Transcranial orbital decompression for progressive compressive optic neuropathy after 3-wall decompression in severe graves' orbitopathy.

Purpose: To determine surgical outcomes after transcranial decompression of the superior orbit in patients with progressive compressive optic neuropathy (CON) secondary to Graves' orbitopathy (GO) who had previously been treated with 3-wall decompression.

Methods: Approval from the West Virginia University Institution Review Board was obtained. A retrospective review of 4 patients with GO who received bilateral transcranial decompression of the orbits for progressive compressive optic neuropathy after bilateral maximal extracranial 3-wall decompression was performed.

Health-related quality of life after surgical removal of an eye.

Purpose: This study compared the general health-related quality of life (HRQOL) and the vision-specific HRQOL in patients following the surgical removal of 1 eye who had good vision in the remaining eye to a group of binocular patients with good vision in OU.

Methods: The Medical Outcomes Study Short Form 12 and the National Eye Institute Visual Function Questionnaire HRQOL surveys were administered to 29 patients who had surgical removal of an eye who attended an ocular prosthetics clinic and to 25 binocular persons who accompanied a patient. All subjects in each group had best-corrected visual acuity of 20/40 or better.

Comparison of orbital fracture repair performed within 14 days versus 15 to 29 days after trauma.

Purpose: To examine whether orbital floor and/or medial wall fracture repair delayed for 15 to 29 days is as effective as early surgery.

Methods: A retrospective review is reported comparing outcomes of early fracture repairs (performed 1-14 days after trauma) to delayed fracture repairs (performed 15-29 days after trauma). Ocular motility, diplopia, and time to resolution of diplopia postoperatively are the main endpoints.

Infiltrating orbital astrocytic proliferation associated with congenitally malformed eyes.

This report describes the clinical and pathologic findings in two adults with orbital infiltration by astrocytic cells associated with congenitally malformed eyes. Both cases had enlarging orbital masses and underwent complete resection. Histopathology revealed proliferation of astrocytes (fibrillary acidic protein-positive) that invaded the orbital tissues.

Ultrasonic bone removal with the Sonopet Omni: a new instrument for orbital and lacrimal surgery.

We used a new instrument that ultrasonically removes bone (Sonopet Omni, model UST-2001 Ultrasonic Surgical Aspirator) in 13 orbital decompressions and 6 dacryocystorhinostomies. We noted no surgical complications of ocular or soft tissue damage, infection, inflammation, or visual loss. Visualization, manipulation, ease of use, and speed were far superior with the Sonopet ultrasonic bone curette compared with drills or rongeurs.

Mutations in the human RAX homeobox gene in a patient with anophthalmia and sclerocornea.

Anophthalmia and microphthalmia are among the most common ocular birth defects and a significant cause of congenital blindness. The etiology of anophthalmia and microphthalmia is diverse, with multiple genetic mutations associated with each of these conditions, along with potential environmental causes. Based on findings that mutations in the Rx/Rax homeobox genes in mice and fish lead to defects in retinal development and result in animal models of anophthalmia, we screened 75 individuals with anophthalmia and/or microphthalmia for mutations in the human RAX gene.

Bilateral optic nerve sheath enhancement from giant cell arteritis.

An 83-year-old man presented with acute bilateral visual loss to no light perception (NLP) OD and 20/50 OS. His fundus examination showed moderate bilateral pallid disc edema. A sedimentation rate was 60 mm/h.

Lower eyelid reverse ptosis repair.

Purpose: To report the results of the surgical repair of lower eyelid reverse ptosis.

Methods: Retrospective case series. Eight patients ranging in age from 31 to 77 years underwent surgical repair of lower eyelid reverse ptosis.

The failed probing.

The management of failed probing for congenital nasolacrimal duct obstruction is given by a panel of authors. Treatment options examined are repeat probing, inferiorturbinate infracture, closed lacrimal intubation and dacryocystorhinostomy. There is considerable variation as to the timing of these interventional techniques.

