Isolated Neurofibroma of the Orbit: Case Report and Literature Review.

PURPOSE: To summarize the clinical, radiographic, and intraoperative characteristics of isolated neurofibromas of the orbit (INFO) in the literature and report a case of INFO. METHODS: Case report and a systematic review of the literature. RESULTS: A total of 45 patients were identified from 18 previous studies. There was no sex predilection and mean ages were between 32.3 and 40.0 years with a standard deviation of 9.8 to 19.5 years, median age was 32 to 38 years with a range of 1.5 to 82 years. On CT imaging, INFO reveals homogeneous precontrast radiodensity similar to that of extraocular muscles. On MR imaging, INFO appears hypointense to orbital fat and isointense to brain on precontrast T1-weighted images. On T2-weighted images, they have been described as being predominantly hyperintense with possible hypointense intralesional islands. To the best of our knowledge, our case identifies the youngest patient with the myxoid histologic variant of INFO. CONCLUSIONS: Patients with orbital neurofibromas should be evaluated for the presence of systemic neurofibromatosis, and the plexiform variant is a commonly associated subtype. The myxoid variant can be part of a lesser known condition called NAME syndrome (nevi, atrial myxoma, myxoid neurofibroma, and ephelides) which may warrant echocardiography in patients to evaluate for associated cardiac tumors.

The quasi-integrated porous polyethylene implant in pediatric patients enucleated for retinoblastoma.

PURPOSE: To describe the clinical outcomes of patients receiving a quasi-integrated porous polyethylene orbital implant following enucleation for retinoblastoma. METHODS: A retrospective review of all retinoblastoma patients who received the quasi-integrated porous polyethylene implant following enucleation during the 56-month period between October 2000 and May 2005 was conducted. RESULTS: Ten patients were identified who received the quasi-integrated porous polyethylene implant as a buried, primary orbital implant. Approximately 6 weeks following implantation, a custom-fitted prosthesis was made by an impression technique to provide a "lock-and-key" fit with the orbital implant in the majority of patients. Follow-up ranged from 2 months to 78.5 months following surgery, with an average of 36 months. One case of implant exposure was noted, with no other significant complications. Good motility of the prosthesis was noted in all cases. CONCLUSIONS: The quasi-integrated porous polyethylene orbital implant is safe to implant and provides good prosthetic motility without the need for pegs or screws. It was associated with an exposure rate similar to other commonly used implants following enucleation in retinoblastoma cases.

Congenitally enlarged extraocular muscles: can congenital thyroid eye disease exist in a euthyroid infant?

A 2-month-old boy presented with hypotropia, eyelid retraction, and proptosis of the left eye. CT and ultrasound demonstrated enlarged extraocular muscles. Both the infant and mother were euthyroid. The patient underwent inferior rectus recession, lower eyelid retractor disinsertion, and entropion repair. Biopsy of the inferior rectus and oblique muscles was normal. The clinical presentation and workup appear to be most consistent with thyroid eye disease, which, to our knowledge, would be the first reported case of euthyroid congenital thyroid eye disease with a euthyroid mother.

Internal brow elevation at blepharoplasty.

OBJECTIVE: To present data on a transblepharoplasty technique that provides a safe and reliable brow elevation and glabellar furrow reduction by releasing inferior tethering and weakening the brow depressor muscles. DESIGN: Nonrandomized retrospective case series and surgical technique description. RESULTS: One thousand patients who underwent internal brow elevation for cosmesis associated with upper blepharoplasty over the past 9 years were reviewed. Follow-up ranged from 6 months to 9 years. There were no serious long-term complications. All patients experienced forehead hypesthesia, which was temporary in most patients. Only 2 patients complained of prolonged and bothersome forehead hypesthesia lasting longer than 2 years. CONCLUSION: The internal brow elevation at blepharoplasty is a reproducibly safe and effective technique to improve eyebrow appearance without fixation.

Corrugator superciliaris muscle excision for tension and migraine headaches.

