DOCSLIB.ORG

Transconjunctival Entropion Repair Steven C

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Transconjunctival Entropion Repair Steven C Transconjunctival Entropion Repair Steven C. Dresner, MD, James W. Karesh, MD lower-eyelid entropion has three underlying correctable causes: eyelid laxity, over- riding of the orbicularis oculi muscle, and attenuation of the lower-eyelid retractors. We de- scribe a new technique for correcting this problem. A transconjunctival approach is used to Involutionaladvance or fortify the lower-eyelid retractors. The orbicularis oculi muscle can also be addressed through this approach. Combining this technique with lateral canthal resuspension anatomically cor- rects the entropion by addressing all three correctable causes. Transconjunctival blepharoplasty can also be performed in conjunction with this technique. Twenty-three eyelids of 18 patients successfully underwent this procedure. Six patients underwent simultaneous transconjunctival blepharoplasty. Follow-up ranged between 9 and 18 months. There were no postoperative recurrences, overcorrections, or lower\x=req-\ eyelid retraction. This approach yields a stable and definitive repair of involutional entropion with excellent postoperative cosmesis. (Arch Ophthalmol. 1993;111:1144-1148) Many procedures have been described for SURGICAL TECHNIQUE correcting involutional entropion.1"11 The development of these techniques has been The lower eyelid is anesthetized through based on an understanding of the various the inferior fomix with an injection of ap¬ correctable pathophysiologic processes un¬ proximately 2 mL of 1 % xylocaine hydro¬ derlying this condition: (1) horizontal eye¬ chloride with a 1:100 000 dilution of epi¬ lid laxity, (2) overriding of the preseptal nephrine. A 1- to 2-mL bolus of this same orbicularis oculi muscle, and (3) attenua¬ solution is instilled into the lateral can- tion of the lower-eyelid retractors. Invo¬ thus down to the periosteum. A protective lutional enophthalmos may also play a role eyelid plate is used over the globe during in the cause of involutional entropion; how¬ the dissection. ever, this factor cannot be safely or easily A lateral canthotomy is performed with managed.1 Definitive surgical correction of a straight tenotomy scissors (Figure 1, top involutional entropion needs to address all left). The inferior crus of the lateral can- three of the correctable causes. We have thai tendon is then incised (Figure 1, top developed a new technique to repair this right). A small retractor is placed in the condition that corrects these anatomic ab¬ lateral canthal incision. Beginning at the normalities and provides increased cosme¬ lateral canthus and extending just lateral sis through a transconjunctival approach. to the punctum, an incision is made with a cutting unipolar cautery just below the lower tarsal border through the conjunc¬ tiva and lower-eyelid retractors (Figure 1, From the Division Plastic and Department of Ophthalmology, of Ophthalmic bottom left). Little is en¬ Reconstructive Surgery, The Jules Stein Eye Institute, UCLA School Medicine, bleeding usually of countered in this bloodless Los Angeles, Calif (Dr Dresner); the Krieger Eye Institute, Sinai Hospital of Baltimore relatively plane. (Md) (Dr Karesh); and The Wilmer Ophthalmological Institute, The Johns Hopkins The orbital septum and the orbicularis oc¬ University, Baltimore (Dr Karesh). uli muscle are not violated during the dis- Downloaded from www.archophthalmol.com at SCELC - City of Hope National Medical Center, on April 23, 2012 Figure 1. Top left, A lateral canthotomy is performed with a straight tenotomy scissors. Top right, The inferior crus of the lateral cantbal tendon is incised. Bottom left, An incision is made with a unipolar cutting cautery just below the tarsal border through the conjunctiva and lower-eyelid retractors. Bottom right, A cutting cautery is used to excise a strip of orbicularis muscle along the full length of the incision. section. The conjunctiva and lower- entropion is