Abstract: PurposeTo investigate the effect of orbital decompression surgery in thyroid orbitopathy (TO) on both refractive status and intraocular pressure (IOP).Patients and methodsA prospective, multicentre, consecutive audit of patients undergoing thyroid decompression surgery. Indications for surgery included cosmetically unacceptable proptosis or corneal exposure. Exclusion criteria included the following: previous orbital surgery, glaucoma, corneal disease, steroid use in the preceding 12 months, or an acute optic neuropathy. Automated refraction, keratometry, pachymetry, Hertel exophthalmometry, and IOP were recorded at 1 month pre- and 3 months postoperatively. IOP using the Tono-Pen (mean of three readings) was measured in the primary, upgaze, and downgaze positions.ResultsData were collected from 52 orbits of 33 patients (East Grinstead, New York, and Adelaide). There was no significant difference between pre- and postoperative data for sphere, cylinder, or central corneal thickness (CCT). The mean spherical equivalent was -0.43±1.49 D pre-operatively and -0.28±1.52 D postoperatively. The steepest meridian of corneal curvature was 93.1 degrees pre- and 94.2 degrees postoperatively, with no significant difference. Mean IOP significantly decreased when measuring by Goldmann applanation tonometry (GAT) (2.28 mm Hg, (*) P=0.001) and Tono-Pen (3.06 mm Hg, (*) P=<0.0001). IOP measured in upgaze was significantly greater than that in the primary position. Regression analysis between change in IOP and either Hertel exophthalmometry or the number of orbital walls decompressed was non-significant ((*)Student's t-test).ConclusionPatients with TO undergoing orbital decompression had, on average, with-the-rule astigmatism not affected by orbital decompression surgery. IOP was significantly reduced by decompression surgery although no relationship between IOP and the degree of decompression was observed.Eye advance online publication, 20 January 2012; doi:10.1038/eye.2011.362.
Abstract: To assess the prevalence of refractive error in schoolchildren aged 12-14 years in urban and rural settings in Cambodia's Phnom Penh and Kandal provinces.
Abstract: To characterize the microscopic anatomy of the lacrimal punctum and canaliculi in relation to the tarsal plate, muscle of Riolan, and Horner muscle; and to report a novel technique to excise the horizontal canaliculus in severe dry eye patients.
Abstract: Lacrimal scintigraphy (LS) or dacryoscintigraphy can demonstrate abnormalities in 80%-95% of patients with symptoms of epiphora and a patent lacrimal system on syringing and up to 40% asymptomatic individuals. Precise localization of the site of delay may not always be possible due to lack of anatomic detail on LS. LS is considered useful in patients with epiphora with delayed tear clearance and patency to syringing and suspected to have either nasolacrimal duct (NLD) stenosis or lacrimal pump failure. It remains unclear, however, as to whether LS can reliably distinguish between the two. The literature reports considerable variation in the technique, normative data, analysis, and interpretation of LS. Qualitative or visual analysis is simpler to perform and to our knowledge used more frequently in comparison to quantitative analysis. There is little extra information to be gained from LS in cases with complete NLD obstruction or severe NLD stenosis on syringing.
Abstract: Proximal obstruction of the lacrimal drainage system is typically managed with conjunctivodacryocystorhinostomy and lacrimal bypass tubes, a technique first described in 1962 by Lester Jones. This initial approach utilizes a temporary stent to allow epithelialization of the fistula. Over the last 49 years numerous alterations to this technique have been described, including permanent intubation of the lacrimal bypass fistula, now the most common approach. We review the range of available lacrimal bypass tubes, indications for their use, and surgical techniques for their insertion and focus on improving success rates and minimising short and long-term complications.
Abstract: Eyelid dermatitis is most commonly caused by an allergenic response, potentially from exposure at another site, rather than from local toxicity. Yet allergic contact dermatitis is a diagnosis often missed by ophthalmologists. The authors review the literature and detail their experience relating to the causes, clinical features and management of this condition. 14 patients over a 2-year period that were referred to the oculoplastic service for a further opinion were reviewed in a retrospective, non-comparative study. All patients underwent patch testing for diagnosis. 8 of the 14 patients had delays of more than 6 months from symptoms to diagnosis. In six of these, this was greater than 1 year. Similar delays are reported in the literature. 79% of the cases were referred by ophthalmologists. Although two of the patients were biopsied, this did not help in making the diagnosis. 13 patients had disease restricted to the eyelids, though only five of these had direct contact of the allergen with the eyelids. Two patients were also sensitised to topical steroid creams prescribed for their treatment. All patients improved after removal of the allergen. Further clinical features and management options from the literature are reviewed and discussed.
Abstract: Introduction:  The microscopic and macroscopic anatomy of the anterior and posterior Tenon's capsule is described. Methods:  An observational anatomic study of twelve orbits of 6 cadavers (mean age, 79.5 years) were examined microscopically and 8 orbits of 4 cadavers (mean age, 76.8 years) were examined macroscopically. After orbital exenteration, an X-shaped incision was made in the specimens to include the posterior part of the globe. The sections were divided into 4 parts: superomedial, inferomedial, superolateral and inferolateral. In the macroscopically examined specimens, the eyelids and globes were removed from the exenterated tissues and the appearance of Tenon's capsule was studied. Results:  In the microscopic study, Tenon's capsule covered the sclera beneath the conjunctiva and contained smooth muscle fibers in the anterior area. This anterior fascia, which had a thick appearance, reached the globe equator. From there, the capsule of the orbital fat, which contained no smooth muscle fibers, enveloped the sclera and reached the optic nerve. This was defined as the posterior capsule. In the macroscopic specimens, Tenon's capsule had a thick and fibrous white appearance in the anterior area. More posteriorly, the capsule was thinner and more translucent. This thin capsular part was generally larger in the lateral area than in the medial area. Conclusions:  Tenon's capsule is composed of an anterior thick fibrous tissue comprising the orbital smooth muscle network and the posterior thin fibrous capsule of the orbital fat.
Abstract: OBJECTIVE:: To report two differing forms of upper lid migration of rigid gas-permeable contact lens and review the literature on embedded contact lenses. METHODS:: Two case reports and review of the literature. RESULTS:: Case 1 was a 36-year-old woman, who presented with a 1-year history of a left upper lid mass. Eversion of the upper lid revealed a tarsoconjunctival mass with an overlying scar. Excision revealed a migrated contact lens within a cyst of conjunctival epithelium. She recalled she had lost the lens 1 year before noticing the mass. Case 2 was a 42-year-old woman, who had a 10-month history of mucopurulent discharge from the right eye. Double eversion of the upper lid revealed an embedded contact lens with pus. Excision demonstrated a lens surrounded by inflamed granulation tissue. She recalled having lost the lens after sleeping overnight with the lens in place approximately 1 year before the development of the mucopurulent discharge. CONCLUSIONS:: These cases highlight the importance of acquiring a detailed history of contact lens loss in patients presenting with upper eyelid masses. Furthermore, the history of lens loss may be remote from commencement of symptoms, which may vary significantly between patients.
Abstract: To present the anatomical characteristics of the superior border of the lateral orbital wall and thereby reduce the risk of inadvertent dural damage during deep lateral orbital wall decompression.
Abstract: OBJECTIVE: To report the neuro-ophthalmic manifestations and outcomes in patients with pituitary apoplexy. METHOD: Retrospective chart review. RESULTS: 23 patients were identified (17 men, mean age 54.1 years (range 23-86 years). The onset was abrupt in 22 patients; one patient had a subclinical presentation. Headache was the commonest presenting symptom (82.6%, 19/23). Neuro-ophthalmic manifestations were present in more than three-quarters of the patients (82.6%, 19/23). At presentation, 55 % (11/20), 47.6 % (10/21) and 60.9 % (14/23) of the patients had reduced visual acuity, field defects and cranial nerve palsies respectively. Management was conservative in 4 patients and surgical in 18 patients; one patient died shortly after presentation. The median follow up period was 10.5 months (22 patients, range 0.2-168 months). At final follow up, improvement was present in 100% of the patients with reduced acuity (8/8) and ocular palsy (13/13) and 81.8% of patients with field deficits (9/11). Age, sex, presence of precipitating factors and timing of surgery did not have an impact on neuro-ophthalmic recovery. CONCLUSION: Pituitary apoplexy should be considered in any patient with abrupt onset of neuro-ophthalmic deficits. Prompt medical and surgical management is lifesaving and can lead to significant improvement in visual and cranial nerve deficits.
Abstract: A 59-year-old Chinese man presented with no light perception in the left eye 1 day following functional endoscopic sinus surgery. The patient underwent endoscopic optic nerve decompression with topical and systemic application of nerve growth factor and steroids after a failed trial of high-dose intravenous corticosteroids. Visual acuity improved to 20/25 at 3 weeks and remained stable at 9 months. Reports of full visual recovery are exceedingly rare following this functional endoscopic sinus surgery complication.
Abstract: There is a paucity of published data on the management of upper eyelid cicatricial entropion. We report on our results using such techniques as lamella repositioning, recession or augmentation and terminal tarsal rotation.
Abstract: The authors describe a group of patients with initially successful dacryocystorhinostomy surgery with late recurrence of epiphora. The causes of late failure and its management are documented.
Abstract: Background:  To analyze the anatomy of the medial canthal tendon (MCT) in Caucasians and to clarify the true anatomical nature of its posterior limb. Methods:  Experimental anatomic study. 7 Caucasian cadavers (11 eyelids; age range: 78-101 years at death). Anatomical dissection and histologic examination of cadaveric eyelids fixed in 10% buffered formalin was performed. The axial sections were made in parallel with the eyelid margin at 1 mm superior or inferior to the upper or lower eyelid margins, respectively. The histologic specimens were first dehydrated and embedded in paraffin and then divided into 7µm thickness sections and stained with Masson's trichrome. Microscopic photographs were taken with a digital camera system attached to the microscope. Results:  The posterior limb of the MCT was not detected in any of the specimens. The medial check ligament supported the posterior aspect of Horner's muscle and inserted into the medial orbital wall through the periosteum. The lacrimal diaphragm around the posterior lacrimal crest ran almost parallel to Horner's muscle and was usually difficult to distinguish from the tendon of Horner's muscle. Conclusions:  The posterior limb of the MCT was not detected in any of the studied specimens. This anatomical structure appears to be Horner's muscle, and the lacrimal diaphragm.
