Long-Term Effects of Frontalis Fascial Slings on the Elastic Properties of the Upper Eyelid.

PURPOSE: To measure the long-term effects of frontalis slings with fascial tissues on the downward eyelid saccadic movements Methods: Downward lid saccades for 10, 20, 30, 40, and 50 degrees of downgaze were measured in a sample of 19 patients with congenital ptosis who underwent frontalis slings with fascia lata (autogenous and banked) and temporalis fascia. Mean postoperative time was 10.7 years ± 3.8 SD. Seventeen age-matched normal subjects comprised the control group. Lid movements as well as the magnitude of brow motion were quantified in all participants with an opto-electronic device that automatically corrected any head movement. RESULTS: Most patients (77.4%) displayed lagophthalmos on eyelid closure. The lid saccades of the patients were severely restricted and did not increase beyond 30 degrees of downgaze. The maximum velocity of lid saccades was also abnormally low. Although the pre- and postoperative lid positions did not differ between eyes operated with the three types of slings, interocular analysis of patients who had bilateral surgery showed that the restrictive effect on the saccadic movements was more asymmetrical with banked fascia than with autogenous tissue. Overall, there was a significant negative correlation between the surgical effect with frontalis contraction and maximum saccadic amplitude. While in controls brow motion accounted for about 3.3-9.3% of the lid saccades, it was responsible for more than 43.5-57.4% lid movements in the patients. CONCLUSION: Fascial slings have a permanent restrictive effect on the elastic properties of the lids. Postoperative lagophthalmos is a natural consequence of any type of fascial sling. Downward saccadic amplitude is negatively correlated with the surgical effect with frontalis contraction.

Graves Lower Eyelid Retraction.

PURPOSE: Graves lower eyelid retraction (GLLR) is a common and controversial sign of Graves orbitopathy. The authors reviewed the mechanisms and surgical techniques currently used to correct this Graves orbitopathy-related eyelid malposition. METHODS: A literature search was performed on the MEDLINE database using the keywords "lower eyelid retraction," "Graves orbitopathy," "thyroid ophthalmopathy," "thyroid eye disease," "spacers," and "eyelid surgery." Only articles in English were included. The level of evidence of publications regarding surgical correction of GLLR was evaluated and graded from I to IV, using a rating system adapted from a validated scientific evidence classification method. RESULTS: The mechanisms responsible for GLLR are not fully understood and no subtypes of GLLR have been distinguished. The surgical literature of GLLR encompasses mainly descriptions of surgical techniques without objective measurements of the results, and uncontrolled studies. Only 1 randomized controlled trial was identified. To lengthen the lower retractors, a large variety of different materials have been used as spacers. CONCLUSIONS: The scientific literature on GLLR is vast, however controlled and randomized studies comparing different surgical techniques are lacking. At the present moment it is not clear if bioengineered materials are superior to conventional autogeneous tissue as lower eyelid spacers. The effects of GLLR on lower eyelid movements and contour have not been studied.

Atypical pneumococcal scleritis after pterygium excision: case report and literature review.

PURPOSE: To describe an unusual case of pneumococcal scleritis after pterygium excision and to review the literature on infectious scleritis associated with pterygium excision. METHODS: Case report and literature review. RESULTS: A 58-year-old white man underwent excision of a nasal pterygium of the right eye. Two weeks postoperatively, the patient developed an infectious scleritis caused by Streptococcus pneumoniae. The scleritis was complicated with hypopyon and a scleral necrosis area 6 mm away from the superior limbus with a positive Seidel test. Topical and systemic antibiotics resolved the case without any surgical procedures. CONCLUSION: Streptococcus pneumoniae must be considered as a possible agent in cases of necrotizing scleritis associated with pterygium excision.

Adult blindness secondary to vitamin A deficiency associated with an eating disorder.

OBJECTIVE: We examined an adult patient who lost one eye due to severe keratomalacia secondary to self-induced vitamin A deficiency. METHODS: This case report provides a clinical, ophthalmologic, and laboratory description in addition to a review of the medical literature. RESULTS: A 33-y-old woman with a 17-y history of an eating disorder presented with bilateral conjunctival xerosis, an infected corneal ulcer in the right eye and a large descemetocele in the left eye. Laboratory and clinical findings were consistent with vitamin A deficiency. Despite a tectonic penetrating keratoplasty, her left eye perforated and had to be eviscerated. In parallel, vitamin A replacement improved her clinical status and the ocular findings in her right eye. CONCLUSIONS: The present report indicates that vitamin A deficiency secondary to eating disorders should be considered in the differential diagnosis of patients with severe dry eye and corneal ulceration.

Intraosseous hemangioma of the lateral orbital wall.

PURPOSE: To report the clinical and radiologic features of two patients with intraosseous orbital hemangiomas of the lateral wall. METHODS: Case reports and literature review. RESULTS: The first patient presented with an indolent mass over the lateral orbital rim. Intraosseous hemangioma was not considered in the differential diagnosis. A biopsy specimen was taken from the tumor, which caused significant bleeding. After biopsy, an orbital CT scan revealed a lesion involving the left lateral orbital rim and soft tissue of the temporal fossa. The rim was grossly enlarged, with several cavities of different sizes. The tumor of the second patient was located more posteriorly and extended into the roof. The patient complained of parietal headache, epiphora, and local pain. A CT scan revealed a round, lytic lesion involving the greater sphenoid wing and frontal bone. The tumor was approached through a coronal flap and resected en bloc without problems. CONCLUSIONS: The diagnosis of intraosseous hemangioma can be difficult, especially when tumors are located in the anterior part of the lateral wall. In this location, intraosseous hemangiomas tend to induce few symptoms and thus have a higher likelihood of biopsy being performed before a correct diagnosis. A CT scan with bone windows can play a beneficial role in the evaluation of lytic bone lesions in intraosseous hemangioma.