PURPOSE: This study investigates the effect of corrugator superciliaris muscle excision on patients with frequent tension or chronic migraine headaches emanating from the glabellar or frontal regions. METHODS: We present a prospective study of 12 patients with chronic and frequent tension and/or migraine headaches. Patients who had already elected to undergo corrugator excision for cosmesis (n = 64) were given questionnaires to evaluate for the presence of chronic, recurrent migraine and/or tension headaches. Patients who answered in the affirmative went on to answer questions such as onset, location, frequency, severity, and duration of their headaches. Patients were grouped by types of headaches: tension, migraine, and combined headaches. Twelve patients who met all criteria were entered into the study and underwent corrugator excision in combination with blepharoplasty. Postoperative questionnaires and interviews were administered to evaluate the response of the patients' headaches to corrugator excision. RESULTS: All 12 patients had less frequent headaches and said they would have the procedure performed again for headache. Eleven of 12 patients (92%) had less intense headaches after corrugator superciliaris excision. Overall, 58% noted complete relief of their headaches. Follow-up ranged from 6 to 19 months. CONCLUSIONS: Corrugator superciliaris muscle excision provides significant relief for headaches emanating from or localizing to the frontal and glabellar regions. Although improvement of migraine headaches has been previously described with this technique, this is the first report, to our knowledge, of effective surgical treatment of tension headaches by corrugator excision.

Cerebral vasospasm and ischemia after orbital decompression for graves ophthalmopathy.

PURPOSE: We describe the first reported cases of cerebral vasospasm, ischemia, and infarct after orbital decompression surgery for Graves disease-related ophthalmopathy. METHODS: We present two patients who had inadvertent penetration of the dura mater during orbital decompression surgery. One case was recognized at surgery; the other was not. All patient data were gathered and relayed in accordance with state and U.S. laws. RESULTS: Postoperative cerebrospinal fluid leak, radiographic evidence of subarachnoid hemorrhage, and severe neurologic morbidity occurred in each case. Cerebral ischemia and infarction resulting from subarachnoid hemorrhage-induced cerebral vasospasm occurred in each case. CONCLUSIONS: The risk of dural penetration, cerebral vasospasm, and ischemia should be considered during preoperative evaluation for orbital decompression surgery. The diagnosis, treatment, and prevention of this previously unreported serious complication of this procedure is paramount.

Enucleation: is wrapping the implant necessary for optimal motility?

PURPOSE: To compare the mobility of wrapped and unwrapped hydroxyapatite orbital implants after enucleation. METHODS: Fifteen consecutive adult patients underwent enucleation with hydroxyapatite implant placement. These patients randomly received either a wrapped or unwrapped implant. A masked observer measured the motility of implants at 6 weeks after implantation. The conjunctiva was marked and measured with a ruler. These measurements were used to compare the motility of the wrapped versus unwrapped implant. RESULTS: The mean elevation for the wrapped group (n = 7) was 4 mm and for the unwrapped group (n = 8) was 3.9 mm. Depression was 4.1 mm for the wrapped group and 3.6 mm for the unwrapped group. Medial excursions were 5.3 for the wrapped group and 5.0 mm for the unwrapped group. Lateral excursions were 3.7 mm for the wrapped group and 3.5 mm for the unwrapped group. A repeated-measures analysis of variance was performed, and no statistically significant difference was found between the two groups. CONCLUSIONS: We conclude that placement of unwrapped hydroxyapatite implants after enucleation provides essentially the same motility as wrapped implants. This technique also saves time and money and eliminates the possibility of infectious disease transmission from donor wrapping materials.

Is reading disability likely to interfere with glaucoma screening of adults using frequency-doubling technology perimetry?

PURPOSE: The present study is a preliminary investigation of whether frequency doubling technology perimetry (FDT) performance deficits exist in adults with reading disability (RD) and could thereby interfere with screening assessments for glaucoma. DESIGN: Cross-sectional. METHOD: The study population was composed of 46 college students. Twenty-four of the participants were identified as having a RD, and 22 served as controls. All participants underwent assessments of reading, IQ, FDT, Humphrey Visual Fields (HVF), and an ophthalmologic examination. RESULTS: No differences between the RD and control groups were found in age, education, IQ, far visual acuity, HVF, or FDT performance, regardless of how FDT was evaluated (P's >.05). CONCLUSIONS: Preliminary results indicate that FDT performance deficits, which have previously been demonstrated in children with RD, are either small in magnitude or do not exist in adults. Thus, it is unlikely that RD will interfere with assessment for glaucoma using FDT perimetry.