Periorbital Region Research Articles

Clinical efficacy of OS-01 peptide formulation in reducing the signs of periorbital skin aging.

The aging of the skin, particularly around the periorbital region, is a complex process characterized by the accumulation of senescent cells, decreased collagen production, and reduced skin elasticity, leading to visible signs such as fine lines, wrinkles, and sagging. This study investigates the efficacy of a novel topical formulation, OS-01 EYE, containing the senomorphic peptide, OS-01, along with other active ingredients, in improving the skin around the eyes. A 12-week clinical study was conducted with 22 participants who applied OS-01 EYE twice daily. Assessments included bioinstrumental measurements of skin hydration, barrier function, firmness, and elasticity, as well as expert photographs grading fine lines, wrinkles, under-eye puffiness, and dark circles. After 12 weeks of product use, transepidermal water loss (TEWL) decreased by 17.33%, hydration increased by 32.49%, skin firmness improved by 10.19%, and elasticity increased by 25.58%, compared to baseline, which was all statistically significant. Expert grading revealed a decrease in fine lines and wrinkles, under-eye puffiness, and dark circles over the study period. Furthermore, subjective assessments showed that 95.46% of participants reported improvements in overall appearance. The OS-01 EYE formulation was found to be safe and effective in mitigating the visible signs of aging in the periorbital region, making it a potent treatment option for enhancing periorbital skin health, function, and appearance.

Decoding Periorbital Aging: A Multilayered Analysis of Anatomical Changes.

Periorbital aging is a complex phenomenon that involves multiple layers of facial anatomy, including bone, fat, and globe. While previous studies have predominantly focused on age-related changes in facial fat compartments, this research aims to provide a comprehensive understanding of all periorbital components, including upper and lower orbital fat, orbital cavity volume, globe volume, and globe position, in the context of aging. We conducted a retrospective study involving 118 patients (236 subjects) aged 18-99years who underwent brain MRI using a 3 Tesla MR system. Baseline demographics and various parameters pertaining to periorbital aging were collected, and comprehensive measurements were obtained through meticulous radiological analysis. Our findings revealed distinct patterns of age-related changes in the periorbital region. Upper orbital fat remained stable with age, while lower orbital fat exhibited a substantial increase in both anterior and posterior compartments. Notably, orbital cavity volume expanded with bony resorption, while eye globe volume decreased, contributing to an enophthalmic appearance. We observed no vertical displacement of the globe with aging. This study provides a comprehensive overview of the multifaceted anatomical changes that occur in the periorbital region with aging. The insights gained from this research offer important clinical implications for addressing the signs of periorbital aging, guiding surgical interventions, and ultimately enhancing patient outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Sex differences in photophobic behaviors following cortical spreading depression in rats.

Photophobia is a common and debilitating symptom associated with migraine. Women are disproportionately affected by migraines, with a higher prevalence and more severe symptoms compared to men. This study investigated the effects of cortical spreading depression on light-aversive and dark-seeking behaviors in a rat model, with an emphasis on sex differences. Experiments were conducted on seven to eight-week-old male and female Sprague Dawley rats. cortical spreading depression was modeled by injections of potassium chloride or artificial cerebrospinal fluid into the occipital cortex through a guide cannula. Key behavioral assessments included light-aversive and dark-seeking behaviors measured using a three-chamber box, pupil to iris ratio, periorbital tightening, periorbital allodynia and facial withdrawal thresholds. Our results demonstrated that cortical potassium chloride injections significantly increased photophobic behaviors, particularly in female rats. Specifically, potassium chloride-injected females demonstrated a significant reduction in the time spent in the light chamber (p = 0.001) and increased time in the dark chamber compared to control rats (p = 0.01), indicating heightened light-aversion. Females exhibited more substantial pupil constriction and eyelid closure at 180 min after potassium chloride injection compared to artificial cerebrospinal fluid injection, suggesting a stronger physiological response to light. Similarly, a greater percent of female rats displayed periorbital allodynia (withdrawal threshold <6 g) over a post injection time course compared to male rats. Among rats that exhibited periorbital allodynia at least two consecutive time points, females had significantly lower facial withdrawal thresholds than males at 60-, 90-, 120-, and 180-min post injection (p < 0.05), suggesting a difference in magnitude and duration. Furthermore, the area under the curve for the time course experiment indicated development of tactile allodynia in periorbital region among female rats (p < 0.0001). Altogether these findings highlight the importance of considering sex-specific differences in developing therapeutic strategies for the treatment of migraine. We report for the first time a complete time course analysis of migraine-related responses, providing a comprehensive overview of the dynamics involved. The results suggest that potassium chloride-induced cortical spreading depression may offer a valuable model for studying the underlying mechanisms and sex differences of photophobia in migraine, aiding in the development of targeted treatments.

