Friedrich August von Ammon (1799-1861).

As this year marks the 200th anniversary of the birth of Friedrich August von Ammon (1799-1861), it presents an opportunity to recall and celebrate Ammon's life and his many contributions that helped shape both ophthalmology and plastic surgery into independent specialties. Some 250 years after Georg Bartisch, Ammon reestablished Dresden as a major center of ophthalmology, through the creation of a teaching institute, the publication of influential periodicals, and his personal publication of important monographs and journal articles. Ammon's Zeitschrift für die Ophthalmologie (founded 1830) was only the third journal in history that had been entirely devoted to ophthalmology. His prize-winning treatise, De Iritide (1835), correctly categorized iritis and gave a detailed description of sympathetic ophthalmia. His beautiful color-plate atlas, Klinische Darstellungen (1838-1841), contains landmark descriptions of congenital eye anomalies and has been described by Norman as 'the best summary of the knowledge of diseases of the eye prior to the introduction of the ophthalmoscope.' Ammon made most of his literary contributions in ophthalmology but he also contributed to another emerging field, plastic surgery. His monograph, Die plastische Chirurgie (1842), critically and comprehensively surveyed the entire history and current practice of plastic surgery, one of the very first textbooks to achieve this goal. In his last monograph (1858) Ammon returned to the subject of embryology of the human eye and drew upon his 30 years of study. Before his death, two of his last papers reported ophthalmoscopic observations, demonstrating his exploration of the frontiers of ophthalmology that characterized his entire career.

Intravascular papillary endothelial hyperplasia: collection of four cases and a review of the literature.

Intravascular papillary endothelial hyperplasia is a benign tumor that rarely presents in the orbit and ocular adnexa. Generally, it occurs as an isolated eyelid mass, not associated with systemic or local disease. Histopathologically, it can be easily confused with angiosarcoma or Kimura's disease. We present our experience with four cases of this tumor in the ocular adnexa, along with a literature review.

Early descriptions of Horner's muscle and the lacrimal pump.

Horner's muscle (musculus orbicularis oculi pars lacrimalis or tensor tarsi) was first discovered by the French anatomist and surgeon, Jacques-François-Marie Duverney. In 1730 his student, Johann Caspar Schobinger, gave priority to Duverney and postulated muscular aid in an active drainage of tears. In 1745 Duverney first published his own anatomic description and the first illustration of this muscle. Credit for J.-F.-M. Duverney's discovery has often been erroneously given to his older brother, Joseph-Guichard Duverney. Subsequent anatomic descriptions by Johann Rosenmüller, William Horner, and others also included hypotheses about the physiology of a lacrimal pump. More recent theories about a lacrimal pump, such as those of Adler, Jones, Doane, and others, have their origins in these earlier writings.

The tarsectomy operation of A.P.L. Gillet de Grandmont (1837-1894) and its periodic rediscovery.

During the past two centuries, several methods of ptosis repair have been described and refined, but each method has typically been subject to cycles of popularity, neglect and reincarnation. Repair of ptosis through partial resection of the tarsus is one such example. Although Sir William Bowman included tarsectomy with his historic levator resections, the French ophthalmologist, A.P.L. Gillet de Grandmont was the first to specifically emphasize resection of tarsus for the correction of ptosis. Yet contemporary advocates of tarsectomy for ptosis repair have generally failed to recognize Gillet de Grandmont's contribution and his role in the history of ptosis surgery. For this reason, a review of this subject is presented.

Periocular granuloma annulare, nodular type. Occurrence in late middle age.

We describe the two oldest individuals with nodular granuloma annulare (pseudorheumatoid nodules) in the ophthalmologic literature and propose a unified classification scheme that recognizes pseudorheumatoid nodules to be granuloma annulare, nodular type. All lesions in both cases revealed so-called necrobiotic granulomas, characterized by an acellular central area containing mucin (hyaluronic acid) surrounded by palisading histiocytes (macrophages), diagnostic of granuloma annulare. These features are identical to those reported in the ophthalmologic and older general pathology literature as pseudorheumatoid nodules and the contemporary general and dermatologic pathology literature as granuloma annulare. We believe the diagnosis of nodular granuloma annulare should be employed for necrobiotic lesions displaying distinctive clinicopathologic features to unite the ophthalmologic, general, and dermatologic pathology literature. Granuloma annulare, nodular type, must also be considered in the differential diagnosis of ocular and periocular lesions at any age.

Orbital lymphoma associated with acquired immune deficiency syndrome (AIDS).

A new case of AIDS-associated, small noncleaved cell (Burkitt's) lymphoma that presented as an orbital mass is described. Extraocular muscle involvement was documented by computed tomography and confirmed by orbital biopsy. Extensive abdominal involvement was subsequently diagnosed and this caused the patient's death only 15 days after the initial consultation and orbital biopsy. A literature review discloses only eight previous case reports of AIDS-associated non-Hodgkin's lymphoma (NHL) involving the orbit: two cases of Burkitt's type and six cases of large cell immunoblastic type. Three additional cases of orbital NHL can be found among larger series of AIDS cases. Affected patients are uniformly young adult males with a history of homosexuality and/or IV drug abuse. Variations in clinical presentation are discussed. Although the morphology of the histopathologic specimen in our case was consistent with a high-grade, small noncleaved cell NHL, flow cytometry revealed an atypical immunophenotype for Burkitt's lymphoma in that CD20 and immunoglobulin light chain antigens were not expressed. Morphologic classification and immunophenotypic characteristics of AIDS-associated NHLs are discussed.

