Search

Between April 1988 and December 1991 42 patients underwent a bilateral lower eyelid blepharoplasty. Depending on the etiology either a skin-muscle-flap or a skin-flap technique was used. When the lid was lax, it was shortened by a wedge-resection to prevent postoperative ectropion. The results were satisfactory with either technique.

From the anatomical and physiological point of view th eyelid may be divided into three layers: a deep layer, comprising the tarsi and the canthal tendons with the levator aponeurosis and the lower lid retractors, the orbicularis muscle layer, and the skin. The surgical particularities of each of these layers are outlined. In the management of eyelid injuries the meticulous reconstruction of the medial canthal tendon and canthus is of paramount importance. Only after this are the lids closed from medially to laterally and from deep to superficial tissues.

The eye is an effective and frequently used means of communication. Innate ocular signals express basic feelings and are identical all over the world. Acquired signals depend on cultural status, intelligence, and education. Eye diseases and orbital anomalies can provide misleading impressions, because they can be confused with true eye signals or because they can trigger innate reaction mechanisms. Surgically, the eye can often be improved as an emittor of signals; the message, however, has to be composed by the patient.

Twenty patients underwent intubation of the lacrimal system with silicone stents. The preliminary results are favourable. New indications for intubation in lacrimal surgery are discussed.

Three unusual cases of posttraumatic upper eyelid retraction are described. They were observed following orbital trauma without apparent involvement of the superior rectus muscle after latency periods ranging from several months to years. As other reasons for the lid retraction were ruled out the question arises as to whether peripheral neurogenic or muscular upper eyelid retraction must be assumed to be a consequence of trauma, although this has never been described before.