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This study described the detailed osteological features of the Setouchi salamander Hynobius setouchi. H. setouchi, which is endemic to central Japan, was recently delineated from the wide range of H. nebulosus species based on molecular and external morphological characteristics. However, the osteological features of the species belonging to the genus Hynobius have not been examined, which has hindered the detailed understanding of morphological diversity in the genus. To address this problem, this study elucidated the osteological features of the salamander using micro-computed tomography scanning and whole-mount double staining methods. The articular, a part of the hypobranchial I, a part of coracoid, pubis, carpus, and tarsus were cartilaginous in small-sized individuals and were partially or completely ossified in large-sized individuals. The degree of ossification varied in the operculum, basibranchial II, and ascending process of the palatoquadrate. However, ossification was not associated with body size. The lacrimal, ossified manus, and ossified pes exhibited varying degrees of articulation or fusion irrespective of body size. Moreover, the cranium and tarsus of H. setouchi exhibited several unique characteristics. These osteological characteristics will aid in revising the taxonomy and phylogeny of the Hynobius species.

The medial tarsal area is a commonly used donor site for skin grafts to the digits and toes, with good color and texture match as well as a concealable donor site scar. Yet, there has been no report as a perforator free flap donor site. The purpose of this report is to present a new perforator flap harvested from medial tarsal region. We present a case of a soft tissue defect of the fifth toe due to essential thrombocythemia (ET), successfully treated with a free medialis tarsus flap (MTF) transfer. A 62-year-old male with ET suffered from the right fifth toe necrosis caused by digital artery thrombosis. After the manifestation of the necrosis, necrotic tissue was completely debrided, which resulted in a 3 × 1.5 cm skin defect with exposure of the tendon and the phalangeal bone. Sixth days after debridement, a 4.5 × 1.7 cm MTF was harvested transversely and inferiorly to the right medial ankle, locating the preoperatively detected posterior tibial artery perforator (PTAP) in the flap. Perforator-to-perforator anastomosis was done using the dorsal metatarsal artery perforator and the subcutaneous vein as recipient vessels. The donor site was closed primarily. Postoperative course was uneventful, and the reconstruction preserved the toe length and functions of extension and flexion at 9 months postoperatively. The patient could walk with conventional shoes by himself. MTF may be an option for small skin defect in the digits and toes where skin graft is not indicated.

Many sexual selection studies focus on conspicuous ornaments, such as long tails, but neglect to investigate inconspicuous traits. Here, we studied a well-known sexual selection mechanism, the Darwin–Fisher mechanism (i.e., breeding date selection), in relation to tarsus length in male barn swallows Hirundo rustica, a model species for sexual selection. When controlling for body size, we found that males with shorter tarsi started breeding earlier than those with longer tarsi. The current study indicates a selective advantage of short-legged males, explaining the reversed sexual dimorphism in tarsus length in this short-legged species.

Background: Conventional aponeurotic surgery for blepharoptosis has many advantages, but there is a potential for recurrence and lagophthalmos. The anatomy of the levator palpebrae muscle is relatively well studied, but the relationship of levator aponeurosis with surrounding layers is still controversial. This study aims to prove the presence of an anterior layer of the levator aponeurosis in clinical cases and to describe a technique involving its use for obtaining predictable outcomes in blepharoptosis correction. Methods: Between January 2014 and October 2018, 173 patients with blepharoptosis underwent correction surgery that involved relocating the anterior layer of the levator aponeurosis. During this procedure, after retracting the preaponeurotic fat pad, we could identify the misinserted anterior layer of the levator aponeurosis on the floor of the fat pad. The anterior layer was divided and advanced with posterior layers to 2 mm below the upper margin of the tarsus. After surgery, patients were followed up for 1 year, and surgical outcomes were evaluated. Results: After 1 year of follow-up, 95.4% of the examined patients showed good long-term outcomes. Moreover, although 4% showed moderate outcomes and lost the double eyelid skin crease, there was no ptosis recurrence in these patients and no lagophthalmos occurred in any of the 173 patients. Conclusions: The authors found the misinserted anterior layer of the levator aponeurosis at the floor of preaponeurotic fat pad in blepharoptosis patients. Relocation of the anterior layer can provide predictable outcomes without lagophthalmos in blepharoptosis correction.

Numerous solutions for post-blepharoplasty lower eyelid retraction are reviewed. Patients require permanent recruitment of skin and soft tissue to lengthen the lower eyelid and control of the lower eyelid shape. The authors use a hand-carved expanded polytetrafluoroethylene (ePTFE) implant held with microscrews to provide volume and felting material at the orbital rim and to permanently fix vertically lifted cheek soft tissue into the lower eyelid. The eyelid margin is also controlled with a hard palate graft inset into the conjunctival surface below the tarsus. This eyelid reconstruction avoids tension on the lateral canthoplasty, a point of failure in other solutions.

The subciliary lower eyelid blepharoplasty has evolved considerably to create a more harmonious natural appearance with a fuller and unoperated look and also to minimize the complications. While lower eyelid malposition was very common in the past, now this complication is significantly reduced by attention to preoperative evaluation, meticulous surgical planning, precise surgical technique, and postoperative care. Various prophylactic maneuvers maintaining/strengthening lower lid support can be utilized to prevent lower lid malposition including preservation of the pretarsal orbicularis oculi muscle, conservative resection of skin and muscle, and suspension of the orbicularis oculi muscle and/or tarsus to the periosteum of the lateral orbital rim. The release of the orbicularis retaining ligament and surgical transposition of orbital fat over the rim rather than excision allows for smoothing of the lid-cheek junction, filling the tear trough deformity, and reducing the appearance of bulging fat in the lower eyelid. In this article the reader will find a comprehensive approach for achieving a smooth contour with gradual blending at the lower eyelid–cheek junction while maintaining/restoring normal lower lid support. A descriptive outline of postoperative care is also provided to help in optimal healing for the patient.

Purpose The results of a technique with a double reinsertion of the aponeurosis to the tarsus and aponeurosis to Whitnall’s ligament (ATW) were compared with a simple reinsertion of the aponeurosis to the tarsus (AT) in acquired aponeurotic palpebral ptosis surgery. Methods Analytical, observational, retrospective, cohort study. Seven hundred and twenty-two consecutive cases with acquired aponeurotic palpebral ptosis have been treated surgically between 2000 and 2012 and have been followed up for 5 years. The cases were divided into two cohorts according to the applied surgical technique (AT vs ATW). Results The mean postoperative MRD after 1 month in cohort AT was 1 mm lower than in ATW (3 ± 0.9 mm vs 4 ± 1 mm). The mean MRD in the long-term follow-up (5 years) was 1 mm lower in cohort AT than in ATW (2.9 ± 1.5 mm vs 3.9 ± 0.9 mm). The rate of long-term recurrence (5 years) was 15% higher in A-T than in A-T-W (20% vs 5%). 70.5% of the eyes studied intra-surgically presented gaps between the Whitnall ligament and the aponeurosis, an anatomical area that we describe as the upper transition zone (UTZ). In an independent analysis, only those patients with open UTZ were evaluated and it was observed that those operated with A-T-W presented elevations greater than 1 mm compared to those operated with the AT technique (4 ± 0.9 mm A-T-W vs 2.8 ± 1 mm A-T) and a much lower recurrence rate (5.4% A-T vs 38.09% A-T-W). Conclusions In our study, the A-T-W technique achieved better results in terms of palpebral elevation and fewer recurrences compared to the A-T technique in all cases studied with aponeurotic ptosis. However, it particularly demonstrates its superiority in patients with large gaps in the UTZ.

