A Deep Learning Model for Screening Computed Tomography Imaging for Thyroid Eye Disease and Compressive Optic Neuropathy.

Purpose: Thyroid eye disease (TED) is an autoimmune condition with an array of clinical manifestations, which can be complicated by compressive optic neuropathy. It is important to identify patients with TED early to ensure close monitoring and treatment to prevent potential permanent disability or vision loss. Deep learning artificial intelligence (AI) algorithms have been utilized in ophthalmology and in other fields of medicine to detect disease. This study aims to introduce a deep learning model to evaluate orbital computed tomography (CT) images for the presence of TED and potential compressive optic neuropathy. Design: Retrospective review and deep learning algorithm modeling. Subjects: Patients with TED with dedicated orbital CT scans and with an examination by an oculoplastic surgeon over a 10-year period at a single academic institution. Patients with no TED and normal CTs were used as normal controls. Those with other diagnoses, such as tumors or other inflammatory processes, were excluded. Methods: Orbital CTs were preprocessed and adopted for the Visual Geometry Group-16 network to distinguish patients with no TED, mild TED, and severe TED with compressive optic neuropathy. The primary model included training and testing of all 3 conditions. Binary model performance was also evaluated. An oculoplastic surgeon was also similarly tested with single and serial images for comparison. Main Outcome Measures: Accuracy of deep learning model discernment of region of interest for CT scans to distinguish TED versus normal control, as well as TED with clinical signs of optic neuropathy. Results: A total of 1187 photos from 141 patients were used to develop the AI model. The primary model trained on patients with no TED, mild TED, and severe TED had 89.5% accuracy (area under the curve: range, 0.96-0.99) in distinguishing patients with these clinical categories. In comparison, testing of an oculoplastic surgeon in these 3 categories showed decreased accuracy (70.0% accuracy in serial image testing). Conclusions: The deep learning model developed in the study can accurately detect TED and further detect TED with clinical signs of optic neuropathy based on orbital CT. The model proved superior compared with human expert grading. With further optimization and validation, this TED deep learning model could help guide frontline health care providers in the detection of TED and help stratify the urgency of a referral to an oculoplastic surgeon and endocrinologist. Financial Disclosures: The authors have no proprietary or commercial interest in any materials discussed in this article.

Unusual Penetrating Orbital and Globe Injury With a Veterinary Needle.

We present a rare case of a penetrating injury to the globe and orbit by a veterinary needle. The patient underwent globe exploration and retinal detachment repair under general anesthesia after receiving medical treatment for orbital cellulitis. The case was managed by a multidisciplinary team consisting of a pediatric ophthalmologist, an oculoplastic surgeon, and a retina surgeon. The orbital cellulitis resolved gradually, after which the site of globe penetration was found to be self-sealed, and the retinal detachment was repaired. B-scan ultrasonography and magnetic resonance imaging (MRI) were performed to assess the extent of the injury and evaluate the integrity of the globe. Exploration of presumed Self-sealing globe wounds by a needle should be deferred until the treatment of life-threatening complications like orbital cellulitis and optic nerve infiltration is complete. Prompt judicious care was necessary in this case. It is crucial to implement preventive measures to address the risks involved in children manipulating dangerous objects to avoid preventable accidents and mitigate the potential visual outcomes that may arise as a result.

Innovative Curriculum to Train Medical Students on Lateral Canthotomy and Cantholysis.

PURPOSE: Orbital compartment syndrome (OCS) is an ocular emergency requiring prompt decompression with a lateral canthotomy and cantholysis (LCC) within 2 hours. This study evaluates the feasibility and effectiveness of a standardized LCC curriculum to train medical students to identify and treat OCS. METHODS: This was a prospective, non-randomized, non-comparative cohort study of 39 novice first-year medical students with no prior LCC training who underwent a standardized LCC curriculum incorporating both didactic and hands-on procedural training. Didactic knowledge of orbital anatomy and OCS was evaluated with written pre- and post-knowledge testing. Expert performance criteria were determined by expert consensus based on the performance of three oculoplastic surgeons and were defined as correctly performing all 12 critical checklist steps of an LCC within 3 minutes twice consecutively on a Sonalyst LCC training system eye model. Utilizing the principles of mastery learning, participants learned how to perform an LCC in a classroom environment and were evaluated on a final test of proficiency in a training lane designed to simulate an austere military environment. RESULTS: Participants required a median of 3.0 practice iterations to achieve expert performance in the classroom environment. During the testing phase, all participants correctly identified the eye with OCS, and 77% (n = 30) of learners successfully performed an LCC at the expert level within their first attempt. The median completion time of those who passed on their first testing was 130 seconds. The mean LCC knowledge test scores significantly improved from 48.7% to 71.2% (P < .001). CONCLUSION: This study successfully developed a standardized LCC curriculum utilizing the principles of hands-on mastery learning to train novice learners to perform an LCC efficiently and effectively.

