The eyelid and conjunctiva are main targets in ophthalmic plastic surgery. Although dry eyes are known to occasionally occur after ophthalmic plastic surgery, little attention has been paid to the secretory glands in the eyelid and conjunctiva. The secretary glands in the eyelid and conjunctiva contain the main lacrimal gland, accessory lacrimal glands of Wolfring and Krause, goblet cells, ciliary glands of Moll and Zeis, and the meibomian gland of the tarsal plate. Understanding the details of these glands is helpful in preventing and managing secretion reduction after oculoplastic procedures.

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PurposeTo analyse the relationship between the results of the phenylephrine test and postoperative eyelid droop in transcutaneous aponeurotic repair using epinephrine-containing local anaesthetic for aponeurotic blepharoptosis.Patients and methodsWe retrospectively reviewed the medical records of 66 eyelids from 40 patients who underwent transcutaneous aponeurotic repair. A positive phenylephrine test result was defined as an increase in margin reflex distance-1 (MRD-1) ≥0.5 mm after application of phenylephrine eye drops. The patients were divided into a positive phenylephrine response group (Group A, 16 patients) and a negative phenylephrine response group (Group B, 24 patients). The ΔMRD-1 was calculated by subtracting the 3-month postoperative value from the intraoperative value. Patient age, sex, pre- and intraoperative MRD-1s, levator function, and phenylephrine response were investigated as factors potentially influencing the ΔMRD-1. The relationship between these factors and ΔMRD-1 was analysed using single and multiple regression analysis.ResultsThe ΔMRD-1 in Group A (0.68±0.52 mm) was significantly greater than that in Group B (0.17±0.56 mm; P=0.004). A moderate correlation was found between phenylephrine response and ΔMRD-1 in the total patient group (Y=0.441 X+0.358; r=0.462; r=0.213; P=0.002).ConclusionsAlthough the ΔMRD-1 in Group B was quite small, the ΔMRD-1 in Group A was considerable, and there was a moderate positive correlation between phenylephrine response and the ΔMRD-1 overall. This indicates that the degree of postoperative eyelid droop can be estimated by the phenylephrine test results in transcutaneous aponeurotic repair.

A 77-year-old woman presented with a 1-year history of a right medial canthal tumor, which was histopathologically diagnosed as a basal cell carcinoma. After removal of the tumor with a 4-mm safety margin, the defect occupied the areas superior and inferior to the medial canthal tendon. We first reconstructed the lower part of the defect using a nasolabial V-Y advancement flap to make an elliptic defect in the upper part. We then created a glabellar subcutaneous pedicled flap to match the residual upper elliptic defect with the major axis set along a relaxed skin tension line. The pedicled glabellar flap was passed through a subcutaneous tunnel to the upper residual defect. At 6 months postoperatively, the patient showed no tumor recurrence and a good cosmetic outcome.

A 43-year-old woman presented with epiphora caused by upper and lower congenital punctual atresia with papilla. She underwent 2-snip punctoplasty and intubation under local anaesthesia. During the surgery, a dacryoendoscopic examination was performed. After performing the punctoplasty, the lacrimal passage was confirmed to have complete canalisation to the nasal cavity. Both upper and lower canaliculi appeared to be narrower and had difficult expansion compared with canaliculi in congenital nasolacrimal duct obstruction or primary acquired nasolacrimal duct obstruction without canalicular stenosis. The lacrimal sac and the nasolacrimal duct also showed complete canalization with normal colour.