Sinonasal complications associated with endoscopic orbital decompression.

Objective: Characterize sinonasal complications associated with endoscopic orbital decompression for thyroid eye disease (TED).

Methods: Retrospective analysis of patients who underwent endoscopic orbital decompression at Houston Methodist Hospital by two otolaryngologists and one ophthalmologist between May 2016 and February 2020 for TED. Patient ethnicity, age, laterality, operative approach (middle turbinectomy vs middle turbinate sparing), and history of prior sinusitis were collected.

Apocrine adenocarcinoma of the eyelid: case report and literature review on management.

Apocrine adenocarcinoma of the eyelid is a rare sweat gland cancer. It is predominant in older adults and has increased prevalence in males. Management is based on recommendations from reported cases and their outcomes.

Traumatic optic neuropathy and second optic nerve injuries.

Importance: Current controversy about the primary treatment of traumatic optic neuropathy (TON) has anchored on final vision following injury, but, to our knowledge, no study has examined the effect of different treatments on regaining and protecting optic nerve reserve or on the outcome of second optic nerve injuries.

Objective: To assess vision improvement in patients treated by various methods who have a second incidence of TON.

Design, Setting, And Participants: Retrospective medical record review of 12 patients with a second TON seen in an 18-year period (mean follow-up, 11.

Management of the 'tight orbit' and associated visual loss.

Purpose Of Review: To review the most recent literature on the management of the orbit under high pressure (the tight orbit) with threatened visual loss.

Recent Findings: Definitive management of traumatic optic neuropathy remains unclear, lacking randomized head-to-head treatment option trials. Instead, numerous case series and anecdotal reports show benefit in each of the four treatment modalities currently in use, but a multitude of variables confound cross-study comparison.

Effect of dietary zinc and phytase supplementation on botulinum toxin treatments.

Purpose: To determine whether oral zinc supplementation might affect the efficacy and duration of botulinum toxin treatments.

Methods: In a double-blind, placebo-controlled, crossover pilot study, we examined the efficacy of three botulinum toxin preparations (onabotulinumtoxinA, abobotulinumtoxinA, and rimabotulinumtoxinB) following oral supplementation with zinc citrate 50 mg and phytase 3,000 PU, zinc gluconate 10 mg, or lactulose placebo in individuals treated for cosmetic facial rhytids, benign essential blepharospasm, and hemifacial spasm.

Results: In seventy-seven patients, 92% of subjects supplemented with zinc 50 mg and phytase experienced an average increase in toxin effect duration of nearly 30%, and 84% of participants reported a subjective increase in toxin effect, whereas no significant increase in duration or effect was reported by patients following supplementation with lactulose placebo or 10 mg of zinc gluconate.

The diagnosis and treatment of thyroid-associated ophthalmopathy.

Background: Little is written in the plastic surgery literature about thyroid-associated ophthalmopathy (TAO), a condition that is separate from Graves-Basedow disease and may not be accompanied by hyperthyroidism. Many patients with this disease frequently seek periocular aesthetic reconstruction prior to medical workup.

Methods: This study presents a comprehensive review of the literature surrounding TAO in order to better understand the prevalence, diagnosis, pathophysiology, and appropriate management of TAO.

Pearls of orbital trauma management.

Orbital fractures account for a significant portion of traumatic facial injuries. Although plastic surgery literature is helpful, additional pearls and insights are provided in this article from the experience of an oculoplastic surgeon. The fundamentals remain the same, but the perceptions differ and provide a healthy perspective on a long-standing issue.

Metaplastic bone formation in the orbit.

Osseous or cartilaginous metaplasia in the orbit are both rare phenomena. The authors describe a unique case of combined primary orbital osseous and cartilaginous metaplasia presenting with orbital pain and ocular dysmotility and discuss the radiologic, histopathologic, and clinical features. This entity should be considered in the differential diagnosis of an orbital mass showing similar radiographic features of calcification.

Periocular laser complications.

Laser periocular surgery has achieved an increased popularity, particularly since the widespread use of CO(2) and erbium:yttrium aluminum garnet laser and more recently with the development of nonablative laser technology. The main target of these techniques is to treat photoaging changes to obtain a rejuvenated skin. Despite the relatively safety of these procedures on experienced hands, postoperative complications affecting the periocular region, and the eye itself, may follow laser surgery.

Periocular anesthesia in aesthetic surgery.

This article focuses on the administration of anesthesia for periocular aesthetic procedures. Special emphasis is given to office-based procedures, most often without any systemic sedation, highlighting the importance of open communication with patients. Finally, attention is given to potential pitfalls including anesthetic systemic toxicity, ocular injuries, and orbicularis myotoxicity.

Eyelid edema.

Facial aesthetic surgeons are sometimes challenged by the predicament of diagnosing and managing patients with chronic eyelid edema. Herein we provide a brief review of some of the more common causes of pre- and postoperative eyelid edema, many of which have important systemic implications, and offer management suggestions.

Perspectives on periocular asymmetry.

Eyelid, orbit, and eye position asymmetry may adversely affect overall facial aesthetics. Armed with the knowledge of important periocular measures and landmarks, asymmetries can be easily identified and consideration may be given to correction or camouflage.

Efficacy of botulinum toxin type a after topical anesthesia.

Purpose: To determine whether the use of topical anesthesia has an impact on botulinum toxin type A (BTX-A) efficacy.

Methods: Forty patients (20 receiving BTX-A for facial cosmetic rhytid reduction and 20 for benign essential blepharospasm) were evaluated in a double-blind, randomized, triple-crossover study at 2.5- to 4.

Botulinum toxin in ophthalmic plastic surgery.

Botulinum toxin chemodenervation has evolved greatly over the past 30 years since its introduction in the 1970s for the management of strabismus. Among ophthalmic plastic surgeons, botulinum toxins are often used as the first line treatment for facial dystonias. These toxins are also efficacious for the temporary management of various other conditions including keratopathies (through so called chemo-tarsorraphy), upper eyelid retraction, orbicularis overaction-induced lower eyelid entropion, gustatory epiphora, Frey's syndrome, and dynamic facial rhytids such as lateral canthal wrinkles (crow's feet), glabellar creases and horizontal forehead lines.

Cold urticaria: an under-recognized cause of postsurgical periorbital swelling.

Purpose: To report cold urticaria as an under-recognized cause of potential periorbital and facial edema after elective oculofacial plastic surgery.

Methods: Retrospective case series of three patients with primary acquired cold urticaria with review of the clinical aspects of each of the cases.

Results: Two of the patients had significant postoperative swelling attributed to primary acquired cold urticaria after the routine use of cool compresses to their surgical sites.

Managing inflammatory reaction to restylane.

A 62-year-old woman received injections of Restylane, cross-linked hyaluronic acid, for the cosmetic filling of facial rhytids and developed a severe dermal inflammatory reaction. Hyaluronidase administered directly in the inflammatory nodules resulted in rapid resolution of pain, palpable nodularity, and visible induration possibly due to dissolution of the hyaluronic acid.

Erasing restylane.

A 65-year-old woman received injections of Restylane, cross-linked hyaluronic acid, for the intended cosmetic filling of periorbital rhytids. The achieved result was undesirable, and the filler lasted more than 5 years. Hyaluronidase administered directly beneath the treated areas resulted in rapid resolution of the Restylane effect.