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Vision Loss Secondary to Facial and Periorbital Steroid Injection: A Systematic Review
Park, Sally S. E. B.S.*; Barmettler, Anne M.D.†
doi : 10.1097/IOP.0000000000001910
November/December 2021 - Volume 37 - Issue 6 - p 511-521
The risk of ophthalmic and retinal artery occlusions following facial and periorbital steroid injection has not been explored. This systematic review examines the prevalence, risk factors, and treatment outcomes of steroid-induced vision losses.
Spheno-orbital Lesions—A Major Review of Nonmeningioma Causes
McNab, Alan A. D.Med.Sc., F.R.A.N.Z.C.O.*,†; Jones, Randall S. M.B.B.S., F.R.A.N.Z.C.R.‡; Hardy, Thomas G. M.B.B.S., F.R.A.N.Z.C.O.*,§
doi : 10.1097/IOP.0000000000001924
November/December 2021 - Volume 37 - Issue 6 - p 522-533
To review the imaging features of the broad range of nonmeningioma lesions of the greater wing of the sphenoid (GWS) bone and adjacent orbit to assist clinicians in differentiating these lesions from each other and from the most common lesion of the GWS and adjacent orbit, meningioma.
Improved Eyelid Muscle Tension Balance With Refined Frontalis Muscle Flap Suspension in the Treatment of Severe Ptosis
Zhu, Xiuying M.D.*; Ma, Yingjie M.D., O.D.*; Woo, David M. M.Med. (Ophth.Sci.)†; Lin, Yanyan M.D.*; Chen, Ben M.D.*; Liu, Jia M.D.*; Chen, Xi M.D.*
doi : 10.1097/IOP.0000000000001933
November/December 2021 - Volume 37 - Issue 6 - p 534-540
The tension balance of the upper eyelid following ptosis repair is crucial to a successful postoperative outcome. To improve on existing surgical techniques, the authors developed a new refined frontalis muscle flap suspension (FMFS) for severe ptosis repair and explored the balancing effect between the orbicularis muscle and frontalis muscle following surgery.
Multidisciplinary Management of Orbital Metastasis and Survival Outcomes
El-Hadad, Christian M.D., C.M., F.R.C.S.C.*; Koka, Kirthi M.D.*; Dong, Wenli M.S.†; Do, Thai M.D.*; Haider, Maryam M.D.*; Ursua, Jocelyn D. B.S.A.*; Ning, Jing Ph.D.†; Debnam, James Matthew M.D.‡; Esmaeli, Bita M.D., F.A.C.S.*
doi : 10.1097/IOP.0000000000001939
November/December 2021 - Volume 37 - Issue 6 - p 541-545
To study the multidisciplinary management and survival outcomes of orbital metastasis (OM).
Kelly Punch Punctoplasty and Simple Punctal Dilatation Are Equally Effective for Punctal Stenosis: A Prospective Study
Zloto, Ofira M.D.*; Weissman, Alon M.D.*; Moroz, Iris M.D.*; Weidenfeld, Jonathan M.D.†; Ben Simon, Guy M.D.*; Sagiv, Oded M.D.*; Rosner, Mordechai M.D.*; Priel, Ayelet M.D.*
doi : 10.1097/IOP.0000000000001940
November/December 2021 - Volume 37 - Issue 6 - p 546-550
To examine the clinical, imaging, and histopathologic differences between Kelly punch punctoplasty and punctal dilatation, both with mini Monoka stent insertion.
The “Quiet TED”—A Special Subgroup of Thyroid Eye Disease
Iñiguez-Ariza, Nicole M. M.D.*,†; Sharma, Anu M.B.B.S.‡; Garrity, James A. M.D.§; Stan, Marius N. M.D.*
doi : 10.1097/IOP.0000000000001942
November/December 2021 - Volume 37 - Issue 6 - p 551-555
Thyroid eye disease (TED) or Graves’ orbitopathy starts with an active inflammatory stage (active disease) followed by resolution of inflammation and progression to a fibrotic, inactive stage. In our practice, we have encountered cases that have not had active disease despite presence of fibrotic sequelae and disease progression. We aim to delineate the clinical characteristic of this unique group of patients.