Abstract: Background:  To estimate the proportion of cataract surgery performed at various visual acuity and lens opacity thresholds that would coincidentally treat early angle-closure disease, and to estimate the effect of this surgery on the incidence of primary angle-closure glaucoma Design:  Cross-sectional, population-based survey in Meiktila, Myanmar Participants:  Total of 2076 inhabitants, 40years of age and over were included. Methods:  Eyes with cataract-induced visual impairment, primary angle-closure suspect (PACS) status and primary angle-closure (PAC) were identified. Analyses were stratified by various thresholds of pinhole-corrected visual acuity (VA) and (Lens Opacity Classification System) LOCS III scores. Main Outcome Measures:  The dual role of cataract surgery in primary cataract treatment and PACG prevention was estimated. Results:  Of 4153 eyes available for analysis, 261 eyes were either PACS or PAC; 975 eyes had a VA of <6/18 and LOCS III score ≥3 on the nuclear or cortical scales. Of these, 86 eyes had either PACS or PAC. If cataract surgery were performed on all 975 eyes, this would potentially prevent up to 86 cases of PACG in this population; 8.82% (95% CI 7.12-10.78) of the cataract surgery would address the cataract and prevent PACG. This would achieve a 38.46% (95% CI: 20.23-59.43) relative reduction in the incidence of PACG in the adult population. Conclusion:  In populations with a high prevalence of both visually-significant cataract and angle-closure disease, quality cataract extraction can serve a dual role of visual restoration and reducing the incidence of angle-closure disease in the population: killing two birds with one stone.
Abstract: To present our experience of early endonasal DCR (endoDCR) in the treatment of acute dacryocystitis (AD). Methods. International multicenter non-comparative retrospective study.
Abstract: To identify the causes of blindness and severe visual impairment (BL/SVI) in children attending schools for the blind in Sri Lanka, and to provide optical devices and ophthalmic treatment where indicated.
Abstract: To describe our attempt in establishing a definitive diagnosis in patients with hypertrophic pachymeningitis in combination with orbital inflammatory disease and report on the outcome.
Abstract: To assess the effectiveness of the upper eyelid double motion sign in Graves' orbitopathy (GO) in detecting thyroid dysfunction or a positive level of thyroid-related autoantibodies.
Abstract: PURPOSE:: To examine the junctional variations of the levator palpebrae superioris (LPS) muscle, the levator aponeurosis, and Müller muscle in Asians. METHODS:: Postmortem specimens of 17 upper eyelids and orbits of 13 Asians (9 right and 8 left; average age, 78.5 years old) were used. Full-thickness sagittal sections of the central part of the upper eyelids and orbits were microscopically examined using Masson trichrome staining. RESULTS:: Peripheral branching of the LPS muscle was demonstrated in 12 specimens. Five of these showed that the complete origin of Müller muscle was from the inferior branch, whereas the levator aponeurosis originated from the superior branch. In the other 7 specimens, part of the Müller muscle origin was from the orbital smooth muscle network. The superior branch was significantly thicker (average: 340.8 μm) than the inferior branch (average: 247.5 μm) (p = 0.014). Two specimens did not demonstrate any branching structures, and most areas of the distal end of the LPS muscle was connected to Müller muscle. The other 3 specimens also did not demonstrate these branching structures, and Müller muscle was seen originating from the orbital smooth muscle network and from the inferior aspect of the LPS muscle. CONCLUSIONS:: The authors demonstrated variations of the junctional anatomy of the LPS muscle, the levator aponeurosis, and Müller muscle. These new anatomical findings may help better understanding of the anatomy of the upper eyelid and the relations to the orbital smooth muscle network.
Abstract: Aims To describe the outcomes and complications for composite eyelid grafts in a large case series over a 9-year period. Method A retrospective study of all patients who underwent a composite graft for eyelid reconstruction between January 2000 and May 2009. A composite eyelid graft involves the excision of a full thickness pentagonal wedge from the donor eyelid, which is inserted into the recipient eyelid defect. The orbicularis muscle is discarded from the composite graft. Initial diagnosis, complications, postoperative eyelid contour and colour were recorded. Results Forty-two patients were identified in the study period; the mean age was 69 years. Reconstruction following basal cell carcinoma excision was the commonest indication for surgery. Thirty-five composite grafts were performed for lower eyelid defects and seven for upper lid defects. The average size of the grafts was 9.1 (range 7-12) mm. Five patients required two grafts to reconstruct the defect. Thirty-six (86%) patients achieved a satisfactory contour and 33 (78%) patients had good matching skin colour. Partial dehiscence occurred in five patients and three patients had bulkiness of the graft postoperatively. We had no episodes of graft failure, although two patients had skin necrosis, which resolved. Conclusion Composite eyelid grafts when combined with mobilisation of the recipient orbicularis muscle can result in good preservation of eyelid function with satisfactory cosmesis.
Abstract: To investigate the effects of Merogel coverage on ostial patency in endonasal endoscopic dacryocystorhinostomy (EES-DCR) for primary chronic dacryocystitis (PCD).
Abstract: To analyze the distribution and characteristics of upper eyelid skin elastic fibers in different areas of skin thickness and in relation to the eyelid crease.
Abstract: To examine the concentrations of elastic fibres in Whitnall ligament and the intermuscular transverse ligament (ITL), and to examine the anatomic relationships between Whitnall ligament and its surrounding structures.
Abstract: A 48-year-old man presented following an episode of sudden onset simultaneous inferior altitudinal visual loss in his left eye and visual obscuration with shimmering in the inferonasal quadrant of the right eye. Clinical examination demonstrated left superior hemiretinal artery occlusion and an area of focal dynamic spasm along the right superior temporal branch retinal artery, the arteriolar spastic cycle was about 2 sec in duration. Hematological (including complete blood count, thrombophilia screen, vasculitic screen and serum magnesium), carotid, and cardiac investigations were normal. He was given acetazolamide 500 mg orally, timolol maleate 0.5% eye drops once daily and sublingual amyl-nitrate 0.8 mg, and maintained on felodipine 10 mg/day and aspirin 100 mg/day. The area of focal arteriolar spasm in the right eye resolved over two months. To our knowledge there are no prior reports of photographically documented dynamic focal retinal vascular spasm on a MEDLINE and PUBMED search.
Abstract: Reconstruction of the upper eyelid is one of the greatest challenges facing the orbitofacial surgeon. This comprehensive review outlines the principles of reconstruction and the range of techniques available. Methods of assessing upper eyelid defects are discussed, and an algorithm for reconstruction based on defect size and lamellar involvement is given. The review contains numerous detailed examples of reconstructive techniques, including secondary intention healing, local flaps, distal flaps, simple and composite grafts, occlusive and non-occlusive methods, and canthal fixation. Eyebrow and eyelash reconstruction is also covered.
Abstract: A 33-year-old man was diagnosed with asthma and within 5 weeks developed bilateral periocular swelling. Examination revealed bilateral axial proptosis with conjunctival nodules. His blood tests revealed a positive p-antineutrophil cytoplasmic autoantibody with significant eosinophilia. MRI of the orbit showed enlarged extraocular muscles, lacrimal glands, and infiltrative changes in the orbital fat. Biopsy demonstrated granulomatous inflammation with eosinophil predominance. A diagnosis of diffuse bilateral inflammation in Churg-Strauss syndrome was made and the patient responded dramatically to prednisolone with resolution of systemic and orbital findings. The second case was a 72-year-old woman with a prolonged prodromal phase of asthma, paranasal sinus disease, and bilateral orbital involvement by a process consistent with reactive lymphoid hyperplasia on initial biopsy. Three years later she developed rapidly worsening orbital disease, marked peripheral eosinophilia, and orbital biopsy showed evidence of granulomatous inflammation with marked eosinophil infiltration and vasculitic changes, and a weakly positive antineutrophil cytoplasmic autoantibody. Hence, diffuse bilateral orbital inflammation occurring in the setting of asthma and peripheral eosinophilia should raise the possibility of Churg-Strauss syndrome and warrants biopsy as early institution of therapy can reduce both systemic and ophthalmic complications.
Abstract: A 45-year-old woman presented with an 8-month history of a firm mass over the right superonasal orbital rim, followed by an episode of hemorrhage and anesthesia 5 months later. Clinical history and CT were suggestive of a venous malformation with phleboliths. Excision biopsy was performed. Histopathology revealed intravascular papillary endothelial hyperplasia with fibrotic-calcific changes. Hypoesthesia in the supra-orbital region persisted postoperatively. Although a benign lesion, intravascular papillary endothelial hyperplasia should be considered a differential diagnosis of a vascular lesion with compressive effects.
Abstract: BACKGROUND/AIMS To report the outcome of primary radiotherapy in patients with progressive optic nerve sheath meningioma (ONSM). METHODS The clinical records of all patients were reviewed in a retrospective, observational, multicentre study. RESULTS Thirty-four consecutive patients were included. Twenty-six women and eight men received conventional or stereotactic fractionated radiotherapy, and were followed for a median 58 (range 51-156) months. Fourteen eyes (41%) showed improved visual acuity of at least two lines on the Snellen chart. In 17 (50%) eyes, the vision stabilised, while deterioration was noted in three eyes (9%). The visual outcome was not associated with age at the time of radiotherapy (p=0.83), sex (p=0.43), visual acuity at the time of presentation (p=0.22) or type of radiotherapy (p=0.35). Optic disc swelling was associated with improved visual acuity (p<0.01) and 4/11 patients with optic atrophy also showed improvement. Long-term complications were dry eyes in five patients, cataracts in three, and mild radiation retinopathy in four. CONCLUSION Primary radiotherapy for patients with ONSM is associated with long-term improvement of visual acuity and few adverse effects.
Abstract: Our review aims to provide an update of management protocols for congenital nasolacrimal duct obstruction (CNDO). Although early probing performed before the age of 1 year was traditionally recommended, many reports have since confirmed high frequencies of spontaneous resolution during the first year of life. Accordingly, a 'wait-and-see' approach, combined with conservative therapies, is judged to be the best option in infants aged<1 year. By contrast, persistent obstruction beyond 1 year of age warrants probing as a first-line interventional therapy. However, the optimal timing for probing remains controversial. Although there remains a high possibility of spontaneous resolution after the first year of age, this must be balanced against the decrease in success rates for probing that accompanies advancing age. If conservative management fails, persistent CNDO beyond 1 year of age should be managed either by further observation or by primary probing according to the severity of symptoms. In patients in whom probing fails, advanced treatment such as balloon catheter dilation, silicone tube intubation or dacryocystorhinostomy may be considered.
Abstract: To describe air regurgitation as a complication in patients on continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) following dacryocystorhinostomy (DCR) surgery with or without Lester-Jones tube (LJT) insertion.
Abstract: To describe the use of a lacrimal bypass tube in the management of epiphora in patients with epiphora attributable to lacrimal pump failure in facial palsy.
Abstract: To describe the clinical, immunohistochemical and prognostic features, as well as outcomes of a large series of patients with orbital and periorbital diffuse large B-cell lymphoma (DLBCL).
Abstract: To assess the dynamic features of the medial rectus capsulopalpebral fascia (mrCPF) and the lateral rectus CPF (lrCPF) during horizontal eye movements using cine mode magnetic resonance imaging (MRI).
