Upper Eyelid Fractional CO2 Laser Resurfacing With Incisional Blepharoplasty.

PURPOSE: Laser resurfacing, performed at the same time as blepharoplasty, has most commonly been applied to the lower eyelid skin but can effectively be used on the upper eyelid to reduce rhytidosis and improve skin quality. The authors evaluate the safety and efficacy of this procedure. METHODS: Fractional CO2 laser resurfacing was performed in conjunction with incisional upper blepharoplasty. The ultrapulsed laser energy was applied to the sub-brow skin, the upper medial canthal skin, and the pretarsal skin in 30 patients. Photos were obtained preoperatively and at 3 months. RESULTS: All patients demonstrated reduction in upper eyelid rhytidosis without any serious complications. Independent rhytidosis grading (0-4) showed a mean improvement of 42%. One patient experienced wound dehiscence that satisfactorily resolved without intervention. CONCLUSIONS: Upper eyelid laser resurfacing is effective and can be safely performed at the same time as upper blepharoplasty. This approach reduces or eliminates the need for medial incisions to address medial canthal skin redundancy and rhytidosis and it directly treats upper eyelid wrinkles on residual eyelid and infra-brow skin during blepharoplasty.

Complications of lower blepharoplasty and midface lifting.

Lower eyelid blepharoplasty and midface lifting share a complex anatomy, which should be mastered before attempting these types of surgeries. In recent years, there have been significant contributions to rejuvenating this area. A thorough understanding of the rejuvenative approaches and their outcomes is imperative. Thus, the problem must be preoperatively evaluated to offer the appropriate technique and minimize complications.

Management of postblepharoplasty lower eyelid retraction.

Future advances in the treatment of lower eyelid retraction will likely focus on new synthetic graft materials that are inert and stable with minimal potential for reabsorption. Other advances may focus on biomodulating agents that reduce the risk of retraction at the time of cosmetic eyelid surgery or reverse existing exuberant scarring. Nonsurgical options are viable for modest cases, and these conservative measures may continue to improve, but, for severe retraction, surgery still offers the best promise of correction.

Effect of sleep position on perceived facial aging.

OBJECTIVE: To determine whether there is an association between sleep position and the appearance of facial wrinkles and facial descent. MATERIALS AND METHODS: One hundred women were questioned about their sleep position preference. An independent expert observer evaluated frontal images with digital laterality randomization to identify the side with more wrinkles and more ptosis. RESULTS: Forty-one right-sided sleepers and 23 left-sided sleepers were identified. There was statistical independence between sleep side and side with more wrinkles and between sleep side and side with more facial ptosis according to the Pearson chi-square test. CONCLUSION: Sleep side preference was not significantly correlated with the appearance of wrinkles or facial descent.

Treatment of refractory axillary hyperhidrosis with a 1320-nm Nd:YAG laser.

Axillary hyperhidrosis consists of excessive underarm sweating and can be a clinical challenge for physicians and a significant social stressor for patients. A patient presented with this condition with symptoms that were resistant to traditional treatments. Subdermal 1320-nm Nd:YAG treatment resulted in a satisfactory improvement.

Patient Satisfaction after Upper Extremity Laser Lipolysis without Suction.

Background and Objective. There has been a heightened interest in laser-assisted fat reduction procedures. We aimed to determine if lipolysis with the 1,320 nm Nd-YAG short-pulsed laser without subsequent suction results in satisfactory contouring of the upper extremity. Materials and Methods. Unilateral laser lipolysis of the upper arm was performed on 5 patients. Subcutaneous, subdermal, and skin surface temperatures were monitored with flexible thermocouples throughout the procedure to aid in the establishment of a treatment endpoint. Photographs and arm circumference measurements were evaluated before and 3 months after laser lipolysis. Patients were given the choice of undergoing the procedure on the contralateral arm at 3 months. Results. All patients achieved no improvement to minimal improvement in upper arm contour. One of five patients was elected to have lipolysis performed on the contralateral arm. Conclusion. Laser lipolysis may be safely performed with the parameters utilized in this pilot study, although minimal improvement was seen in upper extremity contour.

