Bhupendra C. K. Patel

University of Utah | UOU · John Moran Eye Center

Purpose: We present the surgical technique of localised excision of tarsal epithelium and replacement with oral mucous membrane tarsal patch grafting (MMTPG), to highlight novel indications of this technique for tarsal surface abnormalities beyond the lid margin. Methods: Retrospective case series of patients who underwent MMTPG for refractory t...

Purpose: Topical chloramphenicol is one of the most ubiquitous antibiotics used in ophthalmology and oculoplastic surgery globally. It shows broad-spectrum activity against a variety of different pathogenic organisms, is well tolerated on the ocular surface and displays excellent topical pharmacokinetics. Chloramphenicol has been available for pur...

When George Ernst Stahl (1660–1734) established nasolacrimal duct stenosis as a cause of dacryocystitis (1702) and passed a violin thread from the punctum to the stenotic region, little did he know that the foundation for lacrimal irrigation was being laid down.1 He proved an able predecessor to Dominique Anel. Since Anel’s first description of the...

Herpes simplex keratitis is a common and potentially blinding condition caused by recurrent corneal infections with the herpes simplex (HSV) virus. The presentations of herpes simplex keratitis vary with conditions such as herpetic dendrites, geographical ulcers, stromal keratitis, disciform keratitis, and neurotrophic keratopathy. Potential ocular...

Purpose: To investigate oculoplastic conditions in patients diagnosed with coronavirus disease 2019 (COVID-19) seen at ophthalmology departments of three tertiary referral centers in the United Kingdom and the United States, and review of the literature. Methods: Retrospective multicenter case series studied over 18 months. Results: A total of four...

A pediatric cataract is an important cause of treatable childhood blindness. The condition must be recognized and managed early to optimize outcomes. Leukocoria, strabismus, and nystagmus are common presenting signs. Pediatric cataracts may be congenital, arising from genetic or pregnancy-related conditions, such as maternal infections, or acquired...

Meige syndrome is a focal dystonic movement disorder characterized by blepharospasm (double eyelid spasm) and oromandibular dystonia.[1] Dystonia involves abnormal involuntary posturing or body movements resulting from sustained muscle contractions, often arising from neurological or medical causes. In 1910, Dr Henry Meige, a French neurologist, ob...

A pediatric cataract is an important cause of treatable childhood blindness. The condition must be recognized and managed early to optimize outcomes. Leukocoria, strabismus, and nystagmus are common presenting signs. Pediatric cataracts may be congenital, arising from genetic or pregnancy-related conditions, such as maternal infections, or acquired...

Herpes simplex keratitis is a common and potentially blinding condition caused by recurrent corneal infections with the herpes simplex virus (HSV). Herpes simplex keratitis remains the leading infectious cause of corneal ulcers and blindness worldwide. The most ubiquitous types of HSV are HSV-1 and HSV-2, which affect humans, their only natural hos...

The term "ptosis" is derived from the Greek word falling and refers to drooping of a body part. Blepharoptosis is upper eyelid drooping with the eyes in the primary position of gaze. The shape of one's eyes along with the position of the eyelids, shape, and position of the eyebrow determines one's identity. Hence, drooping of the eyelids may produc...

Presenting 25 years of development of the Hammock Lift with the rejuvenation of the upper two-thirds of the face, including the use of nano fat grafts, lasers, and volumization of the face in conjunction with tissue repositioning with minimal incisions

Mask-Associated Dry Eye (MADE) has emerged as a consequence of widespread face mask usage during the Covid-19 pandemic. This review critically assesses the available evidence. A comprehensive search on PUBMED and EMBASE was conducted to identify studies on MADE, which were then categorized based on their design. A total of 26 studies were criticall...

Background/objectives: To determine whether horizontal lower eyelid margin length shortens following facial nerve palsy (FNP). Subjects/methods: A single-centre retrospective audit of lower eyelid margin horizontal length, measuring from the lower lacrimal punctum to lateral canthal angle with a straight plastic ruler, with the eyelid on gentle...

Sympathetic ophthalmia (SO) is known to occur after severe penetrating eye injury, evisceration and even enucleation surgery. Recent evidence suggests that a greater risk lies after multiple vitreoretinal procedures. The risk of SO following evisceration is only minimally greater than that following enucleation surgery. This review evaluates litera...

Background/aims To present a case series of patients with facial nerve palsy (FNP) undergoing lower eyelid surgery where inadequate horizontal tarsal length was encountered and managed with a periosteal flap. Methods A two-centre retrospective, non-comparative case series of all patients with FNP who underwent lower eyelid periosteal flap procedur...

