OBJECTIVE: To investigate effectiveness of transconjunctival lower eyelid blepharoplasty with "super released" orbital fat in correction of lower eyelid pouch protrusion and tear trough and palpebromalar groove depression. METHODS: A clinical data of 82 patients (164 sides) with lower eyelid pouch protrusion and tear trough and palpebromalar groove depression, who met the selection criteria between September 2021 and May 2022, was retrospectively analyzed. Of the included patients, 3 were males and 79 were females, with an average age of 34.5 years (range, 22-46 years). All patients had varying degrees of eyelid pouch protrusion and tear trough and palpebromalar groove depression. The deformities were graded by the Barton grading system as gradeⅠ in 64 sides, grade Ⅱ in 72 sides, and grade Ⅲ in 28 sides. The orbital fat transpositions were performed through the lower eyelid conjunctival approach. The membrane surrounding the orbital fat was completely released, allowing the orbital fat to fully herniate until the herniated orbital fat did not retract significantly in a resting and relaxed state, which is regarded as the "super released" standard. The released fat strip was spread into the anterior zygomatic space and the anterior maxillary space, and percutaneous fixed to the middle face. The suture that penetrates the skin was externally fixed by adhesive tape pasting without knotted. RESULTS: There were 3 sides with chemosis after operation, 1 side with facial skin numbness, 1 side with mild lower eyelid retraction at the early stage after operation, and 5 sides with slight pouch residue. No hematoma, infection, or diplopia occurred. All patients were followed up 4-8 months, with an average of 6.2 months. The eyelid pouch protrusion, tear trough, and palpebromalar groove depression were significantly corrected. At last follow-up, the deformity was graded by Barton grading system as grade 0 in 158 sides and grade Ⅰ in 6 sides, with a significant difference compared to the preoperative score ( P<0.001). Patient's self-evaluation satisfaction reached very satisfied in 67 cases (81.7%), satisfied in 10 cases (12.2%), generally satisfied in 4 cases (4.8%), and dissatisfied in 1 case (1.2%). CONCLUSION The "super released" orbital fat can effectively prevent the retraction of orbital fat, reduce the probability of residual or recurrence of eyelid pouches, and improve the correction effect.
Male ; Female ; Humans ; Adult ; Blepharoplasty ; Retrospective Studies ; Depression ; Eyelids/surgery* ; Face/surgery* ; Adipose Tissue/transplantation*

OBJECTIVE: To summarize the etiology mechanism and treatment of iatrogenic blepharoptosis after double eyelid surgery in Asia. METHODS: To extensively review the literature related to iatrogenic blepharoptosis after double eyelid surgery, and to summarize and analyze the related anatomical mechanism, existing treatment options, and indications. RESULTS: Iatrogenic blepharoptosis is a relatively common complication after double eyelid surgery, sometimes it is combined with other eyelid deformities such as sunken upper eyelid and wide double eyelid, which makes it difficult to repair. The etiology is mainly caused by improper adhesion of tissues and scars, improper removal of upper eyelid tissue, and injury of a link of levator muscle power system. Whether blepharoptosis occurs after double eyelid surgery by incision or suture, it should be repaired by incision. The principles of repair include surgical loosening of tissue adhesion, anatomical reduction, and repair of damaged tissues. The key is to use surrounding tissues or transplanted fat to prevent adhesion. CONCLUSION When repairing iatrogenic blepharoptosis clinically, appropriate surgical methods should be selected based on the causes and severity of the blepharoptosis, combined with treatment principles, in order to achieve better repair results.
Humans ; Blepharoptosis/surgery* ; Treatment Outcome ; Retrospective Studies ; Blepharoplasty/methods* ; Eyelids/surgery* ; Iatrogenic Disease ; Oculomotor Muscles/surgery*

Humans ; Lacrimal Apparatus ; Endoscopy ; Carcinoma ; Eyelids

Objectives: To determine the normative values for upper eyelid and eyebrow dimensions among adult Filipinos and the effects of age and sex on these parameters. Methods: This was a prospective, descriptive study involving 75 Filipino adults who were recruited from a single tertiary government hospital in the Philippines. Profile data collected included age and sex, while clinical data included measurements of the pretarsal skin height (PSH), eyelid crease height (ECH) and eyebrow height (EBH) by a single observer, with the average of an individual’s eyes used as the representative measurement. An intereye correlation coefficient was calculated. The subjects were categorized into 4 age groups (i.e. early, early middle, late middle, and late adulthood) and according to gender for statistical analyses. All measurements were compared across age groups using Analysis of Variance (ANOVA) and between sexes using t-test. Results: This study included 43 males and 32 females. Overall, mean PSH measured was 4.5 ± 1.5 mm; mean ECH was 5.9 ± 1.7 mm, while mean EBH was 10.4 ± 2.7 mm. Means of PSH and EBH showed similar measurements between sexes. The mean ECH of females in early adulthood was significantly higher than the mean ECH of males belonging to the same age group (p=0.01). Among the female group, mean EBH was also observed to increase with age (p=0.02). A high degree of inter-eye correlation was observed (r = 0.94 to 1.00). Conclusion Filipinos have unique upper eyelid and brow features compared to other races. Sex-related differences were not identified in PSH and EBH. While EBH increased with age among female subjects.
Eyelids