Abstract: Aim To describe the ophthalmic side-effects of topical imiquimod for periocular actinic keratoses, squamous cell carcinoma in situ and basal cell carcinoma. Method A retrospective study was carried out in two centres of all patients who underwent topical imiquimod therapy between January 2004 and January 2009. Imiquimod was applied three times weekly for 4-6 weeks. Diagnosis of the lesions, complications, clinical resolution and long-term ophthalmic side-effects was recorded. Patients on therapy were reviewed fortnightly and then every 6 weeks following completion of treatment. Results 47 patients were identified; the mean age was 74 years. 37 patients had actinic keratoses, seven patients had Bowen disease, and three patients had BCC. The lower lid was the commonest site involved (68%). Application site erythema occurred in all patients. Conjunctivitis occurred in 15 patients, and six patients complained of ocular stinging on application of imiquimod. One patient had a staphylococcal keratitis, which responded to topical antibiotic and steroid therapy. Two patients required oral antibiotics for preseptal cellulitis. Three patients had delayed conjunctivitis at a mean of 2.3 weeks. Nine patients discontinued imiquimod due to ocular irritation and conjunctivitis, of whom four patients recommenced and finished the treatment after a rest period. At a mean follow-up of 16 weeks, 34 patients had clinical resolution of the periocular lesions and no patient had any residual ophthalmic side-effects from imiquimod. Conclusion Conjunctivitis and ocular stinging were the commonest ophthalmic side-effects encountered with the application of imiquimod for periocular skin lesions. These effects were temporary and resolved on terminating the imiquimod therapy.
Abstract: To present the microscopic lateral tarsal fixation findings in Caucasians, focusing on the lateral rectus capsulopalpebral fascia (lrCPF), lateral canthal band (LCB), and the tarsus.
Abstract: An 80-year-old man presented with an 8-week history of painless swelling in the right lacrimal gland region with infero-medial dystopia of the globe. The lesion was excised and histology confirmed an orbital plasmacytoma. Multiple myeloma screening was negative and a solitary extramedullary plasmacytoma arising from the lacrimal gland was diagnosed. The patient was subsequently treated with radiotherapy.
Abstract: To identify the causes of blindness and severe visual impairment (BL/SVI) in children attending four schools for the blind in Cambodia and to provide spectacles, low vision aids, orientation and mobility training and ophthalmic treatment.
Abstract: To characterize the microscopic relationships between the lower eyelid retractors and the lacrimal caruncle and to define the possible role of the caruncle in the lacrimal drainage process.
Abstract: To report a series of patients with lacrimal gland lesions simulating the clinicoradiological features of lacrimal gland pleomorphic adenoma (LGPA).
Abstract: Purpose. To report on a patient with compressive optic neuropathy secondary to an Onodi cell mucocele, who fully recovered visual function following surgery. Method. Case report. Results. A 28-year-old male was admitted with a right visual acuity of 20/100 following treatment for an initial diagnosis of optic neuritis. Subsequent examination suggested compressive optic neuropathy, and neuroimaging confirmed the presence of an Onodi mucocele compressing the optic nerve. The patient underwent a right endonasal sphenoethmoidectomy with decompression 5 weeks after the initial onset of symptoms. Three weeks following surgery, the visual acuity was 20/20, and there was complete resolution of the visual field defect, which has remained stable at 1 year. Conclusion. Onodi cell mucocele should be included in the differential diagnosis of a young patient with compressive optic neuropathy. Surgical decompression should be considered even when symptoms have been present for over a month.
Abstract: Objective. To describe the clinicoradiological and histopathological findings in a case of lacrimal gland enlargement secondary to lymphomatoid granulomatosis (LG) and to review the literature. Design. Case report and systematic literature review. Methods. A 75-year-old woman presented with right ptosis. Computerised tomography showed lacrimal gland enlargement, and biopsy done was inconclusive. She subsequently developed pulmonary symptoms and underwent transbronchial biopsy that was diagnosed as LG. Pub Med and OVID databases were searched using the term "orbit/eye involvement in lymphomatoid granulomatosis". Articles that predated the databases were gathered from current references. Results. The patient underwent lacrimal gland biopsy which revealed necrotic and inflamed tissue with no further categorisation but transbronchial biopsy helped in establishing the diagnosis of LG. On initiation of prednisolone and cyclophosphamide, her orbital lesion resolved but the patient died following massive pulmonary hemorrhage within a month of diagnosis. Conclusion. Ophthalmic involvement in LG is very rare. Varied presentations are due to central nervous system involvement, vasculitis, or infiltration of ocular or orbital structures. LG is an angiocentric and angiodestructive granulomatous disorder and can involve any tissue, thus accounting for the variable presentations reported in literature.
Abstract: To describe a case series of patients with anterior orbital invasion by medial canthal basal cell carcinoma (BCC) managed with non-exenterating surgery.
Abstract: Traumatic rupture of the superior oblique tendon is a rare cause of acquired Brown's syndrome. This report describes a case of traumatic rupture of the superior oblique tendon, distal to the trochlea, after injury with a plant hook. The ruptured tendon was reapproximated. Postoperatively, asymptomatic Brown's syndrome developed, although residual function of the superior oblique muscle was retained. Full-thickness upper eyelid lacerations, especially those caused by a hook, must be explored carefully to exclude superior oblique tendon rupture. Careful reapproximation of the tendon can result in residual muscle function.
Abstract: To characterize the attachment site of the orbital septum on the levator aponeurosis and the anatomic level of the inferior end of the preaponeurotic fat pad, both in Asians and whites.
Abstract: A detailed understanding of the relationship between the ethmoidal sinus and the intracranial cavity is essential to prevent intracranial penetration during orbital surgery. The authors analyzed 10 postmortem orbits with their adjacent skull bases of 5 Asian cadavers (3 males and 2 females; mean age of 80 years at death). After removing all orbital contents, skull and brain, the medial orbital wall, ethmoidal cells, and ethmoidal roof were also removed. From the intracranial cavity view, the ethmoidal roof was situated just lateral to the cribriform plate. From the orbital view, the location of the roof was close to the superior border of the medial orbital wall. These anatomical observations may be useful to prevent intracranial penetration and cerebrospinal fluid leakage during medial orbital wall decompression.
Abstract: A 56-year-old man who underwent surgical clipping of a cerebral aneurysm via a bifrontal craniotomy in a Jack-knife position complained of bilateral blindness immediately after surgery. Examinations 14 hours later revealed marked bilateral proptosis with eyelid edema and conjunctival chemosis. MRI demonstrated severe bilateral globe tenting with marked orbital tissue edema. Despite emergent lateral canthotomy and cantholysis, there was no visual recovery. This is a rare case of bilateral irreversible blindness after cerebrovascular surgery caused by orbital compartment syndrome and resulting in severe globe tenting and ocular ischemia. Attention to factors such as direct ocular pressure from skin flaps, congestion from head positioning, and adequate intraoperative eye protection and monitoring may reduce the risk of this complication or allow faster management when diagnosed.
Abstract: There are different techniques for reconstructing traumatic canalicular lacerations. The aim of this study is to report the surgical outcome with the Mini-Monoka monocanalicular stent (FCI Ophthalmics, Issy-Les Moulineaux, France).
Abstract: To present the clinical features and management outcomes in a large longitudinal series of patients with craniofacial fibrous dysplasia (CFD).
Abstract: To reveal the medial and lateral horns of the lower eyelid retractors, measure the horn width, and examine the racial differences of the horns between white and Japanese cadaver specimens.
Abstract: Primary orbital intraosseous hemangioma represents a rare, histopathologically benign, vascular tumor of the bony orbit. Only 41 cases have been documented in the literature to date. The authors present 4 new cases of the disease and review the relevant literature.
Abstract: Bony exostoses can occur at the site of a fracture but are rare in facial bones. We report a case of lateral rectus restriction secondary to a traumatic exostosis in the lateral orbital wall with resolution of diplopia after surgical removal of the lesion. Although orbital masses may cause extraocular muscle restriction, to our knowledge, restriction secondary to an exostosis has not been previously reported. A bony exostosis should therefore be included in the differential diagnosis of mechanical restriction of extraocular muscle movement, and surgical treatment is recommended in symptomatic patients.
Abstract: To examine the microscopic structure of the upper eyelid of Caucasians, in particular looking for evidence of the presence of smooth muscle fibers and the microscopic nature of the levator aponeurosis.
Abstract: Eyelid surgery necessitates a thorough knowledge of eyelid anatomy. Recent contributions to the literature have significantly advanced our understanding of eyelid anatomy. In this review, we present an update of the anatomy and the implications for upper eyelid surgery. Aspects to be covered include the levator aponeurosis, Müller's muscle, lamina propria mucosae of conjunctiva, orbital septum, myoneural junction of the levator palpebrae superioris muscle, adipose tissue, and the ligament system.
Abstract: Staged excision with rush-processed paraffin-embedded tissue sections (Slow-Mohs) is an effective treatment for periocular melanoma. Although there is no consensus on initial margins of excision, narrower margins in the eyelids have the functionally and cosmetically important consequence of smaller postoperative wounds.
Abstract: The authors report 2 patients with idiopathic sclerosing inflammation of the orbit who presented with periorbital paresthesia in the trigeminal nerve distribution. The diagnosis in both cases was confirmed with biopsy and both patients responded to corticosteroid treatment. Although periorbital paresthesia is usually a sign of malignancy, these cases illustrate that it may also occur in patients with sclerosing orbital inflammation.
Abstract: Blepharochalasis is a rare eyelid disorder that often presents in childhood or early adolescence. It is characterized by exacerbations and remissions of painless edema of the upper and occasionally lower eyelids. Although the average duration of attack is only two days, multiple attacks eventually lead to atrophic, wrinkled, and discolored periorbital skin. Other clinical manifestations include ptosis, acquired forms of blepharophimosis, lower lid retraction, pseudoepicanthal folds, proptosis, prolapse of orbital fat, and lacrimal tissue. The etiology of blepharochalasis has yet to be fully elucidated, but histpathologic examinations indicate that elastolytic activity, immunoglobulin A (IgA), and other inflammatory processes might play a substantial role in the pathogenesis of the disease. The treatment of blepharchalasis is primarily surgical, and therefore understanding the natural history is essential to avoid overcorrection and recurrences after surgery. In this review we present the clinical characteristics, differential diagnosis, and treatment options of blepharochalsis.
Abstract: Orbital compartment syndrome is an uncommon, ophthalmic surgical emergency characterized by an acute rise in orbital pressure. When intraorbital tension rises, damage to ocular and other intraorbital structures, including irreversible blindness, may occur if not promptly treated. The diagnosis of orbital compartment syndrome is completely clinical and early recognition and emergent orbital decompression (even prior to imaging) is essential in preventing permanent vision loss. Lateral canthotomy and inferior cantholysis remain the mainstays of management. More extensive incision of the orbital septum and orbital bony decompression may be necessary in unresponsive cases. This review discusses the various etiologies and mechanisms resulting in orbital compartment syndrome, clinical features, imaging findings, treatment, and prognosis.
