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Avisar I, Norris JH, Selva D, Malhotra R. Upper-Eyelid Wick Syndrome: Association of Upper-Eyelid Dermatochalasis and Tearing. Arch Ophthalmol. 2012;130(8):1007–1012. doi:10.1001/archophthalmol.2012.1340
Author Affiliations: Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, England (Drs Avisar, Norris, and Malhotra); and Discipline of Ophthalmology and Visual Sciences, University of Adelaide, and South Australian Institute of Ophthalmology, Adelaide, Australia (Dr Selva).
Objective To highlight a case series of patients manifesting epiphora and misdirection of tears laterally or along the upper-eyelid skin crease. This association has been termed upper-eyelid wick syndrome. We describe the clinical features and outcomes of management of these patients.
Methods A retrospective review of patients referred to 2 oculoplastic centers during a 6-year period for epiphora, who were considered to have misdirection of tears related in some way to upper-eyelid dermatochalasis.
Results Nine patients (7 women and 2 men; mean [SD] age, 61.2 [11.3] years, range, 41-76 years) with bilateral epiphora and lateral spillover (100%), occasionally combined with upper-eyelid wetting (n = 2). All patients had upper-eyelid dermatochalasis. Five patients had upper-eyelid skin obscuring and in contact with the lateral canthus (type 1), and in 4 the lateral canthus was only partially obscured by upper-eyelid skin (type 2). Five patients (56%) had linear excoriation of skin in the lateral canthus. All patients underwent upper-eyelid blepharoplasty, 3 combined with ptosis repair and 3 combined with eyebrow-lift. All patients achieved 80% to 100% improvement in epiphora following surgical intervention to the upper eyelid. The mean (range) follow-up was 2.8 (1-6) years.
Conclusions We defined upper-eyelid wick syndrome as the misdirection of tears laterally or along the upper-eyelid skin crease causing epiphora, related in some way to upper-eyelid dermatochalasis. In all cases, epiphora improved with treatment of upper-eyelid dermatochalasis. Although recognized among physicians, this has never been formally described in the ophthalmic literature, to our knowledge.
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