Periorbital Region Research Articles

Orbital Vascular Anomalies: A Nomenclatorial, Etiological, and Nosologic Conundrum.

Vascular anomalies are a heterogeneous group of disorders that frequently present in the periorbital region. They encompass 2 broad entities: vascular tumors, which possess a proliferative endothelium, and vascular malformations, which are basically localized defects of vascular morphogenesis. The primary goal of this review was to address inaccurate or controversial terminology in the oculoplastic literature concerning orbital and periorbital vascular anomalies and to categorize these lesions in an abridged and simplified hierarchical list that adheres as much as possible to the most recent (2018) iteration for the classification of vascular lesions proposed by the International Society for the Study of Vascular Anomalies (ISSVA). The secondary goal of this review was to review and update information regarding the genetic underpinnings of vascular anomalies and the downstream signaling pathways that are subsequently affected as a result of these genetic errors. A literature review was conducted in PubMed, MEDLINE, PubMed Central, National Center for Biotechnology Information Bookshelf, and Embase for several related keywords including "vascular anomalies, vascular malformations, vascular tumors, and cavernous venous malformation," both with and without adding the keywords "eyelid," "orbital," and "periorbital." In addition, a detailed search was conducted for controversial or obsolete keywords like "cavernous hemangioma," "lymphangioma," and "varices," again in their systemic and orbital/periorbital context. Crucial issues in the 2018 ISSVA classification regarding the proper categorization of orbital vascular anomalies, particularly venous lesions, were critically evaluated and revised, and a regional, simplified, and abridged modification of the ISSVA 2018 classification was proposed. Interdisciplinary and intradisciplinary dialogue concerning orbital vascular anomalies is seriously compromised due to the lack of a unanimous agreement on terminology and the absence of a unified classification concept system. The authors recommend that oculoplastic surgeons adopt ISSVA terminology whenever technically possible and scientifically sound. However, they also propose modifying the ISSVA 2018 classification specifically to adapt to the peculiarities of vascular anomalies in the periorbital region. At present, the simplified classification proposed here is a preliminary first step towards managing patients with orbital vascular anomalies with greater diagnostic and therapeutic precision, until such time in the future when the entire genetic makeup of orbital vascular anomalies is more completely elucidated. Optimistically, this could pave the way for a more robust classification and the ultimate therapeutic cure.

A Study on Pattern of Dermatoses Affecting Periorbital Region and its Clinicodermoscopic Correlation

Background: The periorbital area may be affected by a vast number of dermatoses such as infectious or noninfectious diseases, inflammatory dermatoses, systemic diseases, drug reactions, benign and malignant lesions, and traumatic lesions, thus poses both diagnostic and therapeutic challenge. Objectives: To study the pattern of dermatoses involving periorbital region and to correlate its clinical and dermoscopic findings. Materials and Methods: A cross-sectional study was carried out in patients with periorbital dermatoses (PODs) attending the Department of Dermatology during April 2018–March 2019 after approval from the ethical committee. A detailed history was taken and investigations including hemoglobin levels, Vitamin B12, serum cholesterol, and wood's lamp examination were done as and when required. A prestructured pro forma was used to collect the data. Data were entered into Microsoft Excel 2010 and analyzed using EPI INFO. Ver7 software (Developed by united states of America centre for disease control. Results: A total of 275 patients were studied of which majority of patients belonged to the age group of 41–60 years (38.5%) with a female-to-male ratio of 1.16:1. The most common group of PODs was skin tumors (25.1%), followed by disorders of pigmentation (17.4%), infections (13.1%), and periorbital dermatitis (11.6%). Most common dermoscopy findings of PODs were as follows: (a) common seborrhoeic keratosis (CSK): comedone-like opening, fissures and ridges, and sharp demarcation; (b) verruca vulgaris: finger-like papilla, red brown dots in center of papilla; (c) periorbital hyperpigmentation: blotches, globules, exaggerated pigment network, and reticular vessels; (d) allergic dermatitis: patchy red dots, pinkish hue, and patchy scale; (e) senile comedone: comedone-like opening; and (f) xeroderma pigmentosus: orange–yellow homogenous structures. Conclusion: Periorbital region is an area of cosmetic concern. Dermoscopy improves the differential diagnosis of common PODs and its knowledge may aid to reduce unnecessary invasive procedures such as shaving or incisional biopsies which may lead to scarring.

