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Lower Eyelid (lower + eyelid)

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Medical Sciences	85%

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Selected Abstracts

Treatment of Idiopathic Cutaneous Hyperchromia of the Orbital Region (ICHOR) with Intense Pulsed Light

DERMATOLOGIC SURGERY, Issue 6 2006
NATALIA CYMROT CYMBALISTA MD
BACKGROUND Idiopathic cutaneous hyperchromia of the orbital region (ICHOR) does not have a clear etiopathogenesis. Genetic factors, increased melanin, prominent vasculature, and eyelid skin slackness seem to be involved. OBJECTIVE To evaluate individuals with ICHOR clinically and histologically, before and after treatment with high-energy pulsed light (HEPL), considering epidermal and dermal melanin, in order to evaluate HEPL efficacy in clearing away ICHOR, and 1 month and 1 year later to check whether improvement was maintained. METHODS Twelve individuals with ICHOR underwent clinical and histological evaluation before and after HEPL application, with photographic comparison. They underwent one to four HEPL sessions on the lower eyelid at approximately 30-day intervals. Melanin quantification by area, before and after treatment was performed by digital image morphometry. RESULTS Eyelid skin was significantly lightened (p=.24), and was maintained 1 year later with no ICHOR reincidence. All individuals (100%) showed postinflammatory hyperchromia (average 6-month duration), while 58.33% presented hypochromia (7-month duration). There was significantly decreased epidermal and dermal melanin after treatment. CONCLUSION HEPL was shown to be useful in clearing up ICHOR. This was maintained after 1 year. Epidermal and dermal histopathology showed decreased melanin following treatment. Longer follow-up is needed to evaluate possible later recurrence of ICHOR. [source]

Eccrine Porocarcinoma of the Eyelid Treated With Mohs Micrographic Surgery

DERMATOLOGIC SURGERY, Issue 4 2004
Renee A. D'Ambrosia BS
Background. Eccrine porocarcinoma (EPC) is a rare malignant tumor of the eccrine sweat glands. The lesions are reported to occur most commonly on the lower extremity with variable prognosis. Objective. To discuss the clinical and histologic features and the prognosis of EPC. Methods. We report a 71-year-old man who presented with an asymptomatic lesion on his lower eyelid that had been present for 6 weeks. Results. The 4×4-mm lesion was removed in two stages using the Mohs micrographic surgery fresh-tissue technique. The histopathologic diagnosis was primary EPC. Conclusion. EPCs most commonly occur on the lower extremity. This case is interesting because the lesion was located on the lower eyelid. [source]

Retinal Evaluation After 810 nm Dioderm Laser Removal of Eyelashes

DERMATOLOGIC SURGERY, Issue 9 2002
Randal T. H. Pham MD
background. When operating hair removal lasers on the face or in the periorbital region, even with an ocular shield in place, patients often report seeing "flashing lights" each time the laser is fired. This phenomenon suggests stimulation of retinal photoreceptors and raises laser safety issues. objective. To perform retinal electrophysiologic studies to evaluate the safety of hair removal lasers in the periorbital region. methods. Five patients with severe trichiasis secondary to trachoma were studied. The 810 nm Dioderm laser (Cynosure, Inc., Chelmsford, MA) was used to treat the eyelash follicles on the lower eyelid of each patient. Cox III metal eye shields (Oculo-Plastik, Inc., Montreal, Canada) were placed behind the eyelids of both eyes during the laser procedure. Prior to irradiation, a comprehensive ophthalmic evaluation including pupillary and slit-lamp examination, funduscopy, and full-field electroretinograms (ERGs) was performed. A comprehensive ophthalmic evaluation including ERG testing was repeated 30 minutes and 3,6 months after completion of treatment. An independent blinded assessor evaluated the ERG studies. Subjective reports of laser light sensation, pain, and discomfort during and after the laser procedure were also assessed. results. There was no detectable change in slit-lamp, pupillary, or funduscopic evaluations after periorbital laser irradiation. Similarly the pre- and posttreatment ERGs were unchanged. Three patients reported seeing flashing lights during the procedure. conclusion. We found no ERG evidence of retinal damage after laser hair removal in the periorbital region, with Cox III-type ocular shields over the eyes, even when patients subjectively reported "flashing lights" during laser irradiation. [source]

