Pub Date : 2023-07-01DOI: 10.1097/IIO.0000000000000455
Michelle A J Ting, Daniel G Ezra
The lower eyelid tear trough deformity is a common cosmetic concern presenting to the oculoplastic surgeon. In contrast to the smooth convexity of the transition between the lower eyelid and upper cheek seen in children and young adults, older patients can develop a double convex lid-cheek profile due to deepening of the nasojugal fold (“the tear trough”) (Fig. 1). This is typically due to age-related laxity of the supporting tissues of the face, although the process can also be accelerated by conditions associated with periocular inflammation and orbital fat expansion such as thyroid eye disease.1 The uneven contour often contributes to the appearance of dark circles by creating shadow irregularities, resulting in patients seeking a reduction of “eye bags” or “dark circles” which contribute to a tired and aged appearance. The tear trough is a challenging area to treat due to the complexity of the underlying anatomy and its variation between patients, as well as the range of surgical and nonsurgical approaches available.2–7 Furthermore, intervention in this area carries several potential risks, which the clinician must first know how to minimize, and how to treat should they occur. Here, we aim to review the anatomy of the tear trough region, aided by reference to cadaveric anatomic studies in the literature, and to relate these findings to rejuvenation methods, providing an anatomic approach clinical aesthetic lower eyelid treatments.
{"title":"The Tear Trough and Lower Lid Folds: Etiology and Implications for Treatment.","authors":"Michelle A J Ting, Daniel G Ezra","doi":"10.1097/IIO.0000000000000455","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000455","url":null,"abstract":"The lower eyelid tear trough deformity is a common cosmetic concern presenting to the oculoplastic surgeon. In contrast to the smooth convexity of the transition between the lower eyelid and upper cheek seen in children and young adults, older patients can develop a double convex lid-cheek profile due to deepening of the nasojugal fold (“the tear trough”) (Fig. 1). This is typically due to age-related laxity of the supporting tissues of the face, although the process can also be accelerated by conditions associated with periocular inflammation and orbital fat expansion such as thyroid eye disease.1 The uneven contour often contributes to the appearance of dark circles by creating shadow irregularities, resulting in patients seeking a reduction of “eye bags” or “dark circles” which contribute to a tired and aged appearance. The tear trough is a challenging area to treat due to the complexity of the underlying anatomy and its variation between patients, as well as the range of surgical and nonsurgical approaches available.2–7 Furthermore, intervention in this area carries several potential risks, which the clinician must first know how to minimize, and how to treat should they occur. Here, we aim to review the anatomy of the tear trough region, aided by reference to cadaveric anatomic studies in the literature, and to relate these findings to rejuvenation methods, providing an anatomic approach clinical aesthetic lower eyelid treatments.","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"63 3","pages":"13-33"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10227673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1097/IIO.0000000000000452
Yasuhiro Takahashi, Aric Vaidya
Dysthyroid optic neuropathy (DON) is the most serious manifestation of thyroid eye disease (TED). According to the EUGOGO clinical guidelines, DON is classified as “sight-threatening” TED.1 The incidence of DON ranges from 4% to 8% in all cases of TED.2 Permanent and irreversible vision loss develops in 30% of cases without treatment,3 whereas vision can be rescued after prompt diagnosis and accurate management in most cases. This paper reviews the diagnosis and management of DON.
{"title":"Diagnosis and Management of Dysthyroid Optic Neuropathy.","authors":"Yasuhiro Takahashi, Aric Vaidya","doi":"10.1097/IIO.0000000000000452","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000452","url":null,"abstract":"Dysthyroid optic neuropathy (DON) is the most serious manifestation of thyroid eye disease (TED). According to the EUGOGO clinical guidelines, DON is classified as “sight-threatening” TED.1 The incidence of DON ranges from 4% to 8% in all cases of TED.2 Permanent and irreversible vision loss develops in 30% of cases without treatment,3 whereas vision can be rescued after prompt diagnosis and accurate management in most cases. This paper reviews the diagnosis and management of DON.","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"63 3","pages":"233-248"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10227685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1097/IIO.0000000000000475
Xincen Hou, Alexander C Rokohl, Wanlin Fan, Yongwei Guo, Mohammad Javed Ali, Ludwig M Heindl
Among the periocular malignancies, basal cell carcinoma (BCC) and squamous cell carcinoma are the most common in the west. In contrast, sebaceous and Merkel cell carcinomas are the most aggressive. Premalignant tumors include actinic keratosis, Bowen’s disease, and keratoacanthoma. Eyelid malignancies should be treated differently than other cutaneous tumors of the same cell type because of the particular anatomic concerns of the periocular area and the effect of surgical excision and reconstruction on ocular protection and visual function. The most common treatment is surgical excision, and the following reconstruction of eyelid defects is a critical step. This is because the deformity caused by the disease or surgery can significantly affect the patient’s appearance. It can affect the patient’s perception of themselves and others, as well as the patient’s psychological and social personality. Several surgical treatment options for eyelid reconstruction include various flaps, grafts, and combinations. The objectives of eyelid reconstruction after carcinoma removal have been to protect the cornea, restore the integrity of the lid lamellae, restore normal lid movement, and produce the desired aesthetic outcome.1 The present article provides an overview of the classification of periocular malignancies and discusses the indications, strengths, and weaknesses of the surgical procedures that are currently accessible.
