Ophthalmic Plastic And Reconstructive Surgery[JOURNAL]
Sun
200 papers
Primary Periorbital Extra-skeletal Osteoma: A Novel Clinical Entity.
Chaudhury AS, Gregerson CH, Li M … +2 more , Maddie N, Godfrey KJ
Ophthalmic Plast Reconstr Surg · 2025 Dec · PMID 41698058 · Publisher ↗
Osteomas are typically slow-growing benign masses that do not require surgical intervention unless the patient is symptomatic. Orbital osteomas are rare, with fewer than 15 cases of primary orbital osteomas documented in...
Osteomas are typically slow-growing benign masses that do not require surgical intervention unless the patient is symptomatic. Orbital osteomas are rare, with fewer than 15 cases of primary orbital osteomas documented in the literature. When present, an osseous connection to the bony orbit is usually noted. The authors present the first report of a primary periorbital extra-skeletal osteoma.
Extended Long-Term Follow-Up of Proptosis Regression After Teprotumumab Treatment for Thyroid Eye Disease.
Rosenblatt TR, Chiou CA, Yoon MK … +3 more , Lee NG, Wolkow N, Freitag SK
Ophthalmic Plast Reconstr Surg · 2026 Feb · PMID 41696796 · Publisher ↗
PURPOSE: A previous study found high rates of proptosis regression after teprotumumab treatment for thyroid eye disease, though having been published relatively early in the teprotumumab era, it had gaps in follow-up fre...
PURPOSE: A previous study found high rates of proptosis regression after teprotumumab treatment for thyroid eye disease, though having been published relatively early in the teprotumumab era, it had gaps in follow-up frequency and duration. This study extends on the previously reported cohort to better understand teprotumumab's durability. METHODS: Retrospective analysis of all patients who completed all 8 teprotumumab infusions at 1 institution from January 1, 2020 to December 31, 2022. Primary outcomes were proptosis regression at most recent follow-up compared with immediately posttreatment and pretreatment. RESULTS: Of 113 patients, 150 (66.4%) eyes of 83 patients had regression at most recent follow-up (mean 20.4 months posttreatment) compared with immediately posttreatment, averaging 2.8 mm (range 0.5-10.0). Ninety-five eyes of 55 patients (42.0%) regressed by ≥2 mm (mean 3.8, range 2.0-10.0). Mean time to first documentation of regression was 10.2 months (range 2.7-39.0); 67.2% of eyes continued to worsen after initial regression. Compared with pretreatment, 137 eyes of 77 patients (60.6%) had net improvement, averaging 2.7 mm (range 0.5-10.0), while 71 eyes of 43 patients (31.4%) regressed to become worse than pretreatment by 1.8 mm (range 0.5-5.0). Thyroid eye disease flare occurred in 61 (54.0%) patients, defined as a clinical activity score increase ≥2 (n = 6, 5.3%), proptosis regression ≥2 mm (n = 37, 32.7%), or both (n = 18, 15.9%). CONCLUSIONS: This extended follow-up analysis demonstrated proptosis regression after teprotumumab in two-thirds of eyes at long-term follow-up, with one-third worsening beyond pretreatment proptosis. Two-thirds continued to worsen after initial regression, and over half of patients developed a thyroid eye disease flare. Though most patients maintained net improvement, these results suggest that proptosis effects are not durable in most patients after standard teprotumumab dosing.
Use of Chitosan Granules for Refractory Intraoperative Bleeding in Orbital Vascular Malformations.
Yazici B, Naqadan F, Turudu S … +2 more , Yuksel N, Erdogan C
Ophthalmic Plast Reconstr Surg · 2026 Feb · PMID 41687082 · Publisher ↗
Severe intraoperative bleeding unresponsive to conventional hemostatic methods occurred in 4 patients with distensible orbital venous malformations (n = 3) or orbitotemporal arteriovenous malformations (n = 1) (ages: 15-...
Severe intraoperative bleeding unresponsive to conventional hemostatic methods occurred in 4 patients with distensible orbital venous malformations (n = 3) or orbitotemporal arteriovenous malformations (n = 1) (ages: 15-27 years; 3 women, 1 man) during surgical excision of the vascular masses. The bleeding originated from the intraorbital soft-tissue or intraosseous components of the lesions. In all cases, hemostasis was achieved following the application of chitosan granules with compression. Estimated blood loss ranged from 150 to 700 ml, and 1 patient required a blood transfusion. No postoperative hemorrhage developed, and no ocular toxicity or abnormal healing attributable to the intraorbital use of chitosan granules was observed. Chitosan granules may be useful for managing refractory intraoperative bleeding during orbital surgery. Further studies are warranted to validate these observations.