Background Although Park's "orbicularis-levator fixation technique" has been widely used as a mature double-eyelid surgery in China recently. Shortcomings related to this method cannot be ignored. Thus, a reverse orbicularis-tarsus fixation technique in double-eyelid blepharoplasty has now been devised. The method is to create a physiological double-eyelid fold based on the formation mechanism of double-eyelid creases. Methods A retrospective study of 112 Chinese patients who underwent double-eyelid surgery between October 2017 and September 2019 was undertaken through a review of medical records. All these patients underwent a reverse tarsus and orbicularis oculi muscle fixation technique, with postoperative follow-up ranging from 6 months to 2 years. Postoperative outcomes were reviewed, evaluated, and analyzed. Results Altogether, 112 patients who underwent the double-eyelid surgery were reviewed. Among them, the results were judged as excellent in 104 cases (92.9%), good in 4 cases (3.6%), fair in 3 cases (2.7%), and poor in 1 case (0.8%). Clinical effectiveness was satisfactory in most of the patients (104/112, 92.9%). Only 5 patients (4.5%) expressed subjective dissatisfaction with postoperative outcomes; of these, 3 patients complained of eyelids asymmetry (2.7%). Two patients complained of eyelids scar formation (1.7%); Whereas surgical revision was required in only 1 patient (0.8%). Conclusions The reverse orbicularis-tarsus fixation technique for upper eyelid blepharoplasty is safe and effective, with better biomechanics and a satisfying aesthetic outcome. Therefore, this provides an alternative option in Chinese double-eyelid surgery.Level of Evidence: Level IV, case studies.

Introduction Tarsal malformation is a skeletal malformation of unknown aetiology associated with a variety of morphologic changes to the tarsal and metatarsal bones of the dog. Objective The aim of this study was to determine if early diagnosis and prevalence of tarsal malformation could be obtained at approximately 8 to 9 weeks of age in multiple litters of Bernese Mountain dogs. Methods A prospective study of 51 Bernese Mountain dog puppies were evaluated from 12 litters in northern Italy. Dorsoplantar radiographic views of the tarsus were obtained at 60 ± 5 days of age. Tarsal malformation was defined as an abnormal extension of the central tarsal bone on its medial side, or the presence of ectopic bone located medially to the central tarsal bone, talus and second metatarsal bones (proximomedial, distomedial and metatarsal ossification sites respectively). Results All puppies were found to be clinically normal. Thirty-nine of the 51 puppies showed ossification sites medial to the tarsus as defined. A metatarsal ossification was present in all dogs with either a proximo- or distomedial ossification site. No central tarsal bone extensions were observed. The remainder of the tarsometatarsal joints were normal. Clinical Significance Tarsal malformation can be identified in the 8- to 9-week-old Bernese Mountain dog. The clinical significance of tarsal malformation remains to be determined, either as an incidental finding or a precursor to the development of other clinically relevant and related issues in the tarsus.

Purpose: Complex upper eyelid lacerations can present to the emergency department after a myriad of trauma. The goal of the surgical repair is anatomical and functional recovery along with symmetrical cosmesis. Despite meticulous surgery, post traumatic blepharoptosis may develop. We describe an additional step during upper eyelid laceration repair to help mitigate the development of traumatic blepharoptosis. Methods: Patients with traumatic eyelid laceration without head injury, globe injury or associated orbital fractures, who were planned for a primary upper eyelid repair were included. Intraoperatively, wound margins and tissues were identified to establish anatomical continuity. After the LPS muscle was reinserted onto the tarsus, a single, central suture LPS plication – the “ central levator tuck” was performed. This helped in improving the muscle action as well as strengthening its reattachment onto tarsus. Results: Four cases underwent laceration repair with this modified technique. The nature of eyelid injury, surgical technique, and the outcome at 6 months is described. Three patients had a successful outcome, whereas one patient developed early scarring which reduced with scar therapy over time. Conclusion: We describe a simple and effective “central levator tuck” technique for traumatic eyelid laceration repair with optimal functional and cosmetic outcome while reducing the development of blepharoptosis in four patients.

There is evident variation in body size amongst Anthonomus santacruzi Hustache, 1924, weevils. The aims of this study were to assess if the variation in body size in A. santacruzi weevils is a result of sexual dimorphism and what features can be used to distinguish males from females. The weevils were collected from field sites in Mpumalanga, South Africa, where they were introduced as biocontrol agents of Solanum mauritianum Scopoli. Body structures and the presence/absence of the tergal notch was examined under an optical stereomicroscope and SEM to assess differences between sexes. The morphometric analysis of the body structures included rostrum length (base–apex and antennal insertion–apex), elytral length and width, pronotum length and width, first tarsus length, first tibia length, funiculus length and total body length. Rostrum length, elytra length and width and total body length were significantly larger in females than in males. A tergal notch in the 8th abdominal tergite was present in males and absent in females. The body structure; of rostrum length, elytra length and width and total body length overlapped between sexes in some specimens. The abdominal tergal notch was found to be the most useful body structure to distinguish males from females in A. santacruzi.

PurposeThe main aim of our study was to examine morphological differentiation between and within sex of hen fleas—Ceratophyllus gallinae(Schrank, 1803) population collected from Eurasian blue tit (Cyanistes caeruleusLinnaeus, 1758), inhabiting nest boxes and to determine the morphological parameters differentiating this population.MethodsA total of 296 fleas were collected (148 females and 148 males), determined to species and sex, then the following characters were measured in each of the examined fleas: body length, body width, length of head, width of head, length of comb, height of comb, length of tarsus, length of thorax and length of abdomen.ResultsThe comparison of body size showed the presence of two groups among female and male life forms of the hen flea, which mostly differed in length of abdomen, whereas the length of head and tarsus III were less variable.ConclusionTill now, the only certain information is the presence of two adult life forms ofC. gallinae. The genesis of their creation is still unknown and we are not able to identify the mechanism responsible for the morphological differentiation of fleas collected from the same host. In order to find answer to this question, future research in the field of molecular taxonomy is required.

The lower eyelid changes with aging include atrophy of the orbital septum with subsequent forward herniation of orbital fat, descent of the sub-orbicularis oculi muscle fat, ptosis of the orbicularis oculi muscle, weakening of the orbito-malar ligament and the development of laxity of the eyelid skin, the tarsus and the canthal tendons. In this article we aim at describing our experience of using a modified lower lid blepharoplasty with fat repositioning in patients with lower lid fat prolapse and tear trough deformity. A retrospective, non-randomised non-comparative interventional consecutive case series of patients seeking surgical treatment. Patients underwent surgery between April 2010 and October 2019 by a single surgeon (BL). Patient demographics, clinical examination, preoperative and postoperative clinical photography, outcomes and complications were recorded. Follow-up was initially at 2 weeks and finally at 16–20 weeks. Outcomes were recorded as subjective improvement and degree of patient satisfaction. A total of 150 patients were recruited in the study period. The mean age at the time of surgery was 49. One hundred forty-one (94%) patients were very satisfied with the final outcome of their surgery, 5 were satisfied and 4 were dissatisfied. One patient developed a bilateral lower lid infection requiring abscess drainage. Seventeen other patients experienced minor complications in the postoperative period, including 2 with a unilateral lower lid infection requiring oral antibiotics, 3 with a temporary inferior oblique palsy, 1 with temporary unilateral infraorbital nerve dysfunction, 3 with residual prolapses of the lateral fat pads, 1 with a medial lower lid lump, 2 with a conjunctival granuloma, 2 with a temporary medial ectropion, 1 with persistent unilateral lower lid oedema, 1 with persistent bilateral lower lid oedema and 1 with unilateral lower lid retraction. We report a high patient satisfaction with a low rate of significant complications following our modified lower lid transconjunctival blepharoplasty with fat repositioning. Level of evidence: Level III, therapeutic study

