Steven M. Thiese

Orbital emphysema: A potentially blinding complication following orbital fractures

A case of visual loss due to orbital emphysema secondary to a blow-out fracture of the orbit is presented. Because vision returned to 20/20 following an optic nerve decompression procedure, we hypothesize that our patient developed a compressive optic neuropathy with ischemia due to the emphysema. Essential instructions concerning the injury that the emergency physician should give the patient suffering an orbital blow-out are also presented.

Essential Blepharospasm and Related Dystonias

Essential blepharospasm is an idiopathic disorder of progressive involuntary spasms of the orbicularis oculi and upper facial (corrugator, procerus) muscles. Blepharospasm literally means spasm of the eyelids; however, most patients with blepharospasm also have or will develop squeezing in the lower face and neck muscles (Meiges syndrome, orofacial dystonia, or oromandibular dystonia). Some patients develop dystonic, uncontrolled movements in areas outside the facial nerve distribution (segmental cranial dystonia or craniocervical dystonia). Chronic, forceful squeezing by the periocular muscles becomes debilitating for the patient and leads to functional and cosmetic eyelid deformities. Treatment has included a variety of modalities and oral medications that are of limited efficacy. Botulinum-A toxin injections have delivered the best temporary relief from this disorder, while the periorbital myectomy operation has been shown to give the best long-term results.

Lower eyelid retraction : a minimal incision surgical approach to retractor lysis

Lower eyelid retraction associated with prior blepharoplasty, trauma, or other conditions is a challenging problem for the ophthalmic surgeon. We describe a procedure involving tightening the lower eyelid and supraplacing the lateral canthus in combination with in-glove lysis of the lower eyelid retractors and scar tissue. This is accomplished through a small lateral incision. To date, we have treated over 200 eyelids using this technique with excellent results. We recommend this technique for the treatment of mild to moderate degrees of lower eyelid retraction.

Follow up Retrospective Study of Compliance With a Standard of Care for Retinopathy of Prematurity in One Neonatal Intensive Care Unit

A retrospective chart review was conducted to determine the impact of recently instituted guidelines on compliance with the standard of care for retinopathy of prematurity (ROP) in the Newborn Intensive Care Unit at the University of Utah Medical Center. In a previous study, it was found that infants eligible for participation in a National Institutes of Health-funded study of ROP were routinely receiving screening eye examinations, whereas infants who qualified for ROP screening according to the standard of care, but not eligible for the study, were seen infrequently. Consequently, a plan to improve the compliance with the standard of care for all infants who fit the standard criteria was implemented. The comparison revealed significant improvement in compliance rates. In one subgrouping of infants, compliance rose from three of 16 (18.75%) infants screened for ROP according to the standard of care, to nine of 11 (82%) infants screened for ROP according to the revised standard. This increase in compliance appears to be due to adherence to guidelines recommended in an earlier study, which included increasing staff awareness of the standard of care, designating a person to schedule and track infants who fit the screening criteria, and including the need for ROP screening on the admission and discharge summary.

Intractable Orbicularis Myokymia: Treatment Alternatives

Orbicularis myokymia frequently occurs in young, otherwise health individuals. The intermittent muscle fasciculations are transient and generally disappear with time. If the myokymia is persistent or progressive, neurologic assessment and investigation may be necessary. Muscle relaxants, botulinum-A toxin, and surgical myectomy are methods of treatment that only occasionally need to be considered. We present limited orbicularis myectomy and botulinum-A toxin injections as efficacious treatments in five selected intractable cases of orbicularis myokymia.