Oral Sedation Anesthesia Protocol for In-Office Oculoplastic Surgery.

PURPOSE: To present an oral anesthesia protocol for in-office oculoplastic surgery and to compare safety outcomes and patient and physician experiences to ambulatory surgery center (ASC)-based surgery with intravenous sedation or general anesthesia. METHODS: A prospective study was performed on consecutive patients undergoing surgery at an oculofacial plastic surgery practice. Surgery was performed in an in-office setting using our standardized oral sedation protocol or at an ASC with intravenous sedation or general anesthesia. Preoperative and postoperative surveys were conducted by patients and physicians to compare surgical experience, safety, and efficacy of our oral sedation protocol for in-office surgery in the ASC setting. RESULTS: Two hundred and fifty-three patients (167 in-office and 86 at ASC) underwent surgery between March and November 2022. There was no significant difference in how patients or physicians rated their experience between the 2 locations. A significantly higher proportion of ASC patients would have rather had surgery in-office (34.9% vs. 19.2%; p = 0.006). A significantly higher number of physicians in the office setting would have rather performed surgery at the ASC than the reverse (12.7% vs. 2.3%, respectfully; p = 0.007). There were no safety complications reported in either setting. CONCLUSIONS: Within our patient cohort, the presented oral sedation protocol provided safe and effective anesthesia for in-office oculoplastic surgery that is comparable to an ASC.

Gender Representation Among Ophthalmology Fellowship Directors in 2022.

PURPOSE: Women are under-represented in several medical specialties, including Ophthalmology. Reducing disparities is critical in diversifying perspectives and increasing equity within Ophthalmology, both of which can ultimately improve care delivery. We examined ophthalmic fellowship programs directors in the United States to investigate gender disparities by subspecialty. DESIGN: Cross-sectional study METHODS: Setting: Academic medical center. PATIENT OR STUDY POPULATION: Ophthalmology fellowship program directors. INTERVENTION OF OBSERVATION PROCEDURE(S): Retrospective cross-sectional study. MAIN OUTCOME MEASURE(S): Descriptive analysis of current fellowship directors in 2022 when stratified by subspecialty and demographic features. RESULTS: Analysis was conducted on 358 fellowship directors in the United States. Twenty-nine percent of directors were women. Female directors had significantly fewer years since residency graduation compared to male peers (17 vs 24; p<0.001), however no differences were observed by program type (p=0.896) and location (p=0.104). Differences in female director representation were observed by subspecialty (p<0.001), with the greatest percentage of women in Pediatric Ophthalmology (54%), Other (Oncology and Pathology) fellowships (50%), and Medical Retina (40%). The subspecialties with the lowest percentage of female directors were Oculoplastic and Reconstructive Surgery (13%) Surgical Retina and Vitreous (16%). CONCLUSION: There are disparities in female representation in academic leadership positions across ophthalmic subspecialties. Addressing this difference may have critical impacts on career advancement and opportunities available for marginalized groups in medicine.

Augmented and Virtual Reality Applications in Facial Plastic Surgery: A Scoping Review.

OBJECTIVES: Augmented reality (AR) and virtual reality (VR) are emerging technologies with wide potential applications in health care. We performed a scoping review of the current literature on the application of augmented and VR in the field of facial plastic and reconstructive surgery (FPRS). DATA SOURCES: PubMed and Web of Science. REVIEW METHODS: According to PRISMA guidelines, PubMed and Web of Science were used to perform a scoping review of literature regarding the utilization of AR and/or VR relevant to FPRS. RESULTS: Fifty-eight articles spanning 1997-2023 met the criteria for review. Five overarching categories of AR and/or VR applications were identified across the articles: preoperative, intraoperative, training/education, feasibility, and technical. The following clinical areas were identified: burn, craniomaxillofacial surgery (CMF), face transplant, face lift, facial analysis, facial palsy, free flaps, head and neck surgery, injectables, locoregional flaps, mandible reconstruction, mandibuloplasty, microtia, skin cancer, oculoplastic surgery, rhinology, rhinoplasty, and trauma. CONCLUSION: AR and VR have broad applications in FPRS. AR for surgical navigation may have the most emerging potential in CMF surgery and free flap harvest. VR is useful as distraction analgesia for patients and as an immersive training tool for surgeons. More data on these technologies' direct impact on objective clinical outcomes are still needed. LEVEL OF EVIDENCE: N/A Laryngoscope, 2023.