To present the differentiating clinical findings between intratarsal keratinous cyst (IKC) and chalazion. A retrospective review of medical records of all patients who presented between 2010 and 2018 at King Abdulaziz University Hospital with proven histopathological diagnosis of IKC was done. Complete ophthalmologic evaluation at presentation, surgical procedures performed, complications, histopathological findings, response to treatment and follow-up were recorded. Twelve patients were found to have IKC. All patients presented with an eyelid mass with no signs of local inflammation. All lesions were fixed to the tarsus with freely mobile overlying skin, which was found to be slightly pale compared to the surrounding skin in six patients. On palpation, IKC had well-defined boarders. Isolation with clear surgical plane for cyst excision was achieved in nine patients as they were superficially involving the tarsus. When IKC involved the deep part of the tarsus, bluish/ whitish nodules were seen upon eyelid eversion. Six patients were misdiagnosed and surgically treated as a chalazion elsewhere prior to presentation to us with recurrence. Differentiating IKC from chalazion can be challenging. Careful clinical evaluation helps reaching the right diagnosis and providing the correct treatment, which involves complete excision of IKC to prevent recurrence.

Aims To report the characteristics and management for patients with palpebral pleomorphic adenoma of the lacrimal gland. Methods The records for patients with palpebral pleomorphic adenoma seen at Moorfields Eye Hospital between 1978 and 2019 were reviewed for demographics, presentation, imaging, histopathology, management, and outcome. Results Forty-three patients (25 male; 58%) with palpebral pleomorphic adenoma were identified, presenting at a mean age of 46 years (median 46.4 years; range 24-81 years) with symptoms for an average of 31 months (median 18.0 months; range 1 month to 17 years). The commonest symptom was a painless upper lid lump (37 patients; 86%), although 4 patients (9%) had a localized ache, and 1 (2%) had episodic epiphora. A moderately-mobile, firm round mass (like a "chick-pea") was readily palpable in 39/43 (91%) patients, and significant ptosis and upper lid swelling was noted in 6 cases (14%). Imaging was reviewed in 35 patients, 28 (80%) having a well-defined homogeneous mass in front of the orbital rim, on the anterior pole of the lacrimal gland. With the exception of 8 tumors removed from the actual palpebral lobe using a conjunctival incision, all others were excised intact through an upper eyelid skin-crease incision. Histopathology confirmed an intact pseudocapsule in 39/43 (91%) and 10 (23%) had a mild chronic lymphocytic inflammation within the tumor and/or neighboring lacrimal gland. There were no tumor recurrences at an average follow-up of 40 months (median 9.1; range 2 weeks to 230 years). Conclusion Most palpebral pleomorphic adenomas are discovered as an upper lid lump and a few first become manifest as upper lid swelling with ptosis. To avoid inadvertent incisional biopsy, they should be recognized preoperatively-especially as most are readily palpable as a hard lump superotemporally, often freely mobile in the suborbicularis plane (anterior to the tarsus and main lacrimal gland). Excision, generally easiest through a transcutaneous route, was judged intact in all cases and confirmed in 91% of histological reports, with no recurrent tumors.

Purpose To examine the fine anatomic structures between levator aponeurosis and Muller muscle in front of the tarsus. Materials and methods Postmortem specimens of 6 Chinese males (5 elderly men, aging from 68 to 86 years; 1 child, 10 years old) were used. A 3-μm thickness sagittal section of the central part of the upper eyelid was prepared, and the samples were examined microscopically by using hematoxylin-eosin, Masson trichrome, and anti-smooth muscle actin antibodies staining. Results There are 2 new findings in this study, one is the posterior layer of the levator aponeurosis and the other is the extensions of Muller muscle. The posterior levator aponeurosis had different insertion patterns that approximately paralleled the extension line of the levator aponeurosis at the confluence of attachment site of the orbital septum on the levator superioris. Below the confluence, it took the form of a layered insertion, and then extended to the orbicularis oculi muscle and subcutaneous tissue rather than inserting directly into tarsus. The Muller muscle was a multilayered structure at the upper border of tarsus. The superior Muller muscle extended above the peripheral arcade, and the inferior Muller muscle tendon was attached to the surface of tarsus with an Umbrella-shaped fiber. Conclusions The authors discovered that the levator aponeurosis had different insertion patterns of the posterior layers. The Muller muscle gave branches at the peripheral arcade: the anterior one crossed the peripheral arcade and extended to the tarsus, and the posterior one attached and extended to the tarsus.

Both calcaneal and central tarsal bone fractures are commonly encountered in the racing greyhound. While isolated fractures of the numbered tarsal bones are uncommon, malleolar fractures are encountered frequently in small animal practice. Fractures of the central tarsal bone or calcaneal fractures in both dogs and cats may be either fatigue or stress fractures, or associated with Knees and Teeth Syndrome, which may alter the typically expected presentation and prompt assessment for additional fractures, both in the tarsus and elsewhere. Surgical stabilisation is often the treatment of choice, particularly for fractures with an articular component. In many cases, surgical stabilisation leads to a positive outcome, with Greyhounds often being able to return to racing. However, it is important to be aware that fractures in non-racing dogs tend to be more complex and that this good prognosis may not be appropriate to extrapolate. Depending on the nature and severity of injuries, joint preservation may not always be a realistic goal. If the joint cannot be preserved, arthrodesis may become necessary.

Background Blepharoptosis is a common and challenging clinical problem for oculoplastic surgeons, and various surgical techniques have been used to correct ptosis. The aims of this study were to present the clinical results of a modified technique using levator aponeurosis-Muller muscle-reinforced plication for blepharoptosis correction and to demonstrate its advantages over conventional advancement or plication methods. Methods This study was conducted in the Plastic Surgery Department of Sir Run Run Shaw Hospital between April 2017 and September 2018. By using this modified technique, the levator-Muller complex was reinforced with a plication suture that pierced under and through the levator-Muller complex, and the posterior and lower part of the levator-Muller complex was advanced to the tarsus, which provided permanent, reliable adhesion. The primary outcome was marginal reflex distance 1 preoperatively and postoperatively. Secondary outcomes were the cosmetic outcome, complications, and operative time. Results Eighty-six patients (169 eyelids) underwent this modified surgery. Patients' average age was 26 ± 7.6 years, and the median follow-up was 14 months. The preoperative and postoperative mean marginal reflex distance 1 values were 1.72 ± 0.32 and 3.69 ± 0.28 mm, respectively. The amount of plication ranged from 4 to 15 mm. The overall surgical success rate was 88.17%. Some complications were observed including undercorrection (5.92%), asymmetry (4.73%), lagophthalmos (0.59%), and conjunctival prolapse (0.59%). Conclusions The modified technique provided good functional and cosmetic outcomes for blepharoptosis correction by avoiding unpredicted adhesion, and it has its advantages including simplicity, easy adjustment of the eyelid height intraoperatively, minimal edema formation, and high success rate.

