• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.6
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• pp.430-437
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• 2003

Patient with facial paralysis may develop opthalmic complications. Poor eyelid closure, ectopion and lagophthalmos place the patinet at increased risk for development of corneal problems such as epitheilail defects, stromal thinning, bacterial infection, and even perforation. Inilital treatment should be conservative and include the use of ocular lubricants and taping of the lower eyelid into the proper position. Surgical intervention may be required in patients who have failed medical therapy or in whom the facial paralysis is not expected to improve. Gold weight implantation in upper eyelid and lower lid tightening in lower eyelid has become a popular procedure to correct upper eyelid retraction and lower eyelid laxity and to improve corneal coverage. We describe technique for placement of a gold weight in the upper lid, with attention of the maintenance of symmetric eyelid crease and susture canthopexy to correct malpositioned lower eyelid.

• Journal of Veterinary Clinics
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• v.38 no.1
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• pp.32-35
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• 2021

Three dogs (a 30-month-old spayed female English bulldog; a 12-month-old castrated male English bulldog; a 19-month-old castrated male Shar-pei dog) were presented to the Dana Animal Hospital Eye Center with clinical signs of blepharospasm, epiphora, and ocular discharge (serous to mucopurulent) in one or both eyes. Through ophthalmic examination, the dogs (5 eyes) were diagnosed with trichiasis caused by upper and lower eyelid entropion, including the lateral canthus. To correct upper and lower eyelid entropion, modification using a combination of the Stades forced granulation method for upper eyelid entropion and Hotz-Celsus procedure for lower eyelid entropion was performed in all cases. At the last follow-up, mean 274 days after surgery, clinical signs disappeared and no recurrences of entropion were observed in any of the 3 dogs (5 eyes). Therefore, the combination of the Stades forced granulation method and Hotz-Celsus procedure may be an effective treatment for trichiasis caused by upper and lower eyelid entropion in dogs.

• Archives of Plastic Surgery
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• v.45 no.3
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• pp.222-228
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• 2018

Background The most common surgical treatment for paralytic lagophthalmos is the placement of a weight implant in the upper eyelid; however, this technique confers the risks of implant visibility, implant extrusion, and entropion. In this study, we present a new technique of placing platinum weight implants between the levator aponeurosis and inner septum to decrease such complications. Methods A total of 37 patients with paralytic lagophthalmos were treated between March 2014 and January 2017 with platinum weight placement (mean follow-up, 520.1 days). After dissecting through the orbicularis oculi muscle, the tarsal plate and levator aponeurosis were exposed. The platinum weights (1.0-1.4 g) were fixed to the upper margin of the tarsal plate and placed underneath the orbital septum. Results Five patients could partially close their eye after surgery. The average distance between the upper eyelid and the lower eyelid when the eyes were closed was 1.12 mm. The rest of the patients were able to close their eye completely. Three patients patient developed allergic conjunctivitis after platinum weight insertion, which was managed with medication. None of the patients complained of discomfort in the upper eyelid after surgery. Visibility or extrusion of the implant were observed in three patients. Conclusions Postseptal weight placement is a safe and reproducible method in both primary and secondary upper eyelid surgery for patients with paralytic lagophthalmos. It is a feasible method for preventing implant visibility, implant exposure, and entropion. Moreover, platinum is a better implant material than gold because of its smaller size and greater thinness.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.42 no.6
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• pp.375-378
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• 2016

Human bite injury to the eyelid is extremely rare and poses a significant challenge in surgical reconstruction. We report an extremely rare case of human bite injury to the eyelid in a 43-year-old male with approximately 60% full thickness loss of the upper eyelid and 80% to 90% full thickness loss of the lower eyelid and its successful reconstruction using the local advancement cheek flap.

