Asian Blepharoplasty in Patients
In previous publications,1-7 I discussed the concept of upper eyelid crease configurations and the essential steps required for predictable placement of a lid crease among Asian patients without a crease. My method…
Ophthalmology
Oculoplastics
Oculoplastics resources from the Ophthalmology Hyperguide.
49 resourcesAlphabetical A–Z
BB and Pellet Gun-Related Injuries
Ball bearing (BB) and pellet gun-related injuries represent an important public health concern in the United States. Most of these injuries occur in children and teenagers 19 years of age or younger. In all incidents of…
Benign Eyelid Tumors
Eyelid lesions can be benign, premalignant, or malignant. The history and clinical diagnosis are extremely important in determining the probability of malignancy. The growth rate, change in size or color, sun exposure,…
Blepharoplasty and Browplasty
Introduction The term blepharoplasty comes from the Greek words blepharon (eyelid) and plasso (surgical procedure for repair of a defect or restoration of form or function). The conditions requiring blepharoplasty can…
Blow-out Fractures in Adults and Children
Orbital fractures are seen commonly in patients who have blunt trauma to the face and skull. The orbit is involved in trauma since it assumes a prominent position with regard to the craniofacial skeleton.1 These…
Botulinum Toxin: Oculofacial Clinical Applications
Botulinum A Toxin, which is commercially available as Botox (Allergan), is one of seven toxins produced by Clostridium botulinum, a gram-positive anaerobic bacterium. After the clinical trials conducted by Alan B.…
Brow and Lash Abnormalities
Duke-Elder's classic ophthalmology textbook classifies brow and lash abnormalities into three main categories1:
Classification and Examination of Patients with Acquired Ptosis
Over the years, many classifications of ptosis have been developed. However, recently with refinements in the diagnosis of ptosis, along with improved anatomic evaluation and study of the pathophysiology of certain…
Cold Urticaria and Other Causes of Oculofacial Postoperative Swelling: Important Prevention, Diagnostic, and Management Strategies
Potential causes of increased postoperative swelling include rough tissue handling, poor wound placement, excessive cauterization, and lymphatic disruption. Another contributing factor is poor patient compliance with…
Combination Therapies
New insights into the facial aging process and the introduction of safer, longer-lasting materials for adding volume to facial structures has added a new dimension to noninvasive facial rejuvenation. Since the…
Complications of Ptosis Surgery
Ptosis is one of the most common disorders encountered in ophthalmic plastic surgery. A thorough history taking and physical examination of a patient with ptosis provide the guidelines for making an appropriate choice…
Congenital Anomalies of the Eyelid, Orbit, and Lacrimal System
The development of the lacrimal drainage system begins at approximately 6 week's gestation. Canalization of the ectodermal cord begins during the third month in the area of the medial canthus. Canalization progresses…
Congenital Ptosis
Congenital ptosis, or dysmyogenic ptosis, is the most common ptosis seen in childhood. It is caused by primary dystrophy of the levator muscle. In congenital ptosis, Müller superior tarsal muscle is normal.1 A decrease…
Dry Eye, Meibomian Gland Dysfunction, and Oculoplastic Surgery
Dry eye syndrome (DES) is a complex and prevalent disease that affects approximately 12% of the United States' population. The condition affects more than 3.2 million American women who are middle-aged or older.1 In…
Enucleation, Evisceration and Exenteration
The surgical procedure to remove an eye should be performed with efforts to minimize cosmetic deformity. The anophthalmic socket must be able to hold a prosthesis and allow movement of the prosthesis that matches the…
Eosinophilic Granuloma
Langerhans first described dendritic cell histopathology in 1868. Eosinophilic granuloma is part of a spectrum of histiocytic disorders. These disorders were originally named histiocytosis X in 1953 by Lichtenstein, but…
Essential Blepharospasm
Essential blepharospasm, also called benign essential blepharospasm, is a focal cranial dystonia consisting of involuntary contractions of the obicularis oculi muscles and other muscles of the upper face. These…
Evisceration and Sympathetic Ophthalmia: Is the Procedure Worth the Risk?
Evisceration has been an important technique in ophthalmology for almost 200 years. According to Meltzer it was first described by Bear in 1817, who used the procedure after an iridectomy for acute glaucoma was…
Eyelid Infections
Eyelid infections comprise a heterogeneous group of anatomic substrates and etiologic agents. Clinical findings and treatments vary according to the substrate and agent. The complex anatomy of the eyelid contributes to…
Eyelid Manifestations of Systemic Disease
The eyelid may be a common site for the manifestation of several systemic diseases. Because several structures of the eyelid share a common ectodermal origin with the skin, many diseases may exhibit both dermatologic…
Eyelid Reconstruction
When a lesion is to be resected, complete excision can be performed in a variety of techniques. Mohs resection is usually worthwhile for recurrent lesions, extremely invasive, large lesions or tumors involving the media…
Eyelid Retraction
Normal eyelids protect the globe from desiccation and trauma, exhibit specialized movement, and allow for vision and movement of fluid bathing the cornea. The upper eyelid margin is normally situated 1.5 mm to 2 mm…
Eyelid Trauma
Patients with ocular adnexal trauma often have other significant multisystem injuries. Therefore, awareness of establishing an adequate airway, controlling excessive bleeding, and stabilizing patients' circulatory…
Eyelids and the Lacrimal System
The eyelids first develop in the seventh week of gestation as definite folds forming a circular palpebral aperture. The mesenchymal portion of the upper eyelid develops from a medial and lateral portion of the…
Graves Orbitopathy
Graves orbitopathy varies widely in its pattern of clinical presentation. Generalizations about the disease are not particularly useful when developing treatment plans for an individual patient, but the following…
Gun Shot Wounds of the Eye and Orbit
In 1977, gunshots caused 31,636 fatal injuries and 100,000 nonfatal injuries in the United States. The lifetime costs of treating all US gunshot wounds (GSW) in 1994 were $2.3 billion. The average medical cost of a…
Involutional Entropion and Ectropion: Evaluation and Management
Involutional entropion and ectropion are malpositions of the lower eyelid, commonly encountered in clinical practice. This tutorial will discuss the etiology, symptoms, and differential diagnosis of these disorders, as…
Lacrimal Drainage System
Epiphora is defined as an abnormal overflow of tears down the cheek. This condition may be congenital or acquired.
