Scar formation after lower eyelid incision for reconstruction of the inferior orbital wall related to the lower eyelid crease or ridge in Asians

Background: Transcutaneous lower eyelid approaches are associated with a risk of postoperative scarring depending on the distance between the incision line and the lower eyelid margin. The lower eyelid crease of Caucasians corresponds to a ridge-shaped fold in young Asians. However, this relationship has not been sufficiently evaluated in the latter. The authors, therefore, investigated the location of the scar and the lower eyelid crease or ridge to find the optimal location for the incision line.Methods: This study included 60 out of 139 patients who underwent inferior orbital wall reconstruction through a lower eyelid skin incision between July 2019 and June 2020. According to the location of the scar, the patients were classified into three groups: group A ( ≥ 2 mm above the lower eyelid crease or ridge), group B (within the lower eyelid crease or ridge to 2 mm above the lower eyelid crease or ridge), and group C (within the lower eyelid crease or ridge to 2 mm below the lower eyelid crease or ridge). At 6 or 12 months after surgery, the Patient and Observer Scar Assessment Scale (POSAS) score was obtained, the distance between the lower eyelid margin and the scar (DMS) and the distance between the margins of the peripheral pupil and the lower eyelid (DMPE) were measured, and the occurrence of ectropion was evaluated.Results: Group B had the lowest POSAS score (A: 22.7 ± 8.0, B: 20.9 ± 2.4, C: 32.5 ± 4.1, p < 0.001). Linear regression analysis showed that the DMS was positively correlated with the POSAS score (p < 0.001) and that the risk of DMPE widening increased as the DMS decreased (p = 0.029). None of the patients had ectropion.Conclusion: When using the transcutaneous approach for inferior orbital wall reconstruction, the optimal incision site is within the lower eyelid crease or ridge to 2 mm above the lower eyelid crease or ridge.

“Split-Face” Evaluation of Collagen Changes Induced By Periorbital Fractional CO2 Laser Resurfacing

Background Periorbital fractional CO2 laser resurfacing has been used for facial rejuvenation purposes. However, to the best of our knowledge, no study objectively assessed periorbital neoformation and remodeling of local cutaneous collagen, in a split-face model, from skin samples obtained during upper blepharoplasty. Objectives To objectively evaluate neoformation and remodeling of local cutaneous collagen after periorbital skin fractional CO2 laser resurfacing. Methods Prospective and comparative study in which 16 female subjects presenting with dermatochalasis and periorbital rhytids were evaluated. All subjects underwent unilateral periorbital fractional CO2 laser resurfacing 30 days prior to upper blepharoplasty. Quantification of types I and III collagen from laser treated and untreated eyelid skin samples obtained during upper blepharoplasty was assessed with histochemical analysis (Picrosirius Red staining). Laser resurfacing treatment was applied to the untreated side immediately after the upper blepharoplasty. Two blinded, independent physicians evaluated clinical improvement in pretreatment, 1 and 6-month post-treatment digital images. Results Histochemical analysis showed significant higher intensity in collagen types I (treated: 158.7 ± 5.3, untreated: 139.2 ± 5.0; p&lt;0.0001) and III (treated: 105.1 ± 7.7, untreated: 104.1 ± 7.1; p&lt; 0.0001) in the samples submitted to fractional CO2 laser treatment; a greater difference was detected in collagen type I. A significant improvement in periorbital rhytidosis was observed one month after laser resurfacing (23%); a greater improvement in the periorbital region was observed 6 months after laser resurfacing and upper blepharoplasty (43.67%). Conclusions Periorbital fractional CO2 laser resurfacing demonstrated to be an effective method to improve palpebral skin, with histochemical evidence of increase in collagen types I and III.