INTRODUCTION The floppy eyelid syndrome describes an eyelid disorder characterized by floppy tarsal plates that may be caused by a loss of elastin. The authors attempted to create floppy eyelids by digesting elastin from cadaveric tarsus and then treated them with cross-linking using ultraviolet A and riboflavin. METHODS Nine right and 9 left upper eyelids were excised from cadavers. Four vertical strips of central tarsus were removed from each eyelid. One strip of tarsus from each eyelid was treated with 10 units/ml of elastase for 2 hours. Another tarsal strip from each eyelid was immersed in normal saline for 2 hours (control). A third strip from the same eyelid was cross-linked using ultraviolet A at 6 mW/cm for 18 minutes. Finally, a fourth strip of tarsus was cross-linked in the same manner following treatment with elastase for 2 hours. A microtensile load cell was used to measure the Young modulus (stiffness) of each tissue. RESULTS Mean (standard deviation) Young modulus for controls (18.9 ± 3.6 MPa) was significantly higher than samples treated with elastase alone (6.6 ± 3.8 MPa, p

Objective To introduce the use of a CO2 laser for ablation of the orbicularis oculi muscle (OOM) in a modified Hotz procedure for correction of epiblepharon and to report its clinical outcome. Methods A retrospective consecutive study was conducted from August 2014 to January 2018. Patients who had undergone surgical correction for epiblepharon with the modified Hotz procedure and a CO2 laser ablation of OOM were included. The procedure includes a transverse subciliary incision with removal of a very small amount of skin using CO2 laser ablation. The ablation was carried out continuously on parts of the pretarsal portion and parts of the preseptal portion of the OOM inferior to the lower edge of the incised skin. Finally, the incised skin was closed and secured to the tarsus. The patients were followed for direct inspection of the wound, the direction of the lashes, and the status of the cornea. Results One hundred eyelids from 50 patients were enrolled. The average age was 6.4 years. The mean postoperative follow-up period was 14.3 months. In 90 eyelids (90.0%), the eyelashes were successfully outwardly everted. Undercorrections were noted in 10 eyelids (10.0%). To date, the cosmetic outcome was satisfactory in all cases without complications such as wound dehiscence, ectropion, and eyelid retraction. Conclusions A CO2 laser is a safe and effective alternative to the scalpel in the modified Hotz procedure to correct epiblepharon. Its advantages include limited skin excision, minimal bleeding during surgery, short operation time, and a satisfactory clinical outcome.

The aim of this study was to demonstrate the extent of preseptal orbicularis oculi muscle (OOM) override onto the pretarsal OOM in the lower eyelids. In this experimental microscopic study, 22 exenterated specimens from 22 Japanese cadavers were prepared as full-thickness sagittal sections. All exenterated specimens were devoid of lower eyelid entropion. The tarsal dimension and distance from the lower tarsal edge to the tip of overriding OOM were microscopically measured. The rotation axis of the tarsus was presumed to pass through the tarsal centroid and the distance from an estimated tarsal centroid to the lower tarsal edge was calculated. Consequently, 2 eyelids did not exhibit any overriding of the OOM. In the remaining 20 eyelids with OOM override, the average distance of the overriding OOM was found at a level covering 48.0% of the whole tarsal height. In 15 out of the 20 eyelids, the tip of the overriding OOM was located lower than the centroid. These microscopic findings suggest that overriding of the preseptal OOM does not always produce an inward rotational force on the tarsus.

Objective To establish a treatment protocol for severe blepharoptosis. This protocol helps to achieve improved accuracy and more stable correction outcome. Methods The levator muscle function was evaluated pre-operation. When the levator function was less than 1 mm, the frontalis suspension technique was performed; when the levator function was more than 1 mm, the techniques of levator resection, combined excision of the tarsus and levator, and tarsus–levator–CFS suspension were performed sequentially until a satisfactory correction result was achieved. Results A total of 389 patients with severe ptosis (561 eyes) were included; 102 eyes received levator resection, 314 eyes received combined excision of the tarsus and levator, 53 eyes received tarsus–levator–CFS suspension, and 92 eyes received frontalis suspension. In total, a satisfactory correction result was achieved in 466 eyes, while 95 cases still presented with under-correction. The symmetry findings showed that 107 (27%) cases presented good symmetry, 203 (52%) cases presented moderate symmetry, and 79 (21%) showed poor symmetry. Conclusion This new treatment protocol overcomes the drawbacks of the traditional strategy by standardizing the correction procedure, leading to improved accuracy and more stable correction results.

BackgroundFloppy eyelid syndrome is a disorder in which the tarsal plate is easily distensible and is currently treated with conservative or surgical measures. Human tarsal plate contains type I collagen, which is crosslinked in corneal tissue as a treatment for keratoconus. We hypothesized that collagen crosslinking would similarly stiffen tarsal plate tissue and investigated this in porcine and human tarsal plate specimens.MethodsRiboflavin-sensitized porcine and human tarsus samples were irradiated with ultraviolet-A light. Porcine experiments were analyzed with gross photographs, anterior segment optical computed tomography (AS-OCT) imaging, and tensile testing. A prospective study of human tarsus was performed on samples from patients undergoing wedge resection for floppy eyelid syndrome and was analyzed with AS-OCT and tensile testing.Results73 porcine adnexa and 9 patients (16 eyelids) who underwent wedge excision were included in the study. Grossly, greater stiffness was observed in crosslinked porcine tissue. AS-OCT imaging in porcine tissue showed a distinct hyperreflective band in crosslinked specimens whose area and intensity increased with longer treatment time (P = 0.003); this band was also visible in crosslinked human specimens. Tensile testing was performed, but results were not statistically significant.ConclusionsAS-OCT imaging, which has not been previously described for tarsal plate, showed a characteristic change in crosslinked porcine and human specimens. Tissue stiffness was increased grossly, but changes in tensile properties were not statistically significant. Further study is warranted to determine relevance as a potential treatment for floppy eyelid syndrome.

CASE DESCRIPTION A 3-year-old 27-kg female spayed American Bulldog with severe burn injuries caused by a gasoline can explosion was evaluated. CLINICAL FINDINGS The dog had extensive partial- and full-thickness burns with 50% of total body surface area affected. The burns involved the dorsum extending from the tail to approximately the 10th thoracic vertebra, left pelvic limb (involving 360° burns from the hip region to the tarsus), inguinal area bilaterally, right medial aspect of the thigh, and entire perineal region. Additional burns affected the margins of the pinnae and periocular regions, with severe corneal involvement bilaterally. TREATMENT AND OUTCOME The dog was hospitalized in the hospital’s intensive care unit for 78 days. Case management involved provision of aggressive multimodal analgesia, systemic support, and a combination of novel debridement and reconstructive techniques. Debridement was facilitated by traditional surgical techniques in combination with maggot treatment. Reconstructive surgeries involved 6 staged procedures along with the use of novel treatments including applications of widespread acellular fish (cod) skin graft and autologous skin cell suspension. CLINICAL RELEVANCE The outcome for the dog of the present report highlighted the successful use of maggot treatment and applications of acellular cod skin and autologous skin cell suspension along with aggressive systemic management and long-term multimodal analgesia with debridement and wound reconstruction for management of severe burn injuries encompassing 50% of an animal’s total body surface area.

