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To evaluate the efficacy and safety of ultra-pulsed CO2 fractional laser (UP) in the treatment of periorbital static wrinkles in Asians, and to follow up on its long-term efficacy. This was a prospective, self-controlled study conducted at the Dermatological Cosmetic Center of Xijing Hospital from June 2021 to June 2022. A total of 30 Asian patients aged 30–65 years with periorbital static wrinkles were enrolled (both genders, signed informed consent, and had not received treatment in the previous 6 months. Patients were excluded if they were pregnant or lactating, had facial dermatitis, or had received neuromodulator injections in the treatment area recently). All patients underwent one session of ultra-pulsed CO2 fractional laser treatment. Before treatment, the periorbital area was cleaned and topical anesthesia with compound lidocaine ointment (Beijing Ziguang Pharmaceutical Co., Ltd., lidocaine concentration of 5%, containing prilocaine and lidocaine, 25 mg of each per gram, synergistically enhancing the anesthetic effect with minimal skin irritation) was applied for 1 h. After anesthesia, the treatment area was disinfected, and a metal heat-insulating intraocular shield was placed to protect the cornea. The periorbital area (energy 10 mj, density 10%), forehead, and nasal root (energy 17.5 mj, density 5%) were treated with different energy and density settings. Post-treatment, ice compresses were applied for 20–30 min, and strict sun protection was advised. Photographs were taken before treatment, immediately after treatment, and at 2 weeks, 1 month, 2 months, and 3 months post-treatment to assess efficacy. Skin wrinkle assessment was performed using Think View skin analysis. Pain was assessed using the Visual Analog Scale (VAS) during treatment. Telephone follow-ups were conducted on days 1, 3, and 5 post-treatment to record adverse reactions. The Antera3D skin image analysis system was used to evaluate overall periorbital wrinkle scores, average wrinkle depth, average wrinkle width, and maximum wrinkle depth. All 30 patients tolerated the intraoperative pain, with a VAS pain score of 5.67 ± 1.15. 93% of the subjects were satisfied with the treatment outcomes. The Fitzpatrick wrinkle grading scores decreased after treatment compared to before treatment in all subjects. 3D skin analysis revealed a reduction in overall wrinkle scores post-treatment, with a significant decrease in average wrinkle depth at 3 months post-treatment (p < 0.001). Maximum wrinkle depth improved at 1 month post-treatment (p < 0.05) and decreased significantly at 2 and 3 months post-treatment (p < 0.001). No significant adverse reactions were observed post-treatment.Ultra-pulsed CO2 fractional laser (UP) is effective in improving periorbital static wrinkles in Asians with high safety and tolerability. [ABSTRACT FROM AUTHOR]

Orbital cellulitis is often seen as a serious complication of acute rhinosinusitis. Facial trauma is one of the possible causes of orbital cellulitis. A middle-aged man, a mason by occupation, presented to ENT OPD following a facial trauma. He presented with a laceration over the right zygomatic region with right-sided periorbital swelling and redness. Wide-spectrum antibiotics were initiated for the patient. Pus was drained daily, and surgical debridement of the wound followed by sterile dressing of the wound cavity was done regularly until the pus discharge totally stopped. The patient was taken for secondary suturing and was discharged after that. However, the patient lost to follow-up. Facial trauma is a cause of orbital cellulitis. Orbital cellulitis is an emergency condition and requires urgent medical attention. Adequate antibiotic therapy is of utmost importance to treat the condition. Surgical care is advisable if the medical line of management fails.

Recent years have received huge attention towards monitoring solar ultraviolet radiation due to ozone depletion caused by industrialization and urbanization. Ozone layer is a main significant constituent of the stratosphere and makes life possible on the earth's surface by absorbing the hazardous UV radiation. Adverse effects of UV radiations can be seen in different chemical and biological processes of plants and animals, it damages aquatic life, effects conservation and durability of materials and even human health and also shows its impact on global energy balance and climate change. Light-exposed tissues effected by photo oxidative stress causes and promotes diseases, including skin cancer, cataract and age-related macular degeneration. Ultraviolet (UV) radiation potentially damages the skin, the immune system and structures of the eye. Chronic UV exposure affects the cornea and lens, making effective UV protection crucial for all age groups. Monitoring of solar UV-B and UV-E radiations were performed by measuring the intensities of solar UV radiations using Kipps & Zonen radiometer sensors having spectral sensitivity. In this piece of work, three sites of Uttarakhand were selected for measurement of solar UVB and UV-E radiation and average summer peak of ultraviolet (ASPUV) and average winter peak ultraviolet (AWPUV) were calculated. Altitudinal, monthly and diurnal variations were observed and average summer and winter peak value were calculated. Natural solar UV-B level was minimum in January and maximum in months of June to September. It was found that the intensity of UV-B increases with increase in altitude and also sun's position, altitude, latitude, climate, pollution, dust and cloud affect the solar UV radiation. [ABSTRACT FROM AUTHOR]

