Periorbital Structures Research Articles

OCCUPATIONAL AND ENVIRONMENTAL FACTORS ASSOCIATED WITH OCULAR TRAUMA AMONG PATIENTS ATTENDING EYE CARE SERVICES AT JINJA REGIONAL REFERRAL HOSPITAL. A CROSS-SECTIONAL STUDY.

Background Ocular trauma refers to any injury to the eyeball, its adnexa, orbit, and periorbital structures due to direct contact with fixed or mobile, blunt or sharp objects. The study aims to assess the factors associated with ocular trauma among patients attending eye care services at Jinja Regional Referral Hospital. Methodology A cross-sectional descriptive study design that collected quantitative data from 100 respondents using a non-probability consecutive sampling process from September 2022 to March 2023. Results 70% of the respondents were male while 30% were females. 55% of the respondents were 21-40 years, 32% were 0-20 years, 10% were 41-60 years and 3% were >60 years. Ocular injuries were caused by a foreign body (40%) followed by work-related activities with 20%, accidents with 18%, assault-related actions with 20%, and the least were chemical injuries with 5%. (65%) didn’t have eye protective equipment while 35% had. 40% of the respondents knew about awareness programs on ocular trauma while 60% had not received these programs. (43%) obtained trauma from the workplace, 25% from bars, 17% from homes, and 15% from schools. 55% had used nontherapeutic drugs like alcohol. 50% were using water from protected streams, 30% were using water from taps, 15% were using water from wells and the least were those using water from rivers (05%). Conclusion The most affected age group was 21-40. Males were more affected than females. Literates were most affected, and most cases of ocular trauma were obtained from the workplace. Ocular trauma was associated with the use of non-therapeutic drugs like alcohol. Recommendations Health education on ocular injuries should be adopted by the relevant authorities to increase awareness of the dangers, causes, predisposing factors, and burden of ocular trauma in the community.

Lymph Node Evolution in Eyelid and Orbit Squamous Cell Carcinomas.

To describe a large cohort of eyelid and periorbital SCCs, to compare the location of the tumor and of the pathological lymph nodes, and to analyze the risk factors for lymph node involvement among tumor characteristics. All patients managed inside our institution for an eyelid and periorbital SCCs were included. Tumor characteristics, imaging setup, excision margins, lymph node evolution features, local, regional, and distant recurrences rates, and global survival were reported. The risk for lymph node involvement and location of pathological lymph nodes were analyzed through univariate and multivariate analyses. Between January 2012 and August 2022, 115 patients were included, and 18 presented a lymph node evolution (15.7%), involving the parotid gland in 16 cases (88.9%), the submental and submandibular areas in seven cases (38%), and the jugular and carotid areas in four cases (22%). Tumor size above 20 mm, infiltration of the external canthus and periorbital structures, the presence of perineural invasion or vascular embolism, the depth of infiltration, and the presence of a local recurrence were significantly associated with the risk of lymph node evolution. Periorbital and eyelid SCCs present a true potential for lymph node evolution especially through the parotid gland. Extension setup including the parotid gland and neck should be mandatory, and lymph node dissection should be associated in case of parotidectomy for lymph node involvement. IV Laryngoscope, 2024.

Maxillary Sinus Mucocele With Fungal Ball.

Mucocele is a benign, expansile, and oppressive lesion, more common in the frontal and ethmoid sinus and less in the maxillary sinus. Sinus mucocele mainly causes cheek swelling pain and nasal obstruction. In some cases, the paranasal mucocele grows large enough to compress periorbital structures and lead to impaired vision. Generally, mucocele is full of simple mucus, but pathogens can be found if co-infected, which means a poor prognosis. Functional endoscopic sinus surgery is an effective treatment for this disease. Here, the authors report a case that a mucocele occurred in the maxillary sinus, and a fungal ball was also found during the operation, which is a result of Paecilomyces farinosus co-infection.

Morphometry of the Bony Orbit and Periorbital Structures: Personal Perspectives From Decades of Related Research.

