Use of a porous polyethylene lid spacer for management of eyelid retraction in patients with Boston type II keratoprosthesis.

PURPOSE: To report a novel application of a porous polyethylene implant for lid stabilization and management of eyelid retraction in a patient with an exposed Boston Keratoprosthesis Type II. METHODS: A 54-year-old woman with a history of mucous membrane pemphigoid and failed penetrating keratoplasty of the left eye underwent implantation of a Boston Keratoprosthesis (KPro) Type II along with permanent surgical fusion of the upper and lower lids of the left eye in January 2010. At one month follow-up, significant retraction of the lower lid around the inferior margin of the optic was noted, resulting in partial exposure of the keratoprosthesis. The patient subsequently underwent left lower eyelid reconstruction with a porous polyethylene implant to ensure coverage and stability of the KPro. RESULTS: Eyelid reconstruction using a porous polyethylene implant resulted in stable retention of the KPro Type II for over 2 years. CONCLUSION: In patients with Boston KPro Type II in the setting of severe cicatrizing ocular surface disease, the use of a porous polyethylene implant during eyelid reconstruction around the KPro optic may aid in maintaining eyelid integrity and improving KPro stability and longevity.

Novel management of the microphthalmic orbit in a patient with PHACE syndrome.

A full-term female infant with severe unilateral microphthalmos and ipsilateral orbital hemangioma in the setting of PHACE syndrome was successfully managed with oral propranolol therapy and subsequent orbital conformer placement. After 3 months of systemic propranolol therapy, the orbital hemangioma had shown significant regression without systemic or local complications. The authors believe this to be the first reported use of systemic propranolol therapy in the management of a hemangioma within a microphthalmic orbit of a patient with PHACE syndrome.

Periorbital physical urticaria in an anophthalmic patient with dermatographism.

Physical urticarias are a subset of chronic urticarias in which patients have urticaria induced by a variety of environmental stimuli, including pressure. A 50-year-old white woman with a history significant for dermatographism presented with recurrent swelling of the eyelids shortly after manipulation or removal of her custom-fit prosthesis. This swelling, which lasted for hours to days, responded to treatment with oral corticosteroids. This is an uncommon finding of a physical urticaria in the periorbital region.

Müller's Muscle Conjunctival Resection Ptosis Repair in the Aesthetic Patient.

Posterior eyelid ptosis repair via the Müller's muscle-conjunctival resection procedure is an effective, reliable, and simple technique for periorbital rejuvenation in the aesthetic patient. This procedure may be performed with other periorbital rejuvenation techniques without sacrificing results. Appropriate candidates are patients with maintained levator function whose ptotic upper eyelid elevates close to a normal eyelid level upon instillation of phenylephrine drops to the superior conjunctival fornix.

Group A streptococcal necrotizing fasciitis of the eyelids and face managed with debridement and adjunctive intravenous immunoglobulin.

The authors describe a patient with right upper and lower eyelid necrosis combined with facial, neck, and chest edema and sepsis secondary to Group A streptococcal infection after minor trauma. This is an uncommon, life-threatening condition that was successfully treated with limited surgical debridement, antimicrobial therapy, and intravenous immunoglobulin. Oculoplastic surgeons should be aware of the indications and potential benefit of adjunctive intravenous immunoglobulin therapy for Group A Streptococcus-induced necrotizing fasciitis.