Vascularized Preaponeurotic Fat Flap Coverage in Upper Eyelid Gold Weight Implantation.
Udhay P, Agarwal A
Ophthalmic Plast Reconstr Surg · 2026 Jul-Aug 01 · PMID 41687081 · Publisher ↗
PURPOSE: To describe a novel modification of upper eyelid gold weight implantation using a vascularized preaponeurotic fat pedicle for improved implant concealment, and to report outcomes from a 4-patient case series. ME...
PURPOSE: To describe a novel modification of upper eyelid gold weight implantation using a vascularized preaponeurotic fat pedicle for improved implant concealment, and to report outcomes from a 4-patient case series. METHODS: Four patients with paralytic lagophthalmos underwent tarsal gold weight implantation with concealment using an inferiorly advanced pedicled preaponeurotic fat flap. Implant visibility, eyelid contour, closure, and complications were assessed. RESULTS: All 4 patients achieved improved eyelid closure (complete in 3, near-complete in 1). The vascularized fat flap provided robust implant coverage in all cases. One patient had mild early edema, resolving by 1 month. No implant visibility, extrusion, or contour deformity was noted at final follow-up (8-24 months). CONCLUSIONS: This technique offers a simple and reproducible method to enhance cosmetic results of gold weight implantation. The vascularized fat flap provides durable, living coverage with excellent concealment and maintains optimal lid mechanics without donor site morbidity.
Systemic Effects of Teprotumumab Treatment on Thyroid Function in Patients With Thyroid Eye Disease: A Retrospective Study.
Penteado RC, Sargsyan S, Meller LLT … +5 more , Shoji MK, Al-Sharif E, Kikkawa DO, Korn BS, Liu CY
Ophthalmic Plast Reconstr Surg · 2026 Feb · PMID 41687080 · Publisher ↗
BACKGROUND: Teprotumumab, a monoclonal antibody targeting the insulin-like growth factor-1 receptor, has demonstrated significant efficacy in treating thyroid eye disease. While its ophthalmic benefits are well establish...
BACKGROUND: Teprotumumab, a monoclonal antibody targeting the insulin-like growth factor-1 receptor, has demonstrated significant efficacy in treating thyroid eye disease. While its ophthalmic benefits are well established, limited data exist regarding its effects on thyroid hormone regulation. OBJECTIVE: To characterize changes in thyroid function associated with teprotumumab therapy in thyroid eye disease patients. METHODS: We performed a retrospective comparative study of 46 thyroid eye disease patients treated with teprotumumab and 46 thyroid eye disease patients treated with orbital decompression at a tertiary care facility between January 2020 and December 2023. Thyroid function tests (thyroid-stimulating hormone and free thyroxine) were analyzed at pretreatment and posttreatment. Subgroup analysis was conducted based on prior thyroidectomy or radioactive iodine therapy. Clinical outcomes, including proptosis and Clinical Activity Score, were also evaluated. RESULTS: The teprotumumab cohort had a mean age of 55.9 years, with 80.5% female and 65.2% hyperthyroid at presentation. The orbital decompression cohort mean age was 49.8 years, with 89.1% female and 80.4% hyperthyroid. Both groups showed significant improvements in Clinical Activity Score and proptosis. In the teprotumumab group, free thyroxine levels significantly declined posttreatment (1.7 ± 1.2 to 1.3 ± 0.4, p = 0.049), particularly in patients without prior thyroidectomy/radioactive iodine (1.8 ± 1.4 to 1.2 ± 0.3, p = 0.041). The orbital decompression group showed no significant change in free thyroxine levels (p = 0.63). Over half (52.2%) of teprotumumab patients required medication adjustments during therapy, compared with 12.5% in the orbital decompression group (p < 0.001). CONCLUSIONS: Teprotumumab may impact thyroid hormone homeostasis, especially in patients with functioning thyroid tissue, suggesting a need for endocrine monitoring with treatment.
Dacryocystorhinostomy Practice Patterns Among ASOPRS Members: A Shift in Preferences and Attitudes.