Introduction Although several surgical methods have been introduced to treat mild-to-moderate blepharoptosis, including levator-based techniques such as Müller muscle–conjunctival resection, few complications and better functional and aesthetic outcomes remain elusive for plastic surgeons. Hence, this study aimed to provide a new technique (bridge technique) using the levator aponeurosis–Müller’s muscle flap to achieve optimal blepharoptosis correction for function and aesthetics among Asians. Methods From January 2019 to May 2020, this new technique was performed on 157 consecutive patients with mild-to-moderate blepharoptosis. Our technique was based on the anchor of the levator complex to the tarsus using mattress stitches and three-layer fixation, which provided a reliable motion transmitter for elevating the upper eyelid. The patients’ medical records and photographs were reviewed 12 months postoperatively to assess the margin reflex distance 1 (MRD1), incidence of complications, and aesthetic outcomes. Results The average preoperative and postoperative MRD1 measured 1.2 ± 0.31 mm and 3.7 ± 0.34 mm, respectively. A significant difference was observed between the preoperative and postoperative distance values (p

We describe a new species of Rhinella from montane forests between 1788 and 2305 m a.s.l. in the Departamentos Amazonas and San Martín, Peru. We tentatively assign the new species to the Rhinella festae species Group based on morphological similarities with its other 19 members. It is characterised by large size (maximum SVL 91.6 mm in females), a pointed and protruding snout that is posteroventrally inclined, absence of a visible tympanic annulus and tympanic membrane, long parotoid glands in contact with upper eyelid, presence of a dorsolateral row of enlarged tubercles, outer dorsolateral tarsus surface with a subconical ridge of fused tubercles, and absence of subgular vocal sac and vocal slits in males. One specimen from Departamento Amazonas tested positive for Batrachochytrium dendrobatidis.

We present the case of a Caucasian woman with a histology-confirmed granuloma faciale of the tarsoconjunctival surface of the eyelid. A 66-year-old female patient presented with a 1-week history of painless left upper eyelid mass without history of allergy, trauma, or ocular surgery. There was an elevated well-demarcated flesh-colored lesion within the tarsus. Diagnosis was confirmed by history of wedge biopsy, which demonstrated a mixed inflammatory cell infiltrate on a background of fibrosis with subtle focal leucocytoclasis. The lesion was fully excised without evidence of recurrence at follow up. Granuloma faciale is a rare disease often misdiagnosed clinically. Our case report is the first-documented granuloma faciale on the tarsoconjunctival surface of the eyelid and could suggest alternative pathogenesis in granuloma faciale development. Awareness of granuloma faciale as a nonmalignant for differential for tarsal lesions is important for treating clinicians.

Tarsal coalition is a condition characterized by abnormal connections between ≥2 tarsi. Although tarsal coalition is not rare, tarsal coalitions involving >2 tarsi are very unusual. In this report, we describe a case of multiple tarsal coalitions in a 24-year-old male who experienced progressively worsening pain for 3 to 4 months before presenting for care. This case was unique in that all the tarsal and tarsometatarsal bones in the foot were fused and formed 1 integrated tarsal. All of the metatarsals were fused as well, and the patient had no joints or ranges of motion in the hindfoot or midfoot. The patient's pain was responsive to anti-inflammatory medications, and no surgical intervention was necessary. To the best of our knowledge, this is the most extensive case of multiple tarsal coalitions described in the literature to date.

Aponeurotic ptosis is known to occur due to a wide variety of causes that lead to dehiscence of levator aponeurosis from the tarsal plate. We report here two cases with an unusual mechanism, resulting in this type of ptosis. Both the cases presented with spontaneous progressive drooping of upper lids, more on the right side, and gave a history of repeated playful eversion of upper lids. The first case underwent successful levator palpebrae superioris aponeurosis reattachment. Peroperatively, disinsertion and thinning of aponeurosis confirmed the diagnosis. Repeated habitual eversion of lids had probably caused stretching and mild chronic inflammation of the tarsus and lid retractors, leading to progressive thinning with disinsertion of the levator aponeurosis.

A child was referred for removal of an eyelid mass. She had preseptal cellulitis and a large tick deeply embedded in the tarsus of the upper eyelid necessitating antibiotic therapy and en-bloc excision of the tick with the attached eyelid portion. Large ticks that are embedded in the eyelid are best treated surgically with en-bloc excision of the tick and its attached lid. On the contrary, for small ticks involving the very superficial skin, fine-tipped tweezers can be used to grasp the insect. Ticks are vectors of several diseases like Lyme borreliosis, hence prophylactic antibiotic treatment and close observation are recommended.

Purpose: A follow-up experimental study on the exposure of animal tarsal plate to ultraviolet-A radiation aimed at establishing an optimum range for safe irradiation conditions. Methods: Sheep tarsus specimens were excised postmortem and then subjected to irradiation with ultraviolet-A rays (wavelength 365 nm) at higher irradiances than those reported in an initial study, using a laboratory radiation source. The mechanical properties (tensile strength and Young's modulus) of irradiated and nonirradiated samples were evaluated in a mechanical tester. The test and control specimens were examined histologically with an aim to assess the effects of radiation upon the meibomian glands and tarsal collagen networks, and to establish a safe range for the exposure irradiance level. Results: As expected, irradiation induced both stiffening and strengthening of the tarsal plate specimens. At an irradiance of 50 mW/cm(2) for 3-minute exposure, these effects were at their maximum level, after which a decline in mechanical characteristics were observed. No destruction of the tarsal connective tissue or the meibomian glands were noticed up to an irradiance of 125 mW/cm(2) for 3-minute exposure, corresponding to a fluence of 22.5 J/cm(2). Histology revealed that the collagen network surrounding the glands were packed more compactly following irradiation. At a fluence of 45 J/cm(2), massive destruction of periglandular collagen-rich network and meibocytes were demonstrated histologically. Conclusions: The study indicates that irradiation of tarsal collagen leading to tissue stiffening shall be carried out at levels of fluence between 10 and 15 J/cm(2), a region that is deemed safe. The exposure time can be adjusted according to the surgeon's decision.Safe irradiation conditions are established for the exposure of ex vivo ovine tarsus to ultraviolet-A radiation as a potentially effective treatment for eyelid laxity in human patients.

Squamous cell papilloma (SCP) is generally a human papillomavirus (HPV) induced exophytic or endophytic proliferation on the surface of the skin, oral cavity, larynx, esophagus, cervix, vagina, and anal canal. The endophytic type SCP can cause differential diagnostic difficulties with keratoacanthoma, inverted follicular keratosis, and squamous cell carcinoma; however, these lesions are not associated with HPV infection. The authors present a female patient who noticed an extremely rapidly growing tumor destructing the left lower eyelid. The histological analysis of the biopsy sample revealed a virus-induced squamoproliferative lesion. The eyelid affected was completely removed, and the histological examination resulted in a HPV induced endophytic squamous cell papilloma. The tarsus and the conjunctiva were replaced by a chondromucosal graft harvested from the nasal septum, while the skin defect could be closed directly. Restoration of the eyelid function has been achieved with satisfying functional and cosmetic results.

