Smith and nesi's ophthalmic plastic and reconstructive surgery.

Preface
From the Editor
Acknowledgments
Contents
Contributors
Part I: Anatomy
	1: Anatomy of the Ocular Adnexa, Orbit, and Related Facial Structures
		Introduction
		Osteology
			Orbital Shape and Development
			Orbital Margin
			Orbital Walls
			Orbital Apex
		Nasal and Paranasal Sinuses
			Nose
			Maxillary Sinus
			Ethmoid Sinus
			Frontal Sinus
			Sphenoid Sinus
		Lacrimal Secretory and Excretory System
			Lacrimal Excretory Osteology
			Lacrimal Secretors
		Canaliculi
			Lacrimal Excretory System
			Nasolacrimal Sac and Duct
			Lacrimal Excretory Development
		Eyelid Anatomy
			Eyebrow and Superficial Musculoaponeurotic System
			Superficial Eyelid Anatomy
			Eyelid Margin
		Orbicularis Oculi Muscle
			Medial and Lateral Canthal Ligaments
			Orbital Septum
			Levator Palpebrae Superioris
		Müller’s Muscle
			Lower Eyelid Retractors
			Tarsal Plates
			Meibomian Glands
			Conjunctiva
			Eyelid Comparison
			Eyelid Vessels
			Eyelid Nerves
			Eyelid Development
			Orbit
				Periorbita
				Orbital Fascia
				Orbital Fat
		Extraocular Muscles
		Globe Topography
		Orbital Nerves
			The Optic Nerve (II)
			The Oculomotor Nerve (III)
			The Trochlear Nerve (IV)
			The Abducens Nerve (VI)
			The Trigeminal Nerve (V)
			The Sympathetic Nerves
			Ciliary Ganglion and Parasympathetic Nerves
			Orbital Arteries
			Orbital Veins
			Orbital Lymph Drainage
		Intracranial Orbital Relationships
			Pertinent Intracranial Osteology
			Dura Mater
			Cavernous Sinus
			Cranial Nerves
			Carotid and Intracranial Ophthalmic Arteries
			Optic Chiasm
		References
Part II: General Considerations
	2: Basic Principles of Ophthalmic Plastic Surgery
		Introduction
		Preparation of the Patient
		Perioperative Antibiotics
		Skin Markings and Local Anesthesia
		Incisions
		Retraction and Exposure
		Hemostasis
		Preoperative
		Intraoperative
		Adjuvant Agents
		Postoperative
		Wound Closure
		Suture Needles
		Suture Placement
		Suture Materials
		Skin Defects
		Primary Closure
		Dog Ears
		Flaps
		Z-plasty
		Reconstruction of the Eyelid
		References
	3: Ophthalmic Plastic Surgery: A History in the Making
		Introduction
		Eyelid Repair and Reconstruction
		Ptosis
			Antiquity
			Approaches to Levato
			Tarsectomy/Mullerectomy
		Lid Malpositions
			Antiquity
			Ectropion
			Entropion
		Lacrimal Surgery
		Orbital Surgery
			Antiquity
			Ocular Prostheses
			Approaches to the Orbit
			Orbital Decompression
		ASOPRS
		Cosmetic Oculoplastic Surgery
		Closing Remarks
		References
	4: Instrumentation in Ophthalmic Plastic Surgery
		Introduction
		Photography
		Skin Marking
		Draping
		Surgeon Position
		Visibility of Field
		Incisions
		Tissue Dissection
		Exposure of the Surgical Field
		Hemostasis
		Alternative Hemostasis Technology
		Traction and Exposure
		Soft Tissue Grafts
		Dry Eye Evaluation
		Bone and Cartilage
		Orbital Implants
			Repairing Orbital Fractures
			Orbit Volume Enhancement
			Nonintegrated (Nonporous)
			Integrated (Porous)
			Hydroxyapatite
			Porous Polyethylene (Medpor)
			Wrapping Materials
		Pegged Implants
			Orbital Tissue Expanders
			Ptosis Surgery
			Canalicular Laceration Repair
			Canalicular Stents
		Balloon Catheter Dilation in Lacrimal System
		Endoscopic Surgery
		Endoscopic Brow Lifting
		Endoscopic DCR
		Nonsurgical Facial Aesthetics
		Silicone (Polyorganosiloxane) by Injection
		Complementary Fat Grafting
		Facial Skin Rejuvenation
		Chemical Peel
		Microdermabrasion
		Laser Resurfacing
		References
	5: Neuro-Ophthalmology Approach to Oculoplastic Disorders
		Localization in Neuro-Ophthalmology
		Principles of Localization
		Common Locations
		Common Anatomy
		Prioritized Differential Diagnosis
		Role of Neuro-Ophthalmologist in Oculoplastics
		Neurologic Conditions with Oculoplastic Manifestations
		Cerebral Gaze Deviation
		Cerebral Ptosis
		Basal Ganglia
		Parkinson’s Disease
		Progressive Supranuclear Palsy
		Other Basal Ganglia Diseases
		Brainstem Ocular Motility Disorders
		Internuclear Ophthalmoplegia
		Dorsal Midbrain (Pretectal, Parinaud) Syndrome
		Skew Deviation
		The Ocular Motor Nerves and their Nuclei
		The Oculomotor (Third) Nerve
			Anatomy
			Pathology
		The Trochlear (Fourth) Nerve
			Anatomy
			Pathology
		The Abducens (Sixth) Nerve
			Anatomy
			Pathology
		Cavernous Sinus (Fig. 5.4)
			Anatomy
			Pathology
		Tolosa–Hunt Syndrome
		Carotid-Cavernous Fistula (CCF)
		Orbital Apex Syndrome
		Myasthenia Gravis
		Lambert–Eaton
		Botulism
		Mitochondrial Myopathies
		Myotonic Dystrophy
		Oculopharyngeal Dystrophy
		Rare Myopathies
		Neuroophthalmic Imaging Techniques
		Computerized Tomography (CT)
		Magnetic Resonance Imaging (MRI)
		CT Versus MRI
			CT
			MRI
		CT and MR Angiography
		Gadolinium and Nephrogenic Systemic Fibrosis (NSF)
		References
	6: Traumatic Cranial Neuropathies
		Introduction
		Traumatic Optic Neuropathy
			Types of TON
			Optic Nerve Anatomy
			Specific TON Subtypes
				Anterior Indirect
				Direct TON
				Orbital Hemorrhage and Orbital Compartment Syndrome
			Lateral Canthotomy and Inferior Cantholysis: Surgical Technique
			Management of Anticoagulants in the Trauma Setting
			Posterior Indirect TON
			Treatment of PITON
				Megadose Corticosteroids
				Optic Canal Decompression
				Experimental Modalities
			Prognosis for PITON
			Chiasmal Injury and Posterior Optic Nerve Avulsion
		Injury to the Motor Nerves of the Orbit
			Diagnosis
			Oculomotor Nerve (CN-III) Injury
			Trochlear Nerve (CN-IV) Injury
			Abducens Nerve (CN-VI) Injury
			Management
				CN-III Injury
				CN-IV Injury
				CN-VI Injury
		References
Part III: Eyelid Malpositions
	7: Entropion
		Introduction
		Classification
			Congenital Entropion
			Involutional Entropion
			Cicatricial Entropion
		Therapy
			Treatment of Epiblepharon
			Treatment of Involutional Entropion
		Transconjunctival Entropion Repair
		Treatment of Cicatricial Entropion
		Conclusion
		References
	8: Trichiasis
		Introduction
		Electrolysis Technique
		Cryotherapy Technique
		Laser Techniques
		Lid Splitting Technique
		Conclusion
		References
	9: Ectropion
		Introduction
		Etiology
		Clinical Presentation
		Evaluation of the Patient with Ectropion
			Eyelid Margin
			Eyelid Puncta
			Eyelid Distraction Test
			Snapback Test
			Character of Anterior Lamella
			Orbicularis Oculi Muscle Tone
			Lateral Canthus Evaluation
			Medial Canthus Evaluation
			Posterior Eyelid Inspection
		Treatment [6] (See Fig. 9.3)
