Triamcinolone acetonide injection in the treatment of upper eyelid retraction in Graves’ ophthalmopathy evaluated by 3.0 Tesla magnetic resonance imaging

Purpose: To evaluate changes in the levator palpebrae superioris (LPS) muscle on 3.0 T magnetic resonance imaging (MRI) after triamcinolone acetonide injection for treating upper lid retraction (ULR) with Graves’ ophthalmopathy (GO) and to explore the value of LPS muscle quantitative measurement for clinical treatment. Methods: Patients with GO showing ULR were studied retrospectively and they underwent 3.0 T MRI scans before and after subconjunctival injection o f triamcinolone acetonide. The largest thickness (T) and highest signal intensity (SI) of LPS muscle on the affected eyes were measured in the sequences of coronal T2?weighted, fat?suppressed fast spin echo imaging (T2WI?fs) and T1?weighted, fat?suppressed, contrast?enhanced fast spin echo imaging (T1WI?fs + C), respectively. The SI ratio (SIR) (LPS muscle SI/ ipsilateral temporalis SI) was calculated individually. Depending on the therapeutic effect, patients were divided into effective group and non?effective group. Independent t?test was used to compare SIR and T of LPS muscle in different treatment groups before treatment, and paired sample t?test was used to compare SIR and T of LPS muscle before and after treatment. Then cut?off level for predicting therapeutic effect and the receiver operating characteristic curve (ROC) curve were analyzed. Results: Sixty?two patients (77 eyes) were enrolled. After treatment, the T of LPS muscle showed significant decrease in all sequences in both effective and non?effective treatment groups. However, changes in SIR of LPS muscle in the two groups were different; SIR of LPS muscle on T2WI?fs and T1WI?fs + C decreased after treatment in the effective group (PT2 < 0.001, PT1 + C < 0.001) and SIR of LPS muscle showed no statistically difference in all sequences (all P > 0.05) in the non?effective group. There was a correlation between SIR of LPS muscle before treatment and after treatment with triamcinolone acetonide injection, which was that SIR of LPS muscle in the effective treatment group was lower than that in the non?effective treatment group on T1WI?fs + C (P < 0.001). SIR of LPS muscle on T1WI?fs + C showed 87.5% sensitivity and 66.7% specificity to predict therapeutic effect (area under the ROC curve [AUC] = 0.840). Conclusion: In GO patients with ULR, 3.0 T MRI can be used to evaluate the response of triamcinolone acetonide injection. SIR of LPS may be a predictor of its efficacy

Upper eyelid levator-recession and anterior lamella repositioning through the grey-line: Avoiding a skin-crease incision

Purpose: This study aims to report a case series of upper eyelid cicatricial margin entropion with retraction, corrected through a grey-line approach only. We remind readers of the grey-line approach to levator recession (LR) and lamellar repositioning surgery. Methods: A retrospective review of clinic notes and photographs of patients who underwent grey-line split (GLS), LR, release of orbital septum, recession of levator, advancement of posterior lamella and anterior lamellar repositioning without a skin crease incision, from December 2015 to December 2016. Indications for surgery included mild-to-moderate cicatricial margin upper eyelid entropion, tarsal curling, and meibomian gland inversion. Patients requiring spacer interposition to lengthen the posterior lamella were excluded from the study. Parameters of the study included lid margin position, lid height, ocular surface health and symptom improvement. Results: Eleven eyelids of eight patients were included in the study, and underwent the procedure described. Lid margin position measured as the marginal reflex distance lowered (improved) in 72.7% of patients. Lid margin eversion was achieved in all eyes (100%). Corneal punctate epithelial erosions markedly improved, being present in 72.7% of patients preoperatively, and only 9.1% of patients postoperatively. Eight of eleven eyes showed symptomatic improvement, with six (54.5%) being completely asymptomatic and two achieving partial relief. An added observation was a pretarsal show asymmetry in some patients which improved in 36.4% of surgeries postoperatively. Conclusion: Upper eyelid LR with GLS and anterior lamella repositioning can all be performed through the plane of the split, avoiding a skin incision. Normal lid margin apposition was achieved in all eyes with 91% demonstrating a clear cornea and 72% having symptomatic improvement.