Purpose The objective of this paper is to describe and review our experience with Goldberg's small incision technique for use with involutional entropion. Methods Retrospective consecutive interventional case series with validated late surgical outcomes were reported. All involutional entropion cases with horizontal laxity of less than 8 mm were repaired with a small incision technique. Retractors were separated from the tarsus by blunt dissection made from three 4 mm horizontal incisions. Three 6-0 double-armed polyglactin sutures were used to tighten retractors and the orbicularis oculi muscle. The sutures were removed 3 weeks postoperatively or earlier if overcorrection continued during the first week of the postoperative period. Data were obtained for a postoperative follow-up period of at least 24 months. Results A total of thirty-seven lower eyelids from thirty-one patients with involutional entropion were included in the study. Primary operations were performed on 31 eyelids and reoperations on six eyelids. The mean follow-up time was 40 +/- 11 months. Thirty-six (97.3%) of the eyelids had no recurrence. As overcorrection was seen postoperatively in ten eyelids (27%), a number of sutures had to be removed earlier than planned. The ectropion eventually resolved, and no recurrence was seen during follow-up in these patients. Conclusions In our practice, the small incision technique has been highly effective in involutional entropion repair, with minimal complications. Although this approach does not directly address lateral canthal tendon laxity, the procedure has the advantages of being easy to learn and also that it can be combined with other procedures for tendon laxity.

A 55-year-old woman developed a painless, non-ulcerated left upper eyelid swelling over 6 months. Examination disclosed a fluctuant mass that permitted movement of the eyelid skin over the lesion. A full-thickness eyelid resection contained a well-encapsulated cyst with milky contents that was predominantly located in the tarsus. The cyst’s lining was partially composed of segments of ciliated respiratory-type and non-keratinizing squamous epithelia. Immunohistochemical evaluation with cytokeratins 17, 18, and 19 confirmed the staining pattern of a respiratory-type epithelial cell (whether or not cilia were present in the non-squamous epithelial zones). In the squamous region, entirely different cytokeratin results were obtained vis-a-vis the non-squamous regions of the lining. The current lesion is interpreted as congenital and representing an in situ persistence of embryonic ciliated glandular epithelium that normally exists only transitorily. A more remote possibility is that the lesion was the result of ectopic epithelial cells displaced from an adjacent sinus. A recurrence has not developed during 6 months of follow-up.

Injury of suspensory ligament (SL) branch is a frequently diagnosed problem in horses of different ages and disciplines. This case reports for the first time the ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) findings in a 10-year-old draught horse with traumatic chronic SL branch desmitis of 8 months duration. The horse had a grade 3 of 5 left hindlimb lameness with a moderately hot, painful, and diffuse swelling from the tarsus till the hoof. Ultrasonography, both SL branches appeared as enlarged hyperechogenic structures with poor demarcation of their margins and massive periligamentous echogenic materials consistent with fibrosis. Computed tomography showed no osseous lesions but did show enlarged, hypodense, and heterogeneous SL branches with an evidence of periligamentar and peritendenious adhesions and air entrapment areas intermingled within fibrous adhesion. Magnetic resonance imaging revealed no abnormal signal intensity received from the proximal part of SL and its body. There were high and intermediate signal intensities received from inflammatory fluid and periligamentar fibrous adhesions, respectively, around SL branches. Both CT and MRI findings were confirmed by gross postmortem examination. In conclusion, CT and MRI are valuable tools for diagnosis of extensive adhesions associated with chronic SL branch desmitis.

BACKGROUND: Reconstruction of large eyelid defects remains challenging due to the lack of suitable eyelid tarsus tissue substitutes. We aimed to evaluate a novel bioengineered chitosan scaffold for use as an eyelid tarsus substitute. METHODS: Three-dimensional macroporous chitosan hydrogel scaffold were produced via cryogelation with specific biomechanical properties designed to directly match characteristics of native eyelid tarsus tissue. Scaffolds were characterized by confocal microscopy and tensile mechanical testing. To optimise biocompatibility, human eyelid skin fibroblasts were cultured from biopsy-sized samples of fresh eyelid skin. Immunological and gene expression analysis including specific fibroblast-specific markers were used to determine the rate of fibroblast de-differentiation in vitro and characterize cells cultured. Eyelid skin fibroblasts were then cultured over the chitosan scaffolds and the resultant adhesion and growth of cells were characterized using immunocytochemical staining. RESULTS: The chitosan scaffolds were shown to support the attachment and proliferation of NIH 3T3 mouse fibroblasts and human orbital skin fibroblasts in vitro. Our novel bioengineered chitosan scaffold has demonstrated biomechanical compatibility and has the ability to support human eyelid skin fibroblast growth and proliferation. CONCLUSIONS: This bioengineered tissue has the potential to be used as a tarsus substitute during eyelid reconstruction, offering the opportunity to pre-seed the patient’s own cells and represents a truly personalised approach to tissue engineering.

Purpose: To study different tarsal cysts that share similar presentations and are commonly misdiagnosed clinically as a chalazion. Methods: A retrospective review of medical charts of all consecutive patients who presented eyelid tarsal-related pathology that needed surgical excision between 2010 and 2016 to a tertiary hospital was done. The data collected included preoperative, intraoperative and postoperative observations. Complete ophthalmologic examination at presentation, surgical procedures needed, complications, histopathological findings, response to treatment and follow-ups were recorded. Results: Out of 850 patients who had an eyelid tarsal-related pathology, ten patients were found to have an eyelid cystic lesion related to the tarsus. All patients presented with an eyelid mass with no sign of local inflammation. All lesions were fixed to the tarsus with freely mobile overlying skin. Five patients had a recurrent lesion that was misdiagnosed and surgically treated as a chalazion. All patients underwent a surgical removal of these cysts, and a histopathological examination was performed. An intratarsal keratinous cyst was found in six patients and epithelial inclusion cyst was in one patient. Two patients found to have cystic structure lined by double cuboidal epithelium with numerous goblet cells consistent with benign lacrimal duct cyst (Dacryops). Conclusion: Cysts related to the tarsal plate could have similar presentations. Careful clinical evaluation and histopathological examination play an important role in giving the right diagnosis and in providing the appropriate management. Keywords: Tarsal cyst, Intratarsal keratinous cyst, Benign lacrimal duct cyst, Epithelial inclusion cyst, Chalazion

PURPOSE Muller's muscle-conjunctival resection (MMCR) is a well-known approach for ptosis repair. In its standard fashion, it involves resection of Muller's muscle and conjunctiva, followed by suturing of the conjunctiva and Muller's muscle to the tarsus with absorbable or nonabsorbable sutures. The authors herein present their experience in performing MMCR without sutures. METHODS The study was conducted as a retrospective review of 19 patients (34 eyelids) undergoing sutureless MMCR. Thirty-three eyelids had acquired ptosis and 1 eyelid had congenital ptosis. Surgery consisted of a standard approach and placement of a Putterman clamp. Following excision of the clamped tissues, no internal sutures were placed. Preoperative and postoperative upper margin-to-reflex distances were measured and patients were evaluated for symmetry within 1 mm and the incidence of any complications. RESULTS Nineteen patients underwent 34 sutureless MMCR procedures. Of these, 13 patients had bilateral ptosis repair. Thirty-three of 34 eyelids (97%) showed improvement in margin-to-reflex distances, with an average improvement of 1.4 mm (range, 0-3.5 mm, SD = 0.64) among all patients. Eighteen of the 19 patients (94.7%) showed postoperative symmetry of margin-to-reflex distances within 1 mm (p < 0.001, χ test). One patient who underwent unilateral surgery demonstrated a Herring's response postoperatively, leading to the single case of asymmetry. There was 1 case of corneal abrasion seen postoperatively. CONCLUSIONS The sutureless technique is a rapid and effective method for performing MMCR. This technique is especially useful as an adjunct to blepharoplasty where mild ptosis exists for an added rejuvenating effect. It is low-risk and potentially corneoprotective when compared to the standard suture technique. Further studies could determine if a modified algorithm needs to be applied.

