Impact of ocular care training of nursing staff on the incidence of ocular surface disorder in medical intensive care unit patients

Purpose: To assess the knowledge of nursing staff on ocular care in medical intensive care unit (ICU) and to compare the incidence of ocular surface disorders in patients of medical ICU pre? and post?training. Methods: Two hundred patients admitted in medical ICU for more than 24 h underwent a detailed ocular examination along with documentation of ICU stay, ventilation status, and Glasgow coma scale (GCS) scoring. An assessment on ocular care knowledge among the nursing staff of medical ICU was done. They were further given training in the form of audio?visuals and demonstration, and an eye care protocol was given to them. The second phase of the study was carried out in the same manner. A comparison was made between pre?training and post?training incidence of ocular surface disorders among ICU patients. Results: Ventilated patients had more eye discharge. Incidence of eye discharge was more in patients with duration of stay of more than 7 days in ICU. Ocular surface disorders closely correlated with the degree of lagophthalmos. There was significant reduction in ocular morbidity following ocular care training of the nursing staff. Conclusion: Eye care is a very important part of nursing care in sedated and ventilated patients in the ICU. Ophthalmic consultations are routinely needed in ICU subjects who are hospitalized for more than 1 week or if the ICU staff suspects any eye problems.

Lagophthalmos: An etiological lookout to frame the decision for management

Purpose: To describe the etiology, clinical profile, duration of lagophthalmos cases and thereby, framing a decision for the management based on the severity of Exposure keratitis (EK), Facial palsy (FP) with each etiology and to describe the outcome of the management options. Methods: The method was a prospective review of 120 lagophthalmos cases treated at a single tertiary center from January 2018 to January 2019. The main outcome measures were analysing the association between age, etiology, duration and management of lagophthalmos. Results: Of the 120 patients studied, paralytic etiology was noted in 86 and eyelid etiology in 34 patients. The percentage of various lagophthalmos etiology documented were Bell’s palsy (35.83%), lagophthalmos in ICU patients (15%), traumatic facial palsy(FP) (10.80%), stroke associated FP (6.67%), infection associated FP (6.67%), iatrogenic FP, cicatricial lagophthalmos (5%), lagophthalmos post eyelid surgeries (5%), neoplastic FP(3.33%), congenital FP (1.67%), proptosis induced lagophthalmos (1.67%), floppy eyelid syndrome induced lagophthalmos (0.83%) and lid coloboma associated lagophthalmos (0.83%). A statistically significant correlation was noted between exposure keratitis and age, with an increased prevalence age advances. The management showed significant variation with individual etiology, with some etiologies unquestionably requiring surgical management. Surgical management is crucial as the duration of lagophthalmos increases more than 6 weeks, EK involving pupillary axis and poor FP recovery. Conclusion: This study concludes that the conservative management was sufficient in all cases when the duration is less than 1 week, Exposure keratitis not involving the pupillary axis (EK< Grade II) and FP with good functional recovery ( FP < Grade III). The predominant causes being Bell’s palsy, lagophthalmos in ICU patients and vascular FP. Whereas, cases with poor functional recovery of facial palsy(FP) and permanent eyelid deformation require definitive surgical management like Traumatic FP & cicatricial lagophthalmos

Lagoftalmo na hanseníase: experiência clínica em centro de referência amazonense / Lagophthalmos in leprosy: clinical experience in an Amazon reference center

