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Miotti G, Quaglia D, De Marco L, Parodi PC, D’Esposito F, Musa M, Tognetto D, Gagliano C, Zeppieri M. Surgical management of patients with corneal lesions due to lid pathologies. World J Clin Cases 2025; 13:101889. [DOI: 10.12998/wjcc.v13.i19.101889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 02/17/2025] [Accepted: 02/27/2025] [Indexed: 03/19/2025] Open
Abstract
BACKGROUND The surgical management of corneal lesions resulting from eyelid pathologies requires a comprehensive approach to ensure optimal patient outcomes. Eyelid lesions, ranging from benign to malignant, can lead to corneal damage through mechanisms such as mechanical abrasion, secondary infection, or inflammatory responses.
AIM To assess the surgical methodologies utilized in the treatment of corneal lesions resulting from eyelid disorders and evaluate their effects on patient outcomes, recurrence rates, and postoperative complications. The incorporation of advanced imaging techniques, including optical coherence tomography and ultrasound biomicroscopy, in conjunction with histopathological analysis, is addressed to improve surgical accuracy and patient outcomes.
METHODS The authors searched online databases (PubMed and Cochrane) for publications on the surgical management of lid lesions. Records received from the two databases were checked for duplicates and relevance. Only records with full texts and in English language were included.
RESULTS A total of 28 records were obtained following the screening for relevancy and duplication. The review underscores essential surgical approaches employed in the treatment of corneal lesions resulting from common eyelid diseases, focusing on operative efficacy, complication rates, and long-term results.
CONCLUSION This systematic review emphasizes the significance of choosing suitable surgical techniques tailored to individual patient characteristics and stresses the need for interdisciplinary collaboration in ophthalmic care. The results indicate that sophisticated imaging techniques and careful preoperative preparation markedly improve surgical accuracy and long-term results.
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Affiliation(s)
- Giovanni Miotti
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
| | - Davide Quaglia
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
| | - Luca De Marco
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
| | - Pier Camillo Parodi
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
| | - Fabiana D’Esposito
- Imperial College Ophthalmic Research Group Unit, Imperial College, London NW1 5QH, United Kingdom
| | - Mutali Musa
- Department of Optometry, University of Benin, Benin 300283, Nigeria
| | - Daniele Tognetto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste 34129, Italy
| | - Caterina Gagliano
- Department of Medicine and Surgery, University of Enna "Kore", Catania 94100, Italy
| | - Marco Zeppieri
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste 34129, Italy
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Miotti G, Quaglia D, De Marco L, Parodi PC, Musa M, D'Esposito F, Tognetto D, Gagliano C, Zeppieri M. Management of Eyelid Pathologies That Cause Corneal Lesions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2025; 1479:117-137. [PMID: 39656369 DOI: 10.1007/5584_2024_837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2025]
Abstract
Corneal injuries, which make up 3% of emergency room visits, can vary from small scratches to exposure or trauma-related damage that might be fatal to vision. Mechanical trauma, diseases of the eyelids, neurotrophic abnormalities, and chemical burns are common causes. A thorough examination is necessary for an accurate diagnosis and treatment plan. The goal of this study is to review corneal damage from both functional and traumatic causes associated with eyelid problems and surgical therapy. Based on a comprehensive analysis of the literature, it focuses on identifying important eyelid diseases that can compromise the integrity of the corneal epithelium, including entropion, ectropion, trichiasis, distichiasis, epiblepharon, and lagophthalmos. To find research on surgical care of eyelid disorders resulting in corneal injury, the MEDLINE and Reference Citation Analysis databases were searched (from 2008 to the present). At least two impartial reviewers examined every article to guarantee that all pertinent articles were found. Relevant publications were found using a literature search. Each pertinent paper's reference list was manually checked to include relevant documents the original search missed. There were 28 papers about surgical management of eyelid abnormalities that could jeopardize the integrity of the corneal epithelium: entropion, ectropion, trichiasis, distichiasis, epiblepharon, and lagophthalmos. Entropion treatment was the subject of the majority of these studies. The review strongly emphasizes determining the precise anatomical source of corneal injury in disorders of the eyelids and customizing surgical techniques accordingly. Cooperation between plastic surgeons and ophthalmologists is crucial to manage complicated situations and guarantee stable, long-term results.