Extension of Masses Involving the Lacrimal Sac to Above the Medial Canthal Tendon
Vahdani, Kaveh M.D., F.R.C.Ophth.; Gupta, Tarang F.R.C.Ophth.; Verity, David H. M.D., F.R.C.Ophth.; Rose, Geoffrey E. D.Sc., F.R.C.Ophth.
doi : 10.1097/IOP.0000000000001946
November/December 2021 - Volume 37 - Issue 6 - p 556-559
Retention mucoceles of the lacrimal sac almost always expand below the medial canthal tendon (MCT), whereas the very much rarer malignancies involving the lacrimal sac may progress to form a mass above the tendon. In this study, the incidence of malignancy was determined for patients with a preoperative decision to undergo biopsy for a clinically suspect, hard lacrimal sac mass, together with the proportion having a tumor extending above the MCT.
Anterior Lamellar Repositioning in the Management of Meibomian Gland Inversion Secondary to Meibomian Gland Dysfunction
Samia-Aly, Emma M.B., B.Chir., M.A. (Cantab), F.R.C.Ophth.; Barua, Ankur R. (A.B.) M.B.Ch.B., F.R.C.Ophth., M.A., B.Sc. (Hons), P.G.Dip.; Patel, Radhika P. M.B.B.S., B.Sc., D.T.M.H.; Mehta, Purnima (P.M.) M.B.B.S., M.S. (Ophthalmology), M.R.C.Ophth., F.R.C.S. (Ed)
doi : 10.1097/IOP.0000000000001948
November/December 2021 - Volume 37 - Issue 6 - p 560-563
To describe a simple alternative surgical approach to treat patients with Meibomian gland inversion (MGI; posterior migration of the Meibomian gland orifices) in the upper eyelid, secondary to cicatricial Meibomian gland dysfunction (MGD) not responding to maximal medical management.
Risk Factors for New Onset Diplopia After Graduated Orbital Decompression
Stähr, Kerstin M.D.*; Eckstein, Anja†; Buschmeier, Maren M.D.*; Hussain, Timon*; Daser, Anke*; Oeverhaus, Michael†; Lang, Stephan*; Mattheis, Stefan*
doi : 10.1097/IOP.0000000000001949
November/December 2021 - Volume 37 - Issue 6 - p 564-570
The aim of the study was to identify possible risk factors for new onset diplopia in 20° of primary position (NOD PP) after orbital decompression. A predisposition for NOD has been established for patients with pre-existing diplopia in secondary gaze; therefore, the authors focused on patients without preoperative diplopia.
Conjunctival Actinic Granuloma: A Clinicopathological and Immunohistochemical Study With a Review of the Literature and a Differential Diagnosis
Neerukonda, Vamsee M.D.*; Jakobiec, Frederick A. M.D., D.Sc.*; Barrantes, Paula Cortes M.D.*; Campbell, Douglas M.D.†; Stagner, Anna M. M.D.*
doi : 10.1097/IOP.0000000000001950
November/December 2021 - Volume 37 - Issue 6 - p 571-575
To document a case of actinic granuloma (AG) of the conjunctiva, provide an extensive histopathologic and immunohistochemical description, review previously reported cases, and supply a differential diagnosis.
Carcinoma Expleomorphic Adenoma of the Lacrimal Gland
Vahdani, Kaveh M.D., F.R.C.Ophth.; Rose, Geoffrey E. D.Sc., F.R.C.Ophth.
doi : 10.1097/IOP.0000000000001957
November/December 2021 - Volume 37 - Issue 6 - p 576-582
To report the characteristics and long-term outcomes of patients presenting with carcinoma ex-pleomorphic adenoma (CXPA) or malignant mixed tumor of the lacrimal gland.
Early Experience With the Clinical Use of Teprotumumab in a Heterogenous Thyroid Eye Disease Population
Diniz, Stefania B. M.D.; Cohen, Liza M. M.D.; Roelofs, Kelsey A. M.D.; Rootman, Daniel B. M.D.
doi : 10.1097/IOP.0000000000001959
November/December 2021 - Volume 37 - Issue 6 - p 583-591
To describe the clinical course in a heterogeneous series of subjects with thyroid eye disease (TED) treated with teprotumumab.
