent years. Through the use of 16S rRNA assays and other genomic sequencing techniques, researchers have provided new insights about the communities of microorganisms that inhabit human and animal hosts. There is mounting evidence about the importance of these ‘microbiotas’ in a wide variety of disease states, suggesting potential targets for preventative and therapeutic interventions. Until recently, however, the microbiome received relatively little attention in ophthalmology. This review explores emerging research on the roles that ocular and extraocular microbiotas may play in the pathogenesis and treatment of ophthalmic diseases. These include diseases of the ocular surface as well as autoimmune uveitis, age-related macular degeneration, and primary open angle glaucoma. Many questions remain about the potential impacts of microbiome research on the diagnosis, treatment, and prevention of ophthalmic disease. In light of current findings, we suggest directions for future study as this exciting area of research continues to expand. Impact statement This review describes a growing body of research on relationships between the microbiome and eye disease. Several groups have investigated the microbiota of the ocular surface; dysregulation of this delicate ecosystem has been associated with a variety of pro-inflammatory states. Other research has explored the effects of the gastrointestinal microbiota on ophthalmic diseases. Characterizing the ways these microbiotas influence ophthalmic homeostasis and pathogenesis may lead to research on new techniques for managing ophthalmic disease.

Correction of Lower Eyelid Marginal Entropion by Eyelid Margin Splitting and Anterior Lamellar Repositioning

2014 ◽  
Vol 30 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Youn Joo Choi ◽  
Hyun Chul Jin ◽  
Jeong Hoon Choi ◽  
Min Joung Lee ◽  
Namju Kim ◽  
...  
Keyword(s):  
Lower Eyelid ◽  
Eyelid Margin

Lower Eyelid and Midfacial Rejuvenation

2011 ◽  
Author(s):  
Chun Cheng Lin Yang ◽  
Richard L. Anderson
Keyword(s):  
Lower Eyelid ◽  
Fat Pad ◽  
Tear Trough ◽  
Aesthetic Unit ◽  
Lateral Canthus ◽  
Age Related ◽  
Crow’S Feet ◽  
The Face ◽  
The Aesthetic ◽  
The Individual

Over the past two and a half decades, techniques for midfacial rejuvenation have evolved. Midfacial rejuvenation has gained significant popularity among many aesthetic surgeons, including the ophthalmic plastic surgeon. Yet rejuvenation of the midface remains a challenge for the aesthetic surgeon who seeks facial harmony. A variety of techniques and approaches are available, yet no single approach is ideal for all patients. It is clear that the age-related anatomic alterations that cause patients to seek rejuvenation vary from patient to patient, and that many patients have more than one anatomic alteration that must be addressed to rejuvenate the lower lid. The surgeon must address the individual needs of each patient for optimal results. It has also become clear that the lower eyelid and midface form a continuum that needs to be addressed in its entirety for optimal rejuvenation. To achieve this, the surgeon must understand the basic concepts important to lower eyelid and midface rejuvenation, which include an understanding of eyelid and midfacial anatomy, an understanding of aging changes of the lower eyelid and midface, and surgical approaches and nonincisional options. A full understanding of aging changes in the lower eyelid and midface is essential to successfully address midfacial rejuvenation. A harmonious facial appearance consists of a balanced relationship among all tissues of the face. With age, disturbance of this harmony among midfacial tissues occurs. The aging process of the midface encompasses the lower eyelid, malar fat pad and associated structures, melolabial fold, and lateral perioral region. Hester describes four important features of midfacial aging: (1) baring of the inferior orbital rim with creation of a hollow valley at the junction of the lower eyelid and cheek; (2) descent of the malar fat pad, with loss of malar prominence; (3) deepening of the tear trough; and (4) exaggeration of the nasolabial fold. The midface represents a crucial aesthetic unit of the face. It is bordered by structures that play major roles in the overall appearances of the face. The lower eyelid and tear trough toward the nose and the lateral canthus and crow’s feet at the superior lateral aspect frame the midface superiorly.