The author introduces his personal perspectives on the bony orbit, nerves, arteries, and ligaments relating to orbital re- construction surgery. A supraorbital fissure was 40.0 ± 2.5 mm from the supraorbital notch. Posterior ethmoidal foramen was 31.7 ± 3.0 mm from the anterior lacrimal crest. The infraorbital fissure, where the infraorbital groove started, was 26.4 ± 2.6 mm from the infraorbital foramen. The supraorbital fissure was 34.3 ± 2.7 mm from the frontozygomatic suture. The medial palpebral ligament consisted of 2 layers. The superficial layer of the palpebral ligament (SMPL) was from the anterior lacrimal crest to the upper and lower tarsal plates. The deep layer of the palpebral ligament (DMPL) lay from the anterior lacrimal crest to the posterior lacrimal crest, covering the lacrimal sac. Horner muscle was at the posterior lacrimal crest just lateral to the attachment of the DLPL and ran laterally to the tarsal plate deep to the SLPL. Three components of the lateral canthal area are: (1) lateral palpebral raphe, (2) superficial lateral palpebral ligament (SLPL), and (3) deep lateral palpebral ligament (DLPL). The lateral ends of superior and inferior orbicularis oculi muscles interlaced at the lateral commissure and formed the lateral palpebral raphe. The superficial lateral palpebral ligament extended from the lateral ends of the tarsal plate to the periosteum of the lateral orbital rim. The lateral palpebral ligament extended from the lateral ends of the tarsal plate deep to the origin of SLPL to the Whitnall tu- bercle on the zygomatic bone. The palpebral branch of the in- fraorbital artery emerged from the infraorbital foramen and ran superior and lateral to the orbital septum. After passing through the orbital septum, distributed to the orbital fat.

Brow and Eyelid Rejuvenation: Trends from the 100 Most Cited Articles over 30 Years.

Background and Objective: Various periorbital rejuvenation techniques have been introduced over the last 3 decades. This study highlights important milestones in the evolution of periorbital rejuvenation surgery by identifying the 100 most-cited articles in this field. Material and Methods: The Web of Science citation index was used to identify the 100 most-cited articles concerning periorbital rejuvenation. Articles published in English from January 1989-April 2020 describing periorbital rejuvenation-related surgical techniques, facial aging, and anatomy were included. The terms "lower blepharoplasty", "upper blepharoplasty", "browlift", "browplasty", "endobrow lift", "endoscopic brow", "Foreheadplasty", "lower eyelid anatomy", "upper eyelid anatomy", "forehead lift", "eyelid rejuvenation", "canthopexy", "canthoplasty", "eyelid fat pad", "orbital fat pad", "tear trough", and "eyelid bags" were entered into the citation search. Web of Science Core Collection was the database used for the search. A manual review of the initial 159 studies was performed. Articles describing reconstructive or non-invasive techniques, injectable fillers, lasers, and neurotoxins were excluded. Of the 100 most-cited articles, the publication year, specialty journal, the corresponding author's primary specialty, the focus of the article, the corresponding author's country of residence, the type of study, and the level of evidence were analyzed. Results: The mean number of citations per article was 75 ± 42. There were more articles published from 1989-1999 (n = 53) than later decades. Most articles originated from the USA (n = 82) and were published in plastic surgery journals (n = 81). Plastic surgery was the primary specialty of the corresponding authors (n = 71), followed by oculoplastic surgery (n = 22). Most articles (n = 69) reported on surgical techniques. Of the clinical studies (n = 69), 45 (79%) provided level IV evidence. Conclusions: Of the 100 most-cited studies on periorbital rejuvenation, studies focusing on periorbital anatomy, aging, and surgical techniques comprised the most-cited publications. An anatomically based approach accounting for age-related changes in the periorbital structures is paramount in the field of contemporary periorbital rejuvenation.

The Temporal Subcutaneous Brow Lift with Orbicularis Oculi Muscle Elastic Flap: Technical Considerations, Systematic Review, and Terminology Standardization.

