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A contracted socket is a complication of an anophthalmic socket which results in the inability to support a prosthesis. It is an uncommon but significant problem for the ophthalmic plastic surgeon. A poorly fitting prosthesis results in subpar cosmesis, can be damaging to the psyches of patients, and can result in additional injury and infection. A contracted socket can occur weeks to years after enucleation or evisceration. While historically it was believed that the symblepharon and sulcus deformity associated with a contacted socket were incurable, advances in the use of grafting materials, alloplastic implants, and flaps have allowed contracted sockets to be reformed, therefore returning the function of the normal fornix.
The contracted socket should not be confused with Post Enucleation Socket Syndrome (PESS) which is characterized by a deep upper eyelid sulcus, lower lid laxity, and eyelid malpositions without shrinkage or shortening of the soft tissues. +
A corneal keloid is a benign pearly, gray-white epicorneal lesion that results from abnormal proliferation of fibrous tissue and accumulation of disorganized collagen fibrils and glycoprotein, with characteristic hyperplasia of the corneal epithelium and disruption of Bowman's layer. 1 It can develop after ocular trauma or infection, or can arise congenitally and/or idiopathically. Bilateral cases of corneal keloids are typically associated with congenital disorders including Lowe Syndrome and Rubenstein-Taybi Syndrome. Unlike cutaneous keloids, corneal keloids are rare and less than 100 cases have been documented in the literature since it was first described in 1865. Nonetheless, they can cause significant ocular morbidity, including decreased vision and poor cosmesis, and thus warrant attention. The following will discuss corneal keloids in detail, including associated risk factors, presentation, differential diagnosis, diagnosis, pathogenesis, and treatment. +
A cyclodialysis cleft is a separation of the ciliary body from the scleral spur, creating a direct connection between the anterior chamber and the suprachoroidal space. Many will spontaneously close, but those that do not can cause chronic hypotony, resulting in hypotony maculopathy, optic disc edema, and decreased visual acuity. Treatment begins with conservative medical therapy, but when this fails, a wide range of laser and surgical procedures have been reported to be effective. +
A hypertropia is a form of vertical strabismus where one eye is deviated upwards in comparison to the fellow eye, as opposed to hypotropia, where one eye is deviated downwards. Depending on which eye is fixing, a hypertropia of one eye is the same entity as a hypotropia of the fellow eye, according to Hering’s law. +
A hypertropia is a form of vertical strabismus where one eye is deviated upwards in comparison to the fellow eye. The term of hypertropia is relative to the fellow eye which, by analogy is the hypotrpoic eye- meaning that is deviated downwards. Depending on which eye is fixing, a hypertropia of one eye is the same entity as a hypotropia of the fellow eye, according to Hering’s law. By convention, the designation of the vertical strabismus is made according to the hypertropic eye. +
ADNIV is a rare ocular inflammatory disease that develops slowly over the course of decades to cause significant and devastating blindness. It is characterized by progressive uveitis, retinal pigmentation and degeneration, cystoid macular edema (CME), neovascularization of the retina and iris, vitreous hemorrhage (VH) and tractional retinal detachment (TRD). There have been three independently reported families with genetically-confirmed ADNIV. +
Actinic keratoses are a premalignant squamous lesions. They may appear clinically as a erythematous, scaly macules or papules. Lesions typically present in middle aged or elderly patients. Sun exposed areas are most commonly affected. Squamous cell carcinoma may develop from preexisting actinic keratoses. Thus, biosy of suspected lesions and long term follow-up are necessary in patients with this condition. The risk of subsequent metastastatic dissemination is very low (0.5-3.0%). +
Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an inflammatory chorioretinopathy which was first described by Gass in 1968. It is classified as a White Dot Syndrome. APMPPE is usually bilateral, affects women and men equally, has a tendency to occur between the 2nd to 4th decades, and can have associated systemic conditions. The most common complaint is blurred vision with central or paracentral scotomas. Cases are often self-limited and visual symptoms resolve by 4 to 8 weeks. There is no consensus on treatment, however steroids have been attempted to hasten visual recovery especially in cases with macular involvement. +
Acute zonal occult outer retinopathy (AZOOR) is a retinal disease first described by Gass in 1992; reporting on 13 cases that shared the following features: rapid loss of one or more large zones of outer retinal function, minimal fundus changes, electroretinographic abnormalities, and permanent visual field loss that was associated with delayed development of visible atrophic changes in the pigment epithelium +
