B. Barahimi

Tarsal-Conjunctival Graft or Flap and Skin-Muscle Transposition Flap in Lower Eyelid Reconstruction

Lower eyelid reconstruction requires multiple tools in an oculoplastic surgeon’s armamentarium. Although the tarsoconjunctival (Hughes) flap is reliable, the requirement of a second stage and closure of the eye are definite disadvantages to the procedure. In addition, some defects are in the gray zone between a primary closure with cantholysis and a Hughes flap. This chapter describes two different one-stage procedures for reconstruction of large full-thickness defects of the lower eyelid: one procedure employs a free tarsal graft, while the other uses a laterally based tarsoconjunctival flap.

Intra-arterial Chemotherapy for Lacrimal Gland Adenoid Cystic Carcinoma

Adenoid cystic carcinomas are the most common malignant epithelial tumors of the lacrimal gland. Their overall incidence is rare, accounting for 1.6% of all orbital tumors. In 2012, there were 300 reported cases of lacrimal gland adenoid cystic carcinomas (LGACC) in the United States, with an annual incidence rate of 25 cases. LGACC most commonly affects middle-aged men. These tumors have a bleak prognosis with a 20% 10-year survival regardless of treatment regimen, which can encompass undergoing local excision alone, exenteration, radiation alone, exenteration and radiation, or an unspecified chemotherapeutic protocol. Prognosis is dependent upon the histologic subtype (cribiform, sclerosing, comedocarcinoma, tubular) with the basaloid variant having the worst prognosis (5-year survival rate of 21% and a median survival of 3 years). LGACC is also notorious for microscopic spread. Its proclivity for invading nerves and lymphatic channels contributes to the high recurrence rates seen with LGACC. Recurrences occur most frequently through direct invasion of periorbital soft tissues or orbital bones. It is estimated that nearly half of patients experience recurrence within 2 years. The classic presentation of LGACC is painful proptosis with progressive perineural invasion. Orbital computed tomography can reveal an invasive mass involving the lacrimal gland and biopsy can

Socioeconomic Disparities in the Presentation and Treatment of Graves' Disease and Thyroid Eye Disease.

ABSTRACT Thyroid eye disease (TED) is an inflammatory, autoimmune orbitopathy with multifactorial etiology. Clinical presentation of TED spans a range from mild surface irritation to vision threatening compressive optic neuropathy. Potential vision loss underscores the importance of understanding genetic and environmental factors influencing the severity of TED presentation. This review will describe the classic risk factors for TED, outline treatments for Graves’ disease (GD) and TED, and describe newer evidence of socioeconomic disparities in TED presentation.