Evaluation of homeopathic Arnica montana for ecchymosis after upper blepharoplasty: a placebo-controlled, randomized, double-blind study.

PURPOSE: Ecchymosis is commonly encountered after upper eyelid blepharoplasty. The use of homeopathic preparations of Arnica montana, a flowering herb, has been advocated by physicians, patients, and manufacturers for reduction of postsurgical ecchymosis. The authors evaluate its efficacy after upper eyelid blepharoplasty. METHODS: A prospective, placebo-controlled, double-blind study was performed in which patients were randomly assigned to the administration of homeopathic A. montana or placebo concurrent with unilateral upper eyelid blepharoplasty followed by contralateral treatment at least 1 month later. Ecchymosis was evaluated at days 3 and 7 by rank order of severity and measurement of surface area of observable ecchymosis. RESULTS: There was no statistically significant difference in area of ecchymosis or rank order of ecchymosis severity for days 3 and 7 after treatment with A. montana versus placebo. Additionally, there was no difference in ease of recovery per patient report, and there was no difference in the rate of ecchymosis resolution. CONCLUSIONS: The authors find no evidence that homeopathic A. montana, as used in this study, is beneficial in the reduction or the resolution of ecchymosis after upper eyelid blepharoplasty.

Dual-depth fractional carbon dioxide laser resurfacing for periocular rhytidosis.

BACKGROUND: Laxity and rhytidosis of eyelid skin as a result of photoaging is a frequent cosmetic concern. Fine lines and deep wrinkles may not be optimally addressed with traditional ablative carbon dioxide (CO(2)) resurfacing. Modern devices allow for surface fractional ablation and deep fractional ablation with narrow treatment columns that target deep dermal layers. OBJECTIVES: To examine the efficacy and safety of a combination of deep fractional CO(2) ablation and superficial fractional ablation of eyelid and periorbital skin for improvement of rhytidosis and redundancy. MATERIALS AND METHODS: Fifteen patients underwent dual-depth fractional CO(2) resurfacing of eyelid and periorbital skin. Blinded, independent investigators evaluated rhytidosis and skin redundancy as evident in pretreatment and 6-month post-treatment digital images. RESULTS: Excellent post-treatment improvements were noted for eyelid skin rhytidosis and redundancy, which improved 53.1% and 42.0%, respectively. No serious complications were noted, and the recovery profile was favorable. CONCLUSION: Dual-depth fractional CO(2) resurfacing of eyelid and periorbital skin, including areas within the boundaries of the orbital rim, is safe and effective for the treatment of eyelid photoaging.

Periocular rhytidolysis with the wire scalpel.

PURPOSE: : To describe and evaluate a technique for minimization of lateral periocular rhytids ("crow's feet") with the wire scalpel surgical instrument. METHODS: : Six patients with significant crow's feet were prospectively selected for treatment with the wire scalpel. Preoperative and postoperative photographs were evaluated for severity of crow's feet. RESULTS: : Significant improvement in the appearance of crow's feet was noted in 5 of the 6 patients. CONCLUSIONS: : The wire scalpel surgical instrument can reduce the severity of lateral periocular rhytids via minimally invasive subcutaneous dissection.

Subarachnoid hemorrhage and vasospastic stroke after self-enucleation.

A 31-year-old intoxicated woman self-enucleated her left eye during an acute psychotic episode. CT revealed avulsion of the intracranial optic nerve, chiasmal edema, and adjacent subarachnoid hemorrhage. Exploration via transconjunctival orbitotomy was performed, and the globe and 4.8 cm of contiguous optic nerve were removed. The patient developed postoperative contralateral visual loss followed by middle cerebral artery vasospasm and bilateral cortical infarcts.

Correction of anophthalmic enophthalmos with injectable calcium hydroxylapatite (Radiesse).

A 66-year-old man who presented with anophthalmic enophthalmos desired improvement in his appearance without invasive surgery. A nonincisional technique for volume augmentation in the anophthalmic socket with injectable calcium hydroxylapatite was performed. Clinical improvement was determined by comparison of preoperative and 6-month postoperative exophthalmometry values and photographs. Injectable calcium hydroxylapatite successfully increased orbital volume in this anophthalmic patient.

