"Kissing" basaloid follicular hamartomas of the eyelid.

Basaloid follicular hamartomas (BFHs) are rare, benign, cutaneous adnexal tumors characterized by branching cords and anastomosing strands of basaloid cells in a loose, fibrous stroma. BFHs exhibit variable clinical presentations although they are commonly observed as skin-colored papules and are diagnosed based on histopathological features. Common systemic diseases associated with BFH include alopecia, myasthenia gravis, and palmoplantar pitting. BFH of the eyelid is extremely rare with only five cases reported in the literature to date. Congenital "kissing" lesions have only previously been reported with nevi. Here, we present a novel case of congenital "kissing" BFH of the right upper and right lower eyelid, and histopathological examination revealed intradermal nodules of basaloid cells forming reticulated strands, pseudohorn cysts, mucinous stroma, and palisading with CD34 and Bcl-2 expression in the stromal fibroblasts and periphery, respectively.

Neuromodulator threading: revisiting an approach to neurotoxin delivery.

Neuromodulator toxins are traditionally delivered to facial muscles via a depot technique using a 32g needle. This article revisits the threading technique, which was used more commonly in the 1990s and early 2000s prior to the introduction of the 32g x ½" gamma ray sterilized needle. A description of the threading technique, illustrated by diagrams and patient photos, is presented for the orbicularis oris and corrugator supercilii injection sites. In contrast to the depot technique in which the needle enters the skin at a 90-degree angle, the threading technique enters the skin at a 20- to 30-degree angle. Specifically, for the orbicularis oris, onabotulinum toxin A injections are performed 2 to 5mm beyond the "white roll" of the vermillion border. After the needle punctures the skin, the toxin is injected while withdrawing in a threading manner parallel to the vermillion border. This method is repeated along the entire length of the orbicularis oris muscle. For the corrugator supercilii muscles, the injection technique differs slightly. A depot injection is given at the most medial point of the muscle, targeting the body of the muscle. The tail of the corrugator supercilii is injected using the threading technique as described for the orbicularis oris, in which the needle inserts at a 20- to 30-degree angle. This paper revisits the threading injection technique for neurotoxin treatment of the orbicularis and corrugator supercilii sites.

Soft tissue perineurioma of the lacrimal gland: a case report.

A 17-year-old Caucasian man presented with an enlarging, painless mass causing a bulge in the lateral aspect of the left upper eyelid. An MRI demonstrated a well-circumscribed lacrimal gland mass without bony erosion. A 1-cm lacrimal gland mass was excised. The morphology and immunohistochemical findings were supportive of a soft tissue perineurioma. To the authors' knowledge, they present the first case report of a soft tissue perineurioma involving the lacrimal gland.

Medical management versus surgical intervention of pediatric orbital cellulitis: the importance of subperiosteal abscess volume as a new criterion.

PURPOSE: To investigate age and frontal sinusitis as indications for the surgical management of pediatric orbital cellulitis with subperiosteal abscess (SPA) and to create an SPA volume criterion that would favor nonsurgical management. METHODS: A retrospective chart review was performed to find all patients age 18 years and younger who presented to Hasbro Children's Hospital with orbital cellulitis secondary to sinusitis with an SPA from 2005 to 2009. SPA volume was measured using a CT ruler at the largest axial, coronal, and sagittal dimensions. Student t testing was used for statistical analysis. RESULTS: Twenty-nine patients were included: 8 (27.6%) were managed surgically and 21 (72.4%) were managed medically. The mean age of patients undergoing surgical management was 7.0 years old versus medical management 6.1 years old and was statistically similar (p < 0.001). The age range of patients undergoing surgical management was 17 months to 11 years versus 4 months to 13.4 years for medical management. The mean volume of abscesses needing surgery were larger (3,446.3 mm) than abscesses not needing surgery (420.5 mm) (p < 0.04). Volumes of <1,250 mm did not require surgical management (p < 0.001). The frontal sinuses were visualized on CT scan in 17 patients; frontal sinusitis was found in 11 of 17 (64.7%) patients; of these 11 patients, 4 (36.4%) underwent surgical drainage and only 2 (18.2%) showed positive culture results. The 2 (18.2%) patients who had positive culture results had an SPA volume that was ≥ 1,250 mm. CONCLUSIONS: The volume of SPA seemed to be the most important criterion in determining medical versus surgical management. The volumes of abscesses needing surgery were larger than the volumes of abscesses not needing surgery. Volumes of <1,250 mm did not require surgical management. Most cases of SPA with concurrent frontal sinusitis do not require surgical intervention. The cases of frontal sinusitis requiring surgical intervention always had concurrent SPA volumes of ≥ 1,250 mm. Patients both under 9 years old and ≥ 9 years old required surgical intervention with SPA volumes of <1,250 mm being a consistent determining factor.

Entropion-ectropion: the influence of axial globe projection on lower eyelid malposition.

PURPOSE: To evaluate the effect of axial globe projection on lower eyelid malposition with aging. METHODS: Consecutive patients presenting to 2 oculoplastic surgeons with lower eyelid and tarsal involutional ectropion or entropion underwent axial globe projection measurements with a Hertel exophthalmometer. RESULTS: Data on 36 eyelids of 31 white patients were collected. Axial globe projection in the ectropion group, mu = 19.9, was significantly greater than in the entropion group, mu = 16.1 (p = 0.000021). This held true even when the analysis was confined to the subgroup of male patients. CONCLUSION: Tarsal ectropion directly correlates with more prominent axial globe position, and patients with relatively enophthalmic eyes tend to develop entropion.

Potential impact of seatbelt use on the spectrum of ocular injuries and visual acuity outcomes after motor vehicle accidents with airbag deployment.

PURPOSE: To investigate the association between seatbelt use and (1) the spectrum of ocular injuries and (2) visual acuity outcomes after motor vehicle accidents (MVAs) with airbag deployment. DESIGN: Single-center retrospective observational case series. PARTICIPANTS: Forty-seven patients involved in MVAs with airbag deployment. METHODS: Medical record review of all patients evaluated after an MVA with airbag deployment between January, 1997, and August, 2005, at a single level 1 trauma center. MAIN OUTCOME MEASURES: Type of ocular injury and visual acuity at 3 months after an MVA. RESULTS: Seventy-one percent of patients who did not wear seatbelts experienced type III ocular injuries compared with 31% who wore seatbelts (P<0.0002). Posterior segment injuries occurred only in patients who did not wear seatbelts. At the 3-month follow-up, 76% of patients who did not wear seatbelts achieved a visual acuity of 20/40 or better compared with 96% of patients who wore seatbelts (P>0.10); a visual acuity worse than 20/200 was measured in 14% and 0% of patients in the 2 groups, respectively (P<0.03). CONCLUSIONS: In the current study, the use of seatbelts was associated with less severe ocular injuries and better visual outcomes.