Method for eliminating congenital epicanthus associated with blepharophimosis
The surgical method for congenital epicanthus correction through precise incisions and U-shaped sutures effectively addresses visible scars and tissue thickness issues, achieving a durable cosmetic improvement by aligning eyelid-nasal contours and reducing nasal bridge width.
Patent Information
- Authority / Receiving Office
- RU · RU
- Patent Type
- Patents
- Current Assignee / Owner
- FEDERALNOE GOSUDARSTVENNOE AVTONOMNOE UCHREZHDENIE NATSIONALNYJ MEDITSINSKIJ ISSLEDOVATELSKIJ TSENTR MEZHOTRASLEVOJ NAUCHNO TEKHNICHESKIJ KOMPLEKS MIKROKHIRURGIYA GLAZA IMENI AKADKA S N FEDOROVA MINISTSTVA ZDRAVOOKHRANENIYA ROSSIJSKOJ FEDERATSII
- Filing Date
- 2025-10-15
- Publication Date
- 2026-07-07
AI Technical Summary
Existing surgical methods for correcting congenital epicanthus associated with blepharophimosis result in visible scars, incomplete correction, excess tissue thickness, and high recurrence rates due to inadequate removal of subcutaneous tissue, particularly in the nasal area, leading to unsatisfactory cosmetic outcomes.
A surgical method involving precise skin incisions and U-shaped compression sutures to excise subcutaneous tissues, reposition the medial canthus, and align skin flaps, ensuring complete removal of connective tissue strands, with sutures fixed to periosteum and muscles to achieve anatomical contours and reduce nasal bridge width.
Achieves a complete cosmetic correction with reduced recurrence risk and improved aesthetic appearance by thinning the nasal bridge and aligning eyelid-nasal fossa contours without visible scars, addressing the limitations of previous methods.
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Abstract
Description
[0001] The invention relates to medicine, in particular to ophthalmology, and can be used for the surgical treatment of epicanthus.
[0002] Epicanthus tarsalis is a prominent skin fold in the medial canthus. In most cases, it is crescent-shaped and directed from the upper eyelid downward and medially; less often, the fold is formed on the lower eyelid and directed upward and medially. The presence of this anatomical feature is often perceived as a cosmetic defect, especially in representatives of the Asian population, where the incidence of epicanthus tarsalis reaches 40-90%. (Fatani, Dalal R.; Alsuhaibani, Omar S.; Alsuhaibani, Adel H. Cosmetic results of epicanthoplasty for epicanthus tarsalis. Saudi Journal of Ophthalmology. 2023; 37(2): 94-99.)
[0003] Patients with congenital epicanthus oculi associated with blepharophimosis require special attention from ophthalmic surgeons. The incidence of this pathology is approximately 1 case per 50,000 population. This variant of epicanthus oculi is considered the most difficult to surgically correct due to the severe deformation of the medial canthus.
[0004] The main anatomical features are: the presence of dense subcutaneous connective tissue, forming a protruding skin fold; smoothing of the bridge of the nose; shortening of the horizontal dimension of the palpebral fissure. In such patients, in addition to a pronounced cosmetic defect, a functional impairment may be observed - narrowing of the visual fields due to the overlap of the lacrimal caruncle and semilunar fold, which can inhibit the development of visual functions at an early age (Neuhouser AJ, Harrison AR. Blepharophimosis Syndrome. 2023 Apr 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. PMID: 37276318.; Pfeiffer MJ. Chirurgische Behandlung des medialen Epikanthus durch Hautersatz [Surgical Treatment of Medial Epicanthus by Skin Replacement]. Klin Monbl Augenheilkd. 2016 Jan; 233(1): 50-3. German, doi: 10.1055 / s-0041-109404. Epub 2016 Jan 21. PMID: 26797887.)
[0005] Various methods have been proposed for the surgical treatment of epicanthus.
[0006] The most famous ones are V and Y-plastics, double Z-plastics according to Mustard, which generally work well, mainly for the Asian group category.
[0007] The above-mentioned methods for surgical correction of congenital epicanthus have a number of technical and functional disadvantages: the need for skin incisions in the cosmetic area of the medial angle of the eye, with the risk of subsequent formation of visible coarse scars, a short-term cosmetic effect due to incomplete correction of the skin fold or the lack of effect from the surgical intervention, resulting in the need for repeated surgical treatment; the risk of cicatricial deformation of the medial angle of the eye with the formation of asymmetry in the horizontal size of the palpebral fissure.