			Involutional Ectropion
			Lateral Tarsal Strip
			Medial Spindle with Rotational Suture
			Lazy-T Procedure
			Retractor Advancement
			Cicatricial Ectropion
			Skin Flaps
			Anterior Lamellar Skin Graft
			Paralytic Ectropion
			Mechanical Ectropion
			Congenital Ectropion
			Mixed Mechanism Ectropion
			Upper Eyelid Ectropion
		Conclusion
		References
	10: Facial Palsy: Periocular Management
		Introduction
		Anatomy
		Clinical Syndromes
		Clinical Presentation
		Examination
		Therapy
			Medical
			Surgical
				Tarsorrhaphy
				Lateral Tarsorrhaphy
				Medial Tarsorrhaphy
			Ectropion Repair
			Gold Weight Implantation
		Periocular Adjuncts
			Browlift
			Facial Suspension
		Other Treatments
			Aberrant Regeneration
			Corneal Neurotization
		Conclusion
		References
	11: Essential Blepharospasm and Hemifacial Spasm
		Introduction
		Blepharospasm
		Classification
		Clinical Presentation
		Etiologic Factors
		Therapy
			Supportive Therapies
			Oral Drug Therapy
			Botulinum Toxin Therapy
			Myectomy Surgery
		Current Therapeutic Protocol
		Patient Support
		Hemifacial Spasm
		Etiologic Factors
		Clinical Presentation
		Diagnosis/Work-Up
		Therapy
			Medical
			Surgical Treatment Options
		Summary
		References
	12: Ocular Cicatricial Pemphigoid
		Introduction
		Clinical Presentation
		Staging
		Pathophysiology
		Diagnosis
		Differential Diagnosis
		Treatment
			First-Line Therapy
			Second-Line Therapy
			Third-Line Therapy
		Surgical Therapies
		Treatment of Corneal and Surface Disease
		Summary
		References
Part IV: Blepharoptosis
	13: Ptosis in Neurologic Disease
		Introduction
		Examination Pearls
		Pseudoptosis
			Dermatochalasis
			Contralateral Lid Retraction
			Enophthalmos
			Globe Asymmetry
			Ocular Misalignment
			Spastic Disorders
			Duane Retraction Syndrome
			Parinaud Syndrome
			Floppy Eyelid Syndrome
			Aberrant Facial Nerve Regeneration
		True Ptosis: Neurologic Etiologies
			Myogenic Ptosis
				Congenital Fibrosis of the Extraocular Muscles
				Muscular Dystrophy
				Oculopharyngeal Muscular Dystrophy
			Chronic Progressive External Ophthalmoplegia
				Guillain-Barré Syndrome
			Neurogenic Ptosis
				Oculomotor Nerve Dysfunction
			Marcus Gunn Jaw-Winking Synkinesis
			Myasthenia Gravis
			Horner Syndrome (Oculosympathetic Paresis)
			Botulism
			Cluster Headache
			Recurrent Ophthalmoplegic Cranial Neuropathy
		References
	14: Congenital Ptosis
		Introduction
		Pathology and Epidemiology
			Genetic Associations
			Special Categories and Subtypes
				Superior Rectus Weakness (Double Elevator Palsy)
				Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome (BPES)
		Anatomy, Evaluation, and Preoperative Considerations
			Anatomy
			Evaluation
			Informed Consent for Surgery
			Anesthesia
		Surgery for Congenital Ptosis
		Methods
			Levator Resection
				Complications of Levator Resection (Table 14.5)
			Frontalis Suspension or Sling
				Materials for Frontalis Sling
				Techniques for Frontalis Sling
				Alternative Procedures for Severe Ptosis with Poor Levator Function
				Retrieval of Autogenous Fascia Lata from the Thigh
				Frontalis Suspension Method
				Complications of Eyebrow Suspension (Table 14.6)
		Bilateral Congenital Ptosis
		References
	15: Acquired Ptosis: Classification and Evaluation
		Introduction
			Anatomy and Physiology
			Classification
		Aponeurotic Ptosis
		Myogenic Ptosis
		Myasthenia Gravis
		Chronic Progressive External Ophthalmoplegia
		Myotonic Dystrophy
		Neurogenic Ptosis
		Third Cranial Nerve Palsy
		Horner’s Syndrome (Ocular Sympathetic Paresis)
		Ophthalmoplegic Migraine
		Multiple Sclerosis
		Jaw-Winking (Marcus Gunn Syndrome)
		Guillain–Barré Syndrome
		Traumatic Ptosis
		Mechanical Ptosis
		Pseudoptosis
			Evaluation
				History
				Physical Examination
				Eyelid Measurements
				Photography
				Visual Fields
			Psychological Aspects
		References
	16: Management of Acquired Ptosis
		Introduction
		Anesthesia
		Management of Acquired Ptosis
			Principles
		Nonsurgical Management
		Surgical Management
		The Anterior Approach to Ptosis Repair
			Surgical Technique for Frontalis Suspension
			Levator Aponeurosis Surgery
		The Posterior Approach to Ptosis Repair
			Tarsal-Conjunctival-Müller’s Muscle Resection (Fasanella-Servat Operation)
				Postoperative Management
				Complications
			Müller’s Muscle-Conjunctival Resection
		References
Part V: Cosmetic Surgery
	17: Upper Eyelid Blepharoplasty
		Introduction
		Evolution of Beauty
		Surgical Planning and Applied Eyelid Anatomy
		Surgical Technique
			Anesthesia
			Incision Marking
			Surgical Technique
		Crease Fixation and Closure
		Postoperative Management
		Conclusion
		Suggested Readings
	18: Lower Eyelid Blepharoplasty
		Introduction
		Lower Eyelid Aging
		Evaluation
		Techniques
			Anesthesia
			Lower Eyelid Fat Modification
			Skin Excision
			Orbicularis Suspension
			Canthoplasty/Canthopexy
			Eyelid Skin Resurfacing
			Fat Grafting
			Injectable Fillers
		Aftercare and Recovery
		References
	19: Asian Blepharoplasty: Anatomy and Surgical Techniques
		Anatomy
		Preoperative Evaluation
		Surgical Techniques
		Postoperative Care
		Complications
		Conclusion
		References
	20: Forehead/Brow Ptosis
		Introduction
		Clinical Evaluation
		Anatomic Considerations
		Medical Management
		Surgical Management
			Direct and Temporal Direct Brow Lift
			Midforehead Lift
			Transblepharoplasty Brow Lift
			Pretrichial/Trichophytic Forehead Lift
			Coronal Forehead Lift
			Endoscopic Forehead Lift
		References
	21: Injectables and Fillers
		Introduction
		Botulinum Toxin
			Pathophysiology
			History
			Technique
			Treatment Areas
				Upper Face
				Midface
				Lower Face
			Adjuvant Use
			Complications
		Dermal Fillers
			History
			Treatment Areas
				Upper Face
				Midface
				Lower Face
			Technique
			Products
			Collagen
			Hyaluronic Acid
			Biosynthetic Polymers
			Complications
		Fat Transfer
			History and Rationale
			Preoperative Exam
				Facial Exam
			Procedural Technique
				Body Harvest Site
				Fat Transfer
			Postoperative Evaluations
			Complications
		Summary
		References
	22: Facelift and Midface Lift
		Introduction
		Anatomy
			Superficial Muscular Aponeurotic System (SMAS)
		Platysma
			Facial Nerve
			Greater Auricular Nerve
			Patient Evaluation
		Surgical Techniques
			Skin Excision
			Sub-SMAS Rhytidectomy
			The Mini-lift and Short Scar Lift
		Complications
			Nerve Injury
			Hematoma
			Infection
			Scars
			Alopecia
			Earlobe Deformity
