Post-Hyaluronic Acid Recurrent Eyelid Edema: Pathophysiologic Mechanisms and a Proposed Treatment Protocol.

Background: Hyaluronic acid (HA) filler injections for facial augmentation are commonly administered but can lead to post-hyaluronic acid recurrent eyelid edema (PHAREE). The pathophysiology of this condition has not been fully understood.

Objectives: To report the successful treatment of PHAREE using serial hyaluronidase and fractionated radiofrequency microneedling, with additional carbon dioxide laser skin resurfacing in selected patients.

Orbitocranial Penetration of Ball Bearing Gun Trauma: A Prospective Human Cadaveric Study.

 We completed a prospective human cadaveric study to determine the ability of a ball bearing (BB) pellet to penetrate the orbit and/or surrounding structures.  A single trained sergeant officer discharged an alloy steel air rifle to eight cadaver orbits from four adult human cadaver heads. Five BB pellets each were aimed at three locations (caruncle, upper eyelid, or lower eyelid) at 10 cm and 1 m, and then less specifically, at the orbital region for 3- and 5-m distances.

Teprotumumab for Thyroid Eye Disease-related Strabismus.

Purpose: To assess and quantify teprotumumab's effect on thyroid eye disease-related strabismus by change in measured horizontal and vertical deviations and change in extraocular motility.

Methods: We reviewed a series of patients with thyroid eye disease-related strabismus treated with teprotumumab. Exclusion criteria included age under 18 years, strabismus of alternate etiology, or thyroid eye disease-related reconstructive surgery during the treatment course.

A case of eyelid neuroma with recurrent ptosis.

Purpose: We report a rare case of eyelid neuroma, discovered nine years after external levator advancement, presenting with recalcitrant ocular foreign body sensation and pain, persistent corneal epithelial defect, followed by corneal scarring, and ptosis.

Observations: An 85-year-old man with a history of multiple skin cancers presented with left ptosis, epiphora and recalcitrant eye pain. Nine years prior to presentation, he underwent excision of melanoma in situ of the left forehead, followed by simultaneous forehead reconstruction and left external ptosis repair.

Estimating apparent age using artificial intelligence: Quantifying the effect of blepharoplasty.

Objectives: Quantify the rejuvenation effect of blepharoplasty.

Methods: A dataset of facial photographs was assembled and randomly split into 90% training and 10% validation sets. An artificial intelligence model was trained to input a facial photograph and output the apparent age of the depicted face.

Ensemble neural network model for detecting thyroid eye disease using external photographs.

Purpose: To describe an artificial intelligence platform that detects thyroid eye disease (TED).

Design: Development of a deep learning model.

Methods: 1944 photographs from a clinical database were used to train a deep learning model.

Glue Embolization Without Surgical Resection for Orbital Venolymphatic Malformation.

A 59-year-old man presented with worsening left-sided eye pain and headache from a left orbital venous-dominant venolymphatic malformation. He reported a history of sclerotherapy, experiencing only transient relief with this procedure. Oral analgesia had not helped alleviate the pain.

Revision ptosis surgery for under-correction after Müller muscle conjunctival resection.

Introduction: Müller muscle conjunctival resection (MMCR) may be more likely to lead to under- rather than over-correction. The choice of revision surgery is not clearly defined.

Methods: MMCR patients were included if the post-operated eyelid(s) demonstrated margin reflex distance-1 (MRD1) less than 3.

The Effect of Lighting and Photograph Exposure on Perceived Attractiveness.

Purpose: To assess the effect of various lighting conditions and photograph exposures on perceived attractiveness.

Methods: In the first experiment, 5 variably exposed photographs were taken of 10 subjects using a consistent lighting condition (45° superior box light). In the second experiment, 10 subjects were photographed under variable lighting conditions with consistent exposure: 1) 90° overhead box light, 2) ring light, 3) 45° superior box light, 4) built-in camera flash, 5) 2 straight on box lights, each 45° from midline, and 6) natural light.

Transorbital Debulking of Sphenoid Wing Meningioma.

Objective: To describe the clinical features and outcomes of patients who underwent transorbital debulking of sphenoid wing meningioma.

Methods: Patients with a diagnosis of sphenoid wing meningioma who underwent transorbital debulking were included in this series. Preoperative and postoperative symptoms and examination findings, including best corrected visual acuity (BCVA) and proptosis were extracted from patient charts.

Systemic eosinophilic disease presenting as dacryoadenitis.

Eosinophilic disease with orbital involvement is rare. We present two patients with dacryoadenitis associated with local and systemic eosinophilia. A 32-year-old man presented with episodic dacryoadenitis, lower respiratory inflammation and peripheral eosinophilia.