Facial movement disorders including blepharospasm, facial tics, hemifacial spasm and myokymia

Intraorbital foreign bodies (IOrFBs) are a significant cause of ocular morbidity. Although plastic IOrFBs are rare, the increasing use of plastic and polymer composites in motor vehicles will increase their prevalence. Although challenging to identify, plastic IOrFBs have unique radiographic characteristics. The authors describe a case of an 18-yea...

Keloids are benign, fibroproliferative dermal growths that occur in response to injury of the skin. These hypertrophic scars can cause pain and discomfort and have been associated with negative effects on social well-being, prompting physicians to seek effective treatment modalities with minimal risk of recurrence. Although surgical excision of the...

Keloids are benign, fibroproliferative dermal growths that occur in response to injury of the skin. These hypertrophic scars can cause pain and discomfort and have been associated with negative effects on social well-being, prompting physicians to seek effective treatment modalities with minimal risk of recurrence. Although surgical excision of the...

The obvious first question is whether anything needs to be done at all, as there has long been an argument in the oculoplastic world that loss or injury to one canaliculus will not necessarily lead to epiphora. An oft-repeated saw in ophthalmology is that of Abraham Werb from 1987, ‘The conservation of the inferior canaliculus is for tear drainage...

Conjunctivochalasis (CCh) is characterized by redundant, loose, and non-edematous bulbar conjunctival folds that can induce tear film instability and disruption to the tear drainage pathway. It is often missed due to the wide array of symptoms that can mimic other conditions. Management involves a stepwise approach, ranging from topical lubricants...

Punctoplasty is a common procedure in the management of punctal stenosis and was first described by Sir William Bowman in 1853. Several types of punctoplasty are described, and include 1-snip, 2-snip, triangular 3-snip, rectangular 3-snip and 4-snip procedures. The understanding of the anatomy and physiology of the punctum has greatly improved in t...

Background: This study evaluates the effectiveness of a multidisciplinary protocol for management of patients with papilledema and vision loss secondary to increased intracranial pressure. Methods: Retrospective record review of all adult patients who presented with vision-threatening papilledema (VTPE) and were treated under this protocol. Pati...

Red eyes, ringing ears, sensitivity to light, trouble hearing: although a loss of taste and smell have become well-known sensory symptoms of COVID, accumulating research suggests that vision and hearing are also frequent targets of SARS-COV-2, the virus that causes the disease. More than 10 percent of people who get COVID develop some type of eye o...

Nasolacrimal duct obstruction (NLDO) often results in intractable, bothersome epiphora. In longstanding NLDO, mucus can accumulate, resulting in a mucocele in the nasolacrimal sac or even acute or chronic dacryocystitis. Dacryocystorhinostomy (DCR) surgery can be performed to restore tear drainage and is usually the definitive treatment. This activ...

Eye twitching can be an unpleasant, even scary sensation. Here's what the experts want you to know, including how to stop eye twitching. What does it mean when your eye twitches? Most people have experienced that uncomfortable sensation when an eye begins to twitch. It can be annoying or even concerning, sometimes evoking fears of neurological prob...

Blepharoconjunctivitis is an ocular condition involving the inflammation of the eyelid and conjunctiva. It is a common chronic condition that can lead to permanent deterioration in vision if poorly managed. To avoid complications associated with this disease, it must be recognized early, and the patient counseled on lid hygiene measures and red fla...

Enucleation describes the removal of the entire globe, with separation of all connections from the orbit, including optic nerve transection. It is one of the oldest procedures in ophthalmology, with descriptions dating back to 2600BC. The decision for enucleation can be one of the most difficult to make and discuss with the patient. The main indica...

Uveitis is the inflammation of the uveal tract, that may be classified according to the predominant site of inflammation into anterior, intermediate, posterior, or panuveitis (standardization of uveitis: SUN classification). Uveitic macular edema (UME) is defined as the accumulation of fluid within the retinal layers as cystoid spaces or diffuse re...

Lagophthalmos describes the incomplete or abnormal closure of the eyelids. A full eyelid closure with a normal blink reflex is necessary for the maintenance of a stable tear film and healthy ocular surface. Patients who are unable to blink and completely close their eyes are at risk of corneal exposure, evaporation of the tear film, and subsequent...