unilateral, a limited fat the conjunctiva with the cutting cau¬ eyelid retractors are elevated and excision or none at all can be per¬ tery to create a free edge (Figure 2, separated from the anterior eyelid formed to ensure symmetry with the top left). This free edge is then re¬ lamella and orbicularis muscle. The other eyelid. inserted into the inferior and ante¬ surgical plane is carried inferiorly to¬ The lower tarsal border is then rior tarsal border with two buried 5-0 ward the inferior orbital rim be¬ pulled upward, everting the eyelid. Cut¬ polygalactin sutures (Figure 2, top tween the lower-eyelid retractors and ting cautery is used to excise a strip right). Reattaching the retractors to the fat pads. Downward traction on of orbicularis oculi muscle below the the anterior surface of the tarsus ap¬ the lower eyelid with either a rake tarsus along the full length of the in¬ preciably everts the eyelid margin. No or a small Desmarres retractor is used cision (Figure 1, bottom right). Since closure of the conjunctiva is neces¬ for improving exposure. the orbital septum fuses with the lower- sary since the conjunctiva readily re- Once the fat pads are identified, eyelid retractors approximately 5 mm attaches to the inferior tarsal border. a transconjunctival blepharoplasty can below the tarsal border, excision of The eyelid is then horizontally be performed when necessary. Gen¬ the orbicularis oculi in this area can shortened to correct all eyelid laxity tle pressure on the globe or upward be performed without violating the body and a tarsal strip is formed as a sub¬ traction on the lower-retractors is help¬ of the orbital septum. The lower-eyelid stitute lateral canthal tendon. The nee¬ ful for demonstrating the three lower- retractors are firmly adherent to the dle tip of the electrocautery unit is used eyelid fat compartments. The fine con¬ conjunctiva and immediately poste¬ to create this strip by dissecting the nective tissues covering the fat pads rior to the fat compartments. If there tarsus of the lateral eyelid from the an¬ can be incised with the cutting cau¬ is any uncertainty about their location, terior eyelid lamella and removing the tery. Each fat pad is excised with the the patient can be asked to look up¬ eyelid margin and epithelium from it. needle tip of the cutting cautery with¬ ward and downward to identify the Shortening of the strip before its re¬ out clamping. Small vessels in the fat edge of the retractors. attachment to the lateral orbital rim are cauterized when seen. When the The retractors are separated from periosteum prevents the formation of Downloaded from www.archophthalmol.com at SCELC - City of Hope National Medical Center, on April 23, 2012 a lateral subcutaneous lump after clo¬ pion (Figure 4) and in one patient COMMENT sure of the skin (Figure 2, bottom left). with unilateral entropion. Patients with The tarsal strip is reinserted into the cicatricial entropion were excluded from Most authors agree that there are three lateral orbital rim with two 4-0 poly¬ this study. elements responsible for involu¬ galactin sutures. The canthotomy in¬ All patients underwent horizon¬ tional entropion: lower-eyelid lax¬ cision can then be closed in standard tal eyelid shortening and lateral can- ity, attenuation of the lower-eyelid fashion (Figure 2, bottom right). thai resuspension as well as reinser¬ retractors, and overriding of the or¬ tion ofthe lower-eyelid retractors. Post¬ bicularis oculi muscle.12"15 There¬ RESULTS operative follow-up ranged from 9 to fore, a definitive procedure should 18 months. During this period there address all three of these elements. Transconjunctival entropion repair was were no entropion recurrences. No pa¬ The eyelids should be shortened hor¬ performed successfully on 23 eyelids tient had postoperative eyelid retrac¬ izontally; the lower-eyelid retractors of 18 patients with involutional en¬ tion or scierai show, and there were should be fortified or reinserted; and tropion (Figure 3). There were six no overcorrections. One patient had