Faculty Bibliography

The effectiveness of orbital decompression has been enhanced by the use of endoscopes in orbital decompressive surgery. In patients with severe proptosis and visual compromise, surgical intervention provides definitive therapy. Endoscopes have allowed for more complete removal of the bone posteriorly to the orbital apex under direct visualization, which has led to a decrease in morbidity. Two-wall decompression is now the minimum procedure that successfully achieves release of contents at the orbital apex. Whether the endoscope is used as an adjunct surgically or postoperatively to facilitate debridement, it has become an important tool in the armamentarium for the successful management of proptosis. The endoscopic view of posterior ethmoidal sinuses and the sphenoid sinuses enables the surgeon to successfully carry out a posterior decompression, and provides the opportunity to decompress the optic nerve if the need arises. 2011 Elsevier Inc

PURPOSE OF REVIEW: We review the literature pertinent to surgical correction of upper eyelid retraction resulting from thyroid eye disease (TED). RECENT FINDINGS: Although novel nonsurgical treatment of TED-upper eyelid retraction has been described, with botulinum A toxin and hyaluronic acid; graded full-thickness blepharotomy remains the mainstay of treatment for the condition. SUMMARY: Graded full-thickness anterior blepharotomy provides predictable, reproducible results and is a simple surgical procedure to master. For patients who cannot undergo surgical intervention, botulinum toxin offers a novel nonsurgical answer to lid retraction, but may be complicated by overcorrection and introduces an additional variable that needs to be considered when following the patient

This describes a non-interventional case series of 2 patients, aged 7 and 9 years referred to Oculoplastic Unit, both for evaluation of a gradually enlarging, painless, mass of the cheek. CT scan of the first case revealed left orbital floor destruction from a well-defined intraosseous mass. The second was a round circumscribed orbital floor tumor without bone destruction. Histological diagnosis of myofibroma was rendered in both cases. Solitary myofibromas are rare in the orbit. Their rapid growth and bony destruction can mimic malignant tumors. Complete excision with close follow-up is the preferred treatment. Solitary myofibroma should be considered in the differential diagnoses of fibrous tumors with bone destruction in the orbit

Cavernous hemangioma of the orbit typically presents as a slow-growing tumor with gradual onset of symptoms. Acute onset of clinical signs and symptoms, are a rare feature. We present the case of a 40-year-old female, who developed sudden onset of clinical symptoms. MRI evidence of intralesional hemorrhage was confirmed by histopathology

Radioimmunotherapy with yttrium-90-ibritumomab tiuxetan may result in hemorrhagic tumor necrosis with acute orbital and intracranial inflammation

PURPOSE: To evaluate the relationship between levator excursion and both eyelid lag and lagophthalmos in thyroid eye disease. METHODS: We retrospectively reviewed 104 eyelids of 52 thyroid eye disease patients over a 9-month interval by measuring levator function (mm), eyelid lag (0-4+) and lagophthalmos (mm). RESULTS: Lower levator excursion is associated with higher eyelid lag scores (p < 0.001) and with greater degrees of lagophthalmos (p < 0.001). Both associations were upheld after adjustment for upper eyelid margin reflex distance and Hertel exophthalmometry (p < 0.0001). For every 1-mm decrease in levator function, eyelid lag score increases on average by 0.29 and lagophthalmos increases on average by 0.23 mm. CONCLUSIONS: Diminished levator excursion is associated with increasing levels of eyelid lag and lagophthalmos. Levator excursion is an important clinical measurement in thyroid eye disease patients and may replace eyelid lag grading and lagophthalmos as a more accurate indicator of eyelid retraction in thyroid eye disease

A 28-year-old woman presented with a 2-week history of right upper eyelid swelling and intermittent frontal headaches. CT demonstrated an ill-defined superior right orbital mass with adjacent right frontal bone erosion and undeveloped frontal sinuses. The orbital biopsy revealed tissue strongly positive for CD1a and S100, diagnostic of Langerhans cell histiocytosis. The systemic workup was negative for multifocal lesions and for diabetes insipidus. In addition to subtotal resection, the patient was treated with a 6-month course of oral prednisone and intravenous vinblastine

OBJECTIVE: To identify components of a provisional clinical response index for thyroid eye disease using a modified Delphi technique. METHODS: The International Thyroid Eye Disease Society conducted a structured, 3-round Delphi exercise establishing consensus for a core set of measures for clinical trials in thyroid eye disease. The steering committee discussed the results in a face-to-face meeting (nominal group technique) and evaluated each criterion with respect to its feasibility, reliability, redundancy, and validity. Redundant measures were consolidated or excluded. RESULTS: Criteria were parsed into 11 domains for the Delphi surveys. Eighty-four respondents participated in the Delphi 1 survey, providing 220 unique items. Ninety-two members (100% of the respondents from Delphi 1 plus 8 new participants) responded in Delphi 2 and rated the same 220 items. Sixty-four members (76% of participants) rated 153 criteria in Delphi 3 (67 criteria were excluded because of redundancy). Criteria with a mean greater than 6 (1 = least appropriate to 9 = most appropriate) were further evaluated by the nominal group technique and provisional core measures were chosen. CONCLUSIONS: Using a Delphi exercise, we developed provisional core measures for assessing disease activity and severity in clinical trials of therapies for thyroid eye disease. These measures will be iteratively refined for use in multicenter clinical trials

Optic nerve glioma has been a topic of great interest and controversy, particularly with respect to its tendency to invade the optic chiasm. This case report demonstrates histologically verified optic nerve glioma in an otherwise healthy 5-year-old girl. MRI revealed sequential prechiasmal, chiasmal, and postchiasmal disease during the untreated course of 18 months. The authors also discuss the results obtained with a specific immunohistochemical technique, the mindbomb homolog 1 (MIB-1) labeling index, and speculate that this information, if known early in the course of disease, might influence early surgical decision-making