Orbital cellulitis is often seen as a serious complication of acute rhinosinusitis. Facial trauma is one of the possible causes of orbital cellulitis. A middle-aged man, a mason by occupation, presented to ENT OPD following a facial trauma. He presented with a laceration over the right zygomatic region with right-sided periorbital swelling and redness. Wide-spectrum antibiotics were initiated for the patient. Pus was drained daily, and surgical debridement of the wound followed by sterile dressing of the wound cavity was done regularly until the pus discharge totally stopped. The patient was taken for secondary suturing and was discharged after that. However, the patient lost to follow-up. Facial trauma is a cause of orbital cellulitis. Orbital cellulitis is an emergency condition and requires urgent medical attention. Adequate antibiotic therapy is of utmost importance to treat the condition. Surgical care is advisable if the medical line of management fails. [ABSTRACT FROM AUTHOR]

Background: Dark eye circle (DEC) is one of the most common cosmetic problems. It has a great impact on the patients' quality of life. Carboxytherapy is a cosmetic technique using pure carbon dioxide for different uses in different areas of the body. The goal of this study is to evaluate the efficacy and tolerability of carboxytherapy in the cosmetic correction of DECs. Methods: This study was conducted on 27 patients requesting the correction of DEC. The treatment was performed using a carboxy device in medical grade. The gas injection was performed intradermal after local anesthesia, with a pressure of one tenth bar and a speed of 20 cc/min, 1 cc in each upper and lower eyelid. The treatment sessions were done every 2 weeks for four sessions. Results: The mean physicians' score of DECs before and after treatment was 8.7 ± 0.81 and 4.6 ± 1.1, respectively. The mean patients' score before and after treatment was 9.2 ± 0.5 versus 5.41 ± 1.37. The mean scores showed a significant reduction of skin discoloration without major side effects (p < 0.00001). Conclusion: Carboxytherapy seems to be an effective treatment option for dark circles around the eyes with a good safety profile and patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: To evaluate the efficacy and safety of stromal vascular fraction (SVF), platelet rich plasma (PRP), and 1064‐nm Q‐switched Nd:YAG laser in reducing nanofat treated dark circles and wrinkles under the eyes. Method: This study was a single‐blinded randomized clinical trial conducted on patients with suborbital darkening under the eyes that randomly divided into control and case groups. In the control group, 15 patients were treated with one session of nanofat injection only, and five patients of each intervention groups received one session of nanofat+SVF injection, nanofat+PRP injection, and nanofat injection+Nd:YAG laser, respectively. Assessments methods were (1) evaluation of the degree of darkness and repair under the eyes by a blinded dermatologist based on clinical photographs, (2) investigating patient satisfaction, (3) using biometric variables for color, thickness, and density of the skin (only 3 months after the treatment), and (4) recording the possible adverse effects. Conclusion: In terms of the extent of reduction in the intensity of darkness under the eyes, the combined treatment of nanofat injection together with SVF, PRP, and Nd:YAG laser had a much greater therapeutic effect than nanofat injection alone. In all three groups of combined treatments, patients were 100% satisfied. In terms of biometric variables, amount of changes in colorimeter, complete and dermal thickness, complete and dermal density, between the different groups was statistically significant. The use of combined treatments including nanofat with SVF injection, PRP, and 1064 Q‐switched Nd:YAG laser may be more effective than nanofat alone, in reducing infraorbital dark circles and wrinkles. [ABSTRACT FROM AUTHOR]

Background: The assessment of skin aging through skin measurements faces limitations, making perceived age evaluation a more valuable and direct tool for assessing skin aging. Given that the aging process markedly affects the appearance of the eye contour, characterizing the eye region could be beneficial for perceived age assessment. This study aimed to analyze age‐correlated changes in the eye contour within the Chinese Han female population and to develop, validate, and apply a multiple linear regression model for predicting perceived age. Materials and methods: A naïve panel of 107 Chinese women assessed the perceived ages of 212 Chinese Han women. Instrumental analysis evaluated periorbital parameters, including palpebral fissure width (PFW), palpebral fissure height (PFH), acclivity of palpebral fissure (AX), angle of inner canthal (AEN), and angle of outer canthal (AEX). These parameters were used to construct a multiple linear regression model for predicting the perceived ages of Chinese Han women. A combined treatment using Fotona 4D and an anti‐aging eye cream, formulated with plant extracts, peptides, and antioxidants, was conducted to verify the cream's anti‐aging efficacy and safety. This eye cream was then tested in a large‐scale clinical trial involving 101 participants. The prediction model was employed in this trial to assess the perceived ages of the women after an 8‐week application of the eye cream. Results: All parameters were observed to decrease with age. An intergroup comparison indicated that eyelid aging in Chinese Han women accelerates beyond the age of 50. Consequently, a linear regression model was constructed and validated, with the perceived age being calculated as 183.159 ‐ 1.078 * AEN ‐ 4.487 * PFW + 6.061 * PFH ‐ 1.003 * AX ‐ 0.328 * AEX. The anti‐aging efficacy and safety of the eye cream were confirmed through combined treatment with Fotona 4D, showing improvements in wrinkles, elasticity, and dark circles under the eyes. In a large‐scale clinical evaluation using this eye cream, a perceived age prediction model was applied, suggesting that 8 weeks of use made participants appear 2.25 years younger. Conclusion: Our study developed and validated a multiple linear regression model to predict the perceived age of Chinese Han women. This model was successfully utilized in a large‐scale clinical evaluation of anti‐aging eye cream, revealing that 8 weeks of usage made participants appear 2.25 years younger. This method effectively bridges the gap between clinical research and consumer perceptions, explores the complex factors influencing perceived age, and aims to improve anti‐aging formulations. [ABSTRACT FROM AUTHOR]