Impacts of Acupuncture Therapy on Herpes Zoster: Report of 3 Cases

There were three cases (64, 44 and 81 years of age, all male) referred to the rehabilitation service of the Ophthalmology specialty, with the diagnosis of ophthalmic herpes zoster, due to intense pain and macular lesions, vesicles on erythematous base in the periorbital and frontal region, accompanied by intense edema. 64, 44 and 81 years old in order of appearance. Also treated, in the first instance, by dermatology with: analgesics (Dipyrone, Paracetamol), non-steroidal anti-inflammatory drugs (Ibuprofen, Piroxicam), injectable B-complex vitamin therapy, physiological therapy, eye drops and saline solutions. Pain intensity was measured by the Visual Analog Scale (VAS), at the beginning and at the end of the treatment. Acupuncture treatment for 6 to 9 sessions began on different days of the evolution of her illness. The same acupuncture treatment scheme was applied to the three patients: bilateral LI-4 (Hegu) and LI-11 (Quchi). In points on the face, the needles were placed on the healthy side: UB-2 (Zanzhu), SI-17 (Yifeng) and GB-1 (Tungtzuliao). After the first acupuncture session the pain ceased or lessened, and the blisters began to dry up. None had ocular complications and post-herpetic neuralgia did not appear after three months of finishing acupuncture therapy. The evolution was satisfactory in the 3 patients.

Oral manifestations of Hydroa vacciniforme-like lymphoproliferative disorder: a clinicopathological study of a Peruvian population.

Hydroa vacciniforme-like lymphoproliferative disorder (HVLPD) is a chronic Epstein-Barr virus (EBV)-positive lymphoproliferative disease which may either present as an indolent condition or progress to a systemic T-cell lymphoma. All HVLPD diagnosed over a 10-year period were retrieved, and clinical data regarding sex, age, oral and systemic manifestations, and clinical follow-up were obtained. Immunohistochemistry was done in order to characterize the lymphoid cells, and in situ hybridization was used to demonstrate the presence of EBV. Eleven cases were included, with a male predominance and a mean age of 25.1years. Buccal mucosa and the lips were the most affected oral sites, appearing as painful ulcers. All patients exhibited facial oedema, usually affecting the lips, nose and periorbital region. The clinical course was gradual but progressive, with four patients having fever and 3 showing lymphadenopathies. All cases showed a moderate to severe lymphocytic infiltrate with angiotropism, angiocentricity and epidermotropism. Two cases affecting the lip skin exhibited a periappendageal lymphocytic infiltrate. Few large pleomorphic cells were found, surrounded by smaller and medium-sized lymphoid cells, as well as reactive plasma cells, macrophages, neutrophils and eosinophils. All lesions exhibited a cytotoxic T-cell (CD8+) phenotype with a variable proliferative index. All cases were associated with EBV, and all patients died due to complications of the disease. HVLPD is a rare disease that may show oral involvement with a cytotoxic T-cell phenotype, and is strongly associated with EBV. As shown in this series, HVLPD may show aggressive clinical behaviour.

Treatment of Morbihan disease.

