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Dysthyroid Optic Neuropathy (DON) can lead to irreversible visual loss. We report risk features correlated with poor visual recovery despite an intensive treatment in a series of patients with DON.Retrospective analysis of a non-comparative interventional series.Between 1997 and 2007, 300 consecutive patients with Graves' orbitopathy were seen at the Rothschild Foundation (Paris). Medical records of all consecutive patients who developed a DON were reviewed. Demographic, clinical features and visual function were collected at the time of the first onset, one month follow-up after medical and sometime surgical treatment and at the last examination. Statistical analysis (reflected as p values) gathered the significant observations into detrimental visual recovery prognostic factors for DON.Fifty-six eyes of 29 patients developed a DON. Sixteen eyes (28%) did not improve vision despite usual treatment (intravenous steroids and surgical decompression when necessary). An inferior altitudinal visual field defect (AVF, p=0.0004) and/or a lack of response to intravenous steroids boluses (p= 0.011) were related to a poor recovery.DON prognosis is highly variable. Our results suggest that a non-inflammatory element, probably vascular could be involved in atypical DONs. An earlier recognition could prompt to rapid surgical treatment for these patients.

The complications of blepharoplasty are infrequent, most often minor and transient, and rarely major and permanent with functional or aesthetic consequences. Treatment is above all preventive with screening of "at risk" patients in whom blepharoplasty would be contra-indicated. Patients must be informed of possible risks through informative booklets stressing the most important points. The complications may affect vision. Partial or complete visual loss due to ischemic optic neuropathy, or rarely to compression of the ocular globe by intraorbital hemorrhage, is the most serious complication. Other visual complications include oculomotor disorders, keratoconjunctivitis sicca, epiphora, and chemosis of lymphatic origin. Eyelid complications are more frequent: ptosis of the upper eyelid or lagophthalmia caused by incorrect resection of the skin, scarring, and eyelid fold anomalies. The most severe aesthetic complication is the malposition of the lower eyelid resulting in retraction, lagophthalmia, ectropion, deformation of the external canthus, or lower eyelid tissue relaxation. These malpositions are often minor, sometimes reversible, but they can be major, with psychological, aesthetic, and functional consequences. Other local complications include enophthalmia and hypo- or hypercorrection. General complications may include pigmentation anomalies or infections extending as far as the orbital fat tissue. Finally, complications observed after the newer procedures of laser surgery include ectropion, burns and residual redness. Complications related to periocular injections of filling material are also mentioned. The discussion of these complications is followed by a comprehensive review of the prevention, diagnosis and management of the complications after blepharoplasty.

OBJETIVO: Avaliar os resultados obtidos com a ressecção do músculo de Müller-conjuntiva no tratamento da blefaroptose e analisar suas vantagens. MÉTODOS: Trinta e oito pacientes (39 pálpebras) foram submetidos à ressecção do músculo de Müller-conjuntiva. Blefaroptose no pré-operatório variou de 1,0 mm a 3,0 mm (média: 2,0 mm). O valor de elevação palpebral produzido pelo teste da fenilefrina indicou a quantidade de tecido a ser ressecado. RESULTADOS: 33 pálpebras (85%) que foram tratadas com este procedimento tiveram resultado estético satisfatório. CONCLUSÃO: Ressecção do músculo de Müller-conjuntiva é técnica relativamente simples para o tratamento da blefaroptose, quando houver boa função do músculo levantador da pálpebra superior e teste da fenilefrina 10% positivo. Suas vantagens são a preservação do tarso e o resultado cirúrgico previsível.OBJETIVE: To evaluate the results of Müller's muscle-conjunctival resection for correction of blepharoptosis and to discuss the advantages of this procedure. METHODS: 38 patients (39 eyelids) were submitted to Müller's muscle-conjunctival resection. Blepharoptosis varied from 1.0 mm to 3.0 mm (mean: 2.0 mm). The amount of eyelid elevation produced by phenylephrine guided the amount of tissue to be resected. RESULT: 33 eyelids (85%) treated with this procedure were cosmetically acceptable. CONCLUSIONS: Müller's muscle-conjunctival resection procedure is a relatively simple technique for blepharoptosis, with good levator function and positive 10% phenylephrine test. The advantages are: preservation of tarsus and predictable results.

Microftalmia com cisto colobomatoso orbitário é raro diagnóstico diferencial dos tumores congênitos orbitários. O diagnóstico precoce e o tratamento adequado são importantes para bom crescimento órbito-palpebral. Descrevemos três casos de microftalmia congênita associada a cisto colobomatoso orbitário e analisamos a importância dos exames complementares. Ultra-sonografia, tomografia computadorizada, ressonância nuclear magnética e o estudo histológico da massa excisada estabeleceram o diagnóstico preciso de cisto colobomatoso. Microphthalmos with colobomatous orbital cyst is a rare differential diagnosis of congenital orbital tumors. Early diagnosis and adequate treatment are important for orbital and eyelid growth. We present three cases of microphthalmos with colobomatous orbital cyst and demonstrate the importance of imaging techniques. Ultrasonography, computed tomography, magnetic resonance and histological study of the ablated mass established the correct diagnosis of colobomatous cyst.