Groupe A Streptococcus (SGA) is one of the main bacteria involved in skin and soft tissue infections. Since September 2022, we observe a resurgence of cases of SGA infections associated with an increased mortality. Periorbital localization for necrotizing fasciitis is rare. The most common etiology is dental infection. This affection requires early treatment, associating antibiotherapy and surgery. We report here a case of dental cellulitis evolving in periorbital necrotizing fasciitis. This patient needed intensive care treatment and tracheotomy. Two surgical procedures were necessary for debridement. After the acute phase, two more surgical procedures were realized for eyelids reconstruction. The aim of this case report is alert to the possible evolution of dental cellulitis during a period of SGA's epidemic. [ABSTRACT FROM AUTHOR]

Cutaneous lupus erythematosus (CLE) is an autoimmune skin disease that can manifest itself with a variety of skin symptoms. Periorbital erythema, a rare variant of CLE, presents challenges in terms of diagnosis and treatment. Here, we report a case of CLE presenting with periorbital erythema and edema. A 42-year-old female patient presented with complaints of erythema, edema, and scaling on the right eyelid that started four months ago. A skin biopsy was performed on the lesioned skin of the eyelid to differentiate dermatomyositis, cutaneous lupus erythematosus, sarcoidosis, lupus vulgaris, and cutaneous lymphoma. Histopathological examination revealed focal hyperkeratosis and parakeratosis on the surface of the epidermis, vacuolar degeneration in the basal layer of the epidermis, lymphocyte exocytosis with necrotic keratinocytes, edema in the dermis, melanophages, and perivascular, periadnexal lymphocytic reaction. Laboratory tests showed negative antinuclear antibody and anti-dsDNA, but positivity for anti-Ro-52. In the absence of any other complaints, the patient was diagnosed with cutaneous lupus erythematosus presenting with periorbital erythema based on clinical, histopathological, and laboratory findings. Hydroxychloroquine 200 mg/day, topical corticosteroid, and topical tacrolimus were administered. Two months later, significant improvement in the lesions was observed. In conclusion, it should be kept in mind that periorbital erythema can develop as a rare variant of CLE and can be misdiagnosed as contact dermatitis, dermatomyositis, sarcoidosis, or cutaneous lymphoma. Additionally, the ANA and anti-dsDNA antibodies are often found to be negative in these cases. In establishing the diagnosis, firstly considering the disease, followed by histopathological examinations and laboratory tests, is crucial. [ABSTRACT FROM AUTHOR]

Background: Allergic contact dermatitis (ACD) from topical ophthalmic medications (TOMs) poses an additional disease burden to patients who already suffer from eye problems. Objectives: To investigate the epidemiological/clinical profile of patients with periorbital ACD from TOMs in Turkey. Patients and Methods: This was a retrospective, cross‐sectional, single tertiary centre study based on files of 75 patch tested patients with suspected periorbital ACD from TOMs among a total of 2801 consecutively patch tested patients with suspected ACD of any origin between 1996 and 2019. Results: Periorbital ACD was diagnosed in 25 of 75 (33.3%) patients (female:male = 1.8:1; age range: 6–85 years) with suspected ACD from TOMs showing an overall prevalence of 0.9% (25/2801) among the whole patch test population. Atopy was not present. Tobramycin‐containing TOMs were the most frequent culprits, followed by antiglaucoma preparations. Their frequency increased, whereas no new cases of neomycin‐induced ACD were observed after 2011. Positivities with thimerosal were of unknown clinical relevance, while benzalkonium chloride (BAC) caused ACD in two patients. The diagnosis would be missed in each 20% of patients without performing day (D) 4 and D7 readings and strip‐patch testing. Ten culprits were identified only by testing with patients' own TOMs in eight (32%) patients. Conclusions: Aminoglycosides, particularly tobramycin, were the leading cause of ACD from TOMs. The frequency of ACD from tobramycin and antiglaucoma medications increased after 2011. BAC was a rare but important allergen. Additional D4 and D7 readings, strip‐patch testing, and testing with patients' own TOMs seem essential when patch testing with eye medications. [ABSTRACT FROM AUTHOR]

Background: Carboxytherapy is one of the most popular procedures used in dermatology. The treatments are known to be minimally invasive and highly effective for various skin disorders. Therefore, the research carried out in the paper is purposeful and addresses an important area of aesthetic therapies. Aims: Objective, apparatus‐based assessment of the effect of carboxytherapy on skin elasticity around the eyes. Patients/Methods: The study included a group of 39 Caucasian individuals aged 35–55 years. Participants were subjected to a series of five carboxytherapy treatments of eye area at weekly intervals. The Cutometer measuring probe was used to assess skin elasticity. Additionally, photographic documentation was out using the Fotomedicus system. Results: In this study, statistically significant increase in R2 parameter was found as the result of applied treatment. This parameter is considered to be the most important indicator of changes in skin elasticity. In 29 out of 39 subjects, the carboxytherapy treatment significantly improved skin tension and elasticity. Such therapy may also exert a beneficial effect on flexibility since in 28 participants the favorable change in the R7 parameter was visible. Conclusions: The objective analysis of the impact of carboxytherapy treatment on parameters determining skin elasticity revealed that this therapy can be used as an anti‐aging method in the eye area. Obtained results are in agreement with other biochemical, histological, and photographical documentation analyses of the effect of carboxytherapy on skin, performed by independent researchers. [ABSTRACT FROM AUTHOR]

