Richard N. Palu

Intramuscular lipoma of the eyelid.

To report a unique case of intramuscular lipoma of the eyelid and to alert surgeons to this entity that simulates a common dermoid cyst. A slowly-growing mass of the upper eyelid was excised from a 62-year-old man. Histology showed mature lipocytes interspersed with skeletal muscle. To our knowledge, this case represents the first report of intramuscular lipoma of the eyelid. Lipomas, including the intramuscular variety, are common tumors elsewhere in the body. The differential diagnosis of eyelid masses should include this entity.

Pyogenic granuloma after transconjunctival blepharoplasty : a case report

This is the first known report of a relatively large postoperative pyogenic granuloma developing after a nonsutured transconjunctival blepharoplasty. Inflammation and separation or malapposition of the conjunctival wound edges probably permitted the lesion to proliferate in the inferior fornix. No foreign material could be implicated because no suture was used to close this incision. Additionally, Polydek suture material (braided polyester fiber) was associated with the complication of a suture tract and granuloma when used for a tarsal suspension procedure for ectropion repair in this patient.

Orbital dissemination of Lemierre syndrome from gram-positive septic emboli.

A 45-year-old patient presented with bilateral orbital abscesses. He was found to have Lemierre syndrome, a condition involving septic thrombophlebitis of the internal jugular vein. The patient developed severe proptosis, sepsis, and cavernous sinus thrombosis. Despite aggressive antibiotic and anticoagulation therapy, visual loss was rapid, and the patient ultimately died. Lemierre syndrome, previously thought to be rare, is now becoming more commonly reported. Its prompt diagnosis and treatment are essential for patient survival.

Modified Tarsorrhaphy for Management of the Eye in Facial Nerve Palsy

INTRODUCTION The otolaryngologist–head and neck surgeon encounters patients with facial nerve weakness or paralysis in the setting of Bell’s palsy, trauma, infection, neoplasm, or after neurotologic, skull base, parotid gland, or facial surgery. The ophthalmic manifestations of facial paralysis demand particular attention. The most concerning ophthalmic signs are upper eyelid retraction resulting from unopposed levator palpebrae action, lagophthalmos, paralytic ectropion of the lower eyelid, decreased tear production,1 and loss of the “corneal squeegee effect,” which maintains the tear film.2 Without intervention, these factors may cause corneal irritation, exposure keratitis, and eventually, corneal ulceration and permanent visual loss. In patients with additional cranial nerve V injury, the risk of neurotrophic corneal damage requires additional vigilance. In the sequential approach to management of the eye in facial nerve palsy, the first step is supportive ocular care with lubricating eyedrops, ointments, and eyelid taping while asleep. However, if the patient cannot comply with supportive care, or if the ocular surface shows signs of exposure, surgical intervention is indicated. Tarsorrhaphy is a simple and highly efficacious method of targeting both the upper and lower eyelids.1 It remains a primary option for surgical protection of the eye, especially if rapid recovery of the facial nerve is expected, if there is a coexistent trigeminal nerve deficit, or if the patient is critically ill and is not a candidate for more invasive procedures. However, traditional approaches to tarsorrhaphy are cosmetically unappealing and difficult to reverse. We present a straightforward technique appropriate for both temporary and permanent tarsorrhaphy, which is easily reversible should facial nerve function recover.

Amelanotic Cellular Blue Nevus of the Eyelid

The authors describe an isolated, yellowish papular lesion of the upper eyelid in a 63-year-old man. Following excision, histopathologic analysis showed the features of a benign hypopigmented cellular blue nevus, the first and only case involving the eyelid skin.

Location of the Zygomatico-orbital Foramen on the Inferolateral Orbital Wall: Clinical Implications

Abstract Purpose: To describe the location of the zygomatico-orbital foramen on the inferolateral orbital wall. Methods: This anatomic study examined 28 orbits of 14 dry human adult skulls. The zygomatico-orbital foramen was identified by passing a thin wire from the zygomatico-facial foramen to its orbital aspect and a thin flexible ruler was used to measure 1) the distance perpendicular to the closest point on the inferior orbital rim, 2) the distance from the inferior orbital fissure, and 3) the distance from the area used for retrobulbar injections. Results: The mean distance from the zygomatico-orbital foramen to the closest point on the inferior orbital rim was 4.7 mm (range from 1 to 7 mm). The mean distance from the inferior orbital fissure was 14.9 mm (range from 10 to 18 mm). The mean distance from the area of retrobulbar injection was 6.0 mm (range from 3 to 10 mm). Conclusions: The location of the zygomatico-orbital foramen within the inferolateral orbit is quite variable. This is the first study to attempt to quantify its proximity to the site of retrobulbar injection. We conclude that it is an important anatomical structure to consider when giving retrobulbar anesthesia, especially given the variability in technique among ophthalmologists.