• Archives of Craniofacial Surgery
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• v.19 no.4
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• pp.248-253
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• 2018

Background: The presence of enophthalmos is an important determinant in the decision of orbital wall fracture surgery. We proposed eyelid drooping as a new anthropometric diagnostic measure and analyzed whether eyelid drooping is associated with enophthalmos. Methods: This retrospective study was performed from January 2014 to December 2016. A total of 75 patients with blowout fractures were studied. One experimenter measured the degree of enophthalmos using a Hertel exophthalmometer at 1 week after trauma and at 3 months after surgery. The height change of the upper eyelid was measured using the marginal reflex distance (MRD) on both sides, and the degree of eyelid drooping was calculated by comparing the two lengths. We analyzed statistically the correlation between enophthalmos and eyelid drooping. Results: We found a highly significant correlation between the degree of enophthalmos and the reduction rate of MRD (RRM, as an indicator of eyelid drooping) at 1 week after trauma (r= 0.845). Approximately 2.0 mm of enophthalmos was associated with a 30.8% reduction in MRD on the affected side as compared with the normal side. At 3 months after surgery, patients showed improved eyelid appearance, with a moderate association between enophthalmos and RRM. Conclusion: We demonstrated that the degree of enophthalmos, measured using an exophthalmometer, is associated with a change in the height of the upper eyelid. Thus, upper eyelid drooping can be used as another indicator for orbital wall fracture surgery. Compared with conventional methods, measurements of eyelid drooping are easy to perform, offering a great advantage and understanding to the patient.

• Archives of Plastic Surgery
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• v.41 no.5
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• pp.576-583
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• 2014

Background Standard upper blepharoplasty involves removal of both the skin and a portion of the underlying orbicularis oculi muscle. The senior author had observed sluggishness of eyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patients during the early postoperative period. He postulated that these findings could be due to orbicularis muscle excision. He therefore undertook a prospective study 27 years ago comparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid. Methods A randomized, prospective, single-blinded study was designed using the fellow eye as an internal control. 22 patients undergoing upper blepharoplasty procedure requiring greater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, or previous eyelid surgery were selected. Upper blepharoplasty was performed with skin-only removal on one side, and combined skin-muscle removal on the other side. Patients were evaluated until six months after surgery except for two patients who were lost to follow-up after three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result were outcome measures scored by patient survey, the operating surgeon, and a blinded expert panel. Results There were comparable aesthetic outcomes in both eyelids. The incidence of sluggish eyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelids where wide segments of muscle had been resected. Conclusions Muscle-sparing upper blepharoplasty produces similar aesthetic outcomes as conventional blepharoplasty, while significantly reducing the complications of sluggish eyelid closure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.471-479
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• 2008

Purpose: Sunken eyelid is a deformity of upper eyelid due to atrophy of periocular fat tissue, loss of skin elasticity. It causes the skin retraction of eyelid and unfavorable fold. Sunken eyelid occurs from the results of natural aging process, facial trauma, complication of previous periocular surgery, etc. We acquired a satisfied correction of sunken eyelid and unfavorable fold using autologous fat injection only. The aim of this study is a assessment of autologous fat injection for correction of sunken eyelid accompanied with unfavorable fold. Methods: From August 2002 to March 2006, we performed 37 cases of correction of sunken eyelid with unfavorable fold using autologous fat injection. They were all females with ages ranged from 23 to 63. Fat was harvested from lower abdomen and centrifuged with Coleman system. Multi-layered injection of purified fat was done from orbital fat layer to orbicularis oculi muscle. Results: Overall, improvement of sunken eye and unfavorable fold was observed in the majority of the patients. Discomfort of eye opening was improved in 24 patients. The average injection volume was 1.33 mL in right eyelid, 1.31 mL in left eyelid at first injection. Second injection was done in patients who absorption of injected fat was noted with. No specific complications were observed. Conclusion: Natural and attractive upper eyelid was acquired from fat injection only in sunken eyelid with unfavorable fold. To the authors' knowledge, it is desirable for sunken eyelid accompanied with unfavorable fold to be treated with autologous fat injection at first. Although some shortcomings are substantial, autologous fat injection is easy and effective method for correction of unfavorable fold in sunken eyelid without specific complication.