Morbihan disease (MD) is a rare condition that involves rosaceous lymphedema or erythematous lymphedema of the middle and upper thirds of the face. It typically affects the periorbital region, forehead, glabella, nose, and cheeks. The etiology of MD remains unclear, and its diagnosis is challenging. MD often tends to be unresponsive to therapies commonly used to treat rosacea, including corticosteroids, isotretinoin, and antibiotics. Surgical treatments have therefore been attempted, but most cases showed unsatisfactory responses. These problems could have resulted from an incorrect recognition and interpretation of the pathophysiology of MD and inaccurate planning of the operation, resulting in recurrence or exacerbation of edema.

Periocular rejuvenation using a unique non-ablative long-pulse 2940\xa0nm Er:YAG laser

The periocular region is challenging for cosmetic laser surgeons. Surgery and laser resurfacing have traditionally been used to correct periorbital lines and wrinkles. Although effective, the associated downtime with these methods has made many people reluctant to decide for such treatments. More recently, the non-ablative long-pulse 2940 nm Er:YAG laser is being used to improve the structure and function and hence the appearance of skin in the periorbital region. The objective of this study is to evaluate the safety and efficacy of long-pulse 2940 nm Er:YAG laser for non-ablative treatment of periorbital static wrinkles and skin laxity. This is a prospective analysis of 30 patients treated for periorbital rejuvenation using three sessions of non-ablative long-pulse Er:YAG laser over a 3-month period. All patients were assessed according to Fitzpatrick’s classification of periorbital wrinkles to class I, II, or III and were treated with 2940 nm Er:YAG laser using a fluence of 3.75 J/cm2, a repetition rate of 1.7–2 Hz, and with the SMOOTH™ pulse mode (250 ms). The treatment sessions were performed on each patient, 4 weeks apart. Patient improvement was assessed before each laser session as well as at 12 months after the final treatment. Blind photographic evaluations were performed by three independent physicians using unlabeled before and after photos arranged in non-chronological order. Reviewers were asked to determine the before and after photos. Patients were asked to answer a questionnaire measuring satisfaction 4 weeks after each session, and to report any adverse reactions. There was statistically and clinically significant improvement in the Fitzpatrick classification of the periorbital wrinkles. Blinded evaluators correctly identified the before and after photos in all cases. All patients reported mild edema and erythema, which persisted for 1 to 2 days, and superficial peeling of the skin for 4 to 6 days after each laser treatment. No long-term adverse effects were reported. The non-ablative long-pulse 2940 nm Er:YAG laser seems to be a safe and effective treatment for periocular rejuvenation with minimal and tolerable adverse reaction. The improvement attained from the laser sessions was persisting after 1 year denoting the long-term efficacy of the procedure.

Malignant Facial Neoplasms Detected During the Comprehensive Optometry Exam

Skin carcinomas are the result of the malignant proliferation of epithelial keratinocytes. The two most common nonmelanoma skin cancers are basal cell carcinoma and squamous cell carcinoma and the latter has the potential to metastasize and cause morbidity and mortality. During the comprehensive eye exam, clinicians have an opportunity to conduct a visual inspection of the face to detect skin cancers that may be undiagnosed. The optometrist is trained to detect and describe malignant lesions of the eyelids and periorbital region, and so, extending the exam to include the detection of facial neoplasms can be a life-saving measure. This article provides a review of the clinical appearances of basal and squamous cell carcinomas of the face and ears and discusses lesion characteristics that warrant dermatologic intervention. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/malignant-facial-neoplasms-detected-during-the-comprehensive-optometry-exam)

Transfer of the deep temporal nerve for eyelid reconstruction in Mobius syndrome – an anatomic feasibility study and proposed surgical approach

Facial paralysis may result in significant functional, esthetic, and psychological morbidity. Mobius syndrome is a form of bilateral congenital facial paralysis that is particularly difficult to treat owing to the lack of readily available donor nerves, particularly in the upper face. In this study, we evaluate the feasibility of using the deep temporal nerves as donors for the innervation of free muscle grafts in the periorbital region. Preserved and fresh cadaver facial halves are dissected, and the course of the deep temporal nerves delineated. We find the middle branch of the deep temporal nerve to be located consistently 4.6 cm from the posterior edge of the tragus along the zygomatic arch, giving an easily identifiable surface landmark for our donor. Finally, we outline a proposed surgical approach for using the middle deep temporal nerve to innervate a free muscle graft to the eyelids through an interpositional nerve graft.

