Single-stage Differential Template Technique for the Repair of Palpebral Neurofibromatosis With Severe Blepharoptosis in Adults.

PURPOSE: To report the surgical outcomes of single-stage differential template technique for the correction of palpebral neurofibromatosis associated with severe blepharoptosis in adults. METHODS: This is a retrospective interventional case series. Adult patients with severe unilateral palpebral neurofibromatosis, severe blepharoptosis, and lateral canthal dystopia underwent a single-stage repair. The excess anterior and posterior lamellae of the eyelid tissue were excised in a differential manner, using the other eyelid as a template (differential template technique). The levator muscle was resected and reattached to the tarsus during the reconstruction. The surgical outcomes and complications were evaluated. RESULTS: A total of 5 patients underwent the differential template technique. The median age at presentation was 24 years, and 4 were males. All had severe blepharoptosis, with excess upper eyelid and temporal plexiform neurofibroma. All underwent a single-stage procedure with an average follow-up of 17.8 months. The average palpebral fissure height improved from 0 mm preoperatively to 8.25 mm postoperatively, with a well-formed eyelid crease and an average lagophthalmos of 2 mm. Good functional and cosmetic outcome was noted in all patients, with no exposure keratopathy. Two patients had a lateral canthal "stand-off," and 1 patient developed mild upper eyelid retraction, which was managed conservatively. CONCLUSIONS: A single-stage differential template technique can correct palpebral neurofibromatosis with severe blepharoptosis providing good cosmetic and functional outcomes.

Peripunctal squamous cell carcinoma with canalicular infiltration.

Peripunctal squamous cell carcinomas with canalicular infiltration are a rare clinical entity. Although there are universal guidelines on achieving margin clearance for excision of an eyelid tumor, literature is scarce on achieving the same while dealing with the lacrimal drainage system. The present case describes the management of a rare case of squamous cell carcinoma with secondary extension into the proximal lacrimal system. The surgery was performed with intraoperative frozen section guidance.