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N.N. Patel, N. Tucker; Measuring Eyelid Punctal Height for Surgical Planning in Lower Eyelid Tumor Removal . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5398.
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Purpose: Removal of lower eyelid tumors in the punctum may lead to incomplete blink, dry eye syndrome, and asymmetry between the eyes. This is mainly due to the formation of a scalloped lower eyelid, which results from closure by direct apposition of the wound. We propose that if the margins are closed by apposing the lateral edge of the wound higher than the nasal edge, one may alleviate this dilemma. This study was conducted to measure the height of the punctum in normal eyelids to determine the height at which the lateral edge should be elevated above the nasal edge. Methods: Lid measurements were taken in a group of normal patients between the ages of 19 and 65. 66 eyes of 33 (20 female, 13 male) patients were photographed. Patients with previous eye surgery were excluded. On the photographs, the middle of the medial canthus was connected to the lowest point on the lower eye lid with a straight line. The amount of lid margin that extended above this line was measured. Results: The mean measurement was 0.757 +/– 0.396mm. Measurements varied from 0mm to1.5mm, the median was 0.75mm. No significant difference was found between males and females. Conclusions: We found the mean punctal height to be 0.75 mm and concluded that when removing lower eyelid tumors by wedge resection, it is beneficial to appose the lateral edge of the wound 1 to 1.5 mm higher than the nasal edge. This preserves the contour of the lower lid even after the punctum is removed. This technique has not been previously described and if employed, decreases the incidence of unfavorable side effects and maintains symmetry between the eye.
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