			Rejuvenation of the Midface
		Midface Lift
			Midface Anatomy
		Conclusion
		References
	23: Lasers and Related Technologies
		Introduction
		Vascular Concerns of the Periorbital Skin
		Pigmented Concerns of the Periorbital Skin
		Periorbital Photodamage and Rejuvenation
		Infraorbital Dark Circles
		Xanthelasma
		Adnexal Structures of Periorbital Skin
		Safety and Complications (Including Contraindications)
		Conclusion
		References
	24: Complications of Blepharoplasty
		Introduction
		Complications of Upper Lid Blepharoplasty
		Complications Arising from Preoperative Planning or Surgical Judgment
			Undercorrected Redundant Skin or Fat
			Lid or Crease Asymmetry
			Canthal Webbing
			Superior Sulcus Deformity
			Dry Eye and Exposure Keratopathy
			Lagophthalmos
			Ptosis
			Lacrimal Gland Injury
		Operative Complications
			Ocular Injury
			Hemorrhage
			Fire and Facial Burns
		Postoperative Complications
			Incision Irregularities
			Wound Dehiscence
			Infection
			Diplopia
			Numbness
			Blindness
		Complications of Lower Lid Blepharoplasty
		Complications Arising from Preoperative Planning or Surgical Judgment
			Ectropion and Eyelid Retraction
			Overcorrected or Undercorrected Redundant Skin
			Overcorrected or Undercorrected Herniated Orbital Fat
		Operative Complications
			Ocular Injuries
			Fire/Facial Burns
			Hemorrhage
		Postoperative Complications
			Nonaesthetic Incision and Incision Irregularities
			Diplopia
			Canalicular Laceration and Epiphora
			Conjunctival Chemosis
			Infection
			Inflammation
			Blindness
		References
Part VI: Eyelid Tumors and Reconstruction
	25: Eyelid and Conjunctival Neoplasms
		Introduction
		Eyelid Neoplasms
			Basal Cell Carcinoma
				Pathologic Features
				Clinical Presentation
				Management
			Squamous Cell Carcinoma
				Pathologic Features
				Clinical Presentation
				Management
			Sebaceous Carcinoma
				Pathologic Features
				Clinical Presentation
				Management
			Malignant Melanoma
				Pathologic Features
				Clinical Presentation
				Management
		Rare Eyelid Neoplasms
			Sweat Gland Tumors
			Merkel Cell Carcinoma
			Vascular Tumors
			Lymphoma
			Metastatic Lesions
		Conjunctival Neoplasms
			Melanocytic Tumors
				Pathologic Features
				Clinical Presentation
				Management
			Squamous Neoplasia
				Pathologic Features
				Clinical Presentation
				Management
		Other Conjunctival Malignancies
		References
	26: Eyelid and Ocular Adnexal Reconstruction
		Introduction
		General Principles
			Eyelid Defects Not Involving the Eyelid Margin
			Small Defects Involving the Lower Eyelid Margin
			Moderate Defects Involving the Lower Eyelid Margin
			Large Defects Involving the Lower Eyelid Margin
			Small Defects Involving the Upper Eyelid Margin
			Moderate Defects Involving the Upper Eyelid Margin
			Large Defects Involving the Upper Eyelid Margin
		Lateral Canthal Defects
		Medial Canthal Defects
		References
	27: Mohs Micrographic Surgery of the Periorbital Area
		Introduction
		Treatment Goals for Periorbital Malignancy
		History of Mohs Micrographic Surgery
		Margin Control: Methods and Considerations
		Wide Local Excision (WLE)
		Mohs Micrographic Surgery (MMS)
		Mohs Surgery Training
		Indications for Mohs Micrographic Surgery
		Clinical Features: General Considerations
		Clinical Features: Periorbital Considerations
		Histologic Features
		Patient Considerations
		Relative Contraindications to Mohs Surgery
		Mohs Micrographic Surgery Technique
		MMS and Periorbital Cutaneous Malignancy
			Basal Cell Carcinoma
		Squamous Cell Carcinoma and Squamous Cell Carcinoma In Situ (Bowen’s Disease)
		Sebaceous Carcinoma
		Merkel Cell Carcinoma
		Microcystic Adnexal Carcinoma
		Melanoma In Situ and Invasive Malignant Melanoma
		Summary
		References
	28: Sentinel Lymph Node Biopsy for Conjunctival and Eyelid Tumors
		Introduction
		Sentinel Lymph Node Biopsy
		SLNB for Conjunctival and Eyelid Tumors
		Our Experience to Date: Feasibility, Safety, and False-Negative Rate
		Technique
		Evaluation of SLNs
		Risks
		Indications
		Future Directions
		Conclusion
		References
	29: Oculoplastic Complications of Cancer Therapy
		Introduction
		Oculoplastic Complications of Radiation Therapy
		Normal Tissue Damage
			Skin and Conjunctiva
			Eyelid
			Lacrimal System
			Orbital Bone
			Delayed Wound Healing
			Secondary Neoplasms
		Summary of Oculoplastic Complications of Radiation Therapy
			Oculoplastic Complications of Chemotherapy
			Epiphora, Canalicular Stenosis, and Nasolacrimal Duct Blockage
			Trichomegaly
			Chalazia
			Orbital and Periorbital Edema
			Oculoplastic Complications of Ablative Surgery in Patients with Head and Neck Cancer
		References
Part VII: Lacrimal Disease and Surgery
	30: Lacrimal Sac Tumors: Diagnosis and Treatment
		Introduction
		Clinical Features
		Diagnostic Evaluation
		Pathology
		Management
		Prognosis
		References
	31: Dysfunctional Tear Film, Etiology, Diagnosis, and Treatment in Oculoplastic Surgery
		The Oculoplastic Approach
		References
	32: Congenital Causes of Nasolacrimal Duct Obstruction
		Introduction
		Anatomy and Embryology
		Symptoms
			Epiphora
			Mattering of Lashes and Mucopurulent Discharge
			Periocular Mass
		Diagnostic Studies
		Congenital Etiology of Lacrimal System Obstructions
		Upper System Obstructions
		Punctal Abnormalities
		Congenital Punctal Atresia
		Congenital Punctal Agenesis
		Canalicular Abnormalities
			Canalicular Atresia and Agenesis
			Accessory Canaliculi and Accessory Canalicular Channels
		Lower System Obstructions
			Dacryostenosis
			Amniotocele and Dacryocystitis
			Anatomical Variation Causing Lower System Obstruction
		Supernumerary (Anlage) Ducts
		Facial Clefts
		Amniotic Bands
		Tumors and Their Mass Effect
		References
	33: Acquired Causes of Lacrimal System Obstructions
		History
		Examination
		Lacrimal Pump
		Imaging Studies
		Location of Stenosis or Occlusion
			Punctum and/or Ampulla
			Canaliculus
			Lacrimal Sac
			Duct
			Obstruction of the Nasal Portion of the Nasolacrimal Duct
		Etiologic Causes
			Infectious
			Canaliculitis
			Dacryoliths
			Inflammatory
			Endogenous Origin
			Exogenous Factors
			Tumors (Neoplastic)
			Traumatic
			Fractures
			Iatrogenic Obstruction
			Mechanical
			Dacryoliths
			Medications
			Radiation
		References
	34: Clinical Evaluation and Imaging of Lacrimal System Obstruction
		Clinical Diagnosis
		Clinical History
		External Examination
		Schirmer Tests
		Rose Bengal Staining
		Tear Break-Up Time