[0008] A known method for eliminating epicanthus involves making a linear skin incision in the area of the inner corner of the eye, oriented above and medial to the epicanthal fold. After cutting the skin, a subcutaneous excision of a portion of the connective tissue strand that forms the epicanthal fold is performed. The final stage of the operation is suturing the incision with staged fixation of the skin and underlying tissues to the structures of the medial angle: the medial ligament, periosteum, tarso-orbital fascia and the levator aponeurosis of the upper eyelid. (Kataev M.G., Nerobeev A.I., Filatova I.A., Kononets O.A. Method for eliminating epicanthus / / Patent No. 2179424. Published February 20, 2002, Bulletin No. 5).
[0009] The disadvantages of this method include the formation of a postoperative scar, which remains visually noticeable in the cosmetically important area of the medial canthus—above the natural anatomical palpebral fold. Furthermore, this method does not sufficiently thin the subcutaneous tissue in the lateral nasal wall, resulting in excess soft tissue thickness and a visible skin fold in the bridge of the nose, which reduces the aesthetic effect of the surgery.
[0010] The Blair method is known, which consists of making linear multidirectional skin incisions in the area of the inner corner of the eye with excision of subcutaneous tissue in the area of the eyelid-nasal fossa and moving the skin flaps to a new position. (SA Fox. Ophtalmic Plastic Surgery. Grune and Stratton, NY, 1976, p. 475).
[0011] A disadvantage of this method is the formation of noticeable postoperative scars in an aesthetically important area—the medial canthus. Furthermore, the method does not provide sufficient thinning of the subcutaneous tissue in the projection of the lateral nasal wall, which can lead to the persistence of excess tissue thickness and, consequently, insufficient correction of the cosmetic defect.
[0012] A method for eliminating the epicanthus fold using the Limberg method of intersecting triangles is also known. This method involves longitudinally incising the skin fold in the epicanthus area, followed by two additional oblique incisions at an angle of 30-45° projected along its apices. After mobilizing the triangular skin flaps, they are rotated 90° in opposite directions, creating a new tissue position, after which layer-by-layer suturing is performed. (Zaikova, M.V., Plastic Ophthalmic Surgery. Moscow: Meditsina, 1980, pp. 34-35).
[0013] The disadvantage of this method is visible scars in the cosmetic area of the medial angle of the eye, maintaining the thickness of the subcutaneous tissue in the area of the lateral wall of the nose, creating the visual effect of a wide bridge of the nose.
[0014] The closest to the claimed method - the prototype is the method for treating epicanthus (Pinelis I.S. Method for Treating Epicanthus / / Patent No. 2348387. Published March 10, 2009, Bulletin No. 7). A horizontal skin incision is made from the inner corner of the eye, dissecting the epicanthus fold and continuing medially to its nasal border. Then, two diverging skin incisions are made from the lateral end of the horizontal incision, continuing them along the edge of the upper and lower eyelids. Skin flaps are separated. The tissues of the inner corner of the eye are separated and fixed to the periosteum of the lateral wall of the nose. The common medial apex of the skin flaps is aligned with the lateral end of the horizontal incision and fixed with one interrupted suture. The flaps are straightened along with the epicanthal fold, excess skin or scar tissue is excised, and the edges of the wound are adapted with interrupted sutures.
[0015] Disadvantages of the prototype:
[0016] - preservation of excess thickness of subcutaneous tissue in the area of the lateral wall of the nose, which is caused by the failure to remove the connective tissue structures that form the epicanthus, and leads to the effect of a wide bridge of the nose;
[0017] - lack of clear anatomical contours of the eyelid-nasal fossa in the postoperative period;
[0018] - high risk of recurrence of deformation, or insufficient cosmetic result due to the preservation of deeply located connective tissue formations of the epicanthus in the area of the eyelid-nasal fossa and the lateral wall of the nose.
[0019] The purpose of the invention is to develop an effective method for eliminating congenital epicanthus associated with blepharophimosis.
[0020] The technical result is a high aesthetic result of the operation to eliminate congenital epicanthus associated with blepharophimosis, and a reduced risk of relapse.
