Stuart H. Goldberg

Orbital Fractures in Women due to Sexual Assault and Domestic Violence

PURPOSE Because domestic violence and sexual assault have a widespread societal and medical impact, this retrospective study was designed to determine the frequency of sexual assault and domestic violence as causes of orbital fractures in women. METHODS The records of 54 consecutive patients with orbital fractures presenting to the Ophthalmic Plastic and Orbital Surgery service of Penn State Universitys Department of Ophthalmology were reviewed. The type of trauma resulting in each patients orbital injury was identified. The frequency of orbital fractures resulting from sexual assault or domestic violence was determined. RESULTS The study included 35 male and 19 female patients, ranging in age from 27 months to 63 years. Orbital fracture was the result of sexual assault or domestic violence in one third of the female patients, but no male patients. Motor vehicle accidents accounted for another 31.6 percent of orbital fractures in female patients. CONCLUSIONS Based on this retrospective study, sexual assault and domestic violence are frequent causes of orbital fractures in women. Healthcare workers evaluating female patients with orbital fractures should have a high index of suspicion regarding sexual assault or domestic violence as a possible origin of the injury. A pointed but sensitive approach may be necessary to elicit this history from the patient.

Orbital varix thrombosis.

Venous disease of the orbit is a rare occurrence which can become manifest in a variety of ways including an arteriovenous aneurysm or fistula, a cavernous sinus or superior ophthalmic vein thrombosis, and an orbital varix, with and without thrombosis. Three patients had proptosis due to orbital varix thrombosis. The onset, degree of pain, and presence of diplopia were all variable. In two of three patients, computed tomographic (CT) scans showed lesions reminiscent of cavernous hemangiomas. The clinical, radiographic, surgical, and histopathologic features of this entity are described and discussed and a hypothesis is proposed to explain the pathophysiology of orbital varix thrombosis.

Orbital tumors in children

There are many reviews of pediatrie orbital tumors in the literature. Most of the series originated from the tumor registries of large pathology referral centers, whereas others are from large medical institutions and pediatrie hospitals. The distribution of types of tumors reported in each series are unavoidably biased by the nature of the evaluating facility. The findings were also affected by the geographic location of the clinical facility. We present an analysis of 141 orbital tumors in children and review 9 other series (totaling 1,229 cases) for an aggregate total of 1,370 cases. Our clinically based series had an incidence of malignant lesions of 10.6%, much lower than the 24% incidence among the combined referral center/pediatric hospital studies. Cystic orbital and vasculogenic tumors were the most common, comprising 58% of our cases and 40% of orbital tumors in children among the combined series.

Herpes simplex blepharoconjunctivitis presenting as complete acquired ankyloblepharon.

Purpose A 90-year-old woman was referred to us with a 1-month history of progressively worsening blepharoconjunctivitis. She had a complete acquired ankyloblepharon of the right lids, which resulted in the appearance of a right upper lid abscess on computed tomography. Methods Blepharotomy with separation and debridement of the lid margins was performed. Results Cultures were positive only for herpes simplex virus, type II. Conclusions Herpes simplex blepharoconjunctivitis may take many clinical forms. Our patients severe manifestations led to the clinical and radiologic appearance of preseptal cellulitis with a right upper lid abscess.

Acute dacryocystitis secondary to exudative rhinitis.

This report describes the unusual occurrence of acute dacryocystitis secondary to exudative rhinitis. An 18-year-old man with no prior history of tearing or dacryocystitis presented with acute left dacryocystitis. Nasal mucosal edema, lymphoid hyperplasia, and exudate obstructed the ostium of his left nasolacrimal duct. The patient improved rapidly with systemic antibiotic and nasal decongestant drugs. Both the nasolacrimal duct obstruction and dacryocystitis resolved completely within 2 weeks. One year later, serology suggested Epstein-Barr virus as the cause of the rhinitis. Acute intra-nasal inflammation may obstruct the nasolacrimal duct with potential secondary dacryocystitis. This type of nasolacrimal duct obstruction resolves without sequelae when the rhinitis improves.

Eyelid avulsion : a clinical and experimental study

Traumatic eyelid avulsion is reported infrequently. We cared for an 18-year-old man who lost > 75% of his right upper eyelid. The tissue was recovered 10 h following the initial trauma. Successful surgical reimplantation resulted in a functional upper eyelid with extensive madarosis. An experimental study was undertaken to attempt to determine the optimal method for preservation of avulsed eyelid tissue. Experimental surgery was performed to simulate repair of eyelid avulsion. The postoperative changes in experimentally reimplanted eyelids parallel those noted in the clinical example of eyelid avulsion. This clinical example and experimental study suggested the following management principles for handling avulsed eyelid tissue: eyelid tissues should not be immersed in saline; avulsed eyelid tissues should be stored at 4°C; if reimplantation time is < 6 h, storage in a cold moist environment is adequate.

Hereditary hemorrhagic telangiectasia.

A patient with hereditary hemorrhagic telangiectasia and bloody tears is described. This case report serves to familiarize the ophthalmic plastic and reconstructive surgeon with the differential diagnosis of bloody tears. Conjunctival, oral mucosal and cutaneous findings are documented, and the systemic and ocular manifestations of hereditary hemorrhagic telangiectasia are discussed.

Margins of Safety in Dacryocystorhinostomy

We attempted to clarify the anatomic relationships of the lacrimal sac by performing standard orbital dissections to expose the lacrimal canaliculi, lacrimal sac, the ethmoid air cells, nasal septum, frontal sinuses, and the cribriform plate in five human cadaver heads; and then measuring the distance between the internal common punctum (ICP) and five key structures. The mean vector distance from the ICP to the anterior aspect of the cribriform plate was 25.1 +/- 2.95 mm. This measurement, along with the others, helps clarify osteotomy placement for dacryocystorhinostomy, so that, for example, cerebrospinal fluid leak can be prevented. Improved understanding of the anatomy of this region is also valuable in planning surgery for orbital and naso-orbital tumors, trauma, and congenital abnormalities.