Results of endoscopic KTP laser-assisted dacryocystorhinostomy.

Nineteen consecutive cases of primary endoscopic potassium titanyl phosphate (KTP) laser-assisted dacryocystorhinostomy (DCR) were retrospectively studied. Follow-up ranged from 10 to 16 months. Patients ranged in age from 18 to 93 years (average 65.6 years). Preoperative epiphora was present in all patients, and associated with mucopyocele in nine patients. Bicanalicular-nasal silicone tubes were placed during surgery in all cases. Timing of tube removal in the office ranged from 5 to 15 weeks (average 8.9 weeks). Prolonged patency through the follow-up period was achieved in 13 of 19 cases (68.4%). The six cases (31.6%) of postoperative failure included three cases with preoperative mucopyocele and three cases without. Failures manifested with recurrent epiphora (three cases) or recurrent dacryocystitis (three cases); the onset of symptom recurrence varied from 7 to 27 weeks postoperatively (average 18.3 weeks). Although success rates will vary between surgeons and study populations, patients should be advised that the success rate of KTP laser-assisted DCR may be lower than that of standard DCR. Generally, indications for choosing laser-assisted DCR include the avoidance of a cutaneous incision and reduced potential for mucosal bleeding. The technique may be considered for use in selected cases of nasolacrimal obstruction. The importance of technical variations remains to be elucidated including rhinostomy size and timing of silicone tube removal. Further studies are needed to help define the role of endoscopy techniques and lasers in DCR surgery.

Management of canalicular laceration.

Although canalicular injuries are relatively common, controversy persists regarding indications for repair and the surgical methods that should be employed. In this review, these various treatment philosophies and techniques are analyzed in an historical and a contemporary context. The surgical anatomy, epidemiology and clinical presentation of canalicular injuries are discussed. Inconsistencies in current nomenclature regarding the surgical anatomy of canalicular lacerations are analyzed. Recent studies of lacrimal drainage in systems with monocanalicular obstruction are cited. Various surgical techniques in the repair of canalicular injuries are reviewed, including methods of identifying the medial lacerated lacrimal passages and the various lacrimal stents that have been used. The current popularity of silicone tubing as a lacrimal stent is reviewed. The various methods of stent placement and fixation are systematically categorized. Case series of canalicular repair reported in the literature are reviewed, and the results and complications are compared.

Orbital hemorrhage and eyelid ecchymosis in acute orbital myositis.

We examined two patients with acute orbital myositis associated with orbital hemorrhage and eyelid ecchymosis. Both patients were young women (aged 22 and 30 years) who had painful proptosis, diplopia, and computed tomographic evidence of single extraocular muscle involvement with spillover of inflammatory edema into the adjacent orbital fat. Patient 1 showed contralateral preseptal eyelid inflammation and did not suffer an orbital hemorrhage until after an episode of vomiting. In Patient 2, the diagnosis of occult orbital varix was initially considered but an orbital exploration and a biopsy specimen showed no vascular anomaly. Both patients were treated successfully with high-dose systemic corticosteroids. Some cases of idiopathic orbital inflammation may be related to preexisting vascular anomalies or orbital phlebitis.

Eyelid crease approach for chalazion excision.

Chronic chalazia that predominantly involve the anterior eyelid lamellae are most easily approached through a transcutaneous incision. We describe the use of an eyelid crease incision for chalazia of the upper lid as an alternative to incision directly over the lesion. The technique has been used successfully in 16 patients with anteriorly situated upper eyelid chalazia. The advantages of this technique include excellent exposure with minimal patient discomfort. There is no need for eyelid eversion or compression with a chalazion clamp. The inflamed tissue can be directly inspected and the controlled excision will yield a superior specimen if biopsy is contemplated.

A review of chemical eye burns referred to the Blodgett Regional Poison Center.

We reviewed a random sampling of 500 cases of chemical eye exposures referred to the Blodgett Regional Poison Center from July 1, 1986 to December 31, 1986. While some injuries were encountered in laboratories and industrial plants, the great majority originated in the home (84.4%) and involved commonly used household products. Most exposures were acute and reported within minutes to 1 hr. Cases predominantly involved children suffering accidental exposure. The most common symptoms were eye discomfort (56.2%) and redness (26.4%), but many patients were completely asymptomatic (11.4%). The reported injuries included corneal burns or abrasions (23 cases), and conjunctivitis (7 cases). Only 8 cases (1.6%) were initially seen by an ophthalmologist. In virtually all cases, the recommended emergency treatment was immediate prolonged rinsing of the eye.