Iatrogenic complications related to the use of Herrick Lacrimal Plugs.

Purpose: To report a series of lacrimal complications associated with a specific type of lacrimal plug (Herrick Lacrimal Plug; Lacrimedics Incorporated, Rialto, CA.)

Design: Retrospective, noncomparative case series and survey.

Methods: Members of the American Society of Ophthalmic Plastic and Reconstructive Surgery were asked to submit personally treated cases of patients referred for treatment of complications after placement of a Herrick Lacrimal Plug.

Congenital intraocular teratoma associated with eyelid coloboma.

Purpose: To describe the first case of intraocular teratoma associated with eyelid coloboma and the second reported case of intraocular teratoma.

Design: Interventional case report.

Methods: A left intraocular tumor was surgically resected from a 2-day-old female with an associated lower eyelid coloboma.

Primary temporal fossa dermoid cysts. Characterization and surgical management.

Objective: To detail the characteristics and management of rarely reported and incompletely described dermoid cysts originating in the temporal fossa.

Design: Retrospective case series.

Participants: Five patients ranging from 2 to 38 years of age with a mass in the temporal region (posterior to the lateral orbital rim) participated.

Axial myopia in congenital ptosis: an animal model.

Congenital ptosis in humans has been associated with anisometropia, myopia, astigmatism, and amblyopia. Scientific evidence has shown that visual deprivation causes axial myopia in animals. This study using chicks was undertaken to investigate an animal model of congenital ptosis and the effects of lid position on ocular development.

Ritleng intubation system for treatment of congenital nasolacrimal duct obstruction.

Twenty-eight patients (34 eyes) with congenital nasolacrimal duct obstruction underwent silicone intubation with the Ritleng lacrimal intubation system. The technique involves introduction of a Prolene (Ethicon Inc, Somerville, NJ) monofilament guide thread, securely fastened to the silicone tubing, into a tubular metal probe that opens into the inferior meatus. The outcome was evaluated in terms of ease of intubation and objective success rate.

A new physical finding in floppy eyelid syndrome.

Objective: The authors noted that many of their patients with the floppy eyelid syndrome had a unique finding of eyelash ptosis and lashes that curled in many directions. The purpose of this study was to determine how many of these patients had this physical finding.

Design: Case series.

The perils of permanent punctal plugs.

Purpose: To describe previously unreported complications associated with permanent lacrimal punctal plugs.

Method: Five oculoplastic practices reviewed patients referred to them over the preceding 2 years for permanent lacrimal punctal plug complications.

Results: In 12 patients, 14 lacrimal punctal plugs migrated distally within the lacrimal drainage system, causing symptoms and necessitating surgical removal.

The anatomy of the common canaliculus.

Background: The functional valve between the common canaliculus and the lacrimal sac has traditionally been attributed to the valve of Rosenmüller, although this anatomical structure has never been rigorously documented.

Objective: To define the anatomy of the canaliculus-sac junction.

Methods: Twelve rigid plastic casts of the lacrimal outflow systems were obtained in human cadaver specimens using a well-known biologic casting material (partially polkymerized monomer to which a catalyst and promoter were added).

Measurement of the resistance to fluid flow within the lacrimal outflow system.

Background: Although the presence of complete obstruction within the human lacrimal drainage system can be easily determined with diagnostic techniques currently available, it is not possible to quantitate degrees of partial obstruction. The authors have developed a new instrument that directly measures pressures associated with fluid flow, allowing the calculation (pressure : flow) of resistance within the tear drainage system. The authors believe that the ability to measure the degree of partial lacrimal stenosis quantitatively will be clinically useful, allowing the diagnosis of lacrimal disease before complete obstruction.

Malignant melanoma of the lacrimal sac.

Although malignancies of the lacrimal sac are rare, malignant melanoma of the lacrimal sac is an exceedingly rare occurrence. Patients with abnormalities of the nasolacrimal system may come to otolaryngologists for evaluation. Treatment of lacrimal sac malignancies will necessitate consultation of a head and neck surgeon.