Tocilizumab for the Management of Thyroid-Associated Orbitopathy.

Purpose: To describe the efficacy of tocilizumab in the treatment of a cohort of patients with active thyroid-associated orbitopathy.

Methods: Patients were identified with active thyroid-associated orbitopathy who were intolerant of or had progression of disease despite systemic corticosteroids and subsequently were treated with tocilizumab between January 2015 and December 2020. Clinical Activity Score, Thyroid-Associated Ophthalmopathy Scale score, and thyroid-stimulating immunoglobulin levels were assessed prior to initiation of tocilizumab, following the first dose, and after the completion of treatment.

Delayed periorbital hemorrhage in oculoplastic surgery patients on oral anticoagulants.

Periorbital hemorrhage is a potentially sight threatening surgical complication. The effect of new oral anticoagulants (NOACs) on hemorrhagic events after periorbital surgery has not been investigated. We describe four cases of severe delayed postoperative hemorrhage associated with NOACs, in addition to three cases in patients on traditional antithrombotic agents.

Management of graves myopathy: Thyroid-associated orbitopathy: when should we operate?

Thyroid-associated orbitopathy (TAO) is an autoimmune disorder that affects multiple periocular tissues. In TAO, an active immunologic inflammatory phase is typically followed by a cicatrizing recovery phase. Management in the inflammatory phase is supportive, and surgical rehabilitation should generally be deferred until the patient is stable.

Tocilizumab as a steroid sparing agent for the treatment of Graves' orbitopathy.

Purpose: To describe the effect of tocilizumab in two patients with thyroid associated orbitopathy (TAO).

Observations: We present two patients with TAO who could not tolerate corticosteroids and had a reduction in clinical and laboratory markers of inflammatory activity with subsequent tocilizumab therapy.

Conclusions And Importance: The IL-6 receptor antibody tocilizumab is a promising candidate for the treatment of TAO because it selectively targets a key inflammatory mediator and has a favorable side effect profile.

Long-Term Results for Entropion Repair by Tarsal Margin Rotation With Posterior Lamella Superadvancement.

Purpose: To report the long-term stability of tarsal margin rotation and posterior lamellar superadvancement (TMR PLS) for the repair of upper eyelid cicatricial entropion.

Methods: A retrospective chart review was performed from January 2000 through December 2014 to identify all patients who had TMR PLS at the authors' institution. Charts were reviewed for demographic information, recurrence of entropion or trichiasis, and surgical complications.

Orbital Plasmacytoma Mimicking an Orbital Abscess.

An 83-year-old male with a 15-month history of multiple myeloma presented with acute onset of swelling, redness, and pain around his right eye. CT scan was consistent with an orbital abscess. The patient was taken to the operating room for drainage of the orbital abscess.

Assessing the Effectiveness of Arnica montana and Rhododendron tomentosum (Ledum palustre) in the Reduction of Ecchymosis and Edema After Oculofacial Surgery: Preliminary Results.

Purpose: The purpose of this study was to provide preliminary data on the potential effectiveness of the combination of topical Arnica montana and Rhododendron tomentosum (Ledum palustre) in reducing postoperative ecchymosis and edema in a select population of healthy volunteers after oculofacial surgery.

Methods: This retrospective review examined the postoperative course of healthy volunteers using topical Arnica and Ledum after undergoing common oculofacial procedures, including blepharoplasty, browpexy, and rhinoplasty, in the hands of 4 surgeons at tertiary referral centers from July 1, 2012 to December 31, 2012 using medical records review. Each patient included had used topical hydrogel pads (OcuMend, Cearna Inc.

Eyelid margin basal cell carcinoma managed with full-thickness en-face frozen section histopathology.

Purpose: To determine the tumor control rate of basal cell carcinoma (BCC) of the eyelid margin managed by full-thickness eyelid resection with en-face frozen section-controlled margins and primary reconstruction of the defect.

Methods: This is a retrospective, consecutive, noncomparative, longitudinal interventional case series from a single institution. A review of medical records of all patients with BCC involving the eyelid margin treated by full-thickness en-face frozen section histopathology between June 1997 and June 2011 was conducted.

A national survey of practice patterns: temporal artery biopsy.

Objective: To assess current clinical practice patterns for temporal artery biopsy (TAB) among clinicians in establishing the diagnosis of giant cell arteritis.

Design: A survey was sent via e-mail using the Survey Monkey website (www.surveymonkey.

A new Cylindromatosis (CYLD) gene mutation in a case of Brooke-Spiegler syndrome masquerading as basal cell carcinoma of the eyelids.

A 70-year-old woman sought treatment for confluent flesh-colored papules on all 4 eyelids. Sixteen family members were reported to have similar lesions involving the face and scalp. Initial histopathologic examination of the lesions was interpreted as basal cell carcinoma, but on further review, the lesions were deemed to be consistent with trichoepitheliomas as seen in Brooke-Spiegler syndrome.

