PubMed Health⌕ Search

Biomedical subjects

M Patipa

Publications and source records attributed to M Patipa.

At least 19 recordsLinked to original sources
PubMed2000

The evaluation and management of lower eyelid retraction following cosmetic surgery.

Lower eyelid retraction is a common complication after cosmetic surgery of the lower eyelids, midface, and the adjacent face. Lower eyelid retraction is defined as the inferior malposition of the lower eyelid margin without eyelid eversion. Lower eyelid retraction presents clinically with scleral show; round, sad-looking eyes; lateral canthal tendon laxity; and symptoms of ocular irritation, including photophobia, excessive tearing, and nocturnal lagophthalmos. These patients frequently require ocular lubricants, including artificial tears and ointments, which often provide only minimal alleviation of their symptoms. The author has observed that lower eyelid retraction is usually accompanied by midface descent. On the basis of surgical observations, the causes of lower eyelid retraction seem to be multifactorial and include scarring between the orbital septum and capsulopalpebral fascia (or lower eyelid retractors), lateral canthal tendon laxity, and midface descent. After describing the causes of lower eyelid retraction, the author presents a system for evaluating patients that can assist the surgeon in choosing the surgical procedure(s) required to correct the lower eyelid malposition. The surgeon must know how to tighten a lax lateral canthal tendon, be familiar with the anatomy of the lower eyelid from conjunctiva to skin side, and know how to surgically elevate the midface. The techniques for correcting lower eyelid retraction are also presented. Appropriate surgery, which is determined on the basis of the preoperative evaluation, has allowed for the correction of these previously difficult-to-treat lower eyelid malpositions with minimal complications.

Adult↗
PubMed1997

Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip.

Lower eyelid malposition is the most common long-term complication following transcutaneous lower eyelid blepharoplasty. The malposition may include rounding of the lateral canthal angle, lower eyelid retraction with inferior scleral show, or frank ectropion. The result is cosmetically unacceptable and may be associated with tearing, irritation, and other exposure keratitis symptoms. Multiple factors, including lower eyelid laxity, shortage of skin, and scarring of the middle lamella, may be responsible for this malposition. A systematic examination of the lower eyelid, as presented, helps to assess the degree to which each of these factors is responsible for the malposition. Patients with the most severe degree of lower eyelid malposition generally have middle lamella scarring. If this abnormality is not addressed, lower eyelid procedures aimed at correcting the malposition are doomed to failure. In the presence of significant middle lamella scarring, a spacer is required to provide vertical height and stiffness to support the lower eyelid following release of the cicatrix. A systematic approach aimed at addressing the underlying abnormalities was developed. In patients with significant middle lamella scarring, hard palate mucosa grafts were used as spacers in 29 eyelids (17 patients). A lateral canthotomy and transconjunctival incision allow access to the scarring in the lower eyelid retractors and septum. After careful release of all cicatrix, a hard palate mucosa graft is inserted between the lower border of the tarsal plate and the recessed conjunctiva, lower eyelid retractors, and septum. Horizontal lower eyelid laxity, when present, is corrected by performing a lateral tarsal strip. Most patients do not have a true deficiency of the anterior lamella (skin and orbicularis oculi muscle). When a moderate amount of anterior lamella deficiency is present with significant scarring of the middle lamella, the technique we describe allows correction of the lower eyelid malposition without a skin graft. After a follow-up interval of 6 to 30 months (mean 14 months), excellent results were obtained in all eyelids. Complications included corneal abrasions in two eyes before routine use of bandage cornea contact lenses at the end of surgery and a secondary bleed from the roof of the mouth in one patient. Palate mucosa closely resembles tarsus and provides excellent vertical support to the eyelid. It is stiff enough to maintain eyelid contour without causing a cosmetically unacceptable bump. Tissue can be obtained with ease. The technique, as described, addresses the underlying causes of lower eyelid malposition and gives excellent functional and cosmetic results.

Adult↗
PubMed1996

Use of hard palate grafts for treatment of postsurgical lower eyelid retraction: a technical overview.

Lower eyelid retraction occasionally occurs following the repair of fractures involving the orbital rims, orbital floor, or complex zygomatic maxillary complex fractures. The surgical repair of these scarred eyelids has been historically difficult. The authors have utilized the principle of releasing the scar tissue and attempting to reposition the eyelid in its normal anatomic position by employing a hard palate mucosal graft spacer to correct the eyelid malposition. In this article, the authors discuss the excellent success they have experienced utilizing hard palate autologous grafts as spacers performing revision of scarred contracted lower eyelid retractors and tightening of the lateral canthal tendon complex. Adherence to the principles delineated in the article can yield excellent functional and cosmetic results.