Management of periocular keratinocyte carcinomas with Mohs micrographic surgery and predictors of complex reconstruction: a retrospective study.

BACKGROUND: Skin cancer is the most frequent cancer worldwide and the most frequent periocular tumor. Keratinocyte Carcinomas (KC) located in periorificial areas, such as periocular tumors, are considered high-risk tumors. Mohs Micrographic Surgery (MMS) is considered the first line for the treatment of high-risk KC, providing a lower recurrence rate than conventional wide excision. OBJECTIVE: To describe the clinical-pathological features of periocular KC treated with MMS in a tertiary university center in Chile. METHODS: A single-center, retrospective study of patients with KC located on the periocular area, that underwent MMS between 2017‒2022. MMS details were recorded. RESULTS: One hundred thirteen patients with periocular carcinomas were included. The mean age was 59 ± 13 years; 52% were women. The most frequent location was the medial canthus (53%), followed by the lower eyelid (30.1%). The most frequent BCC histology was the nodular variant (59.3%). Regarding MMS, the average number of stages was 1.5 ± 0.7, and 54% of the cases required only 1 stage to achieve clear margins. To date, no recurrence has been reported. Tumors larger than 8.5 mm in largest diameter or 43.5 mm2 were more likely to require complex reconstruction. STUDY LIMITATIONS: Retrospective design and a relatively low number of patients in the SCC group. Possible selection bias, as larger or more complex cases, may have been referred to oculoplastic surgeons directly. CONCLUSION: The present study confirms the role of MMS for the treatment of periocular KCs. Periocular KCs larger than 8.5 mm might require complex reconstruction. These results can be used to counsel patients during pre-surgical visits.

Surgical excision of eyelid tumors and subsequent ophthalmoplastic reconstruction.

In recent years new modern therapeutic concepts have been developed in the treatment of malignant eyelid tumors; however, surgical restoration remains an important component of the therapeutic options addressed, which include microsurgical tumor excision into healthy tissue and subsequent coverage of the defects. An ophthalmic surgeon experienced in oculoplastic surgery is responsible for the recognition and evaluation of the existing alterations and planning a procedure together with the patient that meets the patient's expectations. The planning of surgery must always be individualized and fit the initial findings. Depending on the defect size and localization, different coverage strategies are available to the surgeon. To ensure successful reconstruction, every surgeon should master a wide range of reconstructive techniques.

Socioeconomic Disparities Associated with Access to Oculofacial Plastic Surgeons: A Cross-Sectional Analysis of US County Demographics.

OBJECTIVE: To compare population demographics with the geographic distribution of oculofacial plastic surgeons (OPS) in the United States (US). DESIGN: A cross-sectional study design was employed to investigate demographic differences between counties with one or more OPS and counties with zero OPS. PARTICIPANTS: The number of OPS were identified in each US County using online public databases - American Society of Ophthalmic Plastic and Reconstructive Surgeons; American Academy of Ophthalmology. Counties were categorized into two groups: one or more OPS and zero OPS. Demographic characteristics at the county level were obtained from the 2021 US Census Bureau Population Estimates and the American Community Survey. Cost of living was collected from the 2022 Economic Policy Institute Family Budget Calculator. MAIN OUTCOME MEASURES: Socioeconomic demographics of the US population as related to geographic OPS distribution. RESULTS: A total of 1238 OPS were identified. States with the most OPS per million were Hawaii (6.2), D.C. (6.0), Connecticut (5.8), Utah (5.1), and Maryland (5.0). Among 3143 counties, 2725 (86.7%) had zero OPS and 418 (13.3%) had one or more OPS. Counties with one or more OPS had a higher median (SD) household income versus counties with zero OPS ($72,969 [$19,724] vs. ($56,361 [$13,857]; difference $16,608; 95% CI, $14,489 to $18,727; P < 0.001). The annual cost of living per person (SD) was higher in counties with one or more OPS versus counties with zero OPS ($39,238 [$6,992] vs. $36,227 [$3,516]; difference $3,011; 95% CI $2,328 to $3,694; P < 0.001). Counties with zero OPS versus counties with one or more OPS had higher proportions of persons with only Medicaid (15.5% vs. 13.7%; difference 1.8%; 95% CI, 1.2% to 2.4%; P < 0.001), no health insurance (9.9% vs. 8.0%; difference 1.9%; 95% CI, 1.4% to 2.3%; P < 0.001), no household internet access (17.0% vs. 9.3%; difference 7.7%; 95% CI, 7.2% to 8.2%; P < 0.001), and higher proportions of persons 65 years or older (20.0% vs. 16.6%; difference 3.4%; 95% CI, 2.9% to 3.8%; P < 0.001). CONCLUSIONS: This cross-sectional analysis of all US counties revealed socioeconomic disparities associated with access to OPS.

