To investigate whether cataract surgery is a risk factor for developing new-onset thyroid eye disease in patients with preexisting thyroid disorders using a large, population-level database. The study utilized a large database of deidentified electronic health records. Patients who underwent cataract extraction were divided into 2 cohorts and were balanced using propensity score matching for demographic factors and comorbidities, including age, sex, race, diabetes mellitus, hyperlipidemia, and nicotine dependence. The incidence of thyroid eye disease-related outcomes was assessed at 3-time intervals following the surgery date: up to 3 months, 3-6 months, and 6-12 months. The need for orbital decompression surgery was also assessed. A secondary sensitivity analysis was conducted for patients with hyperthyroidism. After propensity score matching, 87,179 pairs were analyzed. Patients with thyroid disease had a significantly higher risk for the composite thyroid eye disease outcome at all time intervals: 0-3 months (risk ratio [RR]: 1.30, 95% confidence interval [CI]: 1.12-1.51), 3-6 months (RR: 1.30, 95% CI: 1.12-1.51), and 6-12 months (RR: 1.51, 95% CI: 1.33-1.71). The risk was even more pronounced in the hyperthyroid subgroup (n = 8,381), reaching a 103% increased risk at 6-12 months (RR: 2.03, 95% CI: 1.39-2.95). While no significant difference was observed for orbital decompression surgery in the immediate postoperative period, a significantly increased risk emerged at the 6-12-month interval (RR: 1.59, 95% CI: 1.13-2.24). Cataract surgery is associated with a significantly increased risk of developing thyroid eye disease-related outcomes in patients with underlying thyroid disease. While the overall incidence may be low, the potential consequences can be serious, highlighting the importance of clinical awareness, patient counseling, and close postoperative monitoring for this at-risk population.

This study aims to compare the efficacy of phenylephrine 2.5% ophthalmic solution versus traditional upper eyelid taping in evaluating surgical need and insurance reimbursement eligibility for patients with visually significant ptosis. This single-arm, sequential study included 27 eyes with ptosis. Eyes were evaluated under 3 testing conditions: at baseline, after manual eyelid taping, and post phenylephrine instillation. The outcome measures were change in margin reflex distance 1 and superior visual field, assessed using tangent screen VF testing. Participants completed a poststudy questionnaire evaluating their experience. Margin reflex distance 1 increased from a mean baseline of 0.83 mm to 2.17 mm after phenylephrine (mean improvement 1.33 mm, 95% confidence interval: 1.09-1.57 mm, p < 0.001). Mean VF improved from 6.85° to 21.77° with taping and to 22.56° with phenylephrine. The insurance criterion (≥12° increase) was met in 88.8% of eyes with taping and 92.5% of eyes with phenylephrine, with no significant difference in the proportion of eyes meeting criteria (p = 1.000). Margin reflex distance 1 and VF changes after phenylephrine instillation showed no positive correlation (rs = 0.13, p > 0.05). Patient satisfaction scores were higher with phenylephrine (4.26 ± 0.81) compared with manual taping (3.67 ± 0.48 (mean difference 0.59, p < 0.001). Phenylephrine 2.5% ophthalmic solution provides comparable visual field improvements and significantly higher patient satisfaction compared with manual upper eyelid taping for preoperative VF testing in the context of insurance reimbursement eligibility for patients with ptosis. ClinicalTrials.gov Identifier: NCT05890027.