Successful Treatment of Primary Eyelid Lymphedema by Periorbital Lymphovenous Anastomosis: A Case Report

AbstractEyelid lymphedema is a rare condition that presents as persistent swelling and non-pitting edema of the eyelids. Treatment options for this disease are limited, including surgical debulking and medications, which do not achieve complete resolution. Few studies have demonstrated the use of lymphovenous anastomosis (LVA) in the preauricular area for eyelid lymphedema treatment. In this report, we demonstrate the successful treatment of primary eyelid lymphedema by performing multiple LVAs in the periorbital region, where dermal backflow was visualized using indocyanine green lymphography. A total of four LVAs were performed through two separate incisions at the lateral canthal area and lateral eyebrow in a patient with unilateral upper eyelid lymphedema that resulted in significant improvement without recurrence.

Modified Infrabrow Blepharoplasty for Periorbital Rejuvenation in Asia Women.

The infrabrow blepharoplasty is a common surgical operation indicated in Asians for periorbital rejuvenation. This operation alone is difficult to achieve the correction of crow's feet. Therefore, the authors elucidate the authors' experiences of applying infrabrow blepharoplasty combined with the subcutaneous undermining of the lateral periorbital region to treat upper eyelid dermatochalasis with lateral hooding deformity and alleviate crow's feet, including its indications, operative procedures, and postoperative outcomes. Retrospective review of patients undergoing infrabrow blepharoplasty incorporated with subcutaneous undermining of the lateral periorbital region between January 2019 and December 2023. Thirty-nine patients who were well followed up were retrospectively reviewed. The surgical procedure is described in depth. Frontal and lateral view photographs were obtained to evaluate the curative effect. The following data were collected preoperatively and at postoperative 6 months: distance between the pupil centre and the supratarsal fold, distance between the pupil centre and lower margin of eyebrow, distance between the lateral canthus and the supratarsal fold, distance between the lateral canthus and lower margin of eyebrow, the rating of Crow's Feet Grading Scale (CFGS) at rest and at a maximum smile. The study included 78 eyelids of 39 patients ranging in age from 37 to 56 years, with a mean age of 46.25 years. The mean follow-up for the patients was 6.7 months. Compared with the postoperation with the preoperation, distance between the pupil centre and the supratarsal fold increased from 5.45 ± 1.31 to 5.98 ± 1.62mm, distance between the lateral canthus and the supratarsal fold increased from 3.93 ± 1.24 to 6.13 ± 1.87mm, no evidence of significant changes in distance between the pupil centre and lower margin of eyebrow and distance between the lateral canthus and lower margin of eyebrow. The average change in the rating of CFGS was -0.62 ± 0.11 at maximum contraction and -0.24 ± 0.08 at rest. No significant complications occurred in any patient postoperatively. The combination of infrabrow blepharoplasty with the subcutaneous undermining of the lateral periorbital region was effective in addressing moderate dermatochalasis with lateral hooding and improve crow's feet in middle-aged Chinese patients, resulting in a rejuvenated periorbital area and flattening of the eyebrow is not noted at the same time. The anthropometric measurement of the upper eyelid and CFGS facilitate operation outcome assessment.

