The Marcus Gunn phenomenon. A review of 71 cases.

We have reviewed the clinical findings, natural course, pathologic observations, and management of 71 patients with the Marcus Gunn phenomenon. We found individuals with this syndrome to have a significant incidence of amblyopia (59%), double elevator palsy (25%), anisometropia (25%), and superior rectus muscle palsy (23%). Long-term follow-up did not reveal a case that improved with age. In most patients requiring surgery, we recommend a unilateral levator excision on the affected side plus a bilateral frontalis suspension.

Merkel cell tumor of the eyelid. A clinicopathologic case report.

We treated a patient who had clinical and pathological findings of a primary cutaneous tumor of the eyelid with histological and ultrastructural features of a Merkel cell carcinoma. This neoplasm is composed of cells that are thought to be derived from the neural crest and are found normally in the skin. While it may be a low-grade malignant neoplasm, this tumor can grow rapidly and metastasize. Histologically, it can mimic a metastatic undifferentiated small-cell carcinoma from the lung or other primary sites. To our knowledge, this is the first reported case involving an eyelid.

Naso-orbital fractures, complications, and treatment.

Naso-orbital fractures designate a backward displacement of the bones of the nasoskeletal framework into the interorbital space. This anatomical disruption results in deformities, lacrimal dysfunction, medial canthal deformities, ptosis, blow-out fractures, ocular complication, and most severely, penetration of bony fragments into the anterior cranial fossa. Early and late treatment methods are considered. Restoration of the bony contour of the nose and medial canthoplasty procedures are discussed.

Common presentations of sebaceous gland carcinoma of the eyelid.

Carcinoma of the sebaceous glands of the eyelid is a malignant lesion bearing a close resemblance to other less aggressive lid lesions. A long period of time often elapses between initial presentation and correct diagnosis and treatment. Three cases are presented to illustrate common presentations of sebaceous gland carcinoma.

The use and fate of fascia lata and sclera in ophthalmic plastic and reconstructive surgery.

The introduction and use of newer surgical materials, better surgical instruments, finer suture materials, and improved optical equipment have allowed us to advance certain techniques in ophthalmic surgery and ophthalmic plastic surgery. In oculoplastic surgery, fascia lata and sclera are but a few of these materials used with greater frequency. In this paper, a number of techniques are described depicting the use of fascia lata and sclera. A histologic study of these materials after variable periods of implantation is presented.

Conjunctival cysts of the orbit following enucleation.

Four patients developed orbital conjunctival cysts following enucleation. The cysts were demonstrated by ultrasonography and computerized tomography and confirmed by histopathology. They were lined by a non-keratinizing stratified squamous epithelium without goblet cells and contained fluid with mucinous strands. They were excised at eight, seven, and seven, and 25 years post-enucleation, respectively, the latter being the longest interval yet recorded. A simple classification of conjunctival cysts of the orbit is proposed and the mechanisms of the development of cysts in anophthalmic sockets are discussed. The effects of secretory rate and cyst growth are reviewed and surgical management in prevention and treatment of these lesions is outlined.

Baggy lids:a classification and newer aspects of treatment to avoid complications.

A clinical classification of baggy lids is presented to allow for categorization of existing deformities and their subsequent surgical correction. Standard photographic documentation is suggested for impartial evaluation of the selected surgical procedure. A technique in the placement of skin incisions and their modifications, based on position and degree of skin excess, is outlined and recommendations directed toward avoidance of complications are proposed.

Double wedge resection for severe involutional ectropion.

Although the individual elements of our technique are well known to ophthalmic plastic surgeons and ophthalmologists, their combination into one procedure for use in severe cases of involutional (senile) ectropion has not been described. Some authors have advocated performing a two-stage procedure for a severe medial ectropion. We have met considerable success in our one-stage procedure and advocate its adoption.

Ocular manifestations of focal dermal hypoplasia syndrome.

Although 40 percent of patients with the focal dermal hypoplasia syndrome have ocular abnormalities, to our knowledge, only one case of this condition has been previously described in the ophthalmic literature. Two additional cases are presented, and the systemic and ocular findings are reviewed.

The management of special problems associated with Stevens-Johnson syndrome and ocular pemphigoid.

Various surgical treatment methods were outlined that are currently used in treatment of the severe chronic contractual changes seen in Stevens-Johnson syndrome and ocular pemphigoid. All methods described are not 100% successful in view of the chronicity of the disease, but have greatly aided in delaying the destructive course of action because of various degrees of cicatricial entropion formation. The potential association of ocular pemphigoid with Phospholine Iodide medications in the treatment of open-angle glaucoma is under investigation.

Lacrimal trephine.

This article introduces a surgical instrument that facilitates treatment of obstructions of the common canaliculus or the internal canalicular punctum and which can be used with failure of dacryocystorhinostomy secondary to a membrane formation in the area of nasolacrimal anastomosis.