DOCSLIB.ORG

Anterior Lamellar Recession, Blepharoplasty, and Supratarsal Fixation for Cicatricial Upper Eyelid Entropion Without Lagophthalm

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Anterior Lamellar Recession, Blepharoplasty, and Supratarsal Fixation for Cicatricial Upper Eyelid Entropion Without Lagophthalm View metadata, citation and similar papers at core.ac.uk brought to you by CORE Eye (2016) 30, 627–631 provided by eprints Iran University of Medical Sciences © 2016 Macmillan Publishers Limited All rights reserved 0950-222X/16 www.nature.com/eye Anterior lamellar GH Aghai, A Gordiz, KG Falavarjani and CLINICAL STUDY MB Kashkouli recession, blepharoplasty, and supratarsal fixation for cicatricial upper eyelid entropion without lagophthalmos Abstract Purpose To assess the results of anterior Eye (2016) 30, 627–631; doi:10.1038/eye.2016.12; lamellar recession, blepharoplasty, and published online 12 February 2016 supratarsal fixation procedure in patients with upper eyelid cicatricial entropion Introduction without lagophthalmos. Methods In a prospective interventional case Upper eyelid cicatricial entropion (UCE) may series, 52 eyelids (32 patients) were included present as mild (trichiasis), moderate (entropion (April 2009–December 2010). Excluded were without lagophthalmos), or severe (entropion patients with previous eyelid surgeries, with lagophthalmos) form.1 Different type of lagophthalmos, and o12 months procedures has been introduced for different of follow-up. Using a microscope, after severity of UCE. Since there is no single recessing anterior lamella 3–4 mm above procedure for each severity of UCE, type of 2 the eyelid margin, it was fixed with 4–5 procedure should be tailored individually. interrupted 6-0 vicryl sutures. Excess anterior Trichiasis (mild UCE) is mostly treated with lamella was then excised (blepharoplasty), eyelash ablating procedures such as electrolysis supratarsal fixation sutures (6-0 vicryl) were and occasionally block resection of the involved 3 put and the skin was closed with 6-0 nylon section of trichiasis. Presence of lagophthalmos (severe UCE) implies a need for posterior lamellar sutures. Success and failure defined based graft to lengthen the posterior lamella.2 Some Eye Research Center, upon eyelash-globe touch on the last follow- procedures addressing the moderate UCE include Rassoul Akram Hospital, Iran up visit (at least 12 months), respectively. University of Medical anterior lamellar recession, marginal rotation, Results There were 21 females (65.6%) Sciences, Tehran, Iran and tarsal fracture, in which anterior lamellar and 11 males (34.4%) with a mean age of recession with its modifications have shown a 69.7 years (SD = 6.9) and mean follow-up Correspondence: – 4–8 of 21.06 months (SD = 8.26). Success was good success rate of 72 89% in the literature. MB Kashkouli, Opthalmic Plastic and Reconstructive observed in 39 (75%) and failure in 13 (25%). It consists of splitting skin and orbicularis oculi muscle from tarsus and conjunctiva, Surgery Unit, Eye Research Mean time of failure was 4.5 months (SD = 3). Center, Rassoul Akram Although re-treatment with radio-frequency recessing the anterior lamella and leaving Hospital, Iran University of 6,9,10 electrolysis (eight eyelids) and re-anterior the exposed tarsus bare. Although it is an Medical Sciences, Niayesh lamellar recession (two eyelids) resulted effective procedure, the excess anterior lamella ST. Sattarkhan Avenue, and dermatochalasis remains a bulk and may Tehran 14455-364, Iran in success in 12 eyelids with failure, two Tel: +98 21 88090456; patients (three eyelids) declined further slide on the bare tarsus back toward the eyelid Fax: +98 21 66509162. 4 procedure. Except for thickened eyelid margin. Therefore, covering of the bare tarsus E-mail: mkashkouli2@gmail. margin, no complications were observed. (different grafts) and excess skin removal have com Conclusion Anterior lamellar recession, been recommended to prevent downward blepharoplasty, and supratarsal fixation migration of anterior lamella and provide a less Received: 17 July 2015 4–13 fi Accepted in revised form: procedure is an effective and safe technique bulky eyelid. Furthermore, a rm attachment 21 November 2015 for the treatment of the upper eyelid of the anterior lamella at the supratarsal area, to Published online: cicatricial entropion without lagophthalmos. our view, would prevent downward migration 12 February 2016 Anterior lamellar recession for cicatricial entropion GH Aghai et al 628 and consequently recurrence of the upper eyelid medications included oral antibiotic (Cephalexin 500 mg entropion. Therefore, the aim of this study was to assess the QID for 3 days), topical antibiotic (twice a day for 1 week) results of anterior lamellar recession, blepharoplasty, and and steroid (twice a day for 4 weeks) creams on the supratarsal fixation without any graft on the bare tarsus. wound, and artificial tear eye drop (four times daily). They were followed on day 1 (opening the dressing), week 1 (removing the stitches), month 1, and every Subjects and methods 3 months then after up to at least 12 months (success This is a prospective, non-comparative, interventional assessment). They were asked to return to clinic if they case series of all patients with moderate UCE from became symptomatic at any time. April 2009 to December 2010. Patients with a history of During the follow-up period the surgical success and previous eyelid surgeries (except for eyelash electrolysis), complications including lagophthalmos, consecutive palpebral conjunctival keratin plaque, lagophthalmos, ectropion, pyogenic granuloma, infections, tissue and o12 months of follow-up were excluded. necrosis, and eyelid notching were evaluated. A complete eye and eyelid examination was performed. Success and failure were defined as having or not Extent of entropion was defined as segmental if less than having eyelash-corneal touch on the last follow-up half of the eyelid margin was involved and whole length (at least 12 months), respectively. if more than half of eyelid margin was involved. Study Data were entered with SPSS software (version 19, was approved by Iran University Eye Research Center SPSS, IBM Inc., Chicago, IL, USA) and Χ2-test and Ethics Committee and informed consent was obtained independent samples t-test were used for analysis. from all the patients. P-value of less than 0.05 was considered significant. Upper eyelid blepharoplasty marking was made. Results Under general or local anesthesia and using a surgical microscope, an incision was made at the gray line from There were 11 males (34.4%) and 21 females (65.6%) with punctum to lateral canthus. The anterior lamella was a mean age of 69.7 years (SD = 6.9) and mean follow-up dissected up to 5 mm above the upper tarsus; anterior of 21.06 months (SD: 8.26) (Figures 2 and 3, top). Right lamella was recessed to 3–4 mm above the eyelid eyelid was involved in 46.2% (24/52). Total upper eyelid margin and fixed with 4–5 interrupted 6-0 vicryl (Ethicon, entropion was observed in 43 eyelids (43/52, 82.7%). Cincinnati, OH, USA) sutures. Excess anterior lamella Success (Figure 3, bottom) was observed in 39 (75%) was then excised, 3–5 supratarsal fixation sutures (6-0 and failure in 13 eyelids (13/52, 25%), in which eight vicryl) were put and the skin was closed with 6-0 nylon eyelids (8/52, 15.4%) had less than five trichiatic (Ethicon) sutures (Figure 1). eyelashes (Figure 2, middle-left) and the rest had On completion, the eyelid was dressed using topical recurrence of entropion (Figure 2, middle-right). antibiotic and steroid creams for 1 day. Post-operative Mean time of failure was 4.5 months (SD = 3). Figure 1 Schematic drawing of the anterior lamella recession, blepharoplasty, and supratarsal fixation procedure for upper eyelid moderate cicatricial entropion. (a) Before surgery; sagittal view. (b) Splitting the anterior and posterior lamellae. (c) Recession of the anterior lamella and marking excess skin and muscle. (d) Resection of the excess anterior lamella together with blepharoplasty and supratarsal fixation suture. (e) Skin closure. Eye Anterior lamellar recession for cicatricial entropion GH Aghai et al 629 Figure 2 A patient with bilateral moderate UCE. (top) Before anterior lamellar recession, blepharoplasty, and supratarsal fixation procedure on both upper eyelids. (middle-left) Recurrence of trichiatic eyelashes on the right upper eyelid. (middle-right) Recurrence of UCE on the left upper eyelid. (bottom-left) No trichiasis after radio-frequency electrolysis of right upper eyelid. (bottom-right) No entropion after re-surgery of left upper eyelid. Radiofrequency electrolysis (once for five eyelids and Mean age of patients with failure (77.8 years, SD = 1.7) twice for three eyelids) resulted in complete resolution of was significantly (P = 0.008) older than the patients with the trichiasis in eight eyelids with less than five trichiatic success (69.9 years, SD = 6.3). There was, however, no eyelashes (Figure 2, bottom-left). Two patients with significant effect of gender (P = 0.33), involved side failure (three eyelids) declined further surgery and the (P = 0.10) and extent of entropion (P = 0.62) on the success other two eyelids with failure underwent re-anterior rate. No major complications including lagophthalmos, lamellar repositioning procedure with success (Figure 2, consecutive ectropion, pyogenic granuloma, infections, bottom-right) at the final follow-up time (28 and tissue necrosis, eyelash ptosis none, and eyelid notching 34 months). none were observed. Subtle incomplete blinking was not Eye Anterior lamellar recession for cicatricial entropion GH Aghai et al 630 Figure 3 Upper eyelid moderate cicatricial entropion before (top-left and right) and after (bottom-left and right) anterior lamellar recession, blepharoplasty, and supratarsal