the orbicularis oculi muscle should men (33%) and 12 women (67%) rang¬ a postoperative stitch abscess, which be attended to, either weakening it ing in age from 63 to 94 years. The resolved with antibiotic treatment and or creating a scar barrier under the mean age was 78 years. Five patients removal of the suture. Postoperative tarsus to prevent overriding of the (28%) had bilateral entropion repair ecchymosis was minimal and gener¬ preseptal portion. and 13 (72%) had unilateral repair. ally resolved in 2 weeks. The conjunc¬ In the evolution of entropion re¬ Ofthe 13 unilateral repairs, nine (69%) tival incisions were all fused in the first pair, many techniques have been de¬ involved the right eyelid and four (31%) week after surgery, and persistent con¬ scribed. In general, some failed to ad¬ the left. Transconjunctival blepharo- junctival edema was not a problem. dress any of the causative factors plasties were performed concomitantly No patients had postoperative corneal underlying involutional entropion. in five patients with bilateral entro- stippling or epithelial defects. Most, however, corrected only one Figure 2. Top left, The retractors are separated from the conjunctiva with the cutting cautery to create a free edge. The tip of the cautery points to the lower-eyelid retractors. Top right, The lower-eyelid retractors are reinserted to the inferior anterior tarsal surface with two buried 5-0 polygalactin sutures. Bottom left, A horizontal eyelid shortening and eyelid resuspension through tarsal strip formation is then performed to tighten the eyelids. A small portion of tarsus extends from the horizontally shortened eyelid before its reattachment to periosteum of the inner aspect of the lateral orbital rim. Bottom right, The skin incision is then closed in standard fashion. Downloaded from www.archophthalmol.com at SCELC - City of Hope National Medical Center, on April 23, 2012 Figure 3. Left, Preoperative appearance of a patient with entropion of the right lower eyelid. Right, Postoperative appearance 6 weeks after transconjunctival entropion repair. or two of these factors. Ziegler2 de¬ lid laxity or abnormalities of the lower- effectively and permanently performed. scribed a technique using cautery to eyelid retractors.
Load more

Recommended publications
  • Multipurpose Conical Orbital Implant in Evisceration
    Ophthalmic Plastic and Reconstructive Surgery Vol. 21, No. 5, pp 376–378 ©2005 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Multipurpose Conical Orbital Implant in Evisceration Harry Marshak, M.D., and Steven C. Dresner, M.D. Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A. Purpose: To evaluate the safety and efficacy of the porous polyethylene multipurpose conical orbital implant for use in evisceration. Methods: A retrospective review of 31 eyes that underwent evisceration and received the multipurpose conical orbital implant. The orbits were evaluated at 1 week, 1 month, and 6 months after final prosthetic fitting for implant exposure, superior sulcus deformity, and prosthetic motility. Results: There were no cases of extrusion, migration, or infection. All patients had a good cosmetic result after final prosthetic fitting. Prosthetic motility was good in all patients. Exposure developed in one eye (3%) and a superior sulcus deformity developed in one eye (3%). Conclusions: Placement of an multipurpose conical orbital implant in conjunction with evisceration is a safe and effective treatment for blind painful eye that achieves good motility and a good cosmetic result. visceration has proved to be effective for the treat- forms anteriorly to the sclera to be closed over it, without Ement of blind painful eye from phthisis bulbi or crowding the fornices, and extends posteriorly through endophthalmitis. By retaining the sclera in its anatomic the posterior sclerotomies, providing needed volume to natural position, evisceration has the advantage of allow- the posterior orbit. ing the insertions of the extraocular muscles to remain intact, promoting better motility.
