1: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):165-6. 

Exacerbation of undiagnosed ocular cicatricial pemphigoid after repair of
involutional entropion.

Hatton MP, Raizman M, Foster CS.

Ophthalmic Consultants of Boston, Boston, MA, USA. mphatton@eyeboston.com

We report a case of exacerbation of undiagnosed ocular cicatricial pemphigoid
after repair of involutional entropion. A lateral tarsal strip was performed to
address entropion in the setting of eyelid laxity. No evidence of ocular
cicatricial pemphigoid was observed before surgery. Postoperatively the patient
developed intense conjunctival inflammation and diffuse symblepharon formation.
Conjunctival biopsy demonstrated immunoglobulin and complement deposition at the
basement membrane consistent with ocular cicatricial pemphigoid. Clinicians
should be aware of the possibility of underlying ocular cicatricial pemphigoid
in all patients with entropion, including those without a cicatricial component.

Publication Types:
    Case Reports

PMID: 18356734 [PubMed - indexed for MEDLINE]

2: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):164-5. 

Endocrine mucin-producing sweat gland carcinoma of the eyelid.

Mehta S, Thiagalingam S, Zembowicz A, Hatton MP.

Boston University School of Medicine, Massachusetts General Hospital, Boston,
MA, USA.

A 70-year-old woman was examined for a 4-mm bluish nodule in the left upper
eyelid. The lesion was excised and pathology showed it to be endocrine
mucin-producing sweat gland carcinoma with positive margins. She underwent Mohs
surgery and reconstruction of the resulting defect. Clinicians should be aware
of this entity given its association with invasive mucinous adenocarcinoma, a
locally aggressive tumor with metastatic potential.

Publication Types:
    Case Reports

PMID: 18356733 [PubMed - indexed for MEDLINE]

3: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):162-4. 

Palpebral subconjunctival hemorrhages in herpes zoster ophthalmicus.

Najjar DM, Youssef OH, Flanagan JC.

Department of Ophthalmology, Temple University Hospital, Philadelphia, PA 19140,
USA. danynajjar@hotmail.com

A 75-year-old previously healthy woman was referred for evaluation of pain and
foreign body sensation in her left eye of 4 days\' duration. Two weeks before
presentation she was diagnosed with herpes zoster involving the left forehead
and temple area and started on famciclovir treatment. Examination of her left
cornea revealed inferior superficial punctate keratitis, but no dendrites or
pseudodendrites. Upper eyelid eversion disclosed unusual raised palpebral
subconjunctival hemorrhages on the left side. She was started on topical
prednisolone eyedrops in the left eye, and her symptoms improved over the
following week. Herpes zoster ophthalmicus can initially present in the eyelids.
Careful follow-up with particular attention to the eyelids and eyelid eversion
is recommended in any patient presenting with herpes zoster to detect early
ocular involvement.

Publication Types:
    Case Reports

PMID: 18356732 [PubMed - indexed for MEDLINE]

4: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):160-2. 

Epiphora in the presence of a simulated mucocele secondary to nasal polyposis in
a patient with samter triad.

Figueira EC, Boustred N, Wilcsek GA.

Ophthalmic Surgery Centre, Chatswood, NSW, Australia.

A 69-year-old man was referred with epiphora and soft-tissue swelling in the
left nasolacrimal sac region. Ipsilateral Jones 1 and 2 tests were negative. On
attempting sac "wash out" via the left lower canaliculus, there was fluid reflux
from the left upper canaliculus. CT revealed bony erosion of the lacrimal and
frontal process of the maxillary bone by nasal polyposis. T2-weighted axial MRI
demonstrated severe bilateral intranasal polyposis with those on the left
pushing the lacrimal sac laterally and simulating a mucocele. Transnasal
polypectomy re-established physiologic tear drainage and relieved the swelling
in the region of the lacrimal fossa. This case emphasises the importance of
routine nasal endoscopy as part of the assessment of the lacrimal system.

Publication Types:
    Case Reports

PMID: 18356731 [PubMed - indexed for MEDLINE]

5: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):158-60. 

Congenital lacrimal sac fistula: intraoperative visualization by polyvinyl
siloxane cast.

Bhatnagar A, Eckstein LA, Douglas RS, Goldberg RA.

