Eyelid masses: a 10-year survey from a tertiary eye hospital in Tehran

The purpose of this study was to evaluate the demographics and clinical features of eyelid masses in a tertiary eye hospital over a 10-year period. A retrospective chart review was performed for patients admitted with eyelid tumors from 2000 to 2010. Data were collected and analyzed on the demographic features, location of the tumor, types of treatment, and pathologic findings. A total number of 182 patients were evaluated of which, 82 cases were benign and 100 cases were malignant neoplasms. The most common benign tumors included melanocytic nevi [35%], papilloma [19.5%], and cysts [11%]. The most frequent malignant tumors included basal cell carcinoma [BCC] [83%], squamous cell carcinoma [8%] and sebaceous gland carcinoma [6%]. The most common site for malignancy was the lower lid followed by the upper lid. BCC recurred in 16 cases that were most frequent in the lower lid. Melanocytic nevus, papilloma and cysts are the most common benign lesions and BCC is the most common malignant lesion in the eyelids. Recurrence is a feature of BCC especially in the lower lid

Outcomes of Levator Resection at Tertiary Eye Care Center in Iran: A 10-Year Experience

PURPOSE: To assess outcomes of levator resection for the surgical correction of congenital and acquired upper lid ptosis in patients with fair to good levator function and evaluation of the relationship between demographic data and success of this operation. METHODS: In a retrospective study, medical records of patients with blepharoptosis who had undergone levator resection over a 10-year period and were followed for at least 3 months were reviewed. RESULTS: Overall, 136 patients including 60 (44.1%) male and 76 (55.9%) female subjects with a mean age of 20 +/- 13.8 years (range, 2 to 80 years) were evaluated, of whom 120 cases (88.2%) had congenital ptosis and the rest had acquired ptosis. The overall success rate after the first operation was 78.7%. The most common complication after the first operation was undercorrection in 26 cases (19.1%), which was more prevalent among young patients (p = 0.06). Lid fissure and margin reflex distance (MRD1) also increased after levator resection (p < 0.001). Age, sex, type of ptosis, amblyopia, levator function, MRD1, lid fissure and spherical equivalent were not predictive of surgical outcomes of levator resection. CONCLUSIONS: Levator resection has a high rate of success and few complications in the surgical treatment of congenital and acquired upper lid ptosis with fair to good levator function. Reoperation can be effective in most cases in which levator resection has been performed.

Recurrent orbital cavernous hemangioma due to overlooked multiple tumors

To report late recurrence of orbital cavernous hemangioma in a patient ten years after complete resection of the primary tumor. A 32-year-old woman with a history of progressive visual loss and proptosis underwent lateral orbitotomy for resection of a large cavernous hemangioma. Ten years later, proptosis recurred and the patient developed progressive ocular deviation. Imaging studies were in favor of a recurrent cavernous hemangioma and the tumor was excised via the previous incision site. Reassessment of previous orbital images suggested the presence of two separate tumors, only one of which had been excised at the time of initial surgery. Recurrent orbital cavernous hemangioma may follow incomplete excision of multiple orbital lesions with gradual growth of unidentified residual tumors. Accordingly, when an encapsulated cavernous hemangioma is removed, exploration is recommended to rule out multiple lesions.

Clinical features and outcomes of treatment for fourth nerve palsy

To evaluate the clinical features, etiology and outcomes of treatment for superior oblique [SO] palsy over a 10-year period at Labbafinejad Medical Center. A complete ophthalmologic examination with particular attention to forced duction test [FDT] and tendon laxity was performed in all patients preoperatively. The palsy was divided into congenital and acquired types. Overall, 73 patients including 45 male [61.6%] and 28 female [38.4%] subjects with mean age of 19.7 +/- 11.7 [range, 1.5-62] years, were operated from 1997 to 2007. SO palsy was congenital in 56 [76%] and acquired in 17 [24%] cases. The most common chief complaint was ocular deviation [52.1%]. FDT was positive in only 7 [9.7%] cases. Other clinical findings included amblyopia [19.2%] head tilt [13.7%], chin down position [4.1%], facial asymmetry [6.8%] and tendon laxity [2.7%]. Mean preoperative vertical deviation was 16.1 prism diopters [PD] which was decreased to 1.9 PD postoperatively. Mean exotropia and esotropia were 15 and 13.9 PD respectively before the operation and both decreased to 1.5 PD of horizontal deviation postoperatively. The most common type of SO palsy based on Knapp's classification was type 3 [42.5%]. The most common operated muscle was the inferior oblique [83.6%] and the most common type of operation was inferior oblique myectomy [83.6%]. The success rate for initial surgery was 84% and was increased to 96% with a second intervention. The most common form of SO palsy requiring surgical intervention was congenital which occurred most frequently in young males. Most cases of SO palsy can be successfully treated with a single surgical procedure

Amniotic membrane transplantation for congenital distichiasis

To evaluate the use of amniotic membrane transplantation [AMT] for management of congenital distichiasis. In this interventional case series, 16 eyelids of 5 patients with congenital distichiasis underwent posterior lamella resection and AMT. All patients were male subjects with mean age of 13.6 +/- 15.2 [range 2-42] years. Mean follow up was 17 +/- 7.5 [range 6-29] months. Distichiasis did not recur in 11 eyelids [68.7%]. Misdirected eyelashes recurred in 3 eyelids [18.8%] outside the AMT area and in 2 eyelids [12.5%] within the AMT area which were successfully treated by gentle laser epilation. Postoperatively, symptoms of dry eye were controlled by medical treatment in all patients. Eyelid contour was not significantly altered in any patient. AMT seems to be an for surgical management of congenital distichiasis yielding acceptable eyelid contour with low rate of complications

Comparison of two methods for upper lid fascia lata sling in congenital blepharoptosis: a randomized clinical trial

To compare the results of two different methods of upper lid sling with autogenous fascia lata in the treatment of congenital ptosis. In a randomized clinical trial, patients with congenital upper lid ptosis and poor levator function [<4mm] were randomly assigned to two different methods of upper lid sling: group A, bitriangular fascia sling [modified Crawford method] and group B, monotriangular fascia sling [modified Fox method]. This study included 30 upper eyelids [15 eyelids in each surgical group] of 19 patients [8 unilateral and 11 bilateral cases] with congenital ptosis. Mean increase in eyelid fissure height was 2.7 +/- 2.3 mm in group A and 3.4 +/- 2.2 mm in group B, respectively. Change in eyelid fissure in both groups was significant [P<0.001, paired t-test] but intergroup difference was not [P=0.4, independent sample t-test]. Early complications such as corneal epithelial defects and entropion, and late complications such as undercorrection were comparable in the two groups. No patient experienced recurrent ptosis requiring reoperation in either group. The monotriangular method of upper lid fascia sling can be used instead of the more popular bitriangular method. Advantages include less need for fascial tissue, less periocular scar formation and a shorter period of anesthesia