Use of hyaluronic acid gel in the treatment of lagophthalmos in sunken superior sulcus syndrome.

PURPOSE: To evaluate the use of hyaluronic acid gel in the management of lagophthalmos in sunken superior sulcus syndrome. INTRODUCTION: Lagophthalmos associated with orbital fat atrophy and deep superior sulcus is a known entity described previously. Orbital fat atrophy results in deep superior sulcus where skin, orbicularis muscle, and orbital septum retract posteriorly in the deep superior sulcus, leading to lagophthalmos from suboptimal orbicularis function and effective skin shortening. The authors define this condition as sunken superior sulcus syndrome (SSSS) when the deep superior sulcus leads to exposure keratopathy. Thus, the syndrome consists of deep superior sulcus, lagophthalmos, and exposure keratopathy. Although the use of hyaluronic acid gel has been proposed as a management option for paralytic lagophthalmos, its application in the treatment of lagophthalmos in SSSS has not been reported. METHODS: In this study, 5 patients (10 eyelids) with SSSS were injected with hyaluronic acid gel in the superior sulcus of the upper eyelid. Injected amount was titrated until the desired point was reached: complete or nearly complete eyelid closure. RESULTS: After an average follow up of 9.5 months, lagoph thalmos improved by 2 mm or 69% (p = 0.02) on the right side and by 1 mm or 71% (p = 0.01) on the left side. Most patients also reported significantly improved ocular comfort and appearance of the superior sulcus. The only complications noted were bruising and temporary uneven contour of the upper eyelid sulcus. CONCLUSIONS: Management of lagophthalmos in SSSS with hyaluronic acid gel is an effective and safe alternative to surgery.

Update on botulinum toxin and dermal fillers.

PURPOSE OF REVIEW: The art and science of facial rejuvenation is an ever-evolving field of medicine, as evidenced by the continual development of new surgical and nonsurgical treatment modalities. Over the past 10 years, the use of botulinum toxin and dermal fillers for aesthetic purposes has risen sharply. Herein, we discuss properties of several commonly used injectable products and provide basic instruction for their use toward the goal of achieving facial rejuvenation. RECENT FINDINGS: The demand for nonsurgical injection-based facial rejuvenation products has risen enormously in recent years. Used independently or concurrently, botulinum toxin and dermal filler agents offer an affordable, minimally invasive approach to facial rejuvenation. SUMMARY: Botulinum toxin and dermal fillers can be used to diminish facial rhytides, restore facial volume, and sculpt facial contours, thereby achieving an aesthetically pleasing, youthful facial appearance.

A caruncular choristoma presenting as an eyelid mass in an infant.

A 7-week-old patient presented for evaluation of a congenital eyelid mass. Following surgical excision of the lesion, histopathologic diagnosis of caruncular choristoma was made. To the authors' knowledge, this is the first report of caruncular tissue presenting as an external eyelid mass.

Intravascular lymphoma presenting as an orbital mass lesion: a case report.

We describe a case of intravascular lymphoma that presented as an orbital mass lesion. A 77-year-old female presented with longstanding fatigue and one-month of diplopia. Magnetic resonance imaging (MRI) revealed a frontal lobe brain lesion and a right orbital mass. Brain biopsy was interpreted as anaplastic oligodendroglioma. Orbital biopsy revealed intravascular lymphoma. On review of brain histopathology, the diagnosis was revised to CNS intravascular lymphoma. To the best of our knowledge, this case represents the first report of intravascular lymphoma presenting as an orbital mass lesion.