Load more

Recommended publications
  • 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]
  • 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]
  • 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]
  • 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]
  • Anatomy of the Periorbital Region Review Article Anatomia Da Região Periorbital
    RevSurgicalV5N3Inglês_RevistaSurgical&CosmeticDermatol 21/01/14 17:54 Página 245 245 Anatomy of the periorbital region Review article Anatomia da região periorbital Authors: Eliandre Costa Palermo1 ABSTRACT A careful study of the anatomy of the orbit is very important for dermatologists, even for those who do not perform major surgical procedures. This is due to the high complexity of the structures involved in the dermatological procedures performed in this region. A 1 Dermatologist Physician, Lato sensu post- detailed knowledge of facial anatomy is what differentiates a qualified professional— graduate diploma in Dermatologic Surgery from the Faculdade de Medician whether in performing minimally invasive procedures (such as botulinum toxin and der- do ABC - Santo André (SP), Brazil mal fillings) or in conducting excisions of skin lesions—thereby avoiding complications and ensuring the best results, both aesthetically and correctively. The present review article focuses on the anatomy of the orbit and palpebral region and on the important structures related to the execution of dermatological procedures. Keywords: eyelids; anatomy; skin. RESU MO Um estudo cuidadoso da anatomia da órbita é muito importante para os dermatologistas, mesmo para os que não realizam grandes procedimentos cirúrgicos, devido à elevada complexidade de estruturas envolvidas nos procedimentos dermatológicos realizados nesta região. O conhecimento detalhado da anatomia facial é o que diferencia o profissional qualificado, seja na realização de procedimentos mini- mamente invasivos, como toxina botulínica e preenchimentos, seja nas exéreses de lesões dermatoló- Correspondence: Dr. Eliandre Costa Palermo gicas, evitando complicações e assegurando os melhores resultados, tanto estéticos quanto corretivos. Av. São Gualter, 615 Trataremos neste artigo da revisão da anatomia da região órbito-palpebral e das estruturas importan- Cep: 05455 000 Alto de Pinheiros—São tes correlacionadas à realização dos procedimentos dermatológicos.
    [Show full text]
  • MR and CT Imaging of the Normal Eyelid and Its Application in Eyelid Tumors
    cancers Article MR and CT Imaging of the Normal Eyelid and its Application in Eyelid Tumors 1, , 2, 3 1,4 Teresa A. Ferreira * y, Carolina F. Pinheiro y , Paulo Saraiva , Myriam G. Jaarsma-Coes , Sjoerd G. Van Duinen 5, Stijn W. Genders 4, Marina Marinkovic 4 and Jan-Willem M. Beenakker 1,4 1 Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; [email protected] (M.G.J.-C.); [email protected] (J.-W.M.B.) 2 Department of Neuroradiology, Centro Hospitalar e Universitario de Lisboa Central, Rua Jose Antonio Serrano, 1150-199 Lisboa, Portugal; [email protected] 3 Department of Radiology, Hospital da Luz, Estrada Nacional 10, km 37, 2900-722 Setubal, Portugal; [email protected] 4 Department of Ophthalmology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; [email protected] (S.W.G.); [email protected] (M.M.) 5 Department of Pathology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; [email protected] * Correspondence: [email protected] Co-first author. y Received: 17 January 2020; Accepted: 24 February 2020; Published: 12 March 2020 Abstract: T-staging of most eyelid malignancies includes the assessment of the integrity of the tarsal plate and orbital septum, which are not clinically accessible. Given the contribution of MRI in the characterization of orbital tumors and establishing their relations to nearby structures, we assessed its value in identifying different eyelid structures in 38 normal eyelids and evaluating tumor extension in three cases of eyelid tumors.
