Ophthalmic plastic and reconstructive surgery
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Ophthal Plast Reconstr Surg · Nov 2008
Comparative StudyComparison of orbital fracture repair performed within 14 days versus 15 to 29 days after trauma.
To examine whether orbital floor and/or medial wall fracture repair delayed for 15 to 29 days is as effective as early surgery. ⋯ Although 14 days after trauma is commonly cited as a timeline target for orbital blowout repair, these data show that effective fracture repair can be performed up to 29 days after trauma. Patients with improving diplopia and at low risk for enophthalmos can therefore be observed for 3 to 4 weeks prior to undergoing surgery. This may help prevent unnecessary surgery in some cases. Fourteen days need not be considered a deadline for orbital floor and/or medial wall fracture repair.
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To determine pathways of sympathetic nerves from the orbital apex to the eyelids in human cadaver tissue using immunohistochemistry. ⋯ Sympathetic nerves enter the orbit via the first and second divisions of the trigeminal nerve and a plexus of nerves surrounding the ophthalmic artery. Extraocular motor nerves receive a sympathetic nerve supply from the sensory nerves in the posterior orbit. Some ciliary ganglion cell bodies demonstrated tyrosine hydroxylase-like reactivity, suggesting a sympathetic modulatory role for the ciliary ganglion. Sympathetics innervate ocular structures via the posterior ciliary nerves. Sympathetic axons travel anteriorly in the orbit via the nasociliary and lacrimal nerves to innervate the sympathetic eyelid muscles. Sympathetic nerves also travel with the frontal branch of the ophthalmic nerve to innervate the forehead skin. The ophthalmic artery and all of its branches contain a perivascular sympathetic nerve supply that may be involved in regulation of blood flow to ocular and orbital structures.
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Ophthal Plast Reconstr Surg · May 2008
Case ReportsSubconjunctival injection of tetracycline 2% for chronic bulbar chemosis after transcutaneous four-eyelid blepharoplasty.
A 51-year-old white woman had an 18-month history of unilateral chronic bulbar chemosis after 4-eyelid cosmetic blepharoplasty. Tetracycline 2% was injected subconjunctivally in the area of the chemosis. After 2 injections over a period of 6 months, the chemosis resolved completely. ⋯ He had never had blepharoplasty. Two injections with tetracycline 2% within an interval of 6 months were given. At final follow-up 4 years later, mild residual chemosis was present.
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To identify clinical characteristics of burn patients requiring emergent orbital decompression for vision-threatening orbital compartment syndrome. ⋯ Risk factors for vision-threatening orbital compartment syndrome include fluid volume and periocular burns. Signs of vision-threatening orbital compartment syndrome should be addressed early with orbital decompression.
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Ophthal Plast Reconstr Surg · Mar 2008
Case ReportsDelayed presentation of grease-gun injury to the orbit.
A 44-year-old man was examined for marked edema and ptosis of the right upper eyelid after grease from high-pressure hydraulic machinery penetrated his right orbit 20 days earlier. The diagnosis of residual grease in the injured orbit was confirmed by CT and MRI, and the clinical presentation. ⋯ Among the wide variety of orbital foreign bodies, grease is rarely reported. We present the sixth case of grease-gun injury to the orbit to be reported in the English language literature since 1964.