Blindness after reduction of facial fractures.
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Blindness↗
Biomedical subjects
R W Neuhaus
Publications and source records attributed to R W Neuhaus.
Valsalva DCR bubble test.
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Dacryocystorhinostomy↗
Inadequate inferior cul-de-sac in the anophthalmic socket.
A retrospective review of preoperative findings and postoperative results of conjunctival cul-de-sac fixation surgery performed on 12 patients with acquired anophthalmos and an inadequate inferior conjunctival cul-de-sac was performed. Patients with inadequate conjunctiva or other subconjunctival cicatricial shortening of the inferior cul-de-sac were not suitable candidates for conjunctival cul-de-sac fixation surgery and therefore were excluded from this retrospective study. Only those patients with adequate conjunctiva and loss of inferior cul-de-sac fixation to the lower eyelid retractor complex were selected. Clinical evaluation and theoretical anatomical analysis of this group preoperatively suggested that the absent inferior conjunctival cul-de-sac fixation could allow the intraconal orbital fat to migrate anteriorly, compromising the inferior fornix and prolapsing the conjunctiva of the cul-de-sac superiorly. Surgical correction required direct fixation of the conjunctival cul-de-sac to the periosteum immediately posterior to the inferior orbital rim. No externalized sutures or stents were needed to recreate the inferior conjunctival cul-de-sac. All 12 patients had improved ability to retain a prosthetic eye postoperatively. However, two patients had minimal postoperative lower eyelid retraction and an additional two patients had minimal lower eyelid entropion after surgery. Secondary surgery was not required in any patient.
Conjunctiva↗
Postcataract surgery endophthalmitis in a patient with a functioning Jones tube.
Dacryocystorhinostomy with Jones tube placement has proven to be an effective method for correcting upper-system lacrimal drainage obstruction. The present case report illustrates the potential risk of bacterial contamination of the operative field during subsequent cataract surgery by retrograde passage of airway secretions. Temporary occlusion of the Jones tube by a silicone plug can eliminate this potential source of endophthalmitis. In addition, temporary occlusion of the Jones tube in the office can be used to determine the effectiveness of lacrimal drainage through a reconstructed canalicular system.
Aged↗
Lower eyelid blepharoplasty.
BACKGROUND: Lower eyelid blepharoplasty is a frequently performed procedure to reverse partially gravitational aging effects on eyelid tissues. Careful planning, proper execution, and appropriate management of potential postoperative complications will generally result in a happy and satisfied patient. However, in any surgical procedure that is primarily aesthetic in nature, the surgeon needs to be constantly aware of factors that may compromise the functional integrity of the eyelid. A patient with altered visual function or ocular discomfort is no longer primarily concerned about the final aesthetic appearance of even the most perfectly executed, technically correct blepharoplasty procedure. OBJECTIVE: To describe the preoperative evaluation, surgical technique, and postoperative complications of lower eyelid blepharoplasty. Specific attention will be given to lower eyelid retraction and ectropion following blepharoplasty. CONCLUSION: Successful lower eyelid blepharoplasty surgery can be a source of both patient and physician satisfaction. As long as patient expectations are consistent with realistic surgical goals, lower eyelid blepharoplasty is an important aspect of overall facial aesthetic surgery.
Eyelid Diseases↗
Increased intraocular pressure in severely burned patients.
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Burns↗
Orbital complications secondary to endoscopic sinus surgery.
Eight cases of significant orbital complications associated with endoscopic sinus surgery are described. The anatomic problems generally fall into four categories: nasolacrimal sac or duct injury, extraocular muscle injury, intraorbital hemorrhage/emphysema, or optic nerve injury. The successful management of each complication depends on a thorough knowledge of the anatomy and pathophysiology of the orbital injury. Return to normal function of the traumatized orbital structures after medical and/or surgical intervention is anticipated. However, direct optic nerve injury with immediate visual field and/or acuity deficit is usually irreversible.
Adult↗
Silicone intubation of traumatic canalicular lacerations.
To assist in the repair of canalicular injuries, identification of the medial aspect of the canalicular laceration can easily be accomplished by retrograde probing and intubation of the medial canalicular remnant. A dacryocystotomy along the medial side of the nasolacrimal sac will allow direct visualization of the internal nasolacrimal sac anatomy and common internal punctum of the common canalicular system. A retrograde passage of a modified Quickert probe can then be accomplished through the dacryocystotomy incision into the common internal punctum and present in the traumatic wound, identifying the medial aspect of the canalicular laceration.
Dacryocystorhinostomy↗
Tips for local anesthesia in blepharoplasty.
Successful local anesthesia depends on many factors, but the most important is patient confidence in the surgeon and surgical team. In addition, the proper sequencing of the delivery of the local anesthesia will allow adequate time for anesthesia and vasoconstriction. This requires that the local infiltrative anesthetic injection with Wydase and epinephrine be given prior to preparing, draping, and marking the patient.
