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Raman Malhotra - One of the best experts on this subject based on the ideXlab platform.
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Upper-Eyelid wick syndrome: association of Upper-Eyelid dermatochalasis and tearing.
Archives of Ophthalmology, 2012Co-Authors: Inbal Avisar, Jonathan H. Norris, Dinesh Selva, Raman MalhotraAbstract:OBJECTIVE: To highlight a case series of patients manifesting epiphora and misdirection of tears laterally or along the Upper-Eyelid skin crease. This association has been termed Upper-Eyelid wick syndrome. We describe the clinical features and outcomes of management of these patients. METHODS: A retrospective review of patients referred to 2 oculoplastic centers during a 6-year period for epiphora, who were considered to have misdirection of tears related in some way to Upper-Eyelid dermatochalasis. RESULTS: Nine patients (7 women and 2 men; mean [SD] age, 61.2 [11.3] years, range, 41-76 years) with bilateral epiphora and lateral spillover (100%), occasionally combined with Upper-Eyelid wetting (n = 2). All patients had Upper-Eyelid dermatochalasis. Five patients had Upper-Eyelid skin obscuring and in contact with the lateral canthus (type 1), and in 4 the lateral canthus was only partially obscured by Upper-Eyelid skin (type 2). Five patients (56%) had linear excoriation of skin in the lateral canthus. All patients underwent Upper-Eyelid blepharoplasty, 3 combined with ptosis repair and 3 combined with eyebrow-lift. All patients achieved 80% to 100% improvement in epiphora following surgical intervention to the Upper Eyelid. The mean (range) follow-up was 2.8 (1-6) years. CONCLUSIONS: We defined Upper-Eyelid wick syndrome as the misdirection of tears laterally or along the Upper-Eyelid skin crease causing epiphora, related in some way to Upper-Eyelid dermatochalasis. In all cases, epiphora improved with treatment of Upper-Eyelid dermatochalasis. Although recognized among physicians, this has never been formally described in the ophthalmic literature, to our knowledge.
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management of Upper Eyelid cicatricial entropion
Clinical and Experimental Ophthalmology, 2011Co-Authors: Adam H Ross, Dinesh Selva, Paul S Cannon, Raman MalhotraAbstract:Purpose: There is a paucity of published data on the management of Upper Eyelid cicatricial entropion. We report on our results using such techniques as lamella repositioning, recession or augmentation and terminal tarsal rotation. Design: Observational retrospective case series. Participants: Consecutive cases of Upper Eyelid cicatricial entropion of two specialist oculoplastic centres (Corneoplastic Unit, East Grinstead, UK and South Australian Institute of Ophthalmology, Adelaide, Australia) were reviewed over a 7-year period. Methods: All patients underwent anterior lamellar repositioning or terminal tarsal rotation. Main Outcome Measures: Success was defined by two definitions: anatomical success was defined where the lid margin was restored to its normal position. Complete success was defined where there were no eyelashes touching the globe. Gain or loss (≤ or ≥2 Snellen lines) in best corrected visual acuity using a Snellen chart and resolution of any corneal epitheliopathy at final follow-up were also recorded (as graded by experienced oculoplastic consultants). Results: Fifty-two procedures were performed on 41 patients (11 bilateral). All patients underwent either an anterior lamellar repositioning or a terminal tarsal rotation. Trachoma, previous Upper lid surgery, Stevens–Johnson syndrome and meibomian gland dysfunction were the commonest underlying diagnoses. Ninety-eight per cent of the group had a normal anatomical lid position at follow-up. Nine Eyelids (17%) of the group had recurrence of trichiasis. Conclusion: This large case series demonstrates that Upper Eyelid cicatricial entropion is managed effectively utilizing procedures that involve recession and reposition. We recommend that excision of tissue is avoided, especially in pathology that has a progressive immunological cicatricial drive.
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Techniques of Upper Eyelid reconstruction.
Survey of ophthalmology, 2010Co-Authors: Ana M. S. Morley, Dinesh Selva, Jean-louis Desousa, Raman MalhotraAbstract:Reconstruction of the Upper Eyelid is one of the greatest challenges facing the orbitofacial surgeon. This comprehensive review outlines the principles of reconstruction and the range of techniques available. Methods of assessing Upper Eyelid defects are discussed, and an algorithm for reconstruction based on defect size and lamellar involvement is given. The review contains numerous detailed examples of reconstructive techniques, including secondary intention healing, local flaps, distal flaps, simple and composite grafts, occlusive and non-occlusive methods, and canthal fixation. Eyebrow and eyelash reconstruction is also covered.