Botulinum-A Toxin Treatment of the Lower Eyelid Improves Infraorbital Rhytides and Widens the Eye

DERMATOLOGIC SURGERY, Issue 8 2001
Timothy Corcoran Flynn MD
Botulinum-A exotoxin (BTX-A) can be used cosmetically to improve rhytides, particularly of the upper one-third of the face. In this study, fifteen women had BTX-A (BOTOX, Allergan, Inc.) injected into the orbicularis oculi muscle. One lower eyelid received two units just subdermally in the midpupillary line three millimeters below the ciliary margin. The opposite periocular area received two units BTX-A in the lower eyelid with 12 units BTX-A injected into the lateral orbital ("crow's foot") area. Three injections of four units each were placed 1.5 cm from the lateral canthus, each 1 cm apart. Patients and physicians independently evaluated the degree of improvement (grade 0 = no improvement, grade 1 = mild improvement, grade 2 = moderate improvement, and grade 3 = dramatic improvement). An independent photographic analysis was performed. Patients reported a grade of 0.73 when two units were injected alone into the lower lid, and a grade of 1.9 when the lower eyelid and the lateral orbital areas were injected. Physician assessment was grade 0.7 with injection of the eyelid alone and grade 1.8 with injection of the lower eyelid and lateral orbital area. Single investigator photographic analysis demonstrated that 40% of the subjects who had injection of the lower eyelid alone had an increased palpebral aperture (IPA), while 86% of the subjects who had injection of the lower eyelid and lateral orbital area had an IPA. Subjects receiving two units alone had an average 0.5 mm IPA and a mean 1.3 mm IPA at full smile. Concomitant treatment of the lateral orbital area produced a mean 1.8 mm IPA at rest and a mean 2.9 mm IPA at full smile. The results were more notable in the Asian eye. Two units of BTX-A injected into the lower eyelid orbicularis oculi muscle improves infraorbital wrinkles, particularly when used in combination with BTX-A treatment of the lateral orbital area. [source]

Peribulbar blockade with a short needle for phacoemulsification surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009
W. RIAD
Background: Peribulbar blockade is still widely used for phacoemulsification surgery. The potential complications of this technique include central spread, globe perforation and retrobulbar hemorrhage. The 25 mm needle is the most common needle used to perform the block. The aim of this study was to demonstrate the efficacy of a 12.5 mm needle in performing peribulbar blockade for phacoemulsification surgery. Methods: After obtaining the hospital research and the Human Ethics Committees' approval, 200 patients undergoing the phacoemulsification procedure under local anesthesia were enrolled in this descriptive study. Peribulbar blockade was performed with a 27 G, 12.5-mm-long needle. The needle was inserted transcutaneously through the lower eyelid into the inferotemporal quadrant. Digital pressure was applied by the thumb and index fingers around the needle hub during injection. After negative aspiration, a local anesthetic solution was injected until total drop of the upper eyelid was achieved. Ocular akinesia was assessed 10 min after the block using the simple akinesia score. A score of 3 or less was accepted to provide adequate analgesia for the surgical procedure to be performed. If the block was inadequate for surgery after 10 min, supplementary anesthesia was provided using the same needle. Results: Adequate analgesia after the first injection was reported in 90.5% of the patients while 9.5% required supplementary anesthesia. There were no major sight or life-threatening complications. Conclusion: Using a 12.5-mm-long needle for peribulbar blockade produced satisfactory results. This technique is effective for phacoemulsification surgery. [source]

Tripier myocutaneous flap as a versatile technique to reconstruct the lower eyelid

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 10 2008
F Trindade
[source]