Management of Ectropion and Floppy Eyelids

2011 ◽  
Author(s):  
Douglas P. Marx ◽  
Michael T. Yen
Keyword(s):  
Disease Process ◽  
Underlying Disease ◽  
Lower Eyelid ◽  
Eyelid Margin ◽  
Ocular Discomfort ◽  
Lateral Tarsal Strip ◽  
Orbital Rim ◽  
Lateral Canthotomy ◽  
Medial Canthal Tendon ◽  
Horizontal Eyelid Laxity

Ectropion is defined as an eversion of the upper or lower eyelid away from the globe. Classes of ectropion include involutional, cicatricial, paralytic, and mechanical. Ectropic eyelids develop from horizontal eyelid laxity, medial canthal tendon laxity, vertical skin tightness, neuromuscular dysfunction, and lower eyelid retractor disinsertion. Ocular complications associated with ectropic eyelids include corneal exposure and scarring, conjunctivitis, ocular discomfort, photophobia, epiphora, and decreased vision. The entire face and eye should be carefully examined when a patient presents with ectropion. A systemic approach enables the physician to more fully understand the underlying disease process and best therapeutic approach. Ectropion can be quantified by pulling the central portion of the lid anteriorly and measuring the number of millimeters from the anterior cornea to the apex of the eyelid. Ectropion etiology can be elucidated by evaluating for horizontal eyelid laxity, orbicularis dysfunction, vertical skin tightness, and lower eyelid retractors disinsertion. Horizontal eyelid laxity is typically a result of lateral or medial canthal tendon stretching. Laxity of the canthal tendons produces a redundancy in the eyelid tissues, resulting in ectropion, often referred to as an involutional ectropion. Lateral canthal tendon status can be determined by gently pulling the eyelid nasally. The inferior crus of the tendon can then be palpated to evaluate for dehiscence. The medial canthal tendon can be evaluated by pulling laterally and noting the displacement of the inferior punctum. The severity of canthal tendon laxity should be quantified prior to any surgical intervention. 8-2-1 Lateral Canthal Tendon Laxity and the Lateral Tarsal Strip Procedure. Although a variety of methods have been advocated for treatment of lateral canthal tendon laxity, we prefer the lateral tarsal strip, introduced by Anderson. This procedure corrects the underlying anatomic abnormality, does not require reapproximation of the eyelid margin, and is relatively easy to perform. The lateral canthal region is injected with lidocaine 2% mixed with 1:100,000 epinephrine using a 27- or 30-gauge needle. After ensuring appropriate anesthesia, Stevens scissors are used to create a lateral canthotomy and exposure of the lateral orbital rim.

Outcomes of Second Intention Healing of the Lower Eyelid Margin After Mohs Micrographic Surgery

2019 ◽  
Vol 45 (7) ◽  
pp. 884-889 ◽  
Author(s):  
Diane N. Trieu ◽  
Anna Drosou ◽  
Lucille E. White ◽  
Leonard H. Goldberg
Keyword(s):  
Lower Eyelid ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Eyelid Margin

Emergence of serranid pigment abnormality syndrome (SPAS) in wire netting cod (Epinephelus quoyanus) from Heron Island on the southern Great Barrier Reef

2018 ◽  
Vol 69 (8) ◽  
pp. 1201
Author(s):  
B. K. Diggles ◽  
I. Ernst ◽  
S. Wesche
Keyword(s):  
Great Barrier Reef ◽  
Anthropogenic Impacts ◽  
Skin Lesions ◽  
Barrier Reef ◽  
Course Of Disease ◽  
Coral Trout ◽  
Lower Jaw ◽  
Age Related ◽  
Causative Factors ◽  
Abnormal Pigmentation

Coral reefs worldwide are under increasing stress from anthropogenic impacts, but there are relatively few reports of increased rates of disease in coral reef fish. Herein we report the emergence of abnormal skin lesions in wild-caught wire netting cod (Epinephelus quoyanus) near Heron Island in the southern Great Barrier Reef. The lesion involves conspicuous darkening and disorganisation of the brown ‘wire netting’ colouration pattern typical of this species, most commonly on the lower jaw, premaxilla and head, with occasional involvement of the flanks and dorsal fin in some fish. The lesion was not present during research conducted in the mid-1990s; however, since it was first recorded in 2012, the prevalence of grossly visible lesions has increased to 16.9% in 2017, with fish >340mm long most affected (prevalence 64.7%). These data suggest emergence of the lesion is a recent phenomenon and that causative factors may be age related. Abnormal pigmentation lesions have only been observed to affect E. quoyanus and coral trout (Plectropomus leopardus; since 2010). Given the species affected and the currently unknown aetiology of these lesions, we name the condition serranid pigment abnormality syndrome (SPAS). Further research is required to determine its geographic distribution, establish causation and describe the course of disease in E. quoyanus.

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