The Effect of Zero Gravity on Eyelid and Brow Position
Karlin, Justin N. M.D., M.S.*; Farajzadeh, Justin M.S.†; Stacy, Stephanie C.Phil.‡; Esfandiari, Mahtash Ph.D.‡; Rootman, Daniel B. M.D., M.S.*
doi : 10.1097/IOP.0000000000001961
November/December 2021 - Volume 37 - Issue 6 - p 592-594
To describe the effect of spaceflight on upper eyelid and brow position.
A New Surgical Technique for Postoperative Trachomatous Trichiasis
Merbs, Shannath L. M.D., Ph.D.*; Talero, Sandra L. M.D., M.P.H.†; Tadesse, Demissie M.D.‡; Sisay, Alemayehu M.D., M.P.H.§; Bayissasse, Belay M.P.H.§; Weaver, Jerusha U. M.P.H.?; Gower, Emily W. Ph.D.?,¶
doi : 10.1097/IOP.0000000000002055
November/December 2021 - Volume 37 - Issue 6 - p 595-598
The World Health Organization has identified management of postoperative trichiasis (PTT) as one of the key remaining areas of focus needed to eliminate blinding trachoma as a public health problem. We developed the Bevel-Rotation Advancement Procedure (B-RAP) to treat individuals who need repeat trichiasis surgery.
Re: Fate and Management of Incompletely Excised Solitary Fibrous Tumor of the Orbit: A Case Series and Literature Review
Woo, Kyung In M.D., Ph.D.; Kim, Yoon-Duck M.D., Ph.D.
doi : 10.1097/IOP.0000000000002043
November/December 2021 - Volume 37 - Issue 6 - p 599-600
New Insight Into the Physiologic Function of the Müller Muscle
Putterman, Allen M. M.D.
doi : 10.1097/IOP.0000000000002044
November/December 2021 - Volume 37 - Issue 6 - p 600-601
The Use of Porcine Exenteration Specimens for Simulated Surgical Training in Ophthalmology
Udeh, Adanna M.D.; Tran, Ann Q. M.D.; North, Victoria S. M.D.; Belinsky, Irina M.D.; Kim, Eleanore T. M.D.
doi : 10.1097/IOP.0000000000002053
November/December 2021 - Volume 37 - Issue 6 - p 601-602
Recreating Human Eyelid Anatomy in a Modified Ovine Model
Ghosh, Yohaann A.; Gupta, Ruta M.B.B.S., F.R.C.P.A.; Clark, Jonathan R. M.B.B.S., B.Sc. (Med), M.Biostat., F.R.A.C.S. A.M.
doi : 10.1097/IOP.0000000000002054
November/December 2021 - Volume 37 - Issue 6 - p 602-603
Aesthetic Abstracts
Burroughs, John M.D.*; Hwang, Catherine J. M.D.†; Nakra, Tanuj M.D.‡; Rootman, Daniel B. M.D.§; Wulc, Allan M.D., F.A.C.S.?; Woodward, Julie M.D.¶
doi : 10.1097/IOP.0000000000002101
November/December 2021 - Volume 37 - Issue 6 - p 604-606
Oculoplastic Abstracts
Ali, Mohammad Javed M.D.*; Bernardini, Francesco P. M.D.†; Savar, Aaron M.D.‡; McNab, Alan A. M.D.§; Tawfik, Hatem A. M.D.?
doi : 10.1097/IOP.0000000000002080
November/December 2021 - Volume 37 - Issue 6 - p 607-608
Acquired Epiblepharon Alleviated With Teprotumumab Treatment in Active Thyroid Eye Disease Patient
Chen, Kevin W. B.S.*; Phelps, Paul O. M.D.†
doi : 10.1097/IOP.0000000000002002
November/December 2021 - Volume 37 - Issue 6 - p e195-e196
A 46-year-old Asian female patient with thyroid eye disease reported ocular irritation, eyelid swelling, diplopia, and pain with eye movement. The patient was diagnosed with active thyroid eye disease and secondary thyroid eye disease–acquired epiblepharon, which was causing bilateral punctate epithelial erosion. Treatment was started with newly U.S. Food and Drug Administration approved teprotumumab, an insulin-like growth factor-1 receptor inhibitor. Four infusion treatments later, the patient’s epiblepharon was alleviated with minimal side effects. In this report, the authors present a case of thyroid eye disease–acquired epiblepharon resolving with teprotumumab treatment.
