Janet M. Neigel

Adnexal findings in AIDS

We reviewed the adnexal and orbital findings in a large population with HIV infection followed in one medical center. Around 6% of the series had positive periocular findings. In 1% of the series, the periocular findings were the first manifestation of HIV infection or AIDS. We present the first case of basal cell carcinoma in an HIV-infected individual; the carcinoma involved the eyelid. Orbital findings included lymphoma, cellulitis, Kaposis sarcoma, and nonspecific inflammatory disease. Adnexal findings included Kaposis sarcoma, molluscum contagiosum, bacterial folliculitis, madarosis, psoriasis, basal cell carcinoma, and chalazion. Additional opportunistic infections and tumors involving the periocular region are expected to be re- ported in the future.

Pneumomediastinum following blowout fracture of the medial orbital wall. A case report. Ophthalmol. Plast. Reconstr

An unusual case of cervical emphysema and pneumomediastinum following a blowout fracture of the medial orbital wall is presented. Severe pulmonary distress did not occur, and the trapped air rapidly absorbed. The source of the emphysema and its progression is discussed considering the anatomic relations of the facial and cervical subcutaneous space and the mediastinum. To our knowledge, this complication is rare and has been documented only once before in an isolated blowout fracture of the orbit.

Buccal mucous membrane-fat graft in the management of the contracted socket

A new surgical technique for reconstructing severely contracted sockets using an autogenous buccal mucous membrane-fat graft is presented. The buccal mucosa provides replacement of deficient conjunctival surface area; the fat in the underlying substantia propria of the buccal mucosa replenishes moderate volume deficiency in a single procedure. A custom-designed conformer is used in the immediate postoperative period to maintain reconstructed vertical fornices. We present four consecutive patients with contracted sockets having both a volume deficit and severe conjunctival contracture who were successfully rehabilitated using this technique.

Witnallʼs sling with superior tarsectomy for the correction of severe unilateral blepharoptosis

The management of severe unilateral blepharoptosis is problematic. In the presence of poor levator function, conventional surgical techniques frequently do not adequately elevate a ptotic eyelid. From May 1988 through July 1991, we used 4- to 5-mm external resections of the superior tarsus in conjunction with a maximal aponeurectomy (Whitnalls sling procedure) to augment blepharoptosis correction in selected cases of severe unilateral blepharoptosis. Seventeen (68%) of 25 patients with poor levator function blepharoptosis who underwent this new surgical procedure achieved a lid height within 1 mm of the opposite lid with good or excellent ocular function, cosmesis, and eyelid crease formation. Mild to moderate degrees of exposure keratopathy developed early in the postoperative period in all patients. This exposure keratopathy ultimately resolved in most patients. Superior tarsectomy safely augments the blepharoptosis correction of a Whitnall sling procedure in severe blepharoptosis, improving the results of aponeurotic surgery in patients with severe unilateral blepharoptosis.