Calcinosis cutis involves the inappropriate deposition of calcium within the dermis layer of the skin, and is often associated with rheumatoid disease. A 42-year-old woman presented for evaluation of a hard palpable mass on the left upper eyelid. After everting the eyelid, a large papillomatous mass with a broad base was identified on the superior area of the tarsus. The lesion was partially excised posteriorly under local anesthesia, and pathologists identified the mass as calcinosis cutis. The patient had no systemic or trauma history, and the serum levels of calcium and phosphorous were normal. Idiopathic calcinosis cutis should be included in the differential diagnosis for a protruding papillomatous mass of the tarsal plate, and surgical debulking could be a viable option for large protruding lesions, although more follow-up is necessary to monitor regrowth.
Adult ; Calcinosis/*pathology/surgery ; Eyelid Diseases/*pathology/surgery ; Female ; Humans ; Skin Diseases/*pathology/surgery

Essential blepharospasm is an incurable disease for which many treatment modalities fave been tried. The author has performed the Anderson's muscle stripping procrdure involving the meticulous extirpation of all eyelid protractors and reinrorcement or the retractors in three patients with essential blerharospasm withgratifying results.
Adult ; Aged ; Blepharospasm/*surgery ; Eyelid Diseases/*surgery ; Female ; Humans ; Middle Aged ; Oculomotor Muscles/*surgery

OBJECTIVETo evaluate the treatment effect of the two surgical methods for upper eyelid retraction with thyroid associated-ophthalmopathy.

METHODSTwenty-two patients (32 eyes) with inactive thyroid associated-ophthalmopathy were divided into 2 groups (11 for each group) randomly. 11 patients (18 eyes) in the group A were treated by central tenotomy of levator aponeurosis. Another 11 patients (14 eyes) in the group B were treated by lengthening of Mullers' muscle combined with levator muscle. The treatment effect was investigated in 6-month follow-up study.

RESULTSAll of the patients were improved with the two surgical methods, which there was very significant difference before and after the treatments (P < 0.01), but not between the two surgical methods (P > 0.05) by statistical analysis. There was recurrent retracting in 4 patients (6 eyes) of group A and in 1 patient (1 eye) of group B, which there was significant difference between the two groups (P < 0.05) by Chi-square test. None of the patients was overcorrected.

CONCLUSIONSThe two methods are both effective and safe in correcting upper eyelid retraction. The rate of recurrent retracting is lower in lengthening of Mullers' muscle combined with levator muscle than that in central tenotomy of levator aponeurosis.

Blepharoplasty ; methods ; Eyelid Diseases ; etiology ; surgery ; Female ; Graves Ophthalmopathy ; surgery ; Humans ; Male ; Oculomotor Muscles ; surgery

Myiasis is most prevalent in Mexico, central and south America, tropical Africa, and the southwestern United States. Although dermal myiasis is rare in most of the United States, it is a disorder that may be seen in international travelers. In the United States, external myiasis is usually caused by the cattle botfly. We report here a case of ophthalmomyiasis involving the left upper eyelid of a child. We examined a six-year-old boy who presented to the Massachusetts Eye and Ear Infirmary (MEEI) in September 1998. He complained of persistent swelling of his left upper eyelid for the previous ten days. The edema and erythema were unresponsive to warm compresses and oral antibiotics. Ocular examination revealed a mild preseptal cellulitis of the left upper eyelid with a small draining fistula. On slit-lamp examination, we found one larva protruding intermittently from the fistula site. The larva was extracted with forceps, wrapped in a moist towel and sent in a jar to the parasitology laboratory. The specimen was identified as a Cuterebra larva by a parasitologist at the Harvard School of Public Health. One week later, the patient's eyelid edema and erythema had completely resolved.
Animal ; Case Report ; Child ; Diagnosis, Differential ; Diptera* ; Eye Infections, Parasitic*/surgery ; Eye Infections, Parasitic*/parasitology ; Eye Infections, Parasitic*/diagnosis ; Eyelid Diseases/surgery ; Eyelid Diseases/parasitology* ; Eyelid Diseases/diagnosis ; Eyelids/parasitology* ; Human ; Larva ; Male ; Myiasis*/surgery ; Myiasis*/parasitology ; Myiasis*/diagnosis

