Efficacy of allogenous fascia lata grafts in the management of lower eyelid retraction.

PURPOSE: To report on the use of allogenous fascia lata (FL) grafts in patients with lower eyelid retraction (LER). METHODS: In this retrospective study, a consecutive series of 27 patients (39 eyes) with LER who underwent lower eyelid elevation with FL was included. Examinations including measurement of the palpebral fissure vertical height (PFVH), the inferior scleral show distance, the margin reflex distance 2 (MRD 2), and the evaluation of conjunctival hyperemia were conducted at baseline and after a mean postoperative time of 25.9 ± 25.5 (5.0-81.0, median 13.0, last follow-up) months in all patients. RESULTS: At the last follow-up, a significant reduction of the PFVH (11.3 ± 1.7 versus 12.8 ± 2.1 at baseline, p < 0.001), the inferior scleral show distance (0.7 ± 1.0 mm versus 2.1 ± 1.1 at baseline, p < 0.001), and the MRD 2 (6.4 ± 0.9 versus 7.8 ± 1.3 at baseline, p < 0.001) occurred. The conjunctival hyperemia grading score (McMonnies) was significantly reduced (1.8 ± 0.7) at the last follow-up compared to baseline (2.6 ± 0.6, p < 0.001). No case of ectropion or entropion was observed at the last follow-up visit. CONCLUSION: In this case series, lower eyelid elevation with FL grafts as a spacer led to a significant reduction of the PFVH, MRD 2, inferior scleral show distance, and conjunctival hyperemia. No severe surgery-related complications occurred.

Implants and spacers for paralytic ectropion: Literature review and assessment of a thin-profile porous polyethylene implant.

Purpose: There is no ideal treatment paradigm for paralytic ectropion. This study evaluated lower eyelid spacers and the efficacy of a novel lower eyelid thin profile, bio-integratable, porous polyethylene. Methods: A retrospective review of 15 consecutive patients who underwent thin-profile porous polyethylene implantation and canthoplasty for paralytic ectropion was carried out. A comprehensive literature review of spacers for paralytic ectropion and retraction using the Pubmed database with search terms "[implant or graft or spacer] and [paralytic ectropion or paralytic retraction]," "graft and paralysis and ectropion," "implant and paralysis and ectropion," "graft and paralysis and retraction," and "implant and paralysis and retraction" was carried out. Results: The mean patient age was 69 years (range: 50-88). Lagophthalmos improved from a mean of 5.7 mm (SD = 3.3, range 3-14 mm) to 1.4 mm (SD = 1.1, range 0-3.5 mm), P < 0.0001. MRD 2 improved from a mean of 6.7 mm (SD = 2.3, range 2-12 mm) to 4.2 mm (SD = 0.9, range 3-6 mm), P = 0.0005. No patients needed additional lower eyelid surgery. There were no implant exposures at a mean follow-up of 7.6 months (SD = 7.9, range 0.7-21.6 months). Detailed literature review revealed that hard palate and ear cartilage are the most reported spacers, each with unique disadvantages. Conclusion: The thin-profile porous polyethylene implant is a useful addition to the management of symptomatic paralytic ectropion. Meaningful comparison of lower eyelid spacers is difficult because of variations in surgical technique, spacer size, and poorly reported outcome data. No spacer proves superior.

Axenfeld-Rieger syndrome combined with ectropion uveae and pigment dispersion syndrome: A case report.