Sanchez Figueroa G, Sanchez Figueroa N, Abdelsalam A … +5 more , Yu CY, Bradley EA, Tooley AA, Griepentrog GJ, Wagner LH
Ophthalmic Plast Reconstr Surg · 2026 Feb · PMID 41687079 · Publisher ↗
PURPOSE: To determine current dacryocystorhinostomy (DCR) practice patterns of American Society of Ophthalmic Plastic and Reconstructive Surgery members and identify surgeon and case-related factors impacting preference...
PURPOSE: To determine current dacryocystorhinostomy (DCR) practice patterns of American Society of Ophthalmic Plastic and Reconstructive Surgery members and identify surgeon and case-related factors impacting preference for endoscopic versus external DCR and the use of preoperative imaging. METHODS: A cross-sectional web-based anonymous 16-question survey was distributed to 277 American Society of Ophthalmic Plastic and Reconstructive Surgery members enrolled in survey-based research. The survey assessed surgeons' demographics, practice settings, surgical preferences, and imaging practices. Responses were summarized and compared using statistical tests for frequency distribution. RESULTS: A total of 111 surgeons (40.0%) responded to the survey. Utilization of endoscopic DCR (endoDCR) was highly variable, with 57% of junior surgeons (<5 years in practice) using it for >66% of their cases, compared with only 18.3% of surgeons with >15 years postfellowship experience. High utilization of endoDCR (>66% of cases) was more common in academic surgeons compared with private practice (48.4% vs. 19.6%, p < 0.01). The most cited reasons for endoDCR were scar avoidance and revision surgery. For external DCR, anatomical barriers and concern for mass/need for biopsy were common indications. Most surgeons only order imaging for certain indications, such as prior sinonasal surgery, facial trauma, suspected tumor, or atypical presentation. CONCLUSION: Utilization of endoDCR was correlated with years in practice, with younger surgeons preferring the endoscopic technique. A large majority felt that the relevance of imaging is low in most patients. Future research is needed to standardize case-based indications for endoscopic versus external approaches and preoperative imaging.
Thyroid Eye Disease (TED) Monocytes Express a Functional Thyrotropin Receptor and Express Increased IL-6 and IL-8: Possible Mechanistic Implications.
Douglas RS, Ugradar S, Mester T … +2 more , Parunakian E, Smith TJ
Ophthalmic Plast Reconstr Surg · 2026 Jul-Aug 01 · PMID 41687076 · Publisher ↗
PURPOSE: Monocytes are involved in autoimmune diseases, including Graves disease and thyroid eye disease (TED). The authors studied the expression and function of the thyrotropin receptor (TSHR) in all subsets (classical...
PURPOSE: Monocytes are involved in autoimmune diseases, including Graves disease and thyroid eye disease (TED). The authors studied the expression and function of the thyrotropin receptor (TSHR) in all subsets (classical: CD14 ++ , CD16 - ; intermediate: CD14 ++ , CD16 + ; nonclassical: CD14 + , CD16 ++ ), because the functional consequences of TSHR signaling induced by TSHR autoantibodies may contribute to TED. METHODS: Flow cytometry was used to determine TSHR, intracellular IL-6 and IL-8, Akt phosphorylation, caspase 3, and reactive oxygen species production by monocytes from isolated peripheral blood mononuclear cells. Real-time polymerase chain reaction was used to measure mRNA of TSHR, IL-6, and IL-8 from enriched monocytes. RESULTS: Monocytes express TSHR, with expression induced by thyroid-stimulating hormone and Graves disease-specific autoantibody M22. Basal phosphorylated Akt levels were greater in monocytes from patients with TED. Thyrotropin receptor signaling was mediated through Akt. Monocytes produced reactive oxygen species and cytokines IL-6 and IL-8 in response to TSHR signaling. Cytokine expression was greater in classical and intermediate monocytes from patients with TED than those from healthy controls stimulated with thyroid-stimulating hormone and M22. Thyroid-stimulating hormone and M22 promoted apoptosis in intermediate and nonclassical monocytes but not classical monocytes. Apoptosis of nonclassical and intermediate monocytes appears mediated through caspase 3 since thyroid-stimulating hormone stimulated caspase 3 activation. CONCLUSION: These results demonstrate functional TSHR on monocytes, and TSHR signaling stimulates proinflammatory cytokine and reactive oxygen species response, with increased response in monocytes from patients with TED. This suggests an important role for stimulatory autoantibodies-TSHR interaction in monocyte function and activation, which may be relevant to TED development.
Eyelid Xanthelasma and Cardiovascular Outcomes: A Propensity-Matched Analysis.