As the face ages, cosmetic changes in the periorbital region including eyebrow ptosis, sagging in the lateral temporo-orbital region with superior eyelid hooding, ptosis of orbicularis oculi muscle associated with drooping of the malar area with multiple "crow feets", a deeper lid-cheek junction, and malar festoons also occur. All these periorbital structures should be considered as a single anatomical entity. Numerous techniques have been described to correct brow aesthetics in facial rejuvenation. We report the senior author's (M.P.) current approach utilizing a temporal subcutaneous brow lift (TSBL) associated with an orbicularis oculi muscle (OOM) elastic flap. Furthermore, a systematic review of the literature was performed comparing the different surgical approaches striving to clarify its terminology. A total of 298 patients underwent this procedure in 4 years period. Of these, 230 patients, with at least 12 months of follow-up, were submitted to subjective and objective methods to evaluate the self-perception of scar and their overall aesthetic satisfaction. A committee of experts, blinded to each other's assessment, evaluated the same outcomes. Total eyebrow's tail lift was measured and recorded for each patients. The most satisfying aspect of these techniques is the dramatic periorbital rejuvenation and preservation of the patient's original youthful identity. In fact, the postoperative results appear very natural and do not suffer from an "operated" look. This aspect is noticeable from both the surgeon's and the patient's perceptions. There were no major complications in any of the cases. The proposed TSBL with OOM elastic flap technique, in the hands of senior author (M.P.) has emerged as a reliable, effective, and highly reproducible method to treat sagging and aging of the lateral region of the orbit, even without associated blepharoplasties.

Magnetic Resonance Imaging and Cross-Sectional Anatomy of the Eye and the Optic Nerve in the Egyptian Donkey (Equus asinus)

The eye is a high sense organ which is susceptible to many infectious and traumatic diseases. Using an accurate diagnostic imaging technique became essential for early detection and control of these diseases. The current investigation is proposed to fully describe the normal magnetic resonance imaging (MRI) appearance of the eye, extraocular structures and the optic nerve in the donkey with the aid of the anatomical sections. Eight fresh cadaveric heads of adult donkeys of both sexes were used; two were scanned using an MRI scanner of 1.5 Tesla magnet, and six were frozen to be sectioned into transverse (n=3) and frontal (n=3) sections. The accessed MR images were serially selected in matching to their corresponding gross sections. These MR images provided a comprehensive assessment of the eyeball structures (choroid, ciliary body, iris, cornea, sclera, anterior and posterior chambers, and vitreous body), the ocular adnexa (upper, lower and third eyelids, lacrimal gland, tarsal gland, superficial gland of the third eyelid, extraocular muscles and orbital fat), the various parts of the optic nerve (intraocular, intraorbital, intracanalicular, intracranial) and its surrounding meningeal sheath complex. However, it was difficult to outline the retina. The current investigation administrated a precise anatomical atlas of the eye, periorbital structures and optic nerve in the donkey assisting in the interpretation and diagnosis of both ocular diseases and optic neuropathy.

Retrograde Approach to Maxillary Nerve Block: An Alternative in Orofacial Surgeries in Horses.

