The Iowa implant is a quasi-integrated implant with four mounds on its anterior surface. The rectus muscles are imbricated between the mounds, resulting in a socket with four protrusions that articulate with a custom-fit...The Iowa implant is a quasi-integrated implant with four mounds on its anterior surface. The rectus muscles are imbricated between the mounds, resulting in a socket with four protrusions that articulate with a custom-fitted prosthesis having four concavities. This imparts excellent motility and support for the prosthesis. This article describes the indications for enucleation, the Iowa implant, surgical technique, and postoperative complications.
Evisceration is the removal of the intraocular contents of the globe. I favor evisceration with retention of the cornea when at all possible. Surgical techniques for evisceration with and without keratectomy are discusse...Evisceration is the removal of the intraocular contents of the globe. I favor evisceration with retention of the cornea when at all possible. Surgical techniques for evisceration with and without keratectomy are discussed. A promising new implant material, hydroxyapatite, is described. The outstanding advantage of this material is its transformation into "living tissue." Although extremely rare, evisceration can be associated with postoperative sympathetic ophthalmia in the remaining eye.
Sympathetic ophthalmia is a bilateral diffuse granulomatous panuveitis occurring after accidental or surgical penetrating injury to one eye. Onset of sympathetic ophthalmia may occur as early as 5 days or as late as 42 y...Sympathetic ophthalmia is a bilateral diffuse granulomatous panuveitis occurring after accidental or surgical penetrating injury to one eye. Onset of sympathetic ophthalmia may occur as early as 5 days or as late as 42 years following the injury.
Although penetrating orbital wounds are an uncommon entity they are often associated with vision and life-threatening complications. By careful attention to the history and physical signs of the injured patient and the u...Although penetrating orbital wounds are an uncommon entity they are often associated with vision and life-threatening complications. By careful attention to the history and physical signs of the injured patient and the use of modern computed tomography (CT) scan imaging, the physician will be better able to make an accurate analysis and prognosis of the problem at hand as well as a well-planned therapeutic approach.
Seemingly trivial adnexal injuries may be associated with extensive injuries to the globe, orbit, and brain. A meticulous ophthalmologic examination and orbital and brain computed tomography (CT) scans (axial and coronal...Seemingly trivial adnexal injuries may be associated with extensive injuries to the globe, orbit, and brain. A meticulous ophthalmologic examination and orbital and brain computed tomography (CT) scans (axial and coronal views) are essential for complete evaluation of these patients. The ophthalmologist must remain an active participant in the management of these patients to preserve the integrity of the globe.
Five cases of ocular firearm injuries are presented. A physical analysis of the gunshot wound characteristics, with representative examples, is highlighted. The important early and late complications are completely discu...Five cases of ocular firearm injuries are presented. A physical analysis of the gunshot wound characteristics, with representative examples, is highlighted. The important early and late complications are completely discussed. Appropriate management sequence, including complete evaluation, diagnostic testing, and surgical intervention, is outlined and discussed.
Although periorbital and orbital dog bites are rare, they most frequently occur in young children and commonly involve significant associated adnexal injuries. In most cases, the dog is either the family pet or is otherw...Although periorbital and orbital dog bites are rare, they most frequently occur in young children and commonly involve significant associated adnexal injuries. In most cases, the dog is either the family pet or is otherwise known to the victim. The exact precipitating event is usually unknown. Most victims are treated by a physician soon after injury, and can be reconstructed primarily following meticulous local wound care, including adequate irrigation. Infection is rare, but because of its potentially disastrous consequences, prophylactic treatment with penicillinase-resistant penicillin or cephalosporin seems indicated. Serious, potentially fatal consequences due to underlying intracranial injury in children under aged 2 years, fatal septicemia in splenectomized individuals, tetanus, and rabies must be considered by ophthalmologists who treat such patients.
Periorbital burns require special care as compared with burns of other parts of the body. Not only is one interested in the healing and repair of the burned structures, but also in safeguarding and maintaining the functi...Periorbital burns require special care as compared with burns of other parts of the body. Not only is one interested in the healing and repair of the burned structures, but also in safeguarding and maintaining the function of the underlying eye.
Intravascular occlusion of traumatic carotid cavernous fistulas, originally performed under direct visualization with fascia and/or muscle, has evolved into the use of catheters with pressure-sensitive detachable balloon...Intravascular occlusion of traumatic carotid cavernous fistulas, originally performed under direct visualization with fascia and/or muscle, has evolved into the use of catheters with pressure-sensitive detachable balloons that can be deflated and repositioned prior to final inflation and separation from the catheter. The balloon is filled with contrast material and can be identified with follow-up x-rays. Proptosis is often relieved immediately after this treatment. Detailed pre- and posttreatment ophthalmic evaluations of three consecutive patients with carotid-cavernous fistulas successfully treated with detachable balloon occlusion with a minimum 1-year follow-up are presented. Indications and timing of treatment are discussed. Following blunt head trauma, these patients presented with proptosis, decreased vision, orbital bruit, conjunctival chemosis, diplopia, orbital pain, ocular pulsations and diplopia; they often complained of "a ringing" in the ear on the involved side.