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use of hyaluronic acid gel for Upper Eyelid filling and contouring
Ophthalmic Plastic and Reconstructive Surgery, 2009Co-Authors: Ana M. S. Morley, Raman Malhotra, Mehryar Taban, Robert A. GoldbergAbstract:Purpose: To describe the use of hyaluronic acid gel for Upper Eyelid filling, contouring, and rejuvenation. Methods: In this consecutive, retrospective, interventional case series, standard serial puncture injections with preperiosteal placement of filler were administered at the superior orbital rim. Outcome measures included classification of Upper Eyelid volume deficiency as I) medial A-shaped hollow, II) generalized hollow, III) postblepharoplasty volume loss, and IV) Upper Eyelid hooding with subbrow volume deflation; volume of filler used; masked, independent assessment of pretreatment and posttreatment photographs; patient satisfaction; and complications. Results: Twenty-seven patients were included with a mean follow-up of 13 months. More than 85% were white women with a mean age of 51 years (range, 24‐65 years). Five patients were classified as type I, 8 as type II, 11 as type III, and 3 as type IV. The mean volume of filler used was 0.4 ml/Eyelid (range, 0.1‐1 ml). Photographic assessment showed improved static Upper Eyelid contour in 23 patients (85%), little change in 3 patients (11%), and deterioration in 1 patient (4%). Twentysix patients (96%) were satisfied with the treatment, although 5 (19%) requested additional filler and 1 patient underwent dissolution within 3 months. Two of the 3 type IV patients still required blepharoplasty/ptosis surgery. All patients developed mild bruising and swelling but no discoloration or lumpiness. Conclusions: Hyaluronic acid filler is an effective means of rejuvenating the Upper Eyelid and is particularly successful in patients with medial/generalized Upper Eyelid hollowing, or significant postblepahroplasty Upper Eyelid show. A blepharoplasty/brow lift/ptosis procedure is still frequently required for hooding due to subbrow deflation (type IV). (Ophthal Plast Reconstr Surg 2009;25:000‐000)
Dinesh Selva - One of the best experts on this subject based on the ideXlab platform.
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Upper-Eyelid wick syndrome: association of Upper-Eyelid dermatochalasis and tearing.
Archives of Ophthalmology, 2012Co-Authors: Inbal Avisar, Jonathan H. Norris, Dinesh Selva, Raman MalhotraAbstract:OBJECTIVE: To highlight a case series of patients manifesting epiphora and misdirection of tears laterally or along the Upper-Eyelid skin crease. This association has been termed Upper-Eyelid wick syndrome. We describe the clinical features and outcomes of management of these patients. METHODS: A retrospective review of patients referred to 2 oculoplastic centers during a 6-year period for epiphora, who were considered to have misdirection of tears related in some way to Upper-Eyelid dermatochalasis. RESULTS: Nine patients (7 women and 2 men; mean [SD] age, 61.2 [11.3] years, range, 41-76 years) with bilateral epiphora and lateral spillover (100%), occasionally combined with Upper-Eyelid wetting (n = 2). All patients had Upper-Eyelid dermatochalasis. Five patients had Upper-Eyelid skin obscuring and in contact with the lateral canthus (type 1), and in 4 the lateral canthus was only partially obscured by Upper-Eyelid skin (type 2). Five patients (56%) had linear excoriation of skin in the lateral canthus. All patients underwent Upper-Eyelid blepharoplasty, 3 combined with ptosis repair and 3 combined with eyebrow-lift. All patients achieved 80% to 100% improvement in epiphora following surgical intervention to the Upper Eyelid. The mean (range) follow-up was 2.8 (1-6) years. CONCLUSIONS: We defined Upper-Eyelid wick syndrome as the misdirection of tears laterally or along the Upper-Eyelid skin crease causing epiphora, related in some way to Upper-Eyelid dermatochalasis. In all cases, epiphora improved with treatment of Upper-Eyelid dermatochalasis. Although recognized among physicians, this has never been formally described in the ophthalmic literature, to our knowledge.
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management of Upper Eyelid cicatricial entropion
Clinical and Experimental Ophthalmology, 2011Co-Authors: Adam H Ross, Dinesh Selva, Paul S Cannon, Raman MalhotraAbstract:Purpose: There is a paucity of published data on the management of Upper Eyelid cicatricial entropion. We report on our results using such techniques as lamella repositioning, recession or augmentation and terminal tarsal rotation. Design: Observational retrospective case series. Participants: Consecutive cases of Upper Eyelid cicatricial entropion of two specialist oculoplastic centres (Corneoplastic Unit, East Grinstead, UK and South Australian Institute of Ophthalmology, Adelaide, Australia) were reviewed over a 7-year period. Methods: All patients underwent anterior lamellar repositioning or terminal tarsal rotation. Main Outcome Measures: Success was defined by two definitions: anatomical success was defined where the lid margin was restored to its normal position. Complete success was defined where there were no eyelashes touching the globe. Gain or loss (≤ or ≥2 Snellen lines) in best corrected visual acuity using a Snellen chart and resolution of any corneal epitheliopathy at final follow-up were also recorded (as graded by experienced oculoplastic consultants). Results: Fifty-two procedures were performed on 41 patients (11 bilateral). All patients underwent either an anterior lamellar repositioning or a terminal tarsal rotation. Trachoma, previous Upper lid surgery, Stevens–Johnson syndrome and meibomian gland dysfunction were the commonest underlying diagnoses. Ninety-eight per cent of the group had a normal anatomical lid position at follow-up. Nine Eyelids (17%) of the group had recurrence of trichiasis. Conclusion: This large case series demonstrates that Upper Eyelid cicatricial entropion is managed effectively utilizing procedures that involve recession and reposition. We recommend that excision of tissue is avoided, especially in pathology that has a progressive immunological cicatricial drive.