Simple SummaryMaxillary nerve (MN) desensitization can improve quality and safety of orofacial surgeries in horses, especially when a standing procedure is elected. The purpose of this retrospective study is to report results from 15 horses undergoing orofacial surgery which received an MN block with the retrograde approach within the infraorbital canal. The same technique was used in horses scheduled for orofacial surgeries and grouped as requiring general anesthesia or standing analgo-sedation. From the retrieved anesthetic records, regardless of the group, clinical and physiological parameters continuously monitored during surgery were stable, and none of the horses showed complications during or after the block. These results confirm the feasibility of this loco-regional anesthetic technique as a valid approach to the MN without risk of damaging periorbital structures, which is reported with traditional techniques. Evident landmarks for this approach and limited chances to injure vital structures enclosed within the infraorbital canal make the operator experience less relevant than the ability required to block the MN according to approaches, which currently aim at the pterygopalatine fossa. This substantiates the retrograde approach to block the MN is safe and easy to perform in horses undergoing orofacial surgeries at regions where this nerve provides sensory innervation.The aim of this study was to retrospectively report outcomes resulting from the approach to the maxillary nerve block (MNB) through the infraorbital canal, in terms of needles selection, drawbacks or side effects during or after block execution, and analgesic efficacy leading to clinical and cardiovascular stability during surgery. Anesthetic records of 15 horses undergoing orofacial surgery in standing analgo-sedation (STA, n = 6) and in general anesthesia (GEN, n = 9) were retrieved and analyzed. Horses in group STA required surgery for dental extraction, nasal polyp resection and maxillary/frontal sinusitis. Horses in group GEN underwent surgery for fronto-maxillary, nasal and dental diseases. Size 19 and 20 G Tuohy needles were used in adult horses weighing 350–600 kg, while size 21 and 22 G were used in younger horses or ponies. None of the horses in both groups showed complications related to the block and physiological parameters were stable and within normal ranges during surgery; overall, an adequate anesthetic/sedation depth was achieved. Our results confirm the in vivo applicability of the MNB approached within the infraorbital canal, which had been described only on cadaveric specimens. The retrograde technique resulted in a valid and easy approach to the maxillary nerve that avoids damage to periorbital structures and side effects reported with traditional techniques.

Клінічний випадок ретробульбарного абсцесу у новонародженої дитини

Рідкісні випадки з практики представляють інтерес своєю унікальністю, особливо якщо вони мають грізні ускладнення або нетиповий перебіг. Ретробульбарний абсцес характеризується формуванням локального гнійного вогнища в орбіті. Розлите ураження розцінюють як целюліт, або флегмону, орбіти, що вважається метастатичним інфекційним процесом. Це захворювання є серйозною загрозою для життя дитини через надзвичайно швидкий розвиток критичних ускладнень у вигляді менінгіту або сепсису та відстрочених ускладнень, пов’язаних з локальним ураженням ока. Основними джерелами поширення запалення є периорбітальні структури, можлива вертикальна передача збудника від матері до дитини під час пологів або при подальшому тісному контакті, у тому числі при грудному вигодовуванні. Основним збудником запалення є Staphylococcus aureus, з можливою метицилінрезистентністю (MRSA), і його необхідно мати на увазі, вирішуючи питання про емпіричну антибіотикотерапію. В статті надано випадок ретробульбарного абсцесу у дитини 21 доби життя. Клінічне спостереження ілюстроване фотографіями, даними комп’ютерної томографії та клінічних досліджень, що може доповнити банк знань педіатрів, сімейних лікарів, офтальмологів.

Oculocardiac reflex: an unusual trigger during dental surgery.

The oculocardiac reflex is a trigeminal-vagal reflex that manifests as cardiac arrythmias, most often bradycardia. The reflex can be triggered by manipulation of periorbital structures and unintended pressure on the bulbus oculi maxillofacial procedures. In this brief communication, we describe an unusual trigger of the oculocardiac reflex during maxillofacial surgery that resulted in severe bradycardia. This case highlights the need for careful securement of medical devices and attention to surgical technique to avoid undue pressure on draped fascial structures.

Endoscope Assisted Combined Drainage of Sino-Orbital Abscess: Technique Revisited.

Orbital complications of acute rhinosinusitis may present with painful proptosis and ophthalmoplegia. Surgical management, when required comprises of endonasal endoscopic sinus clearance with or without external orbital abscess drainage. External drainage involves blind dissection and carries a risk of iatrogenic injury to periorbital structures. We describe a novel technique of endoscope guided orbital abscess drainage under direct visualisation via the external incision site. Patients with orbital cellulitis secondary to rhinosinusitis and planned for surgical intervention were recruited. After endonasal endoscopic sinus surgery, the orbital abscess cavity was opened and an endoscope was inserted externally. The cavity was examined; loculi were opened under direct visualisation till drainage was complete. This procedure was performed in seven patients with a successful outcome. The mean time to resolution was 1.5months (36.4 ± 18.2days). None of the patients had any recurrence or residual disease on follow up. In addition, in two cases with obstructed sinus drainage and "walling off" of frontal sinus, visualisation of the instrument placed in the drained abscess cavity via endo-nasally inserted endoscope confirmed the re-establishment of continuity of sinus opening. This approach may allow the surgeon to drain multiloculated abscess completely under direct visualization while minimising iatrogenic damage to periorbital structures. Real time display using endoscopic camera on the monitor screen also serves as a teaching and training tool during the procedure. Technique utilises the existing endoscopic set-up without the need for additional instrumentation.