INTRODUCTION Auricular cartilage has been largely reported as an available substitute of defected tarsus to restore lower eyelid stability. However, undesirable results such as displacement, detachment, warping, down-gaze disturbance, and surface irregularity of the cartilage graft have been reported in previous reports, some of which require reoperations. In this study, the authors present a new technique to use strips of auricular cartilage with a local flap to restore the lower eyelid stability for a reliable eyelid support. METHODS From 2013 to 2018, the technique was carried out on 13 patients who suffered inadequate lower eyelid support with cicatricial retraction or ectropion and incomplete eyeball coverage, which was caused by soft tissue deletion secondary to different etiologies. Two kinds of local flaps were used to reconstruct the anterior soft tissue layer, whereas the posterior layer was supported with a π-shaped auricular cartilage. The preoperative and postoperative photographs were taken. Three indexes, including the vertical distance between inferior corneal margin and inferior palpebral margin, the maximal breadth of palpebral conjunctiva caused by ectropion, and the maximal palpebral fissure breadth when eyelid is closed, were measured before and 6 months after the operation to evaluate the operative effect. RESULTS The average follow-up was 32 months (range, 6-62 months). The local flap survived in all patients. No complications were seen in any of the patients. Postoperative average of the aforementioned first 2 indexes measured at 6 months was 0 mm, whereas the preoperative one was 2.69 and 1.08 mm, respectively. Postoperative average of the third index was also far more lower than the preoperative one (0.08 vs 2.77 mm). The difference between the preoperative and postoperative evaluation of the 3 indexes was statistically significant (paired t test, P < 0.001). No further intervention was required. CONCLUSIONS The present technique using a combination of π-shaped auricular cartilage and a local flap provides a satisfying horizontal and vertical support to maintain the lower eyelid in a normal position without compromising the mobility of the lower eyelid. This technique can be used as an effective and safe method for lower eyelid support.

Background Ixodes collaris Hornok, 2016 is a recently discovered tick species associated with bats in Asia. This study provides the description of the male and the larva, as well as high quality drawings of all stages. Methods Ticks were collected from cave walls and bats in Phia Oac (Vietnam). DNA was extracted from one individual of each stage/sex, while another was morphometrically analysed. Based on two genetic markers, all ticks were identified as I. collaris. Results The male of I. collaris has long legs (i.e. the length of Haller’s organ exceeds the maximum diameter of tarsus I), unlike the male of I. simplex Neumann, 1906, but similarly to males of I. vespertilionis Koch, 1844 and I. ariadnae Hornok, 2014. The lateral and medial edges of the palpi of male I. collaris are both convexly curved, unlike in I. ariadnae and I. simplex, but similarly to I. vespertilionis. The male of I. collaris has long palpal setae (up to 210 µm), unlike the males of I. ariadnae (30–100 µm) and I. simplex (20–80 µm), but similarly to I. vespertilionis (100–200 µm). Males of I. collaris have sparse distribution of long palpal setae (vs dense in I. vespertilionis) and posteriorly diverging, sclerotized trapezoid ridge dorsally on the basis capituli (posteriorly convergent, U-shaped and less evident in I. vespertilionis). The larva of I. collaris has long legs (unlike the larva of I. simplex, but similarly to I. vespertilionis and I. ariadnae), elongated club-shaped palpi (240 × 70 vs 200 × 90 µm in I. ariadnae, 200 × 70 µm in I. vespertilionis; and 140 × 60 µm in I. simplex:), pentagonal scutum, which is longer than broad (different from I. ariadnae and I. simplex, but similar to that of I. vespertilionis). The larva of I. collaris has strongly concave caudolateral margin of ventral basis with perpendicular angle (vs slightly concave, with obtuse angle in I. vespertilionis) and a prominent, dark sclerotized edge, “collar” (absent in I. vespertilionis). Conclusion Several features allow to distinguish the male and the larva of I. collaris morphologically from those of other bat-associated ixodid tick species.

Objectives To investigate the outcomes for correction of involutional lower eyelid entropion by wedge resection of the tarsus combined with the modified Hotz procedure. Design Retrospective study. Participants Patients with lower eyelid involutional entropion that was surgically repaired by wedge resection of the tarsal plate combined with the modified Hotz procedure. Methods In a consecutive series of 43 patients with involutional lower eyelid entropion, wedge resection combined with the modified Hotz procedure was performed with an average follow-up period of 29.6 months (range, 6–62 months). Results Among the patients, 93% had an excellent outcome within the follow-up period. For one patient, the outcome of both eyes was poor. For another patient, incision dehiscence of the eyelid margin in one eye occurred after the stitches were removed. The incision was sutured again, and it healed well. One patient complained of foreign body sensation in one eye after removal of the skin stitches. The complaint was resolved after wearing a corneal contact lens. No other significant complications occurred. Conclusions In our clinic, tarsal plate wedge resection combined with the modified Hotz procedure has been highly effective for correction of involutional lower eyelid entropion. Although this approach does not directly address lateral canthal tendon laxity, it does preserve the eyelid in case there is a future need for reconstruction due to ocular surface disease or trauma. Thus, wedge resection of the tarsal plate combined with modified Hotz procedure is a safe and effective method for involutional lower eyelid entropion.

Objective To describe a modification of trans-conjunctival, lower eyelid retractor advancement to correct tarsal ectropion. Design A retrospective case review. Participants Consecutive patients with lower eyelid tarsal ectropion. Methods Cases of lower eyelid tarsal ectropion, surgically corrected by advancement of inferior retractor to the lower border of tarsus via a transconjunctival approach, were identified. Lateral tarsal strip was also performed simultaneously in all cases. Results Twenty patients (25 eyelids) were included in this study. There were 19 primary lower eyelid tarsal ectropion and 6 recurrent tarsal ectropion. Complete resolution of tarsal ectropion was achieved in all patients postoperatively. Mean follow-up was 8.4 months (range 1–36 months). There were no cases of overcorrection, recurrent ectropion, suture abscess, wound dehiscence, or inferior fornix shortening after surgery. Conclusions Visualization of the lower eyelid retractor (white-line) and advancement to the inferior border of tarsus through a transconjunctival approach is effective in correcting both primary and recurrent cases of tarsal ectropion. This can be performed through a small conjunctival incision in the middle third of the lower eyelid, without the need for any excision of tissue or suture loop tie on the skin surface.

In 2012, construction works at the traditional olive market at Tarsus, in Eski Ömerli district, revealed large-scale architectural remains of the Roman period; the construction works were halted and a salvage excavation was initiated by Tarsus Museum. The remains that appeared at the first stage of the excavations were interpreted as those of a reservoir from the Roman Imperial period, stretching along a N–S axis. On the E side, a structure projects from the E wall of the reservoir, containing a pool that collects water flowing from drainage pipes set in the reservoir’s façade. The pool was extended in two stages in late antiquity.1 Two metres north of this pool and 3 m from the E wall of the reservoir, the excavations revealed a mosaic pavement (9.73 x 5.05 m), apparently forming part of the floor of a building running parallel to the reservoir’s wall (fig. 1).

