Long-Term Results of the Surgical Management of the Upper Eyelids in "Ablepharon"-Macrostomia Syndrome.

PURPOSE: To describe the late results of the placement of skin graft over conjunctiva-Müller muscle complex in 3 patients with ablepharon-macrostomia syndrome (AMS) and to review the procedures used to manage the upper eyelids in AMS. METHODS: The authors searched the Pubmed database for all articles that used the term "ablepharon-macrostomia syndrome" in any field. Data collection included description of eyelid changes, age at surgery, status of the cornea before surgery, type of eyelid repair, and final outcome. Two previously reported siblings were reevaluated 10 and 15 years after a single reconstructive operation. A new case from Peru is also described. RESULTS: Only 15 patients with AMS have been described in 12 articles. In 60% of the cases, the lids were described as absent. The surgical modalities employed to reconstruct the upper eyelids were quite variable, including local flaps, lid sharing procedures, and even a masquerade flap. At long-term follow-up, all 3 cases who underwent upper eyelid lengthening with full thickness skin grafts placed over Müller muscle had clear corneas with a small amount of lagophthalmos. CONCLUSIONS: The lids in AMS are not absent and should not be managed with complex reconstructive techniques. Full thickness skin grafts placed over the inner aspect of the palpebral conjunctiva allow permanent eye protection.The upper eyelids in ablepharon-macrostomia syndrome can be permanently lengthened with full thickness skin grafts over Müller muscle.

Spontaneous Blinking Kinetics on Paralytic Lagophthalmos After Lid Load with Gold Weight or Autogenous Temporalis Fascia Sling.

PURPOSE: To assess the upper eyelid kinematics during spontaneous blinking in unilateral paralytic lagophthalmos before and after upper eyelid load with gold weight (GW) or autogenous temporalis fascia (TF) sling. DESIGN: Comparative case series. SUBJECTS: Patients with long-standing unresolved unilateral facial palsy who underwent surgical treatment with GW (n = 8) or upper lid cerclage with TF (n = 10). The contralateral eyelid served as the control for each patient (control group). METHODS: Preoperative and postoperative measurements of spontaneous blink kinematics with magnetic search coil and clinical assessment of lid margin position, lagophthalmos and ocular surface exposure, and determine amplitude, maximum velocity and main sequence of spontaneous blinks; relative amplitude of blinks to the pupil center; ocular surface exposure scores; magnitude of lagophthalmos and mid-pupil lid distances. RESULTS: The mean (±SE) down-phase amplitude ratio between paralyzed and contralateral eyelids (blink gain) was 10.0% preoperatively for both groups and significantly increased to 29 ± 6% for the GW group (p < 0.05) and 23 ± 4% for the TF group (p < 0.05). At 6 months the gain was significant for the GW group only (32 ± 7%, p < 0.05). There was no effect on the maximum velocity of the blinks or the main sequence of paretic and contralateral blinks with either surgery. Both procedures lowered the lid margin increasing the number of blinks that reached the pupil center. At 6 months this effect was prominent only for the GW group. Exposure keratopathy scores and lagophthalmos decreased postoperatively especially in the GW group. CONCLUSIONS: The beneficial effect of lid load surgeries result from a combination of a small increase on the spontaneous blink amplitude and a static effect due to the reduction of the distance between the lid margin and pupil center.

Two-dimensional video analysis of the upper eyelid motion during spontaneous blinking.

PURPOSE: To validate and to report the results of a new inexpensive video-based method to measure upper eyelid motion during spontaneous blinks. METHODS: Spontaneous blinks were simultaneously recorded in 21 healthy adult subjects for 5 minutes with magnetic search coil (MSC) and a portable video system (VDS) composed by a commercial high-speed camera coupled to a laptop computer and a blue light-emitting diode. Agreement between the 2 methods was assessed using qualitative comparison of the eyelid motion traces and Bland-Altman plots. RESULTS: The blink traces registered with both methods were virtually identical. With the either method, the relationship between amplitude and maximum velocity was well fitted by linear regression with mean r values = 0.81 (MSC) and 0.85 (VDS). Bland-Altman plots showed good agreement between methods. The mean ± SE differences of amplitude (0.06 ± 0.17 mm) and maximum velocity (5.0 ± 3.4 mm/s) were not significant. With the VDS, it was also possible to quantify the horizontal component of the blink movements. The amplitude of the horizontal shift of the eyelid during blinks was 40% of the vertical downward phase of the movement. CONCLUSIONS: Blinking kinematics can be precisely measured using a simple and inexpensive video system suitable for clinical settings.