We read the article titled ‘Ageing increases risk of lower eyelid malposition after
primary orbital fracture reconstruction’ by Rajantie et al with keen interest and
would like to appreciate the authors for their commendable work.
1
It truly is a comprehensive study which has been carried out systematically. We agree
with the outcome that ageing increases the risk of Lower Eyelid Malposition (LEM)
and acknowledge that the transconjunctival incision decreases the chances of LEM in
elderly patients. We understand that this is a retrospective study and is bound to
have certain limitations. However, we would like to highlight a few observations from
our perspective for the benefit of the readers.
- 1.The authors have rightly considered the ‘site of orbital fracture’ as one of the explanatory variables. Isolated medial wall fractures are rare. In contrast, the orbital rims, being prominent, are more prone to get involved in orbital trauma associated with zygomatic complex fractures. Therefore, isolated orbital rim fractures could have been included in the classification.
- 2.Postoperative records of the patient would most probably have had the information pertaining to the kind of wound sustained in the lower eyelid. Hence, it would have been better to classify traumatic wounds as abrasion, laceration, contusion, skin loss etc. Lacerations/skin loss would have had a worse impact than others and would have played a role in the healing of the wound.
- 3.It is well established in the literature that transconjunctival (TC) approaches lead to a lower incidence of ectropion/entropion and should be opted for whenever possible.2,3Hence this doesn’t add to the existing pool of literature. Instead, a study after the exclusion of all TC approaches could be carried out to find out which other approach can be used in ageing patients.
- 4.Extrinsic factors like smoking, nutrition, chronic sunlight exposure, alcohol use, and intrinsic factors like genetics have been suggested to play a role in the ageing mechanism. Gender differences like Tarsal plate/size and axial ocular globe projection have been proven to play a role in LEM.4This is because positive orbital vector causes more involutional entropion in women and the negative orbital vector causes more ectropion in men. Hence, prospective research with all the factors mentioned above may be carried out for a more robust outcome.
- 5.Data regarding existing comorbidities like diabetes, immunosuppression and drug history seem to be missing and should have been considered.
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References
- Ageing increases risk of lower eyelid malposition after primary orbital fracture reconstruction.Br J Oral Maxillofac Surg. 2022; 60: 1391-1396
- Subciliary vs. transconjunctival approach for the management of orbital floor and periorbital fractures: a systematic review and meta-analysis.J Craniomaxillofac Surg. 2017; 45: 1647-1654
- The reliability of the transconjunctival approach for orbital exposure: measurement of positional changes in the lower eyelid.Arch Craniofac Surg. 2017; 18: 249-254
- The influence of orbital vector on involutional entropion and ectropion.Orbit. 2018; 37: 53-58
Article info
Publication history
Published online: December 20, 2022
Accepted:
November 6,
2022
Received:
October 20,
2022
Identification
Copyright
© 2022 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