Silicone intubation for the treatment of epiphora in adults with presumed functional nasolacrimal duct obstruction.

Purpose: To evaluate the long-term efficacy of silicone intubation in adults with presumed functional nasolacrimal duct obstruction.

Methods: This retrospective cohort study reviewed adults with unilateral or bilateral epiphora and presumed functional nasolacrimal duct obstruction treated with silicone intubation and followed for signs of treatment failure (defined as persistent epiphora or need for a secondary procedure). Median time to event (failure) after silicone intubation was calculated using Kaplan-Meier survival analysis.

Human immunodeficiency virus-associated blepharoptosis.

Purpose: To better characterize an unusual blepharoptosis observed in HIV-positive patients and to evaluate histopathology.

Methods: This retrospective case series evaluated patients with HIV/AIDS and blepharoptosis with reduced levator excursion. Exclusion criteria included patients with identifiable causes of ptosis (e.

Long-term results for the use of gold eyelid load weights in the management of facial paralysis.

Background: The placement of gold eyelid load weights to improve passive upper eyelid animation is integral to the management of patients with facial palsy, particularly for patients with long-term paralysis.

Methods: In a retrospective cohort review, outcomes after placement of 104 gold weights in 94 eyelids implanted by one surgeon from 1986 to 2000 were evaluated. The primary outcome measures were improvement in corneal exposure and visual acuity.

Crystal-storing histiocytosis and crystalline keratopathy caused by monoclonal gammopathy of undetermined significance.

Purpose: The purpose of this study was to report the occurrence of crystalline keratopathy and of orbital infiltrative disease resulting from crystal-storing histiocytosis (CSH) in a patient with monoclonal gammopathy of undetermined significance.

Methods: The authors conducted a review of a medical record and immunohistopathologic studies.

Results: A 66-year-old man presented with a 3-year history of unilateral progressive ptosis, proptosis, and external ophthalmoplegia.

Prevalence and risk factors of diabetic retinopathy in a multi-racial underserved population.

Purpose: To describe the prevalence, severity, and associated risk factors of diabetic retinopathy among different racial groups (whites, blacks, Hispanics, and Asians) within an urban, underserved population.

Methods: 2-field non-mydriatic retinal photographs of each eye were reviewed for 1073 patients referred to the San Francisco General Hospital mobile eye service, the Eye Van, for diabetic retinopathy screening. Presence and severity of diabetic retinopathy was determined based on a modification of the Airlie House classification system.

Orbital metastasis from medullary thyroid carcinoma.

A 46-year-old woman with known multiple endocrine neoplasia type 2A was referred for evaluation of left-sided progressive diplopia and proptosis. She was given the presumptive diagnosis of progressive thyroid-associated orbitopathy. Clinical examination revealed significant proptosis and restricted motility of the left eye.

Müller muscle-conjunctiva resection to correct ptosis in high-risk patients.

Purpose: Müller muscle-conjunctiva resection could be seen as a relative contraindication in patients with a prior history of a glaucoma filtering procedure, corneal disease, or corneal surgery. The concern centers around the theoretical risk of bleb-related complications or corneal damage from the palpebral conjunctival sutures. Our study aimed to determine whether any bleb- or cornea-related complications arose in patients who underwent Müller muscle-conjunctiva resection for ptosis correction.

Atypical presentations of pleomorphic adenoma of the lacrimal gland.

Purpose: To report 3 cases of pleomorphic adenoma of the lacrimal gland with atypical features.

Methods: The medical records, radiographic imaging, operative reports, and tumor histopathology of 3 patients with unusual presentations of pleomorphic adenoma of the lacrimal gland were reviewed.

Results: All 3 patients were females ranging in age from 18 to 64 years.

Anatomy of the Asian eyelid.

Asian eyelids have several characteristics that distinguish them from Caucasian eyelids. An understanding of the structural features common to all eyelids, regardless of racial background, allows for a greater comprehension of the underlying anatomic basis of distinctive characteristics and the surgical techniques essential for their maintenance. Failure to recognize and maintain inherent structures can lead to the loss of characteristic ethnic features and a cosmetically unacceptable result.

Supportive care of facial nerve palsy with temporary external eyelid weights.

Background: Patients with facial nerve palsy can have many ocular complications. Lagophthalmos, or poor eyelid closure, and loss of blink secondary to lack of nerve supply to the orbicularis oculi, can lead to exposure keratopathy, corneal breakdown, ulcers, and even perforation. Management of patients should be directed toward the severity of ocular findings and ranges from supportive care to surgical reanimation and soft tissue repositioning.

Bacterial endophthalmitis after resident-performed cataract surgery.

Purpose: To determine if there is an increased rate of postoperative bacterial endophthalmitis after resident-performed cataract extraction relative to the reported rates of experienced surgeons.

Design: Retrospective, observational case series.

Methods: The operative reports of the resident-performed cataract surgeries at San Francisco General Hospital between 1983 and 2002 were reviewed.