Eyelid Wounds: Epidemiological, Clinical and Etiological Aspects

Purpose: The aim is to show epidemiological, clinical and etiological characteristics of palpebral wounds. Methodology: This was a retrospective study focusing on patients with an eyelid wound, over a 10-year period from 2012 to 2021. We collected and analyzed the data using Excel. Results: The frequency of eyelid wounds was 0.1%. The average age of our patients was 19.38 years with a range of 1 and 62 years. The sex ratio was 3.7. Eighty-one percent of patients lived in Dakar. Fifty-seven percent (57%) of patients consulted less than 24 hours after the trauma and 7% of patients on D1. The circumstances were brawls (11%), domestic accidents (9%), road accidents (6%), and work accidents (6%). We noted 1 case of dog bite. Thirteen patients presented with post-traumatic decreased visual acuity. Involvement of the isolated upper eyelid was noted in 40% of cases and both eyelids in 15% of cases. Involvement of the lacrimal ducts was noted in 17% of cases, and that of the free edge in 21% of cases. Eyelid wounds were associated with eyeball damage in 21% of cases. Various associated lesions were observed. Ninety-one percent of patients received surgical treatment. Three cases of superinfections, 1 case of conjunctival granuloma and 1 case of phthysis of the eyeball with postoperative retinal detachment were noted. Conclusion: Eyelid sores are relatively common in our context. They require rapid surgical treatment in order to preserve the functional and aesthetic prognosis. .

Eyelid Kaposi Sarcoma in HIV-Negative Patient

Introduction: Kaposi sarcoma disease is a proliferative and multifocal disorder with dual components, vascular and fibroblastic cellular, cutaneous and visceral expression. Kaposi Sarcoma can affect the ocular surface and adnexa and can masquerade as other entities, delaying prompt diagnosis can lead to diagnostic wandering delaying treatment. Our aim is to describe a case of KS of the eyelid in an HIV seronegative patient. Case Presentation: A seventy-year-old man developed a bilateral growing tumoral reddish purple vascular mass on both the lower and upper eyelid involving rapidly for 6 months. Both feet and the two shanks show the presence of a brown-violet tumor-shaped formation. The patient was negative for HIV. Histology examination showed a nodular tumor-like mass with a fibro hemangioma-epitheliomatous. Polymerase chain reaction was positive for human herpes virus 8. Initial chemotherapy followed by surgery was proposed to the patient. Unfortunately, the patient rejected treatment and was lost to follow-up. Conclusion: This case reports the difficulty of managing KS in developing countries.

Bilateral Congenital Upper Eyelid Eversion (Ectropion): A Rare Presentation Responded Well to Conservative Treatment at Temeke Regional Referral Hospital-Tanzania

Congenital eversion of the upper eyelids is a rare condition, the exact cause of which remains unknown. It is more frequently associated with Down’s syndrome and black babies. If diagnosed early and treated properly, the condition can be managed without surgery. We report a case of non syndromic congenital bilateral severe upper eyelid eversion in otherwise normal 3 days old neonate of African descent (Tanzanian), born by vaginal delivery. The case was conservatively managed by lubricants, antibiotics and eyelid patching. We report this case because from the best of our knowledge it has never been documented here at our hospital and Tanzania before.

A new technique for correction of iatrogenic upper eyelid retraction by using a composite flap of the orbicularis muscle and fascia on the anterior surface of the tarsal plate

Background:Upper eyelid retraction is a challenging complication of cosmetic upper eyelid blepharoplasty.To avoid extra trauma,we developed a new technique for correcting iatrogenic upper eyelid retraction by postmigrating a compound flap of the orbicularis muscle and fascia(OFC)on the anterior surface of the tarsal plate.This method extends the aponeurosis of the levator palpebrae superioris muscle(LPS),which can achieve a good correction for post-blepharoplasty retraction.Methods:We collected data from 15 patients with mild to moderate iatrogenic upper eyelid retraction who were treated at our hospital between February 2017 and December 2019.The OFC was used to replace the missing part of the LPS,and post-migration of the LPS and fixation of the OFC to the tarsal margin were conducted.Postoperative outcome measurements included postoperative binocular symmetry,double eyelid smoothness,eyelid fullness,margin reflex distance(MRD1),degree of eyelid closure,and exposure keratitis.The patients were followed-up at seven days,one month,and six months postoperatively.Results:One patient with moderate eyelid retraction showed undercorrection 6 months postoperatively,with the upper eyelid margin located at the upper edge of the pupil.The remaining patients had the upper eyelid margin stabilized at 1.0–2.0 mm below the upper corneal margin.Other observational indicators were satisfactory,including binocular symmetry,double eyelid fluency,and eyelid fullness.During the follow-up,no exposure keratitis was identified.The MRD1 indexes after the operation were significantly different(P<0.001)from those before the procedure.Conclusions:Extension and post-migration of the LPS using the orbicularis muscle and OFC structure can effectively correct mild iatrogenic eyelid retraction after ptosis with less damage and good postoperative eyelid morphology and closure function.

