Purpose: Our study identified prognostic factors affecting visual outcomes in patients with unilateral indirect traumatic optic neuropathy (TON), determined the risk of legal blindness, and assessed changes in visual acuity, visual fields, retinal structure, and the therapeutic effect of high-dose corticosteroid treatment. Methods: We retrospectively reviewed the medical records of 52 patients (52 eyes) diagnosed with TON between 2014 and 2023. Patients were categorized into two groups according to the final best-corrected visual acuity (BCVA): Group 1 (BCVA ≥0.1) and Group 2 (BCVA <0.1). Prognostic factors were analyzed using logistic regression, and receiver operating characteristic curve analysis was performed to determine optimal cutoff values. Longitudinal changes in visual acuity, visual field index (VFI), and retinal structural parameters were assessed using a generalized linear mixed model. Results: Factors significantly associated with Group 1 included the absence of intracranial hemorrhage, administration of high-dose steroids within 24 h, and better logMAR visual acuity and VFI within 4 weeks post-trauma. In multivariate analysis, VFI within 4 weeks remained significantly associated with favorable visual outcomes (p = 0.008). The optimal VFI cutoff value for predicting a good prognosis was 13%, yielding a sensitivity of 90% and specificity of 93.3%. Visual acuity outcomes over time differed significantly according to the timing of high-dose steroid administration. Conclusions VFI within 4 weeks after injury was the most reliable prognostic indicator, demonstrating high sensitivity and specificity for predicting legal blindness. Early administration of high-dose steroids within 24 h helped prevent visual deterioration. These findings emphasize the importance of early quantitative assessment of visual function and prompt therapeutic intervention to guide treatment strategies in patients with TON.

Purpose: To assess clinical outcomes in patients undergoing surgical excision and eyelid reconstruction for malignancies. Methods: This 17-year retrospective study (2004–2021) analyzed patients with malignant eyelid tumors who underwent excision and reconstruction. Data on tumor type, size, location, surgical techniques, complications, and prognostic factors for recurrence were evaluated. Results: A total of 152 patients underwent surgical excision and reconstruction for eyelid malignancies. Basal cell carcinoma was the most common (52.6%), followed by sebaceous cell carcinoma (32.2%). Direct lid closure was the most frequent reconstructive method. Postoperative complications, including ectropion, entropion, and canalicular obstruction, were minimal but required additional surgery in some cases. Recurrence occurred in 13 patients. Lymph node involvement (odds ratio, 21.291; p = 0.004) and positive intraoperative frozen margins (odds ratio, 7.083; p = 0.018) were significant risk factors for local recurrence. Conclusions Surgical excision and reconstruction are effective treatments for eyelid malignancies, with techniques tailored to tumor size, location, and extension to ensure proper lid function. Lymph node involvement and positive intraoperative frozen margins are key predictors of local recurrence.

Purpose: To assess clinical outcomes in patients undergoing surgical excision and eyelid reconstruction for malignancies. Methods: This 17-year retrospective study (2004–2021) analyzed patients with malignant eyelid tumors who underwent excision and reconstruction. Data on tumor type, size, location, surgical techniques, complications, and prognostic factors for recurrence were evaluated. Results: A total of 152 patients underwent surgical excision and reconstruction for eyelid malignancies. Basal cell carcinoma was the most common (52.6%), followed by sebaceous cell carcinoma (32.2%). Direct lid closure was the most frequent reconstructive method. Postoperative complications, including ectropion, entropion, and canalicular obstruction, were minimal but required additional surgery in some cases. Recurrence occurred in 13 patients. Lymph node involvement (odds ratio, 21.291; p = 0.004) and positive intraoperative frozen margins (odds ratio, 7.083; p = 0.018) were significant risk factors for local recurrence. Conclusions Surgical excision and reconstruction are effective treatments for eyelid malignancies, with techniques tailored to tumor size, location, and extension to ensure proper lid function. Lymph node involvement and positive intraoperative frozen margins are key predictors of local recurrence.

Purpose: To assess clinical outcomes in patients undergoing surgical excision and eyelid reconstruction for malignancies. Methods: This 17-year retrospective study (2004–2021) analyzed patients with malignant eyelid tumors who underwent excision and reconstruction. Data on tumor type, size, location, surgical techniques, complications, and prognostic factors for recurrence were evaluated. Results: A total of 152 patients underwent surgical excision and reconstruction for eyelid malignancies. Basal cell carcinoma was the most common (52.6%), followed by sebaceous cell carcinoma (32.2%). Direct lid closure was the most frequent reconstructive method. Postoperative complications, including ectropion, entropion, and canalicular obstruction, were minimal but required additional surgery in some cases. Recurrence occurred in 13 patients. Lymph node involvement (odds ratio, 21.291; p = 0.004) and positive intraoperative frozen margins (odds ratio, 7.083; p = 0.018) were significant risk factors for local recurrence. Conclusions Surgical excision and reconstruction are effective treatments for eyelid malignancies, with techniques tailored to tumor size, location, and extension to ensure proper lid function. Lymph node involvement and positive intraoperative frozen margins are key predictors of local recurrence.