Delayed Sudden Blindness From Unilateral Ophthalmic Artery Vasospasm Following Endoscopic Sinus Surgery?

Keywords: ophthalmic artery; vasospasm; iatrogenic; endoscopic sinus surgery; blindness
 
 Endoscopic sinus surgery (ESS) is a generally benign, minimally invasive procedure used for management of paranasal sinus diseases, although complications may occur due to proximity of vital structures such as the brain, orbit and great vessels.1 The overall ESS major complication rate is 0.5-1%, of which orbital injury accounts for 0.09% due to direct trauma.2 We report a case of unilateral delayed sudden visual loss without orbital trauma observed intraoperatively or on post[1]operative imaging studies, following a seemingly routine endoscopic sinus surgery for chronic rhinosinusitis.
 CASE REPORT
 An 18-year-old lad with no significant medical history underwent ESS for bilateral chronic rhinosinusitis with nasal polyposis. (Figure 1 A-D) The surgery and recovery from anesthesia were uneventful. On the 12th hour post-operatively, the patient noted blurring of vision on the left. Ophthalmologic examination revealed hyperemic conjunctiva (Figure 2A) with visual acuity of counting fingers at 1 foot while fundoscopy showed retinal hemorrhages. Extraocular eye movements (EOM) and intraocular pressure (IOP) were normal (12mmHg). With an assessment of pre-retinal hemorrhages, 500 mg Tranexamic acid was intravenously infused, and a paranasal sinus (PNS) computed tomography (CT) scan and orbital magnetic resonance imaging (MRI) were requested. A few hours later, he complained of left eye pain with increasing intensity and further deterioration of vision. Repeat visual acuity testing showed light perception. There was now a constricted pupil, non-reactive pupillary light reflex, periorbital swelling and progression of conjunctival chemosis. (Figure 2B) The IOP of the left eye had increased to 30mmHg then progressed to 40mmHg with development of total visual loss and a lateral gaze limitation. With an impression of choroidal hemorrhage and retrobulbar hemorrhage, a lateral canthotomy relieved the eye pain.
 The contrast PNS CT scan with orbital cuts showed that the lamina papyracea was intact with no definite hemorrhagic collections in the intraconal or extraconal spaces of both orbits. (Figure 3A, B) A small hyper density along the lateral inferior margin of the left globe at the intraconal region with slight thickening of the anterior periorbital region represented the lateral canthotomy. The PNS MRI / magnetic resonance angiography (MRA) with orbital cuts showed retinal detachment and periorbital edema in the left eye. (Figure 4) A B-Scan ocular ultrasonogram showed retinal detachment and vitreous opacities. The diagnosis was ocular ischemic syndrome secondary to ophthalmic artery vasospasm, and the patient was given sublingual nitroglycerine and intravenous dexamethasone 8mg every 12 hours for 24 hours, with improvement of periorbital swelling. He was discharged after 12 days with no resolution of the unilateral visual loss.

Immunotherapy in Xeroderma Pigmentosum: a case of advanced cutaneous squamous cell carcinoma treated with cemiplimab and a literature review.

Xeroderma Pigmentosum (XP) is a rare genetic disorder with a poor prognosis due to high photosensitivity in affected patients.Herein, we describe the first case of the use of cemiplimab in a patient with XP, a 19-year-old girl presented with locally advanced squamous cell carcinoma of the right periorbital and nasal region. This treatment has been undertaken after a cycle of proton beam radiotherapy.Besides, it is reported a description of the few cases in the literature describing the effectiveness of immunotherapy on skin cancers in XP-patients.This case is in line with those reported, underlining how anti-PD1 monoclonal antibodies may be a promising treatment in this genodermatosis.