RESUMO Objetivo: O presente trabalho teve por objetivo caracterizar o perfil epidemiológico e clínico de pacientes com lagoftalmo associado à hanseníase, atendidos no ambulatório de oftalmologia da Fundação Alfredo da Matta, Manaus, Amazonas. Métodos: Trata-se de estudo retrospectivo realizado por meio da análise dos prontuários clínicos dos pacientes incluídos no estudo. Sexo, idade, forma clínica, grau de incapacidade no diagnóstico e desfecho foram obtidos dos prontuários. Início, tipo de comprometimento (unilateral ou bilateral), grau de intensidade do lagoftalmo e alterações oculares associadas também foram compilados. Resultados: Foram incluídos 65 pacientes; 66,1% eram do sexo masculino e 53,8% tinham idade superior a 60 anos. Em relação à classificação operacional da hanseníase, a maioria dos pacientes (81,5%) era multibacilar: 33,8% na forma de hanseníase borderline e 47% virchowiana. 36,9% casos apresentavam sequelas oculares associadas ao lagoftalmo: opacidade corneana, epífora, ceratopatia em faixa, e neovascularização corneana.41,6% evoluíram para a cegueira. O lagoftalmo foi conduzido de forma clínica em 23 pacientes e a abordagem cirúrgica foi indicada em 42. Em relação ao tratamento cirúrgico consistiu principalmente no implante de peso de ouro e na cantoplastia de Tessier. Discussão: O lagoftalmo nessa casuística acometeu mais homens idosos, esteve relacionado à forma multibacilar, com hanseníase do tipo virchowiano como relatado na literatura. O diagnóstico de lagoftalmo foi tardio na maioria dos casos, explicando o grande número de sequelas incluindo a cegueira. Conclusão: O presente estudo reforça a necessidade de acompanhamento oftalmológico precoce para que as potenciais e graves sequelas associadas a essa condição sejam evitadas.

ABSTRACT Objective: The present study aimed to characterize the epidemiological and clinical profile of patients with lagophthalmos associated with leprosy, seen at the ophthalmology outpatient clinic of Fundação Alfredo da Matta, Manaus, Amazonas. Methods: This is a retrospective study carried out by analyzing the medical records of the patients included in the study. Sex, age, clinical form, degree of disability in diagnosis and outcome were obtained from medical records. Onset, type of impairment (unilateral or bilateral), degree of intensity of lagophthalmos and associated eye changes were also compiled. Results: 65 patients were included; 66.1% were male and 53.8% were older than 60 years. Regarding the operational classification of leprosy, most patients (81.5%) were multibacillary: 33.8% in the form of borderline leprosy and 47% virchowian. 36.9% of cases had ocular sequelae associated with lagophthalmos: corneal opacity, epiphora, band keratopathy, and corneal neovascularization.41.6% progressed to blindness. Lagophthalmos was performed clinically in 23 patients and the surgical approach was indicated in 42. Regarding surgical treatment, it consisted mainly of gold weight implantation and Tessier's canthoplasty. Discussion: Lagophthalmos in this sample affected more elderly men, was related to the multibacillary form, with leprosy-like leprosy as reported in the literature. The diagnosis of lagophthalmos was delayed in most cases, explaining the large number of sequelae including blindness. Conclusion: The present study reinforces the need for early eye care so that the potential and serious sequelae associated with this condition are avoided.

Implante de pesa de oro palpebral en el tratamiento del lagoftalmo paralítico / Palpebral gold weight implantation in the paralytic lagophthalmos treatment

El lagoftalmo secundario a daño del nervio facial trae como consecuencia alteraciones funcionales y estéticas que pueden tributar a serias complicaciones corneales y eventualmente a la ceguera. El correcto manejo depende de su severidad y del tiempo de recuperación. El implante de pesas de oro en el párpado superior juega un importante papel en el tratamiento a mediano y largo plazo de esta afección. Se presenta un paciente masculino de 74 años con síntomas y signos de parálisis facial periférica derecha, incluyendo lagoftalmo ipsilateral con gran deterioro corneal. Se le implantó una pesa de oro pretarsal en el párpado superior para corregir el lagoftalmo paralítico y se obtuvieron excelentes resultados funcionales y estéticos. Mientras novedosas modalidades de tratamiento se encuentran en el horizonte con gran potencial para alterar el algoritmo de tratamiento actual, este proceder continúa siendo una técnica confiable, segura y efectiva para la rehabilitación permanente del párpado superior(AU)

Lagophthalmos secondary to facial nerve damage brings about functional and esthetic alterations which may result in serious corneal complications and eventual blindness. Appropriate management depends on severity and recovery time. Gold weight implantation in the upper eyelid plays an important role in the medium- and long-term treatment of this condition. A male 74-year-old patient presents with signs and symptoms of right-side peripheral facial paralysis, including ipsilateral lagophthalmos with great corneal deterioration. A pretarsal gold weight was implanted in the upper eyelid to correct the paralytic lagophthalmos, and excellent functional and esthetic results were obtained. While novel treatment modes lie in the horizon with great potential to alter the algorithm of current treatment, this procedure continues to be a reliable, safe and effective technique for the permanent rehabilitation of the upper eyelid(AU)