Lacrimal Tumors
The lacrimal gland is an exocrine gland, nestled within the lacrimal gland fossa of the frontal bone in the superotemporal orbit. The gland is subdivided anatomically, by the lateral horn of the levator aponeurosis,…
Laser Skin Resurfacing
Currently, lasers are used in the periorbital region to treat a wide spectrum of disorders. The following discussion will focus on cutaneous skin resurfacing, the most common laser application.
Malignant Eyelid Lesions
Cutaneous carcinoma is the most common malignancy in the United States. Approximately 500,000 people are treated annually for basal or squamous cell carcinoma of the skin. Approximately 5% to 9% of all skin cancers…
Managing Complications Associated with Pegging and Tips for Successful Peg Placement
Porous orbital implants (e.g., hydroxyapatite, porous polyethylene, aluminum oxide) are commonly used during enucleation, evisceration, and secondary orbital implant surgery.1 The extensive pore systems permit…
Merkel Cell Carcinoma: An Uncommon Tumor Without a Definitive Treatment Protocol
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine malignancy of epidermal origin with a natural history of local recurrence, lymph node metastasis, and distant dissemination.1,2 MCC is an uncommon skin…
Mucocele
Runge opened and obliterated the frontal sinus in 1750. Lanbeck first described the clinical presentation of frontal sinus mucoceles in 1818. In 1884, Ogston created a trephine hole through the anterior table and…
Nevoid Basal Cell Carcinoma Syndrome (Gorlin's Syndrome)
Gorlin's syndrome, also known as nevoid basal cell carcinoma syndrome, is an inherited condition that affects many organ systems. Late in the course of this disease, a patient may present with multiple, aggressive basal…
Ophthalmoplegia Plus Syndromes
Neurologic, ophthalmologic, and systemic disorders with common chronic progressive external ophthalmoplegia (CPEO) have been identified. Chronic progressive external ophthalmoplegia may also occur in isolation of any…
Orbital and Eyelid Lymphangioma
Lymphangioma is a rare, diffusely infiltrating, benign, nonencapsulated vascular tumor most commonly diagnosed in the first or second decade of life. Despite a congenital nature and low proliferative potential,…
Orbital Decompression for Thyroid-Related Orbitopathy
Thyroid-related orbitopathy (TRO) is clinically relevant in approximately 50% of patients with Graves' disease. However, only 3% to 5% of patients develop serious complications that require surgical intervention. In…
Orbital Diseases
The orbit is an important site for primary and secondary disease processes. Because the volume of the orbit is small, many of the presenting signs of orbital disease are ophthalmic. An understanding of the anatomy of…
Orbital Imaging
The orbit of the eye comprises the globe with its muscles, blood vessels, lymphatics, cranial nerves 2, 3, 4, 5, and 6, sympathetic and parasympathetic nerves, adipose tissue, connective tissue, and the lacrimal…
Orbital Rhabdomyosarcoma
Rhabdomyosarcoma is a malignant neoplasm composed of cells with histologic features of striated muscle tissue at various stages of embryogenesis.1 It develops from undifferentiated mesenchymal cells that possess the…
Orbital Surgery
Orbital procedures can be overwhelming, even to the experienced orbital surgeon. Fortunately, advances in neuroimaging modalities, microsurgical techniques, and instrumentation have revolutionized the way we look at…
Orbital Tumors in Adults
Thyroid-related orbitopathy is the most common cause of referral of patients with orbital disease. Other causes include neoplasia, structural, inflammatory, and vascular lesions.
Osteology
To fully understand the eyelid and orbital anatomy, a basic knowledge of the embryology of the eye and its adnexal structures is required. An important distinguishing feature in ocular development is the concept that…
Prion Diseases
The term prion disease refers to a group of fatal neurodegenerative disorders for which no treatment or cure is available. With the emergence of variant Creutzfeldt-Jakob disease (CJD) in the past decade,…
Surgical Treatment of Lid Retraction
In the Eyelid Retraction tutorial, a differential diagnosis was enumerated. In clinical practice, the most common entities related to upper eyelid retraction are:
Temporal Arteritis (Giant Cell Arteritis)
Temporal arteritis, also known as giant cell arteritis or cranial arteritis, is a vasculitis that affects the arteries of the head and neck. The mean age at presentation is 70 years. White women are affected somewhat…
The Anophthalmic Socket
The search for the ideal orbital implant began in 1885 when Mules placed a glass spherical implant into an eviscerated socket. One year later, Frost introduced a similar implant into Tenon's capsule following an…
Wegener's Granulomatosis
Wegener's granulomatosis is characterized by necrotizing granulomatosis lesions of the respiratory tract, glomerulonephritis, and vasculitis.1 However, Wegener's granulomatosis can affect almost any organ system, as its…
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