Anticoagulants and cataract surgery.

A series of 49 cataract operations in 42 patients is presented in support of our contention that if anticoagulants are necessary for a patient's well being, they should not be discontinued for cataract surgery.

Effectiveness of botulinum toxin therapy for essential blepharospasm.

The effectiveness of Botulinum toxin (Oculinum) therapy in 76 patients with the diagnosis of essential blepharospasm was analyzed. Botulinum offers relief to almost all patients suffering from essential blepharospasm, however, this relief is usually temporary. The response time for repeated treatments tended to be longer than the first treatment. Patients with mild blepharospasm responded significantly longer to Botulinum injection, than those with severe spasms. The response to Botulinum was not significantly different in patients with Meige syndrome than in patients with only essential blepharospasm. Patients previously treated surgically for essential blepharospasm did not respond differently than those patients with no previous surgical therapy. The authors believe that Botulinum toxin injection is an effective, although temporary, mode of therapy for the signs and symptoms of this focal dystonia. The authors recognize that there may be psychologic factors affecting the response.

Heterotopic brain tissue in the orbit.

A 3-month-old female infant with Turner's syndrome was noted to have progressive swelling of the left upper lid at the age of 1 month. A computed tomogram demonstrated a well-circumscribed, low-density, homogeneous orbital mass. Initially, the main clinical differential diagnosis included dermoid cyst, hemangioma, and encephalocele. Medial orbitotomy followed by histopathologic examination disclosed a cystic choristomatous malformation containing brain tissue. No choroid plexuses within the mass were demonstrated on microscopic examination. Aspiration of fluid from the cystic mass and subsequent biochemical studies unequivocally demonstrated that the mass was filled with cerebrospinal fluid. Despite five surgical procedures, including two frontal craniotomies, and specialized roentgenographic studies, no communication could be demonstrated between the orbital mass and the central nervous system. We postulate that the cerebrospinal fluid was produced within the orbital mass, which represented ectopic brain tissue. Problems in diagnosis and management of this unusual orbital malformation are discussed.

Intraconal dermoid cyst. A case report.

We report an unusual dermoid cyst that was located entirely within the muscle cone. The delineation of the tumor was enhanced preoperatively by using an MRI scan in conjunction with the CT scan and ultrasonography.

Complications of blepharoplasty.

To avert complications of blepharoplasties the surgeon must first communicate with the patient. Once a rapport is established, a thorough preoperative evaluation is performed. It is imperative to determine the expectations of the patient and to communicate the realistic results that can be achieved from surgery. Strict adherence to proper surgical technique is paramount for good postoperative results. If complications occur, correct diagnosis of the etiology of the problem usually leads to a satisfactory resolution.