Eyelid reconstruction methods:A 10-year review

In ophthalmological practice,eyelid reconstruction is often needed because of the presence of defects that arise after the excision of a tumor or after injuries.Various methods for reconstructing these defects have been previously described.However,it is important to understand the basic principles underlying these techniques and their advantages and disadvantages to ensure the choice of the optimal technique in a particular case.We have analyzed the recent literature on new methods or modifications of existing ones to provide a brief overview of the reconstructive methods of the century for comparison.We searched PubMed and CyberLeninka for articles on restoring eyelid defects reported in the literature over the past 10 years.Most techniques can be considered modified classical reconstruction methods.Postoperative complications included aesthetic defects,such as scarring of the upper or lower eyelid,trichiasis,entropion,and lagophthalmos.Surgeons continue to search for the best methods for complex reconstructive surgery to achieve good cosmetic and aesthetic outcomes.

Reconstruction of eyelid defects using the diplene adhesive membrane

Background The abundance of closely packed vital structures in the periocular and palpebral regions makes resection and subsequent reconstructive interventions extremely difficult.Methods In this novel article,we described a method for closing lower eyelid defects after tumor excision using a skin-muscle flap from the upper eyelid along with the use of an adhesive diplene biodegradable membrane.The membrane was used for seamless fixation of the flap and to prevent the development of lower eyelid deformity.Results The case presented herein demonstrated that using diplene adhesive biodegradable membranes has excellent functional and aesthetic results.Conclusion Our findings suggest that an adhesive biodegradable diplene membrane can be used for the reconstruction of the lower eyelid to prevent the occurrence of retraction,for the surgical treatment of ectropion including recurrent cases,and for seamless fixation of flaps to wound surfaces in patients with a tendency to form keloids and hypertrophic scars.

Subcutaneous pedicled propeller flap technique for microscopic reconstruction of eyelid defects

AIM:To describe the subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects and evaluate its outcomes.METHODS:The clinical data of 23 patients(23 eyes)who underwent microscopic reconstruction of eyelid defects with the subcutaneous pedicled propeller flap technique were retrospectively analyzed.All patients underwent eyelid tumor resection and one-stage microscopic reconstruction with the subcutaneous pedicled propeller flap for anterioror posterior-layer eyelid defects.The survival rate of the propeller flap,eyelid function and appearance,tumor recurrence rate,and patient satisfaction were evaluated after the surgery.RESULTS:The patients consisted of 12 men and 11 women,aged 31–82y(mean,58.9y).The longest followup time was 5y,and the shortest was 3mo.All the propeller flaps survived well.There was no significant difference in color and luster between the flap and adjacent tissues,and there was no dog ear phenomenon.No obvious scarring was observed.There were no obvious abnormalities of eyelid morphology or function,and no adverse complications such as exposure keratitis,entropion,ectropion,ptosis,and eyelid retraction.No tumor recurrence was found at the time of the last follow-up.All patients were satisfied with the surgical results.CONCLUSION:The subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects has satisfactor y outcomes in terms of eyelid function and esthetics,and merits clinical application.