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Affiliation(s)
- Giovanni Miotti
- Department of Plastic Surgery, University Hospital of Udine, Udine, Italy
| | - Davide Quaglia
- Department of Plastic Surgery, University Hospital of Udine, Udine, Italy
| | - Luca De Marco
- Department of Plastic Surgery, University Hospital of Udine, Udine, Italy
| | | | - Mutali Musa
- Department of Optometry, University of Benin, Benin City, Nigeria
| | - Fabiana D'Esposito
- Imperial College Ophthalmic Research Group (ICORG) Unit, Imperial College, London, UK
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Daniele Tognetto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Caterina Gagliano
- Department of Medicine and Surgery, University of Enna "Kore", Piazza dell'Università, Enna, EN, Italy
- Mediterranean Foundation "G.B. Morgagni", Catania, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine, Italy
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Sinha P, Nagano H, Watanabe A, Singh S. Trichiasis in cicatricial ocular surface disease: a multi-center comparison of electroepilation versus eyelash resection outcomes. Orbit 2024; 43:689-694. [PMID: 38796788 DOI: 10.1080/01676830.2024.2355639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the outcomes of trichiasis (excluding entropion) management in non-trachomatous cicatricial ocular surface diseases. METHODS This is a multicenter, retrospective study of 59 patients with trichiasis who were managed using two different techniques: electroepilation using radiofrequency (RF) cautery and eyelash resection. The assessed outcomes were residual trichiasis at 6 weeks, 6, and 12 months of follow-up and the number of procedures needed. RESULTS 41 patients (90 eyelids) underwent electroepilation, and 18 (41 eyelids) were managed with eyelash resection. All patients belonged to either Indian or Japanese ethnicity. Most patients in both groups had Stevens-Johnson Syndrome (63.4% vs. 88.9%). The mean age (43.2 vs. 46 years), disease duration (122 vs. 192.4 months), median trichiasis grade (2 vs. 2), and involvement of upper eyelids (53/90 vs. 23/41) were similar in the two groups. At six weeks, 48.9% of eyelids that underwent electroepilation had no trichiasis, and recurrences were managed with repeat electroepilation (6 eyelids) and mucous membrane grafting (10 eyelids), and 35 eyelids opted for manual epilation, giving 67.8% success at a mean follow-up of 20 months. The eyelash resection group had 75.6% success at 6 months, and recurrences were managed using lid splitting and eyelash resection, resulting in 100% success at a mean follow-up of 79 months. More interventions were needed in the electroepilation group compared to eyelash resection. CONCLUSION Eyelash resection of the trichiatic eyelashes achieves a better success rate than electroepilation in cicatricial ocular surface disorders. Following electroepilation, one needs multiple interventions to resolve trichiasis.
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Affiliation(s)
- Prerna Sinha
- Hariram Motumal Nasta and Renu Hariram Nasta Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, India
| | - Hiromi Nagano
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akihide Watanabe
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Swati Singh
- Hariram Motumal Nasta and Renu Hariram Nasta Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, India
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Suanno G, Genna VG, Maurizi E, Dieh AA, Griffith M, Ferrari G. Cell therapy in the cornea: The emerging role of microenvironment. Prog Retin Eye Res 2024; 102:101275. [PMID: 38797320 DOI: 10.1016/j.preteyeres.2024.101275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Abstract
The cornea is an ideal testing field for cell therapies. Its highly ordered structure, where specific cell populations are sequestered in different layers, together with its accessibility, has allowed the development of the first stem cell-based therapy approved by the European Medicine Agency. Today, different techniques have been proposed for autologous and allogeneic limbal and non-limbal cell transplantation. Cell replacement has also been attempted in cases of endothelial cell decompensation as it occurs in Fuchs dystrophy: injection of cultivated allogeneic endothelial cells is now in advanced phases of clinical development. Recently, stromal substitutes have been developed with excellent integration capability and transparency. Finally, cell-derived products, such as exosomes obtained from different sources, have been investigated for the treatment of severe corneal diseases with encouraging results. Optimization of the success rate of cell therapies obviously requires high-quality cultured cells/products, but the role of the surrounding microenvironment is equally important to allow engraftment of transplanted cells, to preserve their functions and, ultimately, lead to restoration of tissue integrity and transparency of the cornea.