    [Show full text]
  • Extraocular Muscles Orbital Muscles
    EXTRAOCULAR MUSCLES ORBITAL MUSCLES INTRA- EXTRA- OCULAR OCULAR CILIARY MUSCLES INVOLUNTARY VOLUNTARY 1.Superior tarsal muscle. 1.Levator Palpebrae Superioris 2.Inferior tarsal muscle 2.Superior rectus 3.Inferior rectus 4.Medial rectus 5.Lateral rectus 6.Superior oblique 7.Inferior oblique LEVATOR PALPEBRAE SUPERIORIOS Origin- Inferior surface of lesser wing of sphenoid. Insertion- Upper lamina (Voluntary) - Anterior surface of superior tarsus & skin of upper eyelid. Middle lamina (Involuntary) - Superior margin of superior tarsus. (Superior Tarsus Muscle / Muller muscle) Lower lamina (Involuntary) - Superior conjunctival fornix Nerve Supply :- Voluntary part – Oculomotor Nerve Involuntary part – Sympathetic ACTION :- Elevation of upper eye lid C/S :- Drooping of upper eyelid. Congenital ptosis due to localized myogenic dysgenesis Complete ptosis - Injury to occulomotor nerve. Partial ptosis - disruption of postganglionic sympathetic fibres from superior cervical sympathetic ganglion. Extra ocular Muscles : Origin Levator palpebrae superioris Superior Oblique Superior Rectus Lateral Rectus Medial Rectus Inferior Oblique Inferior Rectus RECTUS MUSCLES : ORIGIN • Arises from a common tendinous ring knows as ANNULUS OF ZINN • Common ring of connective tissue • Anterior to optic foramen • Forms a muscle cone Clinical Significance Retrobulbar neuritis ○ Origin of SUPERIOR AND MEDIAL RECTUS are closely attached to the dural sheath of the optic nerve, which leads to pain during upward & inward movements of the globe. Thyroid orbitopathy ○ Medial & Inf.rectus thicken. especially near the orbital apex - compression of the optic nerve as it enters the optic canal adjacent to the body of the sphenoid bone. Ophthalmoplegia ○ Proptosis occur due to muscle laxity. Medial Rectus Superior Rectus Origin :- Superior limb of the tendonous ring, and optic nerve sheath.
    [Show full text]
  • Treatment of Congenital Ptosis
    13 Review Article Page 1 of 13 Treatment of congenital ptosis Vladimir Kratky1,2^ 1Department of Ophthalmology, Queen’s University, Kingston, Canada; 21st Medical Faculty, Charles University, Prague, Czech Republic Correspondence to: Vladimir Kratky, BSc, MD, FRCSC, DABO. Associate Professor of Ophthalmology, Director of Ophthalmic Plastic and Orbital Surgery, Oculoplastics Fellowship Director, Queen’s University, Kingston, Canada; 1st Medical Faculty, Charles University, Prague, Czech Republic. Email: [email protected]. Abstract: Congenital ptosis is an abnormally low position of the upper eyelid, with respect to the visual axis in the primary gaze. It can be present at birth or manifest itself during the first year of life and can be bilateral or unilateral. Additionally, it may be an isolated finding or part of a constellation of signs of a specific syndrome or systemic associations. Depending on how much it interferes with the visual axis, it may be considered as a functional or a cosmetic condition. In childhood, functional ptosis can lead to deprivation amblyopia and astigmatism and needs to be treated. However, even mild ptosis with normal vision can lead to psychosocial problems and correction is also advised, albeit on a less urgent basis. Although, patching and glasses can be prescribed to treat the amblyopia, the mainstay of management is surgical. There are several types of surgical procedure available depending on the severity and etiology of the droopy eyelid. The first part of this paper will review the different categories of congenital ptosis, including more common associated syndromes. The latter part will briefly cover the different surgical approaches, with emphasis on how to choose the correct condition.
