Faculty Bibliography

A patient noting a slowly enlarging bump at the orbital rim underwent surgical excision of the lesion. Pathologic examination showed a benign fibroma, a lesion that to the authors' knowledge has never been previously reported in this location

A healthy 45-year-old man had a retrobulbar hemorrhage 9 days after cosmetic upper eyelid blepharoplasty that resulted in permanent visual loss. After performing a left lateral canthotomy and cantholysis, intraocular pressure returned to normal and vision improved from no light perception to 20/40; however, the patient did have permanent visual field loss. To our knowledge, this is the longest period of time after blepharoplasty that a retrobulbar hemorrhage occurred. Ophthalmologists should have a heightened level of suspicion 1 to 2 weeks after surgery

A case of intraosseous orbital hemangioma is reported to alert surgeons to possible intraoperative hemorrhage during excision of such a lesion. A slowly enlarging mass was excised from the orbital rim of a 49-year-old woman. The clinical diagnosis was not suspected. In retrospect, roentgenographic findings included a focal honeycombed pattern of the zygomatic bone. Surgery was complicated by persistent low-volume bleeding. Histology showed endothelial-lined blood-filled channels within the bone. Intraosseous orbital hemangioma is a rare, benign neoplasm that can often be diagnosed clinically by characteristic roentgenographic findings. Observation should be considered as a therapeutic alternative when the radiographic diagnosis is established and when ocular function is not compromised

PURPOSE: Some patients note a decrease in visual acuity in the operated eye after eyelid surgery. Although, the most common cause for this change is dry eye syndrome, it has been hypothesized that the symptom of blurred vision may result from a change in the corneal curvature. The study was conducted to determine if there is a change in corneal curvature after upper eyelid surgery. METHODS: Standard keratometry and corneal videokeratography (CVK) were performed 1 and 3 months after blepharoplasty (18 lids) and ptosis repair (24 lids). Pre- and postoperative images from CVK data were digitally subtracted for quantitative evaluation. RESULTS: After ptosis repair, the average dioptric change as measured by keratometry and by CVK was approximately 0.60 diopters (D); of note, nearly 30% of these patients showed transient astigmatic changes greater than 1.00 D; After blepharoplasty, the average dioptric change as measured by keratometry and by CVK was approximately 0.55 D; of note, only 11% of patients showed astigmatic changes greater than 1.00 D. CONCLUSION: Repositioning of the upper eyelid after ptosis repair or blepharoplasty may result in visually significant astigmatic changes in the central and peripheral cornea and may alter the patient's spectacle or contact lens correction

BACKGROUND AND OBJECTIVES: The orbital floor may fracture alone, and the fracture is then defined as 'pure'; when there is a rim involvement, the fracture may be defined as 'impure'. Controversy exists as to the pathophysiology of orbital floor fractures and the incidence of orbital rim involvement. The purpose of this retrospective review was to determine the incidence of purity in orbital floor blowout fractures and the rate of ocular injuries in pure and impure floor fractures. METHODS AND MATERIALS: The charts of 250 patients with orbital fractures, treated at a primary trauma center between 1992 and 1996, were reviewed. All fractures had been examined by the Ophthalmology Service and confirmed by high-resolution computerized tomography scans. The average age of the patients was 45 years; more than 90% were male. Motor vehicle accidents were the most commonly documented mechanism of injury, followed by interpersonal violence and falls. Almost 50% could not be categorized for mechanism of injury. RESULTS AND/OR CONCLUSIONS: The incidence of ocular injuries in pure fractures (n = 54; 5.6%) was higher than in impure fractures (n = 26; 2.0%) (p = 0.05). Serious visual injuries following orbital fractures occurred in 17.1% of the patients; they were more common in patients with pure fractures

The resurgence of popularity of the transconjunctival approach to lower eyelid fat removal as a component of cosmetic blepharoplasty has been highlighted by a number of publications in recent years. There has been, however, minimal discussion in the literature of the complications of this procedure. Although the mechanism of muscle injury is similar in transcutaneous and transconjunctival surgery, there is a much more direct route to the inferior extraocular musculature via the latter approach. Herein, we present a series of six patients with diplopia status post-transconjunctival lower eyelid blepharoplasty referred to the Manhattan Eye, Ear, and Throat Hospital for evaluation. Transconjunctival lower lid blepharoplasty was performed as a primary procedure in four patients and as a secondary procedure following transcutaneous blepharoplasty in two patients. Patients were evaluated with ocular examination and orthoptic measurements. Magnetic resonance imaging was obtained in two cases. The inferior rectus and inferior oblique muscles were found to be equally injured in these cases (4 of 6), and the lateral rectus was encountered in one case. Two patients required strabismus surgery to correct their diplopia, whereas four patients improved with observation alone. The possible etiologies of postoperative diplopia following transconjunctival lower lid blepharoplasty are manifold. Mechanisms of extraocular muscle injury may include intramuscular hemorrhage and edema, cicatricial changes within the muscle, and accidental incorporation of extraocular muscle in closure of orbital septum. Avoidance of these complications is probably best achieved through intimate understanding on the part of the surgeon of eyelid anatomy from the transconjunctival perspective