Comparative study on effect of different surgeries for vision and ocular tissues in leprosy patients with lagophthalmos / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To study the effect of different surgeries for vision and postoperative complications in leprosy patients with lagophthalmos.METHODS:A retrospective analysis.Totally 68 leprosy patients (97 eyes) with lagophthalmos were selected who treated with different surgeries during May 2007 to September 2015 in our sanatorium.The surgeries included nylon thread correction surgery, tarsorrhaphy, temporalis transposition surgery.We observed and compared the best corrected visual acuity(BCVA) and the rate of postoperative complications, such as epiphora, lacrimal duct injury, hard to open eyes, infection at the inner and lateral canthus and scar formation of lacrimal apparatus.RESULTS:The effect on BCVA of patients treated with nylon thread correction surgery and tarsorrhaphy:the preoperative and postoperative BCVA was significantly different of the two groups (Z=-4.193,-4.213;P0.05).The postoperative complications:(1) epiphora:there was 91% in patients underwent nylon thread correction surgery, 89% in patients underwent tarsorrhaphy, 59% in patients underwent temporalis transposition surgery, the difference was statistically significant (χ2=12.198, P<0.05);(2) lacrimal duct injury:there was 66% in patients underwent nylon thread correction surgery, 95% in patients underwent tarsorrhaphy, 41% in patients underwent temporalis transposition surgery, the difference was statistically significant (χ2=22.415, P<0.05);(3) hard to open eyes:there was 56% in patients underwent nylon thread correction surgery, 55% in patients underwent tarsorrhaphy, 22% in patients underwent temporalis transposition surgery, the difference was statistically significant (χ2=8.795, P<0.05);(4) infections:there was 84% in patients underwent nylon thread correction surgery, 3% in patients underwent tarsorrhaphy, 11% in patients underwent temporalis transposition surgery, the difference was statistically significant (χ2=60.858, P<0.05).CONCLUSION:There are certain clinical efficacy for lagophthalmos caused by leprosy after surgery, especially patients after temporalis transposition surgery can close eyes by oneself.And their vision does not change significantly, which suggests that this surgery may prevent exposure injury for cornea.But the iatrogenic injury, the vision decrease in patients underwent other surgeries and the ocular tissue damage, such as epiphora, lacrimal duct injury, hard to open eyes, infection at the inner and lateral canthus and scar formation of lacrimal apparatus should be pay more attention to.

A Case of Lagophthalmos after a Corrective Rhinoplasty / 대한이비인후과학회지

Corrective rhinoplasty, a commonly performed plastic surgery, is occasionally followed by numerous risks and complications. In this report, we present, with discussion of the causes and proper management, a case of lagophthalmos that occurred after a rhinoplasty. A 35-year-old female visited our outpatient clinic due to continuous nasal obstruction even after septoplasty. After thorough evaluation, corrective rhinoplasty was performed to release the patient's nasal symptoms and manage the deviated external nose and nasal septum. During the surgery, we encountered excessive nasal bleeding after percutaneous osteotomy. In addition, immediate postoperative findings presented left periorbital edema without limited eye movement or reduced eye vision associated with the paralysis of the eyelid localized to the medial side of the left upper palpebra. Surgeons should be aware of rare but possible complications of corrective rhinoplasty such as lagophthalmos, and a rapid and intensive care is recommended for early management and better prognosis of postoperative complications.

Modified silicone sling assisted temporalis muscle transfer in the management of lagophthalmos.

