Acquired ptosis: dehiscences and disinsertions. Are they real or iatrogenic?

Acquired ptosis has previously been felt to be due to a dehiscence or disinsertion of the levator aponeurosis. In the early years of levator surgery, the aponeurosis was often exposed by using blunt dissection. We have found that with a change in surgical technique, which eliminates blunt dissection, the incidence of aponeurotic defects decreases dramatically. Dehiscence and disinsertion may therefore be caused by traumatic surgical dissection of an attenuated aponeurosis.

Dacryocystorhinostomy use of a "coffee can lid" stent.

Many techniques have been described for performing successful dacryocystorhinostomies (DCRs). The patency of the passageway from the internal common punctum through the osteotomy site into the nasal cavity is usually the limiting factor in the success of the DCR. We present a modification using a "coffee can lid" stent to keep the osteotomy site open when there is no free space between the osteotomy and the nasal septum (medial wall of the nose).

The effects of cautery on the optic nerve.

A case history is presented of a patient who sustained visual loss and a third-nerve palsy after the application of monopolar electrocautery to the orbital apex. Because the third-nerve palsy resolved and most of the vision was regained, it is theorized that the neurological deficits were secondary to myelin damage caused by the monopolar electrocoagulator. The purpose of this article is to compare the effects of monopolar electrocoagulation, bipolar electrocoagulation, and hot-wire cautery on decompressed optic nerves of cats. Although all three forms of coagulation are capable of causing demyelination within the optic nerve when used on the nerve sheath, monopolar electrocoagulation resulted in the greatest degree of demyelination and bipolar electrocoagulation resulted in the least demyelination.

Correction of vertical retraction of the lower lid with an orbicularis hammock.

Radical maxillectomy is the treatment of choice for malignant tumors of the paranasal sinuses and nasopharynx. Unfortunately, adverse side effects include ectropion, diplopia, and nasolacrimal duct obstruction. We describe a new technique for repair of the cicatricial ectropion and vertical retraction of the lower lid.

Dermis grafts in socket reconstruction.

The feasibility of using dermis in socket reconstruction is explored in the rabbit. The results indicate that dermis may be a suitable source of graft material where mucous membrane replacement is needed. Histological sections of the grafts are provided and are contrasted with scleral grafts, a substance whose behavior is socket surgery has been studied previously. A clinical case is presented also of a patient with a severely contracted anophthalmic socket who was reconstructed successfully with a dermis graft.

Pathology of an orbital dermis-fat graft.

A patient had an orbital dermis-fat graft implanted for a secondary socket reconstruction. The graft shrank only minimally and a portion had to be excised to permit better prosthesis fitting. The pathologic findings are presented. Although a generalization cannot be made on the basis of one case, prudence should be exercised with regard to the degree that such grafts are oversized in socket reconstruction.

Blepharochalasis syndrome.

Patients with chronic forms of blepharochalasis often develop eyelid deformities characterized by blepharoptosis and prolapse of the orbital fat and lacrimal gland. Some individuals have an acquired form of blepharophimosis, secondary to the dehiscence of the canthal tendons. In this late stage of the condition, the tendons still adhere to the periosteum of the orbital rims and loss of fixation occurs at the distal attachment between the tendons and the eyelid tissues. This results in a horizontally shortened palpebral fissure and a rounded deformity of the lateral canthal angle. Surgery remains the primary treatment.

Lower eyelid ectropion following chemical face peeling.

A 72-year-old female developed a cicatricial ectropion after a chemical face peel, a previously undocumented complication. Surgical correction was successful. The pathological specimen is presented and therapeutic implications are discussed.

Posttraumatic venous obstructive retinopathy associated with enlarged optic nerve sheath.

A case of posttraumatic unilateral enlargement of the optic nerve sheath associated with a venous obstructive retinopathy and progressive visual loss responded with marked improvement in visual function after nerve sheath decompression. Indirect (closed-head) trauma may be related to the progressive nerve sheath enlargement, venous obstructive retinopathy, and progressive visual loss. It is apparent that a venous stasis retinopathy can result from a posttraumatic optic nerve sheath lesion. Prompt recognition by echographic and/or roentgenographic investigation and subsequent decompression may be curative.

Actinic comedonal plaque of the eyelid.

A variety of actinic lesions occur on the eyelids and facial skin. Actinic comedonal plaque is an unusual entity that falls into this category. We successfully treated such a lesion with cryotherapy.

Orbital leiomyosarcoma.

A 36-year-old man had a six-month history of painless swelling in the medial orbit. Surgical exploration of this mass revealed a leiomyosarcoma. The tumor was entirely removed, as was all local surrounding tissue.

Optic disc changes with intracranial subarachnoid cysts.

We have recently encountered two patients who presented with ophthalmoscopically unusual optic disc changes, and who were found to have intracranial subarachnoid cysts. The discs appeared chronically swollen, had microtelangiectatic vessels on the surface and leaked fluorescein. This report documents unusual swollen discs in patients with no clinical evidence of increased intracranial pressure yet who are found to have intracranial subarachoid cysts by computed tomography.

Eyelid tumors anmd renal transplantation.

The high incidence of malignant neoplasms in renal transplant recipients and other immunosuppressed patients is well recognized. A large proportion of these neoplasms are skin cancers. The frequent occurrence of other ocular complications, such as cataract, elevated intraocular pressure, hypertensive retinopathy, cytomegalovirus retinitis, and herpetic keratitis in patients after kidney transplant, has also been described. This report presents the clinical and histopathologic features of eyelid involvement by keratoacanthoma and squamous cell carcinoma in two patients after renal transplantation and alerts ophthalmologists to the potential for this association.