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

OBJECTIVE: To evaluate the effect of intense pulsed light (IPL) in the treatment of chronic hordeolum. METHODS: Patients with chronic hordeolum who underwent IPL treatment were enrolled in this study. According to the severity of hordeolum, the patients were treated with IPL 3 to 5 times. Patients' satisfaction and visual analog scale scores for ocular discomfort symptoms before and after treatment were collected. The number, congestion, long diameter, short diameter and area of nodules were also recorded and measured. Finally, eyelid margin signs, meibum quality, meibomian gland expressibility, meibomian gland dropout, tear meniscus height, and corneal fluorescein staining were scored. RESULTS: 20 patients were enrolled in this study. The eyelid margins were congestive and swollen, with blunt rounding or irregularity. The meibum was cloudy or toothpaste-like. The meibomian gland expressibility, meibomian gland dropout and tear meniscus height were reduced. The cornea showed scattered fluorescein staining. After treatment, score of visual analog scale, congestion and size of nodules were significantly reduced. Eyelid margin signs, meibum quality, meibomian gland expressibility, tear meniscus height and corneal fluorescein staining scores were improved. Meibomian gland dropout had no significant change. No side effects occurred during treatment. CONCLUSIONS IPL is beneficial for the treatment of chronic hordeolum.
Humans ; Hordeolum ; Meibomian Glands ; Tears ; Fluoresceins

In order to better assist doctors in the diagnosis of dry eye and improve the ability of ophthalmologists to recognize the condition of meibomian gland, a meibomian gland image segmentation and enhancement method based on Mobile-U-Net network was proposed. Firstly, Mobile-Net is used as the coding part of U-Net for down sampling, and then features are extracted and fused with the features in decoder to guide image segmentation. Secondly, the segmentation of meibomian gland region is enhanced to assist doctors to judge the condition. Thirdly, a large number of meibomian gland images are collected to train and verify the semantic segmentation network, and the clarity evaluation index is used to verify the meibomian gland enhancement effect. The experimental results show that the similarity coefficient of the proposed method is stable at 92.71%, and the image clarity index is better than the similar dry eye detection instruments on the market.
Deep Learning ; Diagnostic Imaging ; Dry Eye Syndromes ; Humans ; Image Processing, Computer-Assisted ; Meibomian Glands/diagnostic imaging*

Dry eye is a common ophthalmic disease caused by eye maladjustment due to meibomian gland dysfunction (MGD), which is often accompanied by symptoms such as increased tear film osmotic pressure and ocular surface inflammation. In the treatment of dry eye patients, dredging gland obstruction caused by meibomian gland secretion is an effective treatment method. Based on electrothermal effect and hyperelasticity of the silicone, an auxiliary treatment instrument for MGD is designed, which can improve the blood circulation of the glands through heat compress and massage to achieve the purpose of dredging the meibomian glands. The therapy device can display the temperature and pressure during the treatment in real time, so that the surgeon can grasp the progress of the treatment in real time. The therapy device constructs a user-oriented interactive interface based on parametric modeling method, which can be customized by 3D printing according to the user's eyeball geometric parameters. The designed therapeutic device was finally tested on New Zealand white rabbits. The experimental results show that the therapeutic device has significant effectiveness and safety, as well as clinical application prospects.
Animals ; Dry Eye Syndromes/therapy* ; Humans ; Meibomian Gland Dysfunction ; Meibomian Glands ; Rabbits ; Tears ; Treatment Outcome

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 evaluate clinical findings in phlyctenular keratoconjunctivitis patients and assess the function and morphology of Meibomian glands using an interferometer (LipiView®, TearScience, Morrisville, NC, USA) in such patients.METHODS: This retrospective study included 19 eyes of 13 patients diagnosed with phlyctenular keratoconjunctivitis. The lipid layer thickness (LLT) and meibograph of each eye was quantified by tear interferometry. Tear film break-up time (TBUT) and corneal staining score were measured. Meibomian gland morphology (lid margin vascularity, plugging of gland orifices, lid margin irregularity, lid margin thickening, and partial glands) was evaluated based on anterior photographs and meibographs.RESULTS: The mean age was 21.3 years (8–44 years). Mean BUT and Oxford corneal staining scores were 2.6 ± 1.2 seconds and 1.9 ± 0.8, respectively. Abnormal findings of the Meibomian glands were observed in all patients. The mean LLT was 79.6 ± 27.4 µm and the incomplete eye blinking frequency was 3.8 ± 5.9 during 20 seconds. The graphs of the tear lipid layer showed various patterns such as flat, up-hill, down-hill, and mixed.CONCLUSIONS: Meibomian gland dysfunctions and changes in the tear film lipid layer were noted in patients with phlyctenular keratoconjunctivitis. These factors are to be considered for the treatment of phlyctenular keratoconjunctivitis in young patients under 10 years of age.
Blinking ; Humans ; Interferometry ; Keratoconjunctivitis ; Meibomian Glands ; Retrospective Studies ; Tears

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

PURPOSE: The Ocular Surface Disease Index (OSDI) and the Standardized Patient Evaluation of Eye Dryness (SPEED) which are standard questionnaires of dry eye syndrome were used to determine the associations between clinical dry eye tests and meibomian gland dysfunctions (MGD).METHODS: Forty-one patients with MGD were enrolled in this study. The score of the dry eye syndrome questionnaire and the degree of blepharitis (score: 0–4), Schirmer test results, degree of fluorescence staining of cornea (Oxford Grading System), tear break-up time (TBUT), Pentacam imaging, and anterior segment optical coherence tomography results were used to compare and analyze the results of each test for possible correlations with the dry eye questionnaire answers.RESULTS: There was a significant correlation between OSDI and SPEED (R = 0.278, p = 0.011). SPEED was correlated with the Oxford grade (R = 0.478, p < 0.001) and MGD grade (R = 0.280, p = 0.011) while there was no significant correlation with corneal aberrations, tear meniscus height, tear meniscus area, Schirmer test results, or TBUT. The OSDI correlated with the MGD grade (R = 0.651, p < 0.001), TBUT (R = −0.360, p = 0.001), and age (R = −0.230, p = 0.037). Using multiple regression analyses, the MGD grade affected the OSDI (β = 0.580, p < 0.001) and the Oxford grade significantly influenced the SPEED (β = 0.447, p < 0.001).CONCLUSIONS: In Koreans, the OSDI questionnaire answers were associated with the MGD grade and SPEED questionnaire answers were associated with the corneal surface status. The OSDI questionnaire was therefore clinically useful in patients with meibomian gland dysfunction.
Blepharitis ; Cornea ; Dry Eye Syndromes ; Fluorescence ; Humans ; Meibomian Glands ; Tears ; Tomography, Optical Coherence