		Dye Disappearance Test
		Primary Jones Dye Test
		Secondary Jones Dye Test
		Probing
		Diagnostic Imaging Techniques
			Diagnostic Ultrasonography
			Contrast Dacryocystography
			Computed Tomography
			Magnetic Resonance Dacryocystography
			Radionuclide Dacryoscintigraphy
		Other Diagnostic Techniques
			Percutaneous Contrast Dacryocystography
			Chemiluminescence
			Lacrimal Thermography
			Nasolacrimal Endoscopy
			Interpretation of Diagnostic Tests
		References
	35: Surgery of the Punctum and Canaliculus
		Punctoplasty
		Canaliculitis
		Intracanalicular Plugs
		Lacrimal Trauma
		Dog Bites
		Examination
		Repair
		Choice of Stent
		Bicanalicular Repair
		Monocanalicular Repair
		Pigtail Probe
		Stent Removal
		Punctal Ectropion
		References
	36: Primary External Dacryocystorhinostomy
		Surgical Principles
		Anesthesia
		Procedure
		Postoperative Care
		References
	37: Primary Endoscopic Dacryocystorhinostomy
		Patient Selection
		Surgical Equipment
		Endoscopic Dacryocystorhinostomy
		Postoperative Care
		Complications
		Conclusion
		References
	38: Endoscopic Conjunctivodacryocystorhinostomy
		Introduction
		Preoperative Evaluation
		Gladstone–Putterman Modified Jones Tube
		Indications for Endoscopic CDCR
		Advantages of Endoscopic Technique
		Surgical Technique
		Special Surgical Considerations
		Postoperative Care
		Postoperative Evaluation and Management of Complications
		References
	39: Nasolacrimal Duct Probing, Intubation, and Balloon Dacryoplasty
		Introduction
		Probing and Nasolacrimal Duct Intubation in Children
		Probing and Nasolacrimal Duct Intubation in Adults
		Probing Technique
		Nasolacrimal Duct Intubation Technique
			Crawford
			Ritleng
			Guibor and Jackson Stents
			C-Line CIS
		Complications
		Tube Removal
		Balloon Dacryoplasty
		References
	40: Transcanalicular Laser-Assisted Dacryocystorhinostomy
		Introduction
		Selection of Patients
		Description of Procedure
		Postoperative Care
		Outcomes
		References
	41: Management of the Failed Dacryocystorhinostomy
		Introduction
		Clinical Evaluation and Diagnostic Testing of the Symptomatic Patient After DCR
		Management of the Failed DCR
		Balloon Dilatation [27]
		Repeat Dacryocystorhinostomy
		External Approach Via Skin Incision
		Endoscopic-Assisted Endonasal and Transcanalicular Approaches
		Mitomycin C
		Silicone Intubation
		Summary
		References
Part VIII: Orbital Disease and Surgery
	42: Orbital Evaluation
		Introduction
		Patient History
		Examination
			Visual Acuity
			Pupils
			External Examination
			Lymph Node Examination
			Lacrimal Gland
			Nasolacrimal System
			Axial Displacement
			Nonaxial Displacement
			Extraocular Motility
			Eye: Anterior Segment
			Eye: Posterior Segment
			Accessory Tests When Suspecting Optic Neuropathy
		Laboratory Evaluation
		Imaging
		Patient Management
		References
	43: Orbital Radiology
		Imaging Techniques
			CT Imaging
			MR Imaging
			Dynamic Vascular and Positional Imaging
		Anatomy of the Orbit
		Bony Orbit
		The Globe and Optic Nerve
		The Extraocular Muscles
		Lid Retractor System
		Vascular Supply of the Orbit
		Neural Structures
		Lacrimal System
		Orbital Fat
		Ocular, Optic Nerve, and Orbital Pathology
		Ocular Pathology
			Abnormal Globe and Optic Disk Abnormalities
			Coloboma
			Staphyloma
			Buphthalmos
			Papilledema
		Ocular Detachments
			Retinal Detachment
			Choroidal Detachment
			Leukocoria and Its Causes
			Retinoblastoma
			Persistent Hyperplastic Primary Vitreous (PHPV)
			Coats’ Disease
			Retinopathy of Prematurity
			Toxocara canis Infection
		Intraocular Masses
			Retinoblastoma
			Ocular Melanoma
			Ocular Metastasis
			Choroidal Hemangioma
			Retinal Angioma
			Ocular Calcification
			Ocular Inflammation
			Ocular Trauma
			Surgical Change
			The Optic Nerve
			Optic Neuritis and Demyelinating Disease
			Optic Perineuritis
			Optic Nerve Glioma
			Optic Nerve Sheath Meningioma
		The Orbit
			Infection
		Inflammatory Conditions
			Idiopathic Orbital Inflammatory Disease
			Thyroid Orbitopathy
			Sarcoidosis
			Granulomatosis with Polyangiitis
			Sjögren’s Syndrome
			Tumors and Tumorlike Lesions
			Fibro-Osseous Lesions
			Dermoid, Epidermoid, and Lipoma
			Histiocytosis: Eosinophilic Granuloma
			Lacrimal Gland Neoplasms
			Orbital Lymphoma
			Orbital Leukemia
			Rhabdomyosarcoma
			Metastasis
			Neural Tumors
			Trauma
			Vascular Masses of the Orbit
			Capillary Hemangioma
			Cavernous Malformations
			Orbital Varix
			Lymphatic and Venolymphatic Malformations
			Arteriovenous Malformations
			Carotid Cavernous Fistulas
		References
	44: Orbital Signs of Parasellar Syndromes
		Introduction
		Anatomy
		The Orbital Apex
		Cavernous Sinuses
		Pituitary Gland
		Paranasal Sinuses
		Differential Diagnosis
		Trauma
		Tumors
		Nasopharyngeal Carcinoma
			Pituitary Adenoma
			Meningioma
			Lymphoma
			Metastases
			Miscellaneous
			Vascular
		Carotid-Cavernous Fistula
			Classification
			Pathogenesis
			Venous Drainage
			Clinical Presentation
			Evaluation
			Outcomes and Prognosis
			Treatment: Observation
			Treatment: Surgical Options
		Cavernous ICA Aneurysm
			Clinical Presentation
			Prognosis
			Treatment
		Aseptic Cavernous Sinus Thrombosis
			Pathogenesis
			Clinical Presentation
		Inflammatory Causes
		Tolosa-Hunt Syndrome
			Clinical Presentation
			Neuroimaging
			Treatment
			Hypophysitis
			Infection
		Septic Cavernous Sinus Thrombosis
			Infection Sources
			Clinical Presentation
			Neuroimaging
			Outcomes and Prognosis
			Treatment
		Rhino-Cerebral-Orbital Mucormycosis
			Clinical Presentation
			Risk Factors
			Diagnosis
			Treatment
		Aspergillosis
			Clinical Presentation and Treatment
		Zoster Neuropathy
			Treatment
		Conclusion
		References
	45: Methods for Obtaining and Processing Periocular Tissues for Pathologic Diagnosis
		Introduction
		Resection and Handling of Pathologic Specimens
			Classification of Pathologic Specimens
			Method of Excision and Handling of Pathologic Specimens
			Frozen Sections
			Tissue Fixation
			Labeling of Pathologic Specimens and Completing the Pathology Request Form
		Processing of Pathologic Specimens
			Gross Examination of Pathologic Specimens
			Dissection of Pathologic Specimens
			Identification of Surgical Margins
			Mishandling of Pathologic Specimens
		Rendering a Pathologic Diagnosis
			Review of Previous Pathologic Material
			Histopathologic Diagnosis
			Limitations of Histologic Diagnosis
			Issuing Pathology Reports
			Medicolegal Considerations of Pathologic Specimens