{"title":"Periocular Malignancies and Postoperative Eyelid Reconstruction.","authors":"Xincen Hou, Alexander C Rokohl, Wanlin Fan, Yongwei Guo, Mohammad Javed Ali, Ludwig M Heindl","doi":"10.1097/IIO.0000000000000475","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000475","url":null,"abstract":"Among the periocular malignancies, basal cell carcinoma (BCC) and squamous cell carcinoma are the most common in the west. In contrast, sebaceous and Merkel cell carcinomas are the most aggressive. Premalignant tumors include actinic keratosis, Bowen’s disease, and keratoacanthoma. Eyelid malignancies should be treated differently than other cutaneous tumors of the same cell type because of the particular anatomic concerns of the periocular area and the effect of surgical excision and reconstruction on ocular protection and visual function. The most common treatment is surgical excision, and the following reconstruction of eyelid defects is a critical step. This is because the deformity caused by the disease or surgery can significantly affect the patient’s appearance. It can affect the patient’s perception of themselves and others, as well as the patient’s psychological and social personality. Several surgical treatment options for eyelid reconstruction include various flaps, grafts, and combinations. The objectives of eyelid reconstruction after carcinoma removal have been to protect the cornea, restore the integrity of the lid lamellae, restore normal lid movement, and produce the desired aesthetic outcome.1 The present article provides an overview of the classification of periocular malignancies and discusses the indications, strengths, and weaknesses of the surgical procedures that are currently accessible.","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"63 3","pages":"147-162"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10227675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1097/IIO.0000000000000471
Francesco P Bernardini, Brent Skippen
Esthetic rejuvenation of the periocular area is an effective intervention to address facial aging and tired eyes.1 The importance of the lower eyelids, located crucially in the center of the face, cannot be underestimated. Lower eyelid aging is influenced by gravity and globe weight, responsible for the various clinical manifestations that can be subclassified as: (1) volume changes, represented by eyelid bags and orbito-malar hollowing; (2) skin changes, including skin excess and descent; (3) laxity changes, manifested by eyelid margin rounding, infero-lateral scleral show, lateral canthal angle medialization, and negative canthal tilt. Laxity changes, by widening the youthful narrow palpebral fissure, further contribute to loss of perceived attractiveness.2 Lower blepharoplasty is a commonly performed aesthetic oculoplastic surgical procedure. Traditionally, lower blepharoplasty surgery focused mainly on addressing volume changes and skin excess to achieve effacement of the eyelid/cheek junction with most authors advocating routine adjunctive ancillary procedures to prevent downward displacement of the lower eyelid.3 The authors believe that the added risks of these supporting procedures can overcome the potential benefits and should ideally be avoided at the time of primary blepharoplasty. The authors have previously reported a lower blepharoplasty surgical technique that mimics the effect of digital elevation of the eyelid skin, hence the name “Eyelid Lift,” which addresses volume, skin, and laxity changes simultaneously, whilst at the same time avoiding adjunctive supportive procedures.4
{"title":"The \"Eyelid Lift\" in Lower Blepharoplasty Surgery.","authors":"Francesco P Bernardini, Brent Skippen","doi":"10.1097/IIO.0000000000000471","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000471","url":null,"abstract":"Esthetic rejuvenation of the periocular area is an effective intervention to address facial aging and tired eyes.1 The importance of the lower eyelids, located crucially in the center of the face, cannot be underestimated. Lower eyelid aging is influenced by gravity and globe weight, responsible for the various clinical manifestations that can be subclassified as: (1) volume changes, represented by eyelid bags and orbito-malar hollowing; (2) skin changes, including skin excess and descent; (3) laxity changes, manifested by eyelid margin rounding, infero-lateral scleral show, lateral canthal angle medialization, and negative canthal tilt. Laxity changes, by widening the youthful narrow palpebral fissure, further contribute to loss of perceived attractiveness.2 Lower blepharoplasty is a commonly performed aesthetic oculoplastic surgical procedure. Traditionally, lower blepharoplasty surgery focused mainly on addressing volume changes and skin excess to achieve effacement of