Upper eyelid weighting for lagophthalmos results in contralateral upper eyelid elevation.

Introduction: Upper eyelid weighting decreases lagophthalmos by improving blink dynamics. The effect of weighting on static eyelid position is less well understood. This study describes the effect of upper eyelid weighting on ipsilateral and contralateral upper eyelid position.

Multiple Arterial Vascular Anomalies in the Periorbital, Paranasal, and Intracranial Spaces Treated With Systemic Bevacizumab.

Arteriovenous malformations of the orbit are rare congenital hamartomas defined by a direct connection between the arterial and venous systems without an intervening capillary bed. Treatment can be challenging, as these lesions are anatomically complex, often involve multiple locations, and have a tendency to recur. A multidisciplinary approach is typically required, involving endovascular and surgical teams.

The Effect of Zero Gravity on Eyelid and Brow Position.

Purpose: To describe the effect of spaceflight on upper eyelid and brow position.

Materials And Methods: Images of astronauts on earth and in space were collected from a National Aeronautics and Space Administration image library. For each astronaut, front facing portraits captured within a 5-year period were obtained.

Ophthalmic and orbital considerations in the evaluation of skull base malignancies.

Introduction: The orbital contents, afferent and efferent visual pathways, and the cranial nerves involved in eye movement, corneal sensation and eyelid closure traverse the skull base, a region bounded by the intracranial cavity, the paranasal sinuses, and the deep spaces of the face and head. As such, tumors from above or below have potential to affect some aspect of the visual system.

Methods: We discuss here the clinical ophthalmologic and orbital considerations in the evaluation of patients with these tumors, as well as the ophthalmic sequelae of treatment with radiation or surgery (or both).

Cone Beam Computerized Tomography Dacryocystography (CBCT DCG) for the Evaluation of Lacrimal Drainage System Dysfunction.

Purpose: Lacrimal outflow imaging has been limited in clinical practice due to a combination of modality limitations and efficacy of clinical testing. Cone beam computed tomography dacryocystography (CBCT DCG) has certain advantages over other modalities that may enhance clinical utility. This study was intended to understand the relationships between symptoms, syringing and CBCT DCG in a population of patients presenting with tearing.

Photochemical Collagen Cross-Linking Reverses Elastase-Induced Mechanical Degradation of Upper Eyelid Tarsus.

Introduction: The floppy eyelid syndrome describes an eyelid disorder characterized by floppy tarsal plates that may be caused by a loss of elastin. The authors attempted to create floppy eyelids by digesting elastin from cadaveric tarsus and then treated them with cross-linking using ultraviolet A and riboflavin.

Methods: Nine right and 9 left upper eyelids were excised from cadavers.

Anatomic Features of Head and Neck Keratinocyte Cancer in Virginia.

Background: Keratinocyte cancer (KC) patients benefit from early diagnosis. We describe here the anatomy of head/neck KCs to help guide screening efforts.

Objective: To examine lesion frequency and anatomic distribution of head and neck KC.

Brow height asymmetry before and after eyelid ptosis surgery.

Background: In the setting of upper eyelid ptosis, asymmetric eyebrow position may be observed and may contribute to overall facial asymmetry. In this study, the authors aim to elucidate the prevalence and predictors of brow height asymmetry in the setting of ptosis and to determine the effect of eyelid surgery on brow height asymmetry to guide preoperative evaluation and informed consent.

Methods: In this cohort study, patients undergoing posterior approach ptosis surgery, unilateral or bilateral, with or without blepharoplasty, were included.

Orbital mantle cell lymphoma presenting as myasthenia gravis.

A 69-year-old man, previously treated with pyridostigmine for myasthenia gravis (manifesting as ptosis and diplopia) was evaluated for several concomitant bilateral anterior orbital masses. Imaging revealed 3 discrete, solid masses within and around the orbits. An incisional biopsy demonstrated atypical lymphocytes positive for CD20 and Cyclin-D1, consistent with mantle cell lymphoma.

A comparison of three different corneal marking methods used to determine cyclotorsion in the horizontal meridian.

During toric intraocular lens (IOL) implantation, surgeons must take particular care to ensure that inaccurate preoperative measurement and intraoperative misalignment do not cause unexpected postoperative residual astigmatism. This retrospective, comparative case series study aimed to analyze the rotational deviation, or cyclotorsion, of three corneal marking methods: VERION digital marker (VDM; reference), horizontal slit beam marking (HSBM), and subjective direct visual marking (SDVM) on the table (using a bevel knife tip). Subjects included 81 eyes of 61 patients (mean age: 65.