Combined immunosuppression and radiotherapy in thyroid eye disease (CIRTED): a multicentre, 2 × 2 factorial, double-blind, randomised controlled trial.

Background: Standard treatment for thyroid eye disease is with systemic corticosteroids. We aimed to establish whether orbital radiotherapy or antiproliferative immunosuppression would confer any additional benefit.

Methods: CIRTED was a multicentre, double-blind, randomised controlled trial with a 2 × 2 factorial design done at six centres in the UK.

Success rates in powered endonasal revision surgery for failed dacryocystorhinostomy in a tertiary referral center.

Purpose: To evaluate the causes of failed dacryocystorhinostomy (DCR) surgery, recommend specific endoscopic endonasal techniques in revision DCR, and report postoperative success rates.

Methods: Retrospective case series in a tertiary referral center of 19 consecutive, endonasal revision DCR surgeries in 17 adult patients with previous failed DCR. All cases were revised endonasally by 1 surgeon.

Endonasal endoscopic retrieval of lodged silicone punctal plugs: a case report.

We present the case of a 59-year-old woman whose silicone punctal plugs migrated distally causing lacrimal obstruction. The plugs were removed from the lacrimal sac during endoscopic endonasal dacrocystorhinostomy and is illustrated by endoscopic photographs and videos taken at the time of surgery. This case highlights the potential complications of punctal plugs and the difficulties posed in retrieving them.

Maxillary mucocele with orbital floor remodelling.

A 79-year-old man presents with signs of an orbital mass. A CT scan revealed a large maxillary mucocele eroding through the orbital floor. Surgical drainage of the mucocele and conservative postoperative care, returned all ophthalmic signs to normal and bony remodelling of the orbital floor was demonstrated.

Eyelid necrotizing fasciitis: what were the early signs?

Background: Necrotizing fasciitis is a rare, life-threatening subcutaneous soft tissue infection that causes massive tissue destruction.

Objectives: To illustrate the warning signs of this condition by reporting a rare case of eyelid necrotizing fasciitis.

Case Report: A previously healthy 22-year-old man presented with a preseptal eyelid infection that spread rapidly despite prompt treatment with several intravenous antibiotics.

The use of a pleated strip of autogenous temporalis fascia graft for frontalis suspension in recurrent poor levator function ptosis in adult patients.

Purpose: Poor levator function (LF) blepharoptosis can be corrected surgically using frontalis muscle suspension with a variety of materials. Autogenous grafts such as fascia lata are commonly used. The need for a remote surgical site and the risk of an unattractive leg scar makes the use of an autogenous temporalis fascia (ATF) graft appealing as the scar is concealed in the hair.

Marsupialization for lacrimal ductular cysts (dacryops): a case series.

Purpose: To present the clinicopathological features and treatment outcomes of lacrimal ductular cysts managed with marsupialization.

Methods: Retrospective case review of 13 patients presenting with lacrimal ductular cysts.

Results: Thirteen patients were identified, of which 7 patients with full clinical data were included in the study, 4 female, 3 male, mean age 50 years.

Endoscopic endonasal retrieval of a nasolacrimal duct stone via the valve of Hasner in the inferior meatus.

A 37 year old man presented with a 6 month history of a right epiphora with associated mucus discharge. Lacrimal irrigation demonstrated right unilateral partial nasolacrimal duct obstruction, confirmed with lacrimal scintigraphy. Nasal endoscopy showed a pale elevation in the right inferior meatus.

A very rare case of bloody tears with enigmatic epistaxis and haematuria.

Background: Bloody tears are a rare symptom that can be caused by local or systemic pathology.

Methods: We describe a very rare case of bloody tears that resulted from hyperthyroidism.

Results: A 15-year-old female patient presented with a 6-month history of bloody tears and epistaxis.

Mini-monoka made easy: a simple technique for mini-monoka insertion in acquired punctal stenosis.

Purpose: To describe a simple and effective technique to insert the mini-monoka mono-canalicular stent using a nettleship dilator, without the need for a snip-procedure.

Methods: Description of a surgical technique.

Results: Mini-monoka stents have been shown to have a high rate of stent migration and premature loss when combined with a one-snip procedure.

Treatment of a lacrimal pneumocele with punctal plug insertion.

A 37-year-old man presented with symptoms of air and mucus reflux from the right medial canthus on blowing his nose. Examination showed crepitus in the region overlying the right lacrimal sac, and he was able to produce bubbles in his conjunctival lake on instillation of topical 2% fluorescein. Dacryoscintigraphy showed symmetrical slow passage of tracer from the lacrimal sac in the nasolacrimal duct indicating delay at the postsac level.

Two cases of drug-induced orbital inflammatory disease.