Purpose: To report the etiology, management, and possible risk factors for diplopia after canalicular bypass surgery. Methods: A multicenter retrospective, noncomparative case series of patients who developed diplopia following canalicular bypass surgery were assessed. Results: Twenty-four cases of diplopia were identified across 12 institutio...

Refractive surgery is surgical or laser procedures to alter the eye's refractive power and decrease the patient's dependence on spectacles and contact lenses. Radial keratotomy (RK) was one of the first and most commonly performed refractive surgical procedures of the 20th century. Approximately 10% of practicing ophthalmologists in the United Stat...

Cilia incarnata is the misdirection of eyelashes whereby they grow under the skin through to the surface or posteriorly to the conjunctival surface instead of emerging normally from the eyelid margin. Two types are recognized: 1. Cilium incarnatum internum 2. Cilium incarnatum externum In this paper we discuss the two conditions with a discussi...

Surgical technique of performing a temporal artery biopsy together with a discussion of the underlying anatomy of the temporal branch of the facial nerve, the safe zone and videos of the surgical technique.

Since December 2019, coronavirus disease 2019 (COVID-19) has become a global pandemic caused by the highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1] There have been several reports of eye redness and irritation in COVID-19 patients, both anecdotal and published, suggesting that conjunctivitis may be an ocular ma...

Adenoid cystic carcinoma (ACC) of the eyelid is a very rare tumor, and only 11 cases have been previously reported in the literature. Here the authors report the 12th case of eyelid ACC that was initially diagnosed as adenoid basal cell carcinoma. This is the first report of local recurrence after wide local excision using the Mohs technique. Addit...

We present a comprehensive review of how to best use neuro‑toxins and fillers to rejuvenate the aging face. With modern neuro‑toxins and fillers, it is now possible to achieve an improvement in the aging changes of young, middle‑aged, and older patients. Furthermore, with the appropriate application of these materials, surgical results can be kept...

The term “ptosis” is derived from the Greek word falling and refers to drooping of a body part. Blepharoptosis is upper eyelid drooping with the eyes in the primary position of gaze. The shape of one's eyes along with the position of the eyelids, shape, and position of the eyebrow determines one's identity. Hence, drooping of the eyelids may produ...

The deep plane facelift utilizes a plane of dissection below the superficial muscular aponeurotic system (SMAS) of the midface, allowing for direct lysis of key facial retaining ligaments and maximum mobilization of the superficial soft tissue. By placing tension only at the level of the fascia, the deep plane technique creates a tension-free skin...

Surgery Oculoplastics: Specialty Review and Self-Assessment

Surgery Plastic: Specialty Review and Self-Assessment

Rhabdomyosarcoma (RMS) represents the most common orbital malignancy in children; patients with this disease often present to the ophthalmologist. Because current therapeutic regimens offer an excellent chance for curing isolated orbital disease, prompt diagnosis and treatment are essential. Four decades ago, the standard of care for these tumors w...

Benign orbital tumors represent a broad spectrum of tumors. In addition, orbital inflammation and infection may clinically simulate an orbital neoplasm. In a recent survey of 1264 consecutive patients with suspected orbital tumor referred to an ophthalmic oncology center, 64% of the lesions were benign.

The loss of an eye is devastating, the loss of an eye together with surrounding facial structures doubly so. The relatively new field of anaplastology now allows the patient to be rehabilitated with a realistic orbital and facial custom-made prosthesis. This chapter provides clinical information to the oncologic ophthalmologist regarding restorativ...

Optic nerve sheath fenestration (ONSF) is an important procedure in the management of patients with idiopathic intracranial hypertension (IIH) who do not respond to medical treatment. Traditional surgical approaches for fenestration have limitations. Furthermore, when tumors in the intraconal space medially and superiorly are encountered, complex s...

Many studies over the past decade report a trend toward fewer enucleations, suggesting that improved treatments prevent end-stage eye disease. Interestingly, however, the incidence of enucleation for neoplasia has not decreased despite the more widespread use of globe-sparing techniques, such as chemotherapy and brachytherapy. Here we present the s...

Orbital meningiomas can be divided into optic nerve sheath meningiomas, sphenoid wing meningiomas with orbital involvement, or primary orbital meningiomas. Orbital meningiomas comprise 34% of all primary brain tumors and 4% of all orbital tumors. Orbital meningiomas can cause proptosis, compression of the optic nerve, contents of the superior orbit...

Malignant orbital tumors represent a broad spectrum of tumors which include primary tumors, secondary tumors (extension from adjacent structures), and metastatic tumors. In addition, orbital inflammation and infection may clinically simulate an orbital neoplasm. In a recent survey of 1264 consecutive patients with suspected orbital tumor referred t...