BACKGROUND: In January 2021, we found one case of Axenfeld-Rieger syndrome combined with pigment dispersion syndrome (PDS), and this patient additionally manifested a symptom of ectropion uveae. The co-existence of both 2 syndromes is very rare and has not been reported in any literature yet. CASE PRESENTATION: A 34-year-old female truck driver presented to our institution with a dimness of vision in her right eye. The patient had obvious posterior embryotoxons at bitamporal, and peripheral anterior synechia could be visualized by the slit lamp. The dispersion of pigment granules was observed behind the cornea. The pupil was slightly shifted upwards the nose, with 360° ectropion uveae. Gonioscopy revealed pigment accumulation on the trabecular meshwork. The patient underwent cataract surgery on her right eye, during which, flaky pigmentation around the posterior capsule was observed. These signs were consistent with Axenfeld-Rieger syndrome and PDS. CONCLUSIONS: We report a rare case of Axenfeld-Rieger syndrome with PDS and uveal eversion. Although the patient did not present with glaucoma, follow-up should be noted. Besides, the correlation between these 2 syndromes needs to be demonstrated by more cases or further evidence.

Severe Bilateral Ectropion in Lamellar Ichthyosis: A Case Report.

BACKGROUND Lamellar ichthyosis is a rare type of hereditary ichthyosis disease that is responsible for generalized dry skin and severe scaling. Congenital ectropion and eclabium are often associated with this condition. The ectropion can cause many ophthalmologic complications, mostly due to corneal exposure caused by the lack of eyelid cleft closure. The corneal exposure can cause ulceration and even corneal perforation leading to phthisis bulbi. CASE REPORT We report the case of a North African newborn baby diagnosed with congenital lamellar ichthyosis responsible for severe skin scaling, eclabium, and bilateral ectropion of both the upper and lower eyelids. The therapeutic care of the baby was ensured by a collaboration between ophthalmologist and dermatologist. The newborn was treated by oral acitretin and skin emollients for his dermatological conditions and on the ophthalmological level he was put on lubricating and moisturizing eye drops and gel, associated with daily repeated eyelid massage. The evolution after 6 months of treatment showed excellent results on both the dermatological and the ophthalmological level. CONCLUSIONS At the stage of cicatricial ectropion in lamellar ichthyosis, the management is mainly based on a chirurgical approach. However, if the ectropion is managed early enough, the treatment could be medical, which is much easier, produces very good results, and prevents the progression toward eyelid fibrosis and its associated complications that can make the management of the ectropion much harder.

CDH1-related blepharocheilodontic syndrome is associated with diffuse gastric cancer risk.

We report the first case of diffuse gastric cancer in an individual with familial blepharocheilodontic syndrome (BCD) due to a germline CDH1 likely pathogenic variant. To date, other BCD affected relatives are nonpenetrant for diffuse gastric cancer posing challenges to counseling regarding gastric and breast cancer surveillance, and preventative total gastrectomy.

Severe ectropion in lamellar ichthyosis managed medically with oral acitretin.

Congenital ectropion is commonly associated with lamellar ichthyosis. Severe eyelid ectropion may cause corneal exposure, keratopathy, and permanent corneal scarring. We report a neonate with severe, bilateral, congenital ectropion and eclabium managed using oral retinoids. Both corneas were protected with topical antibiotics and lubricating eyedrops and eye ointments. At 12-month follow-up, the child was doing well, with no ectropion or corneal opacity.

Outcomes of two surgical techniques for major trichiasis treatment.

The purpose of this article is to analyze the outcomes of two surgical techniques to treat major trichiasis. A retrospective chart review of 67 patients (89 eyelids) with major trichiasis was performed who underwent surgical treatment using one of two techniques: intermarginal split lamella with graft (ISLG group) or lid lamella resection (LLR group). There were 30 lids in the ISLG group with mean patient age of 71.8 years and 63.3% were females. There were 59 lids in the LLR group with mean patient age of 72.5 years and 52.5% were female. The minimum postoperative follow up was six months. Statistical analysis included descriptive measures, Goodman association test for contrasts between and within multinomial populations and nonparametric Mann-Whitney test for comparison between groups. P < 0.05 was considered statistically significant. The underlying causes of trichiasis were blepharitis (37.07%), chronic meibomitis (21.3%), multiple causes (20.2%), ectropion (11.2%), actinic keratosis (6.7%), or prior ocular surgery (3.3%). Postoperatively, in the ISLG group, there were 20% lids with complete success, 50% underwent laser or electrolysis, 16.7% required further surgery, and 13.3% were unsuccessful. Postoperatively, in the LLR group, there were 47.5% eyelids with complete success, 46.7% underwent laser or electrolysis, 6.8% required further surgery, and 5.1% were unsuccessful. There was a higher statistical chance of complete success with LLR (P < 0.05). LLR is superior to ISLG surgery for the treatment of major trichiasis. There is a greater chance of success with LLR and it is technically simpler.