Anterior lamellar recession for management of upper eyelid cicatricial entropion and associated eyelid abnormalities

AIM：To evaluate the functional and aesthetic outcomes of upper eyelid cicatricial entropion（UCE） correction using anterior lamellar recession（ALR） with addressing the associated conditions including dermatochalasis,brow ptosis,blepharoptosis,and lid retraction.METHODS：Chart review of patients with upper lid cicatricial entropion who had undergone ALR from 2013 to 2016 was reviewed.Success was defi ned as the lack of any lash in contact with the globe,no need for a second procedure,and acceptable cosmesis at the fi nal follow up.RESULTS：Sixty eight patients（97 eyelids） were operated by ALR with simultaneous correction of associated lid problems in each case when necessary.The mean followup time was 17.8 mo（range,6.0-24.0 mo）.Concomitantly,levator tucking was performed in 19 eyelids（19.6%）,upper lid retractor recession in 18 eyelids（18.6%）,and internal browpexy in 31 eyelids（32.0%）.In 95.8% of patients（95%CI：0.85-0.96）,satisfactory functional and cosmetic outcome was achieved with a single surgical procedure.CONCLUSION：Based on the principles of lamellar recession and concurrently addressing the associated lid problems,this approach is an effective and safe treatment of UCE.

Observation of Clinical Treatment Effect of Plastic Surgery of Asymmetric Double Eyelids

Objective:To explore the clinical efficacy of plastic surgery of asymmetric double eyelid.Methods:The clinical data of 70 patients with asymmetrical double eyelid who underwent plastic surgery in our hospital from April 2018 to December 2019 were retrospectively analyzed.The patients were divided into different groups based on different plastic surgery procedures.The control group(n=35 cases)were the patients who underwent double eyelid incision method,and the patients who used embedding double eyelid method were included in the observation group(n=35 cases).The operation time,intraoperative blood loss,incision size,healing time of incision,satisfaction of p1astic surgery and occurrence of complications were compared between the two groups.Results:The operation time and incision healing time of the observation group were shorter than those of the control group.The intraoperative blood 1oss and incision were less than those of the control group,and the satisfaction was higher than that of the control group.The difference was statistically significant(P<0.05).The incidence of complications in the observation group was slightly lower than the control group,but the difference was not statistically significant(P>0.05).Conclusion:For asymmetric double eyelid,it should undergo embedding double eyelid plastic surgery,because the operation time and incision healing time are shorter.And intraoperative blood 1oss and incision size are smal1er,which can improve patient satisfaction and reduce the incidence of complications.

How and when of eyelid reconstruction using autologous transplantation

Reconstructive surgery of the eyelid after tumor excision,trauma or other causes can be challenging,especially due to the complexities of the anatomic structures and to the necessity of both functional and aesthetic successful outcomes.The aim of this minireview was to investigate the use of tissue transplantation in eyelid reconstruction.Surgical procedures are various,based on the use of both flaps,pedicled or free,and grafts,in order to guarantee adequate tissue reconstruction and blood supply,which are necessary for correct healing.Common techniques normally include the use of local tissues,combining non-vascularized grafts with a vascularized flap for the two lamellae repair,to attempt a reconstruction similar to the original anatomy.When defects are too wide,vast,deep,and complex or when no adjacent healthy tissues are available,distant area tissues need to be recruited as free flaps or grafts and paired with mucosal layer reconstruction.With regards to the anterior lamella,full thickness skin grafts are commonly preferred.With regards to the reconstruction of posterior lamella,there are different graft options,which include conjunctival or tarsoconjunctival,mucosal or palatal or cartilaginous grafts usually combined with local flaps.Free flap transplantation,normally reserved for rare select cases,include the use of the radial forearm and anterolateral flaps combined with mucosal grafts,which are surgical options currently reported in the literature.

Anthropometric Analysis of the Upper Eyelid and Eyebrow in Patients Attended by the Plastic and Reconstructive Surgery Service of the Hospital Central Sur De Petróleos Mexicanos