To analyze the safety of oxymetazoline hydrochloride ophthalmic solution 0.1% for blepharoptosis using real-world Food and Drug Administration Adverse Event Reporting System data. This retrospective pharmacovigilance study queried the Food and Drug Administration Adverse Event Reporting System database utilizing OpenVigil 2.1 for oxymetazoline eye drop adverse drug events (ADEs) from Food and Drug Administration approval on January 7, 2020, through April 30, 2025. Disproportionality analysis employed standard methodologies, including reporting odds ratios (RORs) and chi-squared analyses. Three hundred six patients with 658 ADEs from oxymetazoline eye drop were analyzed, revealing 30 significant safety signals. All ADEs on the drug label were identified in this cohort (multiple RORs, all p < 0.001): ocular surface disease (N = 129, 34.5%), conjunctival hyperemia (N = 43, 11.5%), temporary visual blurring (N = 33, 8.8%), instillation site pain (N = 27, 7.2%), headache (N = 32, 8.6%). Novel ADEs (not on the drug label) were vitreoretinal complications (N = 12, 3.2%, multiple RORs, all p < 0.001)-retinal detachment (N = 3, 0.8%), vitreous detachment (N = 3, 0.8%), vitreous floaters (N = 3, 0.8%), and vitreous hemorrhage (N = 3, 0.8%)-mydriasis (N = 21, 5.6%, ROR 175.4 [112.4-273.7], p < 0.001), hypertension (N = 6, 1.6%, ROR 3.2 [1.4-7.2], p = 0.009), and tachyphylaxis (N = 5, 1.3%, ROR 5.1 [2.1-12.4], p < 0.001). This Food and Drug Administration Adverse Event Reporting System analysis of oxymetazoline eye drops corroborated prior ADEs, including ocular surface disease, conjunctival hyperemia, transient blurred vision, instillation site pain, and headache. The study revealed new safety signals for vitreoretinal complications, hypertension, mydriasis, and tachyphylaxis. Further studies are warranted to confirm these associations and describe mechanisms such as vitreoretinal traction.

To describe a novel technique of tragal cartilage contouring during facelift surgery and evaluate its effectiveness in preserving tragal contour and preventing postoperative tragal deformities. A retrospective chart review was performed of patients who underwent rhytidectomy with tragal cartilage contouring between January 2022 and December 2023 by a single surgeon. Following flap elevation and repositioning, the cephalic tragal rim was trimmed, vertically scored, then contoured with a horizontal mattress suture to support a convex surface postoperatively. Overlying soft tissue was anchored to the superficial musculoaponeurotic system to reduce tension. Standardized pre- and postoperative photographs were evaluated by 3 independent, blinded, oculoplastic surgeons using a 4-point Likert scale to assess tragal contour, peritragal contour, scar visibility, and overall aesthetic result. Patients also provided subjective ratings of their aesthetic outcome. Twenty-eight patients (24 women, 4 men; mean age 62 years, range 51-74) were included, with a mean follow-up of 8 months (range, 4-12). Independent reviewers rated all tragal contour outcomes as "good" or "excellent," with no cases rated "fair" or "poor." All patients rated their aesthetic outcome as "excellent." No complications or secondary interventions occurred. Tragal cartilage contouring is an effective technique that can be performed during rhytidectomy. By addressing cartilage shape and tension distribution, this method preserves tragal contour and prevents common postoperative deformities, supporting consistently favorable aesthetic results.

CASE PRESENTATION Fetal MRI obtained after abnormal prenatal ultrasonography demonstrated a multiloculated retro-orbital cystic mass with anterior displacement of the left globe (Panel A). Marked proptosis was present at birth (Panel B). Despite 3 intraorbital bleomycin injections, follow-up MRI showed no meaningful reduction in tumor size or mass effect (Panel C). The patient developed severe exposure keratopathy with corneal opacification prior to definitive surgical intervention, resulting in deep amblyopia. The lesion was excised via a lateral orbitotomy using a swinging lower eyelid incision with lateral canthotomy and inferior cantholysis. Drilling of the deep lateral orbital wall and entry into the medial orbital floor facilitated piecemeal tumor removal. Histopathologic examination confirmed a mature orbital teratoma. Postoperatively, the globe was structurally preserved with a satisfactory cosmetic outcome (Panel D), and the last documented visual assessment was fix and follow, maintained.

A 73-year-old woman presented with 2 months of painless left periorbital erythema and swelling, previously treated as “orbital cellulitis” with multiple antibiotic courses without response. Examination showed firm, erythematous nodularity of the left upper and lower eyelids with broad extension around the orbital rim and slightly of the right upper lid (panel A,B) with radiographic postseptal orbital involvement without clinical orbital symptoms (panel C,D). Initial biopsy reported “probable chalazion,” but repeat biopsy revealed estrogen receptor–positive, progesterone receptor–positive, human epidermal growth factor receptor 2-negative high-grade invasive histiocytoid lobular carcinoma. Histologically, eyelid involvement of breast cancer metastasis tends to be lobular in subtype, similar to that seen in orbital metastatic cases; however, as the histiocytoid subtype of lobular breast carcinoma may be prone to histopathologic misidentification, recognition of this cutaneous metastatic presentation is critical to enable timely oncologic management. Patient permission was obtained for the use of the photograph.FIG.:

