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Biomedical subjects

N Shorr

Publications and source records attributed to N Shorr.

At least 19 recordsLinked to original sources
PubMed1995

Infraorbital pigmented skin. Preliminary observations of laser therapy.

BACKGROUND: The presence of infraobital dark skin, often known as dark circles under the eyes, is a frequent cosmetic concern. There has been little reported on therapy of this condition. One group of patients was determined to have dermal melanin deposition, which we treated with a Q-switched ruby laser. OBJECTIVE: Our study evaluated the clinical and histological appearance of infraobital skin pigment in 17 patients with dermal melanin deposition treated with a Q-switched ruby laser. METHODS: Seventeen patients with melanin deposition were treated with the Q-switched ruby laser (694 nm) with a pulse width of 28 nanoseconds and fluences of 7.5 J/cm2. Response to treatment was assessed by an independent investigator with patient and photograph evaluation. Skin Biopsies were obtained in nine of the 17 patients. RESULTS: Of those patients treated with one Q-switched ruby session, 23.5% achieved a greater than 50% response. Of those treated twice, 88.9% achieved greater than 50% response. In postreatment skin biopsies there was reduction of dermal melanin deposition. CONCLUSIONS: Patients with infraobital pigmented skin due to dermal melanin deposition may be considered candidates for Q-switched Ruby laser treatment.

Adult↗
PubMed1992

The medical orbital strut in the prevention of postdecompression dystopia in dysthyroid ophthalmopathy.

Ocular dystopia with inferomedial displacement of the globe is an unusual but well-recognized complication of bony orbital decompression. It is caused by displacement of the muscle cone and orbital connective tissue system into the maxillary and ethmoidal sinuses. We illustrate a surgical variation of bony orbital decompression leaving intact a strut of bone at the maxillary-ethmoid junction. This bony strut reduces inferomedial displacement of the muscle cone and provides a medial supporting "ledge" in cases requiring late orbital reconstruction.

Eye Diseases↗
PubMed1992

Eyelid reconstruction with hard palate mucosa grafts.

Hard palate mucosa grafts are an excellent replacement for tarsus and conjunctiva in eyelid reconstruction. Twenty-five eyelids from 18 patients underwent eyelid reconstruction using hard palate mucosa grafts. Patients were treated for a variety of disorders including postblepharoplasty lower eyelid retraction, cicatricial entropion, eyelid retraction secondary to thyroid eye disease, and lagophthalmos following surgery for paralytic ptosis. Surgical results were evaluated, grafts were measured for postoperative shrinkage, and donor site healing was recorded. Several patients had hard palate biopsy specimens evaluated. One of these patients also had a graft biopsied after it had been in place for 3 months. A review of hard palate anatomy and histology and a discussion of surgical technique are presented.

Adult↗
PubMed1992

Considerations in aesthetic eyelid surgery.

BACKGROUND: Successful aesthetic eyelid surgery is based upon multiple complex factors that, when put together, yield a pleasing result. Beauty is inherently related to normal eyelid function and symmetry. OBJECTIVE: To review the critical issues facing the aesthetic surgeon, and to propose a systematic method of assessing the patient preoperatively. METHODS: This article first examines the general considerations for aesthetic eyelid surgery, followed by specific concerns within each anatomic area. RESULTS AND CONCLUSION: The critical task in aesthetic eyelid surgery is to reconstitute or preserve the normal structure and function of the eyelids. This is especially true in the multicontoured areas. It is essential for the surgeon to define the problems in a hierarchal fashion, and plan the surgery accordingly. Thus, not all patients can achieve the desired results in one sitting. The goal of aesthetic surgery is to avoid the telltale signs of surgery and to help the patient attain a youthful and energetic appearance for his or her age bracket.

Eyebrows↗
PubMed1992

"Vertical slat" chalazion excision.

We describe a technique of chalazion excision in which multiple vertical incisions spaced approximately 1 mm apart are used to provide wide exposure of the chalazion. The entire extent of lipogranulomatous tissue can be excised under direct visualization, sparing normal tissues. No tarsoconjunctival tissue is extirpated. The vertical slats heal quickly, and horizontal incisions, which may cut across meibomian glands, are avoided.