The absence of an eye, whether following surgical loss or a congenital absence, is not only visually disabling but also affects the individual cosmetically and psychologically. To that end, the design and fitting of an ocular prosthesis in such patients by a skilled ocularist is of paramount importance. An excellent ocularist not only fits, shapes,...

Tumors of the lacrimal drainage system, especially the lacrimal sac, are rare. Despite their rarity, physicians should be aware of the clinical features of lacrimal sac tumors, as many are life-threatening and early diagnosis and appropriate treatment can save lives. These tumors often masquerade as a chronic inflammatory process. Due to the rarity...

The retina contains photoreceptor cells that function in the process of visual transduction, i.e., transforming light signals to nerve impulses eventually transmitted from the optic nerve to the brain forming an image. There are two types of photoreceptor cells, rod, and cones. The cone cells are for color vision and the rod cells, which function w...

Meige syndrome is one of the focal dystonic movement disorders identified as blepharospasm (double eyelid spasm) and oromandibular dystonia. Dystonia is defined as abnormal involuntary posturing or body movements due to sustained muscle contractions, usually happens due to neurological and medical reasons. In the early 20th century, Henry Meige, a...

Idiopathic subepidermal calcinosis, also known as idiopathic calcinosis cutis, is a rare condition, which typically presents as a small, hard, subepithelial mass in the absence of systemic disease and trauma. We report on an atypical case of idiopathic calcinosis, which appeared in an otherwise healthy 61-year-old female along the tarsus of her rig...

Written by internationally renowned experts, the 3rd edition of this six volume textbook provides detailed practical guidance and advice on the diagnosis and management of the complete range of ocular cancers. Supplying the reader with state-of-the-art knowledge required in order to identify these cancers early and to treat them as effectively as p...

Anthony Trollope's characters with squints and their descriptions in his works sheds light on the prevailing attitude towards people with strabismus.

‘Kissing puncta’ (KP) or punctal apposition is an anatomical phenomenon sparsely reported in the English literature. We describe our experience of managing chronic epiphora in patients with punctal apposition. A retrospective audit of five patients (nine eyes) with KP associated with epiphora. Data including: presenting symptoms, physical signs and...

No abstract is available for this article. This article is protected by copyright. All rights reserved.

Background: Standard electrosurgery provides superior hemostasis compared to a cold steel scalpel, but inferior tissue healing. A novel electrosurgical blade with an advanced waveform, the MEGADYNE ACE BLADE™ 700 Soft Tissue Dissector (ACE), was designed to provide both excellent hemostasis and wound healing. This study compared ACE to scalpel and...

Purpose: To review the clinical and histopathologic findings associated with subepidermal calcinosis of the eyelids. Methods: A systematic review of the literature on subepidermal calcinosis of the eyelids was performed. Cases included were idiopathic in nature and met the histologic criteria for subepidermal calcinosis with calcium deposits in...

Precise description of clinical findings is a sine qua non of effective communication and documentation in medicine. To that end, there have not, to date, been accurate words to describe lateral or medial displacement of the globe. Such displacements are frequently seen with orbital disease. The author makes a case for the use of esoglobus and exog...

Pneumosinus dilatans (PSD) involves paranasal sinus enlargement without radiologic evidence of localized bone destruction, hyperostosis, or mucous membrane thickening. We discuss the surgical implications of PSD-associated proptosis in patients with anterior skull-base meningioma. A 20-year-old man with proptosis, hypoglobus, and lateral globe disp...

A 6-month-old boy presented with recurrent, poorly differentiated orbital sarcoma diagnosed as nonrhabdomyosarcoma soft tissue sarcoma, as pathologic and immunohistochemical evaluation was inconsistent with rhabdomyosarcoma or other specific sarcoma subtypes. He responded favorably to a treatment regimen for poorly differentiated sarcomas.

The authors report a case of a 72-year-old woman with unilateral, complete, reversible blindness (no light perception) immediately after uncomplicated repair of an orbital floor fracture. In this case, vision loss was reversed with prompt surgical intervention with removal of the orbital floor implant. The authors review the etiology of vision loss...

We performed bilateral optic nerve sheath fenestrations on a patient with the syndrome of acquired hyperopia and choroidal folds. We are unaware of previous reports of this procedure being performed in this clinical setting. Despite the incomplete resolution of his posterior segment findings postoperatively, the results of the procedure, along with...