Background: Allergic contact dermatitis (ACD) in the eye region caused by topical eye medications is difficult to diagnose and may be overlooked. Objective: To study the characteristics and causative agents in patients with ACD caused by topical eye medications in a Danish tertiary dermatology department. Methods: A retrospective study of 318 patients, patch tested between 2013 and 2021 due to suspected ACD to topical eye medications. All patients were tested with a locally developed eye medication series, some were additionally tested with suspected eye medications. Medical records were studied in patch test positive patients. Results: Contact allergy to a topical eye allergen/medication was found in 12.9% (n = 41) of 318 patients, and culprit allergens were phenylephrine (6.9%), timolol (2.5%) and ketotifen (1.6%). Patch test positive patients were often previously diagnosed with cataract (29.3%) or glaucoma (24.4%), and the majority reported more than one previous reaction. Initial symptoms were oedema (56.0%), erythema (48.8%) and dermatitis (31.7%) in the eye region, and facial dermatitis was also seen. Conclusions: Patients with symptoms from the eye region who have been using topical eye medications should be patch tested with ingredients from commonly used eye medications supplemented by the products tested 'as is'. [ABSTRACT FROM AUTHOR]

A nematode parasite, Dracunculus medinensis, causes dracunculiasis. Despite being non-fatal, this condition causes significant morbidity. Dracunculiasis is considered an eradicated disease in India since 1999. We report two cases that document the unusual linear morphealike morphology of the calcified D. medinensis and the rare periorbital location of the worm. The cases presented here are rare and a diagnostic challenge, considering the eradicated status of dracunculiasis. [ABSTRACT FROM AUTHOR]

The article discusses a case of a 54-year-old woman with metallic foreign bodies in her periocular region, which were identified during an MRI for colon cancer staging. The woman had undergone a gold threading aesthetic procedure in China 15 years prior, resulting in the presence of a non-ferromagnetic golden rod. This practice, although uncommon in Western countries, serves as a differential diagnosis for ophthalmologists encountering multiple metallic foreign bodies in the periocular area. The authors disclose no conflicts of interest and report no funding associated with the work presented in the article. [Extracted from the article]

Purpose: Orbital cellulitis is a serious condition with potentially severe complications. Treatment requires interdisciplinary care and early introduction of antimicrobial therapy. In our tertiary center, a team of pediatricians, pediatric ophthalmologists, and otorhinolaryngologists successfully participated in the management of pediatric periorbital/orbital cellulitis. This study aimed to demonstrate our interdisciplinary approach and to investigate clinical profile and management of pediatric periorbital/orbital cellulitis. Methods: A retrospective chart review was performed of all pediatric patients hospitalized for periorbital and orbital cellulitis in a tertiary hospital center from September 15, 2016, to March 15, 2020. Results: A total of 26 children—median age 2.7 years (range 0.5–12)—were treated during the study period. Disease presentation was unilateral, mainly during winter (n = 12) and autumn (n = 12), without ophthalmoplegia/proptosis. Seven patients had orbital cellulitis (Chandler classification of ≥III) and were older (6.5 years, P = 0.011) with sinusitis (P < 0.001), required surgery (P = 0.004), underwent longer antimicrobial treatment (13 days, P < 0.001), and had a longer length of hospital stay (13.43 days, P = 0.001). Orbital cellulitis occurred in a median of three days (range 1–12) of acute rhinosinusitis. Radiological survey was performed in 11 patients, whereas six patients were treated surgically. All intraoperatively collected cultures (sinus swabs) were positive, whereas Streptococcus pyogenes and Peptostreptococcus were isolated in five cases. All patients fully recovered. No recurrence was documented. Conclusion: Sinusitis is associated with severe orbital cellulitis and surgical management. Orbital cellulitis occurred early in the course of acute rhinosinusitis, as a distinctive presentation of rhinosinusitis. Interdisciplinary care and early management are crucial in treatment of pediatric periorbital/orbital cellulitis. [ABSTRACT FROM AUTHOR]

Although eyelid melanomas represent less than 1% of eyelid neoplasms, they have the worst prognosis. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are mainstay treatment options. We conducted a retrospective analysis to assess all-cause and cause-specific mortality rates in patients undergoing WLE or MMS for eyelid melanoma. A retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) registry was performed for eyelid melanoma treated with WLE or MMS. Cases were limited to American Joint Committee on Cancer (AJCC) stage T1 primary malignancies. A total of 45 cases of WLE were identified along with 48 cases of MMS for eyelid melanoma. There was no significant difference between subgroups in age group, sex, race, ethnicity, marital status at diagnosis, AJCC N stage, AJCC M stage, melanoma histology, chemotherapy use, and radiotherapy use. Among the cohort, all tumors were unilateral. Kaplan–Meier analysis with log-rank demonstrated no significant difference between MMS and WLE subgroups with regard to overall survival (P = 0.662) and cancer-specific survival (P = 0.494). Cox regression adjusting for variables with α<0.10 and found no significant difference in all-cause mortality (HR, 0.923; 95% CI 0.310–2.747; P = 0.885) or cancer-specific mortality (HR, 0.518; 95% CI 0.047–5.711; P = 0.591) when patients who underwent MMS were compared to those who underwent WLE. While our study is limited by a small number of patients, our analysis demonstrated no significant difference in all-cause or cause-specific survival for patients with eyelid melanoma treated with MMS compared with WLE. In areas requiring preservation of tissue due to cosmetic or functional purposes, MMS is a reasonable surgical approach. [ABSTRACT FROM AUTHOR]