Upper eyelid blepharoplasty is one of the most frequently performed surgeries by plastic surgeons worldwide. A prospective observational study was conducted to describe the anthropometric measurements of the upper eyelid and eyebrow in a Mexican population. The researcher measured the anthropometry of the eyelids and eyebrows to establish the diagnosis and surgical plan according to the checklist created and applied by the plastic and reconstructive surgery service. In anatomical position with a caliper instrument, the marginal reflex distance (MRD1), the tarsal thickness, the length of the vertical and horizontal slit, and finally the distance at which the external canthus is located with respect to the internal canthus were measured in millimeters. For the anthropometry of the eyebrows, the distance from the eyebrows to the hairline, the position in millimeters of the orbital rim with respect to the eyebrow, and the angle of its apex were measured. A sample of 210 patients was obtained, of which 65 were male and 145 females, divided by age groups. It was observed that in the three age groups, females presented a vertical palpebral fissure with a higher mean than males. Similar is the case of tarsal thickness, in which the difference was significantly greater in the female of the three age groups. On the other hand, it was observed that the horizontal slit in males was higher than that of females, while the MDR1 was similar in both sexes. Finally, it was identified that in the group of 41 to 50 years old significant decreases are observed both in the vertical cleft, tarsal thickness and the position of the external canthus compared to the group of 20 to 30 years old, this is due to the aging process. When evaluating the anthropometrics of the eyebrows, a greater distance from the trichion to the eyebrow was observed in males than in females, in contrast to the position of the eyebrow with respect to the supraorbital rim and its apex, in which it was shown that in females there is a greater distance. In the other groups, the trends were maintained;however, a decrease was observed in the angle of the apex of the eyebrow and the RSO-eyebrow distance in males and females with advancing age, being more important in the group of 41 to 50 years. Systematized palpebral and periorbital anthropometric analysis is fundamental in the evaluation consultation. It allows us to make a precise diagnosis of the functional and aesthetic alterations that must be corrected during a surgical procedure, according to the concept of beauty of each culture or ethnicity.

A modified 3D stereophotogrammetry-based distraction test for assessing lower eyelid tension

AIM: To investigate the reliability of a modified threedimensional distraction test(3D-DT) and three-dimensional pinch test(3D-PT) for assessing lower eyelid tension(LET).METHODS: A cross-sectional study was conducted among 97 volunteer s including 97 eyelids with no history of trauma, tumor, or reconstructive surgeries. Six three-dimensional photographs were acquired for each par ticipant, including two photographs obtained in a neutral position(NP), two using a modified 3D-DT with a 15.9-grammes stainless steel eyelid hook performed, and two using 3D-PT.RESULTS: The mean absolute differences between NP, 3D-DT, and 3D-PT measurements varied between 0.07 and 7.42, 0.10 and 13.10, and 0.07 and 15.97, respectively;technical error of measurement varied between 0.05 and 7.81, 0.09 and 10.19, and 0.07 and 12.47, respectively;and relative error measurements varied between 0.10% and 11.50%, 0.16% and 30.51%, and 0.11% and 38.75%, respectively. For intra-rater reliability, the intraclass correlation coefficients(ICCs) were more than 0.80 in seven out of eight measurements obtained in the NP and 3D-DT, whereas those obtained in the 3D-PT were as low as less than 0.30 by rater 1;the ICCs of all the measurements obtained in all the positions(NP, 3D-DT, and 3D-PT) were more than 0.80 by rater 2. For inter-rater reliability six out of eight NP and 3D-DT measurements had an ICC greater than 0.80, whereas those of 3D-PT measurements were less than 0.30. For intra-method reliability, the ICCs of all the NP measurements were more than 0.87, whereas those of the six 3D-DT measurements and four 3D-PT measurements were more than 0.80.CONCLUSION: Our study results prove that the modified 3D-DT, which involves the use of an eyelid hook, can be a highly reliable method for evaluating LET. Furthermore, this novel and simple method may be utilized as the basis for further investigation and routine pre-and postoperative clinical evaluation.