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Affiliation(s)
- Giuseppe Suanno
- Vita-Salute San Raffaele University, Milan, Italy; Eye Repair Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Eleonora Maurizi
- Centre for Regenerative Medicine ''S. Ferrari'', University of Modena and Reggio Emilia, Modena, Italy
| | - Anas Abu Dieh
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada
| | - May Griffith
- Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada.
| | - Giulio Ferrari
- Vita-Salute San Raffaele University, Milan, Italy; Eye Repair Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Singh S, Donthineni PR, Shanbhag SS, Senthil S, Ong HS, Dart JK, Basu S. Drug induced cicatrizing conjunctivitis: A case series with review of etiopathogenesis, diagnosis and management. Ocul Surf 2022; 24:83-92. [PMID: 35247582 DOI: 10.1016/j.jtos.2022.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 12/30/2022]
Abstract
Drug induced cicatrizing conjunctivitis (DICC) is defined as a disease in which conjunctival cicatrization develops as a response to the chronic use of inciting topical and, rarely, systemic medications. DICC accounts for up to one third of cases of pseudopemphigoid, a large group of cicatrizing conjunctival diseases sharing similar clinical features to those of mucous membrane pemphigoid (MMP) but generally without the morbidity of progressive scarring or the need for systemic immunosuppression. The preservatives in topical anti-glaucoma medications (AGM) are the most frequently implicated inciting causes of DICC although topical antivirals, vasoconstrictors and mydriatics and some systemic drugs have been implicated. The literature review summarizes the classification, epidemiology, etiopathogenesis, histopathology, clinical presentation, diagnosis, management, and treatment outcomes of DICC in the context of a case series of 23 patients (42 eyes) with AGM induced DICC, from India and the UK. In this series all subjects reacted to preserved AGM with one exception, who also reacted to non-preserved AGM. At diagnosis >70% of eyes showed punctal scarring, inflammation, and forniceal shortening. Pemphigoid studies were negative in the 19/23 patients in whom they were carried out. DICC can be classified as non-progressive, progressive with positive pemphigoid immunopathology or progressive with negative pemphigoid immunopathology. It is unclear whether progressive DICC is a stand-alone disease, or concurrent (or drug induced) ocular MMP. Progressive cases should currently be treated as ocular MMP. The diagnosis can be made clinically when there is rapid resolution of symptoms and inflammation, usually within 1-16 weeks, after withdrawal of suspected inciting medications, ideally by temporary substitution of oral carbonic anhydrase inhibitors. If the response to withdrawal is uncertain, or the progression of inflammation and scarring continues then patients must be evaluated to exclude concurrent (or drug induced) MMP, and other potential causes of CC, for which the treatment and prognosis is different. Management, in addition to withdrawing inciting medications, may require short-term treatment of conjunctival inflammation with steroids, treatment of associated corneal disease with contact lenses or surface reconstructive surgery, control of intra-ocular pressure with non-preserved AGM and, in some, surgery for glaucoma or for trichiasis and entropion.
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Affiliation(s)
- Swati Singh
- Ophthalmic Plastic Surgery, Orbit and Ocular Oncology Services, L V Prasad Eye Institute, Hyderabad, Telangana, India; Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Swapna S Shanbhag
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sirisha Senthil
- VST Centre for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Hon Shing Ong
- National Institute of Health Research (NIHR), Moorfields Biomedical Research Centre, London, UK; Corneal and External Diseases Department, Singapore National Eye Centre, Singapore
| | - John Kg Dart
- National Institute of Health Research (NIHR), Moorfields Biomedical Research Centre, London, UK
| | - Sayan Basu
- Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India; The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India.