PURPOSE: To report the outcomes of acquired lower eyelid epiblepharon after various surgeries in thyroid associated ophthalmopathy (TAO) patients. METHODS: A retrospective review of the medical records of 53 TAO patients with acquired lower eyelid epiblepharon between October 1999 and June 2011 was performed. Data were collected on demographics, type of lower eyelid epiblepharon, the detailed surgical history such as orbital decompression, retraction repair, or epiblepharon repair and surgical outcomes including follow-up period, recurrence of epiblepharon, and post-operative complications. RESULTS: Among the 53 TAO patients with acquired lower eyelid epiblepharon, 25 eyes of 17 patients underwent surgical management; 6 eyes of orbital decompression, 1 eye of orbital decompression followed by retraction repair, 2 eyes of orbital decompression followed by epiblepharon repair, 6 eyes of lower eyelid retraction repair, and 10 eyes of epiblepharon repair. Twenty two lower eyelid epiblepharons (88%) were resolved after final surgical treatment without complication during mean 16.2 months (SD, +/-29.9 months) of follow up period; three of 6 epiblepharons that remained after orbital decompression underwent subsequent surgical management of retraction repair or epiblepharon repair, and epiblepharons were well-corrected. Mean amount of lower eyelid retraction was decreased from 1.68 mm (SD, +/-1.17 mm) to 0.29 mm (SD, +/-0.44 mm) after surgery, regardless of the type of surgery (n = 25, p < 0.000, Wilcoxon signed rank test). CONCLUSIONS: Acquired lower eyelid epiblepharon of TAO should be managed sequentially according to the general serial order of surgical managements in TAO; orbital decompression, correction of lower eyelid retraction and epiblepharon repair. Acquired lower eyelid epiblepharon was well resolved after surgical management in consecutive order, especially after repair of the lower eyelid retraction with a graft, or lower eyelid epiblepharon repair. Decreased lower eyelid retraction with a resolution of epiblepharon after surgery implied that lower eyelid retraction was associated with lower eyelid epiblepharon.
Adult ; Decompression, Surgical ; Eyelid Diseases/*surgery ; Female ; Graves Ophthalmopathy/*surgery ; Humans ; Male ; Retrospective Studies ; Statistics, Nonparametric ; Treatment Outcome

OBJECTIVETo explore the effective methods for the correction of lower eyelid retraction at different degree.

METHODS258 patients with lower eyelid retraction were treated in our department since 1999. The lower eyelid retraction could be divided into mild, moderate and severe degree. The lateral canthal anchoring (n = 150), Hamra's lower eyelid blepharoplasty (n = 80) and translid cheek lifting (n = 28) were adopted according to the severity. The therapeutic effect for different degree of lower eyelid retraction was compared.

RESULTS98 patients were followed up for 3-12 months, including 51 patients of mild degree, 29 patients of moderate degree, and 18 patients of severe degree. The retraction were corrected completely in 91 patients. The lower eyelid was repositioned to the level of inferior limbus without inferior scleral show when eyes opened. The palpebral fissure could close completely. The blunt lateral canthus turned to be acute and the scar was inconspicious. The retraction was improved, but not corrected completely in 3 patients of moderate degree and 4 patients of severe degree. The complications included petechiae, chemosis, and so on.

CONCLUSIONSThe lower eyelid retraction can be corrected effectively if the appropriate techniques are performed according to the degree of retraction.

Adult ; Aged ; Blepharoplasty ; methods ; Eyelid Diseases ; surgery ; Eyelids ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo investigate the design and technique of the one stage treatment of eyelid divided nevus with adjacent and distant island skin flap.

METHODSUnder local or general anesthesia, the divided nevus on the upper and lower eyelid were excised totally or partially. According to the location, shape and size of the defect, orbicularis oculi musculocutaneous flap, postauricular SMAS-pedicled flap or reversal superficial temporal artery flap was chosen to repair the defect in one stage. The donor site was closed directly.

RESULTSSince 2003, 16 patients were treated in this group, with 10 orbicularis oculi musculocutaneous flaps, 3 postauricular SMAS-pedicled flaps, and 3 reversal superficial temporal artery flaps. The largest size of the nevus on the upper and lower eyelid were 2.5 cm x 2.0 cm and 4.0 cm x 3.0 cm, respectively. One postauricular SMAS-pedicled flap and 1 reversal superficial temporal artery flap showed distal venous refluence obstruction and epidermal necrosis in early postoperative stage, which healed through dressing. The other flaps survived completely.