Navigating the Diagnostic Maze: A Case Report of Uncommon Cardiac Metastasis in Childhood Ewing Sarcoma

AbstractEwing sarcoma is a bone cancer affecting children and young adult males. It usually presents as a single bone tumor, but it can also occur in multiple locations. Nevertheless, Ewing sarcoma is an extremely aggressive tumor capable of metastasizing to other parts of the body, such as the lungs, bones, liver, and lymph nodes. Cardiac metastases are rare, indicating a poor prognosis, as they suggest that the cancer has become more advanced and challenging to treat.This case report describes a 9-year-old boy who presented with complaints of fever and multiple swellings in the calvaria, periorbital region, clavicle, and left thigh. Laboratory investigations revealed a high erythrocyte sedimentation rate, elevated absolute neutrophil count, high phosphate and calcium levels, and low magnesium levels. Computed tomography imaging revealed the presence of multifocal osseous expansile lytic lesions, multiple pulmonary metastases, and extensive soft tissue involvement of the heart. Based on these findings, possible differential diagnoses of Langerhans cell histiocytosis, lymphoma, and Ewing sarcoma were considered. Further histopathological examination and immunohistochemistry confirmed a final diagnosis of metastatic Ewing sarcoma.The most common metastasis sites for Ewing sarcoma are the lungs, with rare occurrences in the central nervous system, and metastasis to the heart is uncommon. We present here a rare undiagnosed Ewing sarcoma with cardiac metastasis, in addition to pulmonary and multifocal osseous metastasis. This case is unique because multifocal osseous involvement is rare and further lung and heart involvement is even rarer in Ewing sarcoma.

Periorbital Placement of a Laser Doppler Probe for Cerebral Blood Flow Monitoring Prior to Middle Cerebral Artery Occlusion in Rodent Models.

Middle cerebral artery occlusion (MCAO) is the gold-standard method for preclinical modeling of ischemic stroke in rodents. However, successful occlusion is not guaranteed by even the most skilled surgical hands. Errors primarily occur when the filament is not placed at the correct depth and include instances of either no infarction or vessel perforation, which can cause death. Laser Doppler flowmetry (LDF) is a reliable technique that provides real-time feedback on regional cerebral blood flow (CBF) during the MCAO procedure. Here we demonstrate a rapid technique for periorbital placement of a laser Doppler probe for measurement of CBF in both mice and rats. Our rationale was to simplify LDF implementation, encouraging widespread usage for improved surgical reliability. The technique eliminates the need for skull thinning and specialized equipment, with placement at the periorbital region rather than dorsal placement, promoting efficiency and ease of adoption. The protocol described here encompasses presurgical preparations, periorbital Doppler probe placement, and post-operative care. Representative results include visual depictions of procedural elements along with representative LDF tracings illustrating successful MCAO surgeries, with instances of unsuccessful filament placement leading to complications. The protocol illustrates LDF in confirming proper filament placement and offers a simplified procedure compared to alternative methods.

Dermoscopy Training Course Improves Ophthalmologists' Accuracy in Diagnosing Atypical Pigmented Periorbital Skin Lesions.