PurposeTo describe the occurrence and severity of upper eyelid skin contracture in facial nerve palsy (FNP).Methods We enroled consecutive patients with unilateral FNP into this study. Patients with previous upper eyelid surgery for either side were excluded. We developed a standardised technique to measure the distance between the upper eyelid mar...

The human tear film is a 3-layered coating of the surface of the eye and a loss, or reduction, in any layer of this film may result in a syndrome of blurry vision and burning pain of the eyes known as dry eye. The lacrimal gland and accessory glands provide multiple components to the tear film, most notably the aqueous. Dysfunction of these glands...

Whereas aging of the white Caucasian face, and even the Asian face has been thoroughly studied, there are no studies of aging of the Indian face. In this paper, we present the first analysis of the aging Indian face with a comparison with age-matched white Caucasian faces. Although preliminary, these initial findings suggest modifications to surgic...

Upper blepharoplasty techniques have evolved over the past several decades through advances in our knowledge of periorbital anatomy and the aging process. Surgeon and patient goals have also evolved, which have allowed us to routinely achieve excellent functional and cosmetic outcomes. The authors review the relevant literature to highlight the upd...

Aim: To report a case series of patients with persistent temple-related problems following lateral wall rim-sparing (LWRS) orbital decompression for thyroid-related orbitopathy and to discuss their management. Methods: Retrospective review of medical records of patients referred to two oculoplastic centres (Corneoplastic Unit, Queen Victoria Hos...

Eruptive vellus hair cysts are a developmental abnormality of vellus hair follicles that result in small cystic papules occurring most frequently on the chest and proximal extremities. Lesions of the ocular adnexa are extremely rare, and to the best of the authors knowledge, involvement of the orbit has never been reported. The authors describe a p...

A 39-year-old man without a significant medical history developed headaches, OS swelling, and limited left-sided ocular motility. An ultrasound of the left orbit and head MRI revealed a retro-orbital mass. A partial left anterior orbitotomy with partial resection was performed, and histopathologic examination of the resected tumor portion was sugge...

The aim of this study was to describe a modified technique of intraorbital irrigation of amphotericin B in the treatment of rhino-orbital mucormycosis. A 38-year-old man was diagnosed with rhino-orbital mucormycosis and subsequently underwent orbital and sinus debridement with postoperative intraorbital irrigation of amphotericin B. Daily irrigatio...

Background/aims To review our approach of cautious surgical correction of blepharoptosis in patients with myasthenia gravis (MG) to minimise risk of exposure complications. Methods Retrospective case note review of 30 patients with symptomatic eyelid concerns despite appropriate medical treatment, who underwent eyelid surgery. The mean age at diagn...

Benign orbital tumors represent a broad spectrum of tumors. In addition, orbital inflammation and infection may clinically simulate an orbital neoplasm. In a recent survey of 1,264 consecutive patients with suspected orbital tumor referred to an ophthalmic oncology center, 64 % of the lesions were benign.

Malignant orbital tumors represent a broad spectrum of tumors which include primary tumors, secondary tumors (extension from adjacent structures), and metastatic tumors. In addition, orbital inflammation and infection may clinically simulate an orbital neoplasm. In a recent survey of 1,264 consecutive patients with suspected orbital tumor referred...

Purpose: To evaluate the outcomes of endonasal dacryocystorhinostomy (EN-DCR) surgery in patients with sarcoidosis. Methods: Retrospective chart review of all patients with sarcoidosis undergoing EN-DCR in 6 practices from 1999-2011. Results: We included 18 procedures in 14 patients (8 female, 6 male) who underwent EN-DCR for acquired NLDO sec...

Lesions of the cavernous sinus remain a technical challenge. The most common surgical approaches involve some variation of the standard frontotemporal craniotomy. Here, the authors describe a surgical approach to access the cavernous sinus that involves the removal of the lateral orbital wall. To achieve exposure of the cavernous sinus, a lateral c...

Metastatic mucinous adenocarcinoma in the orbit is extremely rare. We review the literature and report a case of metastatic mucinous adenocarcinoma of the orbit in a 37-year-old male with primary pancreatic adenocarcinoma.

A 53-year-old man with a 2-month history of left periorbital swelling was found to have a large solid intraconal mass on CT scan. Orbital ultrasound showed that the lesion had a cavernous pattern of internal reflectivity. Histopathology revealed hyaline-vascular type Castleman disease (CD). This article represents the first reported orbital ultraso...