Orbital and Ophthalmic Plastic Surgery Division, Jules Stein Eye Institute,
UCLA, Los Angeles, CA, USA. draparnab@gmail.com

We report the intraoperative use of polyvinyl siloxane impression material to
demonstrate the anatomy of the lacrimal sac, canaliculi, and lacrimal duct in a
case of congenital lacrimal sac fistula. A 1-week-old boy was examined for
tearing since birth. Examination revealed a left congenital lacrimal sac
fistula. After a failed surgery to close the fistula with silicone intubation at
6 months of age, the patient underwent endonasal dacryocystorhinostomy performed
at 14 months of age, aided by intraoperative injection of polyvinyl siloxane
(trade name Reprosil) to mark and protect the nasolacrimal sac and facilitate
endonasal visualization. A polyvinyl siloxane cast demonstrated the anatomy of
the accessory canaliculus causing nasolacrimal duct obstruction.
Postoperatively, the epiphora resolved and the fistula remained closed. The
polyvinyl siloxane cast provides a 3-dimensional "ex vivo " model of the
lacrimal sac, upper duct, and canalicular anatomy, and can be used in
dacryocystorhinostomy surgery to identify and protect the lacrimal sac.

Publication Types:
    Case Reports

PMID: 18356730 [PubMed - indexed for MEDLINE]

6: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):156-8. 

Unilateral orbital fibrosis with blepharoptosis and enophthalmos.

Athanasiov PA, Prabhakaran VC, Selva D.

Oculoplastic and Orbital Division, Department of Ophthalmology and Visual
Sciences, University of Adelaide and the South Australian Institute of
Ophthalmology, Adelaide, Australia. athanasiov@yahoo.com

A 59-year-old woman with congenital orbital fibrosis with ptosis and
enophthalmos underwent surgery to widen the palpebral fissures, which resulted
in an acceptable cosmetic appearance. This is a rare entity that has been
classified as a subtype of congenital fibrosis of the extraocular muscles.
However, after a review of literature we believe that congenital orbital
fibrosis should be considered a separate entity: it is unilateral, diffusely
involves the orbit (not just the extraocular muscles) and does not appear to
have a hereditary predisposition.

Publication Types:
    Case Reports

PMID: 18356729 [PubMed - indexed for MEDLINE]

7: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):154-6. 

Delayed presentation of grease-gun injury to the orbit.

Wang Y, Lu X, Xiao L.

Institute of Orbital Diseases, Armed Police General Hospital, China.

A 44-year-old man was examined for marked edema and ptosis of the right upper
eyelid after grease from high-pressure hydraulic machinery penetrated his right
orbit 20 days earlier. The diagnosis of residual grease in the injured orbit was
confirmed by CT and MRI, and the clinical presentation. During orbital
exploration, the grease was removed completely. Among the wide variety of
orbital foreign bodies, grease is rarely reported. We present the sixth case of
grease-gun injury to the orbit to be reported in the English language literature
since 1964.

Publication Types:
    Case Reports

PMID: 18356728 [PubMed - indexed for MEDLINE]

8: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):152-4. 

Progressive bilateral enophthalmos associated with cerebrospinal shunting.

Cruz AA, Mesquita IM, de Oliveira RS.

Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery,
School of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo,
Brazil. aavecruz@fmrp.usp.br

A 22-year-old woman was examined for a complaint of bilateral progressive
enophthalmos that had begun after the cerebrospinal fluid shunting procedure 9
years ago. Photographs and CT scans taken before surgery proved that the
position of her eyes was normal before surgery. The enophthalmos was so severe
that it induced a poor eyelid-globe apposition with trichiasis and superficial
keratopathy. CT of the orbits showed that both orbital roofs were arched and
displaced toward the anterior cranial fossa. The placement of porous
polyethylene sheets on the orbital roofs through a coronal approach corrected
the eye position. A literature review indicated that cerebrospinal shuntings are
plagued by a variety of complications including bone changes and
craniosynostosis. We believe that enophthalmos associated with cerebrospinal
fluid shunting results from a rare acquired bony orbital anomaly.

Publication Types:
    Case Reports

PMID: 18356727 [PubMed - indexed for MEDLINE]

9: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):150-2. 

Recurrent vision loss after endoscopic sinus surgery managed with palmar
pressure.

Silbert JE, Rudich DS, Wasserman EL, Lesser RL.