Combination of Mustardè cheek advancement flap and paramedian forehead flap as a reconstructive option in orbital exenteration.

To describe a combinatory technique made of Mustardè cheek advancement flap and paramedian forehead flap as a reconstructive option after orbital exenteration. We retrospectively reviewed all patients who underwent orbital exenteration and subsequent reconstruction with this technique at our Head and Neck Department, Divisions of Ophthalmology and Otolaryngology, at San Raffaele Hospital, Milan, Italy. Three patients were treated with the aforementioned technique, following orbital exenteration due to malignancies. All of them were affected by recurrent diseases arising from the ocular components or periorbital structures: one basal cell carcinoma and two squamous cell carcinomas. Excellent result was achieved considering skin texture and colour match, aesthetic results and intra and post-operative complications (only minor, surgically controlled haemorrhage and minimal dehiscence subsequent to defective healing occurred). The proposed technique can be considered by the head and neck reconstructive surgeon as a good option in extended orbital exenteration.

Smoothening the Lid-cheek Junction in Lower Blepharoplasty.

Aim: Transcutaneous lower blepharoplasty is more convenient for its easier learning curve, its better visibility and access to the lower periorbital structures. Conventional techniques entail fat removal to improve the lower eyelid contour. In this study we adopted the extended transcutaneous lower eyelid blepharoplasty that included dissection below the extent of the inferior orbital margin to correct the tear trough deformity that is usually missed in traditional techniques.Methods: From December 2017 to December 2018, 25 patients were subjected to this procedure via a transcutaneous stair-step incision. A retrospective analysis was implemented. On the medial side, palpebral, orbital orbicularis oculi muscle and the orbitomalar ligament were freed with dissection approaching to the premaxillary space. On the lateral side, release of the orbitomalar ligament was done, followed by dissection reaching to the prezygomatic space. Fat pads were dealt with either by excision or redistribution. Results: The mean follow-up was 12 months. High degree of patient’s satisfaction was noted after using this technique. No major complications in term of lid malposition or scleral show or infection.Conclusion: Extended transcutaneous lower blepharoplasty is a safe and effective approach and a very powerful modality for blending the lid-cheek junction and periorbital rejuvenation.Level of evidence: Therapeutic, V.

The Oculocardiac Reflex: Its Evolution and Management.

The oculocardiac reflex is initiated by a pressure stimulus to the orbit or periorbital structures causing in bradycardia transmitted via the trigeminal-vagus nerve reflex arc. While this most frequently occurs with ophthalmologic surgeries, trauma to the orbit and periorbital structures can result in bradycardia and even in some cases, asystole. The aim of this case report and review of the literature is to identify and examine recent studies of the oculocardiac reflex related to facial trauma and to identify associated patient age, symptoms, and fracture patterns. A literature search was performed using the database within PubMed.gov using the term "oculocardiac." Results were reviewed for case reports or series related to facial trauma from the year 2000 to 2019. Studies were then evaluated for fracture pattern, presence of entrapment, patient symptoms, and age. The initial search resulted in 109 articles. A total of 22 articles were case reports or series of trauma patients. Twenty articles met inclusion criteria. Median age was 22 years. Eleven patients sustained orbital floor fractures. Four patients sustained medial wall fractures. Three patients had concomitant orbital floor and zygomatic fractures, and 4 with concomitant orbital floor and medial wall fractures. The most common extracardiac symptom experienced was nausea and vomiting (15/23) followed by diplopia (10/23). Status of entrapment was available in 20 patients of which entrapment was reported in fourteen (14/20). A 26-year old male presents after blunt trauma to the face resulting in a left orbital floor, rim, and maxillary fractures. Extraocular movements were initially intact and the patient had no diplopia. He developed bradycardia to 30 to 40 bpm just prior to induction of anesthesia. He was found to have developed entrapment of the inferior rectus muscle. The orbital floor and rim were repaired with complete resolution of bradycardia. Patients who sustain maxillofacial trauma involving the orbit are at risk of developing the oculocardiac reflex. Patients tend to be younger. The orbital floor is more commonly the site of traumatic injury. Nausea and vomiting are common encountered symptoms. The oculocardiac reflex, clinicians must recognize, is not static but may evolve over a patient's clinical course as seen in our patient.