Adult↗
PubMed1993

Lateral canthal tendon resection with conjunctiva preservation for the treatment of lower eyelid laxity during lower eyelid blepharoplasty.

Lower eyelid laxity is a problem commonly encountered in patients undergoing lower eyelid blepharoplasty. Two problems associated with the numerous surgical procedures used for the management of this condition are (1) postoperative alteration of the shape of the palpebral fissure and lateral canthal angle and (2) difficulty with appropriate suture positioning or placement when reattaching the resected lateral canthal tendon. To address these problems, the surgical technique of lateral canthal tendon resection was modified by preserving the lateral conjunctiva, thus maintaining normal anatomic landmarks and ensuring proper suture placement. To date, this technique has been performed effectively on 50 patients who demonstrated mild to moderate eyelid laxity during preoperative evaluation for lower eyelid blepharoplasty. The only complication encountered has been undercorrection in one patient. The benefits of this procedure have been prevention of alteration of the palpebral fissure or canthal angle shape, greater ease and more accurate suture placement when reattaching the lateral canthal tendon, and avoidance of the need for full-thickness eyelid resection.

Aged↗
PubMed1992

Visual field loss in primary gaze and reading gaze due to acquired blepharoptosis and visual field improvement following ptosis surgery.

Acquired blepharoptosis has been associated with loss of the superior visual field (SVF) in primary gaze. Because many patients with acquired blepharoptosis complained of difficulty reading or performing other visual functions in reading gaze, a prospective study was undertaken to determine if acquired blepharoptosis was the cause of these visual dysfunctions. Preoperative and postoperative SVFs were tested in primary gaze and reading gaze in 19 patients with unilateral or bilateral acquired blepharoptosis totaling 30 eyes. Preoperative testing revealed a marked loss of the SVF in both primary gaze and reading gaze. All patients underwent levator aponeurosis defect repair. Postoperative results showed a significant improvement in both primary and reading gaze SVFs. Therefore, patients with good visual acuity complaining of difficulty reading or carrying out other visual functions in reading gaze should be examined for the presence of acquired blepharoptosis. Blepharoptosis repair can be expected to improve the SVF in both primary gaze and reading gaze.

Adult↗
PubMed1990

Axial dynamic compression plates in the management of complex orbital fractures via transconjunctival orbitotomy.

We describe our 4 years' experience using axial dynamic compression plates in the management of 46 zygomatico-orbital and complex infraorbital fractures. Surgical exposure of the fracture sites was accomplished in all cases by transconjunctival orbitotomy with lateral cantholysis. Transconjunctival orbitotomy with lateral cantholysis provides excellent surgical exposure of periorbital fractures, and axial dynamic compression plates are an excellent method for repairing these fractures.

Adult↗
PubMed1990

Ophthalmic surgical management of facial paralysis.

Combinations of these procedures have been performed on more than 50 patients to date, with the longest follow-up being greater than 8 years. All of these patients presented with complaints of ocular irritation, tearing, photophobia, and impaired vision. Several had severe epithelial keratopathy. Some patients have also been treated following neurosurgical procedures which caused paralysis of the fifth and seventh cranial nerves, resulting in both corneal anesthesia and facial paralysis. Patients have done very well after these procedures and have achieved ocular comfort, reduced tearing, and corneal protection without the need for disfiguring and visually occluding tarsorrhaphies or other procedures. In some instances, they may still require artificial tears during the day or a lubricating protective ointment for the eye at bedtime. There have been no significant complications in this series; no cases of gold weight extrusion, recurrent ectropion, or persistent corneal epithelial keratopathy. Some patients have complained of continued excessive tearing which is most likely due to paralysis of the lacrimal pump, resulting in ineffective tear drainage to the nasal lacrimal duct. However, these patients have still noted markedly reduced tearing compared to their preoperative condition. One patient underwent secondary release of her medial canthoplasty following return of facial nerve function.(ABSTRACT TRUNCATED AT 250 WORDS)

Eyelid Diseases↗
PubMed1987

Eyelid tattooing.

Tattooing has recently regained popularity in medicine. Cosmetic blepharopigmentation for eyelid enhancement by permanent eyeliner has received considerable attention. In addition, permanent pigmentation has been used for eyebrow simulation, camouflaging of scars, nipple areolar pigmentation following breast reconstruction, and the management of several other pigment disorders. This article emphasizes the principles and technique of blepharopigmentation.

Burns↗
PubMed1986

Light and electron microscopic findings with permanent eyeliner.