Congenital ectropion uveae with glaucoma: a case report.

Congenital ectropion uveae (CEU) is a rare anomaly characterized by ectropion uveae, iris hypoplasia, iridotrabecular dysgenesis and glaucoma. The apparent ectropion uveae results from the spread of iris pigment epithelium beyond the iris ruff and onto the anterior surface of the iris. Conclusion Open-angle glaucoma results due to angle dysgenesis, so patients should be carefully examined periodically for its early detection.

Ectropion Improvement with Topical Tazarotene in Children with Lamellar Ichthyosis.

BACKGROUND/OBJECTIVES: Lamellar ichthyosis (LI) is a well-described phenotypic subtype of autosomal recessive congenital ichthyosis (ARCI). The condition typically presents at birth with collodion membrane and leads to thick, plate-like scaling of the skin throughout the body, alopecia, and prominent ocular manifestations. Ocular complications include bilateral cicatricial ectropion and lagophthalmos. These ocular complications can lead to chronic exposure keratitis and in some cases corneal ulceration and blindness. No cure for ichthyosis exists. Treatment of ocular complications in LI includes surgical correction, systemic retinoids, and a variety of topical therapies such as emollients, keratolytics, and retinoids. METHODS: Five children with LI cared for at our institution were identified and included. Patient age at the start of therapy ranged from 2 weeks to 9 years. Electronic medical records were reviewed and data from pediatric dermatologist and pediatric ophthalmologist visits were obtained. Data were collected before and after treatment of daily or twice-daily 0.05% to 0.1% tazarotene cream applied to the face and eyelids. RESULTS: All patients had improvement in the degree of ectropion, with complete resolution in two of the five patients. The two patients with lagophthalmos at the time of tazarotene initiation experienced complete resolution. No adverse effects were reported. CONCLUSIONS: Tazarotene cream appears to be effective in the management of ectropion and lagophthalmos in the setting of LI in children, even in the neonatal period.

Eyelid Necrosis and Secondary Cicatrical Ectropion Secondary to Levamisole-Associated Vasculitis.

A 56-year-old female presented with eyelid necrosis secondary to systemic levamisole-induced vasculitis. Skin biopsy revealed necrotic epidermis with small-vessel thrombosis, fibrinoid reaction, and neutrophilic infiltration of vessel walls in the dermis with +pANCA. She was treated with plasmapheresis and steroids. Six months later, she developed severe, symptomatic cicatrical ectropion with marked anterior lamellar shortage and middle lamellar contracture. Scar release in the middle lamellar plane with lateral tarsal strip procedures was performed, with full-thickness skin grafts from the upper eyelids. She remained fully epithelialized postoperatively with improvement in symptoms, although she incomplete graft take due to her eyelid necrosis and compromised dermal blood supply.

Reconstrucción de defectos oncológicos palpebrales con colgajos regionales sin aporte condromucoso / Reconstruction of oncologic eyelid defects with local flaps with no condromucuos