Orbital inflammatory disease (OID) includes all inflammatory processes affecting the orbit. Although several aetiologies are recognised, a cause may not be elucidated. We describe 2 cases in which drugs (hyaluronidase and zoledronic acid) were the cause of OID.

Orbital floor abscess secondary to sinusitis in an immunocompromised patient.

A 65-year-old man with a history of renal transplantation presented with facial pain, purulent nasal discharge, and periorbital swelling. Signs of optic nerve compromise developed and persisted despite medial orbital wall decompression. Further imaging revealed an orbital floor abscess secondary to direct communication of a maxillary pseudomonal sinusitis.

Hypertrichosis of the upper cheek area associated with travoprost treatment of glaucoma.

Travoprost is a prostaglandin analog used in the treatment of open-angle glaucoma. This drug is safe and efficacious and has a low incidence of systemic and local side effects. Common local side effects are conjunctival hyperemia, iris pigmentation, and hypertrichosis of the eyelashes.

Adjunctive use of hyaluronic acid gel (Restylane Sub-Q) in anophthalmic volume deficient sockets and phthisical eyes.

Purpose: This study aims to present the use of Restylane Sub-Q for orbital volume augmentation in patients with secondary volume deficiency either postenucleation or postevisceration or those with phthisical eyes.

Methods: This prospective case series reviews clinical, photographic, and radiologic records of 16 patients with anophthalmic or enophthalmic orbits who underwent volume augmentation by injection with hyaluronic acid gel in the intraconal and extraconal posterior orbit. The technique is discussed in detail.

Lacrimal surgery success after external dacryocystorhinostomy: functional and anatomical results using strict outcome criteria.

Purpose: To present the results of external dacryocystorhinostomy (ext-DCR) for epiphora using strict outcome criteria and provide an accurate baseline and evidence from which to compare the results of endonasal dacryocystorhinostomy.

Methods: Retrospective case notes review of 158 consecutive adult patients who underwent primary ext-DCR. Functional success was assessed according to the patients' symptoms and anatomical success was measured using objective tests of lacrimal system patency: 1) the functional endoscopic dye test and/or endoscopic endonasal inspection of the ostium; 2) syringing of the lacrimal system; and 3) the fluorescein dye retention test.

A randomized controlled trial comparing everting sutures with everting sutures and a lateral tarsal strip for involutional entropion.

Objective: To determine whether there is a statistically significant difference in the surgical outcome of everting sutures (ES) alone versus everting sutures with a lateral tarsal strip (ES+LTS) in the treatment of involutional entropion.

Design: Prospective randomized comparative trial.

Participants: Sixty-three patients with primary involutional lower eyelid entropion were enrolled in the study.

Medpor lower eyelid spacer: does it biointegrate?

Purpose: To report the histopathologic findings of explanted Medpor lower eyelid spacers (LES) in complicated cases.

Materials And Methods: Four cases of lower eyelid retraction due to thyroid orbitopathy (n = 2), facial nerve palsy (n = 1), and post-enucleation socket syndrome (n = 1) were treated with Medpor LES.

Results: All implants were removed between 6 months to 2 years following their original insertion due to exposure, poor stability, or contour.

Idiopathic orbital inflammation with extensive intra- and extracranial extension presenting as 6th nerve palsy--a case report and literature review.

Introduction: To report a case of idiopathic orbital inflammation with extensive extraorbital involvement presenting as 6th nerve palsy.

Materials And Methods: The patient presented with right periorbital pain, headache, and diplopia. Orthoptic examination revealed 6th nerve palsy.

Early cure rates with narrow-margin slow-Mohs surgery for periocular malignant melanoma.

Background: Staged excision with rush-processed paraffin-embedded tissue sections (Slow-Mohs) is an effective treatment for periocular melanoma. Although there is no consensus on initial margins of excision, narrower margins in the eyelids have the functionally and cosmetically important consequence of smaller postoperative wounds.

Objectives: To report early cure rates for periocular melanoma using Slow-Mohs surgery with en-face margin sectioning.

Orbital and adnexal Rosai-Dorfman disease.

Purpose: To report the clinico-radiological findings, clinical course, and treatment outcomes in five patients with orbital and adnexal Rosai-Dorfman (R-D) disease.

Methods: Analysis of case records of patients with Rosai-Dorfman disease seen at four orbital units between January 2000 and December 2006.

Results: Five patients (3 Caucasian males, 1 Hispanic female, and 1 African female), mean age 41.

Periocular autologous Coleman fat graft survival and histopathology.

Purpose: Autologous Coleman fat transfer is used in the periocular area and intraorbitally for soft-tissue volume augmentation in postenucleation socket syndrome. This article aims to identify areas of low fat absorption and the histopathology of excised fat.

Methods: Noncomparative case series of patients who underwent excision/debulking of injected autologous fat in the inferior sulcus/lower eyelid.