Abstract: Vascular endothelial growth factor (VEGF) is a multifunctional cytokine that plays a role in angiogenesis and microvascular permeability. This study was conducted to determine whether common sequence variation in the VEGFA gene plays a role in the development of diabetic retinopathy (DR).
Abstract: To examine the microscopic anatomic features of lower eyelid retractors in Caucasians, specifically looking for an anatomic division of the retractors into 2 layers, as is present in the Asian eyelid.
Abstract: To investigate whether American Joint Committee on Cancer (AJCC) classification at initial diagnosis of lacrimal gland adenoid cystic carcinoma predicts outcome of treatment on local recurrence.
Abstract: Reactive arthritis is a well-known sequel to both dysenteric and urethritic illnesses, classically occurring in combination with conjunctivitis, arthritis, and/or a variety of dermatologic conditions. Dacryoadenitis has not been previously described as part of the spectrum of reactive arthritis. The authors describe a case of biopsy-proven bilateral dacryoadenitis, which developed in the setting of chlamydial urethritis.
Abstract: Developments in fiberoptic technology and increasing interest in minimally invasive surgery have fueled advances in transcanalicular surgery. This article presents a review of instruments and methods for diagnostic and therapeutic approaches to adult lacrimal drainage obstruction. Available endocanalicular probes, microendoscopes, lasers, microdrills, trephines, and antegrade lacrimal balloon catheters are discussed and compared. Developments in microendoscopy, laser transcanalicular dacryocystorhinostomy, laser canaliculoplasty, transcanalicular drilling and trephination, and transcanalicular balloon dacryoplasty are also discussed in detail. Transcanalicular surgery provides a minimally invasive approach to adult lacrimal drainage obstruction that may also address the pathology causing the obstruction. Long-term success rates of transcanalicular dacryocystorhinostomy appear to be improving, but cost and a paucity of data on long-term results continue to limit the use of transcanalicular surgery.
Abstract: We report a case of pulsating enophthalmos secondary to orbital varix associated with orbital bony defects. A 64-year-old female with pulsating enophthalmos of the right eye was found to have a right orbital mass with bony defects of the orbit. Valsalva maneuver failed to induce proptosis. The diagnosis of orbital varix was confirmed by exploratory orbitotomy. During general anesthesia for orbitotomy, proptosis of the right eye was noted. Ophthalmologists should be aware of the association between orbital varices and cranial bony defects and encephaloceles. Proptosis induced by general anesthesia and positive pressure ventilation suggests an underlying distensible venous anomaly.
Abstract: To determine normal exophthalmometric values for a Sri Lankan population and investigate their demographic, physical, refractive and ocular biometric correlates.
Abstract: To examine the anatomic relationships between the preaponeurotic fat pad, orbital septum, and the distal end of the anterior layer of the levator aponeurosis (DEALLA) in relation to the superior tarsal plate border.
Abstract: The gross anatomy of the lower eyelid is analogous to that of the upper eyelid, however, the lower eyelid has a more simplified structure with less dynamic movement. Common malpositions of the lower eyelid include entropion and ectropion, rehabilitative surgery of which requires a thorough understanding of lower eyelid anatomy. Furthermore, precise anatomic knowledge is a prerequisite for both reconstructive and cosmetic lower eyelid surgery in order for it to be performed appropriately. In this review, we present the clinical anatomy of the structures of the lower eyelid, as well as highlighting relevant surgical implications. Featured here are the structure of the different eyelid lamellae, the lower eyelid retractors and their relations, the orbital septum, fat pad compartments, and Lockwood ligament.
Abstract: To determine the causes of visual impairment and blindness amongst children in schools for the blind in Myanmar; to identify the avoidable causes of visual impairment and blindness; and to provide spectacles, low vision aids, orientation and mobility training and ophthalmic treatment where indicated.
Abstract: To review the literature on biopsy of lacrimal gland pleomorphic adenoma (LGPA) and to examine the validity of the prohibition against biopsy in LGPA.
Abstract: Bilateral trochlear nerve palsies without other signs of dorsal midbrain syndrome following spontaneous midbrain haemorrhage is extremely rare. We report the case of a 37-year-old man with bilateral trochlear nerve palsies causing superior oblique palsies (SOP) from dorsal midbrain haemorrhage which recovered with conservative management. The report highlights the need for imaging in patients with spontaneous bilateral superior oblique (BSO) motility deficits.
Abstract: Classical anatomical teaching reports the presence of the lateral palpebral raphe formed at the union in the preseptal and orbital parts of the orbicularis oculi muscle, or by the tendon adhering these to the underlying zygomatic bone. The lateral palpebral raphe has been shown to be absent in Asian cadavers. The current study uses both evidence from the anatomical dissection of five eyelids from three Caucasian cadavers, and histological assessment of the lateral canthus of 13 eyelids from seven Caucasian cadavers to illustrate the absence of the lateral palpebral raphe in Caucasian population.
Abstract: We describe a vertical lid split orbitotomy approach to perform optic nerve sheath fenestration which was done in a patient with idiopathic intracranial hypertension. A vertical lid split incision was used to enter the superomedial orbit and approach the optic nerve sheath. This approach resulted in a successful nerve sheath fenestration, with improvement in the patient's symptoms. The vertical lid split incision provides access to the optic nerve sheath with minimal morbidity and may be an option for optic nerve sheath decompression.
Abstract: We aimed to microscopically examine whether Caucasian eyelids demonstrate overriding of preseptal orbicularis oculi muscle (OOM) over the pretarsal OOM in both lower and upper eyelids. Full thickness sections of 13 lower eyelids and 11 upper eyelids from seven Caucasian cadavers were examined. In the lower eyelids, all 13 specimens demonstrated clear overriding of preseptal OOM over the pretarsal OOM. The overriding part extended almost to the level of lower eyelid margin. However, in the upper eyelids, only one of the 11 eyelids demonstrated overriding, and the overriding part only extended to the level of mid-tarsal plate. Our result strongly supports the hypothesis of overriding of the preseptal OOM over the pretarsal OOM as an etiology of involutional lower eyelid entropion. The relatively low frequency of upper eyelid overriding preseptal OOM in our study reflects and may explain the rare occurrence of involutional upper eyelid entropion.
Abstract: The role of intubation in routine dacryocystorhinostomy (DCR) surgery is unclear, with there being little evidence in favour of this practice, which appears to have largely come about as a result of history, anecdote and the evolution of DCR surgery. In this paper, a brief history of intubation in DCR surgery is presented and the evidence base is analysed.
Abstract: OBJECTIVE: This review aims to discuss the clinical application of cytogenetic and molecular testing in the diagnosis and prognosis of orbital tumors and, in so doing, highlight the basis of these methods, their advantages, and limitations. SUMMARY: Specific chromosomal aberrations are detected in many lymphoproliferative neoplasms, soft tissue tumors, and in a few benign tumors of the orbit. Detection of these characteristic chromosomal translocations is most helpful to refine the diagnosis and classification, especially when the tumor is poorly differentiated and shows overlapping morphological features with another tumor type. This review outlines orbital tumors with characteristic chromosomal translocations and the relative frequency of detecting the genetic mutation. Various genetic techniques are available for genetic testing, including karyotyping, fluorescence in situ hybridization (FISH), reverse transcriptase polymerase chain reaction (RT-PCR), and genomic polymerase chain reaction (PCR). As yet, the newer methods of array-comparative genomic hybridization (array-CGH) and expression profiling are most commonly used in research settings or in large specialist centers, and their general application to cancer diagnostics is limited by their cost. Therefore, this review focuses on the methodologies that should be available to most diagnostic units. It is true that "one size does not fit all" in this field and that a combination of molecular techniques may be needed to confirm results at the genomic and transcriptional levels.
Abstract: To assess the agreement between ICare rebound tonometer and Goldmann applanation tonometer in the hands of experienced and inexperienced tonometrists.
Abstract: Ethmoidal pneumocele is a rare condition with little known about its etiology. We report a 5-year-old boy who had recurrent right orbital cellulitis, non-axial proptosis, and inferolateral globe displacement. Initial radiological investigations demonstrated an ethmoidal mucocele. There was complete resolution of inflammatory signs with endoscopic drainage of the mucocele; however, repeat CT revealed a residual pneumocele with continued proptosis and lateral displacement of the globe. This case illustrates the potential for chronic sinusitis and iatrogenic drainage of an ethmoidal mucocele to progress to a pneumocele.
Abstract: To report a series of patients who developed late complications secondary to silicone implants used in orbital fracture repairs and review the literature.
Abstract: Eccrine porocarcinoma is an unusual, locally aggressive tumor with a significant risk of metastasis and recurrence after surgical excision. Eyelid involvement is rare. We describe a 70-year-old man who was examined for right upper eyelid eccrine porocarcinoma that was treated with Mohs surgery. Eccrine porocarcinoma should be considered in the differential diagnosis of malignant eyelid tumors.
Abstract: Cerebrospinal fluid leakage is an uncommon but significant complication of orbital and rarely lacrimal surgery which may have serious consequences including death. In a retrospective review of four orbital units, we report an incidence of cerebrospinal fluid leak (diagnosed intraoperatively) during exenteration, orbital decompression, and dacryocystorhinostomy of 1/154 (0.6%), 4/397 (1%), and 0/3,504 (0%), respectively. We found two additional cases of cerebrospinal fluid leaks associated with excision of orbital masses involving the orbital roof. In the literature, the incidence of cerebrospinal fluid leaks associated with orbital exenterations and decompressions was 1.6-16.7% and 0-10%, respectively. Cerebrospinal fluid leaks occur very rarely in dacryocystorhinostomies with only a few case reports found in the literature. Preventative measures, diagnosis, and management of this complication are discussed. Knowledge of anatomy and thorough preoperative assessment may predict areas at high risk for encountering cerebrospinal fluid leaks. Proper surgical technique further minimizes the risk for this complication. If a cerebrospinal fluid leak occurs, however, prompt diagnosis and management usually results in uncomplicated recovery.
Abstract: Velocardiofacial syndrome (VCFS, or Shprintzen syndrome) is the most common syndrome associated with palatal anomalies and is characterized by the following major features: cleft palate, cardiac anomalies, typical facies, and learning disabilities. Ophthalmologic abnormalities are seen in 70% of cases and include posterior embryotoxon, bilateral cataracts, tortuous retinal vessels, and small optic disks. Congenital absence of the nasolacrimal duct is a rare condition with only a few cases reported, most of which describe complete bony occlusion at the distal end of the lacrimal sac. We report a patient with VCFS with congenital absence of the membranous nasolacrimal duct, a finding confirmed at endoscopic dacryocystorhinostomy. The patient was successfully treated with dacryocystorhinostomy and insertion of Jones tubes. To our knowledge, this is the first report documenting absence of the membranous nasolacrimal duct and also the first time this finding has been described in association with VCFS.
