Faculty Bibliography

Nasal glioma, encephalocele, and ectopic brain are rare congenital anomalies. The terminology applied to these entities has been historically confusing. In many cases, the terms overlap and may be employed synonymously although some authors emphasize their differences. The authors describe herein a child with an inner canthal mass of brain-like tissue that they interpret as nasal glioma, a variety of encephalocele that has lost its connection to the intracranial contents. This research was conducted in conformity with the Helsinki Declaration and Health Insurance Portability and Accountability Act regulations.

The authors report 2 cases of apocrine cystadenoma of the eyelid, 1 of which was studied with immunohistochemical and other special stains. While a previous report describes the tumor in a palpebro-orbital location, no other detailed descriptions of a purely eyelid location are present in the literature. Apocrine cystadenoma occupies an unusual portion of the spectrum of Moll gland tumors of the eyelid. It has no definitive clinical characteristics and may be diagnosed pathologically by hematoxylin-eosin-stained sections.

The authors describe a 4-year-old girl presenting with a 2-year history of a superomedial eyelid "bump" that appeared cystic on MRI. The clinical diagnosis was dermoid cyst, possibly of conjunctival origin. Following excision, histology showed a cyst that contained keratin and lanugo hairs in its lumen with sebaceous glands and chronic inflammation in its fibrous wall. An unanticipated finding was the presence of a trichilemmal (pilar) variety of epithelial lining that stained positively for calretinin, an immunostain that identifies trichilemmal epithelium. To the authors' knowledge this is the first case of a dermoid cyst with trichilemmal lining. This study was conducted in compliance with the rules and regulations of the Health Insurance Portability and Accountability Act and in conformity with the Oslo declaration.

Purpose: To evaluate the epidemiology of open globe injuries and to identify factors correlated with differences in visual outcomes in patients presenting to Bellevue Hospital, a public Level 1 Trauma Center in New York City. Methods: A retrospective chart review of all patients with open globe injuries presenting to Bellevue Hospital between July 2008 and June 2015 was performed. Patient demographics, associated ocular injuries, visual acuity, and clinical courses were recorded. Results: Of 59 patients, 41 (69.5%) were males and 18 (30.5%) were females. The mean population was 44.7 years of age (range: 16 months to 85 years). 35 (59.3%) of the cases were reported as assault, with the rest a combination of accidental and un-identified trauma. Based on the Birmingham Eye Trauma Terminology System, there were 30 (50.9%) Zone I, 19 (32.2%) Zone II, and 10 (16.9%) Zone III injuries. Pre-operative visual acuity (VA) was worse than 20/400 in 57 (96.7%) patients, of which 25 (42.4%) patients presented with Light Perception (LP) vision and 18 (30.5%) patients presented with No Light Perception (NLP). Of the 51 patients that followed-up, 26 (50.9%) had no change in VA between initial presentation and their last clinic visit, 19 (37.3%) improved, and 6 (11.8%) worsened. Notably, five patients initially presenting with LP had deteriorated to NLP within an average of 4.5 months, all with Zone I injuries. Final visual outcomes are shown in Figure 1. The mean follow-up time was 426 days (range: 4 days to 7 years, SD: 566 days) and 8 patients (13.6%) were lost to follow-up within 1 month. 2 (3.39%) patients underwent a second operation for endophthalmitis and 7 (11.9%) patients eventually underwent enucleation of which 6 patients had associated orbital fracture injuries. Conclusions: Patients were predominantly male between the ages of 24-50. There was no single or group of prognostic factors that precluded visual recovery, even in the case of NLP upon presentation, highlighting the benefit of primary repair over enucleation. An orbital fracture was the most prognostic factor of enucleation, as globe injuries that involved orbital fractures were likely more severe. Highly variable follow up times combined with co-existing social factors were also associated with poorer outcomes, underscoring the importance of appropriate counseling to help patients manage their care and recovery

A raised erythematous eyelid lesion that appeared in a 31-year-old man was diagnosed as an arteriovenous malformation (AVM), with confirmatory Doppler ultrasound demonstrating high arterial flow. Surgical excision, aided by electrocautery for extensive hemorrhage, resulted in an acceptable cosmetic result. Histopathology of the excised lesion showed collapsed capillary channels lined by endothelium. AVM is rarely encountered in the eyelid.

The authors describe a 23-year-old man with unilateral upper eyelid swelling that evolved into a multinodular lesion with central necrosis, mimicking a neoplasm. Biopsy showed a lympho-histiocytic, eosinophil-rich proliferation with positivity for Langerhans cell markers CD1a and S-100 and histiocytic marker CD68. A literature review disclosed 11 documented cases of Langerhans cell histiocytosis of the eyelid with variable clinical presentations. This rare eyelid lesion, nearly always solitary, has no clinically distinctive characteristics and requires biopsy for diagnosis. Langerhans cell histiocytosis (LCH), formerly histiocytosis X, comprises a group of rare disorders characterized by the proliferation of specialized bone marrow-derived Langerhans cells intermingled with mature eosinophils. Proliferations may be multifocal (disseminated) or unifocal (solitary). Ophthalmic lesions are usually unifocal and tend to be located in the orbital region. Isolated eyelid foci are rare and present with variable patterns that preclude clinical diagnosis. In this report, the authors describe a case of multinodular, ulcerative involvement of the eyelid skin that mimicked a basal cell carcinoma. This study was conducted in compliance with the rules and regulations of the Health Insurance Portability and Accountability Act.

Total eyelid loss, full thickness loss of the upper and lower eyelids, is uncommon and surgically challenging. Eyelid reconstruction after such injuries can be further complicated by loss of adjacent tissue. When tissue for local flaps is unavailable, free flaps must be considered. Few cases of total eyelid reconstruction via microvascular free flap have been reported, especially with an intact globe and good visual acuity. In this report, we describe the use of a microvascular free flap based on the radial artery for total eyelid reconstruction in a patient with an intact globe and useful visual acuity.

BACKGROUND: The objective of this study was to determine the effects of lower eyelid transconjunctival blepharoplasty (TCB) on lower eyelid position. METHODS: Transconjunctival blepharoplasty was performed alone in 15 lower eyelids without simultaneous canthoplasty or upper eyelid procedure. In this study, blepharoplasty was performed by the transconjunctival approach without removal of skin. Four eyes received TCB plus Erbium laser, two patients received TCB plus trichloroacetic acid peel (TCA), and three patients received TCB plus fat transposition. Pre-operative and post-operative margin reflex distance 1 (MRD 1) and margin reflex distance 2 (MRD 2) were compared, with MRD 1 acting as the control. RESULTS: Average time to post-operative photo was 4.6 months (1-10 months). The changes in MRD 2 and MRD 1 were compared pre- and post-operatively, and the difference reached significance by one-tailed comparison (P < 0.05). In 11/15 eyes (73 %), MRD 2 decreased post-operatively. In 6/7 eyes (86 %), lower lid scleral show was eliminated post-operatively. There were no cases of lid retraction noted. CONCLUSIONS: Transconjunctival blepharoplasty (+/- skin resurfacing) did not induce lid retraction but elevated the lower lid in majority of patients. Elevation of the lower lid can reduce or eliminate scleral show inferiorly, providing further cosmetic advantage. The presumed mechanism of lower lid height elevation is partial recession of the lower lid retractors during the surgical approach to the fat pockets. LEVEL OF EVIDENCE IV: This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .