Fat management in upper blepharoplasty: Addition or subtraction blepharoplasties, how and when.

BACKGROUND: As one of the most common aesthetic surgical procedures carried out today, blepharoplasty should be in the repertoire of every plastic surgeon. The term blepharoplasty encompasses a wide range of techniques and options that must be tailored to the specific defect and patient one has to treat. A sound knowledge of the upper and lower eyelids' anatomy is essential for proper surgical execution. Trends have shifted towards more conservative methods (especially of the fat compartment) and sometimes in combination with augmentation techniques, helping to reach a rejuvenated appearance. AIM: To present an overview of the surgical techniques considered for upper lid blepharoplasty and fat pad management, in addition to information on how a surgeon may approach the best treatment for his patient based on current publications in literature. METHODS: We searched the literature published between 2013, to 2023 using Medline and Reference Citation Analysis. The database was searched using the keywords "upper blepharoplasty" AND "fat". Papers without full text/abstracts and reviews were excluded. The search strategy followed the PRISMA. The American Society of Plastic Surgeons guidelines for Therapeutic Studies checklist was used to assess all articles. Two authors individually reviewed each article and rated them for importance and relevance to the topic. A consensus was sought and the most relevant studies. RESULTS: After the application of the selection criteria used in our review, 13 publications were found to address upper lid blepharoplasty specifically. Three of these studies were reviews and three were retrospective studies. Five publications were comparative studies and a further two were clinical trials. CONCLUSION: The tendency of modern surgery is to be conservative, by removing adipose tissue only if strictly necessary and restoring the volume of the upper eyelid in a concept of beauty that espouses a "full" sight. There is no gold standard technique to achieve younger and enhanced eyelids. Long-term prospective comparative studies are fundamental in understanding which path is the best to follow.

Double hit: Mantle Cell Lymphoma associated with squamous cell carcinoma or chalazion? A case report.

Abstract: A few cases of ocular adnexal neoformations related with MCL have been reported in the literature. We present a rare case of tumour duplicity: mantle cell lymphomas (MCL) associated with squamous cell carcinoma (SCC) localised at the level of the ocular adnexa, on left upper eye lid mass since two years of 18 mounth duration in a 57-year-old man who had previously been diagnosed with stage IV MCL for 14 months. The patient had been treated according to the R-DHAP scheme for 4 cycles, in anticipation of a possible autologous HSC transplant, which was not carried out due to a positive diagnosis at the end-of-cycle osteomedullary biopsy (BOM) check. Ophthalmological examination was performed, and afther surgical removal histological examination proved to be squamous cell carcinoma (SCC). The aim of this case report is to decode the signs, symptoms and factors associated with the formation, that appear to be a chalazion, at an early stage in order to prevent the overgrowth of the mass that could invade the surrounding tissues by infiltrating them, as well as negative aesthetic outcomes of the surgery due to the excessive size of the mass, which could compromise the patient's quality of life.

Bees wax wraps-A novel source of colophonium allergic contact dermatitis.

A patient with recurrent face and eyelid eczema after establishing an eco-friendly refill business, she was selling bees wax wraps as part of her business. This case raises awareness of bees wax wraps being a new potential eco-friendly source of colophonium allergic contact dermatitis.

Acute Dacryoadenitis due to Primary Epstein-Barr Virus Infection.

We herein present the case of a 28-year-old male patient who presented with fever and bilateral upper eyelid edema without other upper airway symptoms and was diagnosed with acute dacryoadenitis due to Epstein-Barr virus (EBV) infection. The patient's medical history was unremarkable. Laboratory tests revealed lymphocytosis with atypical lymphocytes and abnormal liver function tests. Physical examination and computed tomography revealed swelling in the lacrimal glands, and serological tests confirmed EBV infection. Although rare, ocular symptoms of primary EBV infection are important for diagnosis. Acute dacryoadenitis should be considered as a rare manifestation and an underdiagnosed complication of primary EBV infection.

Factors associated with the development of blepharoptosis after pars plana vitrectomy surgery.