Eosinophilic Dermatosis of Malignancy Involving the Eyelid
Ho, Tiffany C. M.D.*; Compton, Leigh M.D., Ph.D.†,‡; Sheinbein, David M.D.‡; Custer, Philip L. M.D., F.A.C.S.*
doi : 10.1097/IOP.0000000000002004
November/December 2021 - Volume 37 - Issue 6 - p e196-e198
A 72-year-old man with history of chronic lymphocytic lymphoma presented with a tender, ulcerated cutaneous eyelid lesion. Excisional biopsy revealed a diagnosis of eosinophilic dermatosis of malignancy. This rare paraneoplastic eruption is associated with hematologic malignancies and characterized histopathologically by lymphocytic infiltration accompanied by numerous eosinophils. To our knowledge, eosinophilic dermatosis of malignancy involving the eyelid has not been previously reported.
Metastatic Uterine Carcinosarcoma to the Orbit
Qureshi, Sana M.D.*; Patel, Nimesh A. M.D.†; Patel, Nish M.D.†; Ghassibi, Mark P. M.D.†; Tse, David T. M.D.†; Dubovy, Sander R. M.D.†,‡
doi : 10.1097/IOP.0000000000002006
November/December 2021 - Volume 37 - Issue 6 - p e198-e202
Metastases of solid tumors to the eye and ocular adnexa are rare. Herein, the authors describe the clinical, histologic, and immunohistochemical findings of a patient with a history of adenocarcinoma of the colon and a uterine carcinosarcoma (malignant mixed Müllerian tumor) who presented with proptosis and decreased vision. Positive staining with PAX-8, p16 and negative reaction for CK20 and CDX2 helped to establish the uterine origin of the metastasis. This rare case demonstrates the utility of immunohistochemical probes, especially in patients with a complex oncological history, where multiple primary sources of the metastasis are in the differential diagnosis.
Orbital Lipofibromatosis in a Pediatric Patient
Chang, Angela Y. B.A.; North, Victoria S. M.D.; Tran, Ann Q. M.D.; Kazim, Michael M.D.
doi : 10.1097/IOP.0000000000002008
November/December 2021 - Volume 37 - Issue 6 - p e202-e204
A 10-month-old boy presented with a 3-month history of progressive left lower eyelid swelling. Examination demonstrated left lower eyelid fullness and hyperglobus with a fatty appearing inferior fornix mass. Imaging showed a mass isointense to fat in the left lower eyelid extending posteriorly, surrounding the inferior oblique with complete fatty infiltration, obscuration of the inferior rectus, and adherence to the globe. The patient underwent orbitotomy with biopsy and debulking of the tumor. Surgical pathology showed multiple fragments of adipose tissue with foci of plump and spindle-shaped cells arranged in bundles and fascicles, consistent with lipofibromatosis. This case illustrates a rare presentation of orbital lipofibromatosis in a pediatric patient.
Inadvertent Intraocular Soft Tissue Filler Injection During a Facial Enhancement Procedure
Liu, Fei M.D.*; Ma, Yue M.S.*; Tang, Meiting M.S.*; Zeng, Xueying M.S.*; Kikkawa, Don O. M.D.†; Lu, Wei M.D.*
doi : 10.1097/IOP.0000000000002016
November/December 2021 - Volume 37 - Issue 6 - p e204-e206
Iatrogenic needle penetrating ocular injuries are rare but can result in serious consequences. The authors report a case of inadvertent intraocular hyaluronic acid injection during esthetic periorbital facial enhancement. Visual field, visual evoked potential, and electroretinogram were used for monitoring potential side effects.