A retrospective study of 2228 cases with eyelid tumors

AIM： To describe the histopathologic and clinical features of eyelid tumor cases from Tianjin Eye Hospital during 2002 to 2015. METHODS： In this retrospective study, a total of 2228 cases of eyelid tumors with pathologic diagnoses were enrolled. The eyelid tumors were classified into three groups according to tumor origin： epidermal, adnexal and miscellaneous, including melanocytic, neural and vascular lesions. Inflammatory tumor-like lesions were excluded. The clinical characteristics of the eyelid tumors were analyzed, including age, gender and lesion location. RESULTS： Most eyelid tumors were epidermal in origin（1080, 48.5%）, followed by miscellaneous（885, 39.7%） and adnexal tumors（263, 11.8%）. Among all the tumors, 292（13.1%） were malignant lesions, 1910（85.7%） benign and 26（1.1%） premalignant lesions. Most malignant tumors originated from epidermal cells（60.0%）, followed by adnexal cells（34.6%）. The most common malignant tumors were basal cell carcinomas（56.5%） followed by sebaceous carcinoma（34.6%）, squamous cell carcinomas（3.8%） and lymphoma/plasmocytoma（1.7%）. The benign and premalignant eyelid lesions mostly originated from epidermal cells（46.4%） followed by miscellaneous cell sources（45.2%）, including melanocytic nevus（33.8%）, seborrheic keratosis（13.7%）, squamous cell papilloma（13.0%） and epidermal cysts（11.5%）. CONCLUSION： Eyelid tumors are mostly epithelial in origin. Benign tumors are significantly more common than malignant tumors with an obvious female predominance, and the most frequent malignant tumor are basal cell carcinoma, sebaceous carcinoma and squamous cell carcinomas. The tumor clinical features varied among the different subtypes.

Extensive full-thickness eyelid reconstruction with rotation flaps through "subcutaneous tunnel" and palatal mucosal grafts

· AIM: To reconstruct the extensive full-thickness defects of eyelids is a challenge for the plastic surgeon because of their complex anatomy and special functions.This article presents and discusses an improved surgical technique in which the orbicularis oculi myocutaneous flap is rotated through a "subcutaneous tunnel" in conjunction with a palatal mucosal graft employed for lining.·METHODS: Data from 22 eyes with extensive full-thickness eyelid defects from various causes between2009 and 2013 were analyzed in this study. After the different layers of eyelid were separated completely, a temporally based orbicularis oculi myocutaneous flap was designed following fishtail lines and was mobilized,leaving the base of the pedicle intact with a submuscular tissue attachment. The flap was then rotated through a "subcutaneous tunnel" to the defect, and the donor site was closed primarily. Posterior lamellar reconstruction was performed with a mucosal graft harvested from the hard palate.·RESULTS: All the flaps were survived without any healing problems. There was no corneal irritation, flap contraction, or significant donor-site morbidity in the follow-up period. The incision scars were almost invisible.The defects were repaired completely, and the evaluations showed satisfactory function and appearance.·CONCLUSION: This technique is an improved singlestage operation and can be applied to repair large, full-thickness eyelid defects from various causes. With our method, the functional and aesthetic results can be obtained in either the upper or lower eyelids.

Radiofrequency ablation micro-dissecting of eyelid nevus with XL-RFA device under operating microscope

AIM: To study the effect of an innovative micro-dissection procedure by radiofrequency ablation (MRA) in removing eyelid nevus.METHODS: Fifty-six consecutive outpatients with eyelid nevus were treated with MRA using a monopolar device. The effect of MRA was determined after following-up for 6mo to 5y.RESULTS: Fifty-two cases (52 eyes, 92.9%) were cured once, and 4 cases (4 eyes, 7.1%) received second treatment for small residual. All cases healed well after surgery, with no pigmentation, no scars, no loss of eyelashes, no deformation of eyelid margin. There was no visual impairment after healing.CONCLUSION: MRA of eyelid nevus using the XL-RFA device is highly efficient without significant complications.

Favre-Racouchot syndrome associated with eyelid papilloma:a case report

A 55-year-old Chinese man presented with an asymptomatic pedunculated elevation on his left lower eyelid which had been gradually increasing in size during the past three years. The patient was diagnosed with eyelid papilloma by pathological examination. Concomitantly, the patient developed open comedones with a bilateral linear distribution, along with oblique wrinkle lines in his infraorbital regions. These lesions were noninflamma- tory and remained unchanged for two years. To the best of our knowledge, this distribution of open comedones, especially in combination with eyelid papilloma, has not been reported previously in Favre-Racouchot syndrome.