Objetivo: caracterizar la reconstrucción palpebral de los defectos oncológicos de espesor total con colgajos regionales sin aporte condromucoso. Métodos: se realizó un estudio descriptivo, prospectivo y longitudinal con 30 pacientes, en los Servicios de Oftalmología y Cirugía Reconstructiva del Instituto Cubano de Oncología y Radiobiología, en el período 2009-2012. Se utilizaron las siguientes variables: edad (30-90 años), sexo, color de la piel, párpado afectado, histología del tumor (carcinoma basocelular o epidermoide), tamaño del defecto (desde 25 por ciento hasta 100 por ciento), tipo de reconstrucción, complicaciones, resultados funcionales que fueron buenos si el párpado tuvo posición y apertura normal y resultados estéticos que fueron buenos si tuvieron adecuada simetría con el otro párpado, buena función y poca cicatriz. Resultados: en la muestra predominó el sexo masculino; la edad media fue de 67 años y el tumor más frecuente fue el carcinoma basocelular. El colgajo más utilizado fue el de la región frontoglabelar. En cuanto a la funcionabilidad y estética de la reconstrucción, se obtuvieron buenos resultados en el 86,7 y 76,7 por ciento respectivamente. Las principales complicaciones estuvieron relacionadas con la técnica empleada y fueron el simbléfaron y el ectropión, con el 13,3 por ciento del total de la muestra. Conclusiones: la reconstrucción palpebral sin aporte condromucoso ofrece buenos resultados estéticos y funcionales, así como altas probabilidades de satisfacción de los pacientes, con un mínimo de complicaciones quirúrgicas(AU)

Objective: to characterize the reconstruction of full-thickness oncologic eyelid defects by using local flaps with no condromucous addition. Methods: prospective, descriptive and longitudinal study was carried out with 30 patients in the ophthalmology and reconstructive surgery services of the Cuban Institute of Oncology and Radiobiology from 2009 to 2012. The following variables were used: age (30-90 years), sex, race, affected eyelid, tumor histology (basal cell or epidermoid carcinoma), defect size (25-100 percent), reconstruction type, complications, functional results that were rated as good if the lid had normal position and opening, and aesthetic results that were considered good if they show adequate symmetry with the other eye lid, good function and small scar. Results: males predominated in the sample; the mean age was 67 years and the most common tumor was basal cell carcinoma. The flap in the frontal and glabelar region was the most used. As for functionality and aesthetics of the reconstruction, good results were achieved in 86.7 percent and 76.7 percent of cases, respectively. The main complications were related with the surgical techniques, namely simblepharon and ectoprion accounting for 13.3 percent of the sample. Conclusions: eyelid reconstruction with no condromucosous addition offers good aesthetic and functional results, as well as great possibilities for attaining higher levels of patient's satisfaction, with minimal surgical complications(AU)

Reconstrucción de defectos oncológicos palpebrales con colgajos regionales sin aporte condromucoso / Reconstruction of oncologic eyelid defects with local flaps with no condromucuos

Objetivo: caracterizar la reconstrucción palpebral de los defectos oncológicos de espesor total con colgajos regionales sin aporte condromucoso. Métodos: se realizó un estudio descriptivo, prospectivo y longitudinal con 30 pacientes, en los Servicios de Oftalmología y Cirugía Reconstructiva del Instituto Cubano de Oncología y Radiobiología, en el período 2009-2012. Se utilizaron las siguientes variables: edad (30-90 años), sexo, color de la piel, párpado afectado, histología del tumor (carcinoma basocelular o epidermoide), tamaño del defecto (desde 25 por ciento hasta 100 por ciento), tipo de reconstrucción, complicaciones, resultados funcionales que fueron buenos si el párpado tuvo posición y apertura normal y resultados estéticos que fueron buenos si tuvieron adecuada simetría con el otro párpado, buena función y poca cicatriz. Resultados: en la muestra predominó el sexo masculino; la edad media fue de 67 años y el tumor más frecuente fue el carcinoma basocelular. El colgajo más utilizado fue el de la región frontoglabelar. En cuanto a la funcionabilidad y estética de la reconstrucción, se obtuvieron buenos resultados en el 86,7 y 76,7 por ciento respectivamente. Las principales complicaciones estuvieron relacionadas con la técnica empleada y fueron el simbléfaron y el ectropión, con el 13,3 por ciento del total de la muestra. Conclusiones: la reconstrucción palpebral sin aporte condromucoso ofrece buenos resultados estéticos y funcionales, así como altas probabilidades de satisfacción de los pacientes, con un mínimo de complicaciones quirúrgicas(AU)