Aim: To evaluate the efficacy of modified temporalis muscle transfer (TMT) by silicone sling for the management of paralytic lagophthalmos. Settings and Design: Prospective interventional study. Materials and Methods: Ten patients of lagophthalmos due to facial palsy underwent modified TMT using silicone sling. The patients were followed‑up for a period of 3 months. Palpebral aperture in primary gaze and during eye closure were assessed both pre‑ and postoperatively along with problems associated with lagophthalmos like exposure keratopathy and lacrimation. Statistical Analysis: Paired t‑test was applied to measure the statistical outcome. Results: Eight patients achieved full correction of lagophthalmos with no lid gap on closing the eye. The mean (standard deviation (SD)) lid gap on eye closure was 7.7 (0.86) mm preoperatively, 0.5 (0.47) mm at 1st postoperative day, and 0.7 (0.75) mm at 3rd month. There was a reduction in mean lid gap on eye closure of 7 mm at 3 months (P < 0.0001) which is highly significant. The mean (SD) vertical interpalpebral distance during primary gaze was 12.05 (1.12) mm preoperatively, 10 (0.94) mm at 1st postoperative day, and 10.35 (1.08) mm at 3rd month. There was a reduction in mean vertical inter palpebral distance of 1.7 mm at 3 months (P = 0.001) which is significant. Exposure keratitis decreased in five out of six patients at 3 months. Conclusion: Modified TMT by silicone sling is a useful procedure with lesser morbidity and good outcomes for the treatment of paralytic lagophthalmos due to long standing facial palsy.

Surgical Outcomes of Levator Resection in Ptosis Patients with Deep Superior Sulcus

PURPOSE: To investigate the characteristics and postoperative complications of ptosis patients with deep superior sulcus following levator resection surgery. METHODS: Records of 33 ptosis patients (59 lids) with deep superior sulcus who underwent levator resection surgery from March 2008 to May 2013 were reviewed retrospectively. Operation success rate, reoperation rate, preoperative and postoperative marginal reflex distance 1 (MRD1), and levator function were compared and postoperative complications were evaluated. RESULTS: The patient's mean age was 65.8 years. The MRD1 was -1.0 +/- 1.4 mm preoperatively, 2.5 +/- 1.2 mm at 1 month after surgery, and 2.3 +/- 1.1 mm at 3 months after surgery. Operation success rate was 84.8%. At 1 month after surgery, 52.5% of lids had lagophthalmos as a surgery complication but later all recovered. Additionally, 44.1% of the patients had worn therapeutic contact lenses postoperatively for 7.0 +/- 12.1 days. CONCLUSIONS: Occurrence rate of postoperative lagophthalmos was higher than in other previous studies suggesting a tendency for overcorrection in levator resection surgery for ptosis patients with deep superior sulcus. Additionally, levator resection surgery is cosmetically as well as functionally very effective for deep superior sulcus.

Clinical observation of palpebral spring placement for lagophthalmos secondary to facial nerve palsy / 中华实验眼科杂志

Background The dysfunction of the blink reflex the eyelid-closure ability appears in the patients with facial paralysis,and its management is the implantation of mechanical-assisted eye-closure device in the upper eyelid.A novel device is palpebral spring implant.However,there is no similar study in China.Objective This study was to evaluate the clinical efficacy of palpebral spring placement for lagophthalmos caused by facial nerve palsy.Methods This clinical research complied with Helsinki declaration and the protocol was approved by Ethic Committee of Henan Eye Institute & Henan Eye Hospital.Written informed consent was obtained from each patient prior to the surgery.A retrospective serial case-observational study was performed.The medical records of 11 patients who underwent palpebral spring placement for hypophasis due to facial nerve palsy were reviewed at Henan Eye Hospital from August 2010 to November 2012.Palpebral spring placement was performed by the same surgeon to ensure a more even outcomes.Palpebral spring was made by nickel wire,with the diameter of 0.3 mm and implanted on tarsal plate in 11 eyes of 11 patients with symptomatic facial nerve palsy.The lower tip of Levine spring was encased into a small terylene bag and sutured to the anterior tarsal surface during the surgery.Preoperative and postoperative symptoms,upper eyelid margin to mid pupil distance (ULMD),degree of lagophthalmos and eyelid moving scope were examined and compared between before and after operation.The operating complication was followed-up for 8-38 months.Results The discomforted symptoms disappeared in all the operated eyes.The ULMD was (3.51±0.73) mm in preoperation and (3.20±0.86) mm in posteration,without significant difference between them (t=1.36,P=0.10).The degree of lagophthalmos was (5.94±1.57) mm and (1.06±0.98) mm in preoperation and postoperation respectively,showing a significant difference between them (t =9.42,P =0.00).The eyelid moving scope was (5.89±0.70) mm in postoperation,which was significantly increased in comparison with (0.11 ±0.33) mm of preoperation (t =22.97,P =0.00).The palpebral spring implant was regulated in 1 patient during the follow-up duration due to the trauma.No complication in other 10 patients appeared during the follow-up duration,such as implant exposure,metal fatigue or infection.Conclusions Palpebral spring placement is safe and effective for lagophthalmos in patients with facial nerve palsy.

Comparison of static and dynamic methods in paralytic lagophthalmos treatment / 나학회지

Changes in the eye resulting from leprosy include lagophthalmos, ectropion and the eyelid retraction. In lagophthalmos, an interpalpebral gap(lid gap) of 2mm or less, which is most preferred after correction, does not have any adverse effect on the vision. However, a gap of 3mm or greater can cause or make the eye susceptible to the dryness of the cornea or other vision problems. Bell's phenomenon will adequately prevent eye damages, especially corneal damage when the lid gap is less than 3mm. Although static methods such as autogenous canthal sling, lateral tarsal strip, medial tarsorrhaphy and gold implant had a positive cosmetic effect when used in combination, the lid gap could hardly reduce to less than 3mm. Frequent recurrence of lagophthalmos and ectropion after static methods required further definite surgical treatment. We applied a dynamic method of modified Gillies to correct lagophthalmos and it was successful in reducing the lid gap to less than 2mm in most cases.

Restoration of blinking reflex and facial symmetry in a Bell's palsy patient.

Patients afflicted with Bell's palsy are faced with both functional and esthetic impairment. Prominent among these are the inability to close the eyelids and abnormal facial appearance, with concomitant difficulty in eating, drinking and speaking. Rehabilitation of such patients can be achieved by a multispecialty approach, with the prosthodontist functioning as an integral part of the treatment team. This article describes a simple and effective approach to restore the blinking reflex of the upper eyelid with custom gold implant and facial esthetics with cheek support prosthesis.

Gold weight implantation as a treatment measure for correction of paralytic lagophthalmos.

Ocular complications from facial nerve paralysis can be quite devastating. Facial nerve paralysis results in cosmetic as well as functional problems. Paralysis of the upper eyelids leads to lagophthalmos, which results in incomplete closure of the lid over the cornea, leading to potential complication of corneal ulceration. The management of the affected eye in patients with facial palsy has been improved. Previously, ointment, eye drops, taping, partial or complete tarsorrhaphy was the primary treatment for inability to close the eyelid. Other mechanical techniques for reanimating lid closure are palpebral springs, encircling the upper and lower eyelids with silicone or fascia lata and temporalis muscle transfer. The most popular and widely used static procedure in facial nerve palsy is the upper eyelid gold weight implant. Gold eyelid implants are designed for the gravity assisted treatment of the functional defect of lagophthalmos resulting from facial paralysis. We report a case of a patient with facial paralysis who underwent gold weight implantation of the upper eyelid for correction of paralytic lagophthalmos.

Review of treatment of paralytic ectropion and lagophthalmos / 나학회지

Since 1992, We have treated nearly nine hundreds cases with paralytic ectropion and lagophthalmos as a sequela of Hansen's disease. Treatment to correct paralytic ectropion was performed by already established conventional surgical methods or their minor modifications. Although most of patients quite improved postoperatively, lagophthalmos frequently remained partially. Involutional orbital changes superimposed on decreased tone of the paralyzed orbicularis muscle make the corrective effect short-lived, which in turn brings about recurrence of ectropion and lagophthalmos. Of the surgical techniques, dynamic Gillies' temporalis muscle transfer was used mostly in the early stage. After that, various static methods such as gold plate insertion, transsection of levator muscle and spacer graft in the upper eyelid, and medial tarsorrhaphy, medial canthoplasty, horizontal wedge resection, spacer graft, lateral tarsal strip and lateral canthoplasty in the lower eyelid were applied. Sometimes canthal sling with Alloderm or autologous fascia to pull upward the lower eyelid or Kuhnt-Szymanowsky flap to tighten eyelid skin was added to the surgical procedures. In future, the more sophisticated techniques must be exploited to fulfill complete eyelids closure and to lower the recurrence rate. Upgrade of canthal sling method or return to Gillies' method may be an alternative at present.

Changes in Postoperative Fissure Height after Frontalis Suspension Using Autogenous Fascia Lata

PURPOSE: Most surgeries to correct congenital ptosis in children are performed with the patient under general anesthesia, which makes the postoperative outcome unpredictable. We analyzed the factors influencing postoperative changes in the fissure height of congenital ptosis patients with poor levator function under general anesthesia after frontalis suspension surgery. METHODS: We reviewed the medical charts of 79 congenital ptosis patients with poor levator function (4 mm or less) who underwent frontalis suspension with autogenous fascia lata under general anesthesia between January 2001 and December 2004. We considered lagophthalmos induced by general anesthesia as the baseline lid level, and the lid was elevated in proportion to the amount of ptosis, as assessed by photographic analysis. Photographs were taken and then analyzed using the Scion Map analysis program to measure the fissure height objectively at 1 week, 1 month, and 3 months. RESULTS: The fissure height formed by frontalis suspension surgery increased progressively and stabilized 1 month after the operation. Levator function had no significant effect on postoperative changes in fissure height. However, a more severe preoperative ptosis and a higher lagophthalmos were associated with a relatively smaller increase in adjusted lid height during the follow-up period. CONCLUSIONS: A good postoperative outcome was achieved by adjusting the lid height to a higher level in eyes with higher lagophthalmos. Especially when confronted with the dilemma of how to correct asymmetric ptosis, higher elevation of lid height in eyes with more severe preoperative ptosis and higher lagophthalmos while under (general) anesthesia should be helpful in the prediction of postoperative surgical outcomes.

Changes in Postoperative Fissure Height after Frontalis Suspension Using Autogenous Fascia Lata

PURPOSE: Most surgeries to correct congenital ptosis in children are performed with the patient under general anesthesia, which makes the postoperative outcome unpredictable. We analyzed the factors influencing postoperative changes in the fissure height of congenital ptosis patients with poor levator function under general anesthesia after frontalis suspension surgery. METHODS: We reviewed the medical charts of 79 congenital ptosis patients with poor levator function (4 mm or less) who underwent frontalis suspension with autogenous fascia lata under general anesthesia between January 2001 and December 2004. We considered lagophthalmos induced by general anesthesia as the baseline lid level, and the lid was elevated in proportion to the amount of ptosis, as assessed by photographic analysis. Photographs were taken and then analyzed using the Scion Map analysis program to measure the fissure height objectively at 1 week, 1 month, and 3 months. RESULTS: The fissure height formed by frontalis suspension surgery increased progressively and stabilized 1 month after the operation. Levator function had no significant effect on postoperative changes in fissure height. However, a more severe preoperative ptosis and a higher lagophthalmos were associated with a relatively smaller increase in adjusted lid height during the follow-up period. CONCLUSIONS: A good postoperative outcome was achieved by adjusting the lid height to a higher level in eyes with higher lagophthalmos. Especially when confronted with the dilemma of how to correct asymmetric ptosis, higher elevation of lid height in eyes with more severe preoperative ptosis and higher lagophthalmos while under (general) anesthesia should be helpful in the prediction of postoperative surgical outcomes.

The Changes in Tear Film and Ocular Surface Associated with Lagophthalmos after Frontalis Suspension