the eyelid/cheek junction with most authors advocating routine adjunctive ancillary procedures to prevent downward displacement of the lower eyelid.3 The authors believe that the added risks of these supporting procedures can overcome the potential benefits and should ideally be avoided at the time of primary blepharoplasty. The authors have previously reported a lower blepharoplasty surgical technique that mimics the effect of digital elevation of the eyelid skin, hence the name “Eyelid Lift,” which addresses volume, skin, and laxity changes simultaneously, whilst at the same time avoiding adjunctive supportive procedures.4","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"63 3","pages":"5-12"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10219054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1097/IIO.0000000000000476
Cassie Cameron, Jessica Y Tong, Sandy Patel, Dinesh Selva
{"title":"Cystic Lesions of the Orbit.","authors":"Cassie Cameron, Jessica Y Tong, Sandy Patel, Dinesh Selva","doi":"10.1097/IIO.0000000000000476","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000476","url":null,"abstract":"","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"63 3","pages":"101-135"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10227683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1097/IIO.0000000000000454
Jiawei Zhao, Bita Esmaeli
Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer after basal cell carcinoma.1 cSCC accounts for 5% to 10% of all eyelid cancers with an incidence rate estimated to be 1.37 per 100,000 individuals per year.2–4 Majority of patients with periorbital cSCC are older (60 years of age or older) and fair-skinned with significant sun exposure.3,5–7 Locally advanced cSCC in the periorbital region, when treated with current standard of care which is surgery followed by adjuvant radiotherapy (with or without concurrent chemotherapy) can lead to significant morbidity with poor cosmetic and functional outcome. An attempt for R0 resection (microscopically margin-negative resection) in such patients can be extensive, causing loss of lacrimal drainage apparatus and a significant distortion of the eyelid and orbit despite best efforts in reconstruction. Orbital exenteration is often required in locally advanced periorbital cases of cSCC. Orbital exenteration causes major functional impairment and aesthetic deformity, and is associated with substantial negative emotional and psychosocial impact.8–10 Highdose radiation therapy in the periorbital region is also associated with significant ocular toxicity, including dry eye syndrome, keratopathy, cataract, optic neuropathy, and radiation-induced retinopathy.11 Despite aggressive local treatments, the recurrence rate for locally advanced resectable cSCC of the head and neck region is up to 30% and can progress to death from disease in some patients.12,13 The 2-year diseasefree survival in locally advanced, resectable cSCC treated by current standard of care (surgery and adjuvant radiation) has been reported to be 78%.14
{"title":"Systemic Neoadjuvant Therapies for Treatment of Cutaneous Squamous Cell Carcinoma of the Periorbital Region.","authors":"Jiawei Zhao, Bita Esmaeli","doi":"10.1097/IIO.0000000000000454","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000454","url":null,"abstract":"Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer after basal cell carcinoma.1 cSCC accounts for 5% to 10% of all eyelid cancers with an incidence rate estimated to be 1.37 per 100,000 individuals per year.2–4 Majority of patients with periorbital cSCC are older (60 years of age or older) and fair-skinned with significant sun exposure.3,5–7 Locally advanced cSCC in the periorbital region, when treated with current standard of care which is surgery followed by adjuvant radiotherapy (with or without concurrent chemotherapy) can lead to significant morbidity with poor cosmetic and functional outcome. An attempt for R0 resection (microscopically margin-negative resection) in such patients can be extensive, causing loss of lacrimal drainage apparatus and a significant distortion of the eyelid and orbit despite best efforts in reconstruction. Orbital exenteration is often required in locally advanced periorbital cases of cSCC. Orbital exenteration causes major functional impairment and aesthetic deformity, and is associated with substantial negative emotional and psychosocial impact.8–10 Highdose radiation therapy in the periorbital region is also associated with significant ocular toxicity, including dry eye syndrome, keratopathy, cataract, optic neuropathy, and radiation-induced retinopathy.11 Despite aggressive local treatments, the recurrence rate for locally advanced resectable cSCC of the head and neck region is up to 30% and can progress to death from disease in some patients.12,13 The 2-year diseasefree survival in locally advanced, resectable cSCC treated by current standard of care (surgery and adjuvant radiation) has been reported to be 78%.14","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"63 3","pages":"35-46"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10219059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1097/IIO.0000000000000460