    [Show full text]
  • 1 Conjunctiva
    Dr Parul Ichhpujani Assistant Professor Deptt. Of Ophthalmology, Government Medical College and Hospital, Sector 32, Chandigarh Subdivision of Lectures APPLIED ANATOMY INFLAMMATIONS OF Parts CONJUNCTIVA Structure Infective conjunctivitis Glands – Bacterial SYMPTOMATIC CONDITIONS – Chlamydial Hyperaemia –Viral Chemosis Allergic conjunctivitis Ecchymosis Xerosis Granulomatous conjunctivitis Discoloration DEGENERATIVE CONDITIONS CYSTS AND TUMOURS Pinguecula Pterygium Concretions Conjoin: to join….. has been given to this mucous membrane owing to the fact that it joins the eyeball to the lids. Palpebral conjunctiva Marginal conjunctiva extends from the lid margin to about 2 mm on the back of lid up to a shallow groove, the sulcus subtarsalis. Tarsal conjunctiva is firmly adherent to the whole tarsal plate in the upper lid. In the lower lid, it is adherent only to half width of the tarsus. Orbital part of palpebral conjunctiva lies loose between the tarsal plate and fornix. Bulbar conjunctiva Lies loose over the underlying structures and thus can be moved easily. It is separated from the anterior sclera by episcleral tissue and Tenon's capsule. A 3‐mm ridge of bulbar conjunctiva around the cornea is called limbal conjunctiva. In the area of limbus, the conjunctiva, Tenon's capsule and the episcleral tissue are fused into a dense tissue which is strongly adherent to the underlying corneoscleral junction. At the limbus, the epithelium of conjunctiva becomes continuous with that of cornea Forniceal Conjunctiva: Joins the
    [Show full text]
  • Skin, Orbicularis, Tarsus, and Conjunctiva. the Lower 5 Mm Has 7
    38 ORBIT, EYELIDS, AND OCULAR ADNEXA The upper 5 mm has 4 layers: skin, orbicularis, tarsus, and conjunctiva. The lower 5 mm has 7 layers: skin, orbicularis, septum, pre- CPF (capsulopalpebral fascia) fat, inferior sympathetic mus- cle (equivalent to Mu¨ller’s in the upper lid), CPF (equivalent to levator aponeurosis in upper lid), and conjunctiva. Upper eyelid (Fig. 2–6) (mnemonic: 4-5-7 rule): The lower 5 mm has 4 layers: skin, orbicularis, tarsus, and conjunctiva. The middle 5 mm has 5 layers: skin, orbicularis, levator aponeurosis, tarsus, and conjunctiva. Above 10 mm, the upper eyelid has 7 layers: skin, orbicularis, septum, preaponeurotic fat, levator aponeurosis, Mu¨ller’s muscle, and conjunctiva. Figure 2–6 The upper eyelid and anterior orbit seen in cross-sectional anatomy. Goodman, Ophtho Notes © 2003 Thieme All rights reserved. Usage subject to terms and conditions of license. ANATOMY AND PHYSIOLOGY 39 Vasculature: upper lid supplied by the marginal and peripheral vascular arcades. The lower lid usually has only a peripheral arcade. The peripheral vascular arcade lies along the peripheral border of the tarsus between the lid retractors and Mu¨ller’s (inferior tarsal) muscle. The marginal arcade lies anterior to the tarsus 2 mm above the eyelid margin. In eyelid surgery, visualizing these horizontally running vessels indicates that you are below the level of the aponeurosis. ORBITAL CONNECTIVE AND SUPPORTING TISSUES Most of the orbit is filled with fat. Fat pads: removal of too much fat during surgery may result in sunken orbits, EOM restriction, and cicatricial eyelid changes. Upper lid: two fat pads.
    [Show full text]
  • Aandp1ch08lecture.Pdf
    Chapter 08 Lecture Outline See separate PowerPoint slides for all figures and tables pre- inserted into PowerPoint without notes. Copyright © McGraw-Hill Education. Permission required for reproduction or display. 1 Introduction • Many organs are named for their relationships to nearby bones • Understanding muscle movements also depends on knowledge of skeletal anatomy • Positions, shapes, and processes of bones can serve as landmarks for clinicians 8-2 Overview of the Skeleton Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Frontal bone Parietal bone • Axial skeleton is Occipital bone Skull Maxilla colored beige Mandible Mandible – Forms central Clavicle Clavicle Pectoral girdle Scapula Scapula supporting axis of Sternum body Thoracic Ribs Humerus cage Costal cartilages – Skull, vertebrae, sternum, ribs, Vertebral column sacrum, and hyoid Hip bone Pelvis Sacrum Ulna Coccyx Radius Carpus • Appendicular Metacarpal bones Phalanges skeleton is colored green Femur – Pectoral girdle Patella – Upper extremity Fibula – Pelvic girdle Tibia – Lower extremity Metatarsal bones Tarsus Figure 8.1 Phalanges 8-3 (a) Anterior view (b) Posterior view Bones of the Skeletal System • Number of bones – 206 in typical adult skeleton • Varies with development of sesamoid bones – Bones that form within tendons (e.g., patella) • Varies with presence of sutural (wormian) bones in skull – Extra bones that develop in skull suture lines – 270 bones at birth, but number decreases with fusion 8-4 Anatomical Features of Bones • Bone markings—ridges, spines, bumps, depressions, canals, pores, slits, cavities, and articular surfaces • Ways to study bones – Articulated skeleton: held together by wire and rods, shows spatial relationships between bones – Disarticulated bones: taken apart so their surface features can be studied in detail 8-5 Anatomical Features of Bones 8-6 Anatomical Features of Bones Copyright © The McGraw-Hill Companies, Inc.
    [Show full text]