The authors describe a patient with an orbital floor fracture that did not demonstrate a distinct fracture on computed tomography (CT) imaging. The key radiologic finding was rounding of the inferior rectus muscle.
Magnetic resonance has twin capabilities. It can provide anatomical (magnetic resonance imaging, MRI) and physiochemical (magnetic resonance spectroscopy) information. Nuclei with an odd mass number, particularly hydrogen in free water, have electromagnetic properties. When placed in a strong static magnetic field and excited by radiofrequency waves of a specific wavelength, these nuclei emit a signal. The MR signal can then be digitized, stored in a computer, and subsequently converted into an image. Factors that affect these images are tissue parameters (T1 and T2 time constants, proton density, and flow) and radiofrequency pulse sequences. Surface coils are useful for improving images of the orbit. The magnet can have a major and potentially dangerous influence on the surrounding environment, and access to the MRI area must be carefully controlled. Shielding of the MRI room prevents external factors from adversely affecting the MRI unit and the images produced.
The midline forehead flap is a good, versatile alternative when more standard techniques cannot be used to reconstruct the eyelids, medial canthus or exenterated socket. Indications are where: (1) the recipient site has a poor blood supply; (2) standard reconstructive procedures have failed; (3) deep, as well as superficial, tissue loss is present; and (4) extensive tissue loss is present. Four patients illustrate the value and versatility of the midline forehead flap. Disadvantages also are discussed.
Retrobulbar injection is a routine procedure for achieving akinesia and anesthesia prior to ophthalmic surgery. Previously reported complications to this procedure have included central nervous system toxic effects, globe perforation, retinal vascular occlusion, optic nerve damage, extraocular muscle palsies, ptosis, and retrobulbar hemorrhage.1Visual loss has been reported following retrobulbar hemorrhage from retrobulbar and even peribulbar anesthesia.2We report a case of subperiosteal orbital hemorrhage following a retrobulbar injection resulting in permanent severe visual loss.
Report of a Case.
An 81-year-old woman was transferred emergently for evaluation of a retrobulbar hemorrhage of her left eye that occurred within minutes of receiving a retrobulbar injection prior to a planned cataract extraction. The patient was not receiving any anticoagulant medications. A lateral canthotomy and inferior cantholysis had been performed by the referring ophthalmologist for intraocular pressure as high as 80 mm Hg. The patient had also been started on a
Four surgical techniques, utilizing mucous membrane grafts, collagen film, and eyelid structures anterior to the tarsal plate, are designed to correct severe cicatricial entropion resulting from (1) severe contraction of the tarsoconjunctiva, (2) tarsal scar involving the eyelid margin only, (3) loss of tarsi, and (4) levator resection for ptosis correction by the conjunctival approach. Adapting the surgical procedure to the specific type of deformity present produced satisfactory cosmetic and functional results and improved vision.
Temporary closure of the eyelids is frequently recommended for ocular surface disorders in which reepithelialization of the cornea is problematic, as well as for acute Bell's palsy. We describe an easily performed technique of temporary tarsorrhaphy using plastic tubes sutured externally to the upper and lower eyelids, with eyelid closure accomplished by tightening a loop of suture passed through the two tubes. Corneal epithelial defects in 11 of 13 patients in whom we used this technique resolved satisfactorily without complications. In the remaining two, the polypropylene sutures eroded through the eyelids between 5 and 6 weeks after surgery. The sutured tubes loosened and the loosened sutures had to be replaced. In one patient, the overly long end of a suture rotated between the apposed eyelids, inducing a corneal abrasion, but no permanent damage to the eye. We conclude that the sutured tube-tarsorrhaphy provides excellent short-term closure of the eyelids, while allowing simple, painless opening for examining the globe. The risks of inflammation and infection associated with previously described techniques are minimized.