Efficacy of fractional laser, radiofrequency and IPL rejuvenation of periorbital region

The purpose of this study was to assess skin elasticity, the reduction in the number and the depth of wrinkles and changes in the other skin defects (bags under the eyes, dark circles under the eyes, skin hyperpigmentation in the ageing eye area following the use of non-ablative fractional laser, bipolar radiofrequency and intense pulsed light). Moreover, the study was also comparison which device brought better results than the others. This study included 71 patients (66 women, 5 men), aged 33–63 years (the average age was 45.81 years) with skin phototypes II and III. Twenty-four patients received five treatment sessions with a 1410-nm non-ablative fractional laser in 2-week intervals, 23 patients received five treatment sessions with a bipolar radiofrequency in 1-week intervals and 24 patients received five treatment sessions with an intense pulsed light in 2-week intervals. The treatment was applied on the skin in the eye area. The Cutometer (Courage + Khazaka electronic) reference test was used as an objective method for the assessment of skin elasticity. A questionnaire was used to compare baseline state with changes that occurred after the series of treatment sessions. The results of cutometric measurements of R2, R6 and R7 parameters and the results of questionnaires indicated that non-ablative fractional laser therapy, bipolar radiofrequency and intense pulsed light improved skin elasticity. Of the three treatments, the most significant percentage improvement in the R6 parameter was demonstrated by non-ablative fractional laser therapy which gave better final results than the other methods (p < 0.0001). No other statistically significant relationships were found between RF and IPL. In the (subjective) opinion of study participants (questionnaire), all used methods resulted in the reduction of the amount and the depth of wrinkles. However, they did not observe significant impact of individual treatment method on the signs of skin ageing, including discolorations within eye area, bags (fatty hernia), dark circles (vascular/pigmentary) and oedema (predisposition to water retention). Non-ablative fractional laser therapy, bipolar radiofrequency and intense pulsed light improved skin elasticity and the reduction of wrinkles. The most significant improvement of elasticity was demonstrated by laser therapy. It seems necessary to expand the group with the effect of individual treatments against bags and dark circles under the eyes.

The Use of the Low-Intensity Laser Therapy (LLLT) Technique for Face Burning

This work describes a case report by the Hospital Dentistry team of the Beneficent Association of Campo Grande Santa Casa MS, where a patient presented with a burn caused by the explosion of the carbon dioxide gas (Co2) through the inhalation of the vapor with acute physical changes, which resulted in burns that reached approximately 10% of the anterior area of the skull with involvement of the cervical and pharyngeal region. Admitted under Orotracheal Intubation, he was treated using the LLLT technique with the use of the InGaAIP low intensity laser on the injured tissues. Through a multi professional approach, using the Low Level Laser Therapy (LLLT) technique as a therapeutic alternative for the treatment of burn injuries of the periorbital region, lips and oral cavity, with the daily monitoring of the patient and regular on-site applications of laser therapy, there was a significant improvement in the injured region, and healing with rapid evolution, in addition to analgesia with reduced bleeding and site inflammation

Unusual Skin tear caused by eye taping using acrylic-based adhesive tape in a adult patient with recurrent craniopharyngioma

