Seongmu Lee

Treatment of lower eyelid retraction by expansion of the lower eyelid with hyaluronic Acid gel.

Purpose: To report our preliminary experience utilizing a nonsurgical alternative in the treatment of lower eyelid retraction: expansion and reinforcement of the lower eyelid with hyaluronic acid gel. Methods: Retrospective review of patients with lower eyelid retraction treated with hyaluronic acid gel. Pretreatment, post-treatment, and follow-up photographs were digitized and overall outcomes assessed. Measurements of inferior scleral show were standardized and compared. Results: Sixty-five procedures (31 patients; 14 male; mean age 58 years, range, 33–78 years) with lower eyelid retraction of various etiologies were treated with hyaluronic acid gel. A mean change in scleral show of 1.04 mm was found when pre- and post-treatment measurements were compared. The overall mean follow-up period was 6.2 months (range, 1–12 months). During the interval from initial treatment to follow-up visit (mean 4.6 months, range, 1–12 months), the effect of the hyaluronic acid gel diminished, with a mean increase in inferior scleral show of 0.52 mm. Twelve patients underwent a second, and 6 patients underwent a third, maintenance treatment with an improvement in scleral show of 0.87 mm and 1.13 mm, respectively. Complications were minor and included swelling, redness, bruising, and tenderness at the sites of injection. Conclusions: Based on our preliminary results, hyaluronic acid gel shows promise as a treatment modality for the management of lower eyelid retraction. Long-term follow-up will better clarify the required frequency of maintenance injections, the degree of hyaluronic acid gel retention, and the position of the lower eyelid over time.

Pharmacological treatments for basal cell carcinoma.

Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer, and its incidence continues to rise. Current management options are numerous and focus on tumour eradication while maximising cosmetic and functional capacity. Although surgery continues to be considered the main treatment modality, new pharmacological agents, such as immunomodulators, topical chemotherapeutic agents and photodynamic therapy, have emerged and show promising results. Pharmacological agents offer the potential for lower morbidity and improved tissue preservation compared with surgery and radiotherapy. However, pharmacological treatments possess higher failure rates when compared with surgery, and most studies have investigated only low-risk lesions. Several prospective, randomised, double-blind, vehicle-controlled studies have established the efficacy of imiquimod for superficial BCC.This review summarises the evidence regarding the mechanism, efficacy and safety of pharmacological agents based on the literature from the past 10 years. Experimental treatments that have been successfully utilised in the treatment of BCC are also discussed. Treatment of BCC with other agents, such as tazarotene, glycoalkaloid (BEC-5) cream, cidofovir and calcium dobesilate have been reported, but further studies are needed to ascertain the efficacy and adverse-effect profiles of these treatments.

Mikulicz's disease: a new perspective and literature review.

Purpose To report the clinical and pathophysiologic features of two patients with Mikuliczs disease and to further characterize recommendations for diagnosis and management with a review of the literature. Methods Retrospective nonrandomized consecutive case series, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA. Results Mikuliczs disease is characterized by symmetric lacrimal, parotid, and submandibular gland enlargement with associated lymphocytic infiltrations. The authors noted two cases of Mikuliczs disease. The diagnosis of Mikuliczs disease was based on the following criteria: 1) symmetric and persistent swelling of the lacrimal glands and either or both of the major salivary glands (parotid and submandibular); and 2) the exclusion of other diseases that may mimic this presentation, such as sarcoidosis, viral infection, or lymphoproliferative disorders. Conclusions Mikuliczs disease is a condition in which there is bilateral lacrimal and salivary gland swelling that is not associated with other systemic conditions. The condition is self-limiting and most often, the diagnosis is a clinical one. Previously, Mikuliczs disease was often considered as a subtype of Sjögrens syndrome (SS). Clinical and immunologic differences between Mikuliczs disease and SS may warrant further consideration of Mikuliczs disease as a specific autoimmune phenomenon separate from SS, and Mikuliczs disease may be amenable to different treatment modalities than those employed in patients with SS.

Endoscopic removal of nasoglabellar dermoid cysts

Dermoid cysts are common tumors resulting from entrapped ectodermal elements at fetal suture lines. Management is conceptually straightforward, with surgical excision of the mass in its entirety without rupture. The conspicuous location and potential scarring from direct excision can be objectionable, particularly in children. The authors describe 2 cases using a hidden hairline incision and an endoscopic approach to remove dermoid cysts in the nasoglabellar region.