Facial pigmented skin lesions are extremely common, starting from the fourth to fifth decades, especially in South-European countries, often located in the periorbital region. These include malignant forms, Lentigo maligna (LM) and lentigo maligna melanoma (LMM), characterized by growing incidence, and a series of benign simulators, including solar lentigo (SL), pigmented actinic keratosis (PAK), seborrheic keratosis (SK) and lichen planus-like keratosis (LPK). The clinical differential diagnosis of atypical pigmented skin lesions (aPFLs) can be difficult, even for dermatologists, leading to inappropriate skin biopsies with consequent aesthetic impacts. Dermoscopy of the facial area is a specific dermoscopic field that requires dedicated training and proved to increase diagnostic accuracy in dermatologists. Since these lesions are often seen by ophthalmologists at first, we aimed to evaluate the effect of a focused dermoscopy training course on a group of ophthalmologists naïve to the use of a dermatoscope. A set of 80 periorbital pigmented skin lesions with both clinical and dermoscopic images was selected and evaluated by six ophthalmologists before and after a one-day intensive dermoscopic training course. They were required to evaluate 80 periorbital lesions one month before and after a one-day intensive dermoscopic training course, illustrating second-level diagnostic options such as reflectance confocal microscopy (RCM), obtaining a total of 480 evaluations. Specifically, they had to provide, for each case, a punctual diagnosis and a management option among dermoscopic follow-up/skin biopsy/RCM/LC-OCT. Descriptive statistics were carried out, and the accuracy (ACC), sensitivity (SE), and specificity (SP), with their 95% confidence interval (95% CI), were estimated. In the pre-course test, ophthalmologists achieved 84.0% SP, 33.3% SE and 63.7% ACC, while after the course, SE increased by +9% (i.e., 41.7%), SP decreased by 4%, and ACC remained comparable, i.e., 64.6%. In the management study, the percentage of benign lesions for which a close dermoscopic follow-up was suggested significantly decreased (51.6% versus 22.2%), in parallel with an increase in the number of lesions referred for RCM. As for malignant cases, the reduction in responses "close dermoscopic follow-up" decreased from 37.0% to 9.9%, (-27%), in favor of RCM (+15%) and skin biopsy (+12%). The ophthalmologists proved to be very receptive in quickly metabolizing and putting into practice the concepts learned during the one-day intensive dermoscopy training course. Indeed, after only a one-day lesson, they were able to increase their SE by 9% and to improve their management strategy. The present findings highlight the importance of providing training ophthalmologists in dermoscopy during residency programs, in terms of benefits for the correct patient care.

Primary Cutaneous Mucinous Carcinoma: Case Report of a Rare Adnexal Tumour

Primary cutaneous mucinous carcinoma is a rare malignant adnexal tumour of the skin, with the most common location being the periorbital region. Differentiating this tumour from cutaneous metastases and mucinous adenocarcinomas from other sites can be challenging, and due to its rarity, this tumour merits a more detailed study. The authors present a case of a 55-year-old male who presented with a slow-growing tumour located below the right earlobe. The lesion was clinically differentially diagnosed as either a lymph node or a soft tissue mass. An excisional biopsy of the mass revealed features of cutaneous mucinous carcinoma. The patient was clinically assessed, and the possibility of metastasis from other sites was ruled out. Hence, the present case lesion was diagnosed as primary mucinous carcinoma of the skin. The patient is doing well on follow-up, with no history of recurrence or other relevant issues.

Immunohistochemistry-Assisted Mohs Surgery for Invasive Eyelid and Periorbital Cutaneous Melanoma.

Prior studies describe wide local excision and "slow Mohs" outcomes for periocular melanoma. Mohs micrographic surgery (MMS) with immunohistochemistry maximizes tissue preservation and offers same-day comprehensive margin evaluation, which facilitates expedited repair, and coordination of oculoplastic reconstruction when necessary. To describe oncologic and reconstructive outcomes of invasive periocular cutaneous melanoma treated with immunohistochemistry-assisted MMS. Invasive melanoma cases affecting the eyelids or periorbital region treated with MMS between 2008 and 2018 were reviewed. Eyelid tumors and those in adjacent subunits were compared. Main outcome measures were recurrence, melanoma-specific death, and postreconstructive complications. Of 42 cases, 28 were classified as periorbital and 14 as eyelid involving. Most were T1 (37, 88.1%). There was 1 local recurrence in a patient with persistent positive conjunctival margin (2.4%). No local recurrences were observed in cases where negative Mohs margins were achieved, and no melanoma-related deaths occurred. Eyelid tumors were more likely to result in lid margin involving defects and require oculoplastic reconstruction. Eyelid complications developed in 10 cases (23.8%), and 5 (11.9%) required revision surgery. Mohs micrographic surgery for periocular melanoma results in low rates of local recurrence and melanoma-specific death. Initial tumor location can aid in reconstructive planning.

