Geoffrey Wilcsek

Prince of Wales Hospital and Community Health Services | POWH · Department of Ophthalmology

Importance Floppy Eyelid Syndrome ‘plasty’ (FESplasty) is a surgical technique that addresses underlying superior tarsal plate and lateral canthal instability in FES and aims to restore normal anatomical and physiological function to the upper eyelid. Background To describe the use of FESplasty in the surgical management of FES, and to report outc...

Necrotising fasciitis is a fulminant, rapidly progressive infection associated with extensive tissue destruction and significant mortality. Given the robust blood supply of the face, periorbital necrotising fasciitis is rare in this region. Traditional management consists of prompt initiation of antibiotics and adequate surgical debridement. This r...

Purpose: The human eye is composed of numerous microhabitats. The aim of this study was to understand the communality and differences in the microbiomes of various regions of the eye. Methods: Four ocular sites from different subject groups were assessed including the eyelid margin tissue from patients with lid abnormalities (n = 20), fornix and...

Paranasal mucoceles are cystic masses lined with epithelium thought to result from chronic obstruction of an impaired sinus ostia. If sufficiency large, they can cause ophthalmological sequelae including diplopia, visual acuity, globe displacement as well as the rhinological symptoms of facial pain and headache. We present the case of a 57-year-old...

Purpose: To describe in detail a technique for a modified Fasanella-Servat procedure that provides a simplified method for graded Mueller muscle excision with minimal and controlled tarsal excision. Methods: A retrospective study of 71 patients (102 eyelids) who underwent the modified Fasanella-Servat procedure is reported. Measurements include...

Intranasal corticosteroids (INCS) are prescribed for the long-term prophylactic treatment of inflammatory upper airway conditions. Although some systemic absorption can occur via topical routes, the clinical relevance is controversial. The ef- fects of orally administered corticosteroids on intraocular pressure (IOP) and lens opacity (LO) are well...

Introduction: To present a series of patients with bisphosphonate induced orbital inflammation, and to review the clinical presentation, radiological features, treatment options and outcomes. Methods: We present a multicentre, retrospective case series review of patients with a clinico-radiological diagnosis of bisphosphonate induced orbital inf...

Intranasal corticosteroids (INCS) are prescribed for the long-term prophylactic treatment of inflammatory upper airway conditions. Although some systemic absorption can occur via topical routes, the clinical relevance is controversial. The effects of orally administered corticosteroids on intraocular pressure (IOP) and lens opacity (LO) are well es...

Nasolacrimal duct obstruction is common and is usually a result of benign stricture formation. Although neoplasia near or around the lacrimal system may produce epiphora, the incidence of neoplasia from within the lacrimal system as a cause of nasolacrimal duct obstruction is not well documented. A retrospective study was performed on all patients...

Importance Approximately 5% to 10% of patients continue to experience persistent epiphora following an anatomically successful dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction or stenosis.Objective To investigate the management and success rate of so-called “functional failure” of DCR for nasolacrimal duct obstruction by experienced...

To study the hypothesis that in normal patients, changes in eyelid elasticity may occur asymmetrically and in relation to the side on which the individual sleeps. Prospective, consecutive, single-center study within a large, tertiary-referral ophthalmology department within a university hospital. This prospective study was carried out consecutively...

IgG4-related disease (IgG4-RD) is an inflammatory condition of unknown etiology that can cause tumefactive lesions in a number of tissues and organs, including the orbit and ocular adnexa. Diagnostic criteria for IgG4-RD, including pathology and clinical features and pathology, have been recently proposed. This study presents the first case of unil...

To assess the frequency of simultaneous nasal procedures in powered endoscopic dacryocystorhinostomy performed by oculoplastic surgeons. Retrospective, multicenter study. Demographic, clinical, and surgical data of consecutive endoscopic dacryocystorhinostomy cases at 3 oculoplastic centers, over periods of 6, 4, and 2.2 years, respectively, were r...

Background: Dacryocystorhinostomy (DCR) is commonly performed for epiphora, dacryocystitis and during tumor surgery. External (EXT-DCR) and endoscopic DCR (END-DCR) are both practiced. END-DCR was initially performed with laser (EL-DCR) but has shifted to careful bone removal with mechanical drills (EM-DCR). High level evidence from comparative co...