Mechanotransductive Differentiation of Hair Follicle Stem Cells Derived from Aged Eyelid Skin into Corneal Endothelial-Like Cells

Corneal endothelial insufficiency is one of the leading causes of blindness. The main contemporary treatment for corneal blindness is endothelial keratoplasty, which, however, is unsatisfactory as a medical therapy due to the lack of donor corneas and graft rejection. Therefore, autologous stem cell-based corneal endothelial tissue substitutes may be a promising alternative to conventional grafts in the future. To address the age of most patients suffering from corneal endothelial deficiencies, we investigated the presence and potential of hair-derived stem cells from older tissue donors. Our studies revealed the presence of pluripotency- and neural crest-associated markers in tissue sections from blepharoplasty patients aged 50 to 80 years. In vitro outgrowths from eyelid hair follicles on collagen-coated tissue culture plates revealed a weak decrease in stem-cell potency. In contrast, cells within the spheres that spontaneously formed from the adherent cell layer retained full stem-cell potency and could be differentiated into cells of the ecto- meso and endodermal lineages. Although these highly potent hair follicle derived stem cells (HFSC) were only very slightly expandable, they were able to recognize the biomimicry of the Descemet’s-like topography and differentiate into corneal endothelial-like cells. In conclusion, HFSCs derived from epidermal skin of eyelid biopsies are a promising cell source to provide autologous corneal endothelial replacement for any age group of patients. Graphical Abstract

1590 Reconstructing Periorbital Necrotising Fasciitis - A Case Report

Periorbital necrotising fasciitis is a rare life-threatening presentation. We present a case of an 87-year-old patient with periorbital necrotising fasciitis. The patient was successfully managed by prompt diagnosis, debridement and reconstruction with a thick split thickness skin graft harvested from the scalp. To the best of our knowledge, this is the first case report in literature suggesting the use of sheet skin grafts from the scalp in reconstruction of necrotising fasciitis. The patient was discharged after 20 days and has no residual corneal or scleral show despite losing bilateral upper and lower eyelid skin. We present the case with photographs of initial presentation, debridement, and final reconstruction. Reconstruction of post-debridement necrotising fasciitis offers a challenge to the plastic surgeon. The wound bed is not ideal and commonly colonised. We suggest the use of thick split thickness skin grafts harvested from the scalp. Despite their utility in burns surgery, the use of scalp split thickness skin is not documented in literature for reconstruction of necrotising fasciitis. We believe this type of skin graft offers multiple advantages: higher rate of graft takes, less contracture and inconspicuous donor site morbidity. Time to reconstruction is particularly important in patients with eye lid skin loss and we believe this type of skin graft offers a versatile solution when graft take is essential.

Photodynamic therapy for facial skin cancer developed in the zone of previous radiotherapy (clinical case)

The results of a 13-year clinical observation of a patient after treatment for basal cell carcinoma of the skin of the right cheek Ist cT1N0M0 are presented. The history of the course of the disease is associated with the fact that the patient underwent radiation therapy in early childhood for hemangioma of the lower eyelid of the right eye and right cheek. In 2008, against the background of post-radiation changes in the area of the right cheek, basal cell carcinoma was diagnosed at the Moscow Oncological Research Institute. P.A. Herzen. At the Center for Laser and Photodynamic Diagnostics and Tumor Therapy, the patient underwent organ-preserving PDT treatment. A course of photodynamic therapy (PDT) with 5-aminolevulic acid was carried out. Subsequently, the patient was followed up until 2021 without relapse in the PDT area. In 2016, the patient was diagnosed with a relapse of the disease in the form of a new focus of basal cell carcinoma of the upper eyelid skin on the right Iast cT1N0M0. The patient underwent a course of PDT with a chlorin e6-based photosensitizer. Complete regression of the tumor was achieved, the period of relapse-free follow-up was 5 years.