			Special Techniques in Surgical Pathology
				Special Histologic Stains
				Immunohistochemistry
				Cytologic Techniques
				Electron Microscopy
				Molecular Techniques
				Cytogenetics
				Flow Cytometry
			Other Special Techniques
		Conclusion
		Suggested Reading
	46: Surgical Approaches to the Orbit and Optic Nerve
		Introduction
		Preoperative Assessment
			Age and Race
			Use of Anticoagulants
			Imaging
			Anesthesia and Positioning
			Instrumentation
			Retractors
			Periosteal Elevator
			Other Dissectors
			Drills
			Endoscope
			Cryoprobe
			Image Guidance Procedures
			Biopsy Techniques
			Fine-Needle Aspiration Biopsy
			Excisional Biopsy
			Incisional Biopsy
		Anterior Orbitotomy
			Superior Orbital Lesions: Transcutaneous Approach
			Superior Orbital Lesions: Transconjunctival Approach
			Inferior Orbital Lesions: Transcutaneous Approach
			Inferior Orbital Lesions: Transconjunctival Approach
			Medial Orbital Lesions: Transcutaneous Approach
			Medial Orbital Lesions: Transconjunctival Approach
			Medial Orbital Lesions: Transcaruncular Approach
		Lateral Orbitotomy
			Medial Lid Crease Approach to the Orbit and Optic Nerve
			Endoscopic Orbital Surgery
			Neurosurgical Approach
			Intraoperative Complications
		Postoperative Complications
			Emergent Complications
			Non-emergent Complications
		Suggested Reading
	47: Transcranial Approach to the Orbit
		Introduction
		Definitions
		Suggested Reading
	48: Evaluation and Management of Lacrimal Gland Diseases
		Introduction
		Intrinsic Inflammations of the Lacrimal Gland
			Infectious Lesions of the Lacrimal Gland
			Noninfectious Lesions of the Lacrimal Gland
				Idiopathic Orbital Inflammatory Disease (IOID)
				Systemic Inflammations
					Sjogren’s Syndrome
					Sarcoidosis
					Wegener’s Granulomatosis
					Systemic Lupus Erythematosus
					Graves’ Orbitopathy
		Lymphoproliferative Disorders of the Lacrimal Gland
		Benign Tumors of the Lacrimal Gland
			Pleomorphic Adenoma (Benign Mixed Tumor)
			Myoepithelioma
			Oncocytoma
		Malignant Tumors of the Lacrimal Gland
			Adenoid Cystic Carcinoma
			Primary Adenocarcinoma (De Novo)
			Pleomorphic Adenocarcinoma (Malignant Mixed Tumor)
			Mucoepidermoid Carcinoma
			Acinic Cell Carcinoma
			Squamous Cell Carcinoma
			Malignant Myoepithelial Carcinoma
			Carcinosarcoma
		Miscellaneous Conditions
			Dacryops
			Congenital Dermoid Cysts
			Amyloidosis
			Kimura’s Disease
			Warthin’s Tumor
			Solitary Fibrous Tumor
			Hemangiopericytoma
			Cavernous Hemangioma
			Herniated Orbital Fat
		References
	49: Orbital Inflammation
		Introduction
		Evaluation
		Orbital Infection
		Bacterial Orbital Cellulitis
			Clinical Features
			Diagnosis
			Differential Diagnosis
			Treatment
			Complications
		Orbital Nocardiosis
		Fungal Orbital Cellulitis
		Orbital Aspergillosis
		Orbital Mucormycosis
		Orbital Granulomatous Diseases
		Autoimmune Orbital Granulomatous Disease
		Autoimmune Disorders
			Orbital Sarcoidosis
		Orbital Wegener’s Granulomatosis
		Churg-Strauss Syndrome
		Sjögren’s Syndrome
		Granuloma Annulare
		Idiopathic Orbital Inflammation
			Clinical Features
			Treatment of IOI
		Orbital Myositis
		Dacryoadenitis
		Trochleitis
		Perineuritis
		Idiopathic Posterior Scleritis
		Orbital Apex (Tolosa-Hunt) Syndrome
		Langerhans’ Cell Histiocytosis
		Adult Xanthogranulomatous Diseases
		Kimura Disease and Angiolymphoid Hyperplasia with Eosinophilia
		Intraocular Tumor-Related Orbital Inflammation
		References
	50: Ocular Adnexal Lymphoproliferative Disease
		Introduction
		Definitions
		Epidemiology
		Pathogenesis
			The Role of Chronic Immune Stimulation: In Situ Evolution of Lymphoma
			The Role of Immunosuppression
			The Role of Infectious Organisms/Chronic Antigenic Stimulation
		Classification of Lymphoma
			Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT Lymphoma)
			Follicular Lymphoma
			Diffuse Large B-Cell Lymphoma
			Mantle Cell Lymphoma
		Uncommon and Unusual Ocular Adnexal Lymphomas
			Burkitt Lymphoma
			High-Grade Lymphoma (Including Atypical Burkitt Lymphoma/Burkitt-Like Lymphoma)
			AIDS-Related Lymphoma
			Natural Killer/T-Cell Lymphoma
			T-Cell Lymphoma
			Multiple Myeloma
		Pathology, Immunology, and Cytogenetics
		Clinical Presentation
		Imaging
		Prognostic Indicators
		Management
			Tissue Diagnosis
			Staging
			Treatment
		Conclusions
		References
	51: Orbital Vascular Anomalies
		Introduction
		Arteriovenous Malformation (AVM)
		Venous Malformation
		Lympho-venous Malformation (Lymphangioma)
		Cavernous Malformation (Cavernous Hemangioma)
		Infantile Hemangioma
		Hemangiopericytoma/Solitary Fibrous Tumor
		Carotid-Cavernous Fistulas
		Conclusion
		References
	52: Pediatric Orbital Disease
		Introduction
		Pediatric Orbital Development and Anatomy
		Infectious Orbital Disease
			Bacterial Preseptal Cellulitis
			Bacterial Orbital Cellulitis
			Mycotic Orbital Cellulitis
		Pediatric Orbital Inflammatory Disease
			Idiopathic Orbital Inflammation
			Pediatric Thyroid Eye Disease
		Pediatric Granulomatosis with Polyangiitis
		Systemic Lupus Erythematosus
		Periarteritis Nodosa/Polyarteritis Nodosa
		Sarcoidosis
		Pediatric Crohn’s Disease
		Sjogren’s Syndrome
		Orbital Tumors
			Congenital Orbital Tumors and Cysts
				Hamartomas and Choristomas
			Pediatric Orbital Neural Tumors
				Optic Pathway Glioma
			Orbital Neurofibroma
			Orbital Meningioma
			Orbital Schwannoma
		Pediatric Orbital Vascular Tumors
			Infantile Hemangioma
		Orbital Lymphangiomas
		Pediatric Orbital Mesenchymal Tumors
			Rhabdomyosarcoma
		Fibrous Dysplasia
		Orbital Soft Tissue Sarcomas
			Ewing Sarcoma
			Histiocytic Tumors
			Lymphoproliferative Tumors
			Burkitt Lymphoma
		Lacrimal Gland Tumors
			Adenoid Cystic Carcinoma
		Metastatic Tumors
			Neuroblastoma
		Leukemic Neoplasia
		Pediatric Facial Trauma
		Midfacial Fractures
		Orbital Fractures
			Orbital Floor Fractures
		Orbital Medial Wall Fractures
		Orbital Roof Fractures
		Haug CT Classification of Orbital Roof Fractures
		Lateral Orbital Wall Fractures
		Zygomaticomaxillary Complex Fractures
		Intraorbital Foreign Body
		Orbital Hemorrhage
		Pediatric Traumatic Optic Neuropathy
		Conclusion
		References
	53: Orbital Exenteration
		Introduction
		Indications for Orbital Exenteration
		Preoperative Evaluation and Planning
		Exenteration Techniques
		Total Exenteration
		Eyelid-Sparing Exenteration
		Subtotal Exenteration
		Extended Exenteration with Bone Removal and/or Additional Resection
