Modern approach to diagnosis and treatment of post-traumatic periorbital scarring

Background. The treatment of cicatricial deformities of the periorbital region is one of the most difficult problems of ophthalmoplasty. The choice of treatment tactics depends on the correct assessment of the type of periorbital scarring, which further determines its effectiveness. Based on the analysis of literature sources, the causes of periorbital scarring are determined, and modern me­thods of their clinical assessment and treatment are presented. The purpose: to analyze the current state of the issues of pathogenesis, classification, diagnosis, and treatment of post-traumatic cicatricial deformities of the periorbital region. Materials and methods. The research was carried out using the search and information systems PubMed, eLibrary, Google Scholar, and library databases for the period 2012–2020. Results. It was found that the formation and type of scars depend on many internal and external factors. The most common classification divides the scars into normotrophic, atrophic, hypotrophic, which refer to superficial scars, as well as deep — hypertrophic, keloid, and mixed. Determining the stages of scar tissue formation is important for choosing a method of treating a patient and obtaining the most positive result. Various thoughts are given regar­ding the stages and timing of the wound healing and scar formation process. The main modern methods of assessing and diagnosing scars have been determined, their advantages and disadvantages have been analyzed. The modern approaches to the treatment of scars based on their type were analyzed. Conclusions. The results of the analysis of modern literary sources showed that the issue of the etiology and pathogenesis of pathological scars has not yet been finally resolved. There is no single approach to diagnosis and treatment of scars, the optimal timing of treatment initiation. A particular problem is the treatment of cicatricial deformities of the periorbital region, which is predetermined by its anatomical and functional complexity. All this makes the task of studying the features of the course of scar formation of this particular area and the development of individualized algorithms for their treatment urgent.

Comparative Study between Intense Pulsed Light and Fractional CO2 Laser in the Treatment of Periorbital Wrinkles

Background The periorbital region is one of the areas showing the earliest signs of aging and is especially prone to skin wrinkles and discoloration. Both fractional carbon dioxide (CO2) laser and intense pulsed light (IPL) have been evaluated in treatment of periorbital wrinkles. Objective The objective of this study was to evaluate and compare the efficacy of fractional CO2 laser and IPL in the treatment of periorbital wrinkles. Patients and Methods The present study is a prospective comparative split face study which included 20 adult female patients with mild to moderate periorbital wrinkles. Their age ranged from 30 to 40 years. Each patient received four treatment sessions with three weeks intervals on each side of the periorbital region, one with IPL and one with fractional CO2 laser. Evaluation was done before each treatment session and two months after last session with ordinary photographs and by wrinkles indentation index as calculated by the Antera 3D camera. Results There was a highly statistically difference between the mean percentage of improvement of the wrinkles indentation index by fractional CO2 laser as compared to IPL. Conclusion Both IPL and fractional CO2 laser are promising effective modalities of treatment of periorbital wrinkles which are easy and safe to use. However, fractional CO2 laser is more effective and leads to more improvement in wrinkles indentation index by Antera camera score.

A case report of generalised eruptive syringoma: a rare variant of syringoma

<p class="abstract">Syringomas are benign adnexal neoplasm of eccrine sweat duct usually affecting adult women. They present as firm, skin coloured to yellowish papules in a symmetrical distribution over periorbital region. Eruptive syringomas are infrequent and usually appear at uncommon sites. Herein, we report a case of a 21-year old girl with eruptive syringomas with an extensive involvement.</p>

Unusual Skin tear caused by eye taping using acrylic-based adhesive tape in a adult patient with recurrent craniopharyngioma

Skin tears due to medical adhesives are a ubiquitous but under documented complication that occurs in in almost all clinical settings and frequently in patients with certain risk factors. Due to lack of information regarding proper usage, suitable selection and the right technique for application of adhesive products can influence patient safety besides hampering the quality of life. Medical adhesives-related skin injuries (MARSI) is the latest term used, defined ‘an occurrence in which erythema and/or other manifestations of cutaneous abnormality (including, but not limited to, vesicle, bulla, erosion or tear) persists 30 min or more after removal of the adhesive’ [1]. We describe a report of skin tear due to acrylic based adhesive in a young male who underwent craniotomy and tumor excision. A 21 year-old male with a diagnosis of a recurrent craniopharyngioma was posted for a Pterional craniotomy and excision of the tumour. The patient had secondary hypothyroidism and secondary hypocortisolism on thyroid and steroid replacement respectively. He was shifted to the OT and after attaching all the standard ASA monitors, he was induced after adequate preoxygenation, with Fentanyl, Propofol and Vecuronium and intubated with a 8.5mm sized ET tube. A central venous catheter was inserted post induction in the right subclavian vein and was fixed with an adhesive tape. Before positioning the patient, scalp block with 15 ml of 0.5 % bupivacaine was administered. The eyelids were then taped with acrylic-based adhesive tape. The duration of the surgery was approximately 11 hours. In view of the prolonged nature of the surgery, the decision was made to not extubate the patient in the OT and to shift him to the Intensive Care Unit for further management and elective ventilation. Before the patient was shifted out of the OT, the adhesive tapes over his eyes were removed. While the left eye and periorbital region were found completely normal, the right periorbital region was mildl

A new combined method for the treatment of involutional changes in the periorbital region

Background. The solution to the problem of correction of involutional changes in the periorbital region requires a multidisciplinary approach, as this location can comprise a broad range of problems that need to be addressed. For so many years, laser therapy methods have been the standard for correcting age-related changes. However, many issues concerning combined methods remain open, and the search and development of the most effective protocols for their use is therefore an urgent task of modern medicine. Objective. The goal of the study was to develop a combined method to correct involutional skin changes in the periorbital region in young and middle-aged patients using a fractional Nd:YAG and CO2 laser in conjunction with lower transconjunctival blepharoplasty, based on the study of clinical efficacy results and taking into account the indicators of the qualitative characteristics of the skin, as well as microcirculation. Material and methods. The study enrolled 108 patients with involutional changes in the skin of the lower eyelid. These patients were classified into groups based on the method of treatment. In the study, relevant methods were used, namely, the study of the qualitative characteristics of the skin (cutometry, TEVA-metry, and corneometry) and microcirculatory processes using laser flowmetry. Results. The effectiveness of the developed combined method is based on a substantial positive impact on active and passive hemodynamic mechanisms at all levels of the microvasculature, as demonstrated by an increase of 45.92% in the integral indicator of microcirculation compared to 26.35% and 5.77% in the comparison groups, while the coefficient of variation in the microcirculation indicator increased by 33.02% compared to 24.19% and 6.46% following the use of the method components. The use of the combined treatment method restores the qualitative characteristics of the skin, namely, the moisture index increased by 27% (p 0.05) compared to 14.1% and 7.8% in groups 1 and 2, respectively; the rate of transepidermal water loss decreased by 47% (p 0.05) compared to 35% and 12.7% in groups 1 and 2, respectively; and the elasticity index Ua/Uf increased by 23.2% (p 0.05) compared to 18.4% and 16.4% in groups 1 and 2, respectively. Conclusion. Based on the study, it can be concluded that the combined treatment method developed is highly effective.