DOCSLIB.ORG

The Surgical Management of Dysthyroid Related Eyelid Retraction Using Mersilene Mesh

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Surgical Management of Dysthyroid Related Eyelid Retraction Using Mersilene Mesh Eye (1989) 3, 385-390 The Surgical Management of Dysthyroid Related Eyelid Retraction Using Mersilene Mesh R. N. DOWNESl and K. JORDAW Cambridge Summary The use of Mersilene mesh as a spacer material in the surgical management of seven patients with dysthyroid-related eyelid retraction is presented. To date, fourteen eyelids have been operated on using this material with an average follow-up of nine months. It appears that Mersilene mesh is a realistic alternative to preserved sclera in the surgical management of such cases. The use of synthetic mesh materials has not In upper eyelid retraction a standard previously been described in the English liter­ anterior approach was performed. 7.8 The leva­ ature in eyelid surgery. The experiences tor-aponeurosis complex was identified and reported by other disciplinesi'6 using Mer­ mobilised with careful attention to complete silene mesh suggest that it may be a valuable division of the lateral horn. The posterior substitute for preserved sclera in the manage­ ment of dysthyroid related lid retraction. Table I Patient details A prospective clinical trial was undertaken { using Mersilene mesh as a lid spacer material 5 Female in cases of upper and lower eyelid retraction 7 patients arising from dysthyroid eye disease. 2 Male Age range 25 yr-52 yr. Materials and Methods Average 41 yr. Seven patients with dysthyroid eye disease All clinically and biochemically euthyroid for at had Mersilene mesh inlay procedures per­ least 6 months at the time of operation. formed (Table I). Surgery was undertaken on a total of fourteen eyelids; four upper and ten Table II Previous ophthalmic surgery lower lids. Previous eye surgery had been per­ formed in five patients (Table II). The 1 Patient - (L) orbital decompression for patients were fully evaluated pre-operatively compressive optic neuropathy - Bilateral inferior rectus recessions with particular emphasis upon superior and inferior scleral show in the primary position of 2 Patients - Bilateral lateral tarsorrhaphies ( ) (3 out of4 opened spontaneously post­ gaze Table III . All patients complained of operatively) ocular discomfort and poor cosmesis. All gave informed consent to the planned surgical 1 Patient - Bilateral levator myotomies procedures. 1 Patient - Upper lid scleral inlay From: iOphthalmic Department, New Addenbrookes Hospital, Cambridge and 20phthalmic Department, Princess of Wales Hospital, RAF Ely, Cambs. Correspondence to: Sqn Ldr R N Downes, Consultant Ophthalmic Surgeon, Princess Mary's Hospital, RAF Halton, Aylesbury, Bucks HP22 5PS 386 R. N. DOWNES AND K. JORDAN Table III Pre-operative measurements (in primary the fornix. The lower lid retractors were position of gaze) divided from the tarsal border exposing the Upper lids suborbicularis plane, and mobilised using Range 4-5 mm superior scleral show blunt dissection inferiorly in this plane. A Average 4.7 mm superior scleral show Mersilene mesh spacer was cut to size using Lower lids dimensions adopted for sclera,s.9 with hori­ Range 2-5 mm inferior scleral show zontal dimensions equal to those of the tarsus Average 3.5 mm inferior scleral show and a vertical height of twice the pre-opera­ tive scleral show. The mesh was sutured inferiorly to the free border of the lower eye­ lid retractors and superiorly to the inferior tarsal border using 6/0 vicryl. The conjunctiva was sutured to the tarsal margin so that the mesh was completely covered, using a con­ tinuous vicryl suture. Full thickness bolster sutures were used in some cases. Two lower lid traction sutures, one medial and one lat­ eral, were taped to the brow for 48-72 hours post-operatively. Lateral andlor medial tar­ sorrhaphies were performed in certain cases. All surgery was performed under general anaesthesia. Fig. 1. Close up photograph of Mersilene mesh spacer, demonstrating mesh configuration. The mesh is cut horizontally in the direction arrowed. Results A significant improvement in eyelid position was achieved in all cases (Table IV). Figures plane of dissection was between the levator 2-5 illustrate two patients. To date, the eyelid complex and Muller's muscle such that the height has been maintained in all patients with latter structure with conjunctiva remained an average follow-up of nine months (range attached to the superior tarsal border. A 5-16 months). All the patients were pleased spacer of Mersilene mesh was fashioned based with the post-operative cosmetic result and upon the measurements widely adopted for the majority reported a marked improvement sclera8.9 i.e. horizontal dimensions equal to in, or abolition of, ocular discomfort. Signifi- those of the tarsus and vertical dimensions twice the amount of pre-operative scleral Table IV Post-operative measurements (in primary show laterally, one and one half times the position of gaze) scleral show centrally and medially. Mersilene mesh has a specific fibre-junction configur­ Upper lids ation. To avoid excessive horizontal laxity the (Total 4) All within 1 mm of the superior limbus mesh is cut as illustrated in Figure 1. The mesh I-significant lateral peaking was sutured to the free inferior border of the Lower lids levator complex superiorly and the superior (Total 10) tarsal border inferiorly using continuous 6/0 Range 0-2 mm inferior scleral show vicryl. Interrupted absorbable sutures were Average 0.6 mm inferior scleral show used to close the skin and reform the skin crease. A central upper lid traction suture was Table V Complications taped to the cheek for 48 hours post­ operatively. 