TRATAMENTO DE GORDURA INFRAORBITAL COM ULTRASSOM MICROFOCADO

Aging is a physiological process determined by various intrinsic and extrinsic factors, being a normal and inevitable process. The periorbital region is one of the first to show signs. This aging in the periorbital region is manifested by several anatomical changes that result in dark circles, wrinkles and sagging skin. These changes are influenced by factors such as the loss of adipose tissue volume and reduced collagen production, in addition to the projection of orbital fat and reduced skin elasticity. Given the significant aesthetic impact of these changes, effective treatment of dark circles has become a priority in aesthetic procedures. This study aimed to present and describe a treatment technique and its results in infraorbital pockets, using the non-invasive method of microfocused ultrasound. Through a case report involving a 50-year-old male patient with complaints of persistent dark circles, a treatment protocol was carried out with microfocused ultrasound using 60 shots per infraorbital region in two sessions, with an interval of 3 months. The evaluation of the results included photographic documentation and facial scanning, which showed a significant improvement in skin firmness and a reduction in infraorbital bags. The work concludes that microfocused ultrasound proved to be effective in treating localized fat and repositioning tissues in the dark circles region, promoting facial rejuvenation and representing a less invasive alternative to blepharoplasty. Results may vary depending on age, skin condition and technique used, in which case additional sessions may be necessary.

Microneedling With RF-Assisted Skin Penetration Improves the Hard-to-Treat Periorbital Wrinkles: Nonrandomized Clinical Trial.

This prospective study evaluates the efficacy and safety of minimally invasive radiofrequency microneedling (RFMN) for the correction of periorbital wrinkles. This study aimed to address the challenges posed by the periorbital region's unique anatomy and the limitations of existing non-surgical treatments. Twenty-four subjects, ranging from 34 to 54 years old with Fitzpatrick skin types II-V, underwent a series of treatments using the Voluderm RF microneedling device. Participants were divided into two groups based on the severity of their wrinkles and treated with customized protocols over four sessions, with a 3-month follow-up to assess outcomes. Efficacy was determined through comparisons of pre-treatment and post-treatment wrinkle severity, using the Lemperle Classification of Facial Wrinkles (LFW) and the Global Aesthetic Improvement Scale, evaluated by both the investigators and the patients. Safety and tolerability were assessed through adverse event reporting and a Visual Analog Scale for treatment discomfort. The results demonstrated a statistically significant reduction in periorbital wrinkle severity, with an average 49% decrease of LFW score and improvements noted across all skin types in both groups. The aggregated facial LFW score decreased from baseline mean 13.00 ± 4.75 to 6.09 ± 3.90 (p < 0.05). The treatment was well tolerated without anesthetics, with minimal downtime and few adverse events, which were transient and resolved without intervention. The efficacy of Voluderm RF microneedling in improving periorbital wrinkles of variable severity was demonstrated in patients with diverse skin types. The unique RF-assisted mechanism of the skin penetration granted a high tolerability of the treatments, negligible downtime, and minimum number of adverse events with self-resolution.

Dynamic three-dimensional facial topography in pediatric facial palsy: Understanding asymmetrical facial contours

BackgroundObjective assessment of facial movements remains pivotal for diagnosis, treatment, and long-term monitoring of patients with facial palsy (FP). This study aims to utilize curvature analysis in pediatric patients with and without FP to define facial contours and to quantify three-dimensional (3D) excursion during smile. MethodsPediatric patients with and without FP had 3D motion capture acquired from rest to maximum smile positions. 3D curvature analysis was performed with a custom MATLAB algorithm. A 40-vertex “smile curve” along the nasolabial fold-cheek-orbit contour was extracted from each patient-specific 3D mesh hemiface. This allowed quantification of excursion and asymmetry for affected vs. unaffected sides in FP patients, and comparison with controls. ResultsTwelve FP (mean 12.5yr., range 5-18) and 12 control (mean 12.1yr., range 5-18) patients were analyzed. Differences in facial contour are intensified during animation, especially in the nasolabial fold, cheek, and periorbital regions of interest and the smile curve which links them. Mean excursion differed significantly between the FP and control groups in all regions of interest (p < 0.0001). ConclusionsCurvature analysis provides insight into the unexplored relationship of the 3D morphological dynamics of the concavity and convexity of the face, to add to the understanding of this complex condition. The magnitude of asymmetry between a FP patient’s affected vs. unaffected smile curve excursion, and comparison to the control group, could allow surgical treatment to be tailored to an individual patient’s dynamic anatomy by identifying and quantifying facial region-specific asymmetry.