		Primary Reconstruction of the Exenterated Orbit
		Spontaneous Granulation
		Skin Grafting
		Soft Tissue Reconstruction
		Bony Reconstruction
		Special Clinical Considerations
		Complications of Exenteration
		Rehabilitation of the Exenterated Socket
		Orbital Prosthetics
		Conclusion
		References
	54: Image-Guided Orbital Surgery
		Introduction
		Science of Stereotaxy
		History of Stereotactic Surgery
		Stereotaxy in Orbital Surgery
		Stereotactic Platforms
		Approach to Stereotactic Orbital Surgery
			Getting Started
			Basic Technique
			Benefits of Stereotaxy
		Summary
		References
	55: Silent Sinus Syndrome
		Introduction
		Epidemiology
		Pathophysiology
		Presentation
		Diagnosis
		Differential Diagnosis
		Imaging
		Treatment
		Summary
		References
	56: Orbital Tumors
		Introduction
		Clinical Evaluation
		Ophthalmic and Medical History
		Ophthalmic Examination
		Signs and Symptoms of Orbital Disease
			Proptosis
			Ocular Motility
			Loss of Vision
			Orbital Pain
			Periorbital Inflammation
			Laterality
			Other Key Features
				Nature of Onset
				Age at Onset
				Unusual Features
		Ancillary Imaging Techniques
			Computed Tomography
			Magnetic Resonance Imaging
			Incidence of Orbital Disease
			Cystic Lesions
			Inflammatory Lesions
			Vascular Lesions
			Neural Tumors
			Mesenchymal Lesions
			Tumors of Bone
			Lacrimal Gland Lesions
			Metastatic Tumors
			Lymphoproliferative Lesions
			Secondary Tumors
		Cystic Lesions
			Dermoid Cyst
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Dermoid Cyst of Conjunctival Origin
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Epithelial Cyst
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Respiratory Epithelial Cyst
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Mucocele and Mucopyocele
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Colobomatous Cyst
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
		Vascular Lesions
			Capillary Hemangioma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Cavernous Hemangioma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Lymphangioma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Varices
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Angiosarcoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
		Neural Tumors
			Carcinoid
				Clinical Pearls
				Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Malignant Peripheral Nerve Sheath Tumor
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Meningocele (Meningoencephalocele)
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Neuroblastoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Optic Pathway Glioma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Optic Nerve Sheath Meningioma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Plexiform Neurofibroma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Schwannoma (Neurilemoma)
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Solitary Neurofibroma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Sphenoid Wing Meningioma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
		Mesenchymal Tumors
			Fibrosarcoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Fibrous Histiocytoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Juvenile Xanthogranuloma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Leiomyosarcoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Lipoblastoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Benign Cartilaginous Tumors
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Lipodermoid (Dermolipoma)
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Lipoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Liposarcoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Rhabdomyosarcoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Solitary Fibrous Tumor
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
		Tumors of Bone
			Aneurysmal Bone Cyst
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Cholesterol Granuloma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Ewing Sarcoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Fibrous Dysplasia
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Giant Cell Reparative Granuloma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Ossifying Fibroma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Osteoblastoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Osteoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Osteosarcoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
		Lacrimal Gland Tumors
			Adenocarcinoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Adenoid Cystic Carcinoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Mucoepidermoid Carcinoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Pleomorphic Adenoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
		Metastatic Tumors
			Breast Carcinoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Bronchogenic Carcinoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Malignant Melanoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
		Secondary Tumors
			Basal Cell Adenocarcinoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Basal Cell Carcinoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Inverted Papilloma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Sinonasal Carcinoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
			Squamous Cell Carcinoma
				Clinical Pearls
				Clinical Presentation
				Computed Tomography
				Magnetic Resonance Imaging
				Histopathology
				Treatment
				Prognosis
		Suggested Reading
			Introduction
			Cystic Lesions: Dermoid Cyst
			Cystic Lesions: Dermoid Cyst of Conjunctival Origin
			Cystic Lesions: Epidermoid Cyst
			Cystic Lesions: Mucocele
			Cystic Lesions: Respiratory Cyst
			Vascular Lesions: Capillary Hemangioma
			Vascular Lesions: Cavernous Hemangioma
			Vascular Lesions: Lymphangioma
			Vascular Lesions: Varices
			Vascular Lesions: Angiosarcoma
			Neural Tumors: Carcinoid
			Neural Tumors: Malignant Peripheral Nerve Sheath Tumor
			Neural Tumors: Meningocele
			Neural Tumors: Neuroblastoma
			Neural Tumors: Optic Pathway Glioma
			Neural Tumors: Optic Nerve Sheath Meningioma
			Neural Tumors: Plexiform Neurofibroma
			Neural Tumors: Schwannoma
			Neural Tumors: Solitary Neurofibroma
			Neural Tumors: Sphenoid Wing Meningioma
			Mesenchymal Tumors: Fibrosarcoma
			Mesenchymal Tumors: Fibrous Histiocytoma
			Mesenchymal Tumors: Juvenile Xanthogranuloma