Chalazion↗
PubMed1991

Histoacryl closure of eyelid skin grafts.

Histoacryl is virtually an ideal tissue glue. It has found application in corneal surgery, oculoplastic surgery, as well as many other surgical fields. A clinical series of 18 patients requiring eyelid skin grafts is presented. Each of the patients had skin grafts placed with a combination of sutures and Histoacryl. No complications were encountered. The postoperative course and results were identical to the authors' experience with skin grafts closed with suture alone. The advantages of Histoacryl skin closure are discussed. Other uses of Histoacryl in oculoplastic surgery are also reviewed.

Adult↗
PubMed1990

The transconjunctival approach to the orbital floor and orbital fat. A prospective study.

The transconjunctival approach to the inferior orbit and orbital fat offers the potential advantage of avoidance of scar creation in the lower eyelid skin and anterior lamellae. Complications of this approach, including conjunctival fornix shortening and eyelid margin malposition, have been occasionally reported. We prospectively observed 25 patients undergoing transconjunctival blepharoplasty and orbital floor surgery. Fornix depth, eyelid margin position, and the presence or absence of eyelid retraction were measured preoperatively and at each postoperative visit. No significant permanent change in these parameters was observed. Temporary entropion was observed in two patients; this resolved with conservative treatment. On self-limited suture granuloma was observed. In a subgroup of six patients, the conjunctival incision was closed on one side and left unclosed on the other. No adverse healing was noted on the unclosed side. We conclude that the transconjunctival approach is associated with a low incidence of complications, and that it does not significantly alter the fornix depth or eyelid margin position. A skin incision is avoided. The inferior orbital septum is not violated, greatly reducing the risk of development of lower eyelid retraction.

Adipose Tissue↗
PubMed1990

Blindness following blepharoplasty: two case reports, and a discussion of management.

We present two cases of unilateral permanent visual loss following four-eyelid blepharoplasty. Clinical and radiographic evidence suggested orbital hemorrhage was the cause of visual loss in both cases. In particular, electrophysiologic tests indicated that optic nerve dysfunction, and not retinal ischemia, was responsible for loss of vision. Timely orbital decompression is the cornerstone of managing these dramatic cases.

Blindness↗
PubMed1989

Orbital inflammation and optic neuropathies associated with chronic sinusitis of intranasal cocaine abuse. Possible role of contiguous inflammation.

Three cases of long-standing intranasal cocaine abuse were associated with orbitopathy or optic neuropathy. All three cases were characterized by chronic sinusitis. Histopathologic examination of involved sinus and orbital tissues revealed chronic and acute nonspecific inflammation, with no evidence of unusual infections or of idiopathic midline destructive disease. In two of the cases, there was radiographic evidence of contiguous orbital inflammation associated with sinusitis. The inflammatory orbital process in these two cases was steroid responsive, but in one case recurrent inflammation occurred in response to steroid tapering. One patient suffered a complete loss of vision in the involved eye due to fulminant orbital inflammation and optic nerve dysfunction.

Adult↗
PubMed1989

Complications of blepharopigmentation.

Blepharopigmentation is a commonly performed procedure with a very low rate of reported complications. We present three complications of the permanent eyeliner procedure: two cases of longlasting pigment fanning, and one case of eyelid margin necrosis with cilia loss and secondary cicatricial entropion. These complications may be related to placement of the pigment too deeply, or to overapplication with tissue maceration. Care should be taken to avoid through-and-through eyelid margin penetration, and to limit the number of needle penetrations to no more than is necessary at each application site.

Adult↗
PubMed1988

Nasolacrimal drainage system obstruction after orbital decompression.

We reviewed 123 cases of orbital decompression in 63 patients with dysthyroid ophthalmopathy. Of 90 cases of transantral ethmoidal orbital decompression, 14 (16%) resulted in epiphora. The tearing began between 11 and 18 months after surgery. All patients had obstruction distal to the common internal punctum. The delayed onset suggested progressive cicatricial obstruction of the nasolacrimal drainage system. Damage to adjacent tissues probably caused scarring to extend into the system.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1988

Free autogenous "pearl fat" grafts to the eyelids.