[Current status of French oculoplastics in France and in Europe]. / État des lieux de l'oculoplastie française en France et en Europe.

INTRODUCTION: In 2023, oculoplastics in France is experiencing a paradox with an imbalance between demand and supply of trainees. The goal of this study is to establish a factual overview of oculoplastics in France, with its limitations, and make proposals to optimize this sector. METHODS: An observational study was conducted by compiling epidemiological data related to oculoplastics. This included full-time hospital practitioners (HPs) in French university hospitals (FUH), data from the distributed computerized system for health assessment (SIDES), the specialized cross-disciplinary training (FST) in oculoplastics, the interuniversity diploma (DIU) in oculoplastics, the French University Ophthalmologists College (COUF), and the French Society of Reconstructive and Aesthetic Ophthalmology (SOPREF). RESULTS: Of the 32 FUH, only 11 full-time HPs (among them 5 academic) are specialized in oculoplastics. Several "priority" regions are underrepresented in oculoplastic surgeons. The number of ophthalmology residency coordinators and residents participating in the oculoplastics FST are decreasing over time and favoring other subspecialties. On the SIDES platform dedicated to residents, 26 (11.5%) of the 226 courses are devoted to oculoplastics. The role of women in oculoplastics is also discussed. CONCLUSION: Despite offering quality theoretical training, the future of French oculoplastics is clouded by a lack of practical training. Corrective measures include increasing oculoplastic surgeons in the FUH, developing private practice fellowships, prioritizing residents from "priority" regions for the oculoplastics DIU, optimizing the inter-CHU network, creating innovative teaching resources, and organizing specific congresses for the residents.

Timing of Jones Tube Placement After Excision of Nasal or Lacrimal Drainage System Malignancy: A Survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS).

Purpose: To elicit, from a survey of oculoplastic surgeons, the timing and reason for delaying Jones tube placement after the excision of nasal or lacrimal drainage system malignancy. Methods: The authors reviewed current literature and distributed an anonymous survey to 627 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) to determine the length of time members wait to perform a Jones tube placement after the removal of nasal or lacrimal drainage system malignancy. The survey also included questions about the rationale for this waiting period. Results: Fifty-eight members of ASOPRS (9.3%) responded to our survey, 49 (84.4%) of whom had performed Jones tube placement on patients who had an excision of a nasal or lacrimal drainage system malignancy. Nearly 52% of respondents waited one year for Jones tube placement. However, a sizeable number of respondents opted to wait five years (15.1%). The most common rationale for waiting was a concern for tumor recurrence (42 responses). Conclusion: There is no consensus on when to perform Jones tube placement after the excision of nasal or lacrimal drainage system malignancy. This survey demonstrates a broad array of waiting periods between operations, although most surgeons wait 12 months.

Comparison of the clinical characteristics of benign and malignant eyelid lesions: an analysis of 1423 eyelid lesions, compared between ophthalmology department and plastics department.

PURPOSE: Oculoplastic surgeons excise and reconstruct eyelid tumors, although plastic surgeons have traditionally managed these cases. Current demand of this surgery is growing, and planning referral services is a health management necessity. This pilot study retrospectively reviewed same population eyelid specimens excised by both disciplines comparing data. METHODS: Clinical and epidemiologic features of 1423 eyelid lesions biopsied between 2015- 2020 in Emek Medical Center (EMC), Israel were reviewed. RESULTS: Among 1423 specimens, 1210 (85.0%) were benign and 213 (15.0%) were malignant/pre-malignant. Mean age at diagnosis was significantly higher in malignant tumors than in benign tumors (76 and 59 years respectively, p value < 0.001). The most common benign eyelid lesions were soft fibroma (20.1%), seborrheic keratosis (11.0%) and melanocytic nevus (10.3%). The most common malignant/pre-malignant eyelid tumors were basal cell carcinoma (BCC) (9.2%), actinic keratosis (2.6%) and Bowen's disease (1.9%). Ophthalmology removed 37 malignant/pre-malignant lesions (5.4%) out of 683 compared to plastics removing 142 malignant/pre-malignant lesions out of 740 (19.2%) specimens. Eyelid malignancy in the plastics department was significantly higher than in the ophthalmology department (p value < 0.001). 270 (70.0%) lesions caused by UV exposure were removed by plastics and 116 (30.0%) were removed by ophthalmology (p value < 0.001). CONCLUSIONS: Eyelid lesions in patients aged 76 or older are more likely to be malignant. Ophthalmology eyelid specimens in younger patients are more commonly benign and related to inflammation. Specimens from the plastics department are more commonly malignant, related to UV-exposure, and are from older patients. This difference may be due to a misconception that plastic surgeons have more eyelid cancer reconstruction experience than oculoplastic surgeons, or less awareness of the oculoplastic expertise available today.