Bineshfar N, Schmuter G, Shah J … +2 more , Godfrey KJ, Lee WW
Ophthalmic Plast Reconstr Surg · 2026 Feb · PMID 41687032 · Publisher ↗
PURPOSE: Xanthelasma palpebrarum (XP) is a common periocular lesion often regarded as benign. However, its potential association with systemic lipid dysregulation and cardiovascular disease remains controversial. This st...
PURPOSE: Xanthelasma palpebrarum (XP) is a common periocular lesion often regarded as benign. However, its potential association with systemic lipid dysregulation and cardiovascular disease remains controversial. This study aimed to evaluate the relationship between XP, dyslipidemia, and major cardiovascular outcomes using a large-scale, electronic health record dataset. METHODS: This retrospective propensity score-matched cohort study used de-identified electronic health record data from TriNetX, a global federated research network. Adults aged 20 to 85 years with and without XP were identified between August 5, 2005, and August 5, 2025. XP cases were matched 1:1 to controls without XP based on age, sex, comorbidities, and other covariates. Primary outcomes included the incidence of hyperlipidemia and major adverse cardiovascular events. Secondary measures included lipid profile values and use of lipid-lowering medications. Cox proportional hazards models estimated hazard ratios (HRs) for outcomes, adjusted for demographics and comorbidities. RESULTS: A total of 40,096 patients (20,048 with XP; 20,048 controls) were included in the analysis. The mean age at index was 53.7 years in both groups. Male sex accounted for 28.3% of the XP cohort and 28.4% of the control group. Lipid profiles differed significantly between groups. Compared with controls, patients with XP had higher rates of hyperlipidemia (32.2% vs. 27.6%; p < 0.0001) and major adverse cardiovascular event (13.0% vs. 11.4%; p < 0.0001), while all-cause mortality was not significantly different in unadjusted comparisons (3.1% vs. 3.3%; p = 0.27). In Cox proportional hazards models, XP was associated with increased risk of hyperlipidemia (HR: 1.38; 95% CI: 1.35-1.41; p < 0.0001), major adverse cardiovascular event (HR: 1.26; 95% CI: 1.22-1.31; p < 0.0001), and a statistically significant but small elevation in all-cause mortality (HR: 1.09; 95% CI: 1.01-1.17; p = 0.0324). CONCLUSIONS: XP is significantly associated with atherogenic lipid profiles, greater use of lipid-lowering medications, and increased risk of cardiovascular events. Recognition of XP during routine ophthalmic examinations may provide an opportunity for early cardiovascular risk stratification.
Effect of Subcutaneous Tranexamic Acid on Hemostasis and Ecchymosis in Oculofacial Procedures: A Double-Blind, Placebo-Controlled, Randomized Trial.
Deng W, Kozlov M, Shinder R
Ophthalmic Plast Reconstr Surg · 2026 Feb · PMID 41687031 · Publisher ↗
PURPOSE: The aim of this study was to assess the hemostatic effect of local tranexamic acid (TXA) in varied oculofacial procedures. METHODS: This is a prospective, randomized, placebo-controlled, double-blind study of 3,...
PURPOSE: The aim of this study was to assess the hemostatic effect of local tranexamic acid (TXA) in varied oculofacial procedures. METHODS: This is a prospective, randomized, placebo-controlled, double-blind study of 3,234 consecutive patients undergoing oculofacial procedures by a single surgeon (RS) between July 2020 and July 2024. Institutional review board approval was obtained. Patients undergoing unilateral procedures were randomized to either receive local anesthesia with or without TXA, with a concentration of 10 mg TXA/1 ml local anesthetic. For bilateral procedures (e.g., upper blepharoplasty), patients were randomized to receive local TXA solution in 1 eyelid while the contralateral lid received a placebo. Cautery was used in upper blepharoplasty, dacryocystorhinostomy, and lacrimal gland biopsy. Primary outcomes of the study included the duration of surgery, duration of cautery for specific procedures, degree of ecchymosis on postoperative day 7, and days until ecchymosis resolved. RESULTS: Treatment groups for all procedures were similar in terms of gender, age, medical history, and ultimate histopathologic diagnosis when biopsy was performed. Duration of cautery and surgery, ecchymosis grade on postoperative day 7, and duration to ecchymosis resolution were all significantly decreased for the patients treated with TXA for all surgical procedures. No complications, including thromboembolic events, were noted in the TXA group. CONCLUSION: TXA in local anesthetic proved safe and effective at reducing bleeding, surgical time, and ecchymosis at postoperative day 7, with a shorter overall duration of ecchymosis in this cohort.