Objective: High success rates for endoscopic dacryocystorhinostomy (END-DCR) in partial nasolacrimal duct obstruction (NLDO) have been reported, but comparisons with complete NLDO are lacking. This study compares the success of primary END-DCR with respect to the preoperative nasolacrimal duct patency and reviews factors associated with failure. Me...

It is essential that the clinician correctly identifies the aetiology of the ptosis, which will allow one to forge ahead with confidence and carry out surgical repair of the ptosis. It is important to remember that ptosis may represent the first manifestation of a systemic and possible neurological illness that could be life-threatening, or at leas...

Purpose: Lacrimal drainage system probing and syringing is a commonly performed diagnostic procedure in the evaluation of tearing. However, we believe that the technique is not described in adequate detail in the medical literature. We describe our technique for reliable, safe, and pain-free assessment of the lacrimal drainage system. Case Report:...

Pathology affecting the orbit and orbital apex is diverse and heterogeneous. Many of the differential pathologies require management in a multidisciplinary team involving both otolaryngology and ophthalmology. This article discusses the differential pathologies. Emphasis has been placed on Graves orbitopathy, traumatic optic neuropathy, and the ind...

A watery eye, which is due to a mismatch between the volume of tears produced and the volume of tears removed via the lacrimal drainage system, can have a substantial adverse impact on an individual's quality of life.

Propranolol is a novel therapeutic agent in the treatment of cutaneous infantile haemangiomas. We assessed the effect of propranolol therapy in infantile haemangiomas of the orbit. A case series of four patients with orbital infantile haemangiomas were referred for management in our tertiary referral hospitals. Two of the patients had inadequate re...

A bstract Synchronous radiation‐induced tumours are extremely rare. We present the first reported case of synchronous radiation‐induced orbital meningioma and cavernomas of the cerebellum and bilateral basal ganglia, presenting 16 years after ionizing radiation therapy for parietal anaplastic ependymoma, at the age of five. This case again undersco...

To describe 6 new cases of primary orbital liposarcoma and provide a review of the relevant literature. Noncomparative consecutive case series and literature review. Six patients with primary orbital liposarcoma. Review of patient charts, imaging, and histopathology; literature review. Patient demographics; clinical presentations; results of radiol...

The management of marginal chalazia is not well established. We describe a technique that recreates near-normal lid margin anatomy, and over many years has been a simple, highly effective technique.

To present a combined interventional radiologic and resection technique for the management of a large amblyogenic, highly vascular lesion of the lower eyelid associated with severe mechanical ectropion, conjunctival pyogenic granuloma, and recurrent, spontaneous conjunctival bleeding. Preoperative selective embolization and coil placement were foll...

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A 69-year-old man was referred with epiphora and soft-tissue swelling in the left nasolacrimal sac region. Ipsilateral Jones 1 and 2 tests were negative. On attempting sac "wash out" via the left lower canaliculus, there was fluid reflux from the left upper canaliculus. CT revealed bony erosion of the lacrimal and frontal process of the maxillary b...

To evaluate symptoms in patients with functional (FNLDO) and primary acquired (PANDO) nasolacrimal duct obstruction, evaluated prospectively before and after successful dacryocystorhinostomy (DCR) surgery. A questionnaire delivered by interview, pre- and postintervention. Consecutive patients with either FNLDO or PANDO were derived from a tertiary...

To report our experience in treating distal and common canalicular obstruction by trephination followed by topical low-dose mitomycin C (0.03%) and silicone intubation during endoscopic dacryocystorhinostomy (DCR). Noncomparative interventional case series of five eyes of five patients with epiphora and clinical evidence of distal or common canalic...

A bstract Hydroxyapatite orbital implants are widely used in enucleation surgery. Infection in this setting is an uncommon but severe complication. Herein a patient with a 3‐year history of chronic socket discharge, orbital discomfort, conjunctival breakdown and implant exposure after enucleation and implantation of a hydroxyapatite sphere 7 years...

The authors report a case of hydrogel scleral explant (MIRAgel) causing an incomitant strabismus, diplopia, enophthalmos and a dehiscence in the roof of the orbit secondary to pressure-related atrophy due to swelling of the explant occurring 10 years after its placement.