CONCLUSIONSTreating eyelid divided defects with adjacent or distant island skin flap is a suitable method with satisfactory result and less morbidity in donor sites.

Adolescent ; Child ; Child, Preschool ; Eyelid Diseases ; surgery ; Female ; Humans ; Male ; Nevus, Pigmented ; surgery ; Skin Transplantation ; Surgical Flaps

PURPOSE: Superior sulcus deformity is the main cosmetic problem in anophthalmic patients. Many methods of correcting enophthalmos have been reported, especially in patients with orbital wall fracture. The purpose of this study is to review the long term results of effectiveness in superior sulcus deformity correction by subperiosteal Medpor (R) sheet implantation in anophthalmic patients. METHODS: Subperiosteal Medpor (R) sheets were used in 11 eyes of 11 anophthalmic patients. To estimate the effectiveness, photographs were taken and exophthalmometric value with their own prosthesis using Hertel exophthalmometer was measured in all patients before and after surgery. RESULTS: The overall cosmetic results in superior sulcus deformity were 'excellent' in 3 (27.3%), 'good' in 6 (54.5%), 'fair' in 2 (18.2%). The overall results in enophthalmos were 'excellent' in 3 (27.2%), 'markedly improved' in 4 (36.4%), 'slightly improved' in 4 (36.4%). Most patients had a marked increase in orbital volume, except two patients. They received irradiation treatment in early childhood so showed unsatisfactory results in both superior sulcus deformity and enophthalmos. CONCLUSIONS: Subperiosteal Medpor (R) sheet implantation is considered to be a reliable and safe procedure without serious complication and with an excellent cosmetic results.
*Surgical Mesh ; Surgery, Plastic ; Retrospective Studies ; *Polyethylene ; Middle Aged ; Male ; Humans ; Female ; Eyelid Diseases/*etiology/*surgery ; Enophthalmos/*etiology/*surgery ; Child ; Anophthalmos/*complications ; Adult ; Adolescent

OBJECTIVETo investigate the ideal methods for correction of lower eyelid retraction following lower eyelid blepharoplasty.

METHODSTranscanthal canthopexy was used in 5 patients (8 eyes) with mild lower eyelid retraction. Transcanthal canthopexy combined with Hamra's lower blepharoplasty was used in 15 patients (27 eyes) with severe lower lid retraction.

RESULTS14 patients (25 eyes) were followed up for 6-12 months. Of them, 13 patients achieved satisfactory results; one patient had undercorrection of retraction.

CONCLUSIONTranscanthal canthopexy is a simple and effective method for correction of mild lower eyelid retraction following lower eyelid blepharoplasty. Transcanthal canthopexy combining Hamra's lower blepharoplasty may be an ideal choice for correction of severe lower eyelid retraction.

Adult ; Blepharoplasty ; adverse effects ; Eyelid Diseases ; etiology ; surgery ; Eyelids ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Surgery, Plastic ; methods ; Treatment Outcome

PURPOSE: To investigate the surgical results of an ear cartilage graft and supplemental procedures for correcting lower lid retraction combined with entropion in anophthalmic patients. METHODS: We reviewed retrospectively the medical records of 7 anophthalmic patients with lower lid retraction and entropion, who received a posterior lamellar ear cartilage graft and one or both of lateral tarsal strip or eyelash-everting procedure between March 1998 and March 2003. Preoperative and postoperative lid and socket statuses were also investigated. RESULTS: Ear cartilage grafts were performed in all 7 patients, lateral tarsal strips in 6, and eyelash-everting procedures in 5. Postoperative follow-up durations ranged from 4 to 28 months (average 12.6 months). Retractions were corrected during follow-up in all patients. There were no cases of entropion immediately after surgery. However, the eyelashes of the lower lid returned to an upright position in 4 patients, but not so severe as to touch the ocular prosthesis, and thus did not require surgical correction during follow up. CONCLUSIONS: Lower lid retraction combined with entropion in anophthalmic patients can be corrected effectively using an ear cartilage graft with selective, supplemental procedures.
Retrospective Studies ; Male ; Humans ; Female ; Eyelid Diseases/*etiology/*surgery ; Entropion/*etiology/*surgery ; Ear Cartilages/*transplantation ; Child, Preschool ; Child ; Anophthalmos/*complications ; Adult