Naif Alsulaiman, Shahad F AlTayash, Danah Y Alkadi, Adel H Alsuhaibani
The upper eyelid usually sets 1 to 2 mm below the upper corneal limbus. Upper eyelid retraction (UER) is defined as an abnormally elevated eyelid exposing the upper sclera in the resting position. This definition requires statistical knowledge of the normal population’s upper lid position distribution.1 Multiple causes can lead to UER with thyroid eye disease (TED) especially Graves’ ophthalmopathy being the most common causative disorder.2 Other causes include myogenic etiologies such as congenital UER and poststrabismus/ptosis surgeries, neurogenic causes such as Parinaud syndrome and Collier’s sign, and mechanistic factors such as cutaneous or conjunctival scaring, proptosis, and axial myopia.3,4 Proper patient assessment including comprehensive medical history and physical examination is crucial to deliver the most appropriate management plan and exclude causes of pseudo eyelid retraction such as proptosis and contralateral upper eyelid ptosis. Hence, accurate preoperative understanding and controlling the causative factors are of great value before proceeding to the operating theater. In the clinical settings, patients should be assessed for syndromic features, signs of previous trauma, cranial palsies, TED, conjunctival scaring, or neurological insults. The upper eyelid assessment is typically done using various methods as marginal reflex distance 1 (MRD1) which is normally 4 to 5 mm, palpebral fissure height, levator function, and the mid-pupil to upper lid margin distance.2 Moreover, other assessment tools such as Hertel exophthalmometer, orbicularis oculi function, lagophthalmos, bells phenomenon, corneal sensation, and preoperative
{"title":"The Art of Upper Eyelid Retraction Repair.","authors":"Naif Alsulaiman, Shahad F AlTayash, Danah Y Alkadi, Adel H Alsuhaibani","doi":"10.1097/IIO.0000000000000460","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000460","url":null,"abstract":"The upper eyelid usually sets 1 to 2 mm below the upper corneal limbus. Upper eyelid retraction (UER) is defined as an abnormally elevated eyelid exposing the upper sclera in the resting position. This definition requires statistical knowledge of the normal population’s upper lid position distribution.1 Multiple causes can lead to UER with thyroid eye disease (TED) especially Graves’ ophthalmopathy being the most common causative disorder.2 Other causes include myogenic etiologies such as congenital UER and poststrabismus/ptosis surgeries, neurogenic causes such as Parinaud syndrome and Collier’s sign, and mechanistic factors such as cutaneous or conjunctival scaring, proptosis, and axial myopia.3,4 Proper patient assessment including comprehensive medical history and physical examination is crucial to deliver the most appropriate management plan and exclude causes of pseudo eyelid retraction such as proptosis and contralateral upper eyelid ptosis. Hence, accurate preoperative understanding and controlling the causative factors are of great value before proceeding to the operating theater. In the clinical settings, patients should be assessed for syndromic features, signs of previous trauma, cranial palsies, TED, conjunctival scaring, or neurological insults. The upper eyelid assessment is typically done using various methods as marginal reflex distance 1 (MRD1) which is normally 4 to 5 mm, palpebral fissure height, levator function, and the mid-pupil to upper lid margin distance.2 Moreover, other assessment tools such as Hertel exophthalmometer, orbicularis oculi function, lagophthalmos, bells phenomenon, corneal sensation, and preoperative","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"63 3","pages":"59-73"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10227671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1097/IIO.0000000000000453
Kenneth K H Lai, Matthew C W Lam, Hunter K L Yuen
{"title":"Review of Surgical Techniques in Evisceration.","authors":"Kenneth K H Lai, Matthew C W Lam, Hunter K L Yuen","doi":"10.1097/IIO.0000000000000453","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000453","url":null,"abstract":"","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"63 3","pages":"195-208"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10227677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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