Conjugal temporal arteritis.

We report the simultaneous occurrence of biopsy-proven temporal arteritis in husband and wife. Serologic and viral studies were negative, including viral culture of the wife's temporal artery. The concurrent incidence of giant cell arteritis in a married couple would suggest a common exogenous exposure.

Effects of systemic desmopressin on aqueous humor dynamics in rabbits.

Intravenous desmopressin, a synthetic antidiuretic hormone, resulted in a dose-dependent increase in intraocular pressure (IOP) in rabbits. IOP was increased 3.6 +/- 0.8 mm Hg 6 hr following injection of desmopressin 200 mUnits/kg with the increase lasting over 10 hr. IOP returned to baseline 24 hr after the injection. Systemic blood pressure, plasma osmolarity and arterial blood gases were not altered by desmopressin. The increased IOP was not associated with alterations in measured outflow facility or episcleral venous pressure. Five hours after desmopressin injection, calculated aqueous humor flow was increased approximately 57%. Aqueous humor ascorbate measurements for calculation of flow to diffusion ratios and anterior chamber fluorophotometry also were consistent with an increased rate of aqueous humor formation as the mechanism for the IOP elevation. Desmopressin administration did not increase aqueous humor protein or aqueous humor cyclic AMP concentration. Systemic pretreatment with indomethacin only partially blocked the IOP increase. Systemic pretreatment with demeclocycline completely blocked the desmopressin-induced increase in IOP.

Management of complicated ptosis with contralateral levator recession.

We describe a unique approach to complicated unilateral minimal ptosis. Three cases of unilateral ptosis were successfully managed with the technique of contralateral levator recession. Contralateral levator recession is a useful procedure heretofore undescribed, to our knowledge, for the management of ptosis.

The preauricular skin graft in eyelid reconstruction.

The skin obtained from the preauricular graft for reconstruction of eyelid and midfacial defects is an excellent tissue and color match for the lower eyelid and medial canthus. This area is an excellent alternative graft site, and its usage should be added to the ophthalmic plastic surgeon's therapeutic armamentarium.

Total internal reflection for positioning Jones tube.

Visualization of the Jones tube in the internal nose often poses difficulty for the surgeon and threatens the success of the operation. Postoperatively, localizing the end of the tube in the nose in order to confirm its placement or to analyze the cause of failure may also be technically challenging. A method of visualizing the tube in the nose under both surgical and postsurgical conditions is herein described.

Where is the gray line?

The gray line is a well-known surface anatomic landmark used by surgeons in the repair of lacerations involving the lid margin. To the best of our knowledge, no description of any deep or superficial anatomic counterpart of the gray line has been previously reported. We examined block resections of 51 eyelids histologically following localization of the gray line. The visualized gray line was consistently seen to correspond histologically to the most superficial portion of the orbicularis muscle, known as the muscle of Riolan. We comment on changes in gray line morphology with lid movement, and we advance a hypothesis to explain its "gray" color.

Cerebrospinal fluid leakage complicating orbital exenteration.

In three cases of cerebrospinal fluid leakage complicating orbital exenteration, leakage occurred intraoperatively following relatively low-power (0 to 25 W), high-frequency monopolar cautery to the orbital roof. Six cadaver orbits and 25 dried skulls were examined to investigate possible causes of intraoperative cerebrospinal fluid leakage. In this experimental model, monopolar cautery to the orbital roof did not cause cerebrospinal fluid leakage; however, cautery to preexistent foramina or experimentally created defects in the orbital bones did. In exenteration, monopolar cautery may transmit thermal energy through extant body defects in the orbital roof directly to the dura, resulting in its disruption. These defects may be congenital, tumor related, or iatrogenic. Alternative methods of hemostasis should probably be employed to control bleeding that occurs along the orbital roof during exenteration.

Orbital optic nerve glioma in adult life.

