Aims-To verify and evaluate the eVect of reinsertion of the lower eyelid retractor aponeurosis to correct involutional entropion. Methods-The involutional entropion is one aVection that occurs mainly in the lower eyelid of patients over 60 years old. The surgical techniques proposed to correct this condition are based on correction of horizontal laxity-the preseptal orbicularis muscle overrides the pretarsal muscle, and the reinsertion of the lower eyelid retractor aponeurosis. 30 patients clinically diagnosed with involutional entropion and randomly selected underwent reinsertion of the lower eyelid retractor aponeurosis to the tarsal plate, without horizontal shortening or resection of the skin or orbicularis muscle. Results-Good anatomical and functional correction was achieved in 96.6% of the patients and no recurrence was observed on 29 month follow up examination. The surgical result was very satisfactory. Conclusions-It was concluded that this procedure is eVective and has low recurrence rate, showing the important role of the reinsertion of the lower eyelid retractor aponeurosis in this surgical correction. (Br J Ophthalmol 2000;84:606-608)
Purpose: To describe palpebral fissure changes during early childhood. Methods: Digital imaging was used to analyze the monocular palpebral fissure images of 185 children and 35 adults. Six variables were quantified for each eye: the distance between the pupil center and the upper and lower eyelid margin, the palpebral fissure area, and the obliquity and length of the fissure. The lower eyelid crease pattern also was evaluated qualitatively. Results: The upper eyelid was at its lowest position after birth, and the lower eyelid margin was close to the pupil center. Between ages 3 and 6 months, the position of the upper eyelid reached its maximum and then declined linearly. At the same time, the distance between the pupil center and the lower eyelid margin increased linearly until age 18 months when its position stabilized. Both the horizontal palpebral fissure length and the fissure area followed a logarithmic pattern of growth and were strongly correlated. The obliquity of the fissure was evident at an early age and did not change until adulthood. At birth, the most common pattern of the lower eyelid crease was a single crease. The number of individuals showing a double crease increased with age, and at approximately age 36 months, a double crease became the most common pattern. Conclusion: The palpebral fissure undergoes complex changes during infancy. An accurate knowledge of these changes is important for evaluating eyelid disorders in children. Journal of Pediatric Ophthalmology and Strabismus 2001;38:219-223.
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