Department of Ophthalmology, Yale University, New Haven, CT, USA.
jonsilbert@comcast.net

A 41-year-old woman underwent endoscopic sinus surgery and 24 hours later, she
developed acute orbital emphysema with marked vision loss. CT showed disruption
of the inferior aspect of the medial wall of the orbit with fat herniation. She
was immediately treated with the application of bedside palmar pressure to the
globe with complete return of her vision without the need for a needle
aspiration or orbital decompression. Weeks later, the patient experienced 2 more
episodes of transient monocular visual loss that were again successfully treated
with the same palmar pressure. Bedside digital decompression may be a
potentially helpful method of restoring vision in cases of orbital emphysema
with acute vision loss. We advise attempting this simple bedside procedure
before committing the patient to a more invasive needle aspiration or surgical
decompressive procedure.

Publication Types:
    Case Reports

PMID: 18356726 [PubMed - indexed for MEDLINE]

10: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):148-50. 

Pneumomediastinum after external dacryocystorhinostomy.

Chu YC, Ma L.

Division of Oculoplasty, Department of Ophthalmology, Chang Gung Memorial
Hospital, Guei-Shan, Tao-Yuan, Taiwan.

A 73-year-old man had right chronic epiphora for many years. After uneventful
external dacryocystorhinostomy, he developed dyspnea and neck swelling after
forcefully blowing his nose. CT showed diffuse cervicofacial subcutaneous
emphysema and pneumomediastinum. He was admitted to prevent further
cardiovascular complications. Pneumomediastinum is a rare complication of
routine dacryocystorhinostomy. Supportive treatment to prevent additional air
trapping is mandatory.

Publication Types:
    Case Reports

PMID: 18356725 [PubMed - indexed for MEDLINE]

11: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):147-8. 

Infantile malignant hemangiopericytoma of the orbit.

Arshad AR, Normala B.

Department of Plastic Surgery and Reconstructive Surgery, Hospital Kuala Lumpur,
Kuala Lumpur, Malaysia. araprs@hkl.gov.my

A 5-month-old girl presented with a soft-tissue mass over the lateral aspect of
her right eyebrow. Surgical resection revealed a diagnosis of infantile
malignant hemangiopericytoma. The mass recurred after excision and
reconstruction. The patient died 4 months later with brain and lung metastasis.

Publication Types:
    Case Reports

PMID: 18356724 [PubMed - indexed for MEDLINE]

12: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):145-7. 

Bilateral simultaneous primary orbital lymphoma presenting with unilateral
enophthalmos.

Beden U, Sonmez B, Kandemir B, Erkan D.

Department of Ophthalmology, Ondokuzmayis University, Faculty of Medicine,
Samsun, Turkey. umite@yahoo.com

A 73-year-old woman was examined for palpable orbital masses behind the right
upper eyelid and left lower eyelid leading to entropion. Hertel exophthalmometry
readings were 6.0 mm in the right eye and 11.0 mm in the left eye with a base of
102 mm. MRI revealed bilateral hypointense orbital soft-tissue masses.
Pathologic evaluation of incisional biopsy specimens revealed malignant tissue
composed of diffuse, mitotically active, atypical large lymphoid cells positive
for CD-20 with immunohistochemical staining, confirming the diagnosis of
malignant diffuse large B-cell lymphoma. Systemic survey was negative for
extraorbital involvement. After R-CHOP chemotherapy (Rituximab 375 mg/m2
intravenously, Cyclophosphamide 750 mg/m2 intravenously, Doxorubicin 50 mg/m2
intravenously, Vincristine 1.4 mg/m2 intravenously, Prednisolone 100 mg orally),
Hertel measurements were 9.0 mm in the right eye and 11.0 mm in the left eye.
The mass lesions were totally regressed in follow-up MRI. Although rare,
non-Hodgkin lymphoma may present bilaterally as primary orbital lesions and can
unexpectedly cause enophthalmos instead of proptosis.

Publication Types:
    Case Reports

PMID: 18356723 [PubMed - indexed for MEDLINE]

13: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):143-5. 

Natural killer/T-cell lymphoma masquerading as orbital cellulitis.

Charton J, Witherspoon SR, Itani K, Jones FR, Marple B, Morse B.

