Gerard M. Shannon

Dacryocystorhinostomy: A Review of 119 Cases

One hundred nineteen dacryocystorhinostomies were reviewed and were found to be most commonly performed on females in their seventh decade, with silent epiphora being the most common presenting symptom. Trauma was the single most frequent cause of surgery in males and required complex reconstruction in most cases. Three of the seven dacryocystorhinostomy failures occurred in these traumatic dacryostenosis cases. An unusually high percentage of dacryocystorhinostomy surgery was performed on women who had had previous hysterectomies or serious gynecologic pathology.

Retinal Pigment Epithelium in Incontinentia Pigmenti

An 18-month-old white girl with incontinentia pigmenti presented clinically with leukokoria of the right eye. B-scan ultrasound demonstrated a retrolental mass consistent with a detached retina. Histologic examination of the skin revealed changes compatible with the intermediate verrucous phase of the disease. Microscopic examination of the right eye showed retinal detachment and nodular proliferation of the retinal pigment epithelium. The nodules contained macrophages laden with melanin and lipofuscin. An unusually large amount of lipofuscin was present for a child of this age. The basic pigmentary abnormality may affect the retinal pigment epithelium, resulting in changes in the overlying neurosensory retina that may lead to the retinal dysplasia or retinal detachemnt often associated with this condition.

Experience With Dermis-Fat Grafting: An Analysis of Early Postoperative Complications and Methods of Prevention

During the past 18 months at Wills Eye Hospital we have performed autogenous dermis-fat grafts to anophthalmic orbits in 16 patients. Six early postoperative complications of dermis-fat grafting are presented and discussed, as are the modifications of surgical technique that we feel may minimize early postoperative complications.

Conjunctivodacryocystorhinostomy With Mucous Membrane Graft

Eleven patients with obstructed lacrimal canaliculi underwent conjunctivodacryocystorhinostomy modified by lining the fistula with buccal mucosa at the time of surgery. Four patients had the tube removed after six months. All four have parent mucous membrane lined fistulas with follow-up ranging from ten to 13 months. One patient removed his tube on the second post-operative day. His fistula closed immediately. For comparison, the remaining six patients retain their tubes. They are free from epiphora but suffer from some of the complications of the tube itself, namely tube extrusion, tube migration, and chronic conjunctival irritation and discharge. The surgical technique is described, histopathologic material is presented, and the initial results are discussed.

Blindness Following Blowout Orbital Fractures

Blindness following blowout fractures is an unfortunate complication. The ophthalmologist must be aware of the events and sites of injury to the optic nerve which lead to visual problems. Preventive measures include immediate recognition of the signs of impending optic nerve compression and execution of treatment without delay. The importance of monitoring vision cannot be overstressed. Judicious surgery involves a post-injury delay in cases that are improving daily. The avoidance of additional surgical trauma with implant insertion during that period may help prevent postoperative blowout blindness.

Experience with donor sclera for extruding orbital implants.

Accumulated clinical evidence has confirmed the suitability of eye bank sclera as a structural and reconstructive material for lid and orbital surgery. Since 1970 we have been using fresh donor sclera. In our series of sixty-four cases, seventeen were for extruding or extruded orbital implants. Of these seventeen only two had any sort of complication, and these were easily corrected. This technique has permitted a successful prosthetic fitting within six weeks following surgery, with good cosmesis in all cases.

Unusual Eyelid Involvement in Tuberous Sclerosis

A two-week-old male infant had a nodular salmon-colored lesion on his right lower eyelid and hypopigmented mascular lesions on the abdomen and right thigh since birth. At five months of age he developed a generalized seizure disorder. Histologic examination of the eyelid lesion revealed an angiofibroma, which was an unusual initial site of involvement in tuberous sclerosis.

Orbital Roof Fractures

A wide spectrum of orbital roof fractures is presented through four clinical cases. Neurologic examination is emphasized and reviewed in order to detect the orbital roof fractures that may involve intracranial damage. A combined neurosurgical and ophthalmologic approach is indicated in basilar skull fractures with involvement of the inner table. Without intracranial damage or evidence of a dural tear, a superior orbitotomy is indicated to reduce the fracture and release the incarcerated orbital contents to improve ocular motility.

Basal cell carcinoma recurrence: early diagnosis and surgical treatment.

Twelve patients with twenty recurrent basal cell carcinomas of the lids and adnexa were studied. Observations on the behavior and treatment were discussed. Suggested management was also given. The radical aggressive approach towards these recurrent lesions is suggested, although initial excision of some basal cells need not be as radical. As in all malignancies the prompt recognition of lesion, combined with appropriate treatment and regular follow-up are emphasized to effect a cure with good functional and cosmetic results.