The Utility of the Paramedian Forehead Flap in Lower Eyelid Reconstruction.

BACKGROUND: Malignant cutaneous eyelid tumors account for approximately 10% of all cutaneous cancers. Like other cancerous skin lesions, treatment commonly involves excision with wide margins, requiring tissue reconstruction. The use of the paramedian forehead flap (PMFF) has been described for reconstruction of the medial and upper eyelid, but literature is lacking for its use in lower eyelid anterior lamella reconstruction. We present a case series of patients who underwent reconstruction of lower eyelid defects using the PMFF. CASE PRESENTATIONS: We present 2 patients who underwent reconstruction of lower eyelid defects using the PMFF surgical technique. The patients had previous history of lower lid repair with other reconstructive methods because of cancerous eyelid lesions. In addition, both received adjuvant radiation therapy, which led to development of ectropion. Postoperative signs, symptoms, and photographs were collected to monitor outcomes. MANAGEMENT AND OUTCOMES: Reconstructions were performed by the collaborative efforts of a facial plastic reconstructive surgeon and oculoplastic surgeon using a staged PMFF approach. Postoperatively, both patients had significant improvement in ophthalmologic symptoms, particularly ectropion and lagophthalmos. At their most recent follow-up visit, they were satisfied with their functional and aesthetic outcomes. CONCLUSION: The PMFF may be safely used to reconstruct defects of the lower eyelid anterior lamella. In this study, the PMFF has proven to be an excellent option for patients with complications after previous lower eyelid reconstructions or history of radiation therapy. Overall, the PMFF should be considered as part of the surgeon's reconstructive ladder when addressing lower eyelid defects.

Surgical Correction of Cicatricial Lower Eyelid Retraction: A Systematic Review.

BACKGROUND: Cicatricial lower eyelid retraction is a challenging condition. It involves scarring of the lower eyelid, which causes it to retract and expose the sclera. This can lead to complications such as dry eye syndrome and corneal melting. It can be caused by trauma, burns, or previous eyelid surgery. Detailed assessment and understanding of eyelid anatomy and retraction are critical for successful surgical planning. Dynamic and static examinations of the eyelid including measurements of the lower eyelid margin reflex distance (MRD2) and scleral show are also essential to determine the appropriate treatment approach. METHODS: A systematic review was conducted using Medline, Scopus, and Cochrane databases with keywords related to cicatricial lower eyelid retraction. The publication language was limited to English after 2000. A total of 29 articles were included for data extraction and analysis. RESULTS: The main surgical techniques include tarsoconjunctival grafts, spacers, midface lift, and lateral canthal tendon suspension, although no single procedure has been universally recognized as the gold standard. New innovations such as synthetic grafts and xenografts are being explored for their potential in eyelid reconstruction. Severe cases, defined as those with inferior scleral show greater than 2 mm, may require a combination of reconstruction methods. CONCLUSIONS: Correcting cicatricial lower eyelid retraction is a major challenge in oculoplastic reconstruction. The surgical approach should be individualized, considering the pathologies and etiologies of lid retraction. In-depth knowledge and careful surgical planning are essential for best outcomes. There is no gold standard technique, and postoperative outcomes, complications, and management vary depending on the surgical approach used.

Development and validation of a convolutional neural network to identify blepharoptosis.

