The standard treatment for herniated "bags" of the lower eyelid is surgical removal of excess fat. Sachs and Bosniak in 1986 and de la Plaza and Arroyo in 1988 described a new technique for treatment of palpebral bags that consisted of returning the herniated fat to the orbital cavity and retaining it by continuous sutures of the capsulopalpebral fascia either to the dehiscent portion of the orbital septum or to the periosteum of the lower orbital rim. This article reports a prospective study of 26 patients who underwent standard blepharoplasty in one lower eyelid and capsulopalpebral fascia hernia repair in the other lower eyelid. All were evaluated at 6 weeks and at 6 months after surgery, and the outcomes were compared. The results of the two different techniques in the same patient have shown comparable aesthetic outcomes in the treatment of palpebral bags. However, results indicate that the capsulopalpebral fascia hernia repair technique carries less discomfort and pain during the operation and may be less prone to postoperative bleeding and hematoma formation. In addition, in contrast to standard lower blepharoplasty with fat resection, hollowing of the lower lid or potential sunken appearance of the globe may remain absent with capsulopalpebral fascia hernia repair beyond the 6-month period of this study.

This series demonstrates that prophylactic intubation of the lacrimal system in any trauma or tumor resection near or around the region in addition to those that directly involve these systems should be considered, as the risks of silicone intubation in such cases are relatively negligible compared with the morbidity and nuisance associated with postoperative epiphora and/or recurrent dacryocystitis. Concomitant nasolacrimal intubation in conjunction with the repair of complex midfacial fractures or tumor extirpation is a safe and effective means of ensuring the establishment of a patent, functional drainage system in the absence of direct lacrimal system involvement.

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Blepharoptosis is a well-documented complication of cataract extraction and other ocular procedures. Few authors have described the surgical findings and outcomes of postcataract blepharoptosis repair. The authors present a review of the causes of postcataract blepharoptosis with emphasis on both clinical findings and recommendations for treatment on the basis of their experience with 13 eyelids in eight patients over the past 10 years. They found that all patients had either partial or total disinsertion of the levator muscle from the tarsal plate. Of the eight patients in this series, five had bilateral blepharoptosis after bilateral cataract extraction. Although a multifactorial cause for postcataract blepharoptosis is commonly assumed, the authors propose that the mechanical forces of intraoperative traction on the levator aponeurosis during cataract surgery are the primary cause. This is further supported by their operative findings in the five patients who developed bilateral ptosis after bilateral cataract extraction. All eyelids in this series were repaired by levator muscle advancement and attachment to the tarsal plate with favorable outcomes and no recurrences during a 1-year follow-up. The importance of Hering's phenomenon of equal innervation is also discussed as it applies to bilateral and to apparent unilateral blepharoptosis. The authors propose "Hering's test" as an important indicative study in the preoperative evaluation of all patients with eyelid ptosis.

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Silent sinus syndrome is a known clinical entity caused by negative sinus pressure from acquired obstruction of the maxillary sinus ostium with resulting enophthalmos and hypoglobus. We present a case in which, after septorhinoplasty, a patient developed progressive enophthalmos and hypoglobus. His evaluation was consistent with silent sinus syndrome. This case illustrates the complex reconstructive challenges of repairing an orbit in the setting of fistulization of the orbit with the maxillary sinus cavity. In particular, we highlight the inferior fornyx transconjunctival approach with simultaneous intranasal endoscopic maxillary sinus aeration.

Animal models substantially contribute to the understanding of the pathogenesis of various human diseases, including those associated with genetic defects. Our study investigated the characteristics of antibody responses elicited by T-dependent and T-independent antigens in mice rendered kappa-deficient by targeted deletion of the J kappa C kappa gene segments. It is known that in normal murine species the kappa repertoire dominates the antibody repertoire (kappa/lambda ratio = 95:5). Our results indicate that the kappa gene deletion causes the alternative usage of lambda 1 (93%) and lambda 2 (7%) light chains, confirming previous studies demonstrating that in kappa-deficient mice all B cells express Ig lambda receptors. The anti-trinitrophenylbenzene (TNP) response in K-/- mice was compensated for by lambda 1 and lambda 2 bearing Igs. However, isoelectric focusing analysis of anti-TNP antibodies showed a considerably more restricted pattern of lambda anti-TNP antibodies in K-/- as compared with kappa antibodies in normal mice. No major differences were observed in the affinity for the hapten of kappa or lambda 1 or lambda 2 mAbs obtained from 129/Sv and K-/- mice. Furthermore, lambda 1 and lambda 2 chains can reconstitute the expression of an idiotype (460Id) borne on kappa anti-TNP antibodies. The 460Id was detected both in polyclonal and monoclonal anti-TNP antibodies obtained from K-/- mice. Our results clearly showed that the kappa anti-TNP repertoire is compensated by the lambda repertoire even though the latter is clonally restricted in K-/- mice.

Vision impairment continues to be a major global problem, as the WHO estimates 2.2 billion people struggling with vision loss or blindness. One billion of these cases, however, can be prevented by expanding diagnostic capabilities. Direct global healthcare costs associated with these conditions totaled $255 billion in 2010, with a rapid upward projection to $294 billion in 2020. Accordingly, WHO proposed 2030 targets to enhance integration and patient-centered vision care by expanding refractive error and cataract worldwide coverage. Due to the limitations in cost and portability of adapted vision screening models, there is a clear need for new, more accessible vision testing tools in vision care. This comparative, systematic review highlights the need for new ophthalmic equipment and approaches while looking at existing and emerging technologies that could expand the capacity for disease identification and access to diagnostic tools. Specifically, the review focuses on portable hardware- and software-centered strategies that can be deployed in remote locations for detection of ophthalmic conditions and refractive error. Advancements in portable hardware, automated software screening tools, and big data-centric analytics, including machine learning, may provide an avenue for improving ophthalmic healthcare.