[0021] The invention is illustrated by drawings:
[0022] Fig. 1. Skin incisions.
[0023] Fig. 2. Subcutaneous tissue excision zone.
[0024] Fig. 3. Application of 8 U-shaped compression sutures.
[0025] Fig. 4. Displacement of the medial angle of the eye with fixation in a new position and excision of excess skin.
[0026] Fig. 5. Closing the formed incisions.
[0027] 1. First cut,
[0028] 2. The starting point of the first cut,
[0029] 3. Eyelid commissure,
[0030] 4. Second cut,
[0031] 5. The area of the palpebral-nasal fossa, the lateral wall of the nose and the beginning of the orbital-palpebral fold of the lower eyelid,
[0032] 6. U-shaped compression seams,
[0033] 7. U-shaped seam,
[0034] 8. Threads,
[0035] 9. Horizontal skin incision,
[0036] 10. Point of new position of the medial commissure of the eyelids,
[0037] 11. Excess skin,
[0038] 12. Nodal skin sutures.
[0039] The technical result is achieved as follows. To create surgical access, two skin incisions are made (Fig. 1). The first incision (1), 10 mm long, is made from point (2), located 2 mm medial to the palpebral commissure (3), towards the upper eyelid, 4 mm above the lash line. The second incision (4), also 10 mm long, is made from the starting point of the first incision (2), towards the lower eyelid, 2 mm below the lash line.
[0040] From the formed access (Fig. 2), a skin flap is prepared and in the zone (5) from the palpebral-nasal fossa from above, not reaching 3 mm to the central line of the bridge of the nose medially, to the beginning of the orbital-palpebral fold of the lower eyelid from below, subcutaneous tissues are excised, including the connective tissue strand of the epicanthus, subcutaneous fat, with complete exposure of the medial ligament of the eyelids, the orbicularis oculi muscle and the nasal muscle.
[0041] Next, 8 U-shaped compression sutures (6) using 6 / 0 polypropylene thread are placed in the area of the palpebral-nasal fossa, the lateral wall of the nose, and the beginning of the orbital-palpebral fold of the lower eyelid (5) (Fig. 3). The sutures are placed through the skin and fixed to the periosteum and the orbicularis oculi muscle, resulting in a new position of the prepared skin flap on the lateral surface of the nose, visually reducing the width of the bridge of the nose.
[0042] Then a U-shaped suture is placed with 6 / 0 polypropylene thread (7) through the medial commissure of the eyelids to the periosteum of the posterior lacrimal crest and back, the threads (8) are pulled up, maximally moving the medial corner of the eye towards the nose to the starting point of the first two incisions (2), the threads are tied with four knots.
[0043] Next, a horizontal skin incision (9) is made from the starting point of the first two incisions (2) to the new position of the medial commissure of the eyelids (10), the skin flaps are aligned without tension, and the resulting excess skin is excised (11) (Fig. 4). Interrupted skin sutures (12) are applied to the aligned skin flaps to close the formed incisions (Fig. 5). All sutures are removed on the 10th day after surgery.
[0044] Advantages of the proposed method
[0045] - a complete cosmetic effect is achieved by forming the correct relief of the lateral surface of the nose, restoring the contours of the eyelid-nasal fossa of the upper eyelid, and the orbital-palpebral groove of the lower eyelid.
[0046] - absence of deformation of the shape of the palpebral fissure due to its lengthening, as a result of the movement of the internal commissure of the eyelid;
[0047] - visual reduction of the width of the bridge of the nose and, accordingly, improvement of the patient’s aesthetic appearance;
[0048] - the frequency of epicanthus recurrence in the late postoperative period is reduced due to complete excision of subcutaneous fat in the area of the inner corner of the eye;
[0049] - there are no rough visual scars, since the incisions are made in the anatomical folds of the eyelids.
[0050] Example. Patient Ch., 2 years old, was hospitalized with a diagnosis of congenital blepharopalpebral syndrome in both eyes. Complaints: an additional skin fold in the inner corners of both eyes, drooping of the upper eyelids. No surgeries have been performed.