Quantitative Assessment of New Frontiers in Dermatochalasis and Periorbital Hyperpigmentation Treatment: The Role of Cross-Linked Porcine Collagen.

Collagen dermal fillers have shown efficacy in addressing age-related changes in facial appearance. However, their potential in rejuvenating the periorbital region remains unexplored. The aim of this study was to evaluate the effectiveness, clinical safety, and patient satisfaction associated with the utilization of collagen dermal fillers in individuals with dermatochalasis and periorbital hyperpigmentation. This study was reviewed and approved by the institutional review board of China Medical University Hospital (IRB No. CMUH107-REC2-157). Adults diagnosed with dermatochalasis or periorbital hyperpigmentation received periorbital injections of a sterile cross-linked highly-purified specific antigen free porcine dermal collagen (FACIALGAIN® Collagen Implant with Lidocaine, Sunmax Biotechnology Co. Ltd., Taipei, Taiwan) and were assessed for hydration, elasticity, pigmentation index, redness index, lightness value, and density with the DermaLab® Combo Multiparameter Skin Analysis System (Cortex Technology, Hadsund, Denmark) and Cutometer® Dual MPA 580 (Courage+Khazaka electronic GmbH, Köln, Germany). Data was collected prior to injection and at 1 week, 4 weeks, and 12 weeks after injection. Patient satisfaction on volume augmentation, decrease in hyperpigmentation, persistence, and overall satisfaction were also recorded. A total of 12 samples each were recruited for dermatochalasis and periorbital hyperpigmentation. For dermatochalasis subjects, hydration of the periorbital tissue significantly increased at week 1 and 4 (p = 0.011 and p = 0.015). Elasticity decreased by week 4 and persisted until week 12 (p = 0.001 and 0.014). For periorbital hyperpigmentation patients, lightness value increased significantly starting week 1 (p = 0.016), tapering off at week 12. Elasticity decreased by week 4 and persisted until week 12 (p = 0.002 and p = 0.002). Median overall patient satisfaction was 4 out of 5 for the dermatochalasis group and 4.5 out of 5 for the periorbital hyperpigmentation group, with a mild but insignificant decrease by week 12. DermaLab® Combo and Cutometer® Dual MPA 580 are considered effective methods for evaluating patients undergoing dermal filler injections. The utilization of cross-linked porcine collagen dermal filler injections can serve as a minimally invasive approach to enhance skin laxity in dermatochalasis and address discoloration in periorbital hyperpigmentation. However, it is important to note that regular treatments may be necessary to sustain the desired outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/0026 .

