Surgical Treatment of Sensile Entropion

Senile entropion is caused by following pathophysiologic changes ; disinsertion or weakness of lower lid retractor, upward migration and overriding of the preseptal orbicularis oculi muscle over pretarsal orbicularis muscle, horizontal lid laxity, and relative enophthalmos from absorption of orbital fat. There have been numerous procedures to correct senile entropion, but the difficulty of adequate and concurrent correction of all of the underlying defect result in high recurrence rate. Therefore, authors performed a combined procedure including reattachment of disinserted lower lid retractor or tucking of weakened lower tarsus, and the extirpation of overriding preseptal orbicularis oculi muscle. At the same time we performed the correction of the lower lid laxity using lateral tarsal strip procedure of full-thickness wedge resection. Authors performed this method in 21 cases of 17 patients and the cosmetic and functional result were satisfactory.

A Case of Phthiriasis Palpebrarum

Phthiriasis has been usually known as a sexually-transmitted disease. The majority of these cases are found in the hair of the genital lesion, however, infestation of the eyelashed may occur. Eyeld involvement frequently causes blepharitis or conjunctivitis. The authors found a crab louse, Phthirus pubis and their nits on the eyelashes of 22-year-old female who complained foreign body and itching sensation of her right upper lid. Treatment is accomplished by careful mechanical removal of the louse and nits followed by the epilation and alllication of antibiotic eyedrops. We report a case of Phthiriasis palpebrarum with a review of the literatures.

The Clinical Study On the Surgical Methods of Synkinetic Ptosis Treatment

Synkinetic ptosis refers to abnormal vertical movement of upper eyelid. This abnormal elevation of the eyelid results from opening or closing of the mouth, chewing, sucking, and movement of jaw outward or toward the contralateral side. A number of other stimuli for the phenomenon have been described. These include smile, sternocleidomastoid contraction or tongue protrusion, inspiraion, and voluntary nystagmus. This type of ptosis was most commonly seen with a congenital Marcus-Gunn jaw-winking syndrome. Usually this movement is thought to be due to a congenital misdirection of some of the 5th cranial nerve fibers into the branch of the 3rd cranial nerve that supplied the levator muscle. We experienced 6 cases of synkinetic ptosis, among them, interesting enough, one was typical elevation of upper lid in smile due to misdirection between the oculomotor and facial nerve fibers. The cosmetic problem was the first purpose of the surgery. So, we performed a levator extirpation with frontalis suspension on 4 cases who had the severe jaw-winking phenomenon and undertook only fron talis suspension on 2 cases and one of whom had poor superior rectus function. In the cases who have undergone levator extirpation with frontalis suspension, synkinetic movement was improved in all. However, in those who underwent the frontalis suspension procedure, the synkinetic phenomenon still remained in spite of acceptable improvement of blepharoptosis in primary position.

A Case of Sebaceous Carcinoma

Sebaceous carcinoma of meibomian gland is not so common as is generally re ported. In general feature of this tumor may masquerade as a chronic blepharoconjunctivitis or a chalazion for many months before the true diagnosis is esta blished. In the case of orbital involvement secondarily the patient may occasion ally develop as solid nodule in the fossa of the lacrimal gland that may simulate a primary gland tumor, The authors experienced one case of sebaceous carcinoma which developed in the orbital area. This was a 23-rear-old female who had a growing large mass in the left orbital area, which caused proptosis and decreased vision. Computed tomography of the left orbit demonstrated a large soft tissue mass lesion, about 3 X 3 X 1.5 cm in size, in superotemporal side of the retroorbital portion. The patient underwent a lateral orbitotomy and excisional biopsy of the tumor. Microscopic examination showed intracytoplasmic lipoid vacuoles and mixed pattern which was an admixture of lobular and comedocarcinoma-like area. About 2 months later the tumor recurred, so subtotal orbital exenteration with preservation of lid, conjunctiva, cornea and sclera was undertaken and radiotherapy was taken. However, this tumor was extended to brain.

A Case of Sebaceous Carcinoma

Sebaceous carcinoma of meibomian gland is not so common as is generally re ported. In general feature of this tumor may masquerade as a chronic blepharoconjunctivitis or a chalazion for many months before the true diagnosis is esta blished. In the case of orbital involvement secondarily the patient may occasion ally develop as solid nodule in the fossa of the lacrimal gland that may simulate a primary gland tumor, The authors experienced one case of sebaceous carcinoma which developed in the orbital area. This was a 23-rear-old female who had a growing large mass in the left orbital area, which caused proptosis and decreased vision. Computed tomography of the left orbit demonstrated a large soft tissue mass lesion, about 3 X 3 X 1.5 cm in size, in superotemporal side of the retroorbital portion. The patient underwent a lateral orbitotomy and excisional biopsy of the tumor. Microscopic examination showed intracytoplasmic lipoid vacuoles and mixed pattern which was an admixture of lobular and comedocarcinoma-like area. About 2 months later the tumor recurred, so subtotal orbital exenteration with preservation of lid, conjunctiva, cornea and sclera was undertaken and radiotherapy was taken. However, this tumor was extended to brain.