In September 2006, a well organized and equally well attended joint meeting of the British Oculoplastic Surgery Society (BOPSS) and the European Society of Ophthalmic Plastic & Reconstructive Surgery (ESOPRS) was held in London. This special issue is dedicated to this meeting and contains a selection of the best papers, including the Mustarde Lecture. This prestigious lecture, named after the first President of ESOPRS Jack Mustarde, was given by Mr. Geoffrey E. Rose, MS, DSc, FRCOphth, who spoke brilliantly about his personal experience with 14 cases of visual loss due to orbital surgery between 1991 and 2005. In this issue, Rose takes us back to the 18th century, when “the ‘touch of the devil’ was frequently invoked as the cause of many ailments, particularly the ‘devilishly painful’ ones—such as gout or colic”. The complication most feared by the orbital surgeon and patient is the postoperative loss of vision, to which he refers as the “devil's touch”. Rose analyzes the risk factors and mechanisms leading to this complication. He concludes that prevention of postoperative vasospasm will probably form the mainstay in the prevention of visual loss after orbital surgery.
Another paper by Rose et al., presented by Rossman, describes occult sinus disease as an important cause of discharging eyelid fistulas. Patients with recurrent upper lid erythema and swelling, with spontaneous drainage through a fistula located in the supero-medial eyelid sulcus, may be cured of this condition by means of endoscopic sinus surgery.
A group from Paris (Galatoire et al.) reports on the use of magnetic resonance imaging (MRI) to study inter-individual and inter-racial differences in upper eyelid anatomy, including the position of the skin crease. They conclude that MRI provides excellent images, which help us to better understand the complex architecture of the upper eyelid.
A paper by Shoamanesh et al. reports on the complications of orbital implants in a series of 542 pegged and non-pegged patients. The authors discuss the most frequent complications after both primary and secondary procedures, before and after pegging. They conclude that the least complications are seen with the use of silicone implants. Should patients decide to undergo pegging, the authors prefer the titanium peg and sleeve system over the other peg types.
Dr. Plowman, a visiting oncologist at London's Moorfields Eye Hospital, shares with us his experience with several eyelid malignancies, including lymphomas, carcinomas, melanomas and tumors of the pediatric age group. He discusses the possible involvement of chronic Chlamydia psittaci infection in the etiology of lymphoma. Autoimmune thyroid disease could be another
etiological factor. The location and type of periocular lymphomas have prognostic value and are important for the choice of management. For eyelid melanomas, surgery is not matched by any other treatment modality and wide resection is mandatory for operable disease; this may have to be extensive to achieve clear margins. Plowman points out that squamous and basal cell carcinomas of the lid are clinical problems of local cure, for which both elegant surgical and radiotherapeutic options exist. Finally, he discusses the treatment for orbital rhabdomyosarcoma, which differs between the Americans, who opt for less chemotherapy with radiotherapy, and the Europeans who champion more aggressive chemotherapy (and the withholding of radiotherapy from good responders).
In the paper by Lane et al., the characteristics of patients with white-eyed blowout fractures (WEBOF) and those with conventional orbital blowout fractures are compared. The authors report that WEBOF is a clinical diagnosis consisting of vertical diplopia, gaze restriction and nausea and/or vomiting in the setting of peri-orbital trauma in the pediatric and young adult age group. They conclude that the paucity of external signs of trauma may lead to initial misdiagnosis and delay in treatment. All patients who meet WEBOF criteria should be referred to an ophthalmologist and investigated with orbital CT scanning.
In their paper on ‘naso-jugal groove correction’, Professor G. Botti and colleagues emphasize the role of mid-face lifts for facial rejuvenation in those cases where they can be carried out. With their technique, the authors are able to reposition the soft tissues in the malar-suborbital area (skin, orbicularis and cheek fat pad), which results in an increased prominence of the cheek bone, a reduction in the depth of the naso-labial groove and a major restoration of the eyelids’ firmness. Usually, a valid alternative to this treatment is fat grafting, although the results of this technique may be less predictable. As a third option, the authors discuss the Loeb technique (shifting the adipose “hernias” caudally), which can be performed during blepharoplasty in cases with an excess of fat.
We thank all the authors for sharing their scientific work with the readers of Orbit and hope that you will enjoy reading the papers in this special issue.