8043 IgG4-related disease with isolated involvement of the pituitary gland: case report

Abstract Disclosure: J.M. Ramos: None. Female patient, 36 years old, presented to our service complaining of a headache lasting five weeks, mainly in the frontal and left periorbital region, radiating to the occipital region. The pain was intense and intermittent, lasting about 40 minutes. No nausea or vomiting was reported, but the patient experienced dizziness and double vision. During the symptomatic interview, the patient mentioned increased thirst and urinary volume. In her medical history, she denied comorbidities, with only frequent episodes of tension-type headaches. She had no continuous medication use and no known drug allergies. The patient had undergone two cesarean sections, with the last one in December 2021. On physical examination, she had horizontal binocular double vision in all three gazes to the left, accompanied by pain during eye movement. Increased facial sensitivity on the left in branches V1 and V2 was observed. The rest of the physical examination showed no abnormalities. Initial general laboratory tests were normal. Evaluation of pituitary function was mostly normal, except for slightly elevated prolactin. A cranial MRI revealed an expansive lesion with sellar and suprasellar components measuring 1.2x1.1x1.2cm. Additional imaging of the sella turcica showed an intra- and suprasellar expansive lesion, predominantly isointense on T1, hyperintense on T2, with discreetly heterogeneous enhancement with gadolinium. In consultation with the neuroradiology team, a hypointensity on T2 at the left margin of the pituitary was noted, suggesting an inflammatory etiology. Based on this, laboratory tests were conducted, and treatment with methylprednisolone 1g per day for 7 days was initiated. After treatment completion, the IgG4 level was found to be 146.7 mg/dL (upper limit of reference: 86 mg/dL). A follow-up MRI, five days after the steroid pulse therapy, showed a reduction in lesion size to 0.8 cm in the cranio-caudal dimension, with a preserved appearance of the optic chiasm. The patient experienced considerable symptom improvement and was discharged with oral corticosteroids and a scheduled initiation of rituximab. The patient meets criteria confirming the diagnosis of IgG4-related hypophysitis, a rare condition representing 30% of hypophysitis cases. Isolated pituitary involvement is even rarer, and its association with diabetes insipidus has been described. Treatment involves corticosteroids, and rituximab can be considered, especially in recurrent cases. Presentation: 6/3/2024

Нарушение подвижности глазного яблока у пациентов с травматическим косоглазием

Relevance. Limitation of eyeball mobility is one of the main signs of traumatic strabismus. The following main factors of its occurrence have been identified: trauma to the eye and periorbital region, orbital fracture, concussion and severe cranio-orbital or traumatic brain injury. Oculomotor function may suffer due to paresis/paralysis of the extraocular muscle, its mechanical damage or entrapment in the area of the fracture of the orbital bones (in cases where strabismus has developed as a result of an orbital fracture), or due to the formation of severe tissue fibrosis and restriction. Purpose. To study the dynamics of oculomotor function before and after surgical treatment of traumatic strabismus in patients with dystopia of the eyeball and without it. Material and methods. A retrospective analysis of outpatient records of 269 patients with traumatic strabismus was carried out. Results. Dystopia of the eyeball was detected in 34%. Exophthalmos accounts for approximately a third of all dystopias occurring in traumatic strabismus. An isolated fracture of the orbital wall did not cause exophthalmos. In such cases, other types of dystopias were noted. But in more extensive and severe injuries to the skull, exophthalmos occurred in 10% of cases. Among all cases of exophthalmos, in 40% it developed as a result of injury to the eye or periorbital region, in 60% – with severe cranio-orbital damages (COD) and head injury. It was found that as a result of surgical treatment, the number of patients with normal eyeball mobility increased from 16 to 24%. Lack of eyeball mobility was noted in 7% of patients, while before treatment their number was almost 19%. In the group without dystopia with moderate oculomotor disorders, after treatment, the mobility of the eyeball did not improve in 65% of patients; it improved in 31% of patients; in the group with dystopia, 41% retained the same degree of mobility limitation, and improvement (decrease in the degree of limitation) was detected in 55% of patients. Conclusion.It has been established that dystopia causes more severe oculomotor disorders. However, adequate surgical treatment can improve eye mobility in more than half of the patients. Key words: traumatic strabismus, dystopia, orbital rupture, eyeball mobility, restriction, fibrosis

Cryosurgery of eyelid actinic keratosis and the effect of adrenaline in local anesthetics - temperature mapping using IR thermography

ABSTRACT Purpose The efficacy of cryosurgery is believed to depend on the thaw time. The presence of adrenaline in local anesthetics affects blood perfusion, and may thus also affect the thaw time. The aim of the present study was to use IR thermography to monitor the tissue temperature during cryosurgery of actinic keratosis, and to assess the effect of adrenaline in local anesthetics. Methods Twelve patients with actinic keratosis in the periorbital region underwent cryosurgery. The temperature was continuously mapped using a high-precision IR camera and was also visually assessed by the surgeon. The results obtained when employing local anesthetics with and without adrenaline were compared. Results The temperature change during thawing showed a triphasic pattern. The thaw time was significantly longer when using an anesthetic with adrenaline. This was observed with both IR thermography and by visual observation. Conclusions The findings indicate that a longer freezing time may be needed when using a local anesthetic without adrenaline to achieve the same cryo-effect as when using a local anesthetic with adrenaline. A larger clinical trial is needed on the effects of using local anesthetics with and without adrenaline to treat actinic keratosis, for example, the clearance rate, before recommendations can be made concerning their use.

