cicatricial lagophthalmos

Cicatricial Lagophthalmos: A Condition Characterized by Eyelid Scarring

Cicatricial lagophthalmos is a type of mechanical lagophthalmos that occurs due to scarring of the eyelids. This condition can result from various factors, including:

• Chemical or thermal burns
• Ocular cicatricial pemphigoid
• Stevens-Johnson syndrome
• Mechanical trauma
• Eyelid surgery, such as excessive removal of eyelid skin or muscle (e.g., blepharoplasty, tumor excision)

The scarring can occur in any of the seven structural layers of the upper and lower eyelids, including:

1. Skin and subcutaneous tissue
2. Orbicularis oculi
3. Orbital septum
4. Orbital fat
5. Retraction muscles
6. Tarsal plate
7. Conjunctiva

As a result of this scarring, the eyelids may not close completely, leading to symptoms such as:

• Dry, itchy, watery eyes
• Corneal exposure and subsequent exposure keratopathy
• Excessive evaporation of the tear film

Cicatricial lagophthalmos can be caused by injury to any of these tissues, leading to a lack of eyelid closure. This condition requires prompt medical attention to prevent further complications.

References:

• [10] Cicatricial Lagophthalmos is due to scarring to the eyelids.
• [11] Cicatricial Lagophthalmos: Lagophthalmos caused by eyelid scarring is called a cicatricial type.
• [13] The eyelids are critical in protecting the cornea from injury and in maintaining tear film integrity. Lagophthalmos is the incomplete or abnormal closure of the eyelids and can lead to corneal exposure, excessive evaporation of the tear film, and subsequent exposure keratopathy.

Cicatricial lagophthalmos, a type of lagophthalmos caused by eyelid scarring, can manifest in several ways. According to the available information [12], signs and symptoms of this condition include:

• Exophthalmos: This refers to the protrusion or bulging of the eye from the orbit.
• Bell's phenomenon: A reflexive upward movement of the eye when attempting to close it, which can be a sign of lagophthalmos.
• Eyelid malposition: Abnormal positioning or alignment of the eyelids.

Additionally, cicatricial lagophthalmos can lead to other complications such as:

• Lagophthalmos: A condition where the eyelid cannot close completely, exposing the eye and potentially leading to exposure keratopathy.
• Exposure keratopathy: Damage to the cornea due to prolonged exposure of the eye.
• Ocular irritation: Redness, itching, or burning sensations in the eyes.

It's worth noting that cicatricial lagophthalmos can be caused by a variety of factors, including injury to any of the seven layers of the eyelid [12].

To diagnose cicatricial lagophthalmos, an eye care provider may conduct a series of tests to assess the condition and rule out other potential causes.

• A physical examination is typically performed to evaluate the eyelids and surrounding tissues. This may involve observing how forcefully the patient closes their eyes, measuring the eyelid margins, and counting how often the patient blinks.
• Laboratory tests such as a Complete Blood Count (CBC) can be used to evaluate the degree of systemic inflammatory response, which is often present in cicatricial lagophthalmos. Other laboratory tests may also be ordered to rule out differential diagnoses.
• Imaging studies such as ultrasound or MRI may be performed to assess the extent of tissue damage and scar formation.

The diagnosis of cicatricial lagophthalmos can be challenging, and a high level of expertise is often required to accurately diagnose and treat this condition. Early diagnosis and appropriate treatment are crucial to prevent complications such as corneal exposure and evaporation of the tear film.

Citations: * [7] Diagnostic tests of value include a CBC to evaluate the degree of systemic inflammatory response (leukocytosis, hyperfibrinogenemia, hypergammaglobulinemia) ... * [8] Physical examination and laboratory tests can also be used to determine the etiology of lagophthalmos and rule out the differential diagnosis. Other physical ...

Treatment Options for Cicatricial Lagophthalmos

Cicatricial lagophthalmos, a type of eyelid scarring that leads to incomplete closure of the eyelids, can be treated with various methods. While surgical interventions are often necessary, drug therapy can also play a crucial role in managing this condition.

Timely Moistening of the Orbital Surface

According to medical experts [12], drug therapy for cicatricial lagophthalmos is aimed at timely moistening of the orbital surface of the organ. This approach helps maintain the health and integrity of the eyelid tissue, reducing the risk of further complications.

Treatment Parameters

In some cases, laser treatment may be used in conjunction with other therapies to improve symptoms. For instance, a study on YSGG laser treatment [15] found that this method can lead to improvement in lagophthalmos and ocular surface staining (fluorescein). Treatment parameters for such procedures typically involve:

• YSGG laser (2790 nm)
• Treatment density: 5-15%
• Depth: 1-2 mm

While these treatment options can be effective, it's essential to consult with a medical professional to determine the best course of action for individual cases.

Differential Diagnosis of Cicatricial Lagophthalmos

Cicatricial lagophthalmos, a condition characterized by scarring of the eyelids leading to incomplete closure, has several differential diagnoses that must be considered for accurate diagnosis and treatment. Some of these include:

• Bell's Palsy: A neurological disorder that can cause facial paralysis, which may lead to lagophthalmos.
• Cicatricial Entropion: A condition caused by scarring of the conjunctiva and relative shortening of the posterior lamella, leading to entrapment of the eyelid margin.
• Lagophthalmos resulting in exposure keratopathy: A condition where lagophthalmos leads to exposure of the cornea, causing keratitis.
• Fornix reconstruction with oral mucosa grafts: May be required for cicatrizing conjunctivitis, cicatricial entropion, and lagophthalmos resulting in exposure keratopathy.

These differential diagnoses are important to consider when diagnosing cicatricial lagophthalmos, as they may require different treatment approaches. [10][11][13]

References:

• [10] Cicatricial Lagophthalmos. The upper and lower eyelids consist of seven structural layers.
• [11] Fornix reconstruction may also be required for cicatrizing conjunctivitis, cicatricial entropion, and lagophthalmos resulting in exposure keratopathy.
• [13] Table 1. Differential diagnosis of cicatrizing conjunctivitis