Bilateral preseptal cellulitis without accompanying sinusitis or skin trauma is uncommon. In this report, we present a case of bilateral preseptal cellulitis and an upper eyelid abscess in an otherwise healthy child. A nine-year-old girl presented with severe and progressive bilateral swelling of the upper lids that showed an unsatisfactory response to medical treatments (intravenous ceftazidime and vancomycin) and warranted a referral to our facility. An orbital computed tomography scan and magnetic resonance imaging revealed bilateral preseptal soft tissue swelling with a collection but without intraorbital extension or paranasal sinus fullness. The most probable cause of the condition was considered to be transient bacteremia from an unknown source. Treatment involved administering broad-spectrum antibiotics and performing surgical drainage of the lid collections. Gram-positive cocci were identified in the smear of the drained components, although bacterial growth was not observed in the culture. Intravenous antibiotics were continued for five days, resulting in a remarkable decrease in swelling. In cases of atypical presentations of infectious preseptal cellulitis with abscess formation, particularly when there is bilateral involvement without common predisposing factors, the possibility of hematogenous spread of microorganisms should be carefully considered., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rafizadeh et al.)

Background: Up to date, many surgical techniques have been introduced for upper eyelid rejuvenation. Despite those technical advances, little attention has been put on objective preoperative analysis methods. Objectives: The current study introduces our simplified, versatile, and predictable upper eyelid analysis method for upper blepharoplasty patients. Methods: A total of 1509 surgeries were performed from March 2017 to May 2021 using our preoperative analysis method. Results: As a result of the operation based on this new analysis method, it was possible to individualize the plan according to the patient's needs and obtain satisfactory outcomes. Conclusions: Using our simplified, versatile, and predictable upper eyelid analysis method, we could counsel the surgical result with high predictability. In addition, it is a highly recommended method for beginners as it is easy to understand the mechanism of double eyelid surgery. [ABSTRACT FROM AUTHOR]

Background: Periorbital skin is the thinnest. That is why, it is the easiest to wrinkle and the most challenging to rejuvenate. Platelet-rich plasma (PRP) as well as plasma gel have been used for skin rejuvenation and considered relatively safe and effective. Methods: This split-face study was conducted on forty female patients seeking periorbital rejuvenation where PRP was injected in the right (Rt) side and plasma gel in the left (Lt) side, two treatment sessions 4 weeks apart (week 0 and week 4). Patients were followed up 2 weeks after each treatment session (week 2 and week 6) as well as 12 weeks after the last session (week 16) using both subjective [physician assessment through Global Aesthetic Improvement score (GAIS) and patient's satisfaction (Likert scale)] and objective [Antera 3D camera] assessment methods. Results: Both modalities yielded a significant improvement of periorbital wrinkles after the 2nd session, with significantly better results on the plasma gel injected side; however, the improvement achieved through both modalities could not be maintained for the following 3 months. Besides, objective assessment could not prove any improvement in periorbital hyperpigmentation. Conclusion: Two sessions of both PRP and plasma gel are effective for periorbital rejuvenation, with plasma gel showing significantly better results. However, improvement was not maintained for 3 months. [ABSTRACT FROM AUTHOR]

Periorbital necrotizing fasciitis carries serious risks of loss of vision, eye, and life, and thus represents a true emergency. As such, clinicians must have an appropriate index of suspicion for necrotizing fasciitis and, upon recognition, need to address the disease rapidly and thoroughly. I review the classic features, systemic implications, and management paradigms of necrotizing fasciitis in the hopes of improving outcomes. [ABSTRACT FROM AUTHOR]

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Angiosarcoma is a rare form of malignant endothelial cell tumour characterised by rapidly infiltrating anaplastic cells of vascular or lymphatic origin. We report an uncommon case of cutaneous angiosarcoma (cAS) manifesting as rapidly progressive unilateral periorbital oedema. Due to the acute onset of disease, the patient was initially treated with antibiotics for presumed periorbital cellulitis. The lack of response to conservative management raised the suspicion of a more serious condition, which eventually revealed the diagnosis of angiosarcoma through skin biopsy. As suggested by several previous case reports, the subtle manifestation of cAS made it a great mimicker of benign skin conditions. This case report serves as a reminder to the aggressive nature of angiosarcoma which can lead to marked facial swelling within several weeks. As the tumour was not resectable by the time of diagnosis, the patient was offered palliative radiotherapy.