Abstract: Minimally invasive "keyhole" surgery performed using endoscopic visualization is increasing in popularity and is being used by almost all surgical subspecialties. Within ophthalmology, however, endoscopic surgery is not commonly performed and there is little literature on the use of the endoscope in orbital surgery. Transorbital use of the endoscope can greatly aid in visualizing orbital roof lesions and minimizing the need for bone removal. The endoscope is also useful during decompression procedures and as a teaching aid to train orbital surgeons. In this article, we review the history of endoscopic orbital surgery and provide an overview of the technique and describe situations where the endoscope can act as a useful adjunct to orbital surgery.
Abstract: A 59-year-old woman with congenital orbital fibrosis with ptosis and enophthalmos underwent surgery to widen the palpebral fissures, which resulted in an acceptable cosmetic appearance. This is a rare entity that has been classified as a subtype of congenital fibrosis of the extraocular muscles. However, after a review of literature we believe that congenital orbital fibrosis should be considered a separate entity: it is unilateral, diffusely involves the orbit (not just the extraocular muscles) and does not appear to have a hereditary predisposition.
Abstract: We describe a male patient with ocular colobomata, cleft palate, polydactyly, panhypopituitarism and possible craniosynostosis, whom we have followed for 30 years. Although there are some similarities to other documented syndromes, this previously unreported combination of features appears to constitute a new syndrome.
Abstract: Enophthalmos can be defined as a relative, posterior displacement of a normal-sized globe in relation to the bony orbital margin. Non-traumatic enophthalmos has a wide variety of clinical presentations and may be the first manifestation of a number of local or systemic conditions. It may present with cosmetic problems such as deep superior sulcus, pseudoptosis or eyelid retraction; or functional problems such as diplopia or exposure keratopathy. There are three main pathogenic mechanisms: structural alterations in the bony orbit; orbital fat atrophy; and retraction. Evaluation of enophthalmos patients includes orbital imaging and a thorough ophthalmic and systemic examination. In this review, we discuss the presenting features of non-traumatic enophthalmos and include a brief description of the more important causes. An approach to the clinical evaluation of these patients is also discussed together with a brief overview of the principles of management.
Abstract: Diabetes is an increasing problem in Myanmar with more than three million people affected. There are no data on awareness of diabetic retinopathy among the general practitioners (GPs) or diabetic population of Myanmar. This study aims to evaluate the awareness of diabetes-related eye disease among GPs and diabetic patients in Yangon, Myanmar.
Abstract: To report the clinico-radiological findings, clinical course, and treatment outcomes in five patients with orbital and adnexal Rosai-Dorfman (R-D) disease.
Abstract: The aim of this study is to determine the cataract surgical coverage and investigate the barriers to cataract surgery as reported by those with cataract-induced visual impairment in rural Myanmar.
Abstract: Functional visual loss (FVL) refers to subnormal vision or altered visual fields where no underlying pathology of the visual system can be found. It may be seen in a continuum from frank malingering to hysteria. FVL may first present to the general practitioner or physician and the financial burden of evaluation and potential disability-related claims may be substantial. Diagnosis relies on a high index of suspicion and demonstration with a few simple tests that the patient has better vision than alleged. The aim of this review is to provide a practical approach to examination of patients with suspected functional visual loss. An accurate and early diagnosis of FVL starts with a high index of suspicion. Only a few of the tests need to be learned well, performed smoothly and confidently. These clinical tests obviate the need to perform expensive imaging such as magnetic resonance imaging and if used in the correct setting have the potential to reduce further the cost of diagnosis. Management requires an understanding approach and confrontation is seldom helpful. It is important to stress to the patient that FVL has a good prognosis, thereby providing "a way out" and giving the patient the opportunity to recover.
Abstract: Objective: To describe the technique and indications for an endoscopic-assisted approach to orbital roof lesions. Materials and Methods: The technique was used for six cases of orbital roof lesions. An anterior orbitotomy was performed via an upper eyelid skin crease incision. Areas of the lesion behind the superior orbital rim or abutting the dura were removed with the aid of a rigid Storz 3-chip video-endoscope with 30-, 45-, or 70-degree tip. Results: Six patients with lesions involving the orbital roof were treated using endoscopic-assisted curettage. There were five males and one female with a mean age of 39.6 years (range, 5 months to 67 years). There were two cases each of cholesterol granuloma, Langerhans' cell histiocytosis, and orbital dermoid. The lesions were successfully removed in all cases with a good outcome. Average follow-up was 2.6 years; range, 6 months to 5 years. Conclusion: This technique may be suitable for selected erosive lesions of the superior orbit involving the orbital roof.
Abstract: To determine the central corneal thickness (CCT) and its demographic associations among Aboriginal people attending eye clinics in remote South Australia.
Abstract: The liver produces plasma sex hormone-binding globulin (SHBG), which transports sex steroids and regulates their access to tissues. In overweight children and adults, low plasma SHBG levels are a biomarker of the metabolic syndrome and its associated pathologies. Here, we showed in transgenic mice and HepG2 hepatoblastoma cells that monosaccharides (glucose and fructose) reduce human SHBG production by hepatocytes. This occurred via a downregulation of hepatocyte nuclear factor-4alpha (HNF-4alpha) and replacement of HNF-4alpha by the chicken OVA upstream promoter-transcription factor 1 at a cis-element within the human SHBG promoter, coincident with repression of its transcriptional activity. The dose-dependent reduction of HNF-4alpha levels in HepG2 cells after treatment with glucose or fructose occurred in concert with parallel increases in cellular palmitate levels and could be mimicked by treatment with palmitoyl-CoA. Moreover, inhibition of lipogenesis prevented monosaccharide-induced downregulation of HNF-4alpha and reduced SHBG expression in HepG2 cells. Thus, monosaccharide-induced lipogenesis reduced hepatic HNF-4alpha levels, which in turn attenuated SHBG expression. This provides a biological explanation for why SHBG is a sensitive biomarker of the metabolic syndrome and the metabolic disturbances associated with increased fructose consumption.
Abstract: Apert syndrome is mostly caused by one of the two specific point mutations in the fibroblast growth factor receptor 2 (FGFR2). The objective of this study was to determine whether there were any differences in the prevalence of ophthalmic features in Apert syndrome when comparing the Ser252Trp and Pro253Arg mutations in FGFR2. This was a retrospective study of patients with Apert syndrome with genotype analysis. The prevalence of five ophthalmic features, visual impairment, amblyopia, strabismus, corneal abnormality, and pale optic discs, were compared between the two FGFR2 genotypes. There were 25 (74%) cases with Ser252Trp mutation, and 9 (26%) cases with the Pro253Arg mutation in FGFR2. Ophthalmic findings in 20 cases of FGFR2 Ser252Trp and 9 cases of Pro253Arg mutation were compared. Visual acuity worse than 6/12 in at least one eye was present in 60% patients with FGFR2 Ser252Trp mutation compared with 12.5% patients with Pro253Arg mutation (P < 0.05). Forty percent of eyes with FGFR2 Ser252Trp mutation compared with 12.5% eyes with Pro253Arg mutation were worse than 6/12. There was a trend of more frequent amblyopia and strabismus in FGFR2 Ser252Trp mutation and more frequent optic disc pallor in the FGFR2 Pro253Arg mutation. There was a differential effect of FGFR2 mutations in ophthalmic findings in patients with Apert syndrome, with significantly greater prevalence of visual impairment in the Ser252Trp mutation compared with the Pro253Arg mutation. Further study would elucidate whether the trends in differential effects between the two mutations in amblyopia, strabismus, and optic disc pallor represent real differences.
Abstract: To describe techniques used for reconstruction of the eyelids following total loss of the upper and lower eyelids and to describe visual and functional outcomes.
Abstract: The role of radiotherapy in ophthalmic practice continues to grow. This growth has seen an expansion of indications for radiotherapy, a refinement of the modalities that can be used and a reduction in the ocular and adnexal complications that result from this form of therapy. The compendium of indications for radiotherapy in ophthalmology continues to grow and now includes many conditions such as the treatment of lid and adnexal disease, ocular surface disorders and both benign and malignant disease of the posterior segment and optic pathways. The radiotherapeutic modalities employed to manage these conditions are numerous and include both radioactive plaques (brachytherapy) and external beam radiation techniques. New techniques such as stereotactic radiosurgery are delivering benefits in the management of conditions such as optic nerve sheath meningioma, where the treatment of this blinding and occasionally life-threatening intracranial neoplasm now results in fewer adverse affects. The purpose of this review is to give a brief overview of the indications and treatment modalities, and a more in-depth discussion of the potential side-effects when radiotherapy is used for ocular and periorbital disease.
Abstract: This study aims to determine the sociodemographic characteristics of the Ophthalmology Outpatient Clinic at the Royal Adelaide Hospital, to ascertain satisfaction levels with aspects of care, and determine if patient satisfaction levels can be increased by the provision of information letters prior to appointment.
Abstract: Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer, and its incidence continues to rise. Current management options are numerous and focus on tumour eradication while maximising cosmetic and functional capacity. Although surgery continues to be considered the main treatment modality, new pharmacological agents, such as immunomodulators, topical chemotherapeutic agents and photodynamic therapy, have emerged and show promising results. Pharmacological agents offer the potential for lower morbidity and improved tissue preservation compared with surgery and radiotherapy. However, pharmacological treatments possess higher failure rates when compared with surgery, and most studies have investigated only low-risk lesions. Several prospective, randomised, double-blind, vehicle-controlled studies have established the efficacy of imiquimod for superficial BCC. This review summarises the evidence regarding the mechanism, efficacy and safety of pharmacological agents based on the literature from the past 10 years. Experimental treatments that have been successfully utilised in the treatment of BCC are also discussed. Treatment of BCC with other agents, such as tazarotene, glycoalkaloid (BEC-5) cream, cidofovir and calcium dobesilate have been reported, but further studies are needed to ascertain the efficacy and adverse-effect profiles of these treatments.
Abstract: Fluorouracil (5-fluorouracil, 5-FU) is a pyrimidine analogue that was originally known for its widespread use as an anticancer drug. The ability of 5-FU to reduce fibroblastic proliferation and subsequent scarring has made it an important adjunct in ocular and periorbital surgeries. It is used in primary glaucoma filtering surgeries and in reviving failing filtering blebs, in dacryocystorhinostomy, pterygium surgery, and in vitreoretinal surgery to prevent proliferative vitreoretinopathy. In addition, 5-FU is also gaining recognition in the treatment and surgical management of ocular surface malignancies like ocular surface squamous neoplasia; however, the specific action of the drug on highly proliferating cells limits its use in primary acquired melanosis of the conjunctiva. When applied topically, this drug has a low rate of sight-threatening adverse effects, is inexpensive, and is easy to administer, making it an important tool in enhancing the success rate in ophthalmic surgery and in reducing the recurrence of ocular surface neoplasia.