Clinical case of membranous nephropathy in a patient with IgG4-related disease

IgG4-related disease (IgG4-RD) currently is considered as a chronic fibroinflammatory immune-mediated multisystemic condition of unidentified etiology, which can imitate a wide range of malignant, infectious, rheumatologic, and other diseases. It can affect almost any organ system in the body synchronously or sequentially, but the most often affected are the pancreas, hepatobiliary tract, periorbital structures, salivary glands, kidneys, and lymph nodes. The most frequent renal manifestations of IgG4-RD is IgG4-related tubulointerstitial nephritis. Membranous nephropathy is the most common glomerular disease accompanied by IgG4-RD. Regardless of the organ localization, patients with IgG4-RD are characterized by elevated serum IgG4, but this laboratory abnormality is not specific and can be changed in other diseases. In all suspected cases of IgG4-RD the diagnosis should be confirmed by histological examination. Characteristic pathologic features include diffuse or focal lymphoplasmacytic infiltration with prominent IgG4+ plasma cells, storiform fibrosis, and obliterative phlebitis. Patients with IgG4- RD usually have an excellent clinical response to glucocorticoids, but relapse rates after steroid withdrawal are high, which may require additional use of immunosuppressants or rituximab. Due to the low prevalence and multitude of clinical manifestations the disease often remains underdiagnosed on time. This case report describes middle-aged patients with a history of chronic recurrent pancreatitis complicated by the nephrotic syndrome. Kidney biopsy showed membranous nephropathy and diagnosis IgG4-RD with multiorgan involvement was made. Partial remission was achieved on corticosteroid therapy. The presented case clearly demonstrates the difficulties of diagnosis and treatment of IgG4-RD. IgG4-related membranous nephropathy should be included in the differential diagnosis for patients with nephrotic syndrome accompanied by multiorgan dysfunction.

MR-Eye: High-Resolution Microscopy Coil MRI for the Assessment of the Orbit and Periorbital Structures, Part 1: Technique and Anatomy.

Microscopy coil MR imaging of the orbits has been described previously as a technique for anatomic depiction. In the first part of this 2-part series, the improvement in spatial resolution that the technique offers compared with conventional MR imaging of the orbits is demonstrated. We provide a guide to implementing the technique, sharing pearls and pitfalls gleaned from our own practice to make implementation of microscopy coil MR imaging at your own center easy. As a quick reference guide to the small-scale structures encountered when reading the studies, a short anatomy section is included, which doubles as a showcase for the high-quality imaging that can be obtained. In the second part, our experience of microscopy coil MR imaging in day-to-day clinical practice takes it far beyond being a useful anatomic educational tool. Through a series of interesting cases, we highlight the added benefit of microscopy coil MR imaging compared with standard orbital MR imaging.

Quantitative 3-dimensional Geometry of the Aging Eyelids.

