A technique for eyelid margin repair without use of marginal sutures.

Purpose: To describe and evaluate a novel technique for eyelid margin repair without the use of marginal sutures.Methods: A retrospective chart review of patients who underwent primary repair of full-thickness lid margin defects using the described technique between March 2013 and May 2019 was performed. Clinical data such as indication for repair as well as size of defect was analyzed. The primary outcome measures included presence or absence of lid notching and post-operative complications such as wound dehiscence, infection, eyelid malposition, and keratopathy. Descriptive statistics were used.Results: A total of 31 cases were identified. Five were excluded in post-operative analysis for follow-up of less than 2 weeks. The average age was 59.6 years (range 22-88) and 54.8% of patients were female. Average follow up in post-operative analysis group was 17.0 weeks (range 2 weeks to 42 months). Average defect size was 5.77 mm (range 2-12 mm). Reasons for repair were resection of eyelid lesion in 25/31 (80.6%), floppy eyelid in 4/31 (12.9%), trauma in 1/31 (3.2%), and trichiasis in 1/31 (3.2%). Post-operative eyelid notching was noted in 2/26 patients (7.7%), and there were no instances of wound dehiscence, infection, eyelid malposition, or keratopathy noted.Conclusions: Our technique for full-thickness eyelid margin repair without the use of marginal sutures successfully repairs defects up to 12 mm for various indications. We observed comparable cosmetic outcomes to previously described techniques as well as a low rate of complications using our technique.

MR imaging of orbital inflammatory syndrome, orbital cellulitis, and orbital lymphoid lesions: the role of diffusion-weighted imaging.

BACKGROUND AND PURPOSE: Orbital inflammatory syndrome (OIS) has clinical features that overlap with orbital lymphoid lesions and orbital cellulitis. Prompt diagnosis is needed in all 3 conditions because the management of each one differs greatly. CT and MR imaging, though useful, do not always distinguish among these conditions. The aim of this study was to identify the role of diffusion-weighted imaging (DWI) in differentiating these 3 diagnoses. MATERIALS AND METHODS: A retrospective analysis of orbital MR imaging was conducted. T1- and T2-weighted and postcontrast images were analyzed. Region-of-interest analysis was performed by using measurements in areas of abnormality seen on conventional MR imaging sequences and measurements of the ipsilateral thalamus for each patient. The DWI signal intensity of the lesion was expressed as a percentage of average thalamic intensity in each patient. Similarly, lesion apparent diffusion coefficients (ADCs) and lesion-thalamus ADC ratios were calculated. Statistical significance was determined by the Kruskal-Wallis test, and post hoc pairwise comparisons, by the Mann-Whitney U test for DWI-intensity ratio, ADC, and ADC ratio. RESULTS: A significant difference was noted in DWI intensities, ADC, and ADC ratio between OIS, orbital lymphoid lesions, and orbital cellulitis (P < .05). Lymphoid lesions were significantly brighter than OIS, and OIS lesions were significantly brighter than cellulitis. Lymphoid lesions showed lower ADC than OIS and cellulitis. A trend was seen toward lower ADC in OIS than in cellulitis (P = .17). CONCLUSIONS: DWI may help differentiate OIS from lymphoid lesions and cellulitis and may allow more rapid management.