Massive Orbital Infiltration and Trigeminal Enlargement in Churg-Strauss Syndrome Associated With IgG4 Plasma Cell Positivity
Zanon Zotin, Maria Clara M.D.*; Cunha, Barbara S. A. M.D.†; Chahud, Fernando M.D.‡; Cruz, Antonio Augusto Velasco e M.D.†
doi : 10.1097/IOP.0000000000002018
November/December 2021 - Volume 37 - Issue 6 - p e206-e208
The association of C-antineutrophil cytoplasmic antibody (ANCA) vasculitis and IgG4 positivity is a new condition not well described in clinical terms. The authors examined a 28-year-old man with a previous diagnosis of eosinophilic granulomatosis with polyangiitis, formerly known as Churg-Strauss disease, who presented with bilateral orbital inflammation. Magnetic resonance imaging revealed diffuse orbital infiltration and enlargement of the major divisions of the trigeminal nerve. Biopsy of the orbital contents showed necrotizing granulomatous vasculitis and a high number of IgG4-positive plasma cells (IgG4/IgG = 60%).
Epibulbar Subconjunctival Apocrine Hidrocystoma
Charles, Norman C. M.D.*,†; Raju, Leela V. M.D.*; Kim, Eleanore T. M.D.*
doi : 10.1097/IOP.0000000000002019
November/December 2021 - Volume 37 - Issue 6 - p e208-e209
Apocrine hidrocystomas are benign cystic tumors derived from apocrine sweat glands; they are most commonly located in the skin of the head and neck regions. Ophthalmic occurrences characteristically appear at the lash line and canthi of the eyelid, although rare instances have been described in the conjunctiva, caruncle, and orbit. The authors describe an exceptional instance of a mobile epibulbar subconjunctival apocrine hidrocystoma in a 57-year-old woman without a history of previous ocular injury or surgery. Histopathology of the excised specimen displayed an empty cyst lined by a double layer of cuboidal epithelium with the inner layer exhibiting periodic acid-Schiff-positive apical decapitation secretion. Confirmatory immunohistochemistry included reactivity with cytokeratin-7, smooth muscle actin, D2-40, and CDGFP-15.
Chronic Early-Stage Ocular Cicatricial Pemphigoid
Besagar, Sonya B.S., B.A.*; London, Ashley O. M.S.*; Jairam, Meghan P. B.A.*; Trief, Danielle M.D., M.Sc.†; Dagi Glass, Lora R. M.D.†
doi : 10.1097/IOP.0000000000002021
November/December 2021 - Volume 37 - Issue 6 - p e209-e213
Ocular cicatricial pemphigoid (OCP) represents an insidious, autoimmune-mediated disease of the conjunctiva, initially presenting as chronic conjunctivitis and progressing to fibrosis, cicatrization, and eventually blindness secondary to corneal keratinization. This series reports 3 cases presenting with chronic conjunctivitis lasting an average of 10 years without cicatrix formation, ultimately diagnosed as OCP based on direct immunofluorescence of conjunctival biopsy samples. This chronic conjunctivitis without fibrosis suggests the possibility of an OCP subtype with a prolonged early stage or prodrome prior to cicatrization, which may benefit from early diagnosis and treatment to prevent complications of this disease.
Spheno-Orbital Dermoid Masquerading as Recurrent Orbital Abscess
Yoon, Michael K. M.D.*,†; Habib, Larissa A. M.D.‡
doi : 10.1097/IOP.0000000000002026
November/December 2021 - Volume 37 - Issue 6 - p e213-e215
A 10-month-old girl presented with eyelid edema and erythema that did not improve with systemic antibiotics. Due to a lack of improvement, MRI was performed to avoid ionizing radiation from CT. An orbital abscess was recognized and drained. However, the abscess recurred 2 times. CT scan was performed and a tract in the sphenoid bone helped to diagnose a congenital dural sinus tract with dermoid. Definitive surgery was performed with neurosurgery to remove the entire tract including cutaneous connection. CT scan proved critical to diagnosis and should be considered in infants in select cases despite the concern for ionizing radiation in this vulnerable age group.