Blepharoptosis is a recognized cause of reversible vision loss and a non-specific indicator of neurological issues, occasionally heralding life-threatening conditions. Currently, diagnosis relies on human expertise and eyelid examination, with most existing Artificial Intelligence algorithms focusing on eyelid positioning under specialized settings. This study introduces a deep learning model with convolutional neural networks to detect blepharoptosis in more realistic conditions. Our model was trained and tested using high quality periocular images from patients with blepharoptosis as well as those with other eyelid conditions. The model achieved an area under the receiver operating characteristic curve of 0.918. For validation, we compared the model's performance against nine medical experts-oculoplastic surgeons, general ophthalmologists, and general practitioners-with varied expertise. When tested on a new dataset with varied image quality, the model's performance remained statistically comparable to that of human graders. Our findings underscore the potential to enhance telemedicine services for blepharoptosis detection.

Canalicular obstruction associated with dupilumab.

PURPOSE: Dupilumab is a novel treatment for severe atopic dermatitis and is associated with a range of ocular complications such as blepharoconjunctivitis, keratitis, cicatricial ectropion and punctal stenosis. METHODS: We report 4 patients with canalicular obstruction in association with dupilumab therapy, and we describe their treatment and outcomes in each case. RESULTS: Canalicular obstruction was diagnosed by an oculoplastic consultant between 3 years and 3 months and 4 years and 9 months after the commencement of dupilumab therapy. Case 1 underwent nasolacrimal intubation, case 2 was treated conservatively, and case 4 underwent endonasal dacryocystorhinostomy and these patients' symptoms resolved. Unfortunately, in case 3 despite endonasal dacryocystorhinostomy with stenting they remained symptomatic. CONCLUSION: This case series adds to the growing number of ocular complications associated with dupilumab therapy, and there is yet an optimal treatment strategy to mitigate these complications. It is possible that simple conservative measures such as discontinuation of dupilumab and topical treatments with steroids can eventually lead to some form of recovery and recanalisation of the canalicular system. Early referral to an ophthalmologist prior to the development of canalicular obstruction to control the inflammatory ocular surface could reduce the risks of cicatricial sequelae from dupilumab, and temporary stenting of the canalicular system could be attempted as a method to keep the canalicular system patent, whilst the patient remained on treatment.

Management of eyelids' primary malignancies.

Purpose: We report our experience in surgical management of primary malignant tumors of the eyelids. We have specified the various surgical techniques used, as well as functional and anatomical results.Patients and methods: A review of patients admitted for malignant tumor of the eyelids in the oculoplastic department of the Hedi Raies Institute of Ophthalmology from January 2012 to December 2021.Results: One hundred and twenty-three patients with malignant eyelid tumors were hospitalized. Surgical treatment involved 114 tumor lesions, which represents 95% of the cases. One hundred and eleven lesions (97.4%) had been operated by simple tumor resection. Safety margins were, respectively, 4 mm in 63.2% and from 5 to 6 mm in 34.2%. Extemporaneous histological examination was performed in three cases (2.6%). Reconstruction involved the anterior lamella (AL) in 92 cases (80.7%), the posterior lamella (PL) in 66 cases (57.9%), the medial canthus in 18 cases (15, 8%), and lateral canthus in 4 cases (3.5%). The excision was oncological in 85 cases (74.6%) and incomplete in 19 cases (16.7%). Tumor recurrence occurred in seven cases (6.1%), after an average delay of 36 months.Conclusion: The anatomical and functional features of the eyelids require a good reconstruction of the transfixion eyelid defect. Many reconstruction methods are available, allowing extensive and complex palpebral repairs. Oncologic prognosis is conditioned by the surgical quality.

Teratoma orbitario maduro congénito: reporte de un caso / Congenital mature orbital teratoma: A case report

Los teratomas son neoplasias gonadales o extragonadales, derivadas de los tres tejidos embrionarios, compuesto de células germinales del neuroectodermo, del mesodermo y del ectodermo. El teratoma orbitario congénito (TOC) afecta comúnmente a la órbita izquierda, predominando en mujeres sobre hombres a razón 2:1. Se presenta el caso de un paciente femenino de 9días de vida extrauterina con un teratoma orbitario congénito maduro izquierdo, intervenida por el servicio de órbita y oculoplástica, realizando una exenteración orbitaria y resección total de la masa tumoral (AU)

Teratomas are gonadal or extragonadal neoplasms, derived from the three embryonic tissues, composed of germ cells of the neuroectoderm, mesoderm and ectoderm. Congenital orbital teratoma (OCT) commonly affects the left orbit, primarily affecting women over men at a ratio of 2:1. We present the case of a female patient of 9days of extrauterine life with a left mature congenital orbital teratoma. The orbit and oculoplastic service performed an orbital exenteration and total resection of the tumor mass (AU)