Objective: to characterize the reconstruction of full-thickness oncologic eyelid defects by using local flaps with no condromucous addition. Methods: prospective, descriptive and longitudinal study was carried out with 30 patients in the ophthalmology and reconstructive surgery services of the Cuban Institute of Oncology and Radiobiology from 2009 to 2012. The following variables were used: age (30-90 years), sex, race, affected eyelid, tumor histology (basal cell or epidermoid carcinoma), defect size (25-100 percent), reconstruction type, complications, functional results that were rated as good if the lid had normal position and opening, and aesthetic results that were considered good if they show adequate symmetry with the other eye lid, good function and small scar. Results: males predominated in the sample; the mean age was 67 years and the most common tumor was basal cell carcinoma. The flap in the frontal and glabelar region was the most used. As for functionality and aesthetics of the reconstruction, good results were achieved in 86.7 percent and 76.7 percent of cases, respectively. The main complications were related with the surgical techniques, namely simblepharon and ectoprion accounting for 13.3 percent of the sample. Conclusions: eyelid reconstruction with no condromucosous addition offers good aesthetic and functional results, as well as great possibilities for attaining higher levels of patient's satisfaction, with minimal surgical complications(AU)

Técnica «Dry Lake» para el manejo de la ampolla hipertrófica tras implante de XEN ® Gel Stent / «Dry Lake» technique for the treatment of hypertrophic bleb following XEN ® Gel Stent placement

CASO CLÍNICO: Presentamos el caso de una paciente operada previamente de cirugía de glaucoma con dispositivo XEN® sin incidencias, que presenta una ampolla hipertrófica produciendo un ectropión mecánico secundario. Se describe la técnica «Dry Lake» consistente en drenaje de la ampolla, previo bloqueo viscoelástico del dispositivo XEN® vía ab-interno, y el sellado de la ampolla inferior con pegamento tisular. DISCUSIÓN: En el manejo de este tipo de ampollas se han postulado tratamientos médicos, suturas compresoras e incluso la utilización de sangre autóloga. El uso del Tissucol®, ya descrito en la cirugía del glaucoma, puede ser útil en este tipo de casos de ampollas hipertróficas secundarias al dispositivo ab-interno XEN®

CASE REPORT: The case of a patient with previous uncomplicated XEN® drainage glaucoma surgery is described, who presented with hypertrophic bleb and mechanical ectropion. Treatment consisted of the «Dry Lake» procedure to drain the hypertrophic bleb following blockage with viscoelastic of the ab-interno stent and bleb sealing with a tissue adhesive. DISCUSSION: Proposals for the management of this type of bleb include therapeutic strategies, sutures or even autologous blood. The use of Tissucol®, already described in glaucoma surgery, may be appropriate to treat this complication of XEN® placement

Modified auricular cartilage sling for paralytic ectropion.

OBJECTIVE: To evaluate the outcomes of a modified auricular cartilage sling for paralytic ectropion. METHODS: We treated 17 eyelids of 17 patients (average 67 years old) with an auricular cartilage sling between 2004 and 2012. All patients had paralytic ectropion with lower eyelid ptosis. Cartilage was harvested via an incision just inside the anterior rim of the helix. Skin incisions were made at the subciliary, medial and lateral canthal regions. The auricular cartilage graft was sutured to the medial canthal tendon medially, lateral orbital rim laterally, inferior tarsus superiorly, and lower eyelid retractors inferiorly. Average follow-up period was 40 months (range 16-60 months). RESULTS: The median L-MRD (mm) was improved from 8.4 preoperatively (interquartile range 7.5-8.9) to 5.2 postoperatively (4.8-5.3). The median lagophthalmos (mm) was improved from 5.8 preoperatively (4.7-7.0) to 2.2 postoperatively (1.6-2.6). 16 patients had corneal exposure preoperatively and this resolved completely in 12 patients. All patients experienced good anatomical and functional results with relief of their preoperative pain/discomfort symptoms without complications. No patients required reoperation and none experienced infection, exposure of the cartilage graft, or recurrence of lower eyelid malpositions. Postoperatively, all lower eyelids moved downward with down-gaze. The auricular scar left no significant cosmetic deformity. CONCLUSIONS: The modified auricular cartilage sling with 4 point fixation for paralytic ectropion appears to maintain normal eyelid mobility with down-gaze and avoids the problem of lower eyelid fixation.

