Functional Brain Imaging During Extra-Ocular Light Stimulation in Anophthalmic and Sighted Participants: No Evidence for Extra-Ocular Photosensitive Receptors.

Light plays a critical role in regulating physiology and behavior, including both visual and non-visual responses. In mammals, loss of both eyes abolishes all of these responses, demonstrating that the photoreceptors involved are exclusively ocular. By contrast, many non-mammalian species possess extra-ocular photoreceptors located in the pineal complex and deep brain.

The Effect of Congenital and Acquired Bilateral Anophthalmia on Brain Structure.

The aim of this study was to compare the pattern of changes in brain structure resulting from congenital and acquired bilateral anophthalmia. Brain structure was investigated using 3T magnetic resonance imaging (MRI) in Oxford (congenital) or Manchester (acquired). T1-weighted structural and diffusion-weighted scans were acquired from people with anophthalmia and sighted control participants.

Blepharoptosis surgery in patients with myasthenia gravis.

Background/aims: To review our approach of cautious surgical correction of blepharoptosis in patients with myasthenia gravis (MG) to minimise risk of exposure complications.

Methods: Retrospective case note review of 30 patients with symptomatic eyelid concerns despite appropriate medical treatment, who underwent eyelid surgery. The mean age at diagnosis was 47 years.

The Post-Levator Aponeurosis Fat Pad.

Purpose: To examine the post-aponeurotic space and to confirm and define the presence of a post-aponeurosis fat-pad.

Methods: Experimental anatomic study. Nineteen-orbits from 10 freeze-preserved, unembalmed cadavers of caucasian subjects.

Bisphosphonate-induced osteonecrosis of the maxilla presenting as a cicatricial ectropion.

A 63-year-old gentleman, who was being treated with bisphosphonates for multiple myeloma, presented with a cicatricial ectropion of the lower eyelid, without exposure keratopathy. A CT scan demonstrated extensive destruction of bone with an infraorbital fracture surrounded by sclerotic bony changes. The patient was managed conservatively with discontinuation of bisphosphonate therapy and topical ocular lubricants.

Periocular Scleromyxedema.

Scleromyxedema is characterized by cutaneous mucinosis and rarely presents to oculoplastic surgeons with bilateral upper and lower eyelid swelling. The authors present 2 case reports with a review of the literature and discuss the ophthalmic manifestations of scleromyxedema and the management of these cases. Both patients were in their early 50s and were fit and well prior to the presentation.

Osteoradionecrosis of the exenterated orbit.

Osteoradionecrosis (ORN) occurs in an estimated 2% of head and neck-irradiated patients. It is seen most commonly in the mandible with other reported sites including the maxilla, temporal bone, clavicle, and vertebrae. It is defined as an area of exposed devitalised irradiated bone, with failure to heal during a period of at least 3 months, in the absence of local neoplastic disease.

Management of cicatricial ectropion secondary to pyoderma gangrenosum.

Pyoderma gangrenosum is a rare condition with few cases of eyelid involvement reported in the literature. Pathergy is a well-recognised phenomenon that can trigger this condition. Pyoderma gangrenosum should be considered in cases of progressive cribriform cicatrisation where there is a history of antecedent trauma.

Merkel cell carcinoma of the eyelid: management and prognosis.

Importance: The literature on Merkel cell carcinoma (MCC) of the eyelid remains scarce, and there has yet to be a study using the most up-to-date TNM staging system for this rare but aggressive tumor.

Objective: To analyze the TNM stage, management, and outcomes of patients with MCC of the eyelid.

Design, Setting, And Participants: Retrospective case series of 21 patients from 5 tertiary referral centers in the United Kingdom and Australia with primary MCC of the eyelid presenting at a median age of 77 years, with median follow-up of 54 months.

Complications of blepharoplasty.

This article provides a comprehensive discussion on the complications of blepharoplasty. We discuss the importance of preoperative counselling and surgical planning to provide the patient with a satisfactory outcome. Strategies are presented to manage common complications.

A reliable surgical technique for the management of growing fractures of the frontal bone involving the orbit.