    [Show full text]
  • Inferior Rectus Paresis After Secondary Blepharoplasty
    Br J Ophthalmol: first published as 10.1136/bjo.68.8.535 on 1 August 1984. Downloaded from British Journal of Ophthalmology, 1984, 68, 535-537 Inferior rectus paresis after secondary blepharoplasty EDUARDO ALFONSO, ANDREW J. LEVADA, AND JOHN T. FLYNN From the Bascom Palmer Eye Institute, Department of Ophthalmology, University ofMiami School ofMedicine, Miami, Florida, USA SUMMARY A 52-year-old woman underwent a secondary cosmetic blepharoplasty for repair of residual dermatochalasis. Afterthis procedure vertical diplopia was noted. Ultrasound examination and the findings at operation were consistent with trauma to the inferior rectus muscle. We present this as an additional complication of cosmetic blepharoplasty. Numerous complications ofblepharoplasty have been The patient was examined by an ophthalmologist reported. They include blindness, orbital and eyelid and observation was recommended. One year later haematoma, epiphora, ectropion, lagophthalmos, she was examined by a second ophthalmologist in ptosis, incision' complications, scar thickening, Munich. A left hypertropia of 260 and exotropia of incomplete or excessive removal of orbital fat, 12° were found, and both inferior recti were thought lacrimal gland injury, exposure keratitis, and corneal to be involved. The patient could fuse only in gaze up ulcer. '-" Disturbances of ocular motility are and left. On 21 October 1981 she underwent a 5 mm uncommon, but superior oblique palsy,2 inferior recession ofthe right superior rectus muscle combined oblique injury,- superior rectus incarceration in the with release of conjunctival scar inferiorly, myotomy to ofthe inferior rectus muscle, and insertion of a Teflon wound,4 and restriction secondary retrobulbar http://bjo.bmj.com/ haemorrhage5 have been reported.
    [Show full text]
  • Eyelash Inversion in Epiblepharon: Is It Caused by Redundant Skin?
    ORIGINAL RESEARCH Eyelash inversion in epiblepharon: Is it caused by redundant skin? Hirohiko Kakizaki1 Purpose: To evaluate the effect of redundant lower eyelid skin on the eyelash direction in Igal Leibovitch2 epiblepharon. Yasuhiro Takahashi3 Materials and methods: Asian patients with epiblepharon participated in this study. The Dinesh Selva4 lower eyelid skin was pulled downward in the upright position with the extent just to detach from eyelash roots, and the direction of the eyelashes was examined. These evaluations were 1Department of Ophthalmology, Aichi Medical University, Nagakute, repeated before surgery while the patients were lying supine under general anesthesia. Aichi 480-1195, Japan; 2Division of Results: The study included 41 lower eyelids of 25 patients (17 females, 8 males, average age; Oculoplastic and Orbital Surgery, 5.6 years, 16 cases bilateral, 9 unilateral). In the upright position, without downward traction Department of Ophthalmology, Tel-Aviv Medical Center, of the skin, the eyelashes were vertically positioned and touching the cornea. The redundant Tel-Aviv University, Tel-Aviv, Israel; skin touched only the eyelash roots and had minimal contribution to eyelash inversion. With 3 Department of Ophthalmology downward skin traction, there was no signifi cant change in the eyelash direction. In the spine and Visual Sciences, Osaka City University Graduate School position, the eyelashes were touching the cornea, and there was marked redundant skin that was of Medicine, Osaka 545-8585, Japan; pushing the eyelashes inward. With downward skin traction, there was no signifi cant change. 4 South Australian Institute Conclusions: The direction of lower eyelashes in patients with epiblepharon was less infl uenced of Ophthalmology and Discipline For personal use only.