The management of traumatic ptosis is dependent on its etiology, interval between occurrence and examination, degree of ptosis, and levator function. The surgical approach and timing of intervention varies with each case...The management of traumatic ptosis is dependent on its etiology, interval between occurrence and examination, degree of ptosis, and levator function. The surgical approach and timing of intervention varies with each case and provides a challenge to the oculoplastic surgeon. We discuss our approach to the management of traumatic ptosis. Secondary surgery may be necessary to repair over- or undercorrection.
Disturbances of ocular motility following trauma are manifested by diplopia and faulty ocular rotations which frequently require an abnormal head position for fusion. Motility imbalance may occur following injury to the...Disturbances of ocular motility following trauma are manifested by diplopia and faulty ocular rotations which frequently require an abnormal head position for fusion. Motility imbalance may occur following injury to the eye alone, to the eye and associated extraocular muscles, and to the orbital walls, and also following closed head trauma. The clinical findings early following injury may be very different from the clinical picture several months following injury. The diagnosis of abnormal motility includes the use of forced ductions, saccadic velocity recording, active force generation, measurements of deviations of the eyes in the cardinal positions of gaze as well as the use of computed tomography (CT scan) and ultrasonic techniques. The presence of slipped or lost muscles must be diagnosed, and evaluation of restricted rotations and paretic muscles is essential. The treatment of motility disturbance includes relief of restricted rotations by lysis of adhesions and lengthening or recessing appropriate muscles as well as strengthening underacting muscles by resection and/or advancement. In cases of severe trauma one must not overlook injury to the eye itself in addition to the motility disturbance.
Volkmann's ischemic contractures have long been recognized by orthopedic surgeons as a sequela of increased pressure within osseofascial muscle compartments. We present evidence that the same mechanism is a cause of fibr...Volkmann's ischemic contractures have long been recognized by orthopedic surgeons as a sequela of increased pressure within osseofascial muscle compartments. We present evidence that the same mechanism is a cause of fibrosis and contracture of extraocular muscles following orbital blowout fractures. Surgical treatment of a specific, recognizable type of blowout fracture is proposed.
Prioritizing the repair of complex adnexal trauma is important. A logical rational systematic approach based on anatomic considerations has been presented. The use of these principles has resulted in maximizing functiona...Prioritizing the repair of complex adnexal trauma is important. A logical rational systematic approach based on anatomic considerations has been presented. The use of these principles has resulted in maximizing functional and cosmetic return and, in addition, has decreased the extent and necessity for subsequent complex reconstructive procedures.
Medial wall blowout fractures may accompany orbital floor fractures or may occur as isolated fractures after blunt facial trauma. A "Z-plasty"-type incision over the medial orbital region allows the best exposure and cos...Medial wall blowout fractures may accompany orbital floor fractures or may occur as isolated fractures after blunt facial trauma. A "Z-plasty"-type incision over the medial orbital region allows the best exposure and cosmetic result following the repair of an isolated medial wall fracture.
The repair of orbital floor fractures is complicated not only by the technical aspects of the procedure, but by the decision-making process one must initiate to determine when and if the fracture should be repaired. This...The repair of orbital floor fractures is complicated not only by the technical aspects of the procedure, but by the decision-making process one must initiate to determine when and if the fracture should be repaired. This article examines the indications for repairing orbital floor fractures through the maxillary approach and describes the technical aspects and results that can be achieved with this technique.
The fornix or transconjunctival approach to the orbital floor and inferior orbit provides excellent exposure for the surgeon managing orbital fractures. The technique is ideally suited for patients with isolated blowout...The fornix or transconjunctival approach to the orbital floor and inferior orbit provides excellent exposure for the surgeon managing orbital fractures. The technique is ideally suited for patients with isolated blowout fractures; however, it can be combined with other surgical incisions to provide wide exposure of the inferior orbit, zygoma, and maxilla for the repair of more complex midfacial fractures. The surgical technique provides excellent access to the inferior orbit for biopsy or excision of orbital tumors and excellent opportunity for surgically augmenting orbits with posttraumatic enophthalmos or enophthalmos associated with anophthalmic sockets. Orbital decompression into the maxillary antrum and ethmoid sinus is easily accomplished through this incision. By avoiding a cutaneous incision in the lower eyelid, one reduces the risk for development of postoperative ectropion. During wound closure, the lower eyelid can be elevated and tightened and the canthal angle can be restored if necessary.
Trauma to the orbit is evaluated with a careful history, a thorough physical examination, and specific radiographic studies. Orbital trauma involves a wide range of conditions, including soft tissue adnexal injury, orbit...Trauma to the orbit is evaluated with a careful history, a thorough physical examination, and specific radiographic studies. Orbital trauma involves a wide range of conditions, including soft tissue adnexal injury, orbital contusion, optic nerve damage, ocular injury, intraorbital foreign bodies, and orbital fractures. This article emphasizes the importance of an accurate history and a comprehensive examination. It highlights relevant questions to ask, discusses the meaning of pertinent complaints, describes steps in the examination, discusses the diagnostic importance of the physical findings, and recommends specific radiographic studies for accurate identification and localization of orbital fractures and intraorbital foreign bodies.