Lemierre's syndrome with fourth nerve palsy

Lemierres syndrome is characterized by acute oropharyngeal infection with secondary internal jugular vein thrombophlebitis and subsequent metastatic infections. The anaerobe Fusobacterium necrophorum is the usual etiologic agent, although other microorganisms, including Streptococcus, Staphylococcus, Enterococcus, Bacteroides, and Lactobacilli, may be present alone or in combination with F. necrophorum. Common sites of metastatic infection include the lungs and joints. Thromboembolic complications, such as septic pulmonary embolism, persistent jugular vein occlusion, hepatic abscesses, and nephropathy, may occur. We report a case of Lemierres syndrome in a 3-year-old Caucasian boy who subsequently presented with manifestations of a fourth (trochlear) nerve palsy.

Postoperative Wound Modulation in Aesthetic Eyelid and Periorbital Surgery

The modulation of wound healing in the postoperative setting is a vital component of aesthetic eyelid and periorbital surgery, particularly in situations of disorganized wound healing and exuberant scar formation. While surgical approaches that minimize scar formation continue to evolve, the management of wound healing and scar formation is limited by biologic considerations. Use of nonsurgical treatment modalities that target the underlying biologic process continues to evolve. While the field awaits introduction of specific modulators that interrupt these mechanisms, the adjunct use of anti-metabolites, anti-inflammatory agents, and tissue volume expansion can provide substantial benefit with minimal risk.

Standardized terminology for aesthetic ophthalmic plastic surgery.

Purpose: To determine whether existing Systemized Nomenclature of Medicine (SNOMED) terminology adequately describes aesthetic concepts commonly encountered in the oculoplastic and facial plastic surgery setting. Methods: This was a noncomparative case series. A panel of three oculoplastic surgeons compiled a list of unique concepts describing specialized aesthetic terminology commonly encountered in the oculoplastic and facial plastic surgery setting, with a specific focus on anatomic structures and descriptive findings. A standard electronic browser was used to manually search for the existence of equivalent matching concepts in SNOMED. A quality of match score from 1 to 3 was used with values of (1) no match, (2) partial match, and (3) equivalent match. Results: An assessment of the existing aesthetic terminology revealed that a majority of concepts were not represented. Of 62 total concepts, 68% had no match, 13% had a partial match, and 19% had a complete match. Conclusions: SNOMED coverage of aesthetic terminology was less than in previous studies examining content representation for other medical topics. Such findings underscore a need for further development and refinement of aesthetic content.

Scleral necrosis secondary to nonabsorbable suture following ptosis surgery.

We report a unique case of persistent scleral ulceration in a 68-year-old woman who developed eye redness, pain, and photophobia 2 days following external levator advancement with nonabsorbable suture. Slit-lamp biomicroscopy revealed an area of scleral ulceration superonasal to the limbus. The patient was treated with 6 months of topical steroids with some improvement in her condition but without complete resolution. An exposed suture or foreign body was never directly visualized; however, a mobile nodule was noted upon palpation of the eyelid. Subsequent surgical eyelid exploration revealed a retained polypropylene suture, which was dissected free and removed. Postoperatively, the area of scleral ulceration resolved completely.

A unique case of foreign-body associated orbital myositis.

A 50-year-old woman presented with a 2-week history of diplopia and right-sided orbital pain with eye movement. Examination revealed an edematous, ptotic right upper eyelid with conjunctival hyperemia, proptosis, and significant limitation to upward and downward ductions on the right. MRI was significant for a homogeneously enhancing lesion within the superior rectus muscle. A laboratory evaluation seeking an infectious, inflammatory, or autoimmune process was nonrevealing. A diagnosis of orbital myositis was made, and the patient experienced significant improvement with oral corticosteroids. The patients symptoms, however, recurred after attempts at a slow taper of the corticosteroids. An orbital biopsy of the lesion revealed fibroadipose tissue containing irregularly shaped yellow-white deposits birefringent under polarized light, suggestive of silica crystals. The patient denied any history of trauma or prior surgery. An intraorbital triamcinolone injection to the superior orbit allowed resolution of symptoms and a successful taper off systemic corticosteroids.

Systemic MALToma With Presumed Choroidal Involvement

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