In seven cases, optic nerve glioma presented as an expanding orbital mass in previously asymptomatic adults. Clinically and histologically, these tumors were similar to the orbital optic nerve gliomas of childhood; in contrast to the rapidly progressive malignant gliomas of the chiasm well described in adults, the patients with these tumors had a more benign clinical course. Management of optic nerve glioma in adulthood should be conservative in the presence of useful vision.

Delayed suprachoroidal hemorrhage mimicking acute retrobulbar hemorrhage.

The signs and symptoms of an acute retrobulbar hemorrhage include sudden ocular pain, explosive unilateral proptosis, limitation of extraocular movements and loss of vision. Retrobulbar hemorrhage is a well-described complication of retrobulbar anesthetic injection. We report an unusual case of a presumed acute retrobulbar hemorrhage following intraocular surgery which, on further testing, was found to be a delayed suprachoroidal hemorrhage.

Orbital floor implant migration across the ethmoidal sinuses and nasal septum.

PURPOSE: To report an unusual case of orbital floor implant migration across the ethmoidal sinuses and nasal septum. METHOD: Case report. A 61-year-old woman with a history of right orbital floor fracture repair 25 years earlier is described. RESULTS: The patient presented with sinus congestion and difficulty breathing through the right nostril. Computed tomographic scan disclosed medial migration of the right orbital floor implant across the ethmoidal sinuses and nasal septum. The patient underwent transorbital and transnasal endoscopic surgery with removal of the implant. CONCLUSIONS: When an alloplastic orbital floor implant is required, size and fixation of the implant are important. Late paranasal sinus or nasal airway problems may be sequelae, and the possibility of implant migration should be considered.

Management of unsuccessful lacrimal surgery.

Two hundred and eight cases of failed dacryocystorhinostomy presenting to the Lacrimal Clinic at Moorfields Eye Hospital between 1970 and 1985 were reviewed. All cases underwent a further operation. The reasons for failure were usually apparent on reoperation. The surgical technique is described. A second dacryocystorhinostomy is a highly successful technique that spares both patient and surgeon the lifelong commitment to a bypass tube.

Pseudoepiphora from cerebrospinal fluid leak: case report.

A 4-year-old tearing child with obstruction of the nasolacrimal duct was treated with dacryocystorhinostomy three years after naso-orbital injury. However, what appeared to be tearing persisted, and meningitis developed. Coronal CT scans demonstrated traumatic encephalocele of the posterior superior orbital roof. A chronic orbital cerebrospinal fluid (CSF) leak was diagnosed. To our knowledge no case of chronic CSF leak has been reported that simulated tearing in an otherwise asymptomatic child. In the tearing patient who has a naso-orbital fracture the possibility of chronic CSF leak should be considered.

Chronic localized conjunctival chemosis.

Conjunctival chemosis is a commonly encountered clinical finding stemming from the presence of excess fluid in the conjunctiva. It is typically self-limiting or reversible if the underlying condition is treated. The authors present a series of seven cases of chronic localized conjunctival chemosis. Each patient had a localized area of dependent conjunctival edema for >or= 6 months. Evaluation of each patient included clinical examination, laboratory studies, and neuroimaging to attempt to elucidate the pathogenesis of the chemosis. Conjunctival biopsy was performed in six of the seven patients. In all of the patients studied, clinical examination uncovered no definitive signs of local inflammation. Laboratory evaluation was normal, and neuroimaging failed to confirm obstruction of venous or lymphatic drainage. Conjunctival biopsies showed chronic tissue inflammation or lymphangiectasia. The diagnosis of chronic localized conjunctival chemosis (CLCC) can be made if localized conjunctival edema persists for 6 months. Evaluation of biopsy specimens supports the theory that CLCC may result from scarring and structural alteration of conjunctival lymphatics, which appears to irreversibly affect the distribution of fluid in the conjunctiva.

Cosmetic indications for botulinum A toxin.

This article describes the use of botulinum toxin type A in the cosmetic treatment of facial wrinkles. Injection techniques, volumes, and concentration of the botulinum A toxin are described for various types of facial wrinkles.