Ectropion

Abstract: This retrospective study aimed at investigating indications, surgical approaches, and the materials used for orbital floor reconstructions, as well as the clinical follow-up, particularly with regard to postoperative complications This study comprised 189 patients who underwent surgery for fractures of the orbital floor between 2003 and 2007 Diagnosis and treatment were based on both physical examination and computed tomography scan of the orbit Patients were retrospectively analyzed for data, such as mechanism of injury, classification of fracture, and complications The most common cause of injury was physical assault followed by traffic accidents Surgery was conducted with a mean delay of 29 days after the incident Mid lower eyelid incision was the most common surgical approach to the orbital floor For orbital floor reconstruction, polydioxanone sheets (705%) were mainly used, followed by Ethisorb Dura (233%) and titanium mesh (62%) There were 190% of patients who showed postoperative complications: 58% suffered from persisting motility impairment, 37% from enophthalmos, 32% from consistent diplopia, 26% from ectropion, and 05% from orbital infection Intraorbital hematoma (32%) represented the most severe complications, one patient suffered lasting impairment of sight and another one, complete blindness of the affected eye If postoperative impairment of vision becomes evident, immediate surgical intervention is mandatory Retrobulbar hematoma is more likely to occur in heavily traumatized patients with comminuted fractures and also in patients taking anticoagulative medication The subciliary approach to the orbit and repeated operations by the same approach are associated with a higher risk of developing ectropion

Abstract: Objective: To compare the transcutaneous and transconjunctival approaches for repair of orbital rim and floor fractures. Design: We conducted a retrospective study of the occurrence of eyelid retraction following the repair of 63 orbital fractures, 27 with the subciliary skin-muscle flap approach and 36 with the transconjunctival preseptal approach. Setting: Academic tertiary referral medical center. Participants: Fifty-nine patients underwent 63 orbital explorations. Intervention: Of the 27 transcutaneous explorations, 24 were done early within the first 2 weeks of injury and three were performed for correction of late posttraumatic enophthalmos. Of the 36 transconjunctival explorations, 25 were done early and 11 were performed for correction of late posttraumatic enophthalmos. Outcome Measure: Clinically noted complications. Results: We found a 12% rate of transient ectropion and a 28% rate of permanent scleral show with the subciliary skin-muscle flap approach compared with no transient ectropion and a 3% rate of permanent scleral show with the transconjunctival approach. Conclusions: We believe that the transconjunctival approach provides excellent exposure with less risk of postoperative eyelid retraction and ectropion. (Arch Otolaryngol Head Neck Surg. 1993;119:1000-1007)

Abstract: Floppy eyelid syndrome (FES) usually affects middle-aged obese men, presenting as a unilateral or bilateral chronic papillary conjunctivitis. The upper eyelid is lax, floppy, and easily everted. The laterality corresponds to the side the patient sleeps on. An association with obstructive sleep apnea (OSA) has been suggested. A personal series of 17 new cases is presented, and 79 previously reported cases are reviewed to give a detailed description of the syndrome. In addition to the classical presentation, patients may present with upper lid ptosis, lash ptosis or trichiasis, lower lid ectropion or rarely entropion, or corneal complications. Eight patients with FES were investigated for OSA. Twenty other patients with known OSA were examined for FES and other possibly associated ocular features. All eight patients referred for sleep studies were found to have OSA. One of the 20 patients with known OSA was found to have FES, and two had features of early asymptomatic FES. One patient with FES and OSA had normal tension glaucoma. Patients with FES should be considered for sleep studies because of the known morbidity of OSA. Simple screening of patients with OSA may detect FES and avoid late corneal complications that can compromise vision.

Abstract: Part 1 Eyelids - a partial thickness: primary repair secondary contrature tissue loss - superficial tissue loss - deep tissue loss in the preiorbital regions the conjuntiva. Part 2 Eyelids - full thickness: primary and secondary repair reconstruction of the eyelids reconstruction of the upper lid "Switch flap" reconstruction of the upper lid in severe scarring (trachoma), S.Elroy Pereira reconstruction of both eyelids reconstruction of the eyelids in the absense of the eye surgery of the medical canthus surgery of the lateral canthus the lacrical system, Richard A.N.Welham the eyebrows. Part 3 Miscellaneous: the eyesocket, L.Vistnes post-enucleation anopthalmos and microphthalmos orbital wall trauma, Ian T.Jackson enopthalmos, Ian T.Jackson entropion, trichiasis and ectropion, J.R.O.Collin ptosis, Cromwell and C.Beard congenital ptosis - Mullers muscle and the levator antagonists epicanthus, telecanthus, bleparophimosis and related conditions craniofacial malformations involving the orbital region, Ian T.Jackson congenital colobomas exenteration of the orbit techniques for transfer of resurfacing materials.