Two methods of recovering normal contour of the orbit are presented in which ocularists and ophthalmologists equally participate. One method is for correction of the deep supratarsal retraction following soft tissue atrophy; the other technique is indicated when there has been loss of or major displacement of bone of the orbital rim. Frequently, these two techniques must be used concomitantly in complex reconstructive cases.
Cryosurgical destruction of aberrant eyelashes was performed on 72 eyelids. Seven of nine failures occurred following major deviation from recommended technique. All but one recurrence were successfully re-treated. Notching of the eyelid was observed in one patient. The technique utilized a nitrous oxide gas-cooled cryoprobe. Tissue temperature was monitored by a subcutaneous microthermocouple in the region of the lash follicle to -20 C in a double freeze-thaw cycle.
This preliminary report suggests that cryosurgery has a definite place in the management of certain external periocular and ocular problems. Cryosurgery for basal or squamous cell carcinoma of the lid is easily performed, gives excellent cosmetic results, and has a low recurrence rate. It is not recommended for lesions involving the fornices, or sclerotic and morphea-type basal cell carcinomas. Tumor recurrences following radiation, surgery, or cryosurgery can still be retreated with cryosurgery. To date, there is no evidence that cryosurgery at temperatures above -40 C causes damage to the lacrimal outflow system. Cryosurgery is of value in the management of trichiasis, reactive lymphoid hyperplasia, spider hemangioma, molluscum contagiosum, and conjunctival dysplasia. Cryotherapy for management of intraepithelial epithelioma and squamous cell carcinoma of the conjunctiva and cornea is still under investigation. Cryosurgery will, in our opinion, become the treatment of choice for basal and squamous cell carcinomas of the eyelids. The 96% cure rate with one treatment for these lesions reported here is artificially high since the follow-up period is too short. However, retreatment with cryosurgery is a simple ten-minute outpatient procedure which is certainly not the case with recurrences after other forms of therapy.
Various surgical treatment methods were outlined that are currently used in treatment of the severe chronic contractual changes seen in Stevens-Johnson syndrome and ocular pemphigoid. All methods described are not 100% successful in view of the chronicity of the disease, but have greatly aided in delaying the destructive course of action because of various degrees of cicatricial entropion formation. The potential association of ocular pemphigoid with Phospholine Iodide medications in the treatment of open-angle glaucoma is under investigation.
Scleral transplantation has given excellent results in the surgical repair of eyelid problems. The advantages of using scleral transplantation in repairing eyelid retraction are the relative predictability of the final eyelid position and curve and the decreased incidence of repeated retraction. The characteristics of sclera make it a desirable homologous transplant material for use in transplant surgery.
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