			Mesenchymal Tumors: Leiomyosarcoma
			Mesenchymal Tumors: Lipoblastomatosis
			Mesenchymal Tumors: Benign Cartilaginous Tumors
			Mesenchymal Tumors: Lipodermoid
			Mesenchymal Tumors: Lipoma
			Mesenchymal Tumors: Liposarcoma
			Mesenchymal Tumors: Rhabdomyosarcoma
			Mesenchymal Tumors: Solitary Fibrous Tumor
			Tumors of Bone: Aneurysmal Bone Cyst
			Tumors of Bone: Cholesterol Granuloma
			Tumors of Bone: Ewing’s Sarcoma
			Tumors of Bone: Fibrous Dysplasia
			Tumors of Bone: Giant Cell Reparative Granuloma
			Tumors of Bone: Ossifying Fibroma
			Tumors of Bone: Osteoma
			Tumors of Bone: Osteosarcoma
			Lacrimal Gland Tumors: Adenocarcinoma
			Lacrimal Gland Tumors: Adenoid Cystic Carcinoma
			Lacrimal Gland Tumors: Mucoepidermoid Carcinoma
			Lacrimal Gland Tumors: Pleomorphic Adenoma
			Metastatic Tumors: Breast Carcinoma
			Metastatic Tumors: Bronchogenic Carcinoma
			Metastatic Tumors: Malignant Melanoma
			Secondary Tumors: Basal Cell Adenocarcinoma
			Secondary Tumors: Basal Cell Carcinoma
			Secondary Tumors: Inverted Papilloma
			Secondary Tumors: Nasopharyngeal Carcinoma
			Secondary Tumors: Squamous Cell Carcinoma
	57: Pathogenesis and Medical Management of Thyroid Eye Disease
		Introduction
		Pathogenesis
		Immunology
		Role of Orbital Fibroblasts
		Role of Lymphocytes
		Diagnosis and Role of Autoantigens in TED
		Clinical Monitoring and Classification Systems
		Endocrine Management of Systemic Graves’ Disease
			Thioamide Drugs
			Radioactive Iodine (RAI)
			Surgical Thyroidectomy
		Medical Management of TED
			Conservative Measures
			Corticosteroids
			Targeted Immunotherapies
			Antibody Therapy
		Orbital Radiotherapy
		Conclusions
		References
	58: Surgical Management of Thyroid Eye Disease
		Introduction
		Orbital Decompression
			History
			Surgical Timing
			Preoperative Planning
			Surgical Techniques
				Orbital Fat Decompression
				Lateral Wall Decompression
				Medial Transconjunctival Approach to the Orbit
				Orbital Floor Decompression
				Endonasal Endoscopic Orbital Decompression (Medial Wall and Floor)
			Postoperative Considerations
		Strabismus Surgery
		Eyelid Surgery
			Etiology of Eyelid Changes in TED
			Surgical Techniques
				Upper Eyelid Recession
					Anterior Approach (Full-Thickness Blepharotomy)
					Posterior Approach
				Lower Eyelid Retraction Repair
				Spacer Graft Materials
					Autologous Auricular Cartilage
					Hard Palate Mucosa
					Acellular Dermis
					Free Tarsal Grafts
					Alloplastic Material
					Banked Sclera
					Results
			Postoperative Considerations
		Summary
		References
Part IX: Socket Surgery
	59: Enucleation, Evisceration, and Secondary Orbital Implantation
		Introduction
		Historical Perspective
		Current Perspective: Porous Orbital Implants
			Hydroxyapatite Implants
			Porous Polyethylene Implants
			Synthetic Hydroxyapatite Implants
			Bioceramic Implants
		Porous Versus Nonporous Implants: Which to Use?
		Current Classification of Implants and Terminology (Table 59.1)
		Implant Selection in Adults and Children
		Socket Volume Considerations
		Orbital Implant Wrapping
		Pegging Porous Orbital Implants
		Preoperative Preparation for Enucleation and Evisceration Surgery
		Indications for Enucleation
		Indications for Evisceration
		Enucleation Versus Evisceration
		Nonsurgical Management of the Blind, Painful Eye
		Enucleation Surgical Technique
		Evisceration Surgical Technique (with Keratectomy)
		Secondary Orbital Implants
		Secondary Orbital Implant Placement Surgical Technique (Fig. 59.14)
		Postoperative Care Following Enucleation, Evisceration, and Secondary Orbital Implant Surgery
		Dermis Fat Grafts
		The Ocularist
		Summary
		References
	60: Evaluation and Management of the Anophthalmic Socket and Socket Reconstruction
		Introduction
		Changes Associated with Anophthalmic Socket
		Fabrication, Care, and Maintenance of the Artificial Eye
		Living with a Prosthetic Eye
		Management of Anophthalmic Socket Problems
			Socket Dryness
			Discharge and Irritation
		Lagophthalmos with Exposure of the Prosthesis Surface
		Socket Pain
		Anterior Orbital Cysts
		Eyelid Malpositions
		Deep Superior Sulcus and Enophthalmos
		Secondary Orbital Implantation
			Implant Migration
		Implant Exposure and Extrusion
		Implant Infection
		Complications of Implant Pegging
		Acquired Socket Contracture
		Mild Socket Contracture
		Moderate Socket Contracture
		Severe Socket Contracture
		The Congenital Anophthalmic Socket: Anophthalmos and Microphthalmos
		Long-Term Management of the Anophthalmic and Microphthalmic Socket
		Summary
		References
Part X: Pediatric Considerations
	61: Considerations in Pediatric Oculoplastic Examination
		Introduction
		General Rapport
		Motility and Visual Examination
		Epiphora
		Eyelid
			Ptosis
				Eyelid Tumors
			Benign Eyelid Tumors
			Malignant Eyelid Tumors
		Orbit
		References
	62: Child Abuse Concerns in Oculoplastics
		References
	63: Genetics in Oculoplastics
		Introduction
		The Human Genome
		Gene Structure
		Mutation and Polymorphism
		Patterns of Inheritance
			Mendelian Inheritance
			Autosomal Dominant Inheritance
			Autosomal Recessive Inheritance
			X-Linked Recessive Inheritance
			X-Linked Dominant Inheritance
		Non-Mendelian Inheritance
			Mitochondrial Inheritance
			Chromosomal Aberrations
			Genetic Testing
			MAC Spectrum: Anophthalmia, Microphthalmia, and Coloboma
			Nanophthalmos
			Isolated and Syndromic Anophthalmia/Microphthalmos
			The “SOX2 Anophthalmia Syndrome”
			Waardenburg Anophthalmia Syndrome
		X-Linked Microphthalmia Syndromes
			Lenz Microphthalmia Syndrome
			Oculo-Facio-Cardiodental (OFCD) Syndrome
			Microphthalmia, Dermal Aplasia, and Sclerocornea
		Genetic Testing and Counseling
			Cryptophthalmos
			Congenital Coloboma of the Lids
			Systemic Syndromes with Lid Colobomas
			Distichiasis Syndromes
			Congenital Ectropion
			Congenital Entropion
			Euryblepharon
			Epicanthus
			Telecanthus
			Hypertelorism
			Choristomas
			Hamartomas
		Craniofacial Disorders
			Encephaloceles
			Frontonasal Dysplasia (FND)
			Craniosynostosis
			Craniofacial Clefts
		Genetic Forms of Ptosis
			BPES (Blepharophimosis Syndrome)
		Congenital Fibrosis of the Extraocular Muscles
			CFEOM2
			CFEOM3
			Tukel Syndrome
		Marcus Gunn Jaw Winking Ptosis
			Congenital Myasthenic Syndromes
		Acquired Ptosis
		Chronic Progressive External Ophthalmoplegia
			Kearns-Sayre Syndrome
			Myotonic Dystrophy
			Oculopharyngeal Muscular Dystrophy
