Globe ptosis secondary to maxillary sinus mucocele.

Six patients were treated for gradual onset of enophthalmos, a deep superior sulcus and globe ptosis. There was no history of orbital trauma or sinusitis. CT scan showed an opacified shrunken maxillary sinus with dehiscence and depression of the orbital floor and downward displacement of the orbital contents. Pathological review of the surgical specimens showed a respiratory mucosal lining with thick mucoid secretions, new bone formation, but no purulence. The etiology is thought to be maxillary sinus mucocele. Surgical treatment with an otolaryngologist consisted of a Caldwell-Luc procedure to evacuate the maxillary sinus with nasal antrostomy and an orbital floor exploration with insertion of a methylmethacrylate implant molded at the time of surgery to reform the orbital floor and reposition the globe. Follow-up of 2 1/2-4 years shows excellent functional and cosmetic results.

Molluscum contagiosum of the eyelids in patients with acquired immune deficiency syndrome.

BACKGROUND: Infection with molluscum contagiosum has been reported in patients with acquired immune deficiency syndrome (AIDS). Involvement of the eyelids by molluscum in patients with AIDS has rarely been mentioned. METHODS: Two patients with AIDS presented with eyelid molluscum contagiosum. Detailed examination and follow-up was performed. RESULTS: One patient had noted ocular irritation with epiphora for several weeks and showed a typical viral keratoconjunctivitis in both eyes. The other patient progressed to confluent masses involving the entire lower eyelid on one side. Removal of the lesions by surgery and cryotherapy was followed by recurrences in both patients within 6 to 7 weeks, the incubation period for this viral infection. CONCLUSION: Molluscum contagiosum can form confluent lesions on the eyelids in patients with AIDS, which may cause a keratoconjunctivitis. Local removal of molluscum eyelid nodules appears to be of limited long-term value in patients with T-cell immunodeficiency.

Orbital fractures: eyelid approach.

Orbital floor fractures can be explored through the eyelid with a subciliary or a smile-crease incision. A two-plane incision is made to expose the orbital rim. Orbital contents are removed from the sinus, and an alloplastic implant is used to cover the fracture. The periosteum is closed over the implant. Fine suture material is used to close the skin. These approaches give good exposure of the orbital floor and excellent postoperative cosmesis.

Eyelid reconstruction using temporary tissue expanders and cartilage grafts.

Temporary tissue expanders have been used in general plastic surgery to expand skin for breast reconstruction and for scar revision. A specifically designed eyelid tissue expander was used to reconstruct both upper and lower eyelids in a patient suffering a severe lye burn. The implant consists of an expander and a reservoir, connected by silicone tubing. The implants are inserted into the remnant of both eyelids and expanded slowly with multiple injections of saline into the reservoir. After full expansion is achieved the expanders are removed and ear cartilage grafts inserted into the eyelids. The newly created eyelids resemble normal eyelids. The technique of tissue expansion has had very limited use in oculoplastic surgery but new applications are waiting to be discovered.