Intricacies of Upper Blepharoplasty in Asian Burden Lids.

Differences between Oriental and Caucasian eyelids have been explained in great detail in several reports in the past. The purpose of this article is to discuss the functional aspects of Asian double fold upper blepharoplasty and to present techniques that help to improve both the functional and cosmetic outcomes and satisfaction after surgery. The eyes of Asians are relatively small with thick skin in the eyelids and periorbital area. They typically lack the upper eyelid crease (creating the so-called double eyelid) due to burden factors like thick skin, hypertrophied orbicularis oculi muscle (OOM), submuscular fibroadipose tissue, thick orbital septum, abundant preaponeurotic fat, and lower positioned transverse ligament. Asian eyes may also have a superior visual field defect due to skin overriding the upper lid margin (skin-OOM-fat complex slide down). These burden factors result in the eyelashes appearing short and becoming misdirected and pressed toward the globe, causing functional discomfort. As a compensatory mechanism, Asian people tend to engage the frontalis muscle to lift the eyebrow to help them open their eyes. Along with aesthetic enhancement, double-eyelid surgery in Asian burden lids can improve the functional deficiencies helping the patients to open the eyes more easily. In addition, treatment of the Mongolian fold (medial epicanthal fold), caused by medial hypertrophy of preseptal OOM, augments the surgical results. In this report, we present the appropriate preoperative assessment, surgical technique, and postoperative care that should be employed to achieve consistently good functional and aesthetic outcomes in these patients.

Results of Endoscopic Dacryocystorhinostomy under Local Anesthesia with Minimal Sedation.

PURPOSE: We evaluated the tolerability and efficacy of endoscopic dacryocystorhinostomy (Endo-DCR) in patients treated in the leaning position and under local anesthesia with minimal sedation (LAS). STUDY DESIGN: Questionnaire to determine subjective success of Endo-DCR. METHODS: From May 2013 to August 2014, a total of 95 eyes with epiphora presented to the Myoung Eye Plastic Surgery Clinic in Seoul, Korea, and were treated with Endo-DCR under LAS. Three nerve blocks were administered to achieve local anesthesia. Postoperatively, the wound site was packed with Nasopore to control bleeding and promote wound healing. Outcome measures included a patient questionnaire completed on postoperative day 7 to evaluate intraoperative and postoperative pain based on the VAS (0 to 10). RESULTS: Mean intraoperative and postoperative pain scores were 1.03 and 1.64, respectively, for 95 eyes. Of the 95 eyes treated, the patients in 82 eyes (86.31%) reported that they would prefer LAS over GA for a repeat Endo-DCR. The subjective and objective surgical success rates were 90.14% and 95.77%, respectively. CONCLUSIONS: Endo-DCR carried out under LAS with the patient in the leaning position is more useful, efficient, and feasible than Endo-DCR performed under GA with the patient in the supine position.

Endoscopy-guided transcaruncular Jones tube intubation without dacryocystorhinostomy.

PURPOSE: To evaluate the functional surgical success, complications, and degree of satisfaction after endoscopy-guided transcaruncular Jones tube intubation without dacryocystorhinostomy (DCR). METHODS: A pair of Westcott scissors was passed into the nose from the side of the caruncle, and the lacrimal bone was penetrated between the lacrimal sac and the nasal mucosa. After the proper length of Jones tube was decided, the tube was inserted into the nasal cavity and fixed at the caruncle with nonabsorbable suture material. This procedure was done without DCR. We retrospectively reviewed the 60 patients (70 eyes) with canalicular obstruction who underwent Jones tube intubation in this manner. RESULTS: The overall success rate was 91.4%. The length of Jones tube used ranged from 16 to 30 mm. Retrograde air blowing into the eye via the Jones tube was the most common complaint (25 of 70 eyes). Complications of this technique included tube problems (25.7%), in particular, downward displacement (22.9%), which was corrected easily in the outpatient clinic, and extrusion. Other complications were frequent inflammation and conjunctival growth over the tube opening. CONCLUSIONS: Endoscopy-guided Jones tube intubation without DCR is a simple and useful procedure for correcting canalicular obstruction.

A Korean case of Cornelia de Lange syndrome.

PURPOSE: Cornelia de Lange syndrome is a rare disease showing characteristic facial appearance, developmental delay, growth retardation, low birth weight, skeletal formation anomaly, hirsutism and various ophthalmologic problems. METHODS: We experienced a case of an 18-year-old female with Cornelia de Lange syndrome showing superficial keratitis with entropion, ptosis, high myopia, lacrimal cutaneous fistula and characteristic facial appearance. She was born with low birth weight, operated for cleft palate and diagnosed with ventricular septal defect. In addition, she showed psychological lag and developmental impairment. RESULTS: We performed entropion correction surgery, administered medical therapy for superficial keratitis and prescribed glasses for her myopia. CONCLUSIONS: This is the first case report on the successful correction of entropion with Cornelia de Lange syndrome in Korea.

Six cases of bacterial infection in porous orbital implants.

BACKGROUND: We present 6 cases of bacterial infection that developed after porous orbital implant surgery. CASES: Five patients with hydroxyapatite implants showed lid swelling, discharge, and suppurative granuloma 14 days to 3 years after surgery. The hydroxyapatite implants were removed 14 days to 41 months postoperatively, and synthetic porous polyethylene orbital implants were inserted. Thick discharge and conjunctival melting was noted 14 months after primary Medpor implant surgery in the sixth patient, and the infection was controlled by medical therapy. OBSERVATIONS: The culture of specimens removed with swabs from the conjunctiva of patients and from the hydroxyapatite implants showed growth of Staphylococcus aureus, Staphylococcus epidermidis, alpha-hemolytic streptococcus and peptostreptococcus in 4 patients, whereas Streptococcus pyogenes were cultured from the conjunctiva in the Medpor implant patient. Culture for the remaining patient was negative . CONCLUSIONS: If there is continuous pain, injection, and discharge after porous implant insertion, bacterial infection in the implant should be considered immediately. Systemic antibiotics and topical eye drops should be administered without delay. If no improvement is observed, the implant should be removed and a different approach must be considered.

The transconjunctival approach to a large retrobulbar cavernous hemangioma of the orbit.

Cavernous hemangiomas are one of the most common benign tumors of the orbit in adults. We report a case of a longstanding retrobulbar hemangioma that was removed successfully through a temporal transconjunctival approach combined with lateral canthotomy. A 45-year-old female patient, with a 15-year history of slowly progressive proptosis and decreased visual acuity of the left eye, had a corrected visual acuity of finger count at 50 cm OS, compared with 1.0 OD. Exophthalmometry by the Nagle's method measured 15 mm OD by 26 mm OS. Magnetic resonance imaging (MRI) revealed a well-encapsulated retrobulbar main mass, 2.3 x 3.0 x 3.7 cm in size along with multiple small satellite nodules that were displacing the optic nerve and globe superiorly. The tumors were removed through a superotemporal transconjunctival approach combined with lateral canthotomy. Pathological examination revealed an intraorbital cavernous hemangioma. The patient was free of visible scars, proptosis and any other noticeable complications at her last follow-up, 6 months after surgery.