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Diab MM, Allen RC. Recurrent upper eyelid trachomatous entropion repair: long-term efficacy of a five-step approach. Eye (Lond) 2021; 35:2781-2786. [PMID: 33235346 PMCID: PMC8452750 DOI: 10.1038/s41433-020-01306-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/05/2020] [Accepted: 11/06/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To describe the lid characteristics of recurrent upper eyelid trachomatous entropion and to report the long-term outcomes of a five-step surgical approach based on the principles of upper eyelid crease lamellar splitting and retractor release with redirection. SUBJECTS AND METHODS Retrospective case review of adult patients with recurrent upper eyelid trachomatous entropion who had undergone surgical correction using the five-step surgical technique between March 2014 and March 2018. Cases with primary entropion and/or <2 years of follow-up were excluded from this series. MAIN OUTCOME MEASURES Eyelid deformities (type of trichiasis, anterior lamellar laxity, lid margin abnormality, lid retraction and lagophthalmos), recurrence of entropion and trichiasis, cosmetic satisfaction, and surgical complications. RESULTS Forty-two upper eyelids in 33 patients met inclusion criteria. Preoperative anterior lamellar laxity was present in 36 eyelids (85.7%), lid retraction in 31 eyelids (73.8%) with a mean preoperative MRD1 of 6.48 ± 1.1 mm, atrophic tarsus in 28 eyelids (66.7%), lid margin notching in 22 eyelids (52.4%), and lagophthalmos in 15 eyelids (35.7%). The surgical success rate was 92.9% (95% CI 0.805-0.985). There was no documented recurrence of entropion over a mean follow-up period of 31.79 months. Postoperative trichiasis without entropion occurred in three eyelids, which required repeat epilation. CONCLUSIONS The five step-approach based on the principles of lamellar splitting is effective in correction of recurrent trachomatous entropion with long-term stability. The procedure addresses the fundamental changes frequently seen in recurrent cases, in particular anterior lamellar laxity, scarred shortened posterior lamella, and trichiasis.
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Affiliation(s)
- Mostafa M. Diab
- grid.411170.20000 0004 0412 4537Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Richard C. Allen
- grid.39382.330000 0001 2160 926XDepartment of Ophthalmology, Cullen Eye Institute,Baylor College of Medicine, Houston, Texas USA
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Abdelaziz FM, Kamal MA, Said MM, Diab MM. Anterior Lamellar Recession versus Posterior Lamellar Tarsal Rotation for Lower Lid Trachomatous Trichiasis: A Randomized Controlled Trial. Clin Ophthalmol 2020; 14:2043-2050. [PMID: 32801612 PMCID: PMC7383018 DOI: 10.2147/opth.s261783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/01/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose To compare the outcomes of anterior lamellar recession (ALR) versus posterior lamellar tarsal rotation (PLTR) procedure for the repair of lower eyelid trachomatous trichiasis (TT). Design Prospective randomized comparative trial. Methods Study Population and Interventions: Patients with lower eyelid TT were enrolled. Patients with a history of lower lid surgery, marked horizontal lid laxity, another evident cause for the trichiasis, and those under 18 years were excluded. Participants were randomized to either PLTR or ALR. The sequence was computer-generated by an independent statistician, and the allocation sequence was concealed in sealed opaque envelops. Patients were evaluated at 1 week and 1, 3, 6, and 12 months. Main Outcome Measures: postoperative trachomatous trichiasis (PTT) and cosmetic satisfaction. Results A total of 60 patients were randomly assigned with 30 patients in each group. Two (3.3%) participants in PLTR group did not follow up and were excluded from the analysis. At 1, 3, and 6 months, PTT was significantly more frequent in the PLTR group than the ALR group (14.3% vs 0%; p= 0.048, 25% vs 0%; p= 0.004, 35.7% vs 10%; p= 0.019, respectively). In the ALR group, 6 patients (20%) had PTT at their 12-month follow-up visit compared with 15 patients (53.6%) in the PLTR group (P = 0.008) with absolute risk reduction of 33.6% (95% (CI= 9% −58%)). Cosmetic dissatisfaction was significantly more frequent in the ALR group at the initial follow-up visits compared to the PLTR group. However, this difference was no longer significant at 6 and 12 months follow-up. Conclusion These data provide strong evidence that ALR is more effective in correction of lower eyelid trachomatous trichiasis with acceptable cosmesis compared with PLTR.