Complications of fractional CO2 laser resurfacing: Four cases

LASERS IN SURGERY AND MEDICINE, Issue 3 2009
Douglas J. Fife MD
Abstract Background and Objective Fractional ablative laser therapy is a new modality which will likely be widely used due to its efficacy and limited side-effect profile. It is critical to recognize, characterize, and report complications in order to acknowledge the limits of therapeutic efficacy and to improve the safety of these devices. Study Design/Materials and Methods The photographs, treatment parameters, and clinical files of four female patients aged 54,67 who had scarring or ectropion after fractional CO2 laser resurfacing on the face or neck were carefully reviewed to search for any possible linking factors. Results Patient 1 developed erosions and swelling of the right lower eyelid 2 days postoperatively, which developed into scarring and an ectropion. Patient 2 developed linear erosions and beefy red swelling on the right side of the neck which developed into a tender, band-like scar over 1-month. Patient 3 developed stinging and yellow exudate in multiple areas of the neck 3 days postoperatively. Cultures grew methicillin-resistant Staphylococcus aureus. Despite appropriate treatment, she developed multiple areas of irregular texture and linear streaking which developed into scars. Patient 4 developed an asymptomatic patchy, soft eschar with yellowish change on the left side of the neck. Azithromycin was started, however at 2-week follow-up she had fibrotic streaking which developed into horizontal scars and a vertical platysmal band. The treatment and final outcome of each patient are described. Conclusion Scarring after fractional CO2 laser therapy may be due to overly aggressive treatments in sensitive areas (including excessive energy, density, or both), lack of technical finesse, associated infection, or idiopathic. Care should be taken when treating sensitive areas such as the eyelids, upper neck, and especially the lower neck and chest by using lower energy and density. Postoperative infections may lead to scarring and may be prevented by careful taking of history, vigilant postoperative monitoring and/or prophylactic antibiotics. Lasers Surg. Med. 41:179,184, 2009. © 2009 Wiley-Liss, Inc. [source]

A case of discoid lupus erythematosus of the eyelid

THE JOURNAL OF DERMATOLOGY, Issue 5 2006
Monji KOGA
ABSTRACT A 39-year-old man was first evaluated 12 years ago for erosive erythema of the left lower eyelid. The response to topical therapy was poor. The eyelid lesion was excised on the patient's demand 6 years ago and blepharoplasty was performed. However, recurrence of erythematous plaques at the same site prompted referral to our department. Examination clinically revealed atrophic erythematous plaques and several white papules on the left lower eyelid, in addition to an atrophic erythema of the upper back. The histopathological findings of both plaques and papules were typical of discoid lupus erythematosus. Immunoserological findings suggestive of systemic lupus erythematosus were absent. The lesions improved with administration of low-dose corticosteroids. Discoid lupus erythematosus involving the eyelid is rare, and definitive diagnosis often takes considerable period of time. In patients with lesions of the eyelid such as erythema or papules that are refractory to treatment, skin biopsy and careful physical examination of the entire body for similar lesions are important. [source]

Sporotrichoid Mycobacterium marinum infection of the face following a cat scratch

AUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2010
Tai Anh Phan
ABSTRACT Mycobacterium marinum infections in humans uncommonly affect the face and are not known to be associated with cat scratches. We describe a 24-year-old woman who presented with a 3-month history of multiple tender, occasionally discharging cystic nodules involving the left side of her face in a sporotrichoid distribution. She had suffered a cat scratch to her left lower eyelid 3 weeks before the onset of the eruption and owned multiple tropical fish tanks. She was systemically well and had no lymphadenopathy. She had a background history of a 4.5-mm-thick nodular melanoma of her temple treated by wide local excision and negative sentinel lymph node biopsy 4 years prior. Skin biopsies showed multiple variably sized granulomas surrounded by thick cuffs of lymphocytes involving the superficial and deep dermis with no organisms seen on Ziehl,Neelsen, peroidic acid-Schiff and methenamine silver stains. Laboratory investigations showed a mildly raised erythrocyte sedimentation rate but normal full blood count and C-reactive protein. Fluid from the left cheek grew an acid-fast bacillus identified as Mycobacterium marinum. The skin eruption cleared after 5-month treatment with oral clarithromycin 500 mg twice daily and rifampicin 600 mg daily. [source]

Primary cutaneous mucinous carcinoma: Report of two cases treated with Mohs' micrographic surgery

AUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 3 2006
Roberto Cecchi
SUMMARY We present a 72-year-old woman who presented with a slowly enlarging, asymptomatic, cystic nodule on the right eyebrow, and a 66-year-old woman who had a reddish, nodular lesion on the left lower eyelid. Incisional biopsy from the two neoplasms showed dermal epithelial cell islands embedded in mucin pools. Tumour cells stained positive for cytokeratin 7, oestrogen and progesterone receptors, and negative for vimentin and S-100 protein. These findings were consistent with a diagnosis of mucinous carcinoma. Extensive work-ups excluded cutaneous metastases from primary visceral mucinous carcinomas. To ensure complete tumour removal, both patients underwent Mohs' micrographic surgery (standard fresh-frozen technique). They remain disease-free 42 and 26 months after surgical excision, respectively. Mohs' micrographic surgery appears to be a rational and effective treatment for this uncommon malignancy. [source]

The application of temperature measurement of the eyes by digital infrared thermal imaging as a prognostic factor of methylprednisolone pulse therapy for Graves' ophthalmopathy

ACTA OPHTHALMOLOGICA, Issue 5 2010
Shyang-Rong Shih
Abstract. Purpose:, Graves' ophthalmopathy (GO) involves autoimmune process resulting in proptosis, congestion, oedema and diplopia. Werner's NOSPECS classification and clinical activity score (CAS) of GO cannot objectively describe the inflammatory status. Digital infrared thermal imaging (DITI) detects local temperature and may reflect the degree of orbital inflammation. The aim of this study was to evaluate the clinical application of the eye temperature measured by DITI. Methods:, Forty-six patients with GO receiving intravenously methylprednisolone pulse therapy (MPT) were included in this study. Local temperatures of the lateral orbit, upper eyelid, inner caruncle, medial conjunctiva, lateral conjunctiva, lower eyelid and cornea were measured with DITI before and after MPT. CAS, proptosis, eye movement (EOM) and diplopia were also recorded. Improvement of CAS was defined as at least one point decrease at either side of the eye, which was 0.5 score decrease as to the average of bilateral CAS. Results:, Local temperatures of the eyes decreased after MPT. The mean value of temperature (MT) of 12 points including the lateral orbit, upper eyelid, inner caruncle, medial conjunctiva, lateral conjunctiva and lower eyelid of both eyes before MPT was 32.65°. The mean change of MT after MPT (,T) was ,0.22°. ,T significantly negative-correlated with basal MT (correlation coefficient = ,0.54, p = 0.004). Higher baseline MT and CAS before MPT correlated with higher possibility of improvement of CAS after MPT (p = 0.013 and 0.012, respectively). Baseline MT and CAS together correlated with improvement of CAS after MPT better than baseline CAS alone could do (area under the receiver operating characteristic curve: 82.81% and 66.63%, respectively). Conclusions:, Basal temperature of the eyes measured by DITI was an objective indicator of inflammation of GO. Combining CAS and MT could better predict the outcome of MPT than CAS alone. [source]

Multifocal haemangioma with extracutaneous involvement associated with hypergalactosaemia

CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 8 2009
Y. Uchida
Summary Neonatal haemangiomatosis, characterized by multiple haemangiomas, is a rare disease that develops during the neonatal period with or without visceral involvement. We report a 1-month-old Japanese boy with multifocal haemangiomas with extracutaneous involvement. A haemangioma on his left lower eyelid, present at birth, increased in size during the first postnatal month and more lesions developed during the same period. Neonatal mass screening showed hypergalactosaemia. Laboratory investigations found raised total bile acid and ammonia. Computed tomography and abdominal ultrasonography studies showed multiple hepatic haemangiomas and intrahepatic portovenous shunts. The child's cutaneous and hepatic haemangiomas disappeared spontaneously with normalization of laboratory data, and galactose accumulation improved with the feeding of lactose-free milk. There were no complications and the child has had no recurrence of the symptoms. Our case implies a possible association of multiple haemangioma and hypergalactosaemia, suggesting the necessity for visceral investigation. [source]