Abstract: Squamous cell carcinoma (SCC) is the second most common eyelid malignancy and its incidence is increasing. Because of its variable clinical presentation, SCC may be difficult for even the experienced clinician to diagnose. Hence, all suspicious lesions warrant biopsy. As SCC behaviour may range widely in aggression, management should be individualized based on tumour (e.g. size, location, grade, histological subtype, previous recurrence, perineural invasion) and patient factors (e.g. age, health). Treatment of eyelid SCC should include margin control whenever possible for the highest cure rate in this high-risk area. Immediate histological monitoring of surgical margins with frozen sections or Mohs' micrographic surgery also allows for smaller margins of excision in an area where tissue conservation is important. Other special considerations in the periocular area include maintaining a high level of suspicion for perineural invasion as this may be associated with a poorer prognosis.
Abstract: Choroidal melanoma is a rare occurrence in pigmented races. Low clinical suspicion of choroidal melanoma may result in diagnostic delay. We present a rare case of choroidal melanoma with extrascleral orbital extension in an Australian Aboriginal man. We are unaware of previous reports of uveal melanoma in Aboriginal Australians and could find no reference to it in a computerized search utilizing Medline.
Abstract: The transcaruncular approach to the medial orbit is growing in popularity and although reported complications are minimal, ophthalmic and orthoptic sequelae can occur after any conjunctival surgery and nonophthalmic surgeons should be aware of these. This study aims to document these sequelae in a cohort of patients having transcaruncular surgery. A retrospective case series of all consecutive patients undergoing orbital fracture repair through a transcaruncular approach for medial wall and floor fractures in two centers over a 2-year period was examined. Computed tomography findings, pre- and postoperative ophthalmic and orthoptic findings, including ocular motility (with Hess chart evaluation), Hertel exophthalmometry, slit lamp biomicroscopy examination, follow-up time, and occurrence of complications were recorded. Thirteen patients, mean age 34 years (range, 18-82 years), underwent repair for medial wall (n=5) or combined medial wall and orbital floor (n=8) fractures with median a follow up of 7 months (range, 2-18 months). Preoperative ocular injuries included conjunctival chemosis, eyelid swelling, subconjunctival hemorrhage, retinal haemorrhage, traumatic uveitis and traumatic mydriasis, eye movement restriction, and enophthalmos (range, 3-4 mm). Postoperatively, corneal epitheliopathy with reduced vision (6/60), orbital inflammation, inferior oblique underaction, and superomedial fornix symblepharon at the caruncular incision sight each occurred in one patient along with extensive subconjunctival hemorrhage and a suture-related conjunctival granuloma in others. All patients experienced an improvement in diplopia and globe restriction. Ophthalmic complications can occur with this approach, and so it may be advisable to seek an ophthalmic opinion with the aim of comanagement in planning this approach.
Abstract: Basal cell carcinoma is the most common malignancy in humans, and it is also the most frequent periocular malignancy. Although a slow-growing tumor, it can lead to significant morbidity in the periocular region as a result of orbital invasion. As clinical presentation can be very variable, biopsy is recommended for all suspicious lesions. Management needs to be individualized, taking into account patient factors, tumor characteristics, and histological subtype. Several treatment modalities have been proposed, but surgical excision with monitoring of excision margins has the highest cure rate. As a certain percentage of tumors will recur regardless of treatment modality, careful patient counseling and/or long-term follow-up is recommended. In this review, we discuss the risk factors, pathology, molecular biology, clinical features, and management of eyelid basal cell carcinoma.
Abstract: Eyelid colobomas are congenital defects caused by failure of fusion of the mesodermal lid folds. The timing and approach to surgical repair depend on the severity of the defect and exposure keratopathy. Tarsomarginal grafts have been well described in eyelid reconstructions following tumor excision. Descriptions of lid coloboma repair using this approach are limited. We describe a series of upper lid colobomas repaired with the tarsomarginal graft.
Abstract: To present a novel technique to control hypersecretion from a transplanted autologous submandibular gland (SMG) in a patient with keratoconjunctivitis sicca.
Abstract: The literature on refractive change in thyroid eye disease (TED) is limited. This study documents the refractive change in patients with TED undergoing orbital decompression. The authors propose possible mechanisms for their acquired refractive error.
Abstract: Floppy eyelid syndrome (FES) is a recently recognized entity, originally described in obese men with easily everted upper eyelids and chronic ocular irritation. Although the eyelids are primarily involved, other ocular structures such as the conjunctiva and cornea are frequently affected and cause much of the morbidity. Recent studies have found an interesting association with obstructive sleep apnea (OSA) and with chronic diseases such as hypertension and diabetes. The association of FES with OSA has both diagnostic and therapeutic implications; FES may be a presenting symptom in patients with undiagnosed OSA, and, in addition, treatment of obesity and OSA may have a favorable effect on the course of FES.
Abstract: To present the surgical outcomes and postoperative complications in a series of patients who underwent upper lid surgery using autogenous hard palate grafts (HPGs) or free tarsal grafts (FTGs) as posterior lamella replacement material.
Abstract: Mitomycin (mitomycin C; MMC) is an antibiotic isolated from Streptomyces caespitosus. The drug is a bioreductive alkylating agent that undergoes metabolic reductive activation, and has various oxygen tension-dependent cytotoxic effects on cells, including the cross-linking of DNA. It is widely used systemically for the treatment of malignancies, and has gained popularity as topical adjunctive therapy in ocular and adnexal surgery over the past 2 decades. In ophthalmic medicine, it is principally used to inhibit the wound healing response and reduce scarring of surgically fashioned ostia. Hence, it has been used as adjunctive therapy in various ocular surgeries, such as glaucoma filtering surgeries, dacryocystorhinostomy, corneal refractive surgery and surgeries for ocular cicatrisation. In addition, it has been used as an adjunct in the surgical management of pterygia, ocular surface squamous neoplasia, primary acquired melanosis with atypia and conjunctival melanoma. In many of these surgeries and ophthalmic pathologies, MMC showed a significant beneficial effect.
Abstract: To describe the surgical technique and results of en bloc excision in a series of patients with extensive malignant tumors of the lacrimal drainage apparatus (LDA).
Abstract: Thyroid eye disease (TED), which affects the majority of patients with Grave's disease, is associated with significant ophthalmic morbidity. In patients with mild disease, supportive treatment with lubricating medication can be sufficient. However, in patients with severe TED and disfiguring proptosis or sight-threatening neuropathy, more aggressive medical or surgical interventions are necessary. Corticosteroids remain the preferred pharmacological treatment modality in the majority of patients with an active inflammatory component. Other immunosuppressive drugs in combination with corticosteroids may be helpful in patients with corticosteroid-resistant TED. Newer agents such as somatostatin analogues have not shown to be of significant clinical benefit; however, initial studies on the use of antioxidants and cytokine antagonists are encouraging.
Abstract: The aim of this study is to present a series of patients with orbital inflammatory symptoms associated with significant paranasal sinus inflammation, and to discuss the diagnostic and management modalities.
Abstract: The objectives of this study were to report a series of paediatric patients who underwent endoscopic endonasal dacryocystorhinostomy (DCR) for primary congenital nasolacrimal duct obstruction (NLDO).
Abstract: To compare postoperative best distance visual acuity (VA), contrast sensitivity and colour perception with the blue light-filtering AcrySof Natural (SN60AT) and AcrySof single-piece (SA60AT) intraocular lenses (IOLs).
Abstract: The aim of this study was to present a series of patients with acute orbital inflammatory symptoms secondary to peribulbar hyaluronidase allergy and to discuss the diagnostic and management modalities.
Abstract: To report periocular linear basal cell carcinoma (BCC) as a distinct clinical entity, and to highlight its existence in the ophthalmic literature.
Abstract: Idiopathic orbital inflammation (IOI) is a well-recognised pathological process usually confined to the orbit. It is an orbital mass lesion characterised by infiltration of soft tissues by inflammatory cells and fibrous tissue. It is essentially a diagnosis of exclusion. Extraorbital extension (EOE) is rare and, to the best of the authors' knowledge, inclusive of our series, there have been 22 cases of IOI with EOE reported in the literature. We describe four patients with IOI with EOE-their presentation, histopathological findings and management strategies. Histopathology of three patients revealed sclerosing and one had a nonspecific variant of IOI. In our series, all four patients required additional immunosuppression. Hence, corticosteroid therapy often needs to be supplemented by radiotherapy and/or immunosuppressive therapy.
Abstract: To review the clinical features, investigations, management, and outcomes of Langerhans cell histiocytosis (LCH) with ocular adnexal involvement.
Abstract: To report the clinical features of a series of patients with lacrimal drainage apparatus tumors and present guidelines for management based on histopathology.
Abstract: To determine the prevalence of trachoma and diabetes-related eye disease within the adult Aboriginal population screened by the South Australian Eye Health Program between 1999 and 2004 inclusive.
Abstract: To describe 2 patients with orbital invasion by maxillary ameloblastoma, a rare odontogenic tumor that is not commonly encountered in ophthalmic practice.
Abstract: The purpose of the study is to describe linear basal cell carcinoma (BCC) as a distinct clinical entity, and highlight its existence to the plastic surgery literature. A Medline and PubMed literature search was conducted, and 33 reported cases of linear BCC were analysed. Of these 33 cases, the most common site for linear BCC was the periocular region, accounting for 49% (n= 16). The most common histologic subtype, was nodular BCC, accounting for 50% (n= 17). Of the 33 reported cases the postoperative defect size was mentioned in five cases only. None of these would have been completely excised if a 2 mm margin was applied, and only one out of five if a 4 mm margin was applied. Linear BCC is a distinct clinical entity. Presence of the tumour along relaxing skin tension lines, increase in subclinical extension, and aggressive tumour behavior are reported observations. Because of these observations it is suggested that margin-controlled excision should be considered for linear BCC.
Abstract: The aim of the study is to compare multifocal visual evoked potential (mfVEP) objective perimetry with Humphrey full-threshold visual field (HVF) perimetry, in the assessment of patients with optic neuritis (ON).
Abstract: The purpose of this study was to describe a new surgical technique for the complete excision of the lacrimal drainage apparatus (LDA) that combines external and endoscopic approaches.
Abstract: The purpose of the study is to compare characteristics of Aboriginal patient hospital admissions with non-Aboriginal admissions to the Ophthalmology Unit of the Royal Adelaide Hospital.