Age-related macular degeneration (ARMD) is an acquired degeneration of the retina that causes significant central visual impairment through a combination of non-neovascular (drusen and retinal pigment epithelium abnormalities), and neovascular derangement (choroidal neovascular membrane formation). Advanced disease may involve focal areas of retinal pigment epithelium (RPE) loss, subretinal or sub-RPE hemorrhage or serous fluid, as well as subretinal fibrosis. +
Age-releated macular degeneration is an acquired degeneration of the retina that causes significant central visual impairment through a combination of nonneovascular (drusen and retinal pigment epithelium abnormalities), and neovascular derangement (choroidal neovascular membrane formation). Advanced disease may involve focal areas of retinal pigment epithelium (RPE) loss, subretinal or sub-RPE hemorrhage or serous fluid, as well as subretinal fibrosis. +
Albinism represents a set of inherited conditions characterized by absent or decreased tissue melanin in conjunction with characteristic ocular and visual pathway anomalies. Those affected by this condition manifest varying degrees of hypopigmentation and vision-related disability. +
Albinism represents a set of inherited conditions characterized by absent or decreased tissue melanin in conjunction with characteristic ocular and visual pathway anomalies. Those affected by this condition manifest varying degrees of hypopigmentation and vision-related disability. These conditions generally are incurable but are static. Proper ophthalmic and dermatologic management may be crucial in maximizing visual potential and overall prognosis. +
Amniotic membrane, or amnion, is the innermost layer of the placenta and consists of a thick basement membrane and an avascular stromal matrix. Amniotic membrane transplantation has been used as a graft or as a dressing in different surgical subspecialties. In the field of ophthalmology, it is used broadly 1) to reconstruct the ocular surface after various procedures; 2) as a graft for ocular surface melts; and 3) as a bandage to promote healing in cases of persistent epithelial defects or ocular surface inflammation. All of these indications make use of amniotic membrane's ability to promote healing.
Live fetal membrane, which included both amnion and chorion, was first documented by De Rotth in 1940 for use in conjunctival reconstruction. A very low success rate was reported. During the same year, Brown used rabbit peritoneum as a temporary patch for ocular surface burns which Sorsby later modified with human amniotic membrane in 1946 and 1947. In 1995 Kim and Tseng reintroduced the idea of amniotic membrane for ophthalmic use which has since become increasingly popular. +
Atopic keratoconjunctivitis (AKC) is a chronic inflammatory disease of eye that affects patients with atopic dermatitis. AKC was first described in 1952 by Hogan, who described five cases of atopic eczema associated with bilateral keratoconjunctivitis. Peak incidence is between 30-50 years old. It is characterized by bilateral, non-infectious inflammation of the conjunctiva. +
Axenfeld-Rieger syndrome (ARS) refers to an autosomal dominant genetic condition characterized by anterior segment dysgenesis and systemic abnormalities. In 1920, Axenfeld characterized the anomaly which bears his name when he described posterior embryotoxon and iris strands adherent to the anteriorly displaced Schwalbe’s line. +
Birdshot retinochoroidopathy (also known as birdshot chorioretinopathy, vitiliginous chorioretinitis, or simply birdshot uveitis) is a chronic, bilateral, posterior uveitis with characteristic yellow-white lesions in the fundus. HLA-A29 is a strong genetic risk factor, and the disease has been hypothesized to be due to an autoimmune response to retinal S antigens. +
Blepharitis, an inflammatory condition of the eyelid margin, is a common cause of ocular discomfort and irritation in all age and ethnic groups. While generally not sight-threatening, it can lead to permanent alterations in the eyelid margin or vision loss from superficial keratopathy, corneal neovascularization, and ulceration. +
Blepharitis, an inflammatory condition of the eyelid margin, is a common cause of ocular discomfort and irritation in all age and ethnic groups. While generally not sight-threatening, it can lead to permanent alterations in the eyelid margin or vision loss from superficial keratopathy, corneal neovascularization, and ulceration. +
CBDS can be classified by time of onset, whether it occurs intraoperatively, early postoperatively (first few weeks), or late postoperatively (months or years). Intraoperative CBDS is felt to result from high irrigation pressures during hydrodissection which hyperdistend the posterior capsule, increasing the risk for capsule rupture. Early postoperative CBDS is associated with incomplete viscoelastic removal posterior to the IOL with resulting anterior IOL displacement leading to a myopic shift, anterior chamber shallowing, and IOP elevation. Late CBDS classically does not exhibit these symptoms and is only noticed due to the decreased visual acuity recognized by the patient. +