Skin tears due to medical adhesives are a ubiquitous but under documented complication that occurs in in almost all clinical settings and frequently in patients with certain risk factors. Due to lack of information regarding proper usage, suitable selection and the right technique for application of adhesive products can influence patient safety besides hampering the quality of life. Medical adhesives-related skin injuries (MARSI) is the latest term used, defined ‘an occurrence in which erythema and/or other manifestations of cutaneous abnormality (including, but not limited to, vesicle, bulla, erosion or tear) persists 30 min or more after removal of the adhesive’ [1]. We describe a report of skin tear due to acrylic based adhesive in a young male who underwent craniotomy and tumor excision. A 21 year-old male with a diagnosis of a recurrent craniopharyngioma was posted for a Pterional craniotomy and excision of the tumour. The patient had secondary hypothyroidism and secondary hypocortisolism on thyroid and steroid replacement respectively. He was shifted to the OT and after attaching all the standard ASA monitors, he was induced after adequate preoxygenation, with Fentanyl, Propofol and Vecuronium and intubated with a 8.5mm sized ET tube. A central venous catheter was inserted post induction in the right subclavian vein and was fixed with an adhesive tape. Before positioning the patient, scalp block with 15 ml of 0.5 % bupivacaine was administered. The eyelids were then taped with acrylic-based adhesive tape. The duration of the surgery was approximately 11 hours. In view of the prolonged nature of the surgery, the decision was made to not extubate the patient in the OT and to shift him to the Intensive Care Unit for further management and elective ventilation. Before the patient was shifted out of the OT, the adhesive tapes over his eyes were removed. While the left eye and periorbital region were found completely normal, the right periorbital region was mildl

INCIDENCE OF CATARACT IN DERMATOLOGICAL PATIENTS USING STEROID CREAMS

Background/ Context: Corticosteroids, despite being a very effective line of treatment for various disorders is known to have a wide range of adverse effects. The use of systemic and topical steroids has been associated with cataract formation, however the ophthalmic side effects of application of steroid on skin away from the face has not been studied in depth. With increasing use of corticosteroids as rst line of therapy in treatment of various dermatological conditions, the ocular side effects, if any, of these preparations, cannot be overlooked. Aim: To study the incidence of cataract in patients using skin preparations of corticosteroids away from the face and also to correlate the dose and duration of steroid therapy to incidence of cataract. Materials &amp; Methods: 50 patients with dermatological disorders who were being treated with dermatological steroids, on sites other than the face and periorbital region, for a period of more than six months consisted of the study group. The study group consisted of patients in the age group of 20 – 60 years. The study was conducted over a period of two years at a tertiary care hospital. Visual acuity, Slit lamp biomicroscopy, applanation tonometryand detailed fundus examination using 90D lens were carried out. Results: The incidence of cataract was signicantly higher in patients using dermatological steroids away from the face. Prolonged duration of use of these steroids also indicated a signicantly higher incidence of cataract. However, a larger population based study needs to be carried out to study the relationship between potency of steroid and incidence of cataract, although preliminary studies indicate a denite correlation between the two. Conclusions: Despite, steroids being used away from the face, there was a denite increase in the incidence of cataract. Before coming to any rm conclusions it would be advisable to reproduce the study in a larger population. However from the present pilot study it is prudent to advocate judicious use of innocuous looking steroid creams as they can cause signicant adverse effects

Scalp Swelling and Headache in a 12-year-old Boy

1. Kathryn Westphal, MD* 2. Respicius Bakalemwa, MD† 3. Elizabeth Groothuis, MD, MPH* 1. *Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 2. †Department of Pediatrics, Bugando Medical Centre, Mwanza, Tanzania A 12-year-old boy with sickle cell disease (SCD) is admitted to a hospital in Mwanza, Tanzania, with acute onset of periorbital and scalp swelling. Associated symptoms include fever, headache, difficulty breathing, and back pain. Because resources in sub-Saharan Africa are limited, access to comprehensive care for patients with SCD is variable. The general principles of management focus on early diagnosis, parental education, prevention of infection with vaccinations and prophylactic medications, prompt treatment of infection and pain, the use of hydroxyurea for stroke prevention, and blood transfusions for life-threatening anemia. This patient has a known diagnosis of SCD but has infrequent pain episodes and no previous transfusions. He is not receiving hydroxyurea or prophylaxis against bacterial infections or malaria. He has no history of stroke and no known head trauma. On presentation he is afebrile and his heart rate is 120 beats/min, respiratory rate is 40 breaths/min, and blood pressure is 105/75 mm Hg. His oxygen saturation is 92% in room air. Physical examination is significant for pallor, periorbital edema, scalp edema, dyspnea without adventitious lung sounds, and splenomegaly with diffuse abdominal tenderness. His scalp edema is fluctuant and extends posteriorly from the periorbital region, encompassing the entire scalp. Swelling is most prominent in the frontal and parietal areas. The overlying skin is nonerythematous and nontender but is warm to the touch. His neurologic examination has no focal findings, although generally he appears tired. Initial laboratory results demonstrate a white blood cell count of 84,000/μL (84×109/L) with a lymphocytic predominance (57%), a hemoglobin level of …