Human Papillomavirus Related Neoplasia of the Ocular Adnexa

Human papillomaviruses (HPV) are a large group of DNA viruses that infect the basal cells of the stratified epithelium at different anatomic locations. In the ocular adnexal region, the mucosa of the conjunctiva and the lacrimal drainage system, as well as the eyelid skin, are potential locations for HPV-related neoplasia. The role of HPV in squamous cell neoplasia of the ocular adnexa has been debated for several decades. Due to the rarity of all these tumors, large studies are not available in the scientific literature, thereby hampering the precision of the HPV prevalence estimates and the ability to conclude. Nevertheless, increasing evidence supports that defined subsets of conjunctival papillomas, intraepithelial neoplasia, and carcinomas develop in an HPV-dependent pathway. The role of HPV in squamous cell tumors arising in the lacrimal drainage system and the eyelid is still uncertain. Further, the potential of HPV status as a diagnostic, prognostic, or predictive biomarker in these diseases is a topic for future research.

Hypercalcemia of malignancy in metastatic adenocarcinoma of left lower eyelid - A report of a rare case

Adenocarcinoma of eyelid is a rare disease with an incidence of 1 to 5.5% and is considered to be the most common eyelid malignancy following basal cell and squamous cell carcinoma. The symptoms usually present as swelling, thickening, change in appearance of the eyelid skin and ulceration. Various treatment modalities include surgery, radiation or chemotherapy relying upon the stage of tumor at the time of presentation. However, metastasis of adenocarcinoma of the eyelid to other organs is quite rare. We are presenting a case of a 35 year old male who initially presented with complaints of watering in the left eye and in due course, was diagnosed with adenocarcinoma of eyelid which was being treated and eventually progressed to lung and skeletal tissues. This gentleman also had severe Hypercalcemia which was secondary to paraneoplastic syndrome.

Insinuate Orbital Cellulitis Associated With Diesel Explosion-Induced Injury

Background: Diesel-related orbital cellulitis is uncommon, it has an insinuate appearance whereas develops aggressively, leading to severe vision loss or poor reconstruction. Here we present a case of diesel explosion-associated eyelid trauma with toxic orbital cellulitis, who at last obtained relatively sound vision and appearance after several rounds of surgeries, which is rarely seen for the trauma itself. Case presentation: A 33-year-old male was injured in the right eye by diesel engine explosion. He was initially treated for right eye eyelid laceration however the trauma developed into toxic orbital cellulitis on the next day. Orbital debridement and removing of the orbital residual diesel fluid was performed on him immediately. However, on the second day necrosis developed in the eyelid and sub-dermal tissue. Therefore he received another orbital debridement to remove the necrotized tissue and awaited the subsequent right eyelid skin grafting surgery. The patient finally got his right eye vision saved as well as maintaining a relatively sound structure of the eyelid.Conclusion: Timely debridement and removing the residual diesel in the orbit is necessary for the recovery of patient with diesel-related toxic orbital cellulitis.

Periocular apocrine adenocarcinoma presenting as an orbital mass: clinicopathological features and management in four patients

Purpose: Apocrine adenocarcinoma is a cutaneous adnexal malignancy which can rarely arise from ocular structures. In this retrospective study, we report our experience with four patients who had primary periocular apocrine adenocarcinoma initially presenting with an orbital tumor. Methods: Data extracted included demographics, clinical, imaging, and histopathological features, and treatment outcomes. Results: The definitive diagnosis was established after an incisional biopsy in all cases. Two patients were then managed with exenteration. The third patient underwent local resection followed by radiotherapy but had to be exenterated because of new tumor formation 7 years later. The fourth patient had to be managed with oral bicalutamide which kept the tumor stable for 3 years. Recurrence-free survival for the radical surgical treatment group was 10, 6, and 7 years respectively. Conclusion: Periocular apocrine adenocarcinoma may insidiously develop as an orbital mass without any clinically detectable primary eyelid skin or conjunctival lesions. This tumor must be in the differential diagnosis of medially located ill-defined orbital masses in patients over 50 years of age. Orbital exenteration appeared as an effective treatment of apocrine adenocarcinoma with orbital extension. Anti-androgenic treatment in an androgen receptor-positive tumor provided temporary local tumor control.