Pathologic studies were performed on two specimens of eyelid that had been treated with permanent eyeliner (tattooing with ferrous oxide), one specimen excised four days after injection of the pigment, and the other obtained 12 months later. Each patient had undergone an ectropion repair of the lower eyelid that provided the specimen. The specimen studied four days after injection revealed by light microscopy scattered pigment granules within the epidermis and fine granules and small aggregates dispersed within the dermis. No acute or chronic inflammatory cells were observed in relationship to the deposits. The specimen obtained 12 months after eyeliner injection was studied by both light and electron microscopy. No pigment particles were observed within the epidermis, but rather there were coarse clumps of granular material in the dermis. Apart from scattered mast cells, which occasionally contained fine granules, and apart from the macrophages which appeared to have ingested the pigment granules, no other acute and chronic inflammatory cells were found. Electron microscopy demonstrated that while most of the granular material had been phagocytosed by macrophages, occasional granules were found in small dispersions within the cytoplasm of mast cells and fibroblasts of the dermis. Minimal migration of pigment within macrophages occurred to locations around lymphatic channels and within the superficial orbicularis muscle connective tissue.

Aged↗
PubMed1986

Tattoo devices.

Explore the source record for details and available documents.

Breast↗
PubMed1984

Vertical tarsal buckling as a complication of levator aponeurosis repair for acquired blepharoptosis.

In two patients (a 60-year-old man and a 69-year-old woman) vertical buckling of the superior tarsus followed surgery to correct levator aponeurosis disinsertions for the management of acquired upper eyelid blepharoptosis. The superior tarsus rotated posteriorly and folded on itself because the sutures reattaching the levator aponeurosis to the tarsus were placed too low on the anterior tarsal plate. This complication can be prevented by placing the tarsal sutures above the vertical midpoint of the tarsus. If this complication develops, early correction is possible by revising the suture heights and keeping the tarsus flat with a symblepharon ring. This led to a satisfactory outcome in one of our cases. Late correction of vertical tarsal buckling requires excision of the buckled tarsus and repositioning the levator aponeurosis sutures. In one of our patients, an entropion developed as a result of insufficient vertical tarsal height that caused instability of the upper eyelid. The outcome was otherwise satisfactory.

Aged↗
PubMed1984

Acquired ptosis in patients undergoing upper eyelid blepharoplasty.

Involutional or senile ptosis may be present in patients undergoing upper eyelid blepharoplasties. Several patients have been seen who have requested removal of excess upper eyelid skin when they actually required ptosis surgery. Other patients have undergone blepharoplasties and recognized the presence of ptosis following their cosmetic surgery. The ptosis was either present but unrecognized prior to surgery or developed following their blepharoplasties. Finally, some patients have required combined ptosis repair and upper eyelid blepharoplasties. This article aims to make the surgeon performing eyelid surgery aware of the potential presence of ptosis in patients undergoing blepharoplasties and assist in appropriate workup and management of these patients.

Adolescent↗
PubMed1982

The recognition of acquired ptosis in patients considered for upper-eyelid blepharoplasty.

Involutional or senile ptosis commonly occurs simultaneously with dermatochalasis. Levator aponeurosis dehiscence or disinsertion is the most common etiology of acquired involutional ptosis in our practice. The presence of ptosis should be ascertained prior to performing an upper-lid blepharoplasty. The surgical repair of a levator dehiscence or disinsertion can be performed simultaneously with a blepharoplasty or may be the indicated procedure rather than a blepharoplasty. The recognition and appropriate management of acquired ptosis will provide better cosmetic and functional surgical results in patients undergoing upper-eyelid surgery.

Adult↗
PubMed1982

Metastatic endophthalmitis: a complication of meningococcal meningitis.

A 13-month-old child with Neisseria meningitidis developed bilateral metastatic endophthalmitis. Treatment with systemic and periocular injections of penicillin G and steroids resulted in resolution of the meningitis and the endophthalmitis. This case should alert the pediatrician to the possibility of binding endophthalmitis in a patient with meningitis and ocular abnormalities.

Conjunctiva↗
PubMed1982

Surgical management of congenital eyelid coloboma.

Congenital eyelid colobomas are a partial or total absence of eyelid structures. The degree of severity determines the surgical techniques employed for repairing the eyelid. We feel that early surgical treatment reduces the risk of ocular scarring with satisfactory results. We present four cases of congenital upper eyelid colobomas of differing severity and discuss surgical approaches to these lid abnormalities.

Child, Preschool↗
PubMed1982

Ectropion.

Explore the source record for details and available documents.

Cicatrix↗