PD-1 Inhibitors in Orbital and Periocular Squamous Cell Carcinoma: A Review.
Meer E, Vo A, Zhang M … +4 more , Lu JE, Smith L, Winn B, Grob S
Ophthalmic Plast Reconstr Surg · 2026 Feb · PMID 41687030 · Publisher ↗
PURPOSE: Periocular and orbital cutaneous squamous cell carcinoma (cSCC) poses significant therapeutic challenges due to its proximity to critical ocular structures and risk of local invasion. Conventional treatments suc...
PURPOSE: Periocular and orbital cutaneous squamous cell carcinoma (cSCC) poses significant therapeutic challenges due to its proximity to critical ocular structures and risk of local invasion. Conventional treatments such as surgery and radiotherapy can result in substantial morbidity, especially in cases requiring orbital exenteration. Recently, immune checkpoint inhibitors targeting programmed cell death protein-1 (PD-1) have emerged as a novel treatment option for advanced and refractory cSCC. This study aims to systematically review the clinical application, efficacy, and safety of PD-1 inhibitors in the treatment of periocular and orbital cSCC. METHODS: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Web of Science, Embase, and Cochrane Central were searched in June 2025 for studies reporting outcomes of PD-1 inhibitor therapy in periocular or orbital cSCC. Eligible studies included case reports, case series, and clinical trials. Extracted data included patient demographics, tumor characteristics, treatment regimens, outcomes, and adverse events. RESULTS: Thirty-three studies met inclusion criteria, describing 102 patients treated with PD-1 inhibitors, primarily cemiplimab and pembrolizumab. Therapy was used as first-line or after failure of conventional treatments. Overall, 52% of patients achieved complete response, 34% partial response, 7% stable disease, and 7% progressive disease. Treatment was generally well tolerated; 40 patients experienced adverse events, most commonly fatigue, diarrhea, and rash. One fatal myocarditis case and 2 cases of diabetic ketoacidosis were reported. Mean follow-up was 18.8 months. CONCLUSIONS: PD-1 inhibitors show strong efficacy and acceptable safety in periocular and orbital cSCC, offering a potential globe-sparing alternative to exenteration. Further studies are needed to refine treatment selection and timing.
Vertical Tarsal Plate Buckling Following Conjunctival Mullerectomy: An Unusual Complication.
Cale M, Tse BC, Tse DT
Ophthalmic Plast Reconstr Surg · 2026 Feb · PMID 41687029 · Publisher ↗
A 75-year-old patient presented with vertical tarsal plate buckling of both upper eyelids following a conjunctival mullerectomy. Clinical examination demonstrated significant lid laxity and lateral canthal tendon instabi...
A 75-year-old patient presented with vertical tarsal plate buckling of both upper eyelids following a conjunctival mullerectomy. Clinical examination demonstrated significant lid laxity and lateral canthal tendon instability as well as short surgical scars on the conjunctival surface. The purported mechanism was an imbalance between the strong vertical force exerted by the resected muscle applied to a short width of tissue and the relatively weak horizontal lid stabilizing forces. This case underscores the importance of carefully considering all anatomic forces supporting eyelid dynamics prior to ptosis surgery.
Reticular Fiber Distribution in the Upper Eyelid of East Asians.
Kakizaki H, Ahn H, Lian D … +2 more , Ishijima K, Ikeda Y
Ophthalmic Plast Reconstr Surg · 2026 Feb · PMID 41687021 · Publisher ↗
PURPOSE: To examine the distribution of reticular fibers in the upper eyelid of East Asians. METHODS: Central sagittal sections of 24 upper eyelids were obtained from 15 East Asian cadavers aged 36 to 94 years. The speci...