PURPOSE: To determine the incidence and risk factors for developing blepharoptosis after vitrectomy surgery. METHODS: This prospective observational study conducted in patients who had vitrectomy surgery at the University of California, San Francisco. The patients' eyelids were photographed before, surgery and follow-up visits at 1 day, 1 week, 1 month, 3 months, and 6 months after surgery. Levator excursion (LE), palpebral fissure (PF) height and marginal reflex distance 1 (MRD1) changes from baseline were evaluated. Operative parameters associated with lid parameter changes were analyzed. RESULTS: Thirty-eight eyes were enrolled in the study. Multivariate analysis performed for PF changes from pre-operative were -0.47 mm, 0.33 mm, and 0.09 mm at 1 week, 1 month and 6 months after surgery, respectively (p-value 0.1, 0.2, and 0.8). The mean change of LE from preoperative was -0.44 mm, -0.15 mm, and 0.35 mm at 1 week, 1 month and 6 months after surgery, respectively (p-value 0.3, 0.7 and 0.4). The reduction of MRD1 at 1 week, 1 month and 6 months after surgery were -0.08 mm, -0.13 mm and -0.01 mm, respectively (p = .003, p = .6 and 0.9). Triamcinolone usage was associated with reduction of MRD1 and LE. CONCLUSION: Blepharoptosis presents most during the first week after surgery. The possibility of developing transient changes in eyelid position after vitrectomy surgery should be discussed with patients.

Blefaroplastia biplanar de párpado inferior. Técnica Lima / Double-plane lower eyelid blepharoplasty. Lima technique

Introducción y objetivo: Cuando la cirugía de rejuvenecimiento de párpado inferior implica resección significativa de piel, el riesgo de ocasionar exposición escleral (scleral show) como secuela es alto, razón por la que la mayoría de autores recomiendan ser muy prudentes en las escisiones de piel.En nuestra opinión, no hay una técnica mayoritariamente aceptada para los casos en los que es necesaria una resección cutánea amplia, motivo por el que proponemos la Técnica Lima.Material y métodos.La Técnica Lima, tras revisar la fisiopatología de la exposición escleral, propone como punto principal del nuevo diseño preservar el paralelismo de los fascículos musculares del parpado inferior al resecar el colgajo miocutáneo.Resultados.En nuestra revisión de 285 pacientes, la técnica propuesta permitió resección de piel de párpado inferior de entre 8 a 12 mm, sin riesgo de exposición escleral.Conclusiones.El diseño de la Técnica Lima permite mayor seguridad en la resección amplia de piel de párpado inferior en la cirugía de rejuvenecimiento palpebral. (AU)

Bacground and objective: When performing lower eyelid rejuvenation surgery that involves significant skin resection, the risk of causing scleral show as a consequence is high; so, most authors recommend being overly cautious in skin excision.In our opinion, there is no widely accepted technique for wide skin resections, and for this reason, we propose the Lima Technique to solve this problem.Methods.The Lima Technique, after having reviewed the pathophysiology of the scleral show, proposes as the main condition of the new design, the preservation of the parallelism of the muscular fascicles of the lower eyelid when resecting the myocutaneous flap.Results.In our revision of 285 patients, the proposed technique allowed lower eyelid skin resection between 8 to 12 mm, without the risk of causing a scleral show.Conclusions.The new design of the Lima Technique gave us total safety when performing wide resections of lower eyelid skin in eyelid rejuvenation. (AU)

Eye lid and canalicular laceration due to obstetric trauma. Case report. / Laceración palpebral y canalicular asociada a trauma obstétrico. Descripción de un caso.

Ocular injuries associated with birth trauma are rare. Their incidence increases in cases of instrument-assisted delivery, emergency cesarean section, and abnormal presentation of the fetus. We present the clinical case of a premature Asian male baby, aged 33+2 weeks and weighing 1,500g. The infant was born out of a twin pregnancy and was delivered by emergency cesarean section. Following delivery, a 5mm long lower eyelid laceration was observed in the inner corner of the left eye, with injury to the inferior canaliculus. A Mini-Monoka® (FCI, Issy-Les Moulineaux, France) monocanalicular intubation stent was inserted on the seventh day with anastomosis of the proximal and distal ends of the canaliculus laceration. The skin was then sutured with a polyglactin 8/0 (Vicryl 8/0, Ethicon, Johnson & Johnson S. A., Madrid, Spain) suture. The postoperative treatment consisted of tobramycin and dexamethasone eye drops four times per day for 10 days. A good progression was observed, the position of the inferior lacrimal punctum was adequate, and syringation was normal. The Mini-Monoka® was removed after 14 weeks.

