Brian J. Herschorn

Lacrimal Gland Duct Cysts

Lacrimal gland duct cysts develop insidiously in the superotemporal cul de sac. They may be preceded by trauma, infection, or inflammation of the conjunctiva. They are often asymptomatic but may induce discomfort, a sensation of fullness, a visible mass, lid distortion or ectropion. Fluctuation in size with weeping or environmental stimuli is seen. Histopathology is variable. Six cases are described to demonstrate the features. Complete excision of each cyst by meticulous dissection through a conjunctival approach was performed. Total resection is the optimal technique to prevent recurrence.

Epibulbar Subconjunctival Fibroma: A Tumor Possibly Arising from Tenon's Capsule

A fibroma, a benign neoplasm arising from the periorbita or tendon sheaths, is described in a 74-year-old woman as an indolent, lobular tumor situated in the episcleral and subconjunctival connective tissues with superior limbal fixation. Because most fibromas arise from tendon sheaths or fascial planes, we speculate that our lesion arose from Tenons capsule. The rarity of periocular fibroma is documented by a review of the modern ophthalmic literature. Histopathologically, the tumor was composed of a paucicellular population of fibroblasts, sometimes displaying hyperchromatic nuclei and widely separated by abundant broad bundles of collagen. Mast cells were infrequently dispersed in the lesion. A wide local excision was performed, and no recurrence has developed during an 18-month follow-up period.

Palpebral Dacryoadenectomy for Epiphora

The efficacy of palpebral dacryoadenectomy (PDA) to relieve epiphora was studied in 37 patients. Symptomatic relief and postoperative Schirmer testing was used in the evaluation. The technique is described. All patients had patent lacrimal excretory systems: 62% of patients undergoing lacrimal lo-bectomy had complete relief of epiphora; 19% had some improvement, but incomplete relief; 76% had postoperative decrease in their Schirmer testing; and 14% had postoperative foreign body sensation and some degree of dry eye.

Double sphere orbital implantation in enucleation and evisceration.

A simple technique of orbital implantation of two hollow spheres at enucleation or evisceration is described. The procedure sufficiently replaces lost volume in the enucleated or eviscerated orbit, facilitates prosthesis motility, and diminishes simulated enophthalmos and superior sulcus depression. The risk of implant migration or extrusion is not increased.

Carbon Dioxide Laser Surgery in Hemophilia

We used a carbon dioxide laser to remove a subcutaneous lipoma from the brow of a patient with classical hemophilia A. This technique made the cosmetic procedure safe and effective in a patient for whom surgery would otherwise have held a greater risk.