Pretarsal fat compartment in the lower eyelid

CLINICAL ANATOMY, Issue 3 2001
Kun Hwang
Abstract It is generally accepted that there are three infraorbital fat regions in the lower eyelid; medial, central, and lateral compartments. However, removing only the fat in the lateral compartment does not remove the bulge just below the eyelashes, which is caused by another fat pad. The aim of this study was to describe the anatomy of the pretarsal fat compartment and to demonstrate its clinical implications in lower lid blepharoplasty. Ten cadavers (total 20 lower eyelids) were studied. A skin-muscle flap was reflected to expose the soft pretarsal structures. A small stab incision was made on the lateral portion of the sac containing fat on the tarsus. Methylene blue dye was injected into the sac. Specimens were fixed and sagittal sections in four different planes were prepared for histological analysis. The injected dye remained within the sac and demarcated it as a pear or cone shaped structure. This encapsulated fat compartment sits on the lateral half of the tarsal plate above the lateral compartment fat. Auxillary or submuscular fat is well known. This study, however, designates the pretarsal fat as "encapsulated" in a compartment instead of being unbound. We have named it the "pretarsal fat compartment." Histologically, orbital septal fibers separate "pretarsal fat" from lateral infraorbital fat. It is recommended that fat in the pretarsal fat compartment be removed during lower lid blepharoplasty in order to alleviate the bulge or knoll of the skin just below the lower eyelashes. Clin. Anat. 14:179,183, 2001. © 2001 Wiley-Liss, Inc. [source]

Eyelid Tightening and Improved Eyelid Aperture through Nonablative Fractional Resurfacing

DERMATOLOGIC SURGERY, Issue 11 2008
SEAN A. SUKAL MD
BACKGROUND AND OBJECTIVE The effects of fractional resurfacing on eyelid tightening and aperture are unknown. Our purpose was to retrospectively examine the potential for eyelid tightening and eye-aperture opening in patients treated with nonablative fractional resurfacing for facial photorejuvenation. STUDY DESIGN/MATERIALS AND METHODS Fractional laser treatments using a 1,550-nm erbium-doped fiber laser system on the upper and lower eyelids were given at a pulse energy of 17 to 20 mJ at 125 micro-thermal zones (MTZ)/cm2 to a final density of 500 to 750 MTZ/cm2. Each patient had 3 to 7 treatments. Standard pre- and post-treatment photographs were taken at each visit. Physicians who graded 31 preselected patient photographs using a 4-point scale evaluated eyelid tightening. Increase in eyelid aperture was also evaluated. RESULTS All patients had some degree of eyelid tightening; 19% achieved 1% to 25% tightening, 26% achieved 25% to 50%, 26% achieved 50% to 75%, and 29% achieved 75% to 100%. Increase in eyelid aperture was seen in 55.9% of patients. Postoperative wounding, hypopigmentation, hyperpigmentation, persistent erythema, and scarring were not observed. All patients experienced mild or no edema for a few days after treatment. CONCLUSION Fractional resurfacing tightens and increases eyelid aperture without wounding, downtime, or long-term complications. [source]

Noninvasive Lower Eyelid Blepharoplasty: A New Technique Using Nonablative Radiofrequency on Periorbital Skin

DERMATOLOGIC SURGERY, Issue 2 2004
Javier Ruiz-esparza MDArticle first published online: 3 FEB 200
Background. Laxity and rhytids of the lower eyelids are common cosmetic concerns. Historically, correction has either been surgical through either transcutaneous or transconjunctival blepharoplasty or ablative through laser resurfacing or chemical peeling. Therapeutic options usually require significant postoperative healing and have the potential risk of scarring ectropion or pigmentary loss. Objective. To report the use of a new technique that uses nonablative radiofrequency (NARF) to tighten noninvasively and nonsurgically the flaccid skin of the lower eyelids by treating the periorbital area to produce cosmetic improvement. Methods. Nine patients with skin flaccidity of the lower eyelids had a single treatment session with NARF in a small area of skin in the periorbital region, specifically the zygomatic and/or temporal areas. All patients were treated with topical anesthesia only. The treatment lasted approximately 10 minutes. No postoperative care was required. Results. All of the nine patients in the study achieved cosmetic improvement of the eyelids ostensibly through skin contraction. All patients were able to return to their normal routines immediately. Although the results were gradual, patient satisfaction was remarkable. No complications were seen in this study. Conclusion. This new procedure using NARF was successful in providing a safe, noninvasive, cosmetic improvement in these patients with excessive skin laxity of the lower eyelids. Postoperative morbidity, including down time and complications, was not seen. [source]

Effects of a Brazilian herbal compound as a cosmetic eyecare for periorbital hyperchromia ("dark circles")

