Robert B. Wilkins

Effectiveness of Botulinum Toxin Therapy for Essential Blepharospasm

The effectiveness of Botulinum toxin (Oculinum) therapy in 76 patients with the diagnosis of essential blepharospasm was analyzed. Botulinum offers relief to almost all patients suffering from essential blepharospasm, however, this relief is usually temporary. The response time for repeated treatments tended to be longer than the first treatment. Patients with mild blepharospasm responded significantly longer to Botulinum injection, than those with severe spasms. The response to Botulinum was not significantly different in patients with Meige syndrome than in patients with only essential blepharospasm. Patients previously treated surgically for essential blepharospasm did not respond differently than those patients with no previous surgical therapy. The authors believe that Botulinum toxin injection is an effective, although temporary, mode of therapy for the signs and symptoms of this focal dystonia. The authors recognize that there may be psychologic factors affecting the response.

Involutional Entropion: A Retrospective Analysis of the Wies Procedure Alone or Combined with a Horizontal Shortening Procedure

The surgical management of 95 cases of involutional entropion were reviewed to form this retrospective study. The 66 cases treated with the Wies procedure alone had a recurrence rate of 11%. The 29 cases treated with a combined procedure consisting of a Wies procedure with a lateral canthal horizontal shortening had no recurrences. All patients had a minimum of 6 months postoperative follow-up. The etiologic factors as they relate to the appropriate surgical procedures are discussed.

The recognition of acquired ptosis in patients considered for upper-eyelid blepharoplasty.

Involutional or senile ptosis commonly occurs simultaneously with dermatochalasis. Levator aponeurosis dehiscence or disinsertion is the most common etiology of acquired involutional ptosis in our practice. The presence of ptosis should be ascertained prior to performing an upper-lid blepharoplasty. The surgical repair of a levator dehiscence or disinsertion can be performed simultaneously with a blepharoplasty or may be the indicated procedure rather than a blepharoplasty. The recognition and appropriate management of acquired ptosis will provide better cosmetic and functional surgical results in patients undergoing upper-eyelid surgery.

Surgical Management of Congenital Eyelid Coloboma

Congenital eyelid colobomas are a partial or total absence of eyelid structures. The degree of severity determines the surgical techniques employed for repairing the eyelid. We feel that early surgical treatment reduces the risk of ocular scarring with satisfactory results. We present four cases of congenital upper eyelid colobomas of differing severity and discuss surgical approaches to these lid abnormalities.

Pseudo Oculomotor Palsy as the Presenting Sign of Linear Scleroderma

A case of linear scleroderma presenting as a pseudo oculomotor palsy is reviewed. The patients facial skin abnormalities suggested the underlying etiology. This case illustrates a previously unreported finding in linear scleroderma, mydriasis without atrophy, reminding the clinician to look at the skin in patients with unexplained unilateral pupillary disturbances.

Intraconal dermoid cyst. A case report

We report an unusual dermoid cyst that was located entirely within the muscle cone. The delineation of the tumor was enhanced preoperatively by using an MRI scan in conjunction with the CT scan and ultrasonography.

Vertical tarsal buckling as a complication of levator aponeurosis repair for acquired blepharoptosis.

In two patients (a 60-year-old man and a 69-year-old woman) vertical buckling of the superior tarsus followed surgery to correct levator aponeurosis disinsertions for the management of acquired upper eyelid blepharoptosis. The superior tarsus rotated posteriorly and folded on itself because the sutures reattaching the levator aponeurosis to the tarsus were placed too low on the anterior tarsal plate. This complication can be prevented by placing the tarsal sutures above the vertical midpoint of the tarsus. If this complication develops, early correction is possible by revising the suture heights and keeping the tarsus flat with a symblepharon ring. This led to a satisfactory outcome in one of our cases. Late correction of vertical tarsal buckling requires excision of the buckled tarsus and repositioning the levator aponeurosis sutures. In one of our patients, an entropion developed as a result of insufficient vertical tarsal height that caused instability of the upper eyelid. The outcome was otherwise satisfactory.

Orbital Floor Elevator

A 15-cm orbital floor elevator was used to lift orbital contents, and to reposition and remove bony fragments during orbital floor repair procedure.