Classification and surgical management of upper-lid dermatochalasis in middle-aged and elderly women / 中华医学美学美容杂志

Objective To explore the clinical classification of upper lid dermatochalasis in mid dle-aged and elderly women for choosing appropriate surgical methods and evaluating the efficacy of the treatment.Methods A lot of 98 cases of middle-aged and elderly women above 40,who underwent surgical treatment between January 2005 and September 2015,were retrospectively analyzed.The dermatochalasis was classified according to the relaxation of upper lid soft tissue,eyebrow ptosis and the effect of eye function.Therefore,four surgical treatments were designed for patients-upper eyelid incision,infraeyebrow incision,eyebrow lifting and upper eyelid incision plus eyebrow lifting.Results Of the 133 treated cases,the post-operative cosmetic result was assessed as very satisfactory in 107 (80.4％) cases;as satisfactory in 19 (14.3％) cases,and as dissatisfactory in 7 (5.3％) cases.Conclusions The key to satisfactory treatment of upper lid blepharoplasty for middle aged and elderly women lies in designing personalized treatments and choosing appropriate surgical methods according to the classification of upper lid relaxation.

Frontal Mucocele Masked as Upper Lid Abcess- A Case Report

Frontal mucocele is not commonly masked as upper lid abscess.A 72-year-old Chinese man with underlying hyperthyroidism complained of left upper eyelid swelling of 6 months duration. The swelling had persisted and worsen when intravenous antibiotic was changed oral type. Visual acuity on presentation was hand motion and reverse relative afferent pupillary defect was present. Because the swelling was large and resulted in mechanical ptosis and ophthalmoplegia, a CT imaging was performed, which showed huge left frontal mucocele eroding the supereromedial orbital rim. The left globe was displaced inferolaterally but there was no extension into brain parenchyma. Fundus examination showed pale optic disc with dull macula. Old laser marks were seen at peripheral fundus. Referral to ortholaryngologist was made and endoscopic sinus surgery and evacuation of mucopyocoele was done. Culture and sensitivity of the fluid showed no organism. He recovered well postoperatively with additional two weeks of antibiotics. We highlight the necessity of surgical drainage of mucocele, following a course of antibiotic.

Actinomycotic lid abscess: a rare presentation.

Actinomycosis is a gram positive filamentous branching anaerobic bacilli that Is difficult to Isolate and Identify. We present this case of a 15 year old patient who developed repeated infection over a Contused lacerated wound (CLW) on forehead. Cytology revealed Actinomycosis. He subsequently developed upper eyelid actinomycotic inflammatory swelling. Modified Welsh treatment was started and five months of therapy resulted in complete resolution of the infection. Hence any wound with repeated infection should be examined for Act inomycosis. When identified at the right time, such infections show dramatic response to Modified Welsh Therapy

Clinical Efficacy of Blepharotomy for Upper Eyelid Retraction Associated with Thyroid Eye Disease

PURPOSE: To investigate the clinical efficacy of blepharotomy to treat upper eyelid retraction associated with thyroid eye disease. METHODS: A retrospective survey was performed with 9 eyes of 7 thyroid ophthalmopathy patients, who visited Korea University Medical Center from August 2009 to February 2011, and had undergone blepharotomy. The sex, age, change of upper eyelid retraction, postoperative complication, follow-up periods, and the surgical results were reviewed. To assess the efficacy of blepharotomy more objectively, the preoperative and postoperative pictures of patients were taken and the following lid parameters measured: marginal reflex distance 1, interpalpebral fissure height, total palpebral fissure area, upper nasal palpebral fissure area, and upper temporal palpebral fissure area. RESULTS: The mean age of patients was 37.4 years and mean follow-up period was 12.8 months. Five patients had undergone surgery unilaterally and 2 patients, bilaterally. Seven eyes of 6 patients had undergone full thickness blepharotomy and 2 eyes of 1 patient had undergone graded blepharotomy. According to the 3-month preoperative and postoperative picture analysis, all lid parameters improved significantly after blepharotomy (2.03 mm, 1.95 mm, 24.28 mm2, 12.98 mm2, and 16.21 mm2, respectively). Complications associated with blepharotomy included multiple and high folds in 2 eyes of 2 patients who had undergone full thickness blepharotomy. Re-operation was performed on only 1 eye and the result was satisfactory. CONCLUSIONS: Blepharotomy for upper eyelid retraction is a safe and highly effective surgery for upper eyelid retraction associated with symptomatic thyroid eye disease. This technique achieves excellent functional and cosmetic outcomes.