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Affiliation(s)
- Fatma M Abdelaziz
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Mahmoud Ahmed Kamal
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Mohamed M Said
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Mostafa M Diab
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
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Choung H, Reshef ER, Tanking T, Freitag SK. A conjunctival-sparing surgical technique for lower eyelid cicatricial entropion repair in ocular cicatricial pemphigoid. Orbit 2019; 39:23-30. [PMID: 30732510 DOI: 10.1080/01676830.2019.1573434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To present five cases of lower eyelid cicatricial entropion secondary to ocular cicatricial pemphigoid (OCP) successfully repaired with a conjunctival-sparing surgical technique.Methods: The records of one surgeon (SKF) were reviewed to identify patients with lower eyelid cicatricial entropion secondary to OCP who underwent repair with a conjunctival-sparing technique between September 1, 2016 and October 18, 2017. The medical records were reviewed and extracted data included: age, gender, past medical history, current medical and OCP status, clinical examination, details of entropion repair surgery, and outcome.Results: Five patients (three female, two male) were included with ages ranging from 44 to 93 years. All had biopsy proven OCP, which was in remission at the time of surgery, and all were currently receiving immunomodulatory medications. All patients were symptomatic from cicatricial entropion secondary to OCP and underwent successful lower eyelid entropion repair with a conjunctival-sparing technique described herein, involving infraciliary rotation with suture fixation of the orbicularis muscle to the tarsus. Other contributing mechanisms of eyelid malposition including horizontal eyelid laxity and orbicularis oculi override were addressed simultaneously with lateral tarsal plication or orbicularis muscle debulking, resulting in 100% anatomic success and relief of symptoms with no cases of OCP reactivation, and with good durability with an average 13.9 months follow up (range 6.5-22 months).Conclusions: Successful repair of lower eyelid cicatricial entropion in immunomodulated patients with OCP can be achieved without disease reactivation using a surgical technique that spares the conjunctiva and lower eyelid retractors.
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Affiliation(s)
- Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Edith R Reshef
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Thidarat Tanking
- Ocular Plastic and Reconstructive Service, Department of Ophthalmology, Somdech Phra Pinklao Royal Navy Hospital, Bangkok, Thailand
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Erdoğan M, Karadeniz Uğurlu Ş. Marginal Entropion: A Frequently Overlooked Eyelid Malposition. Turk J Ophthalmol 2016; 45:203-207. [PMID: 27800233 PMCID: PMC5082242 DOI: 10.4274/tjo.20591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 10/28/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To evaluate the clinical findings and outcomes of surgical treatment in patients with marginal entropion. MATERIALS AND METHODS Patients with impairment of the natural square-shaped eyelid margin morphology, anterior migration of mucocutaneous junction and mild lid inversion toward the ocular surface were diagnosed as having marginal entropion. Patients with shortened fornices, cicatricial changes or subconjunctival fibrosis were excluded. Demographic characteristics, ophthalmologic examination findings, surgical procedures and follow-up data were evaluated retrospectively. RESULTS Twelve eyes of 11 patients were included in the study. Median age was 73 years (range, 49-84 years). All cases presented with signs of meibomianitis and were treated preoperatively with oral doxycycline and topical corticosteroids. Tarsal fracture procedure was performed for correction of lid malposition. In all patients, lid malposition was corrected and ocular irritation findings had regressed. No recurrences were observed in the follow-up period of mean 10 months (range, 5-16 months). CONCLUSION Marginal entropion is a common malposition that is frequently misdiagnosed as trichiasis and is overlooked. Complications secondary to misdiagnosis can be avoided and a normal lid position achieved when the correct diagnosis is made.
