ABSTRACT
PURPOSE: Trauma to the pupillary fibers can occur during repair of orbital floor fracture resulting in a fixed and dilated pupil. The authors report, discuss, and propose an etiology of an abnormal pupil in a child with an orbital floor fracture before surgical repair. METHODS: A case report is described. RESULTS: Although the orbital fracture was repaired, anisocoria persisted 18 months after the initial trauma. CONCLUSIONS: Pupillary function must be assessed before surgical repair of an orbital floor fracture as damage of the pupillary fibers can occur secondary to the orbital floor fracture.
Subject(s)
Orbital Fractures/complications , Pupil Disorders/etiology , Child , Humans , Male , Orbital Fractures/diagnosis , Pupil , Pupil Disorders/diagnosis , Tomography, X-Ray ComputedABSTRACT
A rare variant of adenoid cystic carcinoma is the dedifferentiated sarcomatoid form, which has previously been reported in the hard and soft palate, maxillary sinus, submandibular glands, and nasal cavity. The authors report the first case of a dedifferentiated sarcomatoid adenoid cystic carcinoma occurring in the lacrimal gland, that of a 52-year-old man. The patient presented with a 4-month history of diplopia, decreased vision, and right upper eyelid swelling. Radiographic imaging showed a soft tissue mass in the extraconal compartment superolateral to the right eye. The patient subsequently underwent surgical debulking. Histologic examination of the tissue revealed classic cribiform adenoid cystic carcinoma and a sarcomatous component consisting of malignant spindle cells and fusiform cells arranged in whorls. Dedifferentiation is a well-established phenomenon in salivary gland tumors that is associated with aggressive behavior and poor prognosis; however, the exact nature of such dedifferentiated neoplasms remains unclear.
Subject(s)
Carcinoma, Adenoid Cystic/pathology , Cell Transformation, Neoplastic/pathology , Lacrimal Apparatus Diseases/pathology , Orbital Neoplasms/pathology , Cell Dedifferentiation/physiology , Humans , Male , Middle AgedSubject(s)
Corneal Diseases/pathology , Eye Neoplasms/pathology , Histiocytoma, Benign Fibrous/pathology , Limbus Corneae/pathology , Biomarkers, Tumor/analysis , Corneal Diseases/surgery , Eye Neoplasms/chemistry , Eye Neoplasms/surgery , Female , Glucocorticoids/therapeutic use , Histiocytoma, Benign Fibrous/chemistry , Histiocytoma, Benign Fibrous/surgery , Humans , Immunoenzyme Techniques , Keratoplasty, Penetrating , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/drug therapy , Middle Aged , Orbit Evisceration , Prednisone/therapeutic useABSTRACT
Injury and disruption of the canaliculi of the lacrimal excretory system commonly occur from laceration or shearing trauma. This type of injury will likely lead to dysfunction of tear flow from the palpebral sulcus and chronic epiphora. The goal of this article is to give a step-by-step review of canalicular repair.
Subject(s)
Blepharoplasty/methods , Eyelids/injuries , Lacrimal Apparatus/injuries , Lacrimal Apparatus/surgery , Blepharoplasty/instrumentation , Child , Eyelids/surgery , Female , Humans , Lacerations/surgery , Prosthesis ImplantationABSTRACT
The lateral tarsal strip is a mainstay procedure of oculoplastic surgery. The technique is easy to conceive but difficult to master. Awareness of its many indications and its limitations along with a working knowledge of its proper execution is necessary.
Subject(s)
Blepharoplasty/methods , Eyelids/surgery , Surgical Flaps , Ectropion/surgery , Entropion/surgery , Humans , Suture TechniquesABSTRACT
OBJECTIVE: To evaluate the efficacy and safety of a combined endoscopic and transconjunctival orbital decompression in patients with thyroid-related orbitopathy with orbital apex compression. STUDY DESIGN: Retrospective review. METHODS: A sequential series of patients with thyroid-related orbitopathy presenting with orbital apex compressive myopathy with and without optic neuropathy who were undergoing combined endoscopic and transconjunctival decompression by the same surgeons from 1992 to 2001 was reviewed. Patients were regularly evaluated preoperatively and postoperatively over a 3- to 55-month period to record the effects of this approach on visual acuity, Hertel exophthalmometry, and diplopia. Complications and secondary ophthalmological procedures were reviewed. RESULTS: Between 1992 and 2001, 72 combined endoscopic and transconjunctival decompressions were performed on 41 patients with orbital apex compression. Visual acuity improved in 89.3% of the patients with compressive optic neuropathy (P <.0005) and in 34.1% of those without neuropathy. Proptosis was reduced by 3.65 mm, on average. There was one case of transient intraoperative cerebrospinal fluid extravasation at the site of the optic nerve decompression, and one patient developed epistaxis. CONCLUSIONS: The study supports the treatment of thyroid-related orbital apex compression with and without compressive optic neuropathy by a combined transconjunctival and endoscopic approach. This approach offers short hospital stays, excellent visual recovery, and minimal complications in patients with thyroid-related orbital apex compressive myopathy and related compressive optic neuropathy. The beneficial effects observed in the patients with visual loss continued to improve over time and were significant (P <.001).