Background:Although facial aging is a well-known phenomenon, it has not been comprehensively characterized in 3 dimensions. This study introduces a novel technique for capturing periorbital structures across age groups using 3-dimensional (3D) imaging and point cloud data collection.Methods:Forty-six white women were divided into 3 age groups: 20–39 years, 40–59 years, and 60+ years. Patients were scanned with the Canfield 3D photogrammetry system, and data files were exported to the point cloud processing software CloudCompare. Manually selected points specifying eyelid margins, creases, and 5 key periorbital features provided the basis for a fitted model and principal component analysis (PCA). Potential statistical significance across age groups was assessed for PCA values corresponding to each subject's eyelid geometry.Results:Three tendencies emerged with respect to increasing age and eyelid anatomy: the width and height of the palpebral fissure decreases, with the width decreasing more rapidly; the depth of the lateral canthus relative to the medial canthus decreases; and the superior crease becomes more variable. Analyses of variance of PCA values across age groups show statistically significant differences between the youngest and oldest groups.Conclusions:Three-dimensional photogrammetry enables rigorous and reliable evaluation of the aging eyelid. Results suggest age-induced changes to eyelid margin, crease, and lateral canthus positions, which have been noted anecdotally but poorly quantified until now.

Total Eyelid Transplantation in a Face Transplant: Analysis of Postoperative Periorbital Function

BackgroundProlonged impairment of protective ocular functions can compromise vision and lead to blindness if uncorrected. Several facial transplants have incorporated periorbital structures with variable eyelid preservation, but objective assessment of post-transplant periorbital function has been limited. Materials and methodsKinematic data were collected from a full-face recipient that included the fist total eyelid transplantation at 5 separate pre-transplant (PRE) and post-transplant time points (T1-T4). Using optical facial tracking, eyelid movements were tracked during involuntary blinking and compared with controls. ResultsThere was significant improvement in right eye aperture from PRE to T1 (β = 5.54, P < 0.001), with no change between T1 and T4. Aperture fluctuated in the left eye, with a temporary decrease between T2 and T3 corresponding with revision brow lift (β = −4.57, P < 0.001). Although improved from the pre-transplantation, right and left eye apertures remained significantly smaller than controls at T1 and T4 (P < 0.001). Similarly, spatial coupling increased from PRE to T1 (β = 0.63, P < 0.001) and remained high at T4, albeit significantly less than controls (P < 0.001). Temporal coupling improved from PRE to T2 (β = 2.29, P < 0.02) and was sustained at subsequent time points, with no difference relative to controls at T4. Considerable improvement was observed on clinical examination, with full functional status. ConclusionsApplication of a novel method for assessing functional eyelid recovery using facial tracking technology to the first total eyelid transplantation in the setting of a full facial transplant shows clear functional improvement after transplantation and suggests revisions can be performed safely to optimize aesthetic outcomes without permanent negative functional impact.

Should Patients with Hidradenitis Suppurativa Undergo LASIK?

Hidradenitis suppurativa (HS) is a relatively common chronic inflammatory disease with immune dysregulation. While eye manifestations of HS are rare, a dilemma arises when these patients seek treatment for refractive errors. Although excimer laser surgery can be safely performed in patients with autoimmune and immune-mediated inflammatory disease, there are caveats. Aside from the routine laser-assisted in situ keratomileusis (LASIK) screening tests, in some instances, we recommend additional screening tests in patients with HS, such as dry eye tests, consultation with specialists regarding HS diagnosis and treatment, careful assessment of the eyelids and periorbital structures, and thorough history of past and current lesions and treatments. After these patients undergo LASIK, careful, frequent, and long-term follow-up is necessary. Any adverse event or complication should be managed immediately.FundingResearch to Prevent Blindness funded the study. Hoopes Vision funded the Rapid Service Fees.

Orbital Reconstruction.

Orbital reconstruction poses a true challenge for reconstructive surgeons owing to the three-dimensional anatomy of the orbit, proximity to the brain and sinonasal tract, as well as the delicate interface between bone and soft tissue. A thorough understanding of both form and function allows successful reconstruction of this unique region. A defect-driven approach coupled with an understanding of the patient's overall health can guide the reconstructive surgeon in choosing viable options. Orbital reconstruction truly lends itself to the art and skill of the surgeon, as it spans the gamut from trauma repair to resurfacing of exenteration defects to skull base reconstruction. Soft-tissue techniques utilized for eyelid reconstruction are equally challenging due to the propensity of the periorbital structures to readily fibrose and compromise ideal function.