Objective A majority of patients with senile entropion have a lower eyelid pouch. This study aimed to explore a modified method to correct the entropion and enhance ophthalmic cosmetology. Patients and methods Patients with senile entropion and lower eyelid pouches, who underwent anterior fascia of tarsus tightening combined with lower eyelid pouch plastic surgery from 2018 to 2019, were enrolled in the study. The data on operation time, postoperative effect, degree of eyelid swelling after surgery, patient satisfaction, and recurrence rate were recorded. Results The lower eyelid entropion was well corrected in all of the 46 patients after the surgery, and the lower eyelid pouch and saggy skin were satisfactorily repaired. After 1-year follow-up, no recurrence of lower eyelid eversion and ectropion was observed. The shape of the orbital areas was natural in all the patients, the incision scar was hidden, and the patient achieved a high degree of satisfaction. Conclusions In patients with senile entropion and lower eyelid pouch, anterior tarsal fascia tightening combined with lower eyelid blepharoplasty could not only increase the cure rate and reduce the recurrence rate but also achieve good appearance and improve patient satisfaction.

Purpose Surgery is the standard treatment for floppy eyelid syndrome, but crosslinking (CXL) tarsus has recently been proposed as an alternative. To the best of our knowledge, this study is the first to use second-harmonic generation (SHG) microscopy to examine tarsal collagen ex vivo before and after photo-activated crosslinking. To quantify crosslinking, this study examined fluorescence recovery after photobleaching (FRAP), which indirectly measures tissue stiffness. Methods Upper eyelid tarsal plates were dissected from 21 Sprague-Dawley rats (total of 42 tarsal plates). Six normal plates were sent for histopathology and SHG imaging; the remaining 36 were crosslinked with phosphate-buffered saline (PBS) alone or riboflavin in PBS (concentrations of 0.1%, 0.3%, and 0.5%). Tissues were irradiated with 365-nm ultraviolet A light (power, 0.45 mW/cm2) for 30 minutes and immediately underwent SHG microscopy. Stiffness was indirectly measured with FRAP using fluorescein isothiocyanate (FITC)-dextran. Results SHG imaging of normal tarsus showed that the organization of collagen bundles is complex and varies greatly depending on location. After crosslinking with high-concentration riboflavin (0.5%), collagen fibers showed clear structural changes, becoming more densely packed and wavier compared to control. FRAP half-time to fluorescence recovery was significantly increased (P < 0.05), indirectly indicating increased tissue stiffness. No structural changes were observed after crosslinking with lower riboflavin concentrations of 0.1% and 0.3%. Conclusions This is the first report of SHG microscopy used to image tarsus collagen before and after crosslinking. These results highlight collagen structural changes, with effects on tissue stiffness indirectly confirmed by FRAP. Translational Relevance Collagen fibers in the tarsus may be a therapeutic target for crosslinking in order to treat symptomatic floppy eyelid syndrome.

OBJECTIVE The aim of this study was to explore the effective technique of double eyelid surgery for mild, moderate, and severe sunken upper eyelid in Chinese. METHODS According to the degree of the sunken upper eyelid, different procedures were performed. For mild sunken upper eyelid, the key technique was named eyelid volume redistribution (EVR)-1 technique, which was advancing or folding the pretarsal orbicularis oculi muscle flap toward up to the upper margin of the incision. For moderate sunken upper eyelid, the EVR-2 technique included EVR-1 technique and releasing orbital fat toward the upper margin of the tarsus. The other surgical steps were the same as conventional double eyelid surgery. For severe sunken upper eyelid, 2 steps were needed. The first step was eyelid volume augmentation (EVA). This technique injected fat into the retroorbicularis oculi fat layer. The second step was conventional double eyelid surgery which was performed 3 to 6 months later. RESULTS One hundred sixty-seven patients with sunken upper eyelid underwent double eyelid surgery. In addition to the ameliorative recontouring of the sunken deformity, natural double eyelid was created. All patients had no complication, such as infection, skin irregularities, and lumps. The edema, bruising, and temporary ptosis recovered in 2 weeks. The edema resulted from double eyelid surgery, which last about 2 to 3 months. CONCLUSIONS Our study showed that EVR-1, EVR-2, and EVA techniques have stable surgical results for mild, moderate, and severe sunken upper eyelids in Chinese. The procedures are simple, safe, and have less complications and preferable clinical reference value.

BackgroundMagnetic resonance imaging (MRI) is the most versatile and informative imaging modality for the diagnosis of locomotor injuries in many animal species; however, veterinary literature describing the MRI of the dromedary camel tarsus is lacking. Our purpose was to describe and compare the MRI images of twelve cadaveric tarsi, examined in a 1.5 Tesla MRI scanner, with their corresponding anatomical gross sections. Turbo spin-echo (TSE) T1-weighted (T1), T2-weighted (T2), proton density-weighted (PD), and short tau inversion recovery (STIR) sequences were obtained in 3 planes. Tarsi were sectioned in sagittal, dorsal, and transverse planes. MRI images from different sequences and planes were described and compared with the anatomical sections.ResultsThe soft and osseous tissues of the dromedary camel tarsus could be clearly defined on MRI images and corresponded extensively with the gross anatomic sections. The obtained MRI images enabled comprehensive assessment of the anatomic relationships among the osseous and soft tissues of the camel tarsus. Several structure were evaluated that cannot be imaged using radiography or ultrasonography, including the transverse inter-tarsal ligaments, the talocalcaneal ligament, the short dorsal ligament, branches of the short medial and lateral collateral ligaments and the tarsometatarsal ligaments. Specific anatomical features regarding the dromedary camel tarsus were identified, including the fused second and third tarsal bone, an additional bundle of the short medial collateral ligament connecting the talus and metatarsus and the medial and lateral limbs of the long plantar ligament.ConclusionsMRI images provided a thorough evaluation of the normal dromedary camel tarsus. Information provided in the current study is expected to serve as a basis for interpretation in clinical situations.

Background: Mostly Upper eyelid cicatricial entropion (UCE) is a common cause of trichiasis which results from pathological process that causes scarring of the tarsus which leads to inward rotation of the lid margin. Objectives: The aim of the present study is to describe the use of lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella , tarsotomy , and tarsal overlap without external sutures. Patients and methods: This is a prospective consecutive interventional analytical study that included 40 eyes of 20 patients with age ranging from 40 to 80 years with trachomatous upper eyelid entropion presenting to the outpatient clinic of “Qena ” university hospital , Group patients were randomly selected according to the inclusion criteria to undergo the transcautenous margin rotation operation at qena university hospital &the surgery was explained to the patients . The study was approved by by the scientific and ethical comittees at faculty of medicine ,south valley university Results: The mean patients' age for was (56.0 ± 18.27) and a range of (40.0- 76.0) years , Among the 20 patients recruited, 9 (45%) were males and 11 (55%) were females , In our study, 20% of eyes among the TMR group underwent entropion correction and blepharoplasty for dermatochalasis in the same sitting. Out of 40 eyes in the study, 70% developed "grade II" and 30% developed "grade I" post operative lid margin position., Trichiasis recurrence rate was 10% in the studied group Recurrence was seen in four eyelids of four patients despite adequate post operative lid margin position. Conclusion: Upper eyelid cicatricial trachomatous entropion can be effectively managed utilizing the TMR , with no significant incidence in entropion or trichiasis recurrence