Abstract: There are only a few reports on the outcome with full-thickness skin grafts (FTSG) in defect reconstruction after Mohs micrographic surgery (MMS).
Abstract: Madarosis may be a presenting feature of a number of vision and life-threatening conditions, including herpes zoster, leprosy, HIV/AIDS, trachoma, malignant eyelid tumors, discoid lupus, scleroderma, and hypothyroidism. It may occur via two broad pathogenic pathways: scarring and non-scarring, which indicates the potential for lash re-growth. Madarosis may occur as an isolated finding or together with loss of other body and scalp hair. The etiology of madarosis can be further divided into dermatological, infection, endocrine, neoplastic, drug-related, congenital, and trauma. This report includes salient points in the clinical history and examination of patients with madarosis, with an emphasis on excluding or diagnosing visual or life threatening disorders associated with madarosis.
Abstract: A 56-year-old healthy man underwent left medial rectus recession and lateral rectus resection for esotropia. The next day he developed severe left periocular pain with decreased vision, an afferent pupillary defect, periorbital edema, limited ocular motility, and proptosis. Computed tomography showed fat stranding and less than 90 degrees of posterior globe tenting. Despite intravenous antibiotics to treat orbital cellulitis, and a lateral canthotomy and cantholysis to decompress the orbit, visual acuity worsened to no light perception. The patient underwent emergent orbital decompression including release of the superior and inferior septum and outfracturing of the orbital floor and medial wall; however, there was no recovery of vision. Blinding orbital cellulitis is a rare complication after strabismus surgery. Despite poor prognosis, prompt diagnosis and aggressive treatment may maximize visual potential.
Abstract: Sebaceous carcinoma (SC) is well known for its ability to masquerade clinically and histologically as a variety of periocular conditions resulting in a delayed diagnosis. We present a series of periocular SC cases and discuss the difficulties in histopathological diagnosis when this tumor presents with a Bowenoid pattern of intraepithelial spread.
Abstract: To report the clinical findings and management of multiple, recurrent cavernous hemangiomas of the orbit in a patient with concurrent liver involvement.
Abstract: To provide an up-to-date and comprehensive review of Wegener's granulomatosis (WG) as a disease entity, focusing on the ophthalmic manifestations and management options.
Abstract: The ocular manifestations of autoimmune bullous diseases are common and potentially sight-threatening. Major ophthalmic involvement is most commonly seen in mucous membrane pemphigoid (cicatricial pemphigoid), epidermolysis bullosa acquisita, linear IgA bullous disease, pemphigus vulgaris and paraneoplastic pemphigus. The main pathological process is related to autoimmune-induced conjunctival inflammation with consequent lid and corneal pathology, which may eventually result in permanent visual loss. Ocular involvement can be asymptomatic. Early detection is aided by careful attention to symptoms and signs of early ophthalmic disease. Ocular disease can be difficult to treat and management usually involves systemic therapy with immunomodulators to control inflammation and prevent progression to irreversible blindness, as well as surgical intervention in advanced disease. Recent advances in treatment, including methotrexate, mycophenolate mofetil, monoclonal antibodies and topical tacrolimus therapies, have led to promising results.
Abstract: The Australian Mohs micrographic surgery (MMS) database was initiated in 1993 by the Skin and Cancer Foundation Australia (SCFA) with the aim of collecting prospective data, and involved all Mohs surgeons in the country.
Abstract: Esthesioneuroblastoma is a rare malignancy arising from the olfactory mucosa in the nasal fossa, which can invade the orbit producing ophthalmic symptoms and signs. The purpose of this study was to present a case series and review the literature to assess the characteristics of orbital involvement by esthesioneuroblastoma.
Abstract: The authors report the novel use of the video-endoscope as an adjunct in teaching orbital surgery, in particular within the sub-periosteal orbital space. This is of most use during situations where visualisation is of critical importance and direct supervision is not possible.
Abstract: Bowen's disease (BD), also known as squamous intraepidermal carcinoma, is a malignant skin tumor with a potential to progress to invasive carcinoma.
Abstract: Idiopathic sclerosing orbital inflammation (ISOI) has been categorized by some authors as a unique clinicopathologic entity, separate from the heterogeneous group of disorders known collectively as nonspecific orbital inflammation. Histologic similarity and clinical association with other fibrosclerosing conditions has been shown. The authors present a case of ISOI in conjunction with autoimmune hemolytic anemia.
Abstract: This retrospective report presents a series of patients with endogenous endophthalmitis treated over a 13-y period in a tertiary care centre in South Australia. 16 eyes of 13 patients (8 M, 5 F) with a mean age 62 y were included. Systemic predisposing risk factors were mainly diabetes mellitus (30.7%), chronic obstructive airway disease (23.1%) and end-stage renal disease (15.4%). Isolated organisms included fungal species in 11 eyes (7 eyes with Candida albicans and 4 with Aspergillus fumigatus), Gram-positive isolates in 4 eyes, and Pseudomonas aeruginosa in 1 eyes. Presenting visual acuity was 20/200 or lower in 8 patients (61.5%). Final visual improvement of more than 2 lines was noted in 5 patients, it was stable or worse in 6 patients and in 2 patients the eye was either enucleated or eviscerated. Systemic aspergillosis resulted in death of both patients. In conclusion, the clinical course and microbiological profile of pathogens in patients with endogenous endophthalmitis in our series are similar to other recent western reports. Candida species are the leading isolates, with an overall poor visual prognosis, especially in Aspergillus infections. Close monitoring of immune-compromised patients with systemic infections may enable early diagnosis and treatment and improve prognosis.
Abstract: An unusual presentation of sebaceous carcinoma of the eyelid is described in a 96-year-old man who presented with a large papillomatous palpebral conjunctival lesion in the left upper eyelid. The patient underwent a shave excision of the lesion, followed by a full thickness excision with paraffin section margin control. Histopathology revealed a sebaceous gland carcinoma with no evidence of pagetoid spread. Although rare, sebaceous gland carcinoma should be considered in the differential diagnosis of a conjunctival papilloma.
Abstract: Free tarsus autogenous graft (FTG) has emerged as a useful biological spacer in lower eyelid elevation. However, it has limited use where a spacer of greater than 4 mm height is required, because at least 4 mm of upper tarsal height must be preserved to maintain upper eyelid rigidity. We describe an augmentation of FTG in its use as a spacer, by way of creating 2 parallel-placed vertical FTG struts, in contrast to interpositioning the FTG horizontally.
Abstract: To evaluate the complications of periocular full thickness skin grafts (FTSG) in patients treated with Mohs' micrographic surgery (MMS) for periocular malignancy.
Abstract: To analyze the microbiologic spectrum and patterns of resistance of infectious keratitis in patients treated at a tertiary hospital in South Australia.
Abstract: Malignant fibrous histiocytoma (MFH) is a pleomorphic soft tissue sarcoma that occurs rarely in the periocular region. The purpose of this study was to present a case series of periocular MFH and to discuss the differential diagnosis and management.
Abstract: Basosquamous carcinoma (BSC) is a rare tumor defined as a basal cell carcinoma (BCC) differentiating into squamous cell carcinoma (SCC). It is reported to have a high rate of recurrence with standard wide local excision. The aim of the current study was to report a large series of patients with BSC treated with Mohs micrographic surgery (MMS).
Abstract: To present the first reported case of eyelid involvement in pyodermatitis-pyostomatitis vegetans (PDPSV) leading to the diagnosis of ulcerative colitis, and to review the literature.
Abstract: Long-term follow-up is essential to evaluate the role of Mohs micrographic surgery (MMS) in the treatment for cutaneous basal cell carcinoma (BCC).
Abstract: A 54-year-old man presented with left intraconal cavernous haemangioma resulting in globe compression and hyperopia. The tumour was excised completely via lateral orbitotomy approach. Complete excision of tumour did not result in resolution of globe flattening and hyperopia after 21 months. Persistent globe flattening despite removal of a longstanding orbital tumour may be caused by remodelling of the sclera from long-term compression.
Abstract: Conjunctival squamous cell carcinoma is generally a low-grade malignancy. A 42-year-old man presented with histologic evidence of extra-tumoral perineural invasion associated with an incompletely excised limbal conjunctival squamous cell carcinoma. Despite further surgery, close observation, plaque radiotherapy, and eyelid-sparing orbital exenteration followed by external beam radiotherapy, the patient developed intracranial perineural invasion with involvement of the trigeminal and facial nerves, ultimately resulting in death. Repeated magnetic resonance imaging with contrast failed to detect perineural invasion until late in the course of disease. Awareness of the possibility of perineural invasion in patients with conjunctival squamous cell carcinoma and of its aggressive nature may be life-saving. Nevertheless, even with initial aggressive tumor control, some patients will show an aggressive tumor growth with recurrences.
Abstract: We present a 52-year-old woman who was diagnosed with surgically induced necrotizing scleritis 48 years after strabismus surgery. This case demonstrates the importance of a high index of suspicion for this sight-threatening condition, even many years after strabismus surgery.
Abstract: To present a series of patients with a clinical diagnosis of periocular keratoacanthoma and assess the incidence of histologically proven invasive squamous cell carcinoma (SCC).
Abstract: Aberrant facial nerve regeneration (AFR) following facial nerve palsy may give rise to ptosis because of increased orbicularis tone. We describe a series of patients presenting with ptosis where the underlying aetiology of AFR was often not recognized by the referring clinicians.
Abstract: To present the findings and report the outcomes of all patients with periocular squamous intraepidermal carcinoma (IEC) treated with Mohs micrographic surgery (MMS) in Australia between 1993 and 1999.
Abstract: To evaluate the rate of recurrence of horizontal laxity or lid malposition and suture-related complications associated with the use of an absorbable suture in the lateral tarsal strip procedure.
Abstract: To assess the margins required for excision of lentigo maligna (LM) and lentigo maligna melanoma (LMM) by the technique of mapped serial excision (MSE), and to assess the efficacy of MSE.
Abstract: A 54-year-old man presented with an orbitofrontal cholesterol granuloma arising in the left frontal bone and abutting the dura. The lesion was successfully removed with an anterior orbitotomy via a superior lid crease incision. A 70-degree rigid endoscope was used to visualize removal of the granuloma from the inner surface of frontal bone and the dura. The patient made an uncomplicated recovery and there was no recurrence at two years follow-up. A combined anterior orbital and endoscopic approach may be an alternative to either frontal craniotomy or lateral orbitotomy in selected cases of orbitofrontal cholesterol granuloma.
Abstract: To describe three cases of frontal osteoma which were safely removed with a stereotactic-assisted, endoscopic modified Lothrop approach (EMLP).
