It has been shown that systemic propranolol can greatly reduce hemangiomas around the eye, thus sparing the baby risky surgery or steroidal injections to debulk it. But systemic propranolol can be a little risky and requires a hospital stay. Researchers recently got similar results rubbing Timolol on the lesion.

The Iraq War has taught surgeons a valuable lesson- many soldiers with ruptured globes who, by necessity, were forced to delay surgery sometimes up to 4 weeks, still got good results. Just as in a dropped nucleus, maybe it’s OK or better to wait for the eye to quiet down before operating.

Posterior blepharitis, meibomian gland disease- it has several names, we see it very often, and it’s difficult to control. We typically try antibiotic drops/ointment, steroid drops, hot compresses, lid hygiene, Restasis, flaxseed oil etc. Dr. Maskin has come up with a novel idea of probing each gland with a special probe he developed with Rhein, which clears obstruction of the glands and allows the lipid to drain effectively. He claims his patients get many months of relief, and can be repeated. The probes are now commercially available- may be worth a try

Conjunctivochalasis is much more common than we think- we often attribute the symptoms to dry eye and give artificial tears. But ever since I read about this condition some time ago, I see that it is indeed, much more common and symptomatic. I know surgeons will excise the redundant conjunctiva, but I wonder if that’s such a good idea- I have a feeling the patient needs all the conjunctiva they can get for lubrication purposes. I recently saw a video where the surgeon replaces the excised conjunctiva with dry amniotic membrane, glued to the globe- that’s probably a better idea. But I do is the simplest and I think, best- I roatate the eye superiorly and push the conjunctiva down towards the fornix and place about 4-5  8-o Vicryl sutures about 10 mm from the limbus re-attaching it to the globe. That’s it. The sutures create enough irritation to keep the conjunctiva securely on the globe. When I examine the patients later, the conjunctiva is nice and tight on the globe without any redundancy- and I did not sacrifice any conjunctiva. Try it!

I have seen nice results with chemical peels, and I wonder if lasers like CO2 are really worth the expense, or is it mostly a marketing tool?  I would love to hear from those with experience with both, and if TCA is just as good, would like to hear what concentration you use and your technique.