Purpose: Growing fractures involving the orbit occur infrequently. Due to the risk of neurological trauma and the ophthalmic sequelae of progressive intraorbital expansion of the fracture, surgical management is indicated. There is no accepted standard in the approach to the surgical management of these patients.

A case of a spontaneous intraorbital arteriovenous fistula: clinico-radiological findings and treatment by transvenous embolisation via the superior ophthalmic vein.

A 72-year-old male presented with progressive right axial proptosis and red eye. Catheter angiography demonstrated an intraorbital arteriovenous fistula (IAVF) distal to the central retinal artery (CRA). Transvenous embolisation following direct surgical exposure of the superior ophthalmic vein (SOV) resulted in rapid resolution of his symptoms and signs.

Amyloidosis of the orbit and adnexae.

Purpose: To present a series of patients with orbital and adnexal amyloidosis and illustrate the diversity of disease and the challenges of managing such cases.

Methods: Descriptive case series of ten patients with biopsy proven amyloidosis involving the orbit, conjunctiva and eyelids. The presentation, clinical findings and management are discussed for each case.

Orbital lymphangiomas: a review of management strategies.

Purpose Of Review: Orbital lymphangiomas present a difficult management problem for the ophthalmologist. This review offers a strategy for managing the condition.

Recent Findings: There have been recent publications discussing the use of intralesional fibrin glue to aid dissection and intralesional sclerosant to shrink the lesion.

Hyaluronidase toxicity: a possible cause of postoperative periorbital inflammation.

Background: Periorbital inflammation following regional anaesthesia is commonly attributed to hyaluronidase allergy. This case series suggests an alternative explanation in some patients.

Design: Retrospective case series.

Acute dacryocystitis in a 2-year old child caused by pantoea.

A previously healthy 23-month-old girl was admitted for the management of an acute unilateral dacryocystitis following accidental contact with dog faeces. No periocular trauma was reported. Microbiological investigation showed a multiresistant strain of Pantoea species to be the responsible pathogen.

Eyelid avulsion repair with bi-canalicular silicone stenting without medial canthal tendon reconstruction.

Aims: To evaluate the functional and cosmetic success rate of combined canalicular laceration and eyelid avulsion repairs using the bi-canalicular Crawford stent, without the concomitant placement of a medial traction suture to repair medial canthal tendon (posterior limb) avulsion.

Methods: Retrospective, non-comparative consecutive case series of 40 consecutive patients with traumatic eyelid avulsion injuries associated with canalicular laceration from 1997 to 2003 who underwent surgical repair using the bi-canalicular Crawford stent were included. All patients underwent surgical repair of the canalicular laceration under general anaesthesia using the bi-canalicular stent.

The use of soft tissue expanders in periocular reconstruction: a case series.

Purpose: To describe the use of soft tissue expanders for periocular reconstruction in the presence of limited local tissue availability.

Methods: A retrospective case series of 5 patients who attended the Manchester Royal Eye Hospital. They presented a reconstructive challenge due either to the presence of periocular scarring or to a marked loss or limitation of normal local skin for reconstruction.

A case of acute compressive optic neuropathy secondary to aneurysmal bone cyst formation in fibrous dysplasia.

We report a 19-year-old female with craniofacial fibrous dysplasia who had presented with rapidly progressive visual loss in her right eye secondary to aneurysmal bone cyst formation. Craniotomy with drainage and curettage of this bone cyst resulted in progressive improvement in visual acuity that returned to normal 5 months post-operatively.

Difference in response to botulinum toxin type A treatment between patients with benign essential blepharospasm and hemifacial spasm.

Background: Botulinum toxin (BTX) is the first-line treatment in managing benign essential blepharospasm (BEB) and hemifacial spasm (HFS). We wished to assess the difference in duration of effect and the number of BTX treatments required to treat patients with BEB and HFS.

Methods: A prospective study of patients attending the BTX clinic in Manchester Royal Eye Hospital over 6 months.

The surgical management and outcomes for spheno-orbital meningiomas: a 7-year review of multi-disciplinary practice.

Aims/purpose: Spheno-orbital meningiomas account for 9% of all adult intracranial meningiomas. Complete resection is extremely difficult with this condition. We report on our experience in the surgical management of spheno-orbital meningiomas.