Anesthesia, Local↗
Botulinum toxin for the treatment of essential blepharospasm.
Twenty-six patients with essential blepharospasm were treated with botulinum toxin by injection. The onset of protractor weakness in all patients ranged from one to five days following treatment. Maximal weakness developed within 12 days. There was a variable and gradual return of protractor strength over eight to 29 weeks in most patients and, with it, a return of spasm. Twenty-five patients received some degree of functional relief following initial injection. In most patients, however, the post-injection result could not be stabilized and repeat injections have been necessary to control recurrent spasms. There was one treatment failure. Three patients treated by injection following previous neurectomy and myectomy appeared to have a reduced requirement for subsequent injections. Complications included transient ptosis in six patients and mild exposure symptoms in four patients. Extraocular muscle paresis did not occur. There were no systemic side effects from the botulinum toxin injections.
Aged↗
Eyelid suspension with a transposed levator palpebrae superioris muscle.
In patients with severe Marcus Gunn jaw-winking, ablation of the synkinetic eyelid movement requires surgical removal of a significant portion of the levator complex (muscle and aponeurosis). As an alternative to removing this tissue completely, the levator muscle can be transected approximately 25 mm above its tarsal plate insertion. The distal levator muscle and aponeurosis can then be used as a suspensory material to suspend the eyelid to the eyebrow.
Blepharoptosis↗
Anatomical basis of "senile" ectropion.
A study of 20 patients with bilateral ectropion was undertaken to determine the exact anatomical etiology of the horizontal eyelid laxity which leads to "senile" (involutional) ectropion. Two previous studies on normal people have shown a slight increase in the horizontal length of the lateral canthus with increased age. The results of the 20 patients with ectropion revealed that the lateral canthal tendon is significantly increased in horizontal length as compared with normal, age-matched controls. Therefore, surgery directed to the repair of the attenuated, horizontally lax, lateral canthus is more appropriate than full-thickness block or tarsal resection of the normal eyelid in the palpebral fissue. Additionally, since normal full-thickness eyelid tissue is not resected, the horizontal length of the palpebral fissue will not be shortened. This results in a more pleasing cosmetic appearance as well as an improved functional result.
Aged↗
Enucleation with implantation of a proplast sphere.
Proplast, an inert carbon-Teflon alloplastic material, was tested as a primary spherical implant after unilateral enucleation in albino rabbits. The implants were removed at 3 months in three rabbits and at 6 months in the remaining three rabbits. Clinical observation confirmed a high degree of soft tissue fixation and no implant migration. The implant material submitted for light and electronmicroscopy showed extensive fibrovascular ingrowth throughout its matrix without encapsulation of the implant. Subsequent human use has shown good results in four patients followed for 2 years and an additional six patients followed for 1 year.
Animals↗
Use of temporal fascia and muscle as an autograft.
A wide variety of materials have been used for reconstruction around the eyelids and orbit, including alloplastic materials, such as polyfilament surgical suture (Supramid), silicone, and Teflon, that have a tendency toward early infection or late extrusion. Preserved homografts, such as sclera or fascia lata, are unlikely to extrude but have variable absorption rates. Autografts have proved over the years to be the best, most reliable, and least reactive material for reconstruction. Our use of temporal fascia and muscule grafts has been quite successful.
Adult↗
Penetrating orbital trauma.
A small number of patients suffer penetrating injury to the orbit in the absence of trauma to the globe. Hospital records from the Jules Stein Eye Institute and affiliated hospitals were reviewed to obtain such cases. Five cases of penetrating orbital trauma, in which the globe was spared, are discussed. Many of the injuries initially appeared trivial but subsequent complications were severe. A review of these cases suggests that the shape and speed of the penetrating object, the anatomical location of the entry wound, and the physical characteristics of intraorbital structures determine the character and severity of orbital injuries.
Adult↗
Cerebrospinal fluid leakage after dacryocystorhinostomy.
The authors have encountered two presumptive cases of cerebrospinal fluid leakage associated with dacryocystorhinostomy. To understand better the pathophysiology, bilateral dacryocystorhinostomies and anatomic dissections were performed on three fresh cadaver specimens. The average distance from the superior bony nasal window to the floor of the anterior cranial fossa was 5.0 mm. The frontal sinus floor overlies the anterior portion of the nasal window, while the thinnest portion of cribriform plate overlies the posterior portion of the nasal window. A bony fracture of the anterior cranial fossa floor and/or cribriform plate resulted from (1) applying a rotational force to the Kerrison ronguer while enlarging the posterior nasal window or (2) fracturing an attenuated superior wall of an ethmoid air cell which has eroded into the orbital roof.
Adult↗
Modified lacrimal system intubation.
A modified technique for silicone intubation of the lacrimal system is presented to eliminate the two major postoperative problems of punctal erosion and loop retraction.
Humans↗