Kyle J. Godfrey

Glomuvenous Malformation: A Rare Periorbital Lesion of the Thermoregulatory Apparatus.

Glomuvenous malformations (GVMs), previously referred to as glomus tumors or glomangiomas, are benign, mesenchymal venous malformations arising from glomus bodies. Glomus bodies are modified smooth muscle neuromyoarterial structures involved in temperature regulation via blood shunting. These classically occur in the digits but can occur in other locations. The authors present a case of a periorbital GVM presented following blunt trauma to the area.

Blepharoptosis following ocular surgery: identifying risk factors.

Purpose of review To evaluate the incidence of blepharoptosis following ocular surgical procedures, to elucidate mechanisms for its cause, and to identify potential risk factors for ocular surgeons to avoid. Recent findings Postoperative blepharoptosis has been a poorly understood concept. In the search for a definitive cause, various technical components of surgery have been implicated. Recent research highlights the importance of individual anatomy and proposes new mechanisms for postoperative ptosis, including excessive eyelid tension from specula, topical prostaglandin analogue use, and direct trauma at the level of the tarsal plate. Summary Blepharoptosis is common following ocular surgery and can occur through multiple mechanisms. Certain individuals are at a higher risk for postoperative blepharoptosis, but all surgeons and patients undergoing ocular surgery should understand this risk when providing informed consent. Operative techniques can be adjusted to decrease rates of postoperative blepharoptosis.

Orbital Decompression: Graded Surgical Approach

Orbital decompression is an effective surgical intervention for the treatment of thyroid eye disease and other conditions causing expansion of orbital soft tissue volume. Indications for surgery include disfiguring proptosis, compressive optic neuropathy, exposure keratopathy, orbital congestion, and reduction of proptosis in preparation for strabismus surgery. The primary goals of orbital decompression are to expand orbital capacity through bony decompression and reduce orbital soft tissue volume through orbital fat decompression. The amount of decompression performed should be tailored to the individual patient based on the severity of proptosis, with the goal of returning the patient to their pre-disease state. Our preferred progression for graded proptosis reduction is fat decompression, followed by lateral wall, then medial wall, then orbital floor, and then lateral orbital rim removal, as needed. However, in cases of optic neuropathy, maximal apical expansion is created with medial, floor, and lateral decompression. Careful patient selection and improved surgical technique have led to a broadening of the indications for this traditionally rare operation.

The glue that holds the situation together

A 48-year-old man presented with a longstanding left upper eyelid mass that increased in size when bending forward. The mass was associated with enophthalmos and slowly increased in size with Valsalva maneuver. Magnetic resonance imaging and arteriography demonstrated a vascular malformation without an abnormal arterial component. Because of his increasing pain, the vascular malformation was excised in a multidisciplinary approach involving intraoperative fluoroscopic mapping, cyanoacrylate embolization, and surgical excision. Histopathology was consistent with a benign vascular malformation. Clinically, this was a low-flow, distensible venous malformation-or orbital varix.

Large benign de novo conjunctival hemangioma in an 11-year-old boy: case report and literature review

Benign hemangiomas are rare vascular tumors of the conjunctiva that typically present clinically in the first few weeks of life and resolve spontaneously. De novo presentation later in childhood has not been well documented. We present the unusual case of an 11-year-old boy with a rapidly growing benign de novo conjunctival hemangioma that was treated with surgical excision.