A Technique for Severe Lower Eyelid Retraction: The Fascia Lata Sling with Lateral Burr Hole.

BACKGROUND: Lower eyelid retraction is a common and feared complication of both disease processes and aesthetic and cosmetic surgical procedures. A four-finger approach has been previously described to determine adequate treatment of lid retraction. In the authors' experience, they have found that even the most aggressive treatment approach-subperiosteal cheek lift with canthopexy and interpositional graft-is inadequate to address severe lower lid retraction. METHODS: The authors propose a technique of a lower lid fascial sling with a lateral burr hole for support to be used when all five fingers are needed to correct the lower lid retraction. Review of 134 patients who underwent the fascia lata sling with lateral burr hole for severe lower lid retraction was performed. RESULTS: The fascia lata sling with lateral burr hole adequately corrected the lid retraction in all but one patient in one procedure. This patient had persistent lateral ectropion and underwent revision canthoplasty, resulting in resolution of the lateral ectropion. CONCLUSION: The fascia lata sling with lateral burr hole is a reliable procedure to correct lid retraction from a wide variety of causes.

Effect of optic nerve sheath fenestration for idiopathic intracranial hypertension on retinal nerve fiber layer thickness.

The objective of the study was to evaluate whether optic nerve sheath fenestration in patients with idiopathic intracranial hypertension was associated with improvement in visual field pattern deviation and optical coherence tomography retinal nerve fiber layer thickness.The records of 13 eyes of 11 patients who underwent optic nerve sheath fenestration were reviewed. The subjects were patients of a clinical practice in Dallas, Texas. Charts were reviewed for pre- and postoperative visual field pattern deviation (PD) and retinal nerve fiber layer thickness (RNFL).PD and RNFL significantly improved after surgery. Average PD preoperatively was 8.51 DB and postoperatively was 4.80 DB (p = 0.0002). Average RNFL preoperatively was 113.63 and postoperatively was 102.70 (p = 0.01). The preoperative PD and RNFL did not correlate strongly.Our results demonstrate that PD and RNFL are improved after optic nerve sheath fenestration. The pre- and postoperative RNFL values were compared to the average RNFL value of healthy optic nerves obtained from the literature. Post-ONSF RNFL values were significantly closer to the normal value than preoperative. RNFL is an objective parameter for monitoring the optic nerve after optic nerve sheath fenestration. This study adds to the evidence that OCT RNFL may be an effective monitoring tool for patients with IIH and that it continues to be a useful parameter after ONSF.

Periorbital cellulitis due to cutaneous anthrax.

Virgil's plague of the ancient world, Bacillus anthracis, is rare in developed nations. Unfortunately rural communities across the globe continue to be exposed to this potentially lethal bacterium. Herein we report a case of periorbital cutaneous anthrax infection in a 3-year-old girl from the rural area surrounding Harare, Zimbabwe with a brief review of the literature.