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Essentials in Ophthalmology Oculoplastics and Orbit R. F Essentials in Ophthalmology Oculoplastics and Orbit R. F. Guthoff J. A. Katowitz Editors Essentials in Ophthalmology Glaucoma G. K. Krieglstein R. N. Weinreb Cataract and Refractive Surgery Series Editors Uveitis and Immunological Disorders Vitreo-retinal Surgery Medical Retina Oculoplastics and Orbit Pediatric Ophthalmology, Neuro-Ophthalmology, Genetics Cornea and External Eye Disease Editors Rudolf F. Guthoff James A. Katowitz Oculoplastics and Orbit Aesthetic and Functional Oculofacial Plastic Problem-Solving in the 21st Century With 181 Figures, Mostly in Colour and 18 Tables Series Editors Volume Editors Günter K. Krieglstein, MD Rudolf F. Guthoff , MD Professor and Chairman Professor of Ophthalmology Department of Ophthalmology University of Rostock University of Cologne Department of Ophthalmology Joseph-Stelzmann-Straße 9 Doberaner Straße 140 50931 Köln 18055 Rostock Germany Germany James A. Katowitz, MD Robert N. Weinreb, MD Professor of Ophthalmology Professor and Director Children’s Hospital of Philadelphia Hamilton Glaucoma Center R. D. Wood Ambulatory Care Building Department of Ophthalmology – 0946 Division of Ophthalmology University of California at San Diego 34th Street Civic Center Blvd. 9500 Gilman Drive Philadelphia, PA 19104 La Jolla, CA 92093-0946 USA USA ISBN: 978-3-540-85541-5 e-ISBN: 978-3-540-85542-2 DOI: 10.1007/978-3-540-85542-2 Library of Congress Control Number: 2009933987 © Springer-Verlag Berlin Heidelberg 2010 Th is work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. Th e use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: Th e publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: WMX Design, Heidelberg, Germany Printed on acid-free paper 9 8 7 6 5 4 3 2 1 (www.springer.com) Foreword Th e Essentials in Ophthalmology series represents an ership acceptance of the fi rst two series, each of eight unique updating publication on the progress in all sub- volumes. Th is is a success that was made possible pre- specialties of ophthalmology. dominantly by the numerous opinion-leading authors In a quarterly rhythm, eight issues are published cov- and the outstanding section editors, as well as with the ering clinically relevant achievements in the whole fi eld constructive support of the publisher. Th ere are many of ophthalmology. Th is timely transfer of advancements good reasons to continue andstill improve the dissemina- for the best possible care of our eye patients has proven to tion of this didactic and clinically relevant information. be eff ective. Th e initial working hypothesis of providing new knowledge immediately following publication in the peer-reviewed journal and not waiting for the textbook appears to be highly workable. G.K. Krieglstein We are now in the third cycle of the Essentials in R.N. Weinreb Ophthalmology series, having been encouraged by read- Series Editors Preface Th is third volume of Oculoplastic and Orbital Surgery Appearance issues are also discussed in relation to promises to challenge the reader with stimulating new managing ophthalmic anomalies in congenital ano- concepts at the cutting edge of this subspecialty. A variety phthalmic and microphthalmic patients. Controversies in of innovative techniques is described in this volume, cov- enucleation techniques, implant selection, and implant ering both cosmetic and functional aspects of oculoplas- preparation are presented, and the role of pegging an tic and orbital surgery. implant to ultimately improve prosthesis motility is criti- Pearls in cosmetic and oculofacialplastic surgery are cally evaluated. presented in great detail, based on extensive experience. It is our hope, as with the previous two volumes, that Rather than presenting merely anecdotal solutions, spe- this presentation of the latest concepts and management cifi c steps are outlined for problem solving in this rapidly techniques for a variety of problem areas in the fi eld of evolving fi eld. oculoplastic surgery will be of value for both comprehen- Th e latest therapies in the management of capillary sive ophthalmologists and subspecialists with a particular hemangiomas, periorbital infections, and orbital and interest in this fi eld. periorbital malignancies using specifi c targeted therapies demonstrate the increasingly important interaction between ophthalmic plastic surgery and the broad fi eld of Rudolf F. Guthoff modern oncology. James A. Katowitz Contents Chapter 1 2.4.4 Upper Blepharoplasty Surgical Ocular Adnexal Lymphoproliferative Disease Procedure Pearls . 