PURPOSE: To determine whether eyeliner tattoo affects the meibomian gland (MG) and ocular surface.METHODS: The medical charts of an eyeliner tattoo group (16 eyes of 8 patients) and a control group (16 eyes of 18 patients) were retrospectively reviewed. The ocular surface disease index questionnaire, ocular surface staining score, tear film break-up time (TBUT), upper eyelid abnormality, meibum expressibility and quality, and MG loss and tear film lipid layer thickness (LLT) which measured with LipiView® (TearScience, Morrisville, NC, USA) were compared. In the tattoo group, the correlation between the distance from the MG orifice to the tattoo pigment and other indices were analyzed.RESULTS: Compared to controls, the tattoo group had a significantly higher ocular surface disease index (p = 0.002), shorter TBUT (p < 0.001), higher vessel engorgement of the upper lid (p = 0.016), poorer meibum expressibility and quality (p = 0.006 and p < 0.001, respectively), higher MG loss (p < 0.001), and thinner LLT (p = 0.024). In the tattoo group, the closer the tattoo was to the MG orifice, the more the upper lid vessel was engorged and the more MG loss occurred (r(s) = −0.560, p = 0.024; r(s) = −0.563, p = 0.023, respectively), and a thinner LLT was observed (r(s) = 0.567, p = 0.022).CONCLUSIONS: Eyeliner tattoos may be related to changes in the lid margin, loss of the MG, and thinning of the LLT.
Dry Eye Syndromes ; Eyelids ; Meibomian Glands ; Retrospective Studies ; Tears

Choristoma ; pathology ; surgery ; Dermoid Cyst ; diagnosis ; Diagnosis, Differential ; Dissection ; methods ; Eyelids ; pathology ; Hemangioma ; diagnosis ; Humans ; Infant, Newborn ; Male ; Neuroglia ; pathology ; Orbit ; diagnostic imaging ; Orbital Neoplasms ; diagnosis ; Treatment Outcome ; Ultrasonography ; methods

PURPOSE: We report a case of acute dacryocystitis diagnosed with abscess and rupture of lacrimal sac and fistula to posterior orbit during the operation. CASE SUMMARY: A 71-year-old woman visited our clinic with edema and pain in the eyelid from three days ago. For past four months, there was viscous of the left eye and tears. The patient had severe conjunctival chemosis and hyperemia, compared with the left eyelid edema and redness. Orbital CT scan showed orbital cellulitis, which was followed by systemic antibiotics and steroid therapy. On the 4th day of therapy, orbital abscess formation was observed in orbit MRI and surgical drainage was planned. During surgery, we found rupture of the posterior part of lacrimal sac and fistula to posterior orbit. Pseudomonas aeruginosa was identified in the bacterial cultures, and after the administration of appropriate antibiotics, the disease showed improved progress, and then additional dacryocystorhinostomy was performed. CONCLUSIONS: In our case, acute dacryocystitis rarely spread in orbit, which may lead to delayed diagnosis, orbital cellulitis and abscess, resulting in serious complications of vision threat. So, we think that it is necessary to consider surgical treatment more actively in the stage of chronic dacryocysitis.
Abscess ; Aged ; Anti-Bacterial Agents ; Dacryocystitis ; Dacryocystorhinostomy ; Delayed Diagnosis ; Drainage ; Edema ; Eyelids ; Female ; Fistula ; Humans ; Hyperemia ; Magnetic Resonance Imaging ; Nasolacrimal Duct ; Orbit ; Orbital Cellulitis ; Pseudomonas aeruginosa ; Rupture ; Tears ; Tomography, X-Ray Computed