[Keratopathy versus allergic eye disease: misdiagnosis leading to keratitis].

A case report of involutional ectropion associated with exposure keratopathy - which complicated to exposure keratitis due to incorrect management is presented. Upon consulting the local pharmacy the patient was wrongly given anti-allergic eye drops. Patients with involutional ectropion have high risk of dry eye disease and may rarely be complicated with keratitis. Distinguishing between exposure keratopathy and allergic eye disease is pivotal as management differs and wrong therapy may lead to serious eye disease.

[Clinical investigation on AC/A ratio in intermittent exotropia coexisting with ametropia].

OBJECTIVE: To investigate AC/A ratio and coexisting ametropia in intermittent exotropia. To discuss the relation between AC/A ratio and the development of intermittent exotropia. METHODS: The medical records of 135 patients who had an exotropia were retrospectively reviewed. Patients were divided into 3 groups based on the type of ametropia: exotropia without ametropia (-0.50-+3.00 D between the age of 3-6 years old, -0.50-+2.00 D between the age of 7-40 years old) , exotropia coexisting with myopia (-0.50-7.75 D) and exotropia coexisting with hypermetropia ( ≥ + 3.00 D of 3-6 years old , ≥ + 2.00 D of 7 ∼ 40 years old). AC/A ratios of all patients were assessed using synoptophore method. Distance and near deviations were assessed using prism cover test. AC/A ratios and deviation angles of 3 groups were compared. The relationship between AC/A ratios and ametropia/age were investigated. RESULTS: There were obvious differences in AC/A ratios(2.686 ± 1.372, 1.773 ± 1.110, 4.581 ± 1.552, F = 36.323, P < 0.001) and in near deviation angles (44.473(Δ) ± 19.008(Δ), 53.621(Δ) ± 20.749(Δ), 34.455(Δ) ± 13.292(Δ), F = 8.762, P = < 0.001) between 3 groups of patients, no obvious differences were seen in distance deviation angles (40.333(Δ) ± 19.474(Δ), 44.052(Δ) ± 23.722(Δ), 35.590(Δ) ± 11.143(Δ), F = 1.444, P = 0.24). AC/A ratios were negative linear correlated with refractive powers for patients of intermittent extropia coexisting with myopia or with hypermetropia (r = 0.320, P = -0.469 and r = -0.046, P = 0.036, respectively) . A trend of decline with age was found for AC/A ratios only in patients of intermittent extropia without ametropia (r = -0.320, P = 0.019; r = -0.023, P = 0.865; r = 0.246, P = 0.296 for the other 2 groups, respectively). CONCLUSIONS: Myopia and hypermetropia, when coexisting with abnormally low or high AC/A ratio, can destroy the balance between extraocular muscles and induce exophoria to be manifest.

Cicatricial ectropion in grzybowski type of multiple eruptive keratoacanthomas.

A 41-year-old woman previously diagnosed with generalized eruptive keratoacanthomas of Grzybowski type presented with bilateral lower eyelid cicatrical ectropions. She had previously undergone multiple resections of syringomatous adenomas of both nipples, facial keratoacanthomas, and a lower left lip squamous cell carcinoma. Her facial and periocular skin was thickened with a cobblestone appearance. Cicatricial ectropions involved both upper and lower eyelids. Donor skin was harvested from the dorsum of the foot as this was the only disease-free area on her body, and she achieved a stable result with reduced tearing and improved appearance.