    [Show full text]
  • Lid and Lash Conditions
    Perth Veterinary Ophthalmology Lid and Lash Conditions Eyelid Diseases The most common eyelid diseases are entropion, ectropion and facial droop. Entropion Entropion means a turning in of the lids. This is a common complaint in young dogs but can sometimes affect older dogs and cats as well. Most cases in young dogs affect the lower lids, but the upper lid can become affected in later life in some breeds such as Cocker Spaniels and Bloodhounds. Entropion Some breeds such as Shar Peis, Chows, Rottweillers and Mastiffs can have very complex entropion leading to defects in both upper and lower lids. A Shar Pei with severe upper and lower lid entropion Entropion is painful and can be potentially blinding. The rolling in of the lid leads to hair coming into contact with the cornea, leading to pain, ulceration and scarring (which can affect vision). In severe cases this can even lead to perforation of the eye. There are many causes of entropion. It can be primary or secondary to other problems affecting the lids (such as ectopic cilia, distichiasis etc. - see below). Some possible causes include the lid being too long, the lid being too tight, instability of the lateral canthus (outer cornea of the eyelids), misdirection of the lateral canthal tendon, brachycephalic anatomy (big eyes and short nose - e.g. Pekingese, Pugs, Shih Tsus, Persian cats etc.), diamond eye defects, loose or too much skin, facial droop etc. Often these cases are referred to a veterinary ophthalmologist for proper assessment and treatment to provide the best outcome. Entropion requires surgical correction.
    [Show full text]
  • Required List of Bones and Markings
    REQUIRED LIST OF BONES AND MARKINGS Axial Skeleton Skull Cranial Bones (8) Frontal Bone (1) Supraorbital foramina Supraorbital ridges or margins Parietal Bones (2) Temporal Bones (2) External auditory meatus Mastoid process Styloid process Zygomatic process Mandibular fossa Foramen lacerum Carotid foramen Jugular foramen Stylomastoid foramen Internal auditory meatus Occipital Bone (1) Foramen magnum Occipital condyles Ethmoid Bone (1) Cribriform plate Olfactory foramina in cribriform plate Crista galli Perpendicular plate (forms superior part of nasal septum) Middle nasal concha Superior nasal concha Sphenoid Bone (1) Foramen ovale Foramen rotundum Sella turcica Greater wing Lesser wing Optic foramen Inferior orbital fissure Superior orbital fissure Pterygoid processes Skull (cont’d) Facial Bones (14) Lacrimal Bones (2) Lacrimal fossa Nasal Bones (2) Inferior Nasal Conchae (2) Vomer (1) (forms inferior portion of nasal septum) Zygomatic Bones (2) Temporal process (forms zygomatic arch with zygomatic process of temporal bone) Maxillae (2) Alveoli Palatine process (forms anterior part of hard palate) Palatine Bones (2) (form posterior part of hard palate) Mandible (1) Alveoli Body Mental foramen Ramus Condylar process (mandibular condyle) Coronoid process Miscellaneous (Skull) Paranasal sinuses are located in the ethmoid bone, sphenoid bone, frontal bone, and maxillae Zygomatic arch (“cheekbone”) is composed of the zygomatic process of the temporal bone and the temporal process of the zygomatic bone 2 pairs of nasal conchae (superior and middle) are part of the ethmoid bone. 1 pair (inferior) are separate facial bones. All the scroll-like conchae project into the lateral walls of the nasal cavity. Hard palate (“roof of mouth”) is composed of 2 palatine processes of the maxillae and the 2 palatine bones (total of 4 fused bones).
