|Year : 1967 | Volume
| Issue : 3 | Page : 102-104
Cicatricial epicanthus following dacryocystorhinostomy and a new surgical approach to its correction
Department of Ophthalmology, King George's Medical College, Lucknow, U.P, India
|Date of Web Publication||21-Jan-2008|
K K Bisaria
Department of Ophthalmology, King George's Medical College, Lucknow, U.P
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bisaria K K. Cicatricial epicanthus following dacryocystorhinostomy and a new surgical approach to its correction. Indian J Ophthalmol 1967;15:102-4
Dacryocystorhinostomy is becoming more and more popular, thanks to advances in surgery and management of nasolacrimal duct stenosis. One of the complications is the development of an epicanthic fold following this surgery, which complication, though not uncommon, has not found a frequent place in ophthalmic literature.
Blair, Brown and Hamm (1932) have described a similar lesion as traumatic epicanthus, developing after nasal fracture and Spaeth (1948) favoured to retain the same term for such defects after rhino-plastic operations. DukeElder (1952) prefers the term "Pseudoepicanthus" for such an anomaly arising after injuries. Fox (1958) termed it as cicatrical epicanthus and stressed that such lesions are usually traumatic and are accompanied by medial ankyloblepharon, downward displacement of the medial canthus and injury to cauruncle and canaliculi.
As regards the surgical management of such a deformity only few techniques are described in the literature. Spaeth (1948) believes in the correction of traumatic epicanthus to be made by crescentic resection along with removal of two small triangles and the closure of wound edges in a "5" manner. Fox (1958) suggested that if cicatrical epicanthus is present in uncomplicated form, the same surgery as of congenital epicanthus with resection of scar tissue should be performed.
| Case Report|| |
B.B., a 45 year old woman came to us on May 5, 1965 for the treatment of a skin fold over the right medial canthus and inability to open the eye fully Her complaint followed an operation for epiphora 7 years ago.
There was a fold of skin arising from the mid point of a curved scar of dacryocystorhinostomy, which gradually became inconspicuous when traced towards the right upper lid. [Figure - 1].
It was partly covering the medial canthus. The fold became more prominent on elevation of the lid. On retracting the skin obliquely towards the bridge of the nose, the semilunar fold could be obliterated completely [Figure - 2] The lacrimal passage was partially blocked. The cornea, iris and fundus were normal. The visual acuity was 6/9.
The left eye was normal with visual acuity 6/6.
| Operative Procedure|| |
A semilunar piece of skin bearing the whole thickness was excised from the right side of the bridge of the nose.
The curved incision nearer to the skin fold was exactly parallel to its curvature whereas the distal part of the incision was more curved [Figure - 3]. (A). The skin edges were undermined and interrupted sutures were applied [Figure - 3] (B).
The cicatrical tissue at the mid point of operated scar of dacryocystorhinostomy was excised by two angled incisions [Figure - 4](A). Here the edges were well undermined to relieve the tension till the fold completely disappeared. The healthy skin tissue already resected from the side of the nose was used to put over this arrowhead bare area after shaping it properly and interrupted sutures were taken [Figure - 4] (B).
Examination carried out 5 days after the operation revealed good healing of wound edges of the grafted portion as well as that of the crescentic area. [Figure - 5] Sutures were removed on 7th post-operative day. The wounds had well healed up and epicanthal fold and ptosis had disappeared altogether [Figure - 6]
The patient was given four exposures of superficial X-ray therapy in the postoperative period.
| Discussion|| |
The case reported here showed the development of a post operative epicanthal fold as a complication. The associated feature was the presence of ptosis due to mechanical pull exerted by the skin fold.
The author has attempted a new technique to correct such deformity following dacryocystorhinostomy. The success of the operation was based on the resection of a crescentic portion of skin from the side of the nose which pulled the fold towards the bridge of the nose while the same resected skin piece was used as a graft to cover the raw area left after excision of the cicatrical tissue, to relieve the tension.
It is believed that such patients should preferably be given X-ray treatment to guard against development of hypertrophied scars or keloids in the operated area.
| Summary|| |
A rare case of acquired epicanthus of 7 years duration in a 45 years old woman is reported.
The following are the interesting features of the case.
1. The skin fold formed over the right medial canthus following dacryocystorhinostomy.
2. A new method of plastic repair giving good cosmetic and functional results is described.
| References|| |
Blair, V. P., Brown. J. B. and Hamm, W. G., (1932), Amer. J. Ophthal. 15. 498.
Duke-Elder. S.. (1952), Text Book of Ophthalmology, Vol. 5, P. 4653, Henry Kimpton, London.
Fox. S. A.. (1958). Ophthalmic Plastic Surgery, Ed. 2. P. 118. Gune and Stratton. New York.
Spaeth, E. B. (1948), Principles and Practice of Ophthalmic Surgery. Ed.. 4. p. 402. Lea & Febiger, Philadelphia.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]