Microftalmia com cisto colobomatoso orbitário é raro diagnóstico diferencial dos tumores congênitos orbitários. O diagnóstico precoce e o tratamento adequado são importantes para bom crescimento órbito-palpebral. Descrevemos três casos de microftalmia congênita associada a cisto colobomatoso orbitário e analisamos a importância dos exames complementares. Ultra-sonografia, tomografia computadorizada, ressonância nuclear magnética e o estudo histológico da massa excisada estabeleceram o diagnóstico preciso de cisto colobomatoso.Microphthalmos with colobomatous orbital cyst is a rare differential diagnosis of congenital orbital tumors. Early diagnosis and adequate treatment are important for orbital and eyelid growth. We present three cases of microphthalmos with colobomatous orbital cyst and demonstrate the importance of imaging techniques. Ultrasonography, computed tomography, magnetic resonance and histological study of the ablated mass established the correct diagnosis of colobomatous cyst.

We describe an adult without microphthalmos who developed an acquired compressive optic neuropathy secondary to an orbital cyst which showed direct communication with an optic disc pit. Such pits may be revealed by late complications such as orbital compressive cyst of the optic nerve, even in previously normal adult patients.

Therapy for orbital pseudotumor, also called idiopathic orbital inflammation, is nonspecific and mainly based on the use of corticosteroids. Two patients with steroid-dependent idiopathic orbital inflammation, one with myositis and the other with dacryoadenitis, and intolerant of standard steroid sparing agents (methotrexate or azathioprine), were treated with infliximab, a monoclonal antitumor necrosis factor alpha antibody. In both patients, orbital manifestations disappeared following treatment. After follow-up for at least 20 months, the 2 patients still receiving infliximab remained event free. Infliximab enabled steroid tapering to less than 5 mg per day, suggesting that infliximab could constitute an alternative to conventional steroid sparing agents.

Since orbital fractures sometimes occur within the setting of multiple injuries, complications may be overlooked when attending to more vital structures. Oculomotor disorders occur frequently followin

Purpose Idiopathic orbital inflammation is a rare clinical entity which has protean clinical manifestations. It’s a diagnosis of exclusion which imposes a biopsy, and which can be made only after a screening to rule out a systemic etiology of inflammation. Methods Retrospective series of 18 histologically-proven orbital inflammation cases seen in our service between 2006 and 2011. Results The study encompassed 7 men and 11 women, with a mean age of 47 years old (4-83). Patients complained of a pain (44%), a diplopia (33%), a decreased visual acuity (17%). A swollen eyelid or a palpable mass were presents in 78% of the cases. Less often, we noted proptosis, or a diminished ocular motility. The radiologic analysis (CT-scan, NMR, doppler ultrasound examination) found an inflammation localized to the orbital fat, to the lacrymal gland, and to one or several oculomotor muscle(s) in respectively 89%, 67%, and 39% of the cases. Excisional biopsy was curative for 33% of the cases. 61% of the patients received a corticotherapy, with a relapse or a recurrence in 60% of the cases, making necessary to have recourse to immunosuppressive agents (methotrexate), with a good control rate on the inflammation (75%). Finally, 76% of the patients obtained a complete resolution of their symptoms at the end of the follow-up (mean : 20 months). Conclusion Treatment lies on surgical exeresis if it is safely. Corticotherapy is frequently not sufficient. Methotrexate seems to be an interesting alternative. Recent works concentrate on Systemic IgG4 Disease, who could be a frequent cause of orbital inflammation, calling the term "idiopathic" into question, and letting us think about targeting treatments.

The position and appearance of the upper eyelid crease is one of the challenges in eyelid surgery. The aim of this study was to compare the clinical appearance of the upper eyelid crease with its anatomy, including the position of the levator, the septum, and the orbital fat as determined by Magnetic Resonance Imaging (MRI).Oculoplastic examination was performed in normal volunteers of the same age with different appearances of the upper eyelid. MRI (Intera 1.5 T, Philips, the Netherlands) was carried out with both head and surface coils in all volunteers. Subjects were asked to keep their eyes closed during the whole procedure, thus reducing artefacts due to eyeball movements. The protocol lasted 8 minutes and included a multiplanar scout to obtain T1-weighted 3D-images. Thin sagittal T2 sequences were obtained along the plane of the optic nerve and focused on both orbits, allowing a precise analysis of the orbital content and eyelid anatomy.Six volunteers were included in this prospective study, three of Caucasian origin and three of North African, Central African and Asian origin, respectively. We distinguished two appearances of the crease: in some cases, the superior eyelid sulcus was convex, while in other cases it was concave. The superior eyelid fold was either high or low. Two Caucasian subjects had a deep, concave superior eyelid sulcus with a high crease. This crease appearance was correlated with a short concave appearance of the septum, which pulled back the pre-aponeurotic fat. The non-Caucasian volunteers all had a convex superior eyelid sulcus. The orbital septum insertion was low on the levator aponeurosis, and the orbital fat pad drooped onto the levator muscle, accounting for the convexity of the upper eyelid sulcus. A skin fold was formed by redundant skin over the crease.MRI provides excellent images and allows a good analysis of the upper eyelid components. It permits a detailed analysis of the architecture for a better understanding of its appearance and of the crease position, although further investigation with a larger number of volunteers is required.

To evaluate the results of Müller's muscle-conjunctival resection for correction of blepharoptosis and to discuss the advantages of this procedure.38 patients (39 eyelids) were submitted to Müller's muscle-conjunctival resection. Blepharoptosis varied from 1.0 mm to 3.0 mm (mean: 2.0 mm). The amount of eyelid elevation produced by phenylephrine guided the amount of tissue to be resected.33 eyelids (85%) treated with this procedure were cosmetically acceptable.Müller's muscle-conjunctival resection procedure is a relatively simple technique for blepharoptosis, with good levator function and positive 10% phenylephrine test. The advantages are: preservation of tarsus and predictable results.

OBJETIVO: Avaliar os resultados obtidos com a ressecção do músculo de Müller-conjuntiva no tratamento da blefaroptose e analisar suas vantagens. MÉTODOS: Trinta e oito pacientes (39 pálpebras) foram submetidos à ressecção do músculo de Müller-conjuntiva. Blefaroptose no pré-operatório variou de 1,0 mm a 3,0 mm (média: 2,0 mm). O valor de elevação palpebral produzido pelo teste da fenilefrina indicou a quantidade de tecido a ser ressecado. RESULTADOS: 33 pálpebras (85%) que foram tratadas com este procedimento tiveram resultado estético satisfatório. CONCLUSÃO: Ressecção do músculo de Müller-conjuntiva é técnica relativamente simples para o tratamento da blefaroptose, quando houver boa função do músculo levantador da pálpebra superior e teste da fenilefrina 10% positivo. Suas vantagens são a preservação do tarso e o resultado cirúrgico previsível.

Graves' ophthalmopathy (GO) is a chronic autoimmune process that affects the retrobulbar tissue and has strong etiological links with graves' disease. Pathogenesis is incompletely understood. Symptoms include proptosis, extraocular muscle dysfunction, eyelid swelling and retraction. In its severe expression, it is a disfiguring and potentially sight threatening disease that profoundly influences and impairs the quality of life of affected individuals. Only a minority of patients develop severe expressions of the disease, requiring aggressive treatments. Glucocorticoids, orbital radiotherapy and decompressive orbital surgery represent a mainstay and a well established treatment for severe and active GO.

Craniofacial stenoses form a unique syndrome in spite of the extreme diversity of their clinical aspects, such as the Crouzon syndrome, orbital dystopies and hypertelorism. The possibility of surgery for these disorders is still new. The interventions are extremely complex because of the nature of the malformations, which may involve the intrafacial skull. By monobloc orbital osteotomy, the position of the orbit can be corrected in three planes, in the sagittal direction, in craniofacial stenoses, in the vertical direction in orbital dystopia, and in the transverse direction in hypertelorism.

Summary Twenty-nine patients have undergone major subtotal orbital translocation surgery between 1976 and 1980. Extra-ocular muscle function has been studied before and after orbital surgery. Medial orbital translocation, like sagittal orbital translocation, produces a decrease of exotropia; sometimes there is no change which proves the importance of well-established binocular vision. Orbital osteotomy in the three planes can produce a modification of the primary position of a vertical imbalance but it has no action on the vertical movements. The ophthalmologist can predict the post-operative result when he knows what type of ocular abnormality exists and what type of orbital surgery will be performed. He can also discuss the timing of strabismus surgery.

Summary Based on 77 observations including telorbitism, craniofacial stenosis (C.F.S.), and plagiocephalies, oculomotor disorders involving horizontal and vertical imbalance occur very frequently. Abnormalities in the transverse plane (telorbitisms, craniofacial stenoses) give orbital divergence and exotropia. Orbital extorsion with a significant antimongoloid palpebral fissure, may be the cause of rectus muscle extorsion. Abnormalities in the vertical plane (plagiocephalies) induce hypertropia. Abnormalities in the sagittal plane (C.F.S.) lead to exotropia with exorbitism, the V syndrome with double up-shoot. These oculo-motor disorders seem to be the consequence of these orbital structure abnormalities, sometimes combined with sensory factors.