Extensive subcutaneous emphysema after exodonty of molar third parties: Case report

Introduction: Subcutaneous emphysema is an accident where the forced introduction of air into the tissues occurs, which in dentistry can appear after the use of a high-speed pen or triple syringe. The swelling associated with emphysema can be mistaken for bruising, allergies or infections. The differential diagnosis is often related to the presence of crackles on palpation, associated or not, with pain. Treatment is prophylactic and palliative, since the problem tends to resolve spontaneously. Objective: To report a clinical case of subcutaneous emphysema and extraction of third molars, discussing the importance of differential diagnosis to guide the treatment of this complication. Case report: A 22-year-old female patient attended the oral and maxillofacial surgery service of a public hospital in Recife-PE, complaining of pain in the lower left third molar region. During the surgical procedure, it was necessary to use a high-speed pen to perform osteotomy and odontosection of tooth 38. At the end of the surgery, there was an increase in volume in the left periorbital region, compatible with subcutaneous emphysema. After 7 days postoperatively, spontaneous resolution of emphysema was observed. Discussion: According to the current literature, after the emphysema is already under a dermal layer, the air may remain at the surgery site or continue to spread along the facial spaces, depending on the permanence of the air jet. Conclusion: The correct diagnosis of subcutaneous emphysema was effective in ruling out other complications, guiding the management of the reported case, in addition to preventing the emphysema from evolving to an infection involving the cervicofacial or thoracic region.

The Propeller Myocutaneous Flap of the Upper Eyelid: Anatomical Study and its Clinical Implication.

The reconstruction of the upper eyelid and the periorbital region is a challenge for the surgeon. The aims of this reconstruction are to guarantee protection to the eyeball, maintain the visual field, and restore the function of the eyelid without damaging other anatomical structures. In this study, the authors describe the use of a propeller myocutaneous flap based on the small vertical branches of marginal, peripheral ed superficial arcade, for the reconstruction of the upper eyelid or periorbital region. The authors enrolled 3 patients (Caucasian), between 2018 and 2019, and subjected to reconstructive surgery with the propeller myocutaneous flap of the periorbital region at the Plastic Surgery Unit of the University of Messina. The vascularization of the flap was demonstrated through an anatomical study conducted on cadavers at the dissection laboratories of the University of Bordeaux 2. The authors have shown that the myocutaneous flap represents a valid alternative for loss of substance coverage and reconstruction of the upper eyelid or periorbital region, allowing the achievement of a good aesthetic and functional result. Patients were followed up at 3-6-12 months. No complications were reported (flap retraction, periocular region deformity, donor site morbidity). Furthermore, at the last visit, the scars were almost invisible. The use of the propeller myocutaneous flap of the upper eyelid is a valid reconstructive alternative to the standard techniques described so far for the reconstruction of the periorbital region.