PURPOSE: We investigated the incidence of exposure keratopathy, cornea protective changes in tear film such as corneal sensitivity, tear film stability, and tear secretion after frontalis suspension, and the correlation of these with lagophthalmos. METHODS: The corneal sensitivity test, tear film break-up time (tBUT) measurement, and basic secretion test were performed prospectively in patients who had undergone frontalis suspension. RESULTS: The mean lagophthalmos was highest at postoperative 1 week and then gradually decreased. There were no significant changes in corneal sensitivity, tBUT or tear secretion after surgery. No significant differences were found in those parameters between eyes with lagophthalmos of 3 mm or more and those less than 3 mm, nor did these parameters differ between eyes with clear cornea and exposure keratopathy. Only tBUT at postoperative 1 week was significantly shorter in eyes with lagophthalmos 3 mm or more than those less than 3 mm. The average level of lagophthalmos in eyes with exposure keratopathy (15/33 eyes, 45.4%) was more than 3mm at every follow-up period, which was significantly higher than for eyes with a clear cornea. CONCLUSIONS: Tear physiology tends to maintain normal function despite poor blinking induced by lagophthalmos. The cornea is thought to be protected by these functions of tear film. The factor most influential on cornea status was the level of lagophthalmos, and exposure keratopathy should be carefully examined during postoperative period in eyes with higher lagophthalmos, especially more than 3 mm.

Surgical Procedures for Lagophthalmos during 13 years / 나학회지

To affect the complete closure of the eyelids in leprosy patients with lagophthalmos, we have used various surgical methods to avoid using the temporalis transfer method. Although widely accepted as the most effective treatment for the chronic lagophthalmos patient, the temporalis transfer method creates a simultaneous involuntary closure of the eyelids while biting or chewing. This side effect creates a social stigmata which former leprosy patients wish to avoid. As a result, we have attempted to identify the most effective treatment which will also eliminate this involuntary closure of the eyelids during biting or chewing. In the upper eyelid, we performed gold plate implantation and levator muscle severing. In the lower eyelid, lateral tarsal strip, permanent medial tarsorrhaphy, horizontal shortening, cartilage grafting and alloderm graft have all been used in the treatment of ectropion. Based on our treatment of multiple patients, we now believe medial tarsorrhaphy supplemented with the various other methods mentioned above are insufficient to achieve the desired result of complete closure of the eyelids. As a result, we are now looking to a modified temporalis transfer procedure to ensure complete closure of the eyelids without the eye closing side effect.

Complication of Temporalis Muscle Transfer in Lagophthalmos and Ectropion of Korean Leprosy Patients / 나학회지

Recently, there has been a strong decrease in the number of temporalis muscle transfer(TMT) operations in cases of lagophthalmos. The primary cause of this decline is patient dissatisfaction with drawbacks of eye clinching in concert with mouth closure, ectropion and ptosis. This is mostly true of patients who are now more commonly exposed to urban social environments. In 1997, I discontinued the use of TMT as part of my combination treatment method reported in this journal. Since 1998, I have removed the fascia in 20 TMT cases due to complications in the upper and lower eyelid areas. I then corrected these complications using my combination method. I still use TMT in cases of lower lip drooping. Lagophthalmos patients are treated using my combination method of gold lid loading in the upper eyelid and Alloderm insertion in the lower eyelid through fixation of both ends to the medial and lateral canthal ligaments respectively. Previously, I recommended the use of conchal cartilage but noted the complication of cartilage warping which caused creating new partial ectropion several months later. Alloderm has shown no complications and the results of its use remain most satisfactory.

Considerations on the Operation of Gold Lid Load for Seventh Nerve Palsy Lagophthalmos

The correction of seventh nerve palsy lagophthalmos with gold weight implant is popular since it is simple, biocompatible and reversible. But this method may result in various complications, because we insert a foreign body with high density into the upper eyelid whose skin is the thinnest in the body and have to consider the dynamic function of blinking. The operator should pay attention to the preoperative patient evaluation, the design of the gold weight implant to prevent complications. We have improved the patient's evaluation technique, design of the implant and operation procedure considering some critical points. During the preoperative evaluation, the operator must consider the coexistence of trigeminal nerve palsy, upper blepharochalasis, lower eyelid ectropion, and eyebrow ptosis and also note the most severe point of lagophthalmos in the upper lid. Estimating suitable weight, the operator must consider not to interfere the movement of eyelid using the adhesive spray on the back of gold load and also check the eyelid closure in supine position with a pillow. Designing the implant, the operator should consider the shape of tarsal plate of each patient to make fusiform in shape with blunt edge. During the operation, the operator should insert the implant into pretarsal layer to make the implant cross the equator of eyeglobe in supine position, and fix the implant at 5 points to adjust the widest point at the widest gap.