PURPOSE: To examine the distribution of reticular fibers in the upper eyelid of East Asians. METHODS: Central sagittal sections of 24 upper eyelids were obtained from 15 East Asian cadavers aged 36 to 94 years. The specimens were fixed in 10% formalin and stained with silver nitrate. RESULTS: Reticular fibers were abundantly distributed in the upper eyelids. Sheet-like reticular fibers were observed beneath the skin and conjunctiva. The hard tissue of the eyelid margin and the tarsal plate had a lot of reticular fibers. The areas of the tarsal plate without Meibomian glands also demonstrated abundant reticular fibers. The glands (Moll, Zeis, Meibomian, Krause, Wolfring, eccrine, and sebaceous), orbicularis oculi muscle fibers, levator muscle fibers, Müller muscle fibers, cilia, arteries, nerves, and muscle spindles were all surrounded by reticular fibers of comparatively high density. The levator aponeurosis, orbital septum, Whitnall's ligament, and intermuscular transverse ligament showed diffuse distributions of reticular fibers. In contrast, the subcutaneous connective tissue and adipose tissue demonstrated sparse or coarse distributions of reticular fibers. In elderly specimens, both intact and degenerated reticular fibers were observed. A lacerated orbital septum contained few reticular fibers. CONCLUSION: Reticular fibers were distributed a lot in the upper eyelids of East Asians, adapting flexibly to the characteristics of each structure. Elderly specimens exhibited degenerated reticular fibers.
Prevalence of High-Risk Human Papillomavirus in Squamous Cell Carcinomas of the Lacrimal Sac.
Baeza DC, Sayegh Y, Idarraga MA … +4 more , Hernandez ME, Velez-Torres JM, Dubovy SR, Gomez-Fernandez CR
Ophthalmic Plast Reconstr Surg · 2026 Jan · PMID 41586774 · Publisher ↗
PURPOSE: Lacrimal sac malignancies are rare, with squamous cell carcinoma (SCC) being the most common type. High-risk human papillomavirus (HR-HPV) is a known driver of SCC in the oropharynx and other head and neck sites...
PURPOSE: Lacrimal sac malignancies are rare, with squamous cell carcinoma (SCC) being the most common type. High-risk human papillomavirus (HR-HPV) is a known driver of SCC in the oropharynx and other head and neck sites. This study investigated the prevalence of HR-HPV in primary lacrimal sac SCC using p16 immunohistochemistry and RNA in situ hybridization. METHODS: The pathology databases of the Florida Lions Eye Bank Ocular Pathology Laboratory and the Department of Pathology and Laboratory Medicine at the University of Miami Miller School of Medicine were reviewed for cases of primary lacrimal sac SCC with sufficient tissue for HR-HPV testing. P16 positivity was defined as strong, diffuse staining in >70% of tumor cells. RNA in situ hybridization was used to detect transcriptionally active HR-HPV. RESULTS: Fifteen patients (mean age 63 years; 7 men and 8 women) with nonkeratinizing, papillary lacrimal sac SCC were identified. Twelve cases (80%) were positive for both p16 and HR-HPV by RNA in situ hybridization. All 3 HR-HPV negative cases were also p16-negative. Among HR-HPV-positive patients, 92% were Caucasian, with equal gender distribution. The most common presenting symptoms were epiphora (83%), erythema/edema (42%), and pruritus (33%). Most patients were treated with surgery and multimodal therapy. At follow-up (range 5-83 months), 92% of HR-HPV-positive patients were alive. CONCLUSIONS: Primary lacrimal sac SCCs are frequently associated with HR-HPV and typically show nonkeratinizing, papillary morphology. p16 is a reliable surrogate marker for transcriptionally active HR-HPV in these tumors, supporting a potential etiologic role and diagnostic utility.
Thyroid Eye Disease-Like Conditions Associated With Cancer and Immune Check Point Blockage: Systematic Literature Review and Case Report.
Igami Nakassa AC, Sandri Facchin MP, Carregaro V … +1 more , E Cruz AAV
Ophthalmic Plast Reconstr Surg · 2026 Jan · PMID 41575470 · Publisher ↗
PURPOSE: To perform a systematic review of the literature on thyroid eye disease-like (TED-like) orbitopathy occurring as part of paraneoplastic syndromes or associated with immune checkpoint inhibitors and report a case...