Department of Ophthalmology, University of Texas Southwestern Medical Center,
Dallas, TX 75390-9057, USA. justincharton@yahoo.com

We describe 3 cases of natural killer/T-cell lymphoma that presented by
masquerading as orbital cellulitis. All of the patients were examined for pain,
fever, proptosis, and motility restriction. Computed tomography of the orbits
and sinuses revealed orbital soft-tissue swelling without focal abscess in all 3
cases. Bacterial and fungal cultures were negative in each case and all of the
patients had initial improvement on systemic antibiotics, only to relapse
several days later. Diagnosis of natural killer/T-cell lymphoma was then made
based on biopsy of the orbit or sinus. Natural killer/T-cell lymphoma should be
considered in cases of orbital cellulitis or sinusitis that fail to respond to
traditional management. Biopsy of the affected region should be performed
expeditiously to diagnose this condition. Repeat biopsy may be needed.

Publication Types:
    Case Reports

PMID: 18356722 [PubMed - indexed for MEDLINE]

14: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):142-3. 

Langerhans cell histiocytosis of the orbit 10 years after involvement at other
sites.

Wladis EJ, Tomaszewski JE, Gausas RE.

Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania
School of Medicine, Philadelphia, PA 19101, USA. tedwladis@hotmail.com

Langerhans cell histiocytosis within the orbit generally occurs in children and
is marked by periorbital pain and swelling. Although these lesions respond well
to minimal local curettage and concomitant corticosteroid injection, this
disorder can be extremely aggressive and destructive. Recurrences usually occur
within 12 months to 18 months after diagnosis. Herein, we discuss a patient who
initially had mastoid and maxillary lesions and developed unilateral orbital
involvement with periorbital pain and edema after a 10-year disease-free
interval, and review other cases of late recurrence. The patient\'s symptoms
resolved after curettage and injection of intralesional steroids. Clinicians
should be aware that Langerhans cell histiocytosis may reappear at other sites,
including the orbit, even after several years of quiescence.

Publication Types:
    Case Reports

PMID: 18356721 [PubMed - indexed for MEDLINE]

15: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):136-41. 

Surgical anatomy of the Chinese orbit.

Cheng AC, Lucas PW, Yuen HK, Lam DS, So KF.

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong
Kong, Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Pokfulam,
Hong Kong, China. acocheng@gmail.com

PURPOSE: To describe the metric measurements and normal anatomic variants in
Chinese bony orbits. METHODS: Orbital osteology was studied in 194 orbits from
97 Chinese skulls. Morphologic observations and metric measurements were made to
elucidate the variations of the orbital bony anatomy and to localize important
fissures and foramina within the orbit. Sexual dimorphism and side asymmetry of
orbital features were analyzed. Results were then compared with data from other
populations. RESULTS: The details of the orbital osteology in Chinese are
described. Most orbital features show anatomic variations in terms of their
existence, quantity, and location. Anatomic variants including quadruple and
extrasutural posterior ethmoidal foramen are described for the first time. Side
asymmetry and sexual dimorphism (male larger than female) are demonstrated in
some orbital features. Compared with white and American populations, orbital
measurements are generally smaller in Chinese, probably related to their smaller
orbital size. CONCLUSIONS: The Chinese orbital osteology demonstrates
considerable variability. The newly described anatomic variants found on the
posterior ethmoidal foramen may affect surgical procedures related to the medial
orbital wall. Sexual dimorphism and ethnic variations of the orbital bony
anatomy may affect surgical approach to orbital diseases in different
populations.

PMID: 18356720 [PubMed - indexed for MEDLINE]

16: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):131-5. 

Microscopic findings of lateral tarsal fixation in Asians.

Kakizaki H, Zako M, Nakano T, Asamoto K, Miyaishi O, Iwaki M.

Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan.
cosme@d1.dion.ne.jp

PURPOSE: To identify microscopically lateral tarsal fixation in Asians. METHODS:
Specimens from 19 postmortem lateral eyelids and orbits of 11 Asians (11 right,
8 left; aged 45-96 years at death) were used. Samples damaged on sectioning and
samples without tarsal plates were excluded. The samples were fixed in 10%
buffered formalin and examined under a microscope. Two levels of tarsus were
observed in the upper and lower eyelids, suggesting the possibility of different
means of fixation. The first and second sections, which were incised parallel to
the eyelid margin, were obtained at 1 mm and 5 mm from the upper eyelid margin,
and at 1 mm and 3 mm from the lower eyelid margin. The sections were stained
with Masson trichrome. RESULTS: The first sections of all upper eyelids and
those of the lower eyelids except one showed tarsal fixation by both the lateral
rectus capsulopalpebral fascia (lr-CPF) and the tendon-ligament complex of the
lateral canthal tendon (LCT), which in several cases received the muscle of
Riolan. The second sections of all upper eyelids showed fixation by the lr-CPF
and the ligamentous part of the LCT. The second sections of the lower eyelids
were mostly similar to the second sections of upper eyelids, though some showed
only ligamentous fixation. The lr-CPF in all cases included a small amount of
smooth muscle fibers. CONCLUSIONS: The lateral aspect of the tarsus is supported
by the lr-CPF and the LCT, which in some cases includes the muscle of Riolan.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18356719 [PubMed - indexed for MEDLINE]

17: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):126-30. 

Direct insertion of the medial rectus capsulopalpebral fascia to the tarsus.

Kakizaki H, Zako M, Nakano T, Asamoto K, Miyaishi O, Iwaki M.

Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan.
cosme@d1.dion.ne.jp

PURPOSE: To clarify the insertion of the medial rectus capsulopalpebral fascia
to the tarsus in Asians. METHODS: Specimens from 19 (11 right, 8 left)
postmortem medial eyelids and orbits of 11 Asians (aged 45-96 years at death)
were used. Samples had been fixed in 10% buffered formalin before their removal
and microscopic examination. The tarsi were incised at 2 different heights in
the upper and lower eyelids, as it was not disclosed which parts had the
insertion of the medial rectus capsulopalpebral fascia. The first and second
sections, parallel to the eyelid margin, were obtained, respectively, at 1 mm
and 5 mm from the upper eyelid margin, and at 1 mm and 3 mm from the lower
eyelid margin. Sections were stained with Masson trichrome. RESULTS: Both upper
and lower eyelids demonstrated similar findings. The first sections, which
showed the medial rectus capsulopalpebral fascia and included many smooth muscle
fibers, did not insert in the tarsi. However, the deep part of Horner muscle
directly inserted, whereas the superficial part went in the dense fibrous tissue
closely attaching on the tarsi. Then, some of the muscle branched out in the
tarsi. The second sections showed that the medial rectus capsulopalpebral fascia
had a direct insertion to the tarsi. CONCLUSIONS: The tarsi are supported
medially by the medial rectus capsulopalpebral fascia and Horner muscle. The
"medial eyelid retractors, " comprising the medial rectus capsulopalpebral
fascia and smooth muscles, were clearly defined, highlighting the relationship
of the eyelid to the medial rectus muscle and offering a new pathogenesis and
treatment for lateral tarsal shifts and lower medial ectropion.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18356718 [PubMed - indexed for MEDLINE]

18: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):122-5. 

Hybrid cysts of the eyelid with follicular and apocrine differentiation: an
under-recognized entity?

Milman T, Iacob C, McCormick SA.

Department of Pathology and Laboratory Medicine, The New York Eye and Ear
Infirmary, New York, NY 10003, USA. tmilman@nyee.edu

PURPOSE: To describe 6 patients with hybrid cysts of the eyelid that
demonstrated follicular and apocrine differentiation. METHODS: Clinicopathologic
series of 6 cases obtained from review of 1,099 cases of hidrocystoma diagnosed
at the New York Eye and Ear Infirmary from 1990 to 2006. RESULTS: Six patients,
aged 38 years to 85 years (mean 66.5 years), was examined for cystic eyelid
lesions. Histopathologic evaluation revealed cystic structures, lined by a
combination of apocrine, infundibular (epidermoid), and trichilemmal-type
epithelia. Luminal contents consisted of variable amounts of lamellated and
compact keratin, and serous material. Contiguity with a hair follicle was
demonstrated in 4 of 6 lesions. Immunohistochemical evaluation showed intense
immunoreactivity of the entire cyst lining in all lesions for high molecular
weight cytokeratin and variable immunoreactivity for low molecular weight
cytokeratin. All cystic structures displayed immunoreactivity for
carcinoembryonic antigen. Weak focal immunoreactivity for S-100 protein and
gross cystic disease fluid protein-15 was observed in most lesions. CONCLUSIONS:
Hybrid cysts can show apocrine, trichilemmal, and infundibular differentiation,
suggestive of their origin at the junction of keratinizing squamous and
glandular epithelia of the hair follicle. Although, to our knowledge, only 1
such lesion has been described in the eyelid skin, it is likely that hybrid
cysts of the eyelid are not an infrequent finding.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18356717 [PubMed - indexed for MEDLINE]

19: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):117-21. 