Stage IV Burkitt Lymphoma Presenting with Eyelid Swelling

@#Burkitt lymphoma is a rare and aggressive tumour which predominantly affects children. We report a case of Stage IV Burkitt lymphoma (non-endemic type) in a 5-year-old immunocompetent Malay child who initially presented with left upper eyelid swelling. Clinical examination revealed a soft solid swelling over the left upper lid, extending temporally up to the lacrimal gland. Computed tomography (CT) scan showed a homogenous mass of soft tissue density with intracranial and left orbital involvement. Incisional biopsy of the mass revealed histological changes suggestive of B lymphoblastic lymphoma or leukemia. She was treated with 6 cycles of chemotherapy. Post chemotherapy, the left temporal and upper eye lid swelling subsided. Clinicians need to be on alert when encountering children with eyelid swelling, as this could be an initial presenting feature of Burkitt lymphoma without other systemic symptoms. A delay in diagnosis can lead to aggressive orbital involvement followed by permanent visual loss.

[Collision tumor]. / Kollisionstumor.

A 65-year-old woman presented with a painless, partially pigmented and partially hyperkeratotic tumorous lesion on the lower eye lid. Histopathologic findings of the wedge resection showed a collision tumor of a highly differentiated squamous cell carcinoma and a fibrosing basal cell carcinoma. Collision tumors involving these two components are rare, particularly in the periocular region.

Effect of three-dimensional remodeling surgery for upper eyelid coronal S-shaped curve rejuvenation / 中华医学美学美容杂志

Objective To explore the transformation of three-dimensional curve,and to observe effect of three-dimensional remodeling surgery in order to find an ideal method to achieve upper eyelid rejuvenation.Methods Retrospective analysis was conducted after surgical correction for three-dimensional reconstruction in 48 patients with upper eyelid that were female,aged 58 to 76 years;all of them had simultaneous surgery of both eyes.Using double eyelid crease incision to remove loose and redundant skin,we transplanted the herniated fat of the medial orbital septum to the deep surface of the orbicularis oculi muscle in the distinct bony structure of the extra-supraorbital margin,folded and lifted orbital septum fascia;at the same time lifted eyebrow through eyebrow incision,transplanted and filled dermis and muscle fascia flap to remodel the transverse S-shaped stereo curve of the coronal plane of the upper eyelid.Results A lot of 41 cases were followed up more than 6 months from 48 patients,except that one patient had a second surgery due to double eyelid asymmetry after one year,eyelid rejuvenation in 40 patients were improveed.Effect of 33 cases was satisfactory.Satisfaction rate was 80.49％.Less satisfaction were 6 cases,accounting for 14.63％.No satisfaction was 1 case,ac counting for 2.44 ％.Conclusions The surgery can reshape the concavity inside,the full crown outside of upper eyelid by the skin removing,fat shifting,leather fat muscle flap filling,and restore the upper eyelid to three-dimensional full round young shape.It is an ideal surgical method for eye anti-aging treatment.

Meibomian gland cells display a differentiation-dependent composition of desmosomes.

Meibomian glands are a modified type of sebaceous glands within the eye lid, which produce an oily secretion important for the stabilization and the prevention of evaporation of the tear film. The holocrine secretory mode of Meibomian glands is characterized by the centripetal movement, the maturation and finally degeneration of the acinar epithelial cells. The process of maturation and degeneration is paralleled by altered expression pattern of certain proteins and the intracellular accumulation of Meibomian gland lipids. In this study, we investigated the correlation between the differentiation status of Meibomian acinus cells and the presence of adhesive junctions. By ultrastructural analyses, we showed for the first time that the frequency of desmosomes increased with the degree of differentiation. Importantly, we detected a differentiation-dependent distribution pattern of desmosomes within the Meibomian gland cells of the acinus, whereas molecules of other cell junctions, e.g., adherens junctions, are equally distributed. Together, these findings provide new insights into the processes of Meibomian gland secretion and may be important for the interpretation of Meibomian gland dysfunction causing diseases like the dry eye syndrome.

A Rare Presentation of Two Cases of Metallic Intrascleral Foreign Body Entry through Upper Eyelid.

Ocular injury secondary to foreign body remains an important cause of ocular morbidity with or without blindness in working population. Intraocular foreign body may have varied clinical presentation. Initially it may look an apparently normal eye followed by obvious ocular symptoms depending upon its location and degree of inflammation. It can result in partial or full thickness penetration of sclera with or without involvement of posterior segment. We hereby present two cases of metallic intrascleral foreign body entry through upper lid in young carpenters following hammer and chisel injury. In case 1, Intrascleral location of foreign body was confirmed with X ray orbit and B scan ultrasonography while in case 2 the diagnosis of intrascleral foreign body was missed at the first visit to ophthalmology clinic Both the patients underwent exploratory surgeries where intrascleral metallic foreign bodies were found without ocular penetration. An intrascleral foreign body may be missed due to small penetrating scleral wound covered by a large subconjunctival haemorrhage accompanied by minimal or no signs of inflammation and failure on part of treating ophthalmologist to suspect an intrascleral foreign body. To establish a diagnosis of intraocular particularly intrascleral foreign body, careful history taking and clinical examination along with use of imaging studies are mandatory steps which help in successful management and good visual outcome. These cases highlight the importance of considering a presumptive diagnosis of retained intrascleral foreign body in every patient with a history of penetrating ocular trauma through lid or a visible wound/scar on the lid.

