The modified Bick quick strip procedure for surgical treatment of eyelid malposition.

PURPOSE: To describe the quick strip technique, a hybrid procedure that combines features of the classic Bick procedure and lateral tarsal strip, and to evaluate its effectiveness for correction of lower eyelid malpositions due to horizontal laxity (including both ectropion and entropion). METHODS: Retrospective chart review of 225 eyelids of 160 patients receiving the quick strip. Patient demographics, results, complications, and symptomatic improvement were evaluated. Subgroups included 54 eyelids of 42 patients with entropion and 171 eyelids of 118 patients with various degrees of ectropion. RESULTS: Complete resolution of eyelid malposition was achieved in 208/225 (92.4%) eyelids of 146/160 (91.3%) patients. Late recurrences occurred in 1/225 (0.4%) eyelids of 1/160 (0.6%) patients. Symptomatic improvement was achieved in 152/160 (95.0%) patients. Complications were infrequent with no cases of infection, hematoma, or lateral canthal rounding. The procedure can be combined in a straightforward manner with adjunctive procedures such as suborbicularis oculi fat lift and medial spindle for more advanced cases of ectropion. CONCLUSION: Quick Strip is an effective and efficient surgical treatment for the correction of eyelid malpositions that require horizontal tightening as a component of their management.

Isolated squamous cell carcinoma of the orbital apex.

A 43-year-old woman (Case 1), 63-year-old man (Case 2), and a 67-year-old man (Case 3) presented with diplopia (Cases 1, 2, and 3) and upper-eyelid ptosis (Cases 1 and 3). The cases had preceding cranial nerve V1 disturbances ranging from 3 months to 8 years. Each demonstrated complete internal ophthalmoplegia and external ophthalmoplegia. No case had a cutaneous squamous cell carcinoma (SCC) on presentation or by history. Imaging revealed isolated orbital apex masses. Tumor biopsies revealed SCCs of various differentiations. Systemic workup revealed no extraorbital malignancy. All received radiation therapy, and 2 patients underwent adjuvant chemotherapy. One patient is alive since diagnosis (49 months). In Case 2, SCC developed in the contralateral orbit, and the patient died 19 months after diagnosis; and Case 3 died 12 months after diagnosis. These isolated cases of orbital SCC may have arisen from orbital choristomatous squamous epithelium, may represent de novo or metastatic tumors, or may be manifestations of occult perineural spread.

Conjunctival squamous cell carcinoma in situ in the anophthalmic socket.

A 58-year-old man who had his left eye enucleated at the age of 26 after sustaining ocular trauma presented secondary to an inability to tolerate his prosthesis. Examination revealed upper and lower eyelid cicatricial entropion with areas of symblephara and conjunctival scarring causing forniceal shortening. No areas suspicious for malignancy were noted. Surgical correction was performed, and a segment of the conjunctiva sent for pathology revealed squamous cell carcinoma in situ. Map biopsies of the conjunctiva were subsequently performed, with no further areas of malignancy identified. The patient has been followed with close clinical surveillance, with no evidence of any recurrent suspicious areas within the conjunctiva. This case report confirms that squamous cell carcinoma in situ may occur in an anophthalmic socket and be managed conservatively, reserving the need for orbital exenteration for more invasive disease.

Acquired lacrimal sac fistula after incision and drainage for dacryocystitis: a multicenter study.

PURPOSE: To evaluate the frequency of acquired lacrimal sac fistula formation after incision and drainage for dacryocystitis and to determine associated risk factors. METHODS: National multicenter retrospective study of acquired lacrimal sac fistula formation in patients receiving incision and drainage during the course of treatment for dacryocystitis between January 2005 and December 2007. Data collection included patient demographics, past medical history, procedure technique, culture results, and details of the medical and surgical management. The formation of a persistent fistula was ascertained, in addition to the subsequent treatment of the dacryocystitis. RESULTS: Thirty-nine patients from 9 centers were included. Reasons cited for performing incision and drainage included a tense, pointing abscess, severe pain not relieved with narcotics, periorbital cellulitis, dacryocystitis refractory to antibiotics alone, and the need to control infection prior to dacryocystorhinostomy. In 33 of 39 patients (84.6%), incision and drainage and associated medical treatment cured the dacryocystitis. Only 2 of 39 patients (5.1%) developed a persistent fistula following incision and drainage. No risk factors of statistical significance were identified. Dacryocystorhinostomy to correct associated nasolacrimal duct obstruction was subsequently performed in 36 of 39 (92.3%). CONCLUSIONS: Incision and drainage of the lacrimal sac can be an appropriate adjunctive treatment strategy for selected cases of dacryocystitis. Incision and drainage provides appropriate culture media, symptomatic pain relief, and can facilitate resolution. In this series, persistent lacrimal sac fistula formation after incision and drainage and associated medical and surgical treatment for dacryocystitis was rare.