Biomedical subjects
Publications and source records attributed to J P Edelstein.
We describe a new instrument specifically designed to perform a "wedge" punctoplasty. The Reiss punctal punch was designed to be an enhancement of the one-snip punctoplasty by providing greater uniformity and improved tear access to the punctum via an excised posterior tissue wedge as well as inhibiting reapproximation of the cut edges leading to recurrent punctal stenosis.
The primary functional support for the medial eyelid is from the deep attachments of the orbicularis muscle to the posterior lacrimal crest and lacrimal diaphragm. A dehiscence of the deep medial canthal attachments can alter the position of the lower eyelid with subsequent tearing, medial ectropion, and ocular exposure. In this study, medial palpebral tendon reconstruction was performed on seven lower eyelids with medial instability or ectropion and a dehiscence of the medial palpebral tendon. A periosteal flap left attached to the posterior lacrimal crest was used to replace the attenuated or absent medial palpebral tendon. After a mean follow-up of 7 months, 86% (6/7) of the eyelids had acceptable cosmetic and functional results. The use of a periosteal flap to replace a dehiscence of the medial palpebral tendon has several advantages. The periosteal flap is readily available, strong, and autogenous. The lower eyelid and punctum are pulled tightly against the globe. Lastly, the procedure may be repeated or combined with other ectropion procedures.
A dehiscence of the lateral palpebral tendon may cause laxity of the eyelid and result in lower eyelid ectropion. In this study lateral palpebral tendon reconstruction was performed on 45 eyelids with ectropion and lateral palpebral tendon laxity. A periosteal flap from the lateral orbital rim was used to replace the attenuated tendon. After a mean follow-up of 16 months, 91% (41 of 45) of the eyelids had acceptable cosmetic and functional results. Included in this group were 16 eyelids with mild residual ectropion. The use of a periosteal flap to replace an attenuated lateral palpebral tendon has several advantages. The periosteal flap is readily available, strong, and autogenous. The lateral canthus is pulled posteriorly and laterally keeping the eyelid against the globe. Lastly, the procedure may be repeated or combined with other ectropion procedures.
In computed tomographic (CT) scans, a wooden foreign body can appear as a lucency with nearly the same density as air or fat, and it can be indistinguishable from orbital adipose tissue. Magnetic resonance imaging (MRI) can localize these wooden foreign bodies in the orbit. We studied a case in which a wooden golf tee lodged in the right optic canal of a nine-year-old boy. The head portion lodged in the orbital apex and the tip entered the interpeduncular fossa. Clinical examination revealed a right paranasal laceration; the right eye had no light perception and a peripapillary hemorrhage, but was otherwise normal. Surgical exploration and evaluation by CT failed to locate the foreign body. However, the golf tee was demonstrated by MRI as a low intensity image. Although it was removed by craniotomy with good neurological results, bacterial panophthalmitis led to enucleation of the eye. This case emphasizes the diagnostic value of MRI and the hazards of retained wooden foreign bodies.