Neuronavigation and Endoscopy as Adjunctive Tools in Orbital Floor Implant Revision: Surgical Management of Infected, Misplaced Orbital Floor Implant with Chronic Eyelid Fistula and Sinusitis
Derek Sheen, MD1; Cheryl Yu, MD2; Sarah Debs, MD2; Katherine M. Yu, MD2; Alyssa N. Calder, MD2; Kevin J. Quinn, MD3; Dimitrios Sismanis, MD4; Thomas Lee, MD, FACS2
1University of Texas Southwestern Medical Center
2Virginia Commonwealth University Medical Center
3Mass Eye and Ear/Harvard Medical School
4Virginia Oculofacial Surgeons
Orbital floor fractures represent common sequelae of facial trauma that may result in significant functional and aesthetic consequences. This article presents a comprehensive overview of the management of a revision case involving an orbital floor fracture, focusing on complications related to extruded, infected orbital hardware. In addition, common mistakes that involve improper placement of orbital floor implant, poor implant sizing, and lack of adequate implant fixation are discussed.
The featured case involves delayed wound healing and a sino-orbital cutaneous fistula (SOCF) due to infected orbital hardware from a previous orbital floor fracture repair. The discussion centers on preoperative planning, including the choice of surgical approach (transconjunctival with lateral canthotomy) and implant material. Intraoperative neuronavigation was utilized as an adjunctive tool to confirm the position of the newly placed orbital implant. This case provides valuable insight on preventable complications for this procedure, nuances in surgical approach, and uncommon challenges faced by providers who perform operative facial trauma repair.
Lateral Tarsal Strip Procedure for Left Lower Eyelid Entropion
Lilit Arzumanian, MD1; Alexander Martin, OD2; John Lee, MD2
1Vardanants Center for Innovative Medicine
2Boston Vision
Lower lid entropion or inversion is a common involutional inward rotation of the tarsus and eyelid margin. It is caused by a combination of horizontal laxity of the eyelid, attenuation or disinsertion of eyelid retractors, and overriding of preseptal over pretarsal orbicularis muscle fibers. These changes result in the instability of the eyelid with age. The inverted eyelid leads to constant rubbing of eyelashes against the cornea and the globe, causing irritation, foreign body sensation, and in severe cases, corneal erosion, pannus formation, and ulceration. The lateral tarsal strip procedure is aimed at addressing the causes of entropion, thus correcting the eyelid position and improving its function. Upon successful surgical intervention, normal eyelid position and function are restored. Cosmesis of the eyelid also improves. This article will discuss the preoperative assessment of the patient, the preparation, the surgical procedure, and possible complications.
Blepharoplasty for Bilateral Upper Eyelids
Lilit Arzumanian, MD1; Alexander Martin, OD2; John Lee, MD2
1Vardanants Center for Innovative Medicine
2Boston Vision
Upper blepharoplasty is one of the most commonly performed oculoplastic procedures. It is aimed at correcting the involutional changes of the upper eyelids, characterized by loose, excess eyelid skin (dermatochalasis) and preaponeurotic fat herniation (steatoblepharon) as well as some cases of ptosis. These conditions could result in functional symptoms, such as reduced visual fields, as well as cosmetic concerns and perceived body dysmorphia.
In this case, the patient underwent upper blepharoplasty for cosmetic improvement and to remove xanthomatous lesions. This article discusses and demonstrates the preoperative assessment of the patient, the preparation, the surgical technique, and possible complications.
Incision and Curettage on a Left Upper Eyelid Chalazion
Lilit Arzumanian, MD1; Alexander Martin, OD2; John Lee, MD2
1Vardanats Center for Innovative Medicine
2Boston Vision
A chalazion is a sterile granulomatous inflammation of the Meibomian or Zeiss glands. It results from the obstruction of gland orifices, which leads to accumulation of sebum in the tarsus and eyelid soft tissue. The resulting inflammation causes erythema, pain, and swelling. Patients may note a previous history of similar complaints, as well as a history of rosacea and chronic blepharitis.
Chalazion incision and curettage is a treatment of choice in unresolved chalazia or cases that do not respond to conservative treatments such as warm compress. Chalazion surgery aims to effectively drain the blocked gland and remove the inflamed tissue, providing relief to patients and restoring the natural appearance of the eyelid. This article discusses and demonstrates the preoperative assessment of the patient, the preparation, surgical procedure, and the postoperative care.
Cataract Extraction with Phacoemulsification and Posterior Chamber Intraocular Lens
Daniel J. Hu, MD
Tufts University School of Medicine
Cataract is a leading cause of treatable blindness in the world. The diagnosis is made through assessment of visual acuity, visual disability, and slit lamp biomicroscopy. In the US, the standard for cataract extraction has become phacoemulsification.
This article demonstrates and reviews the technique of cataract extraction using phacoemulsification with intraocular lens implantation using the divide-and-conquer technique.
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