[0051] Objectively: a crescent-shaped skin fold is visible in the inner corners of both eyes, extending from the lower to the upper eyelid, completely covering the lacrimal caruncle. The upper eyelid is ptotic (MRD 1 index is 0 mm). The palpebral fissure of both eyes is shortened due to an inverse epicanthus. The skin surface relief between the inner corner and the bridge of the nose is prominent. A standard examination revealed no associated ophthalmological pathology.
[0052] The patient underwent surgery on both eyes using the proposed method.
[0053] Two skin incisions were made on the right eye to create the surgical access. The first, 10 mm long, was made from a point 2 mm medial to the palpebral commissure, toward the upper eyelid, 4 mm above the lash line. The second, 10 mm long, was made from the starting point of the first incision, toward the lower eyelid, 2 mm below the lash line.
[0054] From the formed access, a skin flap was prepared and in the area from the palpebral-nasal fossa from above, not reaching 3 mm to the central line of the bridge of the nose medially, to the beginning of the orbital-palpebral fold of the lower eyelid from below, subcutaneous tissues were excised, including the connective tissue strand of the epicanthus, subcutaneous fat, with complete exposure of the medial ligament of the eyelids, the orbicularis oculi muscle and the nasal muscle.
[0055] Next, in this area of the eyelid-nasal fossa, the lateral wall of the nose and the beginning of the orbital-palpebral fold of the lower eyelid, 8 U-shaped compression sutures were placed with 6 / 0 polypropylene thread - through the skin and fixing them to the periosteum and the orbicularis oculi muscle, as a result of which a new position of the prepared skin flap of the lateral surface of the nose was formed and the width of the bridge of the nose area was reduced.
[0056] Then, using 6 / 0 polypropylene thread, a U-shaped suture was placed through the medial canthus of the eyelids to the periosteum of the posterior lacrimal crest and back. By tightening the threads, the medial angle of the eye was moved as far as possible toward the nose, toward the starting point of the first two incisions. The threads were tied with four knots.
[0057] Next, a horizontal skin incision was made from the starting point of the first two incisions to the new position of the medial canthus. The skin flaps were aligned without tension, and the resulting excess skin was excised. Interrupted skin sutures were placed on the aligned skin flaps to close the incisions.
[0058] Similarly, the operation was performed on the left eye.
[0059] On the first postoperative day, the aseptic dressing was removed. The patient had no complaints. Tissue swelling was observed in the postoperative wound area in both eyes. The skin sutures were clean and adequate.
[0060] The scheduled inspection was carried out on the 10th day.
[0061] The patient has no complaints. Objectively, there is no tissue swelling in the surgical area in both eyes. There is no epicanthus. The skin sutures are clean and adequate and have been removed.
[0062] At a follow-up examination four months after surgery, the patient had no complaints. Epicanthus is gone, the palpebral fissure has lengthened by 3 mm in each eye, and the bridge of the nose has narrowed. Thin, barely noticeable, whitish scars are present on the skin in the inner corner of both eyes.
Claims
A method for eliminating congenital epicanthus associated with blepharophimosis, including making skin incisions in the projection of the medial angle of the eye, removing subcutaneous tissues, excising excess skin, characterized in that from a point located 2 mm medial to the commissure of the eyelids, in the direction of the upper and lower eyelids, two skin incisions 10 mm long are made in the direction of the upper eyelid at a distance of 4 mm above the eyelash line and towards the lower eyelid at a distance of 2 mm below the eyelash line, then from the formed access, a skin flap is prepared and in the area of the eyelid-nasal fossa, the lateral wall of the nose and the beginning of the orbital-palpebral fold of the lower eyelid, subcutaneous tissues are excised, including the connective tissue strand of the epicanthus, subcutaneous fat, with complete exposure of the medial ligament of the eyelids, the orbicularis oculi muscle and the nasal muscle, and 8 U-shaped compression sutures are applied through the skin with fixation to periosteum and orbicularis oculi muscle,then a U-shaped suture is placed through the medial commissure of the eyelids to the periosteum of the posterior lacrimal crest and back, the threads are pulled up, moving the medial corner of the eye towards the nose to the starting point of the first two incisions, the threads are tied with four knots, then a horizontal skin incision is made from the starting point of the first two incisions to the point of the new position of the medial commissure of the eyelids, the skin flaps are combined without tension, the formed excess skin is excised, interrupted skin sutures are placed on the combined skin flaps.