Purpose: Periorbital tumor location presents a significant challenge with 3-dimensional conformal radiation therapy or intensity modulated radiation therapy due to high tumor dose needed in the setting of close proximity to orbital structures with lower tolerance. Proton beam therapy (PBT) is felt to be an effective modality in such cases due to its sharp dose gradient. Materials and Methods: We reviewed our institutional PBT registry and identified 17 patients with tumor epicenters within 2 cm of the eye and optic apparatus treated with passive scatter PBT with comparison volumetric arc therapy plans available. Maximum and mean doses to organs at risk of interest, including optic nerves, optic chiasm, lens, eye ball, pituitary, cochlea, lacrimal gland, and surrounding brain, were compared using the paired Wilcoxon signed rank test. Overall survival was determined using the Kaplan-Meier method. Results: Median age was 67. Median follow-up was 19.7 months. Fourteen patients underwent upfront resection and received postoperative radiation and 3 received definitive radiation. One patient received elective neck radiation, 2 underwent reirradiation, and 3 had concurrent chemotherapy. There was a statistically significant reduction in mean dose to the optic nerves and chiasm, brain, pituitary gland, lacrimal glands, and cochlea as well as in the maximum dose to the optic nerves and chiasm, pituitary gland, lacrimal glands, and cochlea with PBT. The 18-month cumulative incidence of local failure was 19.1% and 1-year overall survival was 80.9%. Conclusion: Proton beam therapy resulted in significant dose reductions to several periorbital and optic structures compared with volumetric arc therapy. Proton beam therapy appears to be the optimal radiation modality in such cases to minimize risk of toxicity to periorbital organs at risk.

Background: Periorbital dark circles are common in all races. Proposed causes include increased vasculature, tear-trough deformity, pigmentary demarcation lines, spongiotic dermatitis, lichenoid dermatitis, acanthosis nigricans, post-inflammatory hyperpigmentation, and heredity. Aims: To evaluate the clinical features and histopathological features of dark circles compared to nearby unaffected skin in South Asians. Methods: Clinical evaluation, skin biopsies, and narrow-band reflectance spectrophotometry of periorbital dark circles and nearby unaffected skin were performed on all subjects. Results: There was a positive correlation between the clinical severity of dark circles and increased melanin based on spectrophotometry. Histological evaluation showed increased dermal melanin content in dark circles compared to normal skin. Limitations: Single-center pilot study. Conclusion: Dark circles in this cohort of South Asians are associated with increased dermal melanin. Other contributing factors may include exaggerated tear trough depression, translucency of eyelid skin, and pigmentary demarcation lines.

Background: Volk Eye Check (VEC) is a portable digital ocular measurement device that automatically captures clinical photographs with facial measurements in real time (Volk Optical Inc), claiming to reduce measurement errors. The accuracy and repeatability of this ocular measurement device in the periorbital region has not been reported. Aim: To report the reproducibility and repeatability of periocular biometric measurements using Volk Eye Check Ocular measurement device. Methods: Prospective, single blind, comparative study. Two experts performed digital photography of 100 volunteers using the standard photography technique using Oculoplasty module of the Volk Eye Check ocular measurement device. Each expert photographed the volunteer twice, to obtain two sets of automated printouts of 13 periorbital biometrics that were measured automatically by the ocular measurement device. Bland Altman plot and multiple comparisons of means from linear mixed‐effects model fit by REML using simultaneous contrasts with p values reported by Bonferroni method were used as statistical tests to analyze following parameters: MRD1 (margin reflex distance‐1), MRD2 (margin reflex distance‐2), PFH (palpebral fissure height), HVID (horizontal visible iris diameter), ALL (aperture length at lateral limbus), and ALM (aperture length at medial limbus). Results: The mean inter‐observer difference in measurement (mm) was as follows: MRD1 (0.04), MRD2 (0.02), HVID (0.01), PFH (0.03), ALL (0.05), ALM (0.08). The mean intra‐observer difference in measurement (mm) was as follows: MRD1 (0.02), MRD2 (0.09), HVID (0.0), PFH (0.09), ALL (0.06), ALM (0.05). Conclusion: Periorbital biometric measurements using Volk Eye Check ocular measurement devices are highly reproducible and repeatable. The oculoplasty module of Volk Eye Check ocular measurement device can provide reliable periorbital measurements for routine clinical use and for objective clinical studies. [ABSTRACT FROM AUTHOR]

Purpose: To report a very rare case of silicone oil (SO) migration and emphysema development in the orbit and periorbital tissue, including the lids and subconjunctival space, after a fourth pars plana vitrectomy (PPV) for retinal detachment (RD) treatment. Observations: A 53-year-old woman with a recurrent rhegmatogenous RD in the right eye underwent a fourth PPV under local anesthesia and 23-gauge vitrectomy with fluid-air exchange and SO injection. Localized choroidal detachment occurred during fluid–air exchange near the end of the surgery. High-pressure infusion of air was used as a temporary control measure prior to SO injection. In the early postoperative period, the patient developed hemifacial and periorbital swelling and the air trapped in the upper lid was associated with lid ptosis and conjunctival chemosis. The emphysema resolved with clinical management, and the mechanical ptosis subsided after partial SO removal from the lid. Conclusions and Importance: The SO migration and emphysema in our case were presumably related to the multiple previous sclerotomies. Periorbital emphysema can show spontaneous resolution, but the migrated SO requires surgical management.

