Reconstruction of the central one half of an eyelid.

The technique recommended in this communication concerns the use of a semicircular graft from the lateral canthal area to close a lid margin defect comprising one half of the lid. When the defect is closed, the semicircular flap will straighten and become the lateral portion of the lid.

Cicatricial upper lid entropion. Treated with banked scleral graft.

Bank sclera is used as a graft in the treatment of cicatricial entropion of the upper lid. Banked bare sclera is sutured into the tarsoconjunctival layer of the entropic lid and is allowed to epithelialize spontaneously.

Orbital leiomyosarcoma.

A 36-year-old man had a six-month history of painless swelling in the medial orbit. Surgical exploration of this mass revealed a leiomyosarcoma. The tumor was entirely removed, as was all local surrounding tissue.

Sebaceous adenocarcinoma of the eyelid. Definition of surgical margins.

Carcinoma of the sebaceous glands of the eyelid carries a serious prognosis. Although uncommon, the diagnosis must be frequently considered owing to the similarity of the early signs of adenocarcinoma to those of chalazion. Three cases with proved sebaceous adenocarcinoma of the eyelid are reviewed to relate subtle evidence of clinical and histopathological malignancy to surgical management.

Acute dacryocystic retention.

Acute dacryocystic retention is a disease of adults under 50 years old due to a noninfective foreign body blocking the nasolacrimal duct. It is characterized by the sudden onset of severe unilateral facial pain without significant localized swelling or erythema. Palpation of the involved lacrimal sac reveals slight induration and marked tenderness. Percutaneous aspiration of lacrimal sac contents, followed by probing of the nasolacrimal duct, is usually curative.

Lid taping in the preoperative management of tearing or asthenopia.

We will describe the use of tape as an aid in the preoperative management of tearing due to horizontal lid laxity or ectropion and of "tired eyes" due to dermatochalasis, drooping brows, or ptosis.

Eyelid tumors anmd renal transplantation.

The high incidence of malignant neoplasms in renal transplant recipients and other immunosuppressed patients is well recognized. A large proportion of these neoplasms are skin cancers. The frequent occurrence of other ocular complications, such as cataract, elevated intraocular pressure, hypertensive retinopathy, cytomegalovirus retinitis, and herpetic keratitis in patients after kidney transplant, has also been described. This report presents the clinical and histopathologic features of eyelid involvement by keratoacanthoma and squamous cell carcinoma in two patients after renal transplantation and alerts ophthalmologists to the potential for this association.

Surgical treatment of eyelid neurofibromas.

The classical surgical treatment of eyelid neurofibromas has been careful dissection of the tumor with preservation of much of the surrounding abnormal lid tissues. The reported outcome has been uniformly unfavorable. These tumors infiltrate extensively and are impossible to dissect out completely. However, the lateral location of lid neurofibromas allows "en bloc" resection of most of the tumor including the adjacent involved lid tissues. Levator function in these cases is potentially good and the lid will elevate well if the levator aponeurosis is joined to the tarsus laterally at the time of surgery. The four cases presented here indicate that this procedure is technically easier and may produce more acceptable results than other forms of treatment.

Posttraumatic venous obstructive retinopathy associated with enlarged optic nerve sheath.

A case of posttraumatic unilateral enlargement of the optic nerve sheath associated with a venous obstructive retinopathy and progressive visual loss responded with marked improvement in visual function after nerve sheath decompression. Indirect (closed-head) trauma may be related to the progressive nerve sheath enlargement, venous obstructive retinopathy, and progressive visual loss. It is apparent that a venous stasis retinopathy can result from a posttraumatic optic nerve sheath lesion. Prompt recognition by echographic and/or roentgenographic investigation and subsequent decompression may be curative.

Actinic comedonal plaque of the eyelid.

A variety of actinic lesions occur on the eyelids and facial skin. Actinic comedonal plaque is an unusual entity that falls into this category. We successfully treated such a lesion with cryotherapy.

Repair of cicatricial entropion of the upper eyelid.

The disparity in vertical length between the skin muscle lamellae and the tarsoconjunctival lamellae in cicatricial entropion of the upper eyelid secondary to contracture of the transconjunctival layer was corrected by a transconjunctival incision allowing the eyelid to straighten. The resultant defect in the tarsoconjunctival lamellae was corrected by means of a bare scleral graft 20% larger than the defect in the eyelid. The graft was allowed to epithelialize spontaneously and was not covered with mucuous membrane.

Blepharochalasis syndrome.

Patients with chronic forms of blepharochalasis often develop eyelid deformities characterized by blepharoptosis and prolapse of the orbital fat and lacrimal gland. Some individuals have an acquired form of blepharophimosis, secondary to the dehiscence of the canthal tendons. In this late stage of the condition, the tendons still adhere to the periosteum of the orbital rims and loss of fixation occurs at the distal attachment between the tendons and the eyelid tissues. This results in a horizontally shortened palpebral fissure and a rounded deformity of the lateral canthal angle. Surgery remains the primary treatment.

Surgical treatment of complications of cosmetic blepharoplasty.

The principles of repair of complications of cosmetic blepharoplasty are aimed at correction of the deformity present. Shortage of skin is usually corrected by skin grafting, lax lower lids by lid shortening procedures, and poor upper lid closure by releasing restricting tissues. Some unusual complications and their treatment are also described.

The use of the "lateral canthal sling" in ectropion repair.

We describe the use of the "lateral canthal sling" in the treatment of non-cicatrical "senile" ectropion of the lower lid. Combined with a resection of the lower retractors and the hypertrophied palpebral conjunctiva we consider it the treatment of choice for repairing non-cicatrical "marginal" ectropion. We offer a theory of the pathogenesis of the latter.