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Concept: Lacrimal lake

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BACKGROUND: Many Asians receive epicanthoplasty to improve their medial epicanthal fold.Excessive performance of such surgery may cause multiple unwanted results, but there is no report on any restoration method for an overcorrected result of epicanthoplasty. Accordingly, the authors have created a new method for reversely restoring the excessively corrected medial epicanthal fold using skin-redraping epicanthoplasty (Plast Reconstr Surg. 2007;119:703-710). METHODS: During the interval between January 2009 and April 2011, 35 patients received surgery for restoration of the epicanthal fold using the authors' method, which involves sufficiently elevating the skin flap and redraping it to reconstruct the epicanthal fold. This method is very simple to design and perform, and it effectively covers the excessively exposed lacrimal lake. In addition, it can be used independently of the type of prior epicanthoplasty. RESULTS: After the surgery, 2 patients experienced overcorrection, and we repeated the epicanthoplasty. In the other patients, there was no severe complication except for mild redness, a condition that improved after several months. The mean measured distance between the medial canthi after the surgery was 36.8 mm, corresponding to a total lengthening effect of 4.5 mm. This improved the aggressive facial expression caused by the exposed lacrimal lake, and the eyes no longer appeared to be too close together. Moreover, in the case of patients who had more visible scars due to prior epicanthoplasty on the medial epicanthal area, the overall scar length decreased. CONCLUSIONS: This method is simple in design and easy to perform. It can also control the degree of restoration with an additional advantage of reducing a prior scar. Using this method, we could effectively restore the overcorrected epicanthal fold.

Concepts: Causality, Scar, Eye, Skin, Oral and maxillofacial surgery, FN SCAR, 2011, Lacrimal lake

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Purpose:To explore changes in lacrimal gland and tear inflammatory cytokines in thyroid-associated ophthalmopathy (TAO) patients. Methods:TAO patients were divided into active and inactive TAO groups. These two TAO groups and the control completed the Ocular Surface Disease Index (OSDI), underwent thorough ophthalmologic examinations, and underwent orbital magnetic resonance scan to measure the size of the lacrimal gland. Basal tears, reflex tears induced by nasal stimulation and serum samples were collected to analyze the concentrations of interleukin (IL)-1β, IL-6, IL-7, IL-17A, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α by multiplex bead analysis. Results:The coronal lacrimal gland area was significantly larger in active TAO (P<0.000) and inactive TAO (P=0.002) than in the control, and the axial lacrimal gland area was significantly larger in active (P<0.000) and inactive TAO (P=0.001) than in the control. The coronal lacrimal gland width was significantly greater in active (P<0.000) and inactive TAO (P=0.001) than in the control, and axial lacrimal gland width was significantly greater in active (P<0.000) and inactive TAO (P=0.035) than in the control. In TAO patients, the axial area was positively correlated with IL-1β and IL-17A concentrations in tears (r=0.357, P=0.013; r=0.359, P=0.012), and both coronal and axial areas were positively correlated with IL-6 concentrations in tears (r=0.346, P=0.016; r=0.340, P=0.018). Conclusions:Increased inflammatory cytokines play an important role in ocular surface damages, and might be associated with the inflammatory involvement of the lacrimal gland.

Concepts: Immune system, Inflammation, Cytokine, Eye, Tears, Nasolacrimal duct, Lacrimal gland, Lacrimal lake