Interstitial Brachytherapy for Orbital Sebaceous Carcinoma
Li, Feng B.A.*; Stewart, Robert D. M.D.†; Finger, Paul T. M.D.*,†
doi : 10.1097/IOP.0000000000002031
November/December 2021 - Volume 37 - Issue 6 - p e215-e217
Sebaceous carcinoma is characterized by its aggressive local tumor behavior and ability to metastasize. Small periocular sebaceous carcinoma are typically treated by excision with cryotherapy. Larger tumors often require adjuvant external beam radiotherapy (EBRT) and/or exenteration surgery. When used alone, EBRT techniques typically exceed the tolerance of critical normal ocular structures. The interstitial orbital brachytherapy-boost technique permits dose escalation to the tumor bed, while minimizing radiation dose to critical normal ocular structures. Here, we present a case of orbital sebaceous carcinoma treated with excision, cryotherapy, and super-thick amniotic membrane fornix reconstruction. Then, after 3 weeks of healing, adjuvant-combined electron interstitial high-dose rate brachytherapy-boost was added to electron-beam radiotherapy to optimize the orbital radiation dose distribution, increase dose to inferonasal orbit, and allow relative sparing of orbital tissues. At 1-year follow-up, there was no evidence of orbital tumor, no significant eye lash loss, normal ocular motility, no radiation retinopathy, optic neuropathy and a visual acuity of 20/20.
Double Frost Suture Technique for Simultaneous Skin Grafting of the Upper and Lower Eyelids
DeMaria, Lauren N. M.D.*; Tran, Ann Q. M.D.*,†; Tooley, Andrea A. M.D.‡; North, Victoria S. M.D.*,†; Flores, Roberto L. M.D.§; Lisman, Richard D. M.D., F.A.C.S.*,†,§; Belinsky, Irina M.D.*
doi : 10.1097/IOP.0000000000002032
November/December 2021 - Volume 37 - Issue 6 - p e217-e221
The double Frost suture is a useful supplement to the reconstruction of ipsilateral upper and lower eyelid defects with full-thickness skin grafts. This technique involves silk traction sutures that overlap the upper and lower eyelids to place them on maximal stretch after placement of 2 full-thickness skin grafts. It has the added benefit of protecting the cornea and compressing both grafts under 1 bolster. The authors illustrate this technique in 2 pediatric cases—a congenital melanocytic kissing eyelid nevus and a periocular burn. Each case resulted in large upper and lower anterior lamellar defects, which were reconstructed with supraclavicular and retroauricular free skin grafts. The double Frost sutures counter vertical cicatricial forces during graft healing, obviating the need for staged procedures. Both described cases resulted in excellent graft survival with minimal contracture.
Thyroid Eye Disease Following COVID-19 Vaccine in a Patient With a History Graves’ Disease: A Case Report
Rubinstein, Tal J. MD*,†,‡
doi : 10.1097/IOP.0000000000002059
November/December 2021 - Volume 37 - Issue 6 - p e221-e223
A 50-year-old woman with a history of controlled Graves’ disease without clinical ophthalmopathy presents with 2 months of left more than right periorbital swelling and proptosis. Her eye symptoms and signs began 3 days following her second vaccination against the COVID-19 virus. Orbital imaging, elevated thyroid stimulating immunoglobulin, and negative systemic work up for other diseases were consistent with a diagnosis of active thyroid eye disease. The temporal relationship to her vaccination was likely consistent with autoimmune/inflammatory syndrome associated with adjuvants. Clinicians should remind patients of the symptoms and signs of thyroid eye disease and to seek appropriate medical and ophthalmic advice if they occur after the COVID-19 vaccine.
Porocarcinoma of the Eyelid Presenting as an Umbilicated Lesion
Charles, Norman C. MD; Kim, Eleanore T. MD
doi : 10.1097/IOP.0000000000001956
November/December 2021 - Volume 37 - Issue 6 - p e224
Syringocystadenoma Papilliferum Arising in an Anophthalmic Socket
Campbell, Benjamin C. M.D.*,†; Al-Omari, Ahmed K. M.D.‡; Lee, H. B. Harold M.D., F.A.C.S.*,†
doi : 10.1097/IOP.0000000000001963
November/December 2021 - Volume 37 - Issue 6 - p e225