Patient-preferred sites of restylane injection in periocular and facial
soft-tissue augmentation.

Morris CL, Stinnett SS, Woodward JA.

Duke University Eye Center, Durham, NC 27710, USA.

PURPOSE: To determine patient-preferred injection sites and frequency for facial
volume augmentation with nonanimal stabilized hyaluronic acid (Restylane).
METHODS:: The authors retrospectively reviewed the records of 145 consecutive
patients who received 0.4 ml or 1.0 ml subcutaneous facial injections of
Restylane. Location, amount, supplemental anesthetic, injection frequency,
follow-up time, and use of botulinum toxin type A or other facial aesthetic
interventions were reviewed. If recorded, patient satisfaction, revision rate,
and any adverse reactions were also noted and analyzed. RESULTS: Median age at
time of initial injection was 54 years; median follow-up was 8 months (mean 10.4
months, range 1-37 months). A total of 309 patient injections were performed
(mean, 2.14 injections/patient), with 26% of patients receiving adjunctive
anesthesia. Injection site frequencies among the 145 patients were nasolabial
folds (72%), melolabial folds (70%), lips (51%), infraorbital rims (24%),
perioral rhytids (24%), glabella (23%), malar hollows (10%), chin (8%), and
other (8%). Among the 75 patients who received repeat injections, injection
intervals were > or =4 months in 56 (76%) and > or =6 months in 28 (38%).
Forty-four percent of patients received Botox and Restylane injections during
the same office visits. Six complications included edema (2); vasovagal reaction
during injection (1); ecchymosis (2); and herpes simplex virus dermatitis (1).
Three revisions were performed. One patient was dissatisfied with the procedure.
CONCLUSIONS: Patients elect to undergo Restylane injections to improve the
appearance of rhytids and augment volume along infraorbital rims, malar hollows,
lips, and depressed scars. Complications are minimal and easily treated.

PMID: 18356716 [PubMed - indexed for MEDLINE]

20: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):113-6. 

Pain relief in patients receiving periocular botulinum toxin A.

Harrison AR, Erickson JP, Anderson JS, Lee MS.

Department of Ophthalmology, University of Minnesota, Minneapolis, MN 55455,
USA. harri060@umn.edu

PURPOSE: We hypothesized that patients with benign essential blepharospasm and
hemifacial spasm experience relief of headache and eye pain after botulinum
toxin injections. METHODS: A retrospective chart review of 85 patients who had
received botulinum toxin injections at the University of Minnesota for treatment
of benign essential blepharospasm and hemifacial spasm was conducted. A
prospective telephone questionnaire was used to ascertain details regarding
improvement of headache and eye pain. RESULTS: Of the 85 patients (34 men, 51
women), 20 patients (23.5%) had headaches and 29 (34.1%) had eye pain. Ten of 20
(50.0%) headache-positive patients and 24 of 29 patients (82.8%) with eye pain
had reduction in their pain after botulinum toxin injections. CONCLUSION: The
findings of this study support the use of botulinum toxin for headache and eye
pain relief in patients with benign essential blepharospasm and hemifacial pain.
In addition, with the expanding uses of botulinum toxin, the results support its
antinociceptive effects. Further investigation should continue in the mechanism
of botulinum toxin\'s effects on pain.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18356715 [PubMed - indexed for MEDLINE]

21: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):107-12. 

Ossifying fibroma: a rare cause of orbital inflammation.

Cruz AA, Alencar VM, Figueiredo AR, de Paula S, Eichenberger GC, Chahud F,
Pedrosa MS.

Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery,
School of Medicine of Ribeirao Preto - University of Sao Paulo, Ribeirao Preto,
Brazil. aavecruz@fmrp.usp.br

PURPOSE: To describe the clinical and radiologic features of 4 cases of
ossifying fibroma affecting the orbit and to review the literature on orbital
involvement by the tumor. METHODS: Small case series. RESULTS: Four patients (3
children and 1 adult) with ossifying fibromas invading the orbit were examined.
Two of the 3 children were examined for ossifying fibromas on the orbital roof.
One had the psammomatoid form of the disease and the other the trabecular
variant. Despite striking differences in the histologic pattern and in the
radiologic appearance of the lesions, both children displayed a significant
degree of orbital inflammation mimicking orbital cellulitis. The third child and
the adult patient had the orbit involved by trabecular ossifying fibromas
invading the orbital floor. The tumor of the adult clearly originated in the
maxilla, filled the maxillary sinus, and eroded the orbital floor. The tumor of
the third child occupied the maxillary, ethmoid, and sphenoid sinuses. In both
cases, the clinical presentation was painless eye dystopia and proptosis.
CONCLUSIONS: Regardless of the histologic pattern (trabecular or psammomatoid),
ossifying fibromas can induce a substantial degree of orbital inflammation in
children and must be included in the differential diagnosis of acute orbital
inflammation during childhood.

Publication Types:
    Case Reports

PMID: 18356714 [PubMed - indexed for MEDLINE]

22: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):102-6. 

Orbital compartment syndrome in burn patients.

Singh CN, Klein MB, Sullivan SR, Sires BS, Hutter CM, Rice K, Jian-Amadi A.

Department of Ophthalmology, University of Washington, Seattle, WA, USA.

PURPOSE: To identify clinical characteristics of burn patients requiring
emergent orbital decompression for vision-threatening orbital compartment
syndrome. METHODS: A retrospective review of 28 burn patients at a trauma center
provided data regarding demographics, physical examination findings, and
resuscitation fluid volumes. Patients requiring orbital decompression were
compared with those who did not, using t tests and Fisher exact test. Linear
regression was used to test for an association between peak intraocular pressure
and fluid volume. Logistic regression was used to assess associations between
need for orbital decompression and fluid volume. RESULTS: Eight of 28 patients
required emergent orbital decompression, which immediately reduced intraocular
pressure from 59.4 +/- 15.9 mm Hg to 28.6 +/- 8.2 mm Hg (p < 0.001). There was a
positive relationship between fluid volume in the first 24 hours and peak
intraocular pressure (p < 0.001). Patients who were treated with orbital
decompression were resuscitated with a higher fluid volume in the first 24 hours
than those who were not (37,218 +/- 14,405 ml versus 24,649 +/- 12,339 ml, p =
0.015). This was no longer statistically significant when adjusted for
periocular burns. The relative risk for undergoing orbital decompression in
patients receiving > or =8.6 ml/kg/% total body surface area burned in the first
24 hours was 4.4 (p = 0.03). CONCLUSIONS: Risk factors for vision-threatening
orbital compartment syndrome include fluid volume and periocular burns. Signs of
vision-threatening orbital compartment syndrome should be addressed early with
orbital decompression.

PMID: 18356713 [PubMed - indexed for MEDLINE]

23: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):98-101. 

Conjunctival squamous cell carcinoma in the anophthalmic socket.

Nguyen J, Ivan D, Esmaeli B.

Section of Ophthalmology, The University of Texas M D Anderson Cancer Center,
Houston, TX 77030, USA

PURPOSE: To describe 2 patients in whom squamous cell carcinoma of the
conjunctiva developed in the anophthalmic socket more than 44 years after
enucleation and chronic use of an ocular prosthesis. METHODS: Retrospective case
reports. RESULTS: These 2 patients did not have known risk factors for squamous
cell carcinoma, including solar ultraviolet radiation or exposure (since they
wore their prosthesis full-time), HIV infection, chronic orbital inflammatory
disease, or immune-compromising systemic disease. Both patients had an orbital
exenteration and underwent a full work-up including evaluation of the regional
lymph nodes and systemic work-up to rule out distant metastasis. CONCLUSIONS:
Squamous cell carcinoma of the anophthalmic socket can develop many years after
enucleation. Regular inspection of the anophthalmic socket containing a
prosthesis to rule out conjunctival squamous cell carcinoma is prudent.

Publication Types:
    Case Reports

PMID: 18356712 [PubMed - indexed for MEDLINE]

24: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):94-7. 

Reconstruction of anophthalmic orbits and contracted eye sockets with
microvascular radial forearm free flaps.

Li D, Jie Y, Liu H, Liu J, Zhu Z, Mao C.