A Case of Conjunctival Lymphangioma With Clinical Manifestations of Superior Limbic Keratoconjunctivitis After Upper Lid Blepharoplasty

PURPOSE: To report a case of conjunctival lymphangioma with clinical manifestations of superior limbic keratoconjunctivitis after upper lid blepharoplasty. CASE SUMMARY: A 55-year-old woman who had upper lid blepharoplasty performed 1 year before complained of pain, injection, and blurred vision in her right eye, which lasted for 2 days. The slit lamp examination revealed a poorly demarcated hypertrophic lesion with central erosion on the superior bulbar conjunctiva and a diffuse corneal erosion and edema in the area of the superior limbus. Tenderness of the superior bulbar conjunctiva and corneal erosion were treated with artificial tears, antibiotic eye drops, and a therapeutic contact lens. Slight anterior chamber reaction was found and treated by steroid eye drops; however, there was no improvement. After eversion of the right upper eyelid with a Desmarres retractor, a hypertrophic lesion with central dimpling was found. However, no exposed sutures were observed. Resection and biopsy of the superior bulbar conjunctiva and a subtarsal triamcinolone injection were performed for diagnosis and treatment. A conjunctival biopsy specimen showed conjunctival lymphangioma. CONCLUSIONS: Conjunctival lymphangioma can occur due to pressure and friction of an eyelid lesion after upper lid blepharoplasty.

Morphological Changes of the Eyelid According to Age

PURPOSE: The morphological changes of the eyelids according to gender among different age groups in Korea were analyzed. METHODS: Six-hundred adults without any ocular disease were selected, and sorted by age (ranging from 20 to 79 years), and gender. Each group consisted of 50 adults. Interpalpebral fissure (IPF), marginal reflex distance 1 (MRD1), amount of the upper lid, degree of browptosis, lateral hood width of the eyelid, and protrusion of the eyelid fat were measured. The measured values were analyzed to determine changes related to the aging process. Other age groups were analyzed and compared with the subjects between 20 and 30 years old, using the Student's t-test with SPSS. RESULTS: MRD 1 and IPF slightly decreased with age, but there was no statistical significance. The upper lid amount showed a statistically significant increase at the 7th and 8th decade. The degree of browptosis showed a statistically significant increase from the 7th decade of age in men, and from the 6th decade in women. In particular, the lateral browptosis was more drooped than the center browptosis. The lateral hood width of the eyelid showed a statistically significant increase from the 7th decade of age in men, and from the 6th decade in women. Eyelid fat was most protruded at the central lower part, but there was no statistical significance. CONCLUSIONS: It is important to understand the change related to aging in the study of eyelid morphology and eyelid operation. The results from present study may be used to determine standard for the safe amount of skin resection in Korean eyelid operations.

Two Cases of Deepening of the Upper Lid Sulcus from Topical Bimatoprost Therapy

PURPOSE: To report two cases of deepening of the upper lid sulcus following bimatoprost. METHODS: A 54-year-old woman who used bimatoprost for one week and a 70-year-old woman who used bimatoprost for 4 months developed deep lid sulcus. Both were using bimatoprost for glaucoma treatment. RESULTS: Both patients also showed improvement of dermatochalasis and widening of the palpebral fissure. One week after discontinuing bimatoprost, the lid sulcus of the 54-year-old returned to baseline and exophthalmometry was unchanged. The orbital CT of the 70-year-old was normal. She did not complain about deepening of the lid sulcus, and she has not discontinued treatment due to this adverse effect.

Intramuscular Hemangioma of the Upper Lid

PURPOSE: Intramuscular hemangioma (IMH) is a rare benign tumor occurring frequently on the trunk and extremities. It is uncommon in the head and neck area, especially in the lid, and is difficult to diagnose preoperatively due to its deep location. A case of IMH of the upper lid area is presented. METHODS: A 14-year-old female presented with a mass in the upper lid and brow area of the left side since 1 month of her age. The patient underwent debulking of the mass. The mass was easy to bleed, yellowish and fatty in appearance. The mass infiltrated surrounding orbicularis and frontalis muscle. RESULTS: Microscopically, the mass was composed of vessels of various size and adipose tissues that extended between individual muscle fibers. CONCLUSIONS: IMH is a rare tumor of the periorbital region, hence preoperative diagnosis is difficult. IMH must be kept in mind as the differential diagnosis in patients of young age presenting with a periorbital soft tissue mass.

Surgical Treatment of Thyroid-related Upper Eyelid Retraction

Lid retraction is one of the most common problems in Grave's disease. Many techniques for correction of the upper eyelid retraction have been described.The authors performed surgeries for correction of upper lid retraction by means of transconjunctival and transcutaneous recession of the aponeurosis of the levator muscle and Muller's muscle. From March 1997 to June 1999, 8 patients underwent for unilateral upper lid retraction through transcutaneous approaches and 6 patients through transconjunctival approaches.Transcutaneous and transcon-junctival approaches were effective when the recession was 1.54 mm, and 2.43 mm, respectively for every millimeter of correction for retraction desired.Two approaches were safe and efficacious and could be used for all degrees of eyelid retraction, but transcutaneous approach was thought to be more appropriate for severe eyelid retraction and blephraplasty simultaneously than transconjunctival approach.