PURPOSE: To perform a systematic review of the literature on thyroid eye disease-like (TED-like) orbitopathy occurring as part of paraneoplastic syndromes or associated with immune checkpoint inhibitors and report a case of paraneoplastic TED-like orbitopathy. METHODS: A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases up to July 2025 using predefined keywords related to orbitopathy, malignant neoplasms, paraneoplastic syndromes, and immune checkpoint inhibition. Only full-text articles were included. Eligible studies were independently screened, and data were extracted regarding patient demographics, oncologic diagnosis, immune checkpoint inhibitor exposure, clinical presentation, and imaging features. RESULTS: Thirty-nine reports were retrieved in the literature; among those, 21 patients developed TED-like orbitopathy following immune checkpoint inhibitor therapy, most commonly with anticytotoxic T-lymphocyte-associated protein 4 or antiprogrammed cell death protein 1/programmed cell death protein ligand 1 agents. The clinical pattern was remarkably consistent, characterized by bilateral proptosis, inflammatory signs, and extraocular muscle enlargement, while upper eyelid retraction was present in only 16% of cases. In addition, 18 paraneoplastic cases mimicking TED were retrieved, mainly associated with seminomas, lymphomas, and pulmonary carcinomas. Imaging findings were similar to those seen in classic TED, yet thyroid autoimmunity was absent. We also present a patient with a hepatosplenic T-cell lymphoma who developed bilateral inflammatory orbitopathy and lateral rectus muscle hypertrophy. CONCLUSION: TED-like orbitopathy represents a rare but increasingly recognized manifestation in oncology, occurring either as a paraneoplastic phenomenon or as an immune-related adverse event of checkpoint inhibition. The absence of TRAb positivity and thyroid dysfunction highlights a possible alternative immune mechanism underlying orbital inflammation mediated by cytotoxic T lymphocytes.
Management of Severe Congenital Ptosis: Enhancing Surgical Predictability.
Diab MM, Allen RC
Ophthalmic Plast Reconstr Surg · 2026 Jan · PMID 41575466 · Publisher ↗
PURPOSE: To review current management strategies for severe simple congenital ptosis, highlight technical refinements that optimize levator surgery outcomes, and propose an intraoperative algorithm to enhance surgical pr...
PURPOSE: To review current management strategies for severe simple congenital ptosis, highlight technical refinements that optimize levator surgery outcomes, and propose an intraoperative algorithm to enhance surgical predictability. METHODS: A comprehensive PubMed-based literature review was conducted to identify studies on severe congenital ptosis, preoperative determinants of surgical planning, and operative techniques. Emphasis was placed on intraoperative anatomical variability of the levator palpebrae superioris complex, modifications of levator-based surgery (LBS), and the role of combined procedures. RESULTS: Recent studies demonstrate considerable intraoperative variability in the levator palpebrae superioris complex morphology, including the aponeurosis, muscle belly, and Whitnall's ligament. Traditional reliance on preoperative metrics and standardized resection formulas in LBS often fails to account for this intraoperative variability and the heterogeneity of congenital ptosis. The unpredictability of LBS in severe ptosis has led some surgeons to favor frontalis suspension for its relative consistency, albeit at the cost of physiologic dynamics. Several technical modifications of LBS have been described, including septal debulking, fibrosis release, and direct intraoperative levator assessment. Combined procedures integrating levator advancement with adjunctive lifting tissues have been reported to further enhance eyelid elevation. CONCLUSION: Advances in LBS, including intraoperative levator exploration, fibrosis release, and adjunctive use of neighboring elevator structures, have broadened the potential for functional and aesthetic success in severe congenital ptosis. These findings underscore the importance of dynamic, anatomy-based intraoperative judgment over rigid preoperative formulas. A flexible intraoperative algorithm is proposed to guide surgical choice and improve predictability.
Involutional Entropion: Demographics, Presenting Findings, Surgical Management.
Custer PL, Huecker JB
Ophthalmic Plast Reconstr Surg · 2026 Jul-Aug 01 · PMID 41528965 · Publisher ↗
PURPOSE: This study explores the demographics, presentation, and anatomic features associated with involutional entropion, offering insight into the etiology of the condition. Surgical techniques and results are presente...
PURPOSE: This study explores the demographics, presentation, and anatomic features associated with involutional entropion, offering insight into the etiology of the condition. Surgical techniques and results are presented. METHODS: A retrospective chart/photographic review was performed on patients treated between 2005 and 2024. RESULTS: Demographic analysis was limited to 405 patients without prior surgery. Incidence increased with age, with only 1.7% ≤60 years old. Males were more frequently affected than predicted using population data. Unilateral right (57%, p = 0.015) was more common than left entropion. Unilateral entropion was associated with an ipsilateral larger or inferiorly positioned orbit, findings more common on the right. Throughout the study, 30.6% of patients showed signs of bilateral disease. Five hundred nineteen procedures (612 eyelids) were performed. Most included a lateral tarsal strip and posterior retractor attachment. Twenty-one percent of lids had insufficient laxity for a standard lateral tarsal strip. Recurrent cases more commonly involved males (63%, p = 0.018) and the right side (63%, p = 0.047). Postoperative ectropion was more frequent after anterior ( p < 0.001) and chemosis after posterior surgery ( p < 0.001). Recurrence developed in 8 study eyelids (1.3%). Preoperative ipsilateral ptosis (≥1 mm) was present in 33.4% of unilateral cases and often improved after repair. CONCLUSIONS: Incidence of involutional entropion increases with age and is greater in males and on the right. Enophthalmos, retractor laxity, and canthal instability are likely predisposing anatomic factors. Significant horizontal laxity is seldom present. The lateral tarsal strip reestablishes canthal stability, and when combined with posterior retractor attachment to tarsus and orbicularis is highly effective. Complications are uncommon and usually apparent soon after surgery.