Acquired punctal stenosis (APS) represents a common cause of epiphora and a reason for attendance at oculoplastic clinics. The three-snip punctoplasty is the mainstay of APS treatment, although perforated punctal plugs (PPPs) represent an alternative, offering reversibility and less burden on minor-operation lists. This study aimed to identify if PPPs are an acceptable alternative to the three-snip punctoplasty through comparison of functional, anatomical, and quality of life outcomes. Participants with APS were randomized to receive either a three-snip punctoplasty or PPP in this assessor-masked study. Participants were followed up for 1 to 2 years, with a total of 3 follow-up visits. Data collected included patient demographics, slit-lamp examination findings, punctum dimensions on punctal optical coherence tomography, and results of Watery Eye Quality of Life questionnaire assessment. Forty-seven patients were recruited, with 25 attending the first postoperative visit and 32 providing final follow-up data via a telephone questionnaire. Both groups had significant reductions in weekly eye watering episodes and total Watery Eye Quality of Life scores, with no significant difference between groups. Only the three-snip group had a significant improvement in their simple 1 to 10 quality-of-life rating, with a significantly greater improvement than the PPP group. Following the intervention, three-snip had wider punctal optical coherence tomography and Kashkouli grade. Both punctoplasty and PPPs are effective APS interventions. Despite greater enlargement to punctal anatomy following three-snip punctoplasty, PPPs, and three-snip punctoplasty both improve epiphora, although three-snip punctoplasty may provide a greater improvement to quality of life.

A 65-year-old male presented with a 5-year history of right-sided eyelid swelling and retrobulbar pressure sensation. Ophthalmic examination revealed visual acuity of 20/20 bilaterally, with no ocular motility defects or signs of compressive optic neuropathy. There was right upper eyelid fullness and 3 mm of proptosis (Panel A). MRI of the orbits demonstrated an expansile mass at the right greater wing of the sphenoid with intracranial extension to the middle cranial fossa and a large intraconal cystic mass in the lateral orbit causing mass effect on the lateral rectus, globe, and optic nerve (Panel B). No optic nerve signal abnormality was detected. An orbitotomy and biopsy were performed to obtain a tissue diagnosis of the cystic lesion and sphenoid bone (Panel C). Histopathological analysis showed a meningothelial neoplasm composed of sheets of spindle cells and inflammatory infiltrate with a prominent cystic component, revealing a WHO Grade 1 spheno-orbital meningioma (Panel D). Mitotic activity was 2 per 10 high-power microscopic fields, and the Ki67 proliferation marker was focally increased. The patient then underwent a gross total resection of the spheno-orbital meningioma and decompression of the optic nerve via a right pterional craniotomy. Spheno-orbital meningiomas are typically solid, en-plaque tumors with sheetlike infiltrative growth. Only 3.5% of all intracranial meningiomas have a cystic component, and cystic spheno-orbital meningiomas are even rarer, with only 1 case reported in the literature. Once the diagnosis is established, surgical management includes gross total resection when able.FIG.:

A 52-year-old healthy man presented after a fall with direct blunt impact against a table edge. Head CT demonstrated a fracture of the right zygomatic process, with an inwardly displaced bony fragment impinging on the posterior globe wall (red arrow), without evidence of globe rupture or perforation (Panel A, left). Fundus examination revealed a focal superotemporal indentation of the posterior segment corresponding anatomically to the site of external compression (Panel B). B-scan ultrasonography demonstrated focal deformation of the globe contour with a posterior acoustic shadowing caused by the compressive bony fragment (Panel C). Optical coherence tomography through the corresponding region revealed focal indentation of the posterior globe wall (Panel D). Given the degree of globe compression, the patient underwent urgent orbital surgery via an extended eyelid crease approach. Four inwardly displaced orbital bone fragments were identified and removed, resulting in decompression of the globe. Postoperative CT obtained several hours after surgery demonstrated resolution of the bony impingement on the globe (Panel A, right). This case underscores the importance of a thorough dilated ocular examination following orbital trauma, as well as the need for dedicated orbital imaging. To our knowledge, optical coherence tomography documentation of posterior globe wall indentation from external bony compression has not been previously reported. Optical coherence tomography may provide additional value in evaluating the retina and choroid at the site of compression and may guide surgical urgency or prognosis.FIG.: