Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

We present two cases of unilateral permanent visual loss following four-eyelid blepharoplasty. Clinical and radiographic evidence suggested orbital hemorrhage was the cause of visual loss in both cases. In particular, electrophysiologic tests indicated that optic nerve dysfunction, and not retinal ischemia, was responsible for loss of vision. Timely orbital decompression is the cornerstone of managing these dramatic cases.

Asunto(s)

RESUMEN

Many surgical procedures have been described for correction of cicatricial entropion of the upper eyelid. However, many of them fail to address the altered anatomy responsible for cicatricial entropion, which may lead to excessive scarring, eyelid margin malposition, or blepharoptosis. Tarsoconjunctival grafts provide a strong and permanent buttress to correct the scarring of the posterior eyelid margin that characterizes cicatricial entropion. They provide a smooth mucosal surface to interface with the corneal tear film. Depending on the circumstances, we use free ipsilateral, free contralateral, or sliding "bucket handle" tarsoconjunctival grafting. Mucosal grafts are rarely needed. Blepharoptosis is avoided by conservative dissection in the supratarsal space, sparing most of the attachments of the levator aponeurosis.

Asunto(s)

RESUMEN

Free autogenous "pearl fat" grafts of 5-6 mm in diameter are used as a method of soft tissue augmentation for the eyelid. This method is useful in restoring eyelid contour defects, separating the eyelid lamella to lower the upper eyelid crease, and augmenting eyelids in anophthalmos. Graft survival is variable and pretreatment of fat with insulin is used in an attempt to prolong fat survival. The rationale, indications, and surgical procedure are discussed.

Asunto(s)

RESUMEN

We found medial entropion of the lower eyelid to be common following orbital decompression for dysthyroid opthalmopathy. In our series significant postoperative medial entropion was noted in 14 of 69 patients, an incidence of 20%. Only four of these patients had entropion severe enough to require surgery (6%). Before orbital decompression, only one patient was found to have significant medial entropion (1.4%). Analysis of associated factors disclosed a positive relation between the amount of operative proptosis reduction and the degree of postoperative medial entropion. A strong correlation was also observed with the type of approach; transantral surgery was much more likely to be associated with significant postoperative medial entropion than was transconjunctival surgery. We suggest that the inferomedial displacement of the muscle cone that follows orbital decompression results in a force vector, transmitted through the lower eyelid retractors and capsulopalpebral ligament, that intorts the medial lower eyelid. Medial entropion in this setting often coexists with lower eyelid retraction, and if a "spacer" of sclera or ear cartilage is to be inserted into the lower eyelid, it should be carried into the medialmost portion of the eyelid to recess the posterior lamellae, including the medial retractors, and allow the eyelid margin to return to its normal anatomic position.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Patients with chronic progressive external ophthalmoplegia (CPEO) are often disabled by ptosis; however, conventional ptosis surgery may induce lagophthalmos and exposure keratitis. Ten patients with CPEO underwent ptosis correction via bilateral frontalis suspensions, using monofilament synthetic material. Three of these patients were also treated with lower eyelid horizontal tightening. The frontalis sling was adjusted to provide a firm linkage between the eyebrow and eyelid, but was loose enough to allow eyelid closure when the frontalis muscle is relaxed. All patients experienced lessening of ptosis and relief from visual obstruction. One patient required reoperation of one eyelid for undercorrection. No lagophthalmos or corneal complications occurred. The rationale for treatment, preoperative evaluation, and operative procedure in CPEO is discussed herein.

Asunto(s)

Asunto(s)

RESUMEN

A 48-year-old black female had a 1-year history of increasing proptosis and headache. Sinus films and CT scan demonstrated an expansive soft tissue mass in the right frontal-ethmoid sinus with lateral displacement of the medial orbital wall, consistent with a mucocele. Resection revealed a solid tumor which was identified pathologically as a neurilemmoma. To our knowledge, this is the first published report of a frontal-ethmoid neurilemmoma presenting solely with proptosis, and also mimicking a mucocele.

Asunto(s)