30 Timothy J. Sullivan 2.5 Lower Blepharoplasty, Fillers, and Midface Augmentation . 33 1.1 Pathogenesis . 2 2.5.1 Introduction . 33 1.2 Chronic Antigen Stimulation . 3 2.5.2 Patient Evaluation. 33 1.3 Immunosuppression . 3 2.5.3 Lower Blepharoplasty 1.4 Pathology. 4 Anesthesia Pearls . 37 1.5 Cytogenetics. 4 2.5.4 Lower Blepharoplasty Surgical 1.6 Clinical Features. 7 Procedure Pearls . 38 1.7 Imaging Findings . 8 References . 44 1.8 Staging . 9 1.9 Positron Emission Tomography . 9 Chapter 3 1.10 Treatment . 9 Current Concepts in the Management 1.11 Follicular Lymphoma . 11 of Idiopathic Orbital Infl ammation 1.12 Mantle Cell Lymphoma. 11 Katherine A. Lane and Jurij R. Bilyk 1.13 Radiotherapy . 11 1.14 Chemotherapy. 12 3.1 Introduction . 47 1.15 Immunotherapy. 12 3.2 What Is the Diagnosis? . 47 1.16 Radioimmunotherapy . 13 3.2.1 Pitfalls of Diagnosis. 48 1.17 Outcome . 13 3.2.2 A Diagnostic Corticosteroid Trial? . 54 1.18 The Future . 13 3.2.3 The Question of Biopsy . 56 References . 14 3.3 Treatment . 56 3.3.1 Corticosteroids. 57 Chapter 2 3.3.2 Radiation . 58 Pearls in Cosmetic Oculofacial Plastic Surgery 3.3.3 Other Agents . 58 Jonathan A. Hoenig 3.4 Special Circumstances. 60 3.4.1 Pediatric IOIS. 60 2.1 General Introduction . 21 3.4.2 Sclerosing Pseudotumor . 60 2.2 The Aging Process and Facial Analysis. 22 3.4.3 Tolosa–Hunt Syndrome. 62 2.3 Endoscopic Brow Lift . 23 References . 63 2.3.1 Introduction . 23 2.3.2 Endoscopic Browlift Anesthesia Pearls . 26 Chapter 4 2.3.3 Endoscopic Browlift Surgical Lacrimal Canalicular Infl ammation and Occlusion: Procedure Pearls . 26 Diagnosis and Management 2.3.4 Endoscopic Browlift Postoperative David H. Verity and Geoff rey E. Rose Care Pearls . 27 2.4 Upper Blepharoplasty . 29 4.1 Introduction . 67 2.4.1 Introduction . 29 4.2 Embryology, Anatomy, Physiology, 2.4.2 Patient Evaluation. 29 and Pathophysiology of the Canalicular 2.4.3 Upper Blepharoplasty System. 67 Anesthesia Pearls . 30 4.3 Infective Causes. 69 x Contents 4.3.1 Periocular Herpes Simplex Infection . 69 5.7.3.1 The Upper Eyelid . 85 4.3.2 Bacterial Canaliculitis. 70 5.7.3.2 The Lower Eyelid and Midface . 85 4.4 Systemic Infl ammatory Disease . 70 5.7.4 Orbital Involvement . 86 4.4.1 Lichen Planus . 70 5.7.4.1 Proptosis. 86 4.4.2 Ocular Cicatricial Pemphigoid . 70 5.7.4.2 Proptosis Due to Orbital 4.4.3 Drug Eruptions (Stevens–Johnson Neurofi bromas. 87 Syndrome) . 71 5.7.4.3 Proptosis Due to Optic Nerve Glioma . 87 4.5 Iatrogenic Causes . 71 5.7.4.4 Orbital Enlargement with Dystopia 4.5.1 Systemic Drugs . 71 and Hypoglobus . 87 4.5.1.1 5-Fluorouracil (5-FU) . 71 5.8 The Natural History of NF1 Tumor 4.5.1.2 Docetaxel (Taxotere) . 72 Growth from Birth to Senescence . 90 4.5.2 Radiotherapy . 72 References . 92 4.5.3 Topical Ophthalmic Treatments. 73 4.5.3.1 Preservative-Related Chronic Chapter 6 Conjunctivitis . 73 Clinicopathologic Features of Lesions 4.5.3.2 Mitomycin C Therapy. 73 Aff ecting the Lacrimal Drainage System in External Dacryocystorhinostomy 4.5.4 Lacrimal Stents and Plugs . 73 4.6 The Surgical Approach to Managing Ludwig M. Heindl, Anselm G. M. Jünemann, Canalicular Disease. 74 and Leonard M. Holbach 4.6.1 Surgical Technique for 6.1 Introduction . 95 Dacryocystorhinostomy with 6.2 Surgical Anatomy of the Lacrimal Retrograde Canaliculostomy. 74 Drainage System . 96 4.6.2 Placement of a Jones Canalicular 6.3 Basic Diagnostics for Disorders Bypass Tube. 75 of the Lacrimal Drainage System. 97 References . 76 6.4 Selective Lacrimal Sac Biopsy in External Dacryocystorhinostomy . 97 Chapter 5 6.5 Defi nitive Treatment and Prognosis Orbitofacial Neurofi bromatosis 1: Current Medical and Surgical Management of Lesions Aff ecting the Lacrimal Drainage System . 99 William R. Katowitz and James A. Katowitz 6.5.1 Case A . 99 5.1 Introduction . 79 6.5.2 Case B . 99 5.2 Nomenclature. 79 6.5.3 Case C . 100 5.3 Clinical Manifestations of NF1 . 79 6.5.4 Case D . 100 5.4 Orbitofacial Tumors in NF1 . 80 6.5.5 Case E . 101 5.4.1 Neurofi bromas. 80 6.5.6 Case F . 101 5.4.2 Malignant Peripheral Nerve 6.5.7 Case G . 101 Sheath Tumors . 81 References . 103 5.4.3 Optic Pathway Gliomas. ..
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