Unilateral levator sling for repair of congenital synkinetic ptosis

Management of synkinetic ptosis is a complex subject .Although levator muscle resection can correct ptosis, it will potentiate the associated synkinetic movements. Several techniques were prescribed for management of such cases. In 7 cases of synkinetic ptosis, the levator aponeurosis was severed 1cm above the Whitnall's ligament while its distal part was left attached to the tarsus. The aponeurosis then sutured to the frontalis muscle through a single central supraorbital tunnel incision. The synkinetic movements were abolished in all patients while the ptosis was fully corrected in 6 patients and undercorrected in one patient moreover, there were no adverse side effects.The unilateral levator sling technique is an easy, safe and effective procedure for correcting the functional and cosmetic aspects of unilateral synkinetic ptosis

Vertical orientation of the sensory nerve fibres of the upper eyelid. a clinical study

Vertically oriented nerve fibres are frequently encountered during upper eyelid surgery Cadaveric dissection and immunohistochemical studies had proved that these nerve fibres are sensory in nature.The present study aimed at proofing the nature of these nerves clinically. Intraoperative electrical stimulation of these fibres resulted in no contraction of the orbicularis muscle while stimulation of the muscle itself showed an obvious consistent contraction. Meanwhile, histological examination of the excised vertically oriented fibres showed they are nerve fibres. This study concluded that the vertically suborbicular nerve fibres are sensory in nature

reliability of brush cytology for preoperative diagnosis of ocular surface and lid neoplasia

Several methods had been existed for cytological examination of the ocular surface lesions. They include brushing, aspiration and impression techniques. The present study was designed to evaluate the reliability of the brushing cytology for preoperative diagnosis of some ocular surface and lid neoplasia. The study included 15 cases of variable ocular surface and lid lesions. Brushing was done as an out patient procedure. Surgical procedures were planned according to the clinical diagnosis, then biopsies were taken from the excised tissues. Correlation was done between the cytological and histopathological reports. Cytological and histopathological correlation was noticed in 13 cases [86.68%], while poor correlation and non - correlation appeared in one case [6.66%] for each. The brush cytology is highly reliable for diagnosis of ocular surface and lid neoplasia. Also, it is an easy and simple technique that can be used in routine clinical practice

Early adjustment of sutures for repair of upper eye lid retraction

Upper eye lid retraction is a cosmotic and functional problem that usually possess a threat to sight from the associated keratopathy. Adjusting the sutures that used for its repair had been tried with variable results. This study was designed to evaluate the efficacy of the earlier adjustment of these sutures. The study included 13 patients [21 lids] 8 of them had bilateral thyroid related upper lid refraction. The other 5 patients had overcorrected ptosis surgeries. The upper lid retractors were released through an anterior approach, then sutured to the anterior tarsal surface with knotting the ends [bow tie] on the skin side. The lid height and contour were adjusted accurately during surgery, then readjusted in ward 8 hours after surgery. The technique was successful in correction of upper lid retraction in 90% of cases all over the follow up period. Recurrence occurred in 2 cases only [10%]. Earlier adjustment of sutures used for repair of upper eye lid retraction is an easy, simple and valuable technique. It is an adjuvant and not a replacing technique for the usual surgical procedure