    [Show full text]
  • Eleventh Edition
    SUPPLEMENT TO April 15, 2009 A JOBSON PUBLICATION www.revoptom.com Eleventh Edition Joseph W. Sowka, O.D., FAAO, Dipl. Andrew S. Gurwood, O.D., FAAO, Dipl. Alan G. Kabat, O.D., FAAO Supported by an unrestricted grant from Alcon, Inc. 001_ro0409_handbook 4/2/09 9:42 AM Page 4 TABLE OF CONTENTS Eyelids & Adnexa Conjunctiva & Sclera Cornea Uvea & Glaucoma Viitreous & Retiina Neuro-Ophthalmic Disease Oculosystemic Disease EYELIDS & ADNEXA VITREOUS & RETINA Blow-Out Fracture................................................ 6 Asteroid Hyalosis ................................................33 Acquired Ptosis ................................................... 7 Retinal Arterial Macroaneurysm............................34 Acquired Entropion ............................................. 9 Retinal Emboli.....................................................36 Verruca & Papilloma............................................11 Hypertensive Retinopathy.....................................37 Idiopathic Juxtafoveal Retinal Telangiectasia...........39 CONJUNCTIVA & SCLERA Ocular Ischemic Syndrome...................................40 Scleral Melt ........................................................13 Retinal Artery Occlusion ......................................42 Giant Papillary Conjunctivitis................................14 Conjunctival Lymphoma .......................................15 NEURO-OPHTHALMIC DISEASE Blue Sclera .........................................................17 Dorsal Midbrain Syndrome ..................................45
    [Show full text]
  • Strabismus Surgery and Its Complications
    Strabismus Surgery and its Complications von David K Coats, Scott E Olitsky 1. Auflage Springer-Verlag Berlin Heidelberg 2007 Verlag C.H. Beck im Internet: www.beck.de ISBN 978 3 540 32703 5 Zu Inhaltsverzeichnis schnell und portofrei erhältlich bei beck-shop.de DIE FACHBUCHHANDLUNG Part I Surgical Management of Strabismus Chapter Surgically Important Anatomy 1 1 A clear grasp of the relevant anatomy and an understanding leys, and by transmitting forces generated by contraction of the of important anatomical variations are obvious prerequisites extraocular muscles indirectly to the sclera. Even a “lost” rec- for the strabismus surgeon. The strabismus surgeon must not tus muscle may continue to have a minor to moderate ability only be familiar with the anatomy of the extraocular muscles, to move the eye through these secondary attachments with the but must also be cognizant of adjacent structures in the orbit globe, despite complete disruption of the normal anatomical and the ocular adnexa. Much of the anatomy that the strabis- insertion. mus surgeon must be familiar with is covered routinely during This chapter will highlight key elements of ocular and or- the normal course of training in an ophthalmology residency bital anatomy that are important for the strabismus surgeon program. This standard training should be considered as an in- to understand. Major structures of anatomical importance in- troduction. The strabismus surgeon needs to understand many volving the eyelids, conjunctiva, Tenon’s fascia, and other or- intricacies of the ocular anatomy as they relate to cause and bital tissues will be reviewed, concluding with an assessment surgical treatment in order to both effectively plan and execute and review of key elements of the ocular and orbital anatomy surgery to correct strabismus.
    [Show full text]
  • The Management of Congenital Malpositions of Eyelids, Eyes and Orbits
    Eye (\988) 2, 207-219 The Management of Congenital Malpositions of Eyelids, Eyes and Orbits S. MORAX AND T. HURBLl Paris Summary Congenital malformations of the eye and its adnexa which are multiple and varied can affect the whole eyeball or any part of it, as well as the orbit, eyelids, lacrimal ducts, extra-ocular muscles and conjunctiva. A classification of these malformations is presented together with the general principles of treatment, age of operating and surgical tactics. The authors give some examples of the anatomo-clinical forms, eyelid malpositions such as entropion, ectropion, ptosis, levator eyelid retraction, medial canthus malposition, congenital eyelid colobomas, and congenital orbital abnormalities (Craniofacial stenosis, orbi­ tal plagiocephalies, hypertelorism, anophthalmos, microphthalmos and cryptophthalmos) . Congenital malformations of the eye and its as echography, CT-scan and NMR, enzymatic adnexa are multiple and varied. They can work-up or genetic studies (Table I). affect the whole eyeball or any part of it, as Surgical treatment when feasible will well as the orbit, eyelids, lacrimal ducts extra­ encounter numerous problems; age will play a ocular muscles and conjunctiva. role, choice of a surgical protocol directly From the anatomical point of view, the fol­ related to the existing complaints, and coop­ lowing can be considered. eration between several surgical teams Position abnormalities (malpositions) of (ophthalmologic, plastic, cranio-maxillo-fac­ one or more elements and formation abnor­ ial and neurosurgical), the ideal being to treat malities (malformations) of the same organs. Some of these abnormalities are limited to Table I The manag ement of cong enital rna/positions one organ and can be subjected to a relatively of eyelid s, eyes and orbits simple and well recognised surgical treat­ Ocular Findings: ment.