Free autogenous "pearl fat" grafts of 5-6 mm in diameter are used as a method of soft tissue augmentation for the eyelid. This method is useful in restoring eyelid contour defects, separating the eyelid lamella to lower the upper eyelid crease, and augmenting eyelids in anophthalmos. Graft survival is variable and pretreatment of fat with insulin is used in an attempt to prolong fat survival. The rationale, indications, and surgical procedure are discussed.

Adipose Tissue↗
PubMed1988

Medial entropion following orbital decompression for dysthyroid ophthalmopathy.

We found medial entropion of the lower eyelid to be common following orbital decompression for dysthyroid opthalmopathy. In our series significant postoperative medial entropion was noted in 14 of 69 patients, an incidence of 20%. Only four of these patients had entropion severe enough to require surgery (6%). Before orbital decompression, only one patient was found to have significant medial entropion (1.4%). Analysis of associated factors disclosed a positive relation between the amount of operative proptosis reduction and the degree of postoperative medial entropion. A strong correlation was also observed with the type of approach; transantral surgery was much more likely to be associated with significant postoperative medial entropion than was transconjunctival surgery. We suggest that the inferomedial displacement of the muscle cone that follows orbital decompression results in a force vector, transmitted through the lower eyelid retractors and capsulopalpebral ligament, that intorts the medial lower eyelid. Medial entropion in this setting often coexists with lower eyelid retraction, and if a "spacer" of sclera or ear cartilage is to be inserted into the lower eyelid, it should be carried into the medialmost portion of the eyelid to recess the posterior lamellae, including the medial retractors, and allow the eyelid margin to return to its normal anatomic position.

Entropion↗
PubMed1988

Laser treatment of juvenile hemangioma.

Capillary hemangioma in the infant may result in amblyopia, refractive error, or strabismus, and is often disfiguring. Treatment is challenging with respect to maintaining vision, as well as preserving function of the eyelids and ocular adnexa and obtaining the best possible cosmetic outcome. Neodymium-YAG laser photocoagulation may be a useful modality for the treatment of these lesions. We review the characteristics of the three types of lasers currently in wide use in skin surgery, with particular emphasis on their applicability for treatment of juvenile hemangioma. A possible role for the Nd-YAG laser in the management of these tumors is suggested.

Evaluation Studies as Topic↗
PubMed1988

Tarsoconjunctival grafts for upper eyelid cicatricial entropion.

Many surgical procedures have been described for correction of cicatricial entropion of the upper eyelid. However, many of them fail to address the altered anatomy responsible for cicatricial entropion, which may lead to excessive scarring, eyelid margin malposition, or blepharoptosis. Tarsoconjunctival grafts provide a strong and permanent buttress to correct the scarring of the posterior eyelid margin that characterizes cicatricial entropion. They provide a smooth mucosal surface to interface with the corneal tear film. Depending on the circumstances, we use free ipsilateral, free contralateral, or sliding "bucket handle" tarsoconjunctival grafting. Mucosal grafts are rarely needed. Blepharoptosis is avoided by conservative dissection in the supratarsal space, sparing most of the attachments of the levator aponeurosis.

Cicatrix↗
PubMed1987

Cyanoacrylate-fixed silicone sleds in the orbit. An animal model.

Subperiosteal wedge-shaped sleds of various materials have been used in treating the enophthalmic anophthalmic socket and in correcting the enophthalmic seeing eye. Posterior fixation of the sled may be difficult, as the sled tends to migrate anteriorly. Tissue adhesives were studied as a fixation method for silicone sleds in rabbit orbits. Gross examination revealed that the sleds were secured in position until well encapsulated. Butyl 2-cyanoacrylate (Histoacryl Blue) induced minimal inflammation, while ethyl cyanoacrylate (Crazy Glue) caused a giant-cell response.

Animals↗