• Archives of Craniofacial Surgery
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• v.20 no.1
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• pp.3-9
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• 2019

Facial nerve palsy has an effect on a person's well-being functionally and psychologically. Therefore, comprehensive patient management is essential. One of the most common uncomfortable and potentially debilitating features is associated with the incapacity for eye closure. Restoration of eye closure is a key consideration during the surgical management of facial palsy. In this article, we introduce simple surgical methods-which are relatively easy to learn and involve the upper and lower eyelids-for achieving eye closure. Correcting upper eyelid function involves facilitating the component of eye closure that is in the same direction as gravity and is, therefore, less complicated and favorable outcomes than correction of lower lid. Aesthetic aspects should be considered to correct the asymmetry caused by facial palsy. Lower eyelid function involves a force that opposes gravity for eye closure, which makes correction of lower eyelid ectropion more challenging than surgery for the upper eyelid, particularly in terms of effecting a sustained correction. Initially, proper ophthalmic evaluation is required, including identifying the chronicity and severity of ectropion. Also, it is important to determine whether or not lateral canthoplasty is necessary. The lateral tarsal strip procedure is commonly used for lower lid correction. However, effective lower lid correction can be achieved with better cosmesis when extensive supporting techniques are applied, including those involving cheek tissue.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.449-453
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• 2006

Purpose: Perceiving the experience that $MRD_1$ is increased after small-incision double-eyelid operation, it has been statistically verified the improvement of $MRD_1$ retrospectively. Therefore, we suggest new interpretation for Korean-specific small eye and more definite classification for ptosis. Methods: In operation, we made 3 small incisions according to the line designed on upper eyelid and removed some soft tissues including connective tissues. Then, figure-of-8 continuous buried ligation was performed through the incision windows. This study is a retrospective study, measures $MRD_1$ changes and excursion distance change of eyelid margine and eyebrow using pre-and post-operative photos of 14 patients. Results: Postoperative photos were taken on the 4th day and all of 14 patients had an improvement in $MRD_1$ statistically. The excursion distance of upper eyelid was improved in half of patients, though not in the range of statistical verification. It was statistically confirmed that the movement of eyebrow was reduced after operation. Conclusion: It is thought that $MRD_1$ improvement without any operation on levator complex means that soft tissue including connective tissue eliminated in operation restricts the movement of upper eyelid. It is defined such factors as burden factors and such phenomenon as burdened eyelid. It is thougt that Korean's small eye is mainly burdened eyelid and cosmetic improvement may be obtaind even by removing such burden factors.

• Archives of Craniofacial Surgery
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• v.9 no.2
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• pp.93-96
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• 2008

Purpose: Sudoriferous cyst usually occurs on the face, and especially on the ear and scalp as a solitary cystic mass. It is derived from the sweat glands of Moll and results from the obstruction of excretory ducts with the retention of fluid. In the eyelid, it is usually seen as small and firm vesicle arising at the eyelid margin. If it rarely occurs on the orbit, it develops from orbital ectopic epithelial cells predetermined to form glands of Moll. We experienced a case of sudoriferous cyst on eyelid which was adhered to levator aponeurosis and it disappeared when patient closed eyes. Methods: A 55-year-old women suffered palpable mass on left upper eyelid without pain that had been present for 25 years. Orbital computed tomographic finding showed a oval mass($2.1{\times}0.6{\times}0.6cm$ size) inside upper eyelid and it invaded the orbit. The mass was completely excised under general anesthesia and histopathological examination was followed. Results: Cystic mass was purple color and it was located in superiorly to tarsal plate. The mass was adhered to levator aponeurosis and levator palpabrae superioris muscle between the fat layer of post-orbital septum and the Whitnall ligament. The mass was completely excised without injury of aponeurosis and muscle. Microscopically, the lesion was a solitary cyst lined by two layers of cuboidal epithelial cells and innermost cells displaying eosinophilic cytoplasm with apical expansions. Conclusion: Sudoriferous cyst usually occurs on eyelid margin. But in this case, cystic mass occurred on upper eyelid and disappeared when patient closed the eyes because it was partially adhered to levator aponeurosis and levator palpebrae superioris muscle. Therefore, if sudoriferous cyst occurs on eyelid, it is necessary to excised the mass carefully.