    [Show full text]
  • Involutional Lateral Entropion of the Upper Eyelids a New Physical Finding in Asian Patients
    CLINICAL SCIENCES Involutional Lateral Entropion of the Upper Eyelids A New Physical Finding in Asian Patients Jorge G. Camara, MD; Ly T. Nguyen, MD; Marither Sangalang-Chuidian, MD; Jesus N. Ong, MD; Jessica P. Fernandez-Suntay, MD; Ronald B. Zabala, MD; Roderick B. D. Domondon, MD Objective: To describe a new physical finding called in- the lateral aspect of the upper eyelid bilaterally. The pre- volutional lateral entropion (ILE) of the upper eyelid senting symptoms were foreign-body sensation (85%), found in Asian patients. tearing (77%), eye redness (34%), eye pain (26%), and itchiness at the lateral canthal area (25%). Clinical find- Methods: A prospective case series study of 53 con- ings included lateral dermatochalasis (100%), trichiasis secutive patients with ILE of the upper eyelid, from the (100%), lateral canthal eyelid laxity (100%), localized lat- practice of one of the authors (J.G.C.), was performed. eral conjunctivitis (42%), punctate epithelial keratopa- All of the patients in this series were Asian. Clinical find- thy (11%), blepharitis (11%), and distichiasis (8%). ings on ocular examination, symptoms, age, and sex were obtained and tabulated. Conclusion: We describe ILE of the upper eyelid in Asian patients and explain the anatomic correlates respon- Results: The mean±SD age of patients was 68.9±10.1 sible for this condition. years (range, 41-88 years); 70% were women and 30% were men. All patients presented with in-turning of only Arch Ophthalmol. 2002;120:1682-1684 CCORDING TO Dryden and Asian patients as young as in the fifth Doxanas1 and Fox,2 invo- decade of life.
    [Show full text]
  • Infantile Glaucoma in Rubinstein–Taybi Syndrome J Dacosta and J Brookes 1271
    Eye (2012) 26, 1270–1271 & 2012 Macmillan Publishers Limited All rights reserved 0950-222X/12 www.nature.com/eye CASE SERIES Infantile glaucoma J DaCosta and J Brookes in Rubinstein–Taybi syndrome Abstract Taybi syndrome. Nystagmus, enophthalmos, right exotropia, unilateral axial myopia, Purpose Long-term follow-up of patients increased horizontal corneal diameters, and with Rubinstein–Taybi-associated infantile corneal oedema were present. Intraocular glaucoma. pressures were 45 mm Hg on the right and Methods Case series. 28 mm Hg on the left with advanced optic disc Results Three cases of infantile glaucoma in cupping. Bilateral goniotomies were performed association with Rubinstein–Taybi syndrome and this controlled intraocular pressure in are presented. combination with topical treatment. Vision was Discussion This report highlights the 6/96 on the right and 6/19 on the left at the importance of measuring intraocular pressure age of 3 years. in this condition, as glaucoma is one of the major preventable causes of blindness in childhood. Case 3 Eye (2012) 26, 1270–1271; doi:10.1038/eye.2012.123; published online 22 June 2012 A 5-month-old boy with micrognathia and broad thumbs. The left corneal diameter was Keywords: glaucoma; infantile; Rubinstein– increased with corneal oedema. Previously, Taybi syndrome goniotomy had been attempted. Intraocular pressure was not controlled with topical therapy, and Baerveldt tube surgery was Introduction performed. Eighteen months after surgery, intraocular pressure was controlled and Multiple ocular abnormalities have been described in Rubinstein Taybi syndrome. This vision was 6/76 on the right and 6/96 on case series describes long-term follow-up of the left.
    [Show full text]