Correlation and Expression of COX-2 and P53 Protein in Basal Cell Carcinoma of Eyelid

The correlation between the expression of COX-2 and p53 protein in basal cell carcinoma （BCC） of eyelid and apoptosis was investigated. Specimens of BCC were collected from 40 cases （aged 28-68 y） at the Department of Pathology, Renmin Hospital of Wuhan University, and Department of Pathology, Zhongnan Hospital of Wuhan University during from 1999 to 2006. Five specimens of paracancerous tissues served as control group. Immunohistochemical staining was performed to detect the expression of COX-2 and p53 in the tissues. The average absorbance （A） and the average positive area rate of COX-2 and p53 protein were measured by image analysis. The positive area rate of COX-2 and p53 protein was analyzed by linear correlation analysis. It was found that COX-2 and p53 proteins were highly expressed in BCC of eyelid, and weakly expressed in paracancerous tissues. Image analysis revealed that the expression of COX-2 and p53 proteins in BCC of eyelid was sig- nificantly higher than that in paracancerous tissues （P〈0.01）. Spearman rank correlation analysis demonstrated a positive correlation between the expression of COX-2 and p53 （r=0.113, P=0.421）. It was concluded that COX-2 can increase the expression of p53 protein, therefore suppressing apoptosis.

Conjunctival flap with auricular cartilage grafting: a modified Hughes procedure for large full thickness upper and lower eyelid defect reconstruction

AIM:To investigate the suitability of a modified Hughes procedure,which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect.METHODS:Patients with full thickness eyelid carcinoma involving more than 50%margin length who underwent surgical resection were retrospectively reviewed in the study.The defects were reconstructed using conjunctival flap with auricular cartilage grafting,covered with myocutaneous flap above.Followed-up time ranged from 12 to 24 mo.Outcomes were classified as“good”,“fair”,and“poor”by evaluating the margin appearance,eyelid appearance,and complications.RESULTS:A total of 42 patients were enrolled in the study(26 males,16 females,mean age,68.6±7.7 y,range:53 to 82 y).The mean defect widths measured 23.2±2.9 mm(range,17 to 28 mm).The mean posterior lamellar defect height was 5.5±1.3 mm(4 to 8 mm).Thirty-seven patients had a“good”outcome(88.1%),5 patients had a“fair”outcome(11.9%),and no one had a“poor”outcome.CONCLUSION:Conjunctival flap with auricular cartilage grafting and myocutaneous flap grafting is an effective procedure in reconstructing large full thickness upper and lower eyelid defect.It can not only achieve satisfied reconstruction,but also preserve intact tarsal plate of the opposite eyelid,avoiding retraction or entropion.

Clinicopathologic features and prognostic factors of malignant eyelid tumors

AIM:To investigate the clinical characteristics and prognosis of patients with malignant eyelid tumors.·METHODS:This was a retrospective,non-randomized,clinical reviews.Between January,2002 and December,2011,75 cases with histologically confirmed malignant eyelid tumors were evaluated.Patients’ charts were reviewed for clinical information,treatment procedure,and disease course.Survival analysis in terms of recurrence-free survival was performed using age,sex,location of tumor and histopathological type.The followup ranged from 1 to 78 months(mean=21 months).·RESULTS:The 75 eyelid tumors included 35 basal cell carcinoma(BCC,46.7%),22 sebaceous gland carcinoma(SGC,29.3%),7 squamous cell carcinoma(SCC,9.3%),10 malignant melanoma(MM,13.3%),and 1 Merkel cell carcinoma(MCC,1.3%).Recurrence developed in 17cases(22.7%).The recurrence rate of BCC(4/35,11.4%)was significant lower than MM(6/10,60.0%,P 【0.001).The mean interval of recurrence was 21 months(range 3-62) for all eyelid tumors.Tumor located at canthus had higher recurrence rate(50%) compared with those located at eyelid(19%,P 【0.05).Histological type was independent variable for recurrence by Cox regression analysis.·CONCLUSION:It is important to achieve a negative tumor margin in canthus located malignant eyelid tumor.Clinicians should have a high level of suspicion for recurrence according to histological type when treating patients with eyelid tumor.

Repair of Full-Thickness Defects of the Lower Eyelid

The defect after an enlarged resection of lower eyelid tumor was reconstructed by transplantation of a mucosaCartilage composite graft from the nasal septum and a mucosa graft from the oral cavity for inner part of the eyelid. A pedicled skin flap from the adjacent region was rotated to cover the defect. The results in 4 patients were all satisfactory. The keypoint of the operation is the selection and design of an ideal pedicled skin flap.