Temperatures of the Ocular Surface, Lid, and Periorbital Regions of Sjögren's, Evaporative, and Aqueous-Deficient Dry Eyes Relative to Normals.

PURPOSE: To compare the temperatures of the ocular surface, eyelid, and periorbital skin in normal eyes with Sjögren's syndrome (SS) eyes, evaporative dry eyes (EDE), and aqueous deficient dry eyes (ADDE). METHODS: 10 eyes were analyzed in each age-matched group (normal, SS, EDE, and ADDE). A noninvasive infrared thermal camera captured two-dimensional images in three regions of interest (ROI) in each of three areas: the ocular surface, the upper eyelid, and the periorbital skin within a controlled environmental chamber. Mean temperatures in each ROI were calculated from the videos. Ocular surface time-segmented cooling rates were calculated over a 5-s blink interval. RESULTS: Relative to normal eyes, dry eyes had lower initial central OSTs (SS -0.71°C, EDE -0.55°C, ADDE -0.95°C, KW P<.0001) and lower central upper lid temperatures (SS -0.24°C, ADDE -0.51°C, and EDE -0.54°C, KW P<.0001). ADDE eyes had the lowest initial central OST (P<.0001), while EDE eyes had the lowest central lid temperature and lower periorbital temperatures (P<.0001). Over the 5-s interblink interval, the greatest rate of temperature loss occurred following eyelid opening, but varied by group (normals -0.52, SS -0.73, EDE -0.63, and ADDE -0.75°C/s). The ADDE group also had the most substantial heat loss over the 5-s interblink interval (-0.97°C). CONCLUSIONS: Differences in OST may be related to thermal differences in lids and periorbita along with an altered tear film. Thermography of the ocular surface, lids, and surrounding tissues may help to differentiate between different etiologies of dry eye.

The Effects of Warm Compression on Eyelid Temperature and Lipid Layer Thickness of Tear Film

PURPOSE: Warm compression using a commercial heat pad was used to evaluate the effects of temperature on the eyelids and tear film lipid layer thickness. METHODS: Targeting 13 patients (26 eyes) with non-specific eye disease such as dry eye syndrome or Meibomian gland dysfunction, we measured the average thickness of the tear film lipid layer in both eyes with the LipiView 2® System (Tearscience®, Morrisville, NY, USA). We performed warm compression on the right eye only in order to evaluate the effectiveness of massage and measured the temperature of the right eye lid immediately, 3 minutes, and 5 minutes after compression in order to compare with the untreated left eye. After warm compression for 5 minutes, we measured tear film lipid layer thickness of both eyes and analyzed the effectiveness of warm compression. RESULTS: The average tear film lipid layer thickness was 55.1 ± 21.0 nm in the right eyes and 53.9 ± 13.9 nm in the left eyes (p = 0.474). Before performing the warm compression, the temperature of the right eye lid was 53.9 ± 13.9 nm, and that of the left was 35.9 ± 0.2℃. The eye lid temperature of the right eye immediately, 3 minutes, and 5 minutes after warm compression was 40.3 ± 1.3℃, 40.3 ± 1.3℃, and 40.3 ± 1.9℃, respectively, and these temperatures were relatively constant during the massage. Tear film lipid layer thickness after warm compression in the right eye was 83.5 ± 18.8 nm, which was increased compared to the original temperature (p = 0.001) and showed significant difference compared with the 65.5 ± 27.1 nm in the left eye (p = 0.005). CONCLUSIONS: Warm compression increased the tear film lipid layer thickness and showed a relatively constant increased temperature of 40.3℃ over 5 minutes. This technique will be helpful for maintaining tear film lipid layer thickness in patients with Meibomian gland dysfunction.