Background: Early evaluation and treatment of periorbital infantile hemangiomas (POIH) were associated with lower rates of ophthalmological complications. Objective: To evaluate age and characteristics associated with improved anisometropic astigmatism (anisoastigmatism) and eye symmetry measured by diopters and a 5-point scale, respectively, in patients with POIH treated with surgical excision. Methods: A retrospective study was performed on patients with POIH. Patient characteristics and eye symmetry were analyzed between patients with resolved and unresolved anisoastigmatism after surgery. Statistical analyses included the Mann-Whitney U tests, chi-square tests, and linear regression models. Results: In total, 54 patients were included (male: 20, female: 34). Upper medial eyelid was the most commonly affected site (resolved: 45%, unresolved: 43%), followed by upper lateral and upper central. Fifty-six percent (31/55) had postoperative resolution of anisoastigmatism, whereas 44% (24/55) did not. Earlier surgical evaluation (median: 4.5 vs. 6.0 months, p = 0.047) and excision (median: 5.0 vs. 12.0 months, p = 0.005) were associated with reversible anisoastigmatism. Good and suboptimal eye symmetry were not associated with earlier surgical excision (median: 6 vs. 6.5 months, p = 0.87). Follow-up ranged from 1 month to 12 years. Conclusion: Earlier surgical excision was associated with reversing anisoastigmatism but was not significant for improving eye symmetry.

Periorbital hyperpigmentation is a problem with complex multifactorial etiology, with early knowledge expanding. The purpose of the present study was to review studies on the efficacy of laser on periorbital hyperpigmentation. A systematic review of the data banks of scientific and research articles including PubMed, Web of Knowledge, Google Scholar, SCOPUS, and Iranian databases including SID and Magiran is performed. The following keywords were used to evaluate existing articles: Periorbital Hyperpigmentation, Periorbital Darkening, Dark Eye Circle, Eye Dark Circle, Infraorbital Hyperpigmentation, Infraorbital Dark Circle, and Laser (1990–2018). Finally, 10 clinical trial articles were included. A total of 2.76% of patients responded poor, 11.4% responded fair to different types of lasers, 45.3% responded good, and 35.9% excellent responded to have been cured. As a long-term effect, less than 1% of patients received a poor score after their laser treatment. Twenty-five percent of the patients showed a fair result. In total, 26.27% of patients achieved good and 43.35% of patients received excellent response from laser treatment on periorbital hyperpigmentation after 4–6 months of laser therapy. A large percentage of patients (76.4%) were satisfied with the effect of lasers on the reduction of moderate to high periorbital hyperpigmentation rates in the studies. Laser therapy is an effective and satisfactory therapeutic choice for treatment of periorbital hyperpigmentation. Also, it is safe overall with favorable sustainable results, although the follow-up periods usually last about several months. [ABSTRACT FROM AUTHOR]

Background: Dynamic and static wrinkling are observed on the facial skin as a result of aging. Previously, it was showed that fractional Er:YAG laser was effective in the treatment of facial wrinkles. Aims: The aims of this study are to determine the effects of age, Glogau stage, and smoking status on the treatment efficacy of fractional Er:YAG laser; and to compare the success of laser treatment on periorbital wrinkles with perioral wrinkles. Material/Method: Periorbital and perioral wrinkles of the same patient were treated with fractional Er:YAG laser (2940 nm) for 4 sessions with monthly intervals. Treatment parameters were affluence of 1.5J, a spot size of 7 mm, and a frequency of 5 Hz. Treatment efficacy was evaluated by a blinded physician evaluation scale and patient satisfaction scale 2 months after the final treatment session. Results: Fifteen patients completed the study. The mean age of the patients was 42.8 years. The blinded physician evaluation of the improvement in the periorbital wrinkles decreased (P =.034) and the patient satisfaction in perioral wrinkles decreased (P =.049) with increasing age. The relationship between smoking and patient satisfaction in the treatment of periorbital wrinkles was also statistically significant (P =.014). No difference in terms of treatment efficacy was found between periorbital and perioral regions. Conclusion: Fractional Er:YAG laser (2940 nm) is equally successful in the treatment of periorbital and perioral wrinkles. The treatment success decreases with smoking and increasing age. [ABSTRACT FROM AUTHOR]

Background: Periorbital dark circles are common in all races. Proposed causes include increased vasculature, tear-trough deformity, pigmentary demarcation lines, spongiotic dermatitis, lichenoid dermatitis, acanthosis nigricans, post-inflammatory hyperpigmentation, and heredity. Aims: To evaluate the clinical features and histopathological features of dark circles compared to nearby unaffected skin in South Asians. Methods: Clinical evaluation, skin biopsies, and narrow-band reflectance spectrophotometry of periorbital dark circles and nearby unaffected skin were performed on all subjects. Results: There was a positive correlation between the clinical severity of dark circles and increased melanin based on spectrophotometry. Histological evaluation showed increased dermal melanin content in dark circles compared to normal skin. Limitations: Single-center pilot study. Conclusion: Dark circles in this cohort of South Asians are associated with increased dermal melanin. Other contributing factors may include exaggerated tear trough depression, translucency of eyelid skin, and pigmentary demarcation lines. [ABSTRACT FROM AUTHOR]

Background:  Imatinib mesylate is a selective tyrosine kinase inhibitor used in the treatment of chronic myelogenous leukemia.  Ocular side effects of imatinib include periorbital edema, which may become so severe as to obstruct the visual field.Purpose: The purpose of this case study is to describe the clinical characteristics of imatinib- induced postoperative periorbital purpura.Materials and methods: We retrospectively reviewed the medical literature using PubMed, searching the terms edema, Gleevec, imatinib, periorbital, postoperative and purpura.  Patient reports and previous reviews of the subject were critically assessed and the salient features are presented.Results: Three patients have undergone surgery to reduce the imatinib-induced periorbital edema; two of these individuals have developed imatinib-induced postoperative periorbital purpura.Conclusion:  We recommend discontinuing imatinib usage one week prior to periorbital surgery and not resuming therapy until the eighth postoperative day.

