Orbital Volume Augmentation for Enophthalmos Following Ventriculoperitoneal Shunting: A Case Study in "Silent Brain Syndrome".

A 21-year-old female with a history of infantile hydrocephalus and ventriculoperitoneal shunting presented with bilateral persistent tearing. Examination revealed marked bilateral enophthalmos, poor lower eyelid apposition to the ocular surface, and patent nasolacrimal systems. Radiographic imaging demonstrated expanded orbital volumes with high arching orbital roofs, sequestered air under the eyelids, short, straight optic nerves, and expanded paranasal sinuses. Surgical intervention included insertion of mesh and block implants within the subperiosteal space of the orbital roof, resulting in correction of enophthalmos, improved lower eyelid apposition and resolution of tearing. However, new onset myopic astigmatism and bilateral ptosis were noted postoperatively and treated successfully with corrective spectacles and ptosis repair. Current literature has demonstrated the benefit of orbital roof implants through a upper eyelid crease incision. The authors present a case that supports the utility of this approach and addresses its potential complications, including postoperative-induced astigmatism/myopia and ptosis.

Physical and chemical injuries to eyes and eyelids.

Ocular and periocular injuries are common reasons for emergency department visits. In fact, an estimated 2 million Americans suffer ocular injuries each year. Evaluation and treatment of physical and chemical injuries to the eyes and eyelids begin with a systematic examination. Visual acuity and pupillary reaction should be assessed first. Evaluation of the eye should precede examination of the periocular structures due to the potential for causing further damage to a full-thickness ocular injury with manipulation of the eyelids. Physical injuries to the eyes and periocular structures include lacerations, abrasions, foreign bodies, and open globe injuries and can range from minor irritation to visual devastation. Chemical injuries can be divided into alkali and acid injuries. Alkali burns are more common, due to the prevalent use of alkali substances in industrial and home cleaning applications, and usually result in more serious injuries. Definitive care of chemical injuries ranges from topical antibiotics to full-thickness skin grafts with the goal of preventing cicatricial scarring and exposure of the ocular surface. Familiarity with the various types of ocular and periocular injuries is important for all medical professionals and is critical to providing the most appropriate management.

Circadian dependence of corticosterone release to light exposure in the rat.

Previous studies have demonstrated a positive correlation between glucocorticoid levels and circadian reentrainment time following a shift in the light:dark (LD) cycle. We conducted a series of experiments to examine the circadian dependence of the corticosterone (CORT) response to light. Exp. 1 measured CORT release in rats exposed to light at six timepoints. Light presented during the subjective night increased CORT (p<0.05), while light presented during the subjective day did not. In Exp. 2, we documented the time course of the CORT response to light in entrained animals. Rats exposed to light at zeitgeber time (ZT) 18 had a maximal increase in CORT levels following 60 min of stimulus presentation (p<0.05). There was also an increase in adrenocorticotropic hormone following 15 min of light at ZT18 (p<0.05). In an effort to elucidate the effect of changes in the LD cycle on the circadian profile of CORT, Exp. 3 followed the CORT rhythm (in cerebrospinal fluid) of rats prior to and following a shift in the LD cycle. The CORT nadir was elevated following a 6 h photic advance (p<0.05), as was the mean CORT concentration during the peak phase (p<0.05). Most components of the circadian CORT rhythm, however, failed to show an immediate shift towards the change in the light cycle. Together, these data support the hypothesis that a photic phase-shift results in elevated CORT levels, while the rhythm of CORT secretion is robust against changes in the photic environment.