Abstract: A 14-year-old boy with 11 mm of proptosis and exposure keratopathy secondary to an orbital lymphangioma underwent surgical debulking with a carbon dioxide laser through a lateral orbitotomy combined with a 3-wall orbital decompression. The proptosis was reduced by approximately 2 mm as a result of the debulking procedure, but a further 5 mm reduction was achieved with the orbital decompression. No serious adverse effects were encountered. Bony orbital decompression may be a useful alternative treatment in patients with severe proptosis secondary to orbital lymphangioma.
Abstract: A 26-year-old Asian woman presented with bilateral disk swelling, retinal exudates and infarcts. Evaluation found the underlying cause of the hypertensive optic neuropathy to be renal artery stenosis due to Takayasu's arteritis.
Abstract: To present the results of all patients with periocular squamous cell carcinoma (SCC) treated with Mohs' micrographic surgery (MMS) in Australia between 1993 and 1999.
Abstract: To evaluate the results of endoscopic sinus surgery (ESS) for paranasal sinus mucocoele with orbital involvement and assess the frequency with which a direct orbital approach is required in these cases.
Abstract: Thyroid orbitopathy is characterized by spontaneous remissions and exacerbations. Although data on the natural history are scarce, the active phase is usually self-limited, encompassing an average period of 18-36 months. Late reactivation, defined as active orbitopathy occurring after more than 5 years of quiescent disease, appears to be an uncommon and poorly documented event. The aim of the present study was to assess the incidence and characteristics of late reactivation of thyroid orbitopathy within a tertiary referral orbital clinic.
Abstract: Sebaceous carcinoma (SC) accounts for 1% to 5.5% of all eyelid malignancies. Diagnosis is often delayed because of its ability to masquerade as other periocular lesions both clinically and histologically.
Abstract: To present the findings of all patients with periocular basal cell carcinoma (BCC) treated with Mohs' micrographic surgery (MMS) in Australia between 1993 and 1999.
Abstract: To report the outcome with 5-year strict follow-up (only cases where 5-year follow-up is available) of all patients with periocular basal cell carcinoma (BCC) treated with Mohs' micrographic surgery (MMS) in Australia between 1993 and 1996.
Abstract: Primary tumors of orbital bone constitute 0.6% to 2% of all orbital tumors. Our experience over a 24-year period in the Orbital Clinic at the University of British Columbia yielded 62 (1.9%) cases from a total of 3,340 orbital tumors. Although a heterogeneous group, primary orbital bone tumors may be classified on a clinicopathologic basis into benign fibro-osseous or cartilaginous, reactive, neoplastic and vascular disorders. Presentation is usually a gradual mass effect, with infiltration and acute hemorrhage being features of malignant and reactive lesions respectively. The two most commonly encountered entities were fibrous dysplasia and osteoma, accounting for 22 cases. Although both these conditions rarely present a diagnostic challenge, nonspecific histologic and radiologic appearances can result in poor characterization of several of the rarer lesions. Hence, close cooperation between clinician, radiologist and pathologist is essential for accurate diagnosis.
Abstract: This study evaluated the efficacy of the modified endoscopic Lothrop procedure (MELP) for complicated frontal mucoceles and endoscopic marsupialization for other paranasal sinus mucoceles. It was a retrospective, consecutive case review of sinus mucoceles treated endoscopically by a single surgeon over a four-year period (1998-2002). There were 41 mucoceles in 28 patients, including 24 frontal, eight frontoethmoidal, three ethmoidal, five maxillary and one frontal mucocele. Twenty-one patients underwent the modified Lothrop procedure for frontal mucoceles, and seven underwent simple drainage and marsupialization for frontoethmoidal, ethmoidal and maxillary mucoceles. At median follow-up of 16 months, all patients had a patent mucocele opening. Patients treated by drainage and marsupialization did not have any complications or mucocele recurrence. All patients treated by the modified endoscopic Lothrop procedure had improvement in symptoms and signs. Four patients had minor complications including epistaxis and adhesions and five required further surgery. The average hospital in-patient stay was 2 +/- 1.4 days. Endoscopic techniques, including MELP are effective in the short term for the management of complex and simple paranasal sinus mucoceles. MELP has a useful place in the management of mucoceles with a significant bony partition from an adjacent sinus or nasal cavity. It is also indicated when the mucocele is associated with loss of lateral support in the sinus with risk of medial-wall collapse of the orbital contents obstructing drainage.
Abstract: Two cases of post-traumatic maxillary sinus mucoceles are described. In both scenarios, the patients had sustained severe facial injuries many years prior to presentation. Proptosis and globe displacement were identified clinically, and both patients had radiographic evidence of a maxillary sinus mucocele. Maxillary sinus mucoceles may occur as a late complication of facial fractures even if the draining ostium is normal.
Abstract: Atypical fibroxanthoma (AFX) and malignant fibrous histiocytoma (MFH) are neoplasms of probable fibrohistiocytic lineage. The precise relationship between AFX and MFH remains controversial. We present two cases in which a lesion was excised from the face of an elderly person and reported as AFX. Both cases recurred within 12 months and were reclassified as MFH. They were excised with slow Mohs' micrographic surgery, with adjuvant radiotherapy in one case. In the other, a further recurrence was treated with orbital exenteration and radiotherapy. We review the difficulties in differentiating between AFX and MFH and the implications for treatment.
Abstract: A 28-year-old woman had an extensive osteoma arising in the frontoethmoidal sinuses and involving the orbital roof. The tumor was successfully removed by means of a combined sinus endoscopic and orbital approach, with the assistance of stereotactic localization. The patient had postoperative ptosis, diplopia, and supraorbital nerve anesthesia, which all resolved over a 3-month period. A stereotactic-assisted, sino-orbital approach to selected frontoethmoidal osteomas may provide a viable alternative to an orbitocranial approach.
Abstract: Discoid lupus erythematosus (DLE) is an autoimmune disorder that usually affects the sun-exposed skin. Periocular involvement occurs uncommonly and may progress from eyelid erythema to scarring and madarosis.
Abstract: Thyroid orbitopathy (thyroid eye disease, thyroid ophthalmopathy) is an organ specific, autoimmune disorder with the potential to cause severe functional and psychosocial effects.
Abstract: Trichilemmal carcinoma (TLC) is a rare adnexal tumour related to the external hair sheath. We describe the first case of TLC on the upper eyelid to be treated with Mohs micrographic surgery.
Abstract: This paper describes the use of endoscopic visualization in curettage of orbital cholesterol granuloma (OCG). Two males aged 54 and 50 years presented with orbitofrontal cholesterol granulomas arising in the superolateral frontal bone and abutting the dura. The granulomas were approached via a superior eyelid crease incision and a 70 degree rigid endoscope was used to visualize curettage of the granuloma from the inner surface of the frontal bone and the dura. Both patients made an uncomplicated recovery and there was no recurrence at eight months and two years follow up. Percutaneous endoscopic curettage is an alternative to blind curettage, lateral orbitotomy or frontal craniotomy for OCG.
Abstract: To report the early cure rate for periocular lentigo maligna (LM) and LM melanoma (LMM), using modified Mohs surgery with vertically cut paraffin-embedded sections (mapped serial excision [MSE]). A secondary aim was to identify differences in the clinical features and outcomes between periocular LM and LMM and those found elsewhere on the head and neck.
Abstract: To report a case of punctal-canalicular stenosis after topical mitomycin C use for corneal dysplasia. To the authors' knowledge, this association has not previously been described.
Abstract: Two cases are presented of orbital cholesterol granuloma associated with gradual proptosis arising in men aged 35 and 41 years. Computed tomography demonstrated osteo-lytic masses in the frontal bone at the lacrimal fossa. Curettage revealed a characteristic histology of foreign body reactions surrounding cholesterol clefts. In both cases abnormal bone, more consistent with fibrous dysplasia than reactive change, was found at the periphery. The finding of abnormal bone associated with orbital cholesterol granulomas suggests that a pre-existing bone anomaly may be present in a subset of these cases.
Abstract: A 34-year-old man presented with bilateral inferior and lateral globe displacement and spontaneous, dynamic proptosis in both eyes, pulsatile in nature. Computed tomography and magnetic resonance imaging scans confirmed bilateral frontoethmoidal mucoceles with erosion of the orbital roof, and intracranial extension. Following a transcutaneous mini-trephine of the left orbital mucocele, the dynamic proptosis disappeared, and both proptosis and restriction of eye movements in the left eye improved. This is the first reported case of frontoethmoidal sinus mucocele causing bilateral spontaneous dynamic proptosis.
Abstract: We present a case of recurrent, nodulocystic and morphoeic basal cell carcinoma (BCC) at the lateral canthus, with clinically silent orbital and intracranial invasion which was treated with radiotherapy. Orbital invasion is a rare complication of periocular BCC and occurs primarily in high-risk canthal lesions. Preoperative ophthalmological review and imaging should be considered in these cases.
Abstract: Haemangiopericytoma (HPC) of the orbit is a rare tumour occurring in all age groups and presenting with slowly progressive proptosis, ocular motility impairment and visual loss. Although most are benign tumours that are resectable at diagnosis, one-third of these tumours demonstrate malignant features and recur locally or metastasize, usually with a fatal outcome. In 1995, a morphologically unique variant, termed lipomatous haemangiopericytoma (L-HPC), was described. Only one case has been reported previously arising in the orbit. In this paper, a case is reported of L-HPC occurring in the orbit and consider the prognostic implications of this HPC variant.
Abstract: Orbital foreign bodies may be difficult to diagnose clinically and radiologically. In cases where a foreign body is suspected, both the mechanism of injury and the composition of the offending material need to be taken into account. A case is described of an orbital foreign body misdiagnosed as a superior orbital rim fracture, resulting in persistent ptosis and diplopia, and leading to delayed recovery for the patient, a commercial airline pilot.
Abstract: To present a case of orbital granulomatous giant cell myositis and review the literature. We describe the case of a 51-year-old woman, with a past history of melanoma, who presented with an acutely painful orbital myositis. This evolved into a chronic relapsing process involving multiple muscles bilaterally; which demonstrated partial steroid responsiveness. Biopsy revealed a granulomatous giant cell myositis. Orbital granulomatous giant cell myositis is a rare histological entity which has an association with giant cell myocarditis and underlying malignancy.
Abstract: Hypovitaminosis A is a well-recognized condition in many developing countries. However, in the developed world the diagnosis is frequently missed or delayed because of its rarity. A 67-year-old man from metropolitan Adelaide presented to us with gradual but severe bilateral visual loss. He had marked punctate epithelial keratopathy in both eyes. Hypovitaminosis was suspected because of his bizarre dietary habit, and this was confirmed by a combination of impression cytology of the ocular surface and biochemical testing of his venous blood. His vision responded dramatically to vitamin A supplementation. Hypovitaminosis A should be suspected in severe cases of 'dry-eye', especially in those patients with unusual dietary habit or malabsorption.
