Surgical Microanatomy of Lower Eyelid Tarsal Ectropion Repair With a Putterman Ptosis Clamp.

PURPOSE: To examine the changes in microscopic anatomy of the lower eyelid tarsal ectropion repair with the Putterman ptosis clamp and better understand the anatomical changes associated with the eyelid malposition correction. METHODS: Ten orbits from 5 fresh frozen cadaver heads, ranging in age from 53 to 77 years, were used for the dissection. For each head, a Putterman clamp tarsal ectropion repair was performed on one side, while the contralateral unoperated orbit served as a control. After performing the procedure, both orbits were exenterated and they, along with the resected specimens, were studied microscopically using Verhoeff-Masson trichrome and hematoxylin-eosin stains. RESULTS: Conjunctiva, capsulopalpebral fascia, and smooth muscle were present on all tissue specimens incarcerated within the ptosis clamp. Tarsus was present in one specimen. There was a shortening of the posterior lamella of the eyelid with advancement of the capsulopalpebral fascia on all operated specimens when compared with controls. CONCLUSION: The Putterman clamp ectropion repair works by shortening the posterior lamella of the eyelid and advancing the lower eyelid retractors superiorly. This advancement tightens the lower eyelid retractors and thus stabilizes the eyelid in a more vertical position. In addition to a lateral tendon tuck as described in the original article to tighten horizontal eyelid laxity, this procedure addresses both vertical and horizontal laxity of tarsal ectropion.

Septic cavernous sinus thrombosis with diffuse spread leading to cerebral ischemia.

INTRODUCTION: Septic cavernous sinus thrombosis (CST) is a rare disease with many etiologies and a diffuse array of initial presentation leading to high mortality. CASE: A 25-year-old male with a history of a nasal furuncle presents with an acute onset of fixed and dilated pupils, bilateral exophthalmos, hemorrhagic chemosis, elevated intraocular pressures, restricted extraocular motility, and unresponsiveness. A retinal septic emboli in the left eye is present on dilated fundoscopic exam while an exudative retinal detachment is present in the right eye. MRI/MRV revealed extensive thrombosis of cavernous sinuses, distal sigmoid dural sinuses, and proximal internal jugular veins with associated cerebral edema and multifocal areas of venous infarction. Blood cultures grew Methicillin-resistant Staphylococcus aureus and the patient suffered multi-system organ failure. Despite treatment with full dose systemic anticoagulation and broad spectrum antibiotics the patient suffered a cardiopulmonary arrest and expired. COMMENT: The acuity of onset coupled with the multiple risk factors for septic cavernous sinus thrombosis in this patient led to a fulminant presentation of this disease and ultimate poor outcome.

Traumatic superior ophthalmic vein thrombosis in a child.

Superior ophthalmic vein thrombosis (SOVT) is a rare condition of multiple etiologies that generally presents with proptosis, ophthalmoplegia, periorbital edema, and occasionally decreased visual acuity. We describe a unique case of a two-year-old child presenting with extensive superior forniceal chemosis obstructing the visual axis after trauma in a motor vehicle accident. Angiography revealed complete thrombosis of the superior ophthalmic vein. Management and outcome are also discussed.

Eye Popping Disease: Common Characteristics and Management of Spontaneous Globe Subluxation.

PURPOSE: The objective of this study was to describe the clinical features, predisposing factors, and management of 8 new cases of spontaneous globe subluxation (SGS) and provide a review of the relevant literature. DESIGN: Patient demographics, clinical presentations, investigations, management, complications, and outcomes were measured. METHODS: This was a retrospective, case-note analysis of 8 patients with SGS and a major review of the English-language literature. RESULTS: Eight new cases of spontaneous globe subluxation were identified with varying clinical manifestations and treatments. Literature review has shown less than 50 cases. Space-occupying lesions such as thyroid eye disease, shallow orbits, and floppy eyelids were major contributors to predisposition to SGS. CONCLUSIONS: Orbital congestion, shallow orbits, and floppy eyelids can all play a role in predisposing patients to SGS. Successful surgical management of SGS, when required, should be tailored to the individual patient profile for best results.