In vitro activity of fluoroquinolones, vancomycin, and gentamicin against methicillin-resistant Staphylococcus aureus ocular isolates.

PURPOSE: To determine the antibacterial activity of fluoroquinolones, vancomycin, and gentamicin against methicillin-resistant Staphylococcus aureus (MRSA) ocular surface isolates. DESIGN: Retrospective review. METHODS: MRSA isolates were obtained from 21 patients. The MIC(50) (mean inhibitory concentration)(microg/ml) values of 31 MRSA ocular surface isolates were determined for gatifloxacin, moxifloxacin, ciprofloxacin, ofloxacin, vancomycin, and gentamicin using the Etest (AB Biodisk, Solna, Sweden) or the VITEK system (bioMérieux, Inc, Durham, North Carolina, USA). Susceptibility data were interpreted based on criteria specified by the Clinical and Laboratory Standards Institute (CLSI). MAIN OUTCOME MEASURES: MIC(50) values in microg/ml and interpretation of susceptibility or resistance. RESULTS: In vitro resistance rates and median MIC(50) in microg/ml for the MRSA isolates were: gatifloxacin (71%, 8.0), moxifloxacin (68%, 8.0), ciprofloxacin (94%, 8.0), ofloxacin (94%, 8.0), vancomycin (0%, 1.0), and gentamicin (3%, 0.5). CONCLUSIONS: MRSA ocular isolates exhibited a relatively high rate of in vitro resistance to all fluoroquinolones tested, including the fourth generation. In contrast, MRSA isolates were found to be highly sensitive to vancomycin and gentamicin.

Dacryocystitis caused by community-onset methicillin-resistant Staphylococcus aureus.

PURPOSE: To describe the occurrence of community-onset methicillin-resistant Staphylococcus aureus (MRSA) infections of the lacrimal system and their treatment. METHODS: This cases series consisted of data obtained from seven clinical cases of acute or subacute MRSA dacryocystitis, with or without concurrent conjunctivitis, occurring in nonhospitalized individuals presenting between December 2001 and July 2003. Clinical presentations, microbial culture results, treatment modalities, and outcomes were retrospectively reviewed. RESULTS: Three patients were successfully treated with antibiotics and lacrimal surgery with no recurrence of symptoms after surgery for 6 months or longer. Four patients had temporary relief of symptoms with antibiotic therapy, but surgery was not performed for non-ophthalmologic reasons, and recurrence occurred. CONCLUSIONS: The treatment of MRSA dacryocystitis can be challenging. Microbiologic cultures should be performed in all patients with dacryocystitis that is unresponsive to conventional first-line antibiotic treatment and in patients at risk for acquisition of MRSA. Appropriate antibiotic therapy in combination with dacryocystorhinostomy appears to be the optimal treatment.

Ophthalmologic manifestations in pediatric patients with acute disseminated encephalomyelitis.

INTRODUCTION: Acute disseminated encephalomyelitis (ADEM) is an inflammatory syndrome affecting the central nervous system that often is associated with para-infectious causes. Optic neuritis is a common feature of this demyelinating disease, and a paucity of data regarding this entity exists in the ophthalmologic literature. METHODS: We describe 10 pediatric patients with ADEM who presented at our institution between 1995 and 2003. RESULTS: Six of these patients had optic neuritis, with visual acuities in the affected eyes ranging from 20/30 to light perception. Five of those with optic neuritis had bilateral disease. All patients were treated with high-dose methylprednisolone, and 4 of these patients had recovered with a visual acuity of 20/40 or better in the affected eyes. Two patients were lost to follow-up, and final visual acuities were not available. Nine of 10 patients had an identifiable preceding viral illness or immunization. CONCLUSIONS: ADEM is a known cause of optic neuritis in children and should be considered by the ophthalmologist treating this population of patients. All patients in this series were treated with high-dose intravenous steroids followed by an oral steroid taper and/or intravenous immunoglobulin. Final visual outcomes were favorable in all patients.