Supernumerary orbital muscle in congenital eyelid retraction.

PURPOSE: Although several reports of supernumerary orbital muscles related to the levator palpebrae superioris have been published, no case has been associated with congenital eyelid retraction. This report describes an apparent causal relationship between an accessory levator muscle slip and congenital eyelid retraction. METHODS: Case report and literature review. RESULTS: Release of the anomalous muscle's attachment from the superior tarsal border alone resulted in resolution of the eyelid retraction. CONCLUSIONS: Eyelid muscle anomalies may be a cause of congenital eyelid retraction. Ophthalmologists who treat eyelid disorders should be aware of this possibility when evaluating and operating on patients with congenital eyelid retraction.

The tarsal sandwich: a new technique in lateral canthoplasty.

PURPOSE: Trauma and infection sometimes produce lower lid malpositions that are difficult to repair cosmetically with standard canthoplasty techniques. A new variation is described. METHODS: Surgical techniques of the tarsal strip canthoplasty and of lateral tarsorrhaphy are combined into the tarsal sandwich. RESULTS: Representative cases with preoperative and postoperative photos are presented. CONCLUSION: The sandwich technique allows the surgeon more flexibility in achieving the necessary vertical lift of the lateral canthus in difficult cases of entropion, ectropion, and lagophthalmos.

Eyelid microcystic adnexal carcinoma.

Microcystic adnexal carcinoma is an uncommon cutaneous tumor with multiple synonyms. On cursory microscopic examination, the tumor mimics syringoma and other benign skin adnexal tumors. However, the asymmetric, infiltrative growth pattern clearly sets the lesion apart as carcinoma. The tumor is locally aggressive, with recurrences common, but regional metastases are rare. Histogenesis is controversial. Optimal treatment consists of complete surgical excision with clear surgical margins.

The partial dissection trabeculectomy.

We retrospectively reviewed the results of the first 20 procedures of a modification of the penetrating trabeculectomy ab externo procedure in which an attempt is made to limit subconjunctival fibrosis at the filtering site. With a follow-up ranging from 2 to 29 months, the average intraocular pressure was reduced from 33 to 12 mm Hg.

Orbital inflammatory disease associated with systemic lupus erythematosus.

Orbital inflammatory disease in a patient with systemic lupus erythematosus is rare and presents a diagnostic dilemma as well as a therapeutic challenge. Ours appears to be the sixth such case reported in the literature.

Involutional entropion of the upper lid.

Involutional entropion is an inturning of the eyelid margin caused by changes of lid tissues due to aging. Two patients with the uncommon finding of involutional entropion of the upper lid were treated with surgery based on the principles used to treat common lower lid entropion. The causes of lower lid entropion include increased horizontal and vertical lid laxity, and correcting these same factors in the upper lid resulted in a satisfactory repair of the entropion. Treatment of involutional entropion in the upper lid is compared and contrasted with that of the lower lid.

Orbital angiolipoma.

Successful resection of an orbital angiolipoma in a 3-year-old child was performed. To our knowledge, this is the first report of angiolipoma in this site.

Aphakic cystoid macular edema secondary to betaxolol therapy.

Since the approval of timolol for the treatment of open-angle glaucoma, beta-adrenergic blocking drugs have replaced epinephrine, a pure alpha and beta agonist, as the treatment of choice for glaucoma in aphakic patients. To date, there have been no reports of cystoid macular edema secondary to timolol, a non-selective beta-adrenergic blocker that apparently has little intrinsic sympathomimetic activity. Betaxolol is a new beta-adrenergic receptor blocker that preferentially blocks beta 1 receptors. We report a case of angiographically proven cystoid macular edema secondary to betaxolol therapy that resolved after discontinuation and recurred after a monocular therapeutic trial.

Hodgkin's disease and granulomatous uveitis.

A poorly understood association between Hodgkin's disease and noncaseating granulomas has been well documented in all stages of the lymphoma. Characteristically, the granulomas are found within liver, spleen, lymph nodes, and bone marrow. The following case report describes a 21-year-old woman with Stage 1-A nodular sclerosis Hodgkin's disease who had both multiple noncaseating granulomas in her spleen and an abdominal lymph node, as well as bilateral granulomatous uveitis.

Loss of central visual acuity after laser peripheral iridectomy.

To our knowledge, this is the first case report wherein visual acuity was lost after peripheral laser iridectomy. Certain facts surrounding this particular event are unusual and may help to broaden our understanding of the mechanism of "snuff".