Ophthalmic Plastic and Reconstructive Surgery

Traumatic Optic Neuropathy A patient presented to a tertiary trauma center after a fall from standing. On arrival to the hospital, he was found to have extensive facial fractures and was describing loss of vision in the left eye. Detailed review of the CT scan revealed a bone fragment protruding in…

Complications of Titanium Mesh Floor Implant A patient with a disfiguring bony lesion of the orbit was eventually diagnosed with fibrous dysplasia. This needed eventual medial maxillectomy and removal of the orbital floor, requiring reconstruction. Titanium mesh orbital floor implant was utilized, …

Blepharophimosis Syndrome Two patients, both children, presented with FOXL2 mutation and similar constellation of findings, namely blepharophimosis, ptosis, telecanthus, and epicanthus inversus. Exam demonstrates ptosis with amblyopia risk, chin up positioning, and frontalis activation. The first p…

Active Thyroid Eye Disease with Pretibial Myxedema A patient with a 10-year history of hyperthyroidism treated with levothyroxine and liothyronine developed one month of intermittent double vision, redness, and foreign body sensation. His exam was notable for vision 20/20 in the right eye and 20/30…

Sebaceous Cell Carcinoma A patient presents to the Bascom Palmer emergency room with complaints of bloody tearing. Exam demonstrates a large, erythematous epithelial mass on the left upper eyelid palpebral surface. Biopsy of the lesion demonstrates a poorly differentiated carcinoma demonstrating po…

Infantile Hemangioma An infant with history of preterm birth presented to the Bascom Palmer emergency room with a rapidly progressive left upper lid mass. Evaluation showed non-axial proptosis and a large superonasal, vascular mass deep in the left orbital rim. MRI brain and orbits with and without…

Kabuki Syndrome Associated Euryblepharon and Ptosis Repair with Post Operative Hematoma A teenager with a history of Kabuki Syndrome presents to the ophthalmology clinic for evaluation of bilateral ptosis and eye rubbing, and epiphora. Best corrected visual acuity is 20/40 bilaterally, intraocular …

Presumed Rhino-Orbital Mucormycosis A patient with a past medical history of PCOS and type 2 diabetes mellitus presented to an outside hospital six weeks pregnant with right sided facial pain and periorbital swelling. Ophthalmology was consulted for sudden, progressive vision loss in the right eye.…

Sub-Periosteal Abscess A pediatric patient presented as a transfer from OSH with orbital cellulitis secondary to a superior located sub-periosteal abscess (SPA). The patient has a history of acute on chronic sinusitis and had FESS with sinus debridement and abscess drainage 5 days prior to arrival.…

Intraorbital Foreign Body A patient presented with right eye redness, swelling, and diplopia for 6 weeks after a dirt bike accident, where his right eye hit a tree branch. He underwent imaging and evaluation at an outside institution which revealed orbital fractures, but no evidence of an orbital f…

Intraosseous Hemangioma An otherwise healthy patient presented to the Emergency Room for evaluation of a left orbital rim lesion, found incidentally by an eyebrow technician. On exam, there was a firm bony mass along the superior orbital rim. Eye exam was otherwise unremarkable. CT scan of the orbi…

Conjunctival SCC A patient presented to the emergency department with a right eye conjunctival mass. Examination showed a large mass, emanating from the conjunctiva. CT scan showed inferior orbital involvement. Surgical treatment via exenteration was carried out, using a lid sparing technique, prov…

A unique way to provide cosmesis.

Hydrolyzed MIRAgel Scleral Buckle A patient presented with one year of gradually worsening left eye pain and binocular diplopia. He had a history of remote retinal detachment repair in 1988 and prostate cancer in 2019 s/p radiation therapy in remission. In the left eye, he had limitations to gaze i…

Intraorbital Foreign Body Intraorbital foreign bodies most commonly present with an ocular or penetrating injury. However, when the globe is not involved, the presentation of an intraorbital foreign body can be subtle. Here, we present a case of a 21-year-old female with right upper and lower lid s…

Slit lamp photo post trauma with bungee cord. There was 5 clock hours of iridodialysis superior nasally with inferior crystalline lens subluxation seen on retroillumination. Post-surgical iris repair and lensectomy the anatomy is restored.

In this module, we will look at:


Eyelids

Tear Drainage System

Orbit

An elderly patient with anophthalmic socket pain underwent orbital exploration. Intra-operative photo shows a large cystic lesion superior to her orbital implant. Close up photograph of the cyst shows a 1-mm intact cystic lesion filled with gray opaque fluid.