Eyelid laxity, obesity, and obstructive sleep apnea in keratoconus.

PURPOSE: The association between floppy eyelid syndrome and keratoconus (KCN) has been well established, but the converse relationship has not yet been examined and is the objective of this study. The study also investigates the prevalence of obesity and obstructive sleep apnea (OSA) in KCN patients. METHODS: A prospective case-control study of KCN patients with age-, sex-, race-, and body mass index-matched controls was conducted at the Ross Eye Institute, Buffalo, NY. Fifteen patients were enrolled in each group. Extensive eyelid laxity measurements were performed on both groups. Complete medical/ophthalmic history and Epworth Sleepiness Scales were completed on 50 KCN patients and were compared with the normal population. RESULTS: Increased eyelid measurements of the vertical lid pull, lower lid pull, medial canthal tendon distraction, and palpebral width were found in the KCN group compared with the matched control group (P = 0.001, 0.005, 0.04, and 0.01, respectively), and a more rubbery tarsus (P = 0.03), increased corneal diameter (P = 0.02), and increased exophthalmometry measurements (P = 0.01) were also found. The prevalence of OSA (24%, 14/50) and obesity (52%, 26/50) were higher in the KCN patients versus the normal population. CONCLUSIONS: KCN patients have increased laxity to their eyelids, along with a more rubbery tarsus, which may be along the spectrum of floppy eyelid syndrome. KCN patients had a high prevalence of OSA and obesity. The high prevalence of OSA in KCN patients is an important association that carries an increased risk of death from any cause and stroke.

Percutaneous embolization of an orbital hemangiopericytoma with Onyx facilitates its surgical excision.

This is a case report on the surgical treatment of orbital hemangiopericytoma. The patient initially underwent an attempted excision of the tumor with significant hemorrhage elsewhere, which precluded its complete excision. Due to continued growth and pain, the patient underwent percutaneous embolization with Onyx-18 under fluoroscopic radiographic guidance. The patient continued to have pain, progressive enlargement of the tumor, and underwent surgical excision. The excision was noted to have minimal bleeding and was relatively easy to dissect and excise compared with the typical hemangiopericytoma. Embolization with Onyx-18 may be a useful preoperative treatment option for hemangiopericytomas and other vascular lesions of the orbit, and elsewhere.

The graded levator hinge procedure for the correction of upper eyelid retraction (an American Ophthalmological Society thesis).

PURPOSE: Many surgical techniques have been developed to address eyelid retraction with varying results. Identifying and evaluating the anatomical and pathophysiological factors involved will assist in its surgical treatment. This prospective study evaluated the graded levator hinge procedure, in combination with a Müllerectomy and/or lateral canthoplasty when indicated, in an attempt to precisely and selectively target the pathophysiology responsible for the various causes of eyelid retraction in only one surgical session. METHODS: This is a clinical, prospective study of patients with moderate to severe eyelid retraction due to various causes who underwent the graded levator hinge procedure, in combination with a Müllerectomy and/or lateral canthoplasty when indicated. The exact amount of hinging of the levator aponeurosis, and combination with a Müllerectomy and/or lateral canthoplasty, was determined by the clinical operative findings with active cooperation from the conscious patient. RESULTS: Thirty-two consecutive patients (48 eyelids) with varying degrees of upper eyelid retraction underwent the graded levator hinge procedure in combination with a Müllerectomy and or lateral canthoplasty when indicated. The mean (+/- standard deviation) preoperative palpebral vertical fissure height was 12.4 mm (+/- 0.45 mm), and the mean postoperative palpebral fissure height was 9.0 mm (+/-0.20 mm). The mean preoperative asymmetry in the palpebral fissure height was 2.41 (+/- 0.29) mm, and the mean postoperative asymmetry was 0.59 mm (+/- 0.09), and this difference was statistically significant (P <.001). The mean reduction in the palpebral fissure height was 4.6 mm (+/- 0.29 mm) (range, 1-10 mm). The graded levator hinge procedure in combination with a Müllerectomy and or lateral canthoplasty when indicated, led to a statistically significant (P <.001) reduction in mean palpebral fissure height for all patients, the bilateral subset of patients, the unilateral subset of patients, and the thyroid-related orbitopathy subgroup. The graded levator hinge procedure in combination with a Müllerectomy and/or lateral canthoplasty when indicated led to a statistically significant reduction in palpebral fissure height, asymmetry between the eyes in the total set of patients, the unilateral set of patients, and the thyroid-related orbitopathy subset, but not in the bilaterally operated subset of patients, which were already relatively symmetric preoperatively. Postoperatively 90.6 % of all eyelids were within 1 mm of the desired postoperative level (25% were equal, 68.8% were within 0.5 mm, and 6.2% greater than 1 mm from the desired level). CONCLUSIONS: The graded levator hinge procedure, alone or in combination with a Müllerectomy and/or lateral canthoplasty, is a safe and highly effective surgical approach for the treatment of various causes of upper eyelid retraction. Through consideration of the various anatomical and pathophysiological causes of eyelid retraction, excellent functional and cosmetic results are achieved with a graded procedure tapered to the needs of each individual.

Acquired Monocular Vision Rehabilitation program.

Existing programs concerning patients with low vision do not readily meet the needs of the patient with acquired monocular vision. This article illustrates the development, need, and benefits of an Acquired Monocular Vision Rehabilitation evaluation and training program. This proposed program will facilitate the organization of vision rehabilitation with eye care professionals and social caseworkers to help patients cope with, as well as accept, and recognize obstacles they will face in transitioning suddenly to monocular vision.