PURPOSE: Congenital double puncta are usually unilateral, and the accessory punctum exists on the medial side in a slit configuration that is distinct from the shape of the normal punctum. We report a case of an unusual case of double lacrimal puncta which the lateral, rather than the medial, punctum was judged to be the accessory punctum. CASE SUMMARY: A 39-year-old male patient with no underlying disease and no ophthalmologic history visited our clinic with right eye epiphora of 2 weeks duration. On slit lamp examination, double puncta were observed in the right lower eyelid and the remaining puncta were normal. On lacrimal syringing test and dacryocystography were performed and revealed incomplete obstruction with partial narrowing of the nasolacrimal duct. Silicone tube intubation was performed through the right lower medial punctum and symptoms improved postoperatively. CONCLUSIONS: The present case is an unusual case of double lacrimal puncta which has not been reported in Korea. Unlike the previous literature, the lateral, rather than the medial, punctum was judged to be the accessory punctum. Because accessory punctm can be present on the lateral side, it is necessary to distinguish between the accessory punctm and the main punctum through the accurate dacryocystography and lacrimal syringing test for the treatment of the patient.
Adult ; Eyelids ; Humans ; Intubation ; Korea ; Lacrimal Apparatus ; Lacrimal Apparatus Diseases ; Male ; Nasolacrimal Duct ; Silicon ; Silicones ; Slit Lamp

PURPOSE: To report two cases of postoperative endophthalmitis caused by Streptococcus dysgalactiae subspecies equisimilis (SDSE), which appeared as hyperacute presentation and panophthalmitis. CASE SUMMARY: A 68-year-old male was treated with cataract surgery and was evaluated the next day (less than 24 hours after surgery) because of acute loss of vision. There was severe inflammation and the visual acuity was light perception. The patient underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. The vitreous culture revealed SDSE. After PPV, regression of inflammation was observed, although the corneal edema had progressed. The cornea evolved to decompensate due to bullous keratopathy and visual acuity of the eye decreased to no light perception after 3 months. A 87-year-old male who underwent phacoemulsification and intraocular lens implantation 2 days previously was hospitalized due to severe ocular pain and visual loss. There was severe inflammation, and the visual acuity was no light perception. The patient received only intravitreal injections of antibiotics due to severe corneal necrosis. The aqueous humor revealed SDSE. Four days after intravitreal injection, erythema and swelling of the eyelid of the affected eye was observed, and diagnosed as panophthalmitis. After treatment with intravenous antibiotics, cellulitis of the eyelid was resolved. The eye progressed as phthisis after 3 months without recurrence. CONCLUSIONS: Postoperative SDSE endophthalmitis showed aggressive and hyperacute presentation, resulting in blindness despite prompt treatment. SDSE is an emerging organism and should be considered a potential cause of postoperative endophthalmitis.
Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; Aqueous Humor ; Blindness ; Cataract ; Cellulitis ; Cornea ; Corneal Edema ; Endophthalmitis ; Erythema ; Eye Infections ; Eyelids ; Humans ; Inflammation ; Intravitreal Injections ; Lens Implantation, Intraocular ; Male ; Necrosis ; Panophthalmitis ; Phacoemulsification ; Recurrence ; Streptococcus ; Visual Acuity ; Vitrectomy

PURPOSE: To discuss the clinical course and diagnosis of corneal dysplasia in a xeroderma pigmentosum patient based on a genetic evaluation. CASE SUMMARY: A 42-year-old female visited our clinic for decreased left visual acuity and corneal opacity. She had undergone several surgeries previously due to the presence of basosquamous carcinoma in the left lower eyelid, neurofibroma, and malignant melanoma of the facial skin. The patient showed repeated corneal surface problems, with a suspicious dendritic lesion; however, antiviral therapy was ineffective, and herpes simplex virus polymerase chain reaction results were negative. Despite regular follow-ups, the patient showed neovascularization around the corneal limbus and an irregular corneal surface. We performed corneal debridement with autologous serum eye drops for treatment. The patient's visual acuity and corneal surface improved after the procedure. The impression cytology result was corneal dysplasia. In whole exome sequencing, two pathogenic variants and one likely pathogenic variant of the POLH gene were detected. CONCLUSIONS: This is the first genetically identified xeroderma pigmentosum case with ophthalmological lesions of the eyelid and cornea in Korea. Debridement of the irregular corneal surface and autologous serum eye drop administration in xeroderma pigmentosum could be helpful for improving visual acuity.
Adult ; Carcinoma, Basosquamous ; Cornea ; Corneal Opacity ; Debridement ; Diagnosis ; Exome ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Ichthyosis ; Korea ; Limbus Corneae ; Melanoma ; Neurofibroma ; Ophthalmic Solutions ; Polymerase Chain Reaction ; Simplexvirus ; Skin ; Visual Acuity ; Xeroderma Pigmentosum