Locally Advanced Conjunctival Squamous Cell Carcinoma not Responsive to Immune Checkpoint Inhibitor Therapy: 3 Cases and a Literature Review.
Wolkow N, Lee NG, Emerick KS … +5 more , Freitag SK, Kaufman HL, Miller DM, Chang HP, Stagner AM
Ophthalmic Plast Reconstr Surg · 2026 Jan · PMID 41528963 · Publisher ↗
Three patients with locally advanced conjunctival squamous cell carcinoma originating in the inferior fornix were treated with immunotherapy: a 74-year-old male was treated with 4 cycles of cemiplimab, a 54-year-old fema...
Three patients with locally advanced conjunctival squamous cell carcinoma originating in the inferior fornix were treated with immunotherapy: a 74-year-old male was treated with 4 cycles of cemiplimab, a 54-year-old female was treated with 3 cycles of pembrolizumab, and a 69-year-old female was treated with 2 cycles of pembrolizumab. Tumor progressed in all 3 patients on immunotherapy, requiring orbital exenteration for disease control. Tumor mutational burden was low in all 3 patients: 1.2, 8.1, and 7.1 mut/Mb. Review of the literature reveals 18 cases of invasive conjunctival squamous cell carcinoma treated with immunotherapy in addition to the 3 cases reported herein, with tumors of responders tending to have a higher tumor mutational burden than those of nonresponders. There is increasing evidence that conjunctival squamous cell carcinoma originating in the sun-protected inferior fornix/inferior palpebral conjunctiva has low tumor mutational burden and is less likely to respond to immunotherapy than squamous cell carcinoma of bulbar conjunctival origin.
Radiation Therapy and Nivolumab with Relatlimab-rmbw Achieved a Complete Response in Metastatic Cutaneous Melanoma to the Orbit.
Sellers BT, Chaudhry A, Mitra D … +2 more , Learned K, Sagiv O
Ophthalmic Plast Reconstr Surg · 2026 Jan · PMID 41528958 · Publisher ↗
We present a patient with left orbital metastasis of cutaneous melanoma, treated with 30 Gy in 10 fraction radiation therapy followed by a combination of programmed death-1 inhibitor, nivolumab, and lymphocyte-activation...
We present a patient with left orbital metastasis of cutaneous melanoma, treated with 30 Gy in 10 fraction radiation therapy followed by a combination of programmed death-1 inhibitor, nivolumab, and lymphocyte-activation gene inhibitor, relatlimab. The patient achieved a complete response to treatment, with no evidence of recurrence of the orbital mass, 17 months after treatment initiation.
Upper Eyelid Retraction: An Atypical Sign of Orbital Conjunctival Inclusion Cyst.
da Silva AR, Cunha RF, Chahud F … +1 more , Cruz AAVE
Ophthalmic Plast Reconstr Surg · 2026 Jan · PMID 41528954 · Publisher ↗
Orbital conjunctival inclusion cysts are uncommon lesions that may develop as congenital choristomatous rests or as a result of traumatic or iatrogenic implantation of conjunctival epithelium. Depending on their size and...
Orbital conjunctival inclusion cysts are uncommon lesions that may develop as congenital choristomatous rests or as a result of traumatic or iatrogenic implantation of conjunctival epithelium. Depending on their size and location, they can be asymptomatic or cause proptosis, diplopia, mechanical ptosis, and ocular motility disturbances. We report a rare case of a 63-year-old female patient who developed marked upper eyelid retraction due to a conjunctival inclusion cyst associated with a retinal detachment procedure performed 20 years before presentation. A literature review did not disclose any case of upper eyelid retraction associated with orbital conjunctival inclusion cysts.
A Call to Stop Using Gold.
Allen RC, Malhotra R
Ophthalmic Plast Reconstr Surg · 2026 Jul-Aug 01 · PMID 41528953 · Publisher ↗
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