Laporan Kasus &lt;i&gt;Acrodermatitis Enteropathica &lt;/i&gt;pada Anak 5 Tahun dengan Level Zink Serum Normal

Acrodermatitis enterophatica (AE) is an inherited or acquired condition associated with zinc malabsorption. Clinical symptoms of AE are periorificial and acral dermatitis, alopecia, and diarrhea. Serum zinc levels usually decrease in AE patients. A 5-year-old boy presented with crusted erosion on the face, trunks and extremities that have been appeared for one year and worsened last month. It also accompanied by hair and eyebrow loss, diarrhea, and eating disorder. Patient was also malnourished. Dermatovenereology examination showed papules, patches, multiple erythematous plaques with squama, erosions with brownish yellow crust above located on perioral, periorbital, posterior trunk, inguinal, perianal, cubital, popliteal and dorsum pedis region. The oral region showed stomatitis and cheilitis. The orbital region showed conjunctival injection and eye discharge. The scalp, eyebrows and lashes showed total alopecia. Laboratory test showed normal serum zinc levels and decreased levels of alkaline phosphatase. The patient was diagnosed with acquired form of AE. Clinical improvement was seen after zinc supplementation. The diagnosis of AE cannot be made only by low serum zinc levels. If a classical triad of AE was found, we must be able to recognize it immediately, thus prompt and appropriate therapy could be given.

Efficacy, safety and complications of autologous fat grafting to the eyelids and periorbital area: A systematic review and meta-analysis.

In recent years, autologous fat grafting (AFG), also known as fat transfer or lipofilling, has been widely performed for periorbital rejuvenation and defect correction, although the evidence regarding its efficacy and safety is still lacking. Besides, with respect to the periorbital region, it is invariably the earliest appearance area of the facial aging phenomenon. Therefore, a systematic review and meta-analysis is needed to evaluate the efficacy and safety of this technique. A literature search was performed in PubMed, Embase, and the Cochrane library databases on November 20, 2020, adhering to the PRISMA guidelines, to identify all relevant articles. Then, a data extraction and standardization process was performed to assess all outcome data. Ultimately, the data were assessed using a random effects regression model with comprehensive meta-analysis software. Thirty-nine studies consisting of 3 cohorts and 36 case series with a total of 4046 cases were included. Meta-analysis revealed a relatively high satisfaction rate of 90.9% (95% CI, 86.4%-94.0%). Frequent complications in 4046 patients receiving AFG were edema, chemosis, and contour irregularity, with an overall complication rate of 7.9% (95% CI, 4.8%-12.8%). This systematic review and meta-analysis showed that AFG for rejuvenation of eyelids and periorbital area provided a high satisfaction rate and did not result in severe complications. Therefore, AFG might be performed safely for periorbital rejuvenation and reconstruction.

Ocular marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue masquerading as chalazion: a case report

A case of ocular marginal zone non-Hodgkin B-cell lymphoma of mucosa-associated lymphoid tissue of the conjunctiva masquerading as chalazion is reported in a 57-year-old Chinese man, known to have diabetes mellitus. He presented with painless swelling of the lower lid and redness in the right eye for 3 months duration. A diagnosis of chalazion was made, and incision and curettage were performed by a general ophthalmologist. The swelling worsened and spread to the whole lower lid. Magnetic resonance imaging showed a lesion involving the right periorbital region limited to the anterior orbital septum that was hypointense on T1 and hyperintense on T2. A diagnosis of periorbital cellulitis with possibility of lymphoma was suggested.&#x0D; When he came to our eye clinic for expert opinion, his visual acuity, anterior segment and fundus were normal except early cataract changes in both eyes. There was a hard, non-tender, immobile mass within the lower eyelid associated with conjunctival injection and chemosis. Histopathology of the conjunctival biopsy showed features of low-grade non-Hodgkin B-cell lymphoma and the immunohistochemistry report was suggestive of marginal zone lymphoma. He was treated with chemotherapy (cyclophosphamide, vincristine, prednisolone) and radiotherapy, following which the swelling resolved.&#x0D; When patients do not respond to treatment as expected after incision and curettage of chalazion, a high index of possibility of malignancy should be kept in mind whenever a recurrence of hard swelling is observed at the same site in the eyelid. All suspicious lesions should be biopsied to find out the correct diagnosis.