Primary eyelid leiomyoma.

A 10-year-old white male presented with a recurrent painful nodule of the left lateral lower eyelid margin with associated madarosis. The initial pathologic diagnosis at an outside institution was reported as chalazion. The lesion was re-excised, and histopathologic examination with immunohistochemical evaluation confirmed the diagnosis of leiomyoma. This is the first reported case of primary leiomyoma originating in the eyelid.

Intubation of the ostium and nasolacrimal duct with a single self-linking silicone stent in external dacryocystorhinostomy.

PURPOSE: To describe a stent placement method that eliminates stent prolapse in external dacryocystorhinostomy. METHODS: A retrospective, institutional review board- approved case series of patients undergoing external dacryocystorhinostomy with an alternative stenting method. Following anastomosis of the posterior flaps, one arm of a Crawford silicone stent is passed through each canaliculus. Both arms are then passed through the nasolacrimal duct and retrieved in the inferior meatus. The 2 distal arms are redirected in the nose; one arm is looped around the proximal portions within the lacrimal sac and tied to the second arm. The stent is self-linked around the inferior turbinate. RESULTS: Nine patients underwent external dacryocystorhinostomy with alternative stenting. None experienced postoperative stent prolapse. At last follow-up (average, 38 months; range, 5-102 months), 8 patients reported resolution of tearing and exhibited normal dye clearance. On compression of the lacrimal sac, none of these 8 patients exhibited reflux of stagnant tears or dye through the canaliculi. CONCLUSIONS: This alternative method improves stent retention by using the inferior turbinate as a stopper to eliminate stent prolapse. The self-linking nature obviates the need and expense of additional biomedical devices.

Outcomes of orbital implants after evisceration and enucleation in patients with endophthalmitis.

PURPOSE OF REVIEW: This manuscript reviews enucleation and evisceration and primary versus secondary orbital implant placement in patients with endophthalmitis. A brief discussion of sympathetic ophthalmia is included as well. RECENT FINDINGS: Opinions remain variable when considering enucleation versus evisceration and primary versus secondary orbital implant placement in patients with endophthalmitis. Although rare, sympathetic ophthalmia remains a concern among surgeons. SUMMARY: Recent findings indicate enucleation and evisceration are performed for blind eyes with endophthalmitis and both porous and nonporous implants may be placed primarily with acceptable outcomes in these patients.

Congenital eyelid eversion.

Congenital bilateral upper eyelid eversion is a rare, benign condition that often resolves spontaneously without permanent sequelae. The authors present an unusual case requiring multiple surgical interventions in a newborn child. A previously undescribed method that restored anatomic eyelid position in this patient is also outlined.

Efficacy of fresh versus refrigerated botulinum toxin in the treatment of lateral periorbital rhytids.

PURPOSE: To determine if there is a difference in the efficacy of refrigerated (previously reconstituted) versus freshly reconstituted botulinum toxin (Botox Cosmetic, Allergan, Irvine, CA, U.S.A.) in the treatment of lateral periorbital rhytids. METHODS: This is a randomized, double-blind, controlled, prospective study. Participants included individuals who were interested in the treatment of their lateral periorbital rhytids (crow's feet) and responded to signs posted in ophthalmology clinics at our institution. Patients were randomized to receive fresh botulinum toxin on 1 side and refrigerated (reconstituted 2 weeks prior) botulinum toxin on the other. Photographs were taken at the pretreatment visit and at the 2-week, 6-week, and 3-month post-treatment visits. Patients were asked to describe any improvement in the appearance of the rhytids at the 2-week visit, the appearance of the rhytids at the 6-week visit, the appearance of the rhytids at the 3-month visit, and finally, the duration of effect at the 3-month visit as well as whether any intervening loss of efficacy had been noted subjectively. The subjective information was recorded by 1 investigator (JIH) at each of the follow-up visits. At the conclusion of the study, the photographs were shown to an ophthalmic plastic and reconstructive surgery fellow, who did not participate in the interventional portion of the study, to determine the response to treatment. This physician was masked to the study protocol and purpose and looked at each photograph without knowledge of treatment arm or timeline. The physician used the Wrinkle Assessment Scale developed by Lemperle et al. to grade the lateral periorbital rhytids on a 0 to 5 scale. RESULTS: Forty-five patients were included in the final analysis. One patient felt there was a difference in the time of onset with the refrigerated toxin taking effect on day 3 versus day 4 for the fresh toxin. Unmasking revealed the following: 5 patients felt there was a greater effect on the freshly reconstituted side while 6 patients felt there was a greater effect on the refrigerated side. The independent physician evaluator determined there was a difference in effect between sides in 4 patients with the greater effect on the fresh side in 2 patients and the refrigerated side in 2 patients. CONCLUSIONS: This study demonstrates that 2 weeks of refrigeration does not appear to significantly affect the time of onset or efficacy of botulinum toxin in the treatment of lateral periorbital rhytids.

Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule.

OBJECTIVE: To review the clinical features and treatment of patients with retained nuclear fragments in the anterior chamber (AC). DESIGN: Single-center, retrospective, noncomparative, consecutive case series. PARTICIPANTS: Sixteen patients with a diagnosis of retained nuclear fragments in the AC. METHODS: Retrospective review of the medical records at Bascom Palmer Eye Institute in Miami, Florida, to identify all patients with a diagnosis of retained nuclear fragments in the AC after phacoemulsification surgery without rupture of the posterior capsule. Charts were reviewed and patient characteristics, ocular history, clinical findings, treatment (medical and surgical), and visual outcomes were recorded. MAIN OUTCOME MEASURES: Visual outcome and visual acuity at last follow-up visit. RESULTS: Most patients presented with corneal edema and anterior segment inflammation. All patients proved refractory to medical management, and surgical extraction of the retained lens fragment was required. Ten patients were myopic or had long axial lengths and/or steep keratometry readings. Three patients underwent penetrating keratoplasty for intractable corneal edema. One patient required a second surgery for fragment removal after a previous unsuccessful attempt at removal. Visual outcomes for the patients without macular disease who had lens fragment removal alone ranged from 20/20 to 20/40. Of the 2 patients without macular disease who underwent penetrating keratoplasty, the visual outcomes were 20/50 and 20/30. CONCLUSIONS: Retention of nuclear fragments in the AC may occur after phacoemulsification. This complication was associated with myopia in a majority of patients in this series, and we hypothesize that small fragments may hide in the posterior chamber in these larger eyes. Surgical removal was associated with a good visual outcome in patients without macular disease.

Desmoplastic malignant melanoma of the lip: a report of 6 cases and review of the literature.

Desmoplastic malignant melanoma is a rare neoplasm consisting primarily of spindle-shaped melanoma cells embedded in a fibrous stroma, with approximately 6% of cases occurring in the lip. A literature search revealed that most reported cases occur in sun-exposed areas in older men. Few cases of desmoplastic malignant melanoma of the lip in young people (in their mid-twenties) have been described. We report 6 previously undocumented cases of labial desmoplastic malignant melanoma occurring in young individuals and review 20 cases from the literature. Physicians should consider the possibility of desmoplastic malignant melanoma in young people who present with atypical lip lesions, which on histopathologic analysis demonstrate spindle-cell hyperplasia. Although this diagnosis is rare and there have not been reports of such patients in the literature thus far, our findings should alert clinicians to the possibility of desmoplastic malignant melanoma as a diagnosis for lip lesions in young people.