A 36-year-old woman presented with a 7-week history of foreign body sensation in the superior right orbit after orbital trauma sustained during an accidental face-down fall onto a broken drinking glass. CT identified a 10.35 x 3.91-mm radiopaque foreign body in the right orbit superolateral to the globe. Orbital exploration superficial to the levat...

To describe the use and outcomes of a versatile surgical technique in the reconstruction of deep soft tissue and bony defects of the medial canthus. A retrospective review of consecutive cases requiring reconstruction of medial canthal defects involving loss of periosteum or bone by a median forehead pericranial flap and full-thickness skin graftin...

Primary lymphoma of the lacrimal sac Primary lymphomas of the lacrimal sac (PLLS) are rare, but are a genuine cause of secondary acquired nasolacrimal duct obstruction.1 The aim of the article on PLLS by Sjo et al 2 in this issue of the BJO (p 1004) was to define their clinical and histopathological characteristics. Their report on 15 cases of PLL...

rypan blue vital staining has been used increasingly in ophthalmic surgery. We de- scribe a new extraocular application of trypan blue in staining of the Tenon capsule during enucleation surgery. The most common clinical use of trypan blue is staining of the anterior Tenon capsule to assist in creating a capsulorrhexis during removal of a white or...

A bstract A 55‐year‐old Caucasian woman presented with an orbital cavernous haemangioma superior to the optic nerve in the orbital apex. Preoperative imaging demonstrated a mass involving the superomedial and superolateral quadrants of the posterior orbit. A stereotactic fronto‐orbital approach was performed by the neurosurgical team, and cryoextra...

To revisit an important but outmoded periorbital reconstructive technique. We present cases to illustrate the usefulness of the Fricke flap and describe a method of rapid intraoperative tissue expansion (RITE), which can enhance the applicability and effectiveness of the Fricke flap. A comparison between those cases performed with and without adjun...

Conjunctivochalasis, a secondary cause of the watery eye, is frequently seen in the older age group as an elevation of the bulbar conjunctiva lying along the lateral or central lower lid margin. A prospective, interventional, case-controlled clinical and histopathological study was conducted. The relevant features of 18 patients (29 eyes) who had t...

We were interested to read the approach taken by Sahni and Clark1 to facilitate the effective argon laser treatment of trichiasis. They have ably reviewed the complications of trichiasis, the different forms of management of trichiasis, the advantages of argon laser treatment in the management of trichiasis, the technique of argon laser trichiasis...

Many thousands of dacryocystorhinostomies (DCRs) are performed by ophthalmologists routinely without problems. Postoperative pain and nausea may wrongly be attributed to wound pain and post-anaesthetic nausea. Medical and nursing staff need to be aware of the potential for intranasal cocaine to precipitate acute angle closure glaucoma (AACG). We re...

A 74-year-old man experienced vertical diplopia. Two years earlier, he was diagnosed with a squamous cell carcinoma of the periorbital frontal skin, with perineural spread involving the ophthalmic division of the right trigeminal nerve and the right facial nerve. The clinical findings were consistent with a right fourth cranial nerve palsy. Compute...

A 74-year-old man experienced vertical diplopia. Two years earlier, he was diagnosed with a squamous cell carcinoma of the periorbital frontal skin, with perineural spread involving the ophthalmic division of the right trigeminal nerve and the right facial nerve. The clinical findings were consistent with a right fourth cranial nerve palsy. Compute...

Objective To report a retrospective case series of 29 Australian and New Zealand patients with orbital and adnexal Wegener’s granulomatosis (WG).

A method to stabilize the posterior limb of the medial canthal tendon (MCT), using a transcaruncular medial orbitotomy (TMO) approach, is described in a stepwise fashion. The technique described is a modified version of procedures published by Ritleng, Crawford and Collin, and Fante and Elner A prospective clinical evaluation of MCT stabilization v...

This retrospective report describes the management and outcome of seven patients who suffered an acute surgical orbital haemorrhage (ASOH), secondary to a surgical procedure performed on either the sinuses, orbits or eyelids. All patients but one recovered their pre-operative vision. A management plan is outlined on how to assess and tackle this co...