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Techniques of Upper Eyelid reconstruction.
Survey of ophthalmology, 2010Co-Authors: Ana M. S. Morley, Dinesh Selva, Jean-louis Desousa, Raman MalhotraAbstract:Reconstruction of the Upper Eyelid is one of the greatest challenges facing the orbitofacial surgeon. This comprehensive review outlines the principles of reconstruction and the range of techniques available. Methods of assessing Upper Eyelid defects are discussed, and an algorithm for reconstruction based on defect size and lamellar involvement is given. The review contains numerous detailed examples of reconstructive techniques, including secondary intention healing, local flaps, distal flaps, simple and composite grafts, occlusive and non-occlusive methods, and canthal fixation. Eyebrow and eyelash reconstruction is also covered.
Adam H Ross - One of the best experts on this subject based on the ideXlab platform.
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management of Upper Eyelid cicatricial entropion
Clinical and Experimental Ophthalmology, 2011Co-Authors: Adam H Ross, Dinesh Selva, Paul S Cannon, Raman MalhotraAbstract:Purpose: There is a paucity of published data on the management of Upper Eyelid cicatricial entropion. We report on our results using such techniques as lamella repositioning, recession or augmentation and terminal tarsal rotation. Design: Observational retrospective case series. Participants: Consecutive cases of Upper Eyelid cicatricial entropion of two specialist oculoplastic centres (Corneoplastic Unit, East Grinstead, UK and South Australian Institute of Ophthalmology, Adelaide, Australia) were reviewed over a 7-year period. Methods: All patients underwent anterior lamellar repositioning or terminal tarsal rotation. Main Outcome Measures: Success was defined by two definitions: anatomical success was defined where the lid margin was restored to its normal position. Complete success was defined where there were no eyelashes touching the globe. Gain or loss (≤ or ≥2 Snellen lines) in best corrected visual acuity using a Snellen chart and resolution of any corneal epitheliopathy at final follow-up were also recorded (as graded by experienced oculoplastic consultants). Results: Fifty-two procedures were performed on 41 patients (11 bilateral). All patients underwent either an anterior lamellar repositioning or a terminal tarsal rotation. Trachoma, previous Upper lid surgery, Stevens–Johnson syndrome and meibomian gland dysfunction were the commonest underlying diagnoses. Ninety-eight per cent of the group had a normal anatomical lid position at follow-up. Nine Eyelids (17%) of the group had recurrence of trichiasis. Conclusion: This large case series demonstrates that Upper Eyelid cicatricial entropion is managed effectively utilizing procedures that involve recession and reposition. We recommend that excision of tissue is avoided, especially in pathology that has a progressive immunological cicatricial drive.
Dagmar Ammann-rauch - One of the best experts on this subject based on the ideXlab platform.
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Effect of Upper Eyelid Surgery on Corneal Topography
Archives of Ophthalmology, 2007Co-Authors: Martin S. Zinkernagel, Andreas Ebneter, Dagmar Ammann-rauchAbstract:Objective To compare the effects of different Upper Eyelid procedures on corneal topography. Methods Eighty-two eyes of 43 patients with various degrees of dermatochalasis or ptosis underwent computed corneal topography before surgery and at 3 months after surgery. Patients were divided into groups depending on the extent of surgery. In addition, the thickness of the central cornea was correlated with the change in astigmatism. Results There were mean changes in total astigmatism of 0.25 diopter (D) after ptosis surgery (P = .02) and 0.21 D after blepharoplasty with reduction of large fat pads (P = .04) compared with 0.09 D in patients after skin-only blepharoplasty. In addition, there was a correlation between corneal thickness and change in astigmatism of more than 0.2 cylinders after ptosis surgery (P Conclusions We found a statistically significant correlation between the severity of Upper Eyelid abnormality and topographical corneal changes after surgery. These findings emphasize the importance of advising patients, especially those with ptosis and severe dermatochalasis, that Upper Eyelid repositioning procedures may induce vision changes.
Clinton D. Mccord - One of the best experts on this subject based on the ideXlab platform.
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Upper Eyelid reconstruction.
Plastic and reconstructive surgery, 2004Co-Authors: Lisa M. Difrancesco, Mark A. Codner, Clinton D. MccordAbstract:Learning Objectives: After studying this article, the participant should be able to: 1. Understand Upper Eyelid anatomy and function. 2. Analyze Upper Eyelid defects. 3. Understand an algorithm of Upper Eyelid reconstruction. 4. Have a basic understanding of techniques for Upper Eyelid reconstructio