Loss of normal facial asymmetry in schizophrenia and bipolar disorder: Implications for development of brain asymmetry in psychotic illness

Development of the craniofacies occurs in embryological intimacy with development of the brain and both show normal left-right asymmetries. While facial dysmorphology occurs to excess in psychotic illness, facial asymmetry has yet to be investigated as a putative index of brain asymmetry. Ninety-three subjects (49 controls, 22 schizophrenia, 22 bipolar disorder) received 3D laser surface imaging of the face. On geometric morphometric analysis with (x, y, z) visualisations of statistical models for facial asymmetries, in controls the upper face and periorbital region, which share embryological intimacy with the forebrain, showed marked asymmetries. Their geometry included: along the x-axis, rightward asymmetry in its dorsal-medial aspects and leftward asymmetry in its ventral-lateral aspects; along the z-axis, anterior protrusion in its right ventral-lateral aspect. In both schizophrenia and bipolar disorder these normal facial asymmetries were diminished, with residual retention of asymmetries in bipolar disorder. This geometry of normal facial asymmetries shows commonalities with that of normal frontal lobe asymmetries. These findings indicate a trans-diagnostic process that involves loss of facial asymmetries in both schizophrenia and bipolar disorder. Embryologically, they implicate loss of face-brain asymmetries across gestational weeks 7–14 in processes that involve genes previously associated with risk for schizophrenia.

Presentation of a case of a dermoid cyst with a rare location

Dermoid cysts are choristoma that accumulate normal embryonic tissue in abnormal locations, making up 3% to 5% of congenital orbit conditions. They are found in various parts of the body, including the head and neck, frontal, periorbital, scalp, cervical, and nasoethmoidal regions. Nasoethmoidal dermoid cysts can compromise deep structures and may extend intracranially, with a frequency of 1% to 45%. They are usually diagnosed in the first 3 years of life, but some may go undetected until adulthood. Two theories explain the origin of nasal dermoids: the cranial origin theory and the superficial inclusion theory. Nasal dermoids can be pale, flesh-colored, pearly, or erythematous and may be accompanied by congenital anomalies. Different diagnoses include epidermal cysts, gliomas, meningoencephaloceles, tumors of vascular origin, fibromas, neurofibromas, osteomas, and lipomas. Imaging evaluations are necessary for diagnosis, determining the degree of involvement of neighboring structures, rule out associated malformations, and establish potential intracranial extension. The only curative treatment for nasoethmoidal dermoid cysts is surgical removal, as untreated lesions can cause nasal deformities, recurrent infections, and intracranial extension.

Eye injuries caused by high intensity macro and micro focused ultrasound treatment: a case report

BackgroundHigh Intensity Macro and Micro Focused Ultrasound ( HIFU) is a safe and effective method for the treatment of skin laxity. However, the application of high-intensity focused ultrasound energy on eyelids has been associated with potential ocular complications including traumatic cataract, iridocyclitis, and conjunctival hemorrhage, among others.Case presentationA 40-year-old female developed blurred vision in her left eye after receiving HIFU treatment on binocular eyelids, and her left far vision was 20/66. The examination revealed left eye iris depigmentation and conjunctival hemorrhage. Both eyes exhibited multiple white streaking or tadpole-shaped opacities in the lenses.ConclusionExcessive ultrasonic energy generated by HIFU can cause protein denaturation, leading to conditions such as traumatic cataract, visual impairment, injuries to the iris and conjunctiva when applied to the eyes. We recommend that individuals undergoing cosmetic treatment in the periorbital region should be highly aware of the possible ocular side effects.