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical
University, Beijing, China. ldmlily@x263.net

PURPOSE: To reconstruct the anophthalmic orbit using a microvascular radial
forearm free flap in patients with significant volume loss and socket
contracture after exenteration or enucleation. METHODS: This is a retrospective
observational case series of 22 subjects with acquired anophthalmic orbits after
tumor resection or trauma: 14 patients with retinoblastoma who underwent
enucleation followed by adjuvant radiation therapy and 8 patients with malignant
orbital tumors or orbital trauma who underwent exenteration of the orbit. All
patients had large orbital defects or severely contracted eye sockets. Patients
underwent orbital reconstruction with implantation of a microvascular radial
forearm free flap with or without placement of a hydroxyapatite sphere or
conical implant. RESULTS: All patients were followed for 6 months to 6 years.
Long-term improvement of socket contracture, prosthesis fit, and cosmetic
appearance of patients was observed. The prosthetic eyes were well fitted in the
eye socket using this technique. CONCLUSIONS: Our results demonstrate successful
functional and clinical outcomes for treatment of severe anophthalmic orbital
syndrome using microvascular radial forearm free flaps. However, further
prospective, long-term studies are recommended.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18356711 [PubMed - indexed for MEDLINE]

25: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):90-3. 

Anatomic position of the common canaliculus in patients with a large lacrimal
sac.

Yazici B, Yazici Z.

Department of Ophthalmology, Uludag University, Bursa, Turkey.
byazici@uludag.edu.tr

PURPOSE: To study the canalicular anatomy in patients with an enlarged sac
secondary to nasolacrimal duct obstruction. METHODS: This study included 76
lacrimal drainage systems (LDS) of 41 adult patients with a palpable sac, which
were visualized using posteroanterior digital subtraction
macrodacryocystography. In 42 LDS, there was a palpable enlarged sac secondary
to nasolacrimal duct obstruction. In 20 LDS, the sac enlargement was associated
with a valve-type canalicular obstruction preventing retrograde reflux of the
sac content, and in 22 LDS, there was no associated canalicular obstruction.
Thirty-four LDS were either normal or had a nasolacrimal duct obstruction
without a palpable sac. RESULTS: Dacryocystography showed a common canaliculus
in all LDS. In 35 (83%) of 42 LDS with a palpable sac (17 LDS with and 18 LDS
without canalicular obstruction), the anatomic orientation of the common
canaliculus in the superior-inferior direction showed a consistent change. The
common canaliculus was bending inferiorly with a sharp angle as it was coursing
to the sac. In all LDS with a nonpalpable sac, the common canaliculus had an
approximately direct, horizontal, or slightly upward course to the sac.
CONCLUSIONS: Lacrimal sac enlargement secondary to nasolacrimal duct obstruction
changes the anatomic orientation of the common canaliculus. The canaliculus
shows an acute, inferior angulation from the superior-to-inferior direction
while coursing to the sac in most instances. This anatomic variation should be
considered during lacrimal interventions.

PMID: 18356710 [PubMed - indexed for MEDLINE]

26: Ophthal Plast Reconstr Surg. 2008 Mar-Apr;24(2):85-9. 

The hydrogel lacrimal stent for dacryocystorhinostomy: preliminary experience.

Goldberg RA, Samimi DB, Tsirbas A, Douglas RS.

Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles,
CA 90095-7006, USA. Goldberg@jsei.ucla.edu

PURPOSE: To present the results of dacryocystorhinostomy with the use of a newly
designed hydrogel lacrimal stent for repair of acquired nasolacrimal duct
obstruction. METHODS: Noncomparative interventional case series. Twenty-three
cases of acquired nasolacrimal duct obstruction confirmed by probing and
irrigation underwent dacryocystorhinostomy using the hydrogel lacrimal stent.
Tearing symptoms, functional endoscopic dye test, and anatomic appearance of
ostia were noted at follow-up. RESULTS: Five of 23 ostia closed during the
postoperative period (1-3 months), translating to a late success rate of 78.3%.
The 5 failed cases were treated successfully with ostium revision, 1 case
requiring 2 revisions. All patients had endoscopic follow-up with a minimum
follow-up of 6 months after stent removal. In the successful cases we noted a
large, quiet ostium with good separation of the nasal septum and middle
turbinate. Eleven cases (47.8%) had history of previously failed
dacryocystorhinostomy surgery, chronic sinusitis, deviated septum, or
maxillofacial surgery. There were no complications or reports of unusual pain or
symptoms associated with the stent itself. CONCLUSIONS: Early experience
suggests the hydrogel lacrimal stent is a well-tolerated, effective tool for
dacryocystorhinostomy surgery after acquired nasolacrimal duct obstruction. The
device may serve as a useful surgical tool by holding open the ostium,
maintaining apposition of the mucosal edges, and decreasing the incidence of
nasal adhesions.

PMID: 18356709 [PubMed - indexed for MEDLINE]