The Massachusetts Eye and Ear Infirmary Illustrated Manual by Peter K. Kaiser, Roberto Pineda II Neil J. Friedman

By Peter K. Kaiser, Roberto Pineda II Neil J. Friedman

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45 46 Figure 1-35 • Same patient as Figure 1-34 with prosthesis in place. • • • • • • • Eyelids should be observed for cellulitis, ptosis, or retraction. Superior tarsal conjunctiva must be examined for giant papillae (see Chapter 4). In the absence of conjunctival defect or lesion, treat with broad spectrum topical antibiotic (gentamicin or polymyxin B sulfate [Polytrim] 1 gtt qid). If conjunctival defect is observed, refer to an oculoplastic surgeon for evaluation. Treatment may include removal of avascular portion of porous implant, secondary implant, dermis fat graft placement, or other techniques.

No treatment usually required, especially for acquired forms, which may improve spontaneously depending on the etiology. • Consider injection of steroids near trochlea or oral steroids if inflammatory etiology exists. • Muscle surgery for abnormal head position or large hypotropia in primary position: superior oblique muscle tenotomy or tenectomy or silicon band expander, with or without ipsilateral inferior oblique muscle recession. Dissociated Strabismus Complex: Dissociated Vertical Deviation, Dissociated Horizontal Deviation, Dissociated Torsional Deviation • Updrift, horizontal, oblique, or torsional movement of nonfixating eye with occlusion or visual inattention.

Recurrence and malignant transformation are rare. Figure 1-29 • Neurilemoma (Schwannoma) producing proptosis of the left eye. Orbital CT scan: Well-circumscribed lesion; virtually indistinguishable from “cavernous hemangioma”; may have cystic areas. • A-scan ultrasonography: Low internal reflectivity. • Complete surgical excision should be performed by an oculoplastic surgeon. Meningioma • Symptoms relate to specific location, but proptosis, globe displacement, diplopia, and optic neuropathy are common manifestations.

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