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Affiliation(s)
- Mustafa Erdoğan
- Gaziemir Nevvar Salih İşgören Government Hospital, Clinic of Ophthalmology, İzmir, Turkey
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Chi M, Kim HJ, Vagefi R, Kersten RC. Modified tarsotomy for the treatment of severe cicatricial entropion. Eye (Lond) 2016; 30:992-7. [PMID: 27101749 DOI: 10.1038/eye.2016.77] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 02/25/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo analyze the efficacy of modified tarsotomy for the management of severe cicatricial entropion.MethodsTwenty-seven eyelids of 18 patients who underwent modified tarsotomy between March 2011 and July 2013 were retrospectively assessed. The data collected included patient demographics, etiology of cicatricial entropion, and surgical history. Outcome measures included surgical success rate, preoperative and postoperative eyelid position, and surgery-related complications.ResultsMean follow-up time was 13.2 months (range, 6-25.4 months), and the success rate was 81.8% (22 of 27 eyelids). Complications included eyelid margin notching (n=1) and blepharoptosis secondary to avascular necrosis of the distal marginal fragment (n=1), both were corrected by minor surgical intervention.ConclusionsThe study findings suggest modified tarsotomy is effective for the correction of severe cicatricial entropion.
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Affiliation(s)
- M Chi
- Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea.,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - H J Kim
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, Permanente Medical Group, Hayward, CA, USA
| | - R Vagefi
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - R C Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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Suzuki Y, Hama Y, Yoshikawa-Kobayashi I, Tomita K, Inoue M, Hirakata A. Eyelash line resection for cilial entropion in patients with Down's syndrome. Br J Ophthalmol 2014; 98:1442-7. [PMID: 24831720 DOI: 10.1136/bjophthalmol-2014-304946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To describe a surgical procedure for excising the eyelash line to treat cilial entropion in patients with Down's syndrome. METHODS 24 Down's patients with cilial entropion and medial epiblepharon underwent eyelash line resection bilaterally. The area and density of fluorescein staining of the superficial punctate keratopathy (SPK; 0=none to 3=wide or severe) and the frequency of spectacle wear (0=no wear to 2=all day wear) were evaluated prospectively. RESULTS The postoperative area and density of the SPK improved significantly in both eyes (p<0.001, p<0.001). The score of spectacle wear was 1.3 ± 0.8 preoperatively which improved significantly to 1.7 ± 0.5 after surgery (p=0.018). Five patients had a partial recurrence of misdirected eyelashes adjacent to the site of the excision. Two patients had extended excisions of the misdirected eyelashes 3 years after the initial surgery, and they did not have any further recurrences. Three other patients were followed without additional treatment because lacrimation and eye discharge were mild even with some eyelashes misdirected toward cornea. CONCLUSIONS Eyelash line resection is a simple and effective technique for cilial entropion and medial epiblepharon in patients with Down's syndrome. The surgery improves the SPK and frequency of spectacle wear. TRIAL REGISTRATION NUMBER NCT01758718.
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Affiliation(s)
- Yumi Suzuki
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Yukiko Hama
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Kaoru Tomita
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Makoto Inoue
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Akito Hirakata
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
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Linear IgA bullous dermatosis: an unusual cause of upper eyelid cicatricial entropion. Ophthalmic Plast Reconstr Surg 2013; 29:e151-4. [PMID: 23446308 DOI: 10.1097/iop.0b013e3182831c6a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic cicatrizing conjunctivitis is a relatively uncommon condition resulting in significant ophthalmic morbidity, including keratoconjunctivitis sicca, cicatricial entropion, trichiasis, corneal scarring, significant discomfort, and visual loss. The potential causes of cicatrizing conjunctivitis are varied and include commonly encountered entities such as ocular cicatricial pemphigoid, Stevens-Johnson syndrome, and trachoma and many more rare causes which are particularly difficult to diagnose and treat and may not be familiar to the ophthalmologist. The authors herein present a case of chronic cicatrizing conjunctivitis, cicatricial entropion, and trichiasis caused by a rare entity called linear IgA bullous dermatosis. The case presentation conforms to the tenets of the Declaration of Helsinki and is Health Insurance Portability and Accountability Act compliant. This chronic dermatosis has a varied presentation, and the ophthalmic manifestations in particular have been infrequently described. This case demonstrates the benefits of immunohistochemistry in diagnosis and the difficulties in medical and surgical management of linear IgA bullous dermatosis while underscoring the lifelong difficulties in managing chronic inflammatory conditions causing ocular cicatrization.