Purpose: To assess clinical outcomes in patients undergoing surgical excision and eyelid reconstruction for malignancies. Methods: This 17-year retrospective study (2004–2021) analyzed patients with malignant eyelid tumors who underwent excision and reconstruction. Data on tumor type, size, location, surgical techniques, complications, and prognostic factors for recurrence were evaluated. Results: A total of 152 patients underwent surgical excision and reconstruction for eyelid malignancies. Basal cell carcinoma was the most common (52.6%), followed by sebaceous cell carcinoma (32.2%). Direct lid closure was the most frequent reconstructive method. Postoperative complications, including ectropion, entropion, and canalicular obstruction, were minimal but required additional surgery in some cases. Recurrence occurred in 13 patients. Lymph node involvement (odds ratio, 21.291; p = 0.004) and positive intraoperative frozen margins (odds ratio, 7.083; p = 0.018) were significant risk factors for local recurrence. Conclusions Surgical excision and reconstruction are effective treatments for eyelid malignancies, with techniques tailored to tumor size, location, and extension to ensure proper lid function. Lymph node involvement and positive intraoperative frozen margins are key predictors of local recurrence.

Purpose: To assess clinical outcomes in patients undergoing surgical excision and eyelid reconstruction for malignancies. Methods: This 17-year retrospective study (2004–2021) analyzed patients with malignant eyelid tumors who underwent excision and reconstruction. Data on tumor type, size, location, surgical techniques, complications, and prognostic factors for recurrence were evaluated. Results: A total of 152 patients underwent surgical excision and reconstruction for eyelid malignancies. Basal cell carcinoma was the most common (52.6%), followed by sebaceous cell carcinoma (32.2%). Direct lid closure was the most frequent reconstructive method. Postoperative complications, including ectropion, entropion, and canalicular obstruction, were minimal but required additional surgery in some cases. Recurrence occurred in 13 patients. Lymph node involvement (odds ratio, 21.291; p = 0.004) and positive intraoperative frozen margins (odds ratio, 7.083; p = 0.018) were significant risk factors for local recurrence. Conclusions Surgical excision and reconstruction are effective treatments for eyelid malignancies, with techniques tailored to tumor size, location, and extension to ensure proper lid function. Lymph node involvement and positive intraoperative frozen margins are key predictors of local recurrence.

Carotid-cavernous fistulas, characterized by abnormal arteriovenous communication within the cavernous sinus (CS), can be classified as direct or indirect. Direct fistulas are defined as a direct connection between the internal carotid artery (ICA) and CS, whereas indirect fistulas result from an abnormal connection between the CS and dural arterial branches. The first-line treatment for both types of fistulas is endovascular intervention, most commonly accomplished through the transarterial and transvenous approaches of the conventional pathway, including the ICA, inferior and superior petrosal sinuses, or basilar plexus. Nonetheless, a retrograde approach through the superior ophthalmic vein may be necessary for individuals in whom conventional endovascular treatment fails. Herein, the current principles of surgical indication and technique are presented, along with case studies.

Purpose: To report a case of traumatic optic neuropathy aggravated by orbital emphysema after an orbital fracture.Case summary: A 19-year-old man with no specific medical history was referred for a right orbital fracture caused by blunt trauma to the supraorbital rim of the right eye. Computed tomography (CT) showed a right orbital fracture involving the inferomedial wall and inferomedial strut. The corrected visual acuity was 0.4 in the right eye (RE) and 1.0 in the left and the intraocular pressure was 15 and 18 mmHg, respectively. Restriction on downgaze, abduction, and an indefinite relative afferent pupillary defect (RAPD) were observed in the RE. Fundus exam was non-specific other than commotio retinae on the temporal side of the macula in the RE. After 12 hours post trauma, the visual acuity of the RE had decreased to light perception. Definite RAPD was observed with optic disc swelling on the fundus photo and optical coherence tomography. Orbital CT showed air shadows, which were not seen on the initial evaluation, adjacent to the optic disc. We diagnosed traumatic optic neuropathy aggravated by orbital emphysema. High-dose intravenous steroid was given for 3 days. Despite a lateral canthotomy and cantholysis to decompress the right orbit, visual acuity did not improve above counting fingers. Conclusions Increased intraorbital pressure and congestion caused by orbital emphysema may exacerbate traumatic optic neuropathy. Therefore, close observation is required.