Palpebral fissures occur when the fibrous tissue in the cerebrospinal fluid moves into a narrow canal. The precise location of this focal point within the brain is not known. There are two types of this problem: one is called a primary and the other is called a secondary. In the primary, the opening of this canal is close to the surface of the cerebral wall and does not affect the level of cerebral blood flow. In the second case, the opening is deep within the brain.
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Outside Canthal Distance
The palpebral fissure length is derived from both the inside anthill and the outside canthal distances measured at various age levels. The mean value of palpebral fissure height at birth (1.279 +/-0.27 cm) is almost exactly what it should be: an indicator that the infant is healthy. The height continues to increase until about age six months or so when the child is usually tired and weak. Thus, the measurement of this point along the midline of the forehead does not indicate intelligence.
Facial Asymmetry
If the infant has a prolonged period of neck pain accompanied by decreased vision, seizures, difficulty learning to speak or swallowing, this may be an indication of a chronic condition such as sleep apnea. Studies in infancy show that some infants with a history of sleep apnea have shorter than normal palpebral fissures, whereas others have longer than normal openings. In addition, sometimes the enlarged upper lid skin (rhomborollis) can be associated with facial asymmetry. Thus, surgery to correct the appearance of facial asymmetry can be a useful adjunct to the management of facial asymmetry in infancy. Rhomborollis of the lower eyelid skin may be corrected through a reduction of fat in this area.
Infantile Blepharoplasty
The other common type of cosmetic surgery for infantile blepharoplasty is blepharoplasty for augmentation. This term refers to the removal of extra skin, which may include the upper lid or eyebrows. The effect of adding extra skin to these areas is to raise the eyelid. Some infants with large blepharoplasty scars (over half the total length of the nose) may have their upper lids drooped over their eyes. This condition is known as “raccoon’s face.”
Lengthening The Length of Palpebral Fissure
A method of treating long-term symptoms of palpebral fissure involves lengthening the length of the palpebral fissure. The term for this procedure is “interpupillary distance.” The interpupillary distance is the distance between the lower eyelid and the upper lid. The length of this distance, measured in millimeters, has been found to be very effective in correcting long-term facial asymmetry. In some cases, additional eyelid reshaping may be necessary for addition to lengthening the interpupillary distance.
Computerized Photographic Analysis
Another method used to treat long-term palpebral fissure symptoms involves the use of computerized photographic analysis. Computerized photographic analysis can be used to evaluate the relationship between facial asymmetry and the degree of forehead recession, which may be indicative of facial asymmetry. Computerized photographic analysis can also be used to analyze facial asymmetry and the effects of aging on this disorder. Older adults are often found to have more severe forms of palpebral fissure, which makes the treatment of this disorder particularly challenging.
Intercanthal Distance
One common surgical procedure for treating the disorder involves intercanthal distance. The intercanthal distance refers to the distance between the lower eyelid and the upper lid. When this distance becomes too short or reaches a significant difference, the patient may benefit from palpebral fissure surgery. Patients may also benefit from intercanthal distance lengthening. In this procedure, the upper intercanthal distance is extended, generally by an additional 2 millimeters. Which can significantly improve the patient’s appearance. Additional procedures may also be recommended by a plastic surgeon for patients suffering from severe forms of the palpebral fissure.
Levator Aponeurosis
For patients suffering from eyelid droops, drooping eyelids, and excessive wrinkling of the upper eyelids. A plastic surgeon can recommend the surgical treatment of levator aponeurosis or levator reticularis syndrome. The treatment involves removing the excess tissue from around the upper eyelid or making changes in the structure of the levator muscle. Which causes the muscle to straighten out. Digital image analysis and computerized tomography (CT) scan will provide additional information about the condition and its treatment options. Proper diagnosis and management of this condition are critical for patients’ visual ability to function daily. So it is important to undergo appropriate medical care.