Keywords: Infant tumors; low-grade myofibroblastic sarcoma; periorbital; recurrent tumor; sarcoma EN Infant tumors low-grade myofibroblastic sarcoma periorbital recurrent tumor sarcoma 2744 2746 3 07/15/22 20220701 NES 220701 Low-grade myofibroblastic sarcoma (LMFS) is a rare, intermediate grade tumor of myofibroblast cell origin, mostly found in adults. On light microscopy, fascicles of spindle-shaped tumor cells, with focal storiform pattern, were seen infiltrating soft tissues. Infant tumors, low-grade myofibroblastic sarcoma, periorbital, recurrent tumor, sarcoma. [Extracted from the article]

Angiosarcoma is a rare form of malignant endothelial cell tumour characterised by rapidly infiltrating anaplastic cells of vascular or lymphatic origin. We report an uncommon case of cutaneous angiosarcoma (cAS) manifesting as rapidly progressive unilateral periorbital oedema. Due to the acute onset of disease, the patient was initially treated with antibiotics for presumed periorbital cellulitis. The lack of response to conservative management raised the suspicion of a more serious condition, which eventually revealed the diagnosis of angiosarcoma through skin biopsy. As suggested by several previous case reports, the subtle manifestation of cAS made it a great mimicker of benign skin conditions. This case report serves as a reminder to the aggressive nature of angiosarcoma which can lead to marked facial swelling within several weeks. As the tumour was not resectable by the time of diagnosis, the patient was offered palliative radiotherapy. [ABSTRACT FROM AUTHOR]

Objectives: Sinusitis is a common pediatric illness that can be complicated by periorbital or intracranial extension. Patients can be managed with antimicrobials alone or in conjunction with surgical intervention. This article examines management patterns and outcomes in pediatric patients presenting with complicated sinusitis.Study Design: Case series with chart review.Setting: Tertiary care pediatric hospital.Subjects and Methods: An evaluation of 168 pediatric patients with complicated sinusitis with periorbital complications presenting at a single institution from 2008 to 2018 was performed. Demographics, disease characteristics, in-hospital management, and outcomes were recorded and analyzed.Results: The most common complication was orbital cellulitis, seen in 49% of children. Surgical intervention occurred in 49% of patients, with 36% receiving medical therapy followed by surgery (MTS). Chandler I patients underwent surgical intervention 30% of the time, Chandler II patients 29%, and Chandler III patients 83%. Nineteen percent of initially nonoperative patients started on ampicillin-sulbactam required MTS vs 57% of those started on other antibiotic regimens (P = .01). Twelve percent of initially nonoperative Chandler I to II patients started on ampicillin-sulbactam needed MTS vs 40% started on other antibiotic regimens. Hospital charges for operative patients were $45,056 vs $14,311 for nonoperative patients (P < .01). Hospital charges for patients with surgery followed by medical therapy (SMT) were $45,563 vs $44,393 for MTS (P = .92).Conclusion: Nonoperative early stage patients started on ampicillin-sulbactam had a lower risk of MTS. MTS did not cost significantly more than SMT, and there were no significant outcome differences seen. [ABSTRACT FROM AUTHOR]

Background: Pathogenic mechanism that determines the localization of vitiligo patches and thus a patterned distribution in patients with nonsegmental vitiligo has remained poorly elucidated. A distributional similarity of the vitiligo patches with Blaschko's lines has been documented in patients with segmental vitiligo, both isolated segmental vitiligo and mixed vitiligo but never in cases of nonsegmental vitiligo.Methods: Distribution of nonsegmental vitiligo patches on face and neck regions was assessed and compared with Blaschko's lines and also with embryonic pigmentary segments on the face.Results: This study has documented distributional similarity of the nonsegmental vitiligo patches on face and neck with Blaschko's lines and the "embryonic pigmentary segments" among 154 (58.6%) cases. Patches around the palpebral and other fissures like periorbital, perinasal, perioral, and periaural were more common. In addition to the vitiligo patches, the spared areas were also found to respect the embryonic segmental outlines and follow the Blaschko's lines.Conclusion: Distributional pattern of the individual nonsegmental vitiligo patches along the Blaschko's lines and embryonic pigmentary segments suggests that mosaicism might control the susceptibility to the disease process in a patterned manner.Limitation: No genetic testing could be performed to confirm the hypothesis. Evaluation of nonsegmental vitiligo was done only on the face and neck areas. [ABSTRACT FROM AUTHOR]

Background and objectives: Anti-aging treatments in the periorbital region are usually difficult to treat due to their frequent side effects. This case report explains the use of a thermomechanical device (Tixel®, Novoxel®) to improve the skin's appearance in terms of wrinkles. Patients and methods: a 62-year-old woman with skin type II and slightly sun-damaged skin was treated once with a fractionated thermomechanical device (a protrusion of 800%m and a pulse duration of 16 ms, double-pulse). Result: Already after only one application an improvement of the skin condition with regard to the wrinkles in the periorbital region was observed. Conclusions: In aesthetic medicine we know about the difficulties of treating the periorbital region. This alternative treatment method shows an impressive response of this area. Further studies should follow, so that the introduction of substances by means of thermo-mechanical pre-treatment can possibly be supplemented as an add-on. [ABSTRACT FROM AUTHOR]