2 Patients - Mesh 'erosion' through conjunctiva In lower eyelid retraction a conventional 1 Patient - Chronic papillary conjunctivitis posterior approach was adopted.7.H The con­ 2 Patients - Localised lid tenderness (both in lower lid) junctiva was incised along the lower tarsal 3 Patients - Intermittent, chronic discharge border and extensively undermined down to DYSTHYROID RELATED EYELID RETRACTION AND MERSILENE MESH 387 Fig. 2. Pre-operative appearance. Fig. 3. Post-operative appearance of patient illus­ trated in Figure 2 fo ur months after insertion of Mer­ silene mesh spacers in all four eyelids. Fig. 4. Pre-operative appearance. Fig. 5. Post-operative appearance of patient illus­ trated in Figure 4 six months after bilateral lower lid Mersilene mesh inlay procedures and left levator com­ plex recession. cant lateral peaking of the upper eyelid similar although asymptomatic area of lower occurred in one patient who had a similar eyelid mesh exposure. The exposed mesh was appearance of the contralateral lid following a excised and covered with conjunctiva in each scleral inlay. Subsequent bilateral upper lid case with no further problems and no effect on explorations were performed with adequate the eyelid position. release of the lateral horns: satisfactory upper eyelid contours resulted. Discussion A number of complications were encoun­ The current management of significant lid tered (Table V) the most troublesome of retraction in dysthyroid eye disease is some­ which was a chronic, unilateral papillary con­ what controversial. 715 Whilst it is generally junctivitis in one patient who had undergone agreed that a lid spacer material is required bilateral lower lid Mersilene inlays. Topical for the correction of 2 mm or more of lower antibiotics and steroids were required with eyelid retraction no such consensus exists gradual resolution of the condition over regarding the management of upper eyelid several months. Three patients noticed retraction. Some authors believe that an localised tenderness of the lids. No cause was upper eyelid can be satisfactorily lowered, found in two cases which resolved spon­ whatever the amount of retraction, with sur­ taneously. The third case demonstrated a gery directed towards recessing and/or weak­ small area of mesh exposure through the con­ ening the levator complex.ll-l3 Others believe junctiva of the upper lid. One patient had a that a lid spacer is required to correct in excess 388 R. N. DOWNES AND K. JORDAN of 3 mm of upper eyelid retraction. 7.8.91. 0.1416. If proven record. Additionally sclera acts, at a lid can be lowered adequately without resort least in the initial post-operative period, as a to the use of foreign materials then so much lid spacer. This feature is felt to be particularly the better but it is our experience that a more important when used in the lower eyelid. Pre­ reliable lid height can be achieved with a served sclera does however have certain dis­ single operative procedure if a spacer material advantages8.911.16. (Table VI) not least of which is used to lengthen the retractor complex. is a variable and unpredictable absorption A variety of materials have been used in the which can result in an unsatisfactory finaleye­ surgical management of eyelid retrac­ lid position. As a result of these disadvantages tion.8.9.11.16 Sclera, fascia, cartilage, tarsus and the use of a synthetic nonabsorbable mesh collagen film have all been employed as lid material, instead of sclera, was considered. spacers. The most popular and widely used is Non absorbable meshes are currently preserved sclera. It is easily implanted, inex­ manufactured using a variety of materials. pensive, usually readily available and has a Polyester mesh appears to have certain advan­ tages which prompted the use of Mersilene mesh in this clinical study. Table VI Preserved sclera Nylon becomes significantly weakened after prolonged implantation and the mesh­ Advantages Widely used; proven 'track record' collagen adhesions are less regular than these Availability found with polyester. 1.17 Metallic meshes Inexpensive and easily implanted create a marked tissue inflammatoryresponse 'Lid stiffener' and the sites of fibre junctions are subject to Disadvantages stress fatigue. Carbon fibre materials frag­ Variable absorption ment after three months or so and produce a Lid bulk/oedema Antigenic response progressive resorption of surrounding col­ Overlying skin changes lagen as a result of inflammationcaused by the Cyst formation fibre breakdown.3 Availability; 24-hour preparation Mersilene mesh is an interlocking polyester H.!.
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]