JOURNAL OF COSMETIC DERMATOLOGY, Issue 2 2009
Samara Eberlin PhD
Summary Background, Evidence suggests that periorbital hyperchromia (dark circles) occurs mainly as a consequence of postinflammatory hemodynamic congestion producing a typical bruising aspect on the lower eyelids. Aims, To evaluate the clinical effects of Pfaffia paniculata/Ptychopetalum olacoides B./Lilium candidum L.-associated compound (PPLAC) on periorbital hyperchromia and to study in vitro its underlying anti-inflammatory and antioxidant mechanisms. Methods, Twenty-one volunteers presenting with periorbital hyperchromia received a serum sample containing 5.0% PPLAC, which was applied topically in the periorbital area twice a day for 28 days. Skin color was measured using variations in the individual typological angle (,ITA0) and skin luminance (,L*) calculated in the area around the eyes and in the adjacent area. Colorimetric readings were taken at the onset and end of the 28-day treatment. Volunteers were also asked to fill out a questionnaire concerning the improvement in "dark circles." The anti-inflammatory and antioxidant effects of PPLAC were measured by quantification of prostaglandin E2, leukotriene B4, histamine, and superoxide dismutase levels using an in vitro model of human skin culture. Results, Topical application of PPLAC led to a significant improvement in skin luminance and tone in the periorbital area, which was demonstrated by increased values of ITA0 and L* in about 90% of volunteers. In addition, subjects reported reduced intensity and improved appearance of "dark circles." A dose-dependent decreased production of inflammatory mediators, concomitant to increased antioxidant enzyme levels, was observed in our in vitro studies, under basal and lipopolysaccharide-stimulated conditions. Conclusions, Although the precise mechanisms related to PPLAC remain to be clarified, our results indicate that the reduction in the inflammatory process as well as the antioxidant protection against deleterious elements may be considered as an integral approach to preserve the integrity of vascular endothelium, preventing the hemodynamic congestion that culminates in the formation of "dark circles" around the eyes. [source]

Early Onset Childhood Cicatricial Pemphigoid: A Case Report and Review of the Literature

PEDIATRIC DERMATOLOGY, Issue 2 2010
Monia Kharfi M.D.
We describe a new case in a 20-month-old boy, who is to our knowledge the youngest patient reported yet. The disorder had begun 10 months before he was referred to our department by mucosal crusted erosions of the oral and nasal cavities and conjunctivae. Cutaneous examination showed buccal erosions with limited mouth opening, entropion of the lower eyelids, trichiasis, cicatricial cornea, synechia of the nasal cavities and hypopigmented lesions of the abdomen. There were no anal or genital lesions. Cicatricial pemphigoid was confirmed by positive direct and indirect immunofluorescence on mucous biopsy. Systemic corticosteroids (2 mg/kg/day), maintained for 12 months, had led to complete healing of lesions. But due to cicatrization, synechia of the nasal cavities and corneal opacities, leading to a dramatic visual loss, have occurred. Dapsone 25 mg/day and topical ocular cyclosporine are now maintained to avoid relapse. Our review of the literature of all cases of CP showed that ocular and to a less degree, vulvar lesions are the most severe ones, due to the serious complications with scar formation. [source]

Discoid lupus erythematosus of the eyelids associated with staphylococcal blepharitis and Meibomian gland dysfunction

CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 1 2006
P. Ena
Summary Lower eyelid involvement occurs in 6% of patients with discoid lupus erythematosus (DLE). Eyelid lesions are rarely the initial manifestation of DLE. We describe a 25-year-old woman presenting with discoid lesions of the lower eyelids, staphylococcal blepharitis and Meibomian gland dysfunction, who later developed a discoid lesion on the chin. Histopathological and immunofluorescence studies of a biopsy specimen from this lesion established the diagnosis of DLE. We are unaware of any previously reported cases of DLE presenting with discoid eyelid lesions associated with staphylococcal blepharitis and Meibomian gland dysfunction. DLE should be considered as a differential diagnosis in chronic blepharitis that persists despite usual medical management and eyelid hygiene. Misdiagnosis may lead to eyelid margin deformities, necessitate a complicated full-thickness biopsy, and delay diagnosis of systemic lupus. [source]