The Effects of Warm Compression on Eyelid Temperature and Lipid Layer Thickness of Tear Film

PURPOSE: Warm compression using a commercial heat pad was used to evaluate the effects of temperature on the eyelids and tear film lipid layer thickness. METHODS: Targeting 13 patients (26 eyes) with non-specific eye disease such as dry eye syndrome or Meibomian gland dysfunction, we measured the average thickness of the tear film lipid layer in both eyes with the LipiView 2® System (Tearscience®, Morrisville, NY, USA). We performed warm compression on the right eye only in order to evaluate the effectiveness of massage and measured the temperature of the right eye lid immediately, 3 minutes, and 5 minutes after compression in order to compare with the untreated left eye. After warm compression for 5 minutes, we measured tear film lipid layer thickness of both eyes and analyzed the effectiveness of warm compression. RESULTS: The average tear film lipid layer thickness was 55.1 ± 21.0 nm in the right eyes and 53.9 ± 13.9 nm in the left eyes (p = 0.474). Before performing the warm compression, the temperature of the right eye lid was 53.9 ± 13.9 nm, and that of the left was 35.9 ± 0.2℃. The eye lid temperature of the right eye immediately, 3 minutes, and 5 minutes after warm compression was 40.3 ± 1.3℃, 40.3 ± 1.3℃, and 40.3 ± 1.9℃, respectively, and these temperatures were relatively constant during the massage. Tear film lipid layer thickness after warm compression in the right eye was 83.5 ± 18.8 nm, which was increased compared to the original temperature (p = 0.001) and showed significant difference compared with the 65.5 ± 27.1 nm in the left eye (p = 0.005). CONCLUSIONS: Warm compression increased the tear film lipid layer thickness and showed a relatively constant increased temperature of 40.3℃ over 5 minutes. This technique will be helpful for maintaining tear film lipid layer thickness in patients with Meibomian gland dysfunction.

Subepidermal calcified nodule in upper eyelid: A case report and review of the literature.

Calcinosis cutis involves the inappropriate deposition of calcium within the dermis layer of the skin and is often associated with autoimmune diseases. A 3-year-old healthy Omani child presented for evaluation of asymptomatic hard nodule on the left upper eyelid. Pathological examination identified the mass as subepidermal calcified nodule. The patient had no history of trauma or metabolic disturbances. Serum levels of calcium and phosphate were normal. Idiopathic calcinosis cutis should be included in the differential diagnosis for eye lid mass.

The use of polypropylene suture as a frontalis suspension material in all age groups of ptosis patients.

PURPOSE/AIM: To evaluate the use of 2-0 polypropylene suture for frontal suspension in ptosis patients with poor levator function. MATERIALS AND METHODS: This retrospective study included 20 eyelids of 16 patients (5 female, 11 male) with 4 mm or less levator function. The operation was considered successful when the difference between the two upper lids was ≤ 1 mm, and the upper lid covered the upper limbus by <3 mm. RESULTS: Median patient age was 22.94 years (2 to 59). Mean follow-up time was 18.06 months (12-29). A successful result was obtained in 14 patients (87.5%). Ptosis recurrence was observed in two patients (12.5%). Lagophthalmos with punctate epithelial keratitis and subsequent spontaneous recovery occurred during the first postoperative week in six patients (37.5%). Two patients with hypocorrection underwent revision surgery in the first postoperative week. Granuloma and material exposition at the forehead incision site observed in one patient at the postoperative fifth month were repaired by excision of the granuloma and suture reposition. CONCLUSIONS: Polypropylene suture as a frontalis suspension material in ptosis patients with poor levator function maintained satisfactory results at follow-up. This material allows easy and repeatable eyelid height adjustment and does not obviate future eyelid procedures.

Loa loa macrofilariasis in the eyelid: case report of the first periocular subcutaneous manifestation in India.

We report a case of periocular subcutaneous macrofilariasis as an initial sign of a systemic Loa loa infection. Thorough history, eye examination, surgical intervention and parasitological analysis. A periocular adult Loa loa worm was extracted from the left upper eyelid of an Indian lady living in Mumbai after presenting to our department with sensation of worm crawling under the left upper eyelid skin. Patient was admitted and was treated with diethylcarbamazine, oral steroids and albendazole with steroid cover under observation. In an era of increasing global travel, this case highlights the importance of direct questioning of previous travel as signs may be nonspecific and transitory. With clinical suspicion of Loa loa infestation, initiation of systemic investigation should not be prolonged and early treatment should be started under observation.

Gold weights as upper eyelid implants for facial paralysis.

Facial nerve palsy results in paralysis of orbicularis oculi muscle. This results in symptoms of ocular irritation due to inadequate eyelid closure. The primary objective of the surgeon is to protect the eye, via surgical or non-surgical methods. Surgical methods involve tarsrrhaphy, gold weights or springs as well as lower lid procedures. Nine such cases where Gold Weights were implanted in the upper eyelid with good results, are presented.