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Botulinum toxin complications and management
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
Both orbital and periorbital cellulitis may be caused by tracking infection of the soft tissues surrounding the orbit. Should the infection make its way to the eye itself then, there the consequences can be devastating. The key anatomical discriminator for orbital or periorbital cellulitis is the orbital septum, a thin, fibrous, multilaminated structure which attaches peripherally to the orbital margin to form the arcus marginalis which provides mechanical support to the orbital fat. Should an infection remain anterior to the orbital septum then this is known as periorbital cellulitis, whereas should it penetrate the septum and enter the soft tissues within the orbit, it is known as orbital cellulitis.
Anatomy of the Forehead and Periocular Region
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Marcelo B. Antunes, Stephen A. Goldstein
The anterior hairline is also aesthetically important. The ideal hairline creates a balanced face when it is divided into horizontal thirds. A naturally low hairline will shorten the upper third and is best addressed surgically. A receding and thinning hairline tends to lengthen the forehead and contribute to the perception of aging. An increasing distance between the hairline and eyebrows is a visual sign of aging. The earliest signs of an aging eyebrow include glabellar and horizontal rhytides typically starting in the early thirties. As people age, actinic skin changes in combination with weakening support of the soft tissue of the upper face continue to contribute to the visual signs of aging. Clinically, this presents as dermatochalasis of the upper eyelids. The forehead rhytides become more defined as the frontalis muscle attempts to compensate for progressive descent of the eyebrows. Eyebrow descent adds to excess skin and lateral hooding of the eye (1). The orbital fat then breaks through the orbital septum in the upper eyelid causing mechanical eyelid descent and fat pad herniation. The combination of these age-related changes creates a tired or angry appearance.
The cases
Published in Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young, Paediatric Radiology for MRCPCH and FRCR, 2020
Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young
The orbital septum divides the soft tissues of the eyelid (pre-septal space) from those of the orbit (postseptal space). The extraocular muscles subdivide the postseptal space into the intraconal and extraconal spaces. The intraconal space contains the optic nerve and retrobulbar fat.
The eye area as the most difficult area of activity for esthetic treatment
Published in Journal of Dermatological Treatment, 2022
Anna Kołodziejczak, Helena Rotsztejn
Fatty bags under the eyes, often mistaken for swelling, are most often associated with a genetic tendency to accumulate fat under the eyes. An orbital hernia may be located within the upper and lower eyelid. In young people, the orbital septum is very tense and supports superior ocular and infernal ocular fat. The osseocutaneous facial ligaments comprise the primary structural divisions of the facial fat compartments. The strong orbicularis oculi muscle of the eye is an additional support. With age, this septum gradually weakens and the muscle decreases its volume and support force. At that time, hernias may occur. The lower eyelid fatty hernia is referred to as "bags under the eyes" (1,2,4,7). As a result of aging, mounds of loose skin, muscles and fat hernia (Malar Festoons) are also formed in the eye area (2–4).
Current clinical diagnosis and management of orbital cellulitis
Published in Expert Review of Ophthalmology, 2021
Sara A. Khan, Ahsen Hussain, Paul O. Phelps
Orbital cellulitis exists within a continuum of inflammatory diseases of the orbit and neighboring structures. It is important to emphasize that these diseases mostly exist as discrete pathologies and only rarely manifest as progressive diseases [36] (Table 1). One of the first widely utilized classification systems to understand orbital cellulitis was created by Chandler et al., which defined the diseases of the orbit into five categories [26,28]. The main anatomical landmark for differentiating the five diseases is the orbital septum. The orbital septum is continuous with the periosteum of the orbital rim (arcus marginalis) and connects anteriorly to the tarsal plate [12]. It contains the orbital contents, provides structural support, and prevents extension of superficial infections into the post-septal space [25,37]. Preseptal cellulitis is more specifically defined as infection of the eyelid with a known infection source and exists anterior to the orbital septum [38,39]. Within the original Chandler classification, Chandler I was defined as ‘inflammatory edema’ caused by obstruction of venous blood flow due to sinus congestion [28,38]. Preseptal cellulitis is often defined as ‘Chandler I’ in some literature, and in this study, we will define Chandler I as ‘inflammatory edema.’
Efficacy of vertical lid split versus lateral canthotomy and cantholysis in the management of orbital compartment syndrome
Published in Orbit, 2021
Julia Elpers, Christopher Areephanthu, Peter J. Timoney, William R. Nunery, H.B. Harold Lee, Roxana Fu
Blindness following orbital trauma is rare, however when vision loss does occur, it is most often due to orbital compartment syndrome.1–3 The orbital contents are bound posteriorly by four bony walls and anteriorly by the orbital septum, which fuses with the periosteum and eyelids. These rigid confinements limit the compliance of the space, and any increase in volume, as occurs with edema, neoplasm, infection, anesthetic injection and retrobulbar hemorrhage, will increase orbital pressure. In OCS, the orbital pressure rises above perfusion pressure of the posterior ciliary arteries leading to optic nerve ischemia, and the central retinal artery may also become occluded. Studies have shown irreversible damage occurs between 60 and 120 minutes with sustained high orbital pressure.4,5