		Syndromes with Lacrimal System Abnormalities
			Congenital Secretory Anomalies
				Congenital Alacrima
				Nasolacrimal System Anomalies
		Phakomatoses with Oculoplastic Manifestations
			Neurofibromatosis 1 (NF1)
			Tuberous Sclerosis (TS)
			Sturge-Weber Syndrome (SWS)
		References
	64: Congenital Soft Tissue Deformities
		Major Eyelid Deformities
			Cryptophthalmos (Online Mendelian Inheritance in Man (OMIM)# 123570)
			Ablepharon Macrostomy Syndrome (OMIN # 200110) and Barber-Say (OMIM # 209885) Syndromes
			Upper Eyelid Colobomas
				Isolated Colobomas
				Colobomas with Corneopalpebral or Conjunctival Adhesions
				Craniofacial Cleft Numbers 11, 10, and 9
				Oculoauriculovertebral Spectrum (Goldenhar) and Other Rare Syndromes
				Surgical Repair
			Lower Eyelid Involvement in Craniofacial Clefting
			Congenital Accessory Palpebral Fissure
		Canthal Abnormalities
			Medial Canthus
				Blepharophimosis, Ptosis, and Epicanthus Inversus Syndrome (BPES) (OMIN #110100)
			Lateral Canthus
				Treacher Collins/Franceschetti Syndrome
				Tessier’s Cleft Number 8
				Euryblepharon and Blepharocheilodontic Syndrome
		Congenital Eyelid Malpositions
			Upper Eyelid Eversion Associated with Lid Laxity
			Eyelid Ectropion Associated with Anterior Lamella Shortening
			Upper Eyelid Entropion
			Eyelid Retraction
		Minor Deformities
			Ankyloblepharon
			Epiblepharon
		References
	65: Specific Issues in Pediatric Periocular Trauma
		Introduction
		Pediatric Periocular Dog Bite Injuries
			Surgical Technique
		Pediatric Orbital Fractures
			The Pediatric Orbit and Orbital Roof Fractures
			The White-Eyed Blowout Fracture
			Surgical Technique
		CT Imaging in Children
		Periocular and Orbital Foreign Bodies
		References
	66: Anesthesia and the Pediatric Oculoplastics Patient
		Introduction
		Role for Sedation
		Nonmedical Prevention of Anxiety
		Distraction
		Talking at the Child’s Level
		Working Without Sedation
		Levels of Sedation
		Contraindications to Sedation
		Choice of Sedation
		Anesthesia for Surgery
			Topical Anesthetics
			Injectable Anesthetics
		Postoperative Nausea and Vomiting
		Postoperative Pain Control
		Conclusion
		References
Part XI: Eyelid and Orbital Trauma
	67: Management of Ocular Adnexal Trauma
		Introduction
		Principles of Wound Healing
		Phases of Wound Healing
			Inflammation (Wounding Through Day 5)
			Chemotaxis and Activation
			Proliferation (Day 4–14)
			Remodeling Phase (14 Days to 1 Year)
			Clinical Factors Affecting Wound Healing
			Excessive Healing
		Eyelid Trauma
			Systemic Considerations
			General Principles
			History
			Patient Evaluation
			Surgical Management
			Operative Considerations
		Management of Blunt Trauma
			Medial Canthal Injuries
			Lateral Canthal Injuries
		Management of Sharp Trauma
			Extramarginal Lacerations
				Simple Lacerations
				Complex Lacerations
			Eyelid Margin Lacerations
			Complex Eyelid Margin Lacerations
		Traumatic Levator Dehiscence
		Secondary Repair
		Canalicular and Lacrimal System Trauma
		Management of Dog and Human Bites
		Gunshot Wounds of the Orbit
		References
	68: Adnexal Burns
		Introduction
		Classification of Thermal Eyelid Burns
		Evaluation and Acute Treatment
		Tarsorrhaphy
		Masquerade Procedure
		Intermediate Care
		Late Reconstruction
		Medial Canthal Reconstruction
		Tear Drainage System Abnormalities
		Summary
		References
	69: General Principles of Management of Orbital Fractures
		Introduction
		Orbital Anatomy
		Orbital Roof
		Medial Orbital Wall
		Orbital Floor
		Lateral Orbital Wall
		Evaluation
		Radiological Examination
		General Management Principles of Orbital Fractures
		References
	70: Blowout Fractures of the Orbit
		Introduction
		Clinical Examination
		Orbital Imaging
		Buckling Theory Versus Hydraulic Theory
		Management
		Surgical Technique for Orbital Floor Fracture Repair
		Complications
		Summary
		References
	71: Zygomaticomaxillary Complex Fractures
		Introduction
		Frequency
		Evaluation
		Imaging
		Indications for Surgery
		Contraindications to Surgery
		Classification
		Treatment
		Complications
		Suggested Readings
	72: Le Fort Fractures
		History of Le Fort Fractures
		Relevant Anatomy
		Vertical Buttresses
		Horizontal Buttresses
		Classification of Le Fort Fractures
			Type I Le Fort Fracture
			Type II Le Fort Fracture
			Type III Le Fort Fracture
		History and Physical Examination
			History
			Special Considerations for Examination
			Imaging
			Management and Surgical Treatment
			Intubation
			Plating Systems
			Maxillomandibular Fixation
		Surgical Approaches to Le Fort Fractures
			Intraorally via Sublabial (Oral Vestibular) or Supramarginal Incision
			Periocular via the Subciliary (Lower Lid Transcutaneous), Lower Lid Transconjunctival, Combined Transconjunctival and Lateral Canthotomy, or Upper Eyelid Incision
			Brow Incision
			Coronal
			Existing Lacerations
		General Principles for Repairing Panfacial Trauma
		Specifics of Repair Depending on Fracture Pattern
			Le Fort I Fractures
			Le Fort II Fractures
			Le Fort III Fractures
			Pediatric Le Fort Fractures
			Postoperative Management
			Complications of Le Fort Fractures
		References
	73: Post-traumatic Enophthalmos and Three-Dimensional Imaging
		Introduction
		Anatomy and Pathophysiology
		Mechanisms of Traumatic Orbital Wall Displacement
			Floor
			Medial Wall
			Lateral Wall
			Roof
			Evaluation
			Imaging
		Timing of Intervention
			Floor and Medial Wall Fractures
			Lateral Wall Fractures
		Predictors of Enophthalmos
		Surgical Techniques
			Materials
			Principles
			Orbital Floor
			Medial Orbital Wall
			Three-Dimensional (3D) Imaging
			Masqueraders
			Complications
		Conclusions
		References
	74: Orbital Foreign Bodies and Penetrating Orbital Injuries
		Introduction
		Prevention
		Classification
		Clinical Assessment
		Imaging Penetrating Orbital Injuries and IOrbFBs
		MRI and Suspected Metallic IOrbFBs
		Complications of Retained IOrbFBs
		Treatment of Penetrating Orbital Injuries and IOrbFBs
		Summary
		References
	75: Combat Casualty Ophthalmic Care for the Oculoplastic and Orbital Surgeon
		Introduction
		Casualty Care Goals
			Assessment
			Pain Management and Prevention of Further Damage
			Evacuation
		Ocular Injuries
			Open Globe Injury
			Blunt Trauma
			Chemical Injury
		Soft Tissue Trauma
			Eyelid Laceration
			Thermal Burn
		Orbital Trauma
			Orbital Compartment Syndrome
			Orbital Wall Fracture
		Mass Casualty
		Packing and Planning Considerations
		References
Index