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Han JH, Doh SH. Treatment for trichiasis through a combination of eyelash trephination and electrocautery. Acta Ophthalmol 2012; 90:e211-3. [PMID: 22008226 DOI: 10.1111/j.1755-3768.2011.02266.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE This article introduces 3-mm-deep eyelash trephination combined with electrocautery as a way to increase the success rate for treatment for trichiasis. METHOD We have modified surgical instruments, ready-made ophthalmic microtrephine and cautery tip for a 3-mm-deep eyelash trephination and electrocautery. After eyelash trephination with microtrephine, electrocautery was added with a bended cautery tip after embedding in the trephination site. The trephined eyelids were photographed biweekly and checked for recurrence until 8 weeks after operation. RESULT Eyelash trephination combined with electrocautery was carried out on 20 Korean patients. The number of removed cilia was 109. Of these, the number of successfully removed hair follicles was 89. During 8 weeks, the total recurring rate of eyelash trephination combined with electrocautery was 17%. In the case of hair follicle removal success with electrocautery, the recurring rate was as low as 11%, but in the case of hair follicle removal failure with electrocautery, recurring rate is 45%. We checked the depth of removed eyelash follicles, and the mean depth was 2.03 ± 0.085 mm in this study. No serious complication was found during the period of this study. CONCLUSION The eyelash trephination combined with electrocautery for trichiasis is a method with a low recurrence rate and few complications.
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Affiliation(s)
- Jae-Hyung Han
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Outcomes of lower eyelid cicatricial entropion with grey-line split, retractor recession, lateral-horn lysis, and anterior lamella repositioning. Ophthalmic Plast Reconstr Surg 2012; 28:134-9. [PMID: 22410661 DOI: 10.1097/iop.0b013e3182467c11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report indications and outcomes of a technique for the correction of lower eyelid cicatricial entropion using a lower eyelid gray-line split, inferior retractor recession, lateral-horn lysis, and anterior lamella repositioning. PATIENTS AND METHODS Retrospective, 5-year, single-center, consecutive case series of patients with lower eyelid cicatricial margin entropion undergoing the above procedure. Patients with significant inferior fornix contraction or symblepharon undergoing concurrent fornix reconstruction with buccal mucosal grafts at the same time as lamella repositioning were excluded. Outcomes were assessed based on the review of medical case notes and clinical photographs assessed independently. Success was defined by: 1) improvement in eyelid position and 2) improvement in lower eyelid retraction. RESULTS Twenty-one eyelids of 19 patients (mean age 57.7 ± 22.6 years, range 5-95 years, 8 men and 11 women) were included. The mean follow up was 27.4 ± 16.8 (range 3.2-59.6) months. The causes of cicatricial entropion were as follows: ocular cicatricial pemphigoid (6), Stevens-Johnson syndrome (3), previous eyelid reconstruction (2), socket scarring (2), thermal burn (1), chemical burn (3), postradiotherapy (1), and meibomian gland dysfunction (1). A second procedure was carried out in 38% (8/21) of eyelids within 1 year. Within 3 years, 10% (2/21) and 5% (1/21) of eyelids required a third and fourth procedure, respectively. The most common lower eyelid revision procedures included anterior lamellar repositioning. Other procedures required included buccal mucous membrane grafts, everting sutures, and lateral tarsorrhaphy. Three patients with loss of >50% inferior fornix depth were included. Two had previously undergone mucosal grafts and 2 required subsequent mucosal grafts. Overall, 90% (19/21) of eyelids eventually achieved improvement in lower eyelid position following repeat surgery, including mucosal grafts in 3 eyelids. Mid-pupil lower eyelid elevation was 1 mm in 6 of 19 (32%) patients and lower eyelid lateral retraction significantly improved in 9 of 19 (47%) patients. CONCLUSION Based on the principles of lamella repositioning and posterior middle lamella release with formal retractor recession through a gray-line incision, this technique is of value as a lash-preserving procedure in moderate-to-severe cicatricial lower eyelid entropion, particularly where tarsoconjuctival contraction or eyelid margin distortion exists.
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Jung H, Elwood R. Pediatric ophthalmologic infectious diseases in the developing world. Int Ophthalmol Clin 2010; 50:149-162. [PMID: 20930589 DOI: 10.1097/iio.0b013e3181f1302f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Hoon Jung
- Ophthalmology Clinic, 301 Fisher Street, Keesler AFB, MS 39534, USA
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