 So I guess we'll maybe get started because I need to get to the operating room. I just have a brief presentation, a patient that we presented upstairs, a patient of Dr. Mifflin's in mind, Mr. Elowitz, who's actually stuck around here just to hear kind of what's going on and what the thoughts are today. So I'll just present his history real briefly and then we can talk a little bit about differential, any thoughts that anybody might have of something that we didn't think about and then thoughts on how to manage his condition. So, in brief, he's a 54-year-old male who presented to us with a six-month history of chronic recurrent swelling and irritation around his left eye. Basically, the diagnosis that he was given was chronic congenitival bolus chemosis and he had been treated, you know, over the time prior to seeing us for some blepharitis in both eyes and was, at the time we initially saw him being treated with predforte four times a day and as a site once a day. And he noted, you know, some occasional symptomatic improvement but no significant improvement in the chemosis in his eye. His past medical history is pretty much benign. It doesn't take any systemic medications. And the significant clinical findings, as I mentioned, were some mygobomian gland dysfunction and bolus chemosis affecting left eye. The edema kind of settles in a dependent fashion and inferiorly and, you know, he notices that it kind of seems most prominent at the end of the day after night's sleep. The kind of path is pretty flat and worsens over time. Hasn't affected his vision too much other than causing some occasional blurriness. Is that pretty close, Mr. Owitz? All right, so in thinking about this, this is a long differential and it doesn't, it's not necessarily an order of priority of what we considered as far as a diagnosis but in many cases, you know, when you see a picture like this, you think of some kind of localized inflammation, whether or not it's due to infection, allergic conjunctivitis, toxicity from either topical or oral medications. Those would be the first thoughts. Really, you know, he didn't have any clear history that was significant for anything other than having some mild blufferitis. And, of course, this has only affected his left eye really. So, you know, in thinking about this, we also wanted to think about, you know, along the lines of more of the zebras. As I said, the differential is pretty thorough but thyroid eye disease would be, you know, consideration, any kind of orbital process, either venous congestion or mass, including all these that I've listed, crotted cavernous fistula, orbital pseudo tumor, cavernous sinus thrombosis, orbital metastasis, superior vena cava syndrome, nephrodic syndrome. All those would kind of be on your differential, they wouldn't necessarily be at the top of the differential. So, our first thought was to get, you know, a basic set of labs on him and then consider whether or not we wanted to do any imaging at that point based on those labs. The labs were completely normal, no indication of any thyroid disease or any other, you know, ongoing disease process. We initially got an ultrasound with Dr. Harry that suggested maybe that there was a little inflammation around one of the rectus muscles insertions, but it wasn't a firm thing. As I said, his exam was normal, there was nothing to suggest an orbital process. We did decide to get a CT scan with and without contrast. That CT scan was negative, it showed no mass, no filling defects, completely normal, no suggestion of any enlargement in any of the medial rectus, any of the muscle insertions. So, no evidence of any kind of pseudo tumor process going on. So, that's where we kind of stand at this point. You know, we continued treating him with steroids, he hasn't seen really any significant benefit from them. So, as I said, that was the workup we did. And kind of open this up to the floor and ask if anyone has any other thoughts on the etiology of this condition, any other avenues that we should explore. And then, what are thoughts right now about the next best step in management? You know, he really is bothered by this and would like to do something about it. I did not put that on the list, but yeah, certainly. It does bother him a little bit, but it's not been, you know, awful. Some of these patients can get, you know, Dowans, I've seen case reports, you know, with severe commosis, but I think the ones that I ordered were the TFTs and the thyroid function test. So, I got T3 and free T4. He's not. So, you know, just my own literature search revealed, you know, this case series of seven patients. Basically, this was an article published in cornea back in 1996, and it's seven patients that were presented, which with very similar kind of clinical picture. All of the patients that were presented had a localized area dependent contractival edema that was present for at least a six month period. Various treatments had been tried, and full workups were done on all of them, which revealed nothing. The commosis, you know, did not improve and at the end of each case report, you know, the last statement was that the commosis persisted in all of these patients. They did have conjunctival biopsies. Those biopsies revealed chronic inflammation, T-landectasia is lymphatic ectasia. And basically, the article, you know, the authors decided to call this chronic localized conjunctival commosis. And they said it was a diagnosis, kind of an exclusion, and the etiology wasn't firmly established. You know, literature more recently just calls this refers to as lymphatic tasia. And basically, you know, it's disturbance in the normal fluid distribution in the conjunctiva, and due to the whatever the underlying etiology is, it's kind of an irreversible process. So various treatments have been proposed from simple excision to cryotherapy to kind of a modification of the technique that's commonly used for conjunctival chelases. And Dr. Mifflin has actually had a couple of cases similar to Mr. Elwitz's case that he's managed in the past. So does anybody have any other thoughts about, you know, addressing this surgically? Anything that's worked particularly well for them? Or a lot of the reports that I've seen, you know, the goal is to induce some scarring between the conjunctiva underlying tenons. I've also seen some techniques that describe the use of fiber and glue during the excision to induce localized inflammation and kind of scar things down. I don't, unfortunately. Couple of an areas is covered. Yeah, yeah, it's kind of dependent. So I've seen this where it's a little more localized areas in the process, so it's an altered tendon, so I think a case like this works mostly in interior. All right, well, thank you very much.