Rampat, Radhika; Gupta, Ankur; Henderson, Hugo; Ezra, Daniel
Here, the authors present 2 rare cases of nontraumatic subperiosteal orbital hemorrhage during uncomplicated labor. Case 1 (Fig. 1) shows a 29-year-old primigravida Caucasian with an uneventful antepartum course that developed sudden-onset diplopia and right-sided proptosis during labor. She had no significant medical history including bleeding disorders or dyscrasias and was not on any medication. The patient reported noting double vision and dull ache during labor. Examination findings were within normal limits apart from a 5-mm proptosis and slight limitation in upgaze. The patient received conservative management, and by 2 weeks, full resolution had occurred clinically. Case 2 (Fig. 2) shows a 31-year old multigravid Caucasian with a very similar history. She was only diagnosed when she presented 3 days later to the authors’ eye casualty with double vision. Her visual parameters were also not affected just as in case 1; thus, an intervention was not performed. Both interestingly had a right superomedial nontraumatic subperiosteal orbital hemorrhage, which could be a defining clinical presentation in uncomplicated labor-induced nontraumatic subperiosteal orbital hemorrhage.
Ali, Mohammad Javed
Septate lacrimal sac diverticula are uncommon and can present with acute dacryocystitis. Their management can pose surgical challenges. A boy, aged 5 years, presented with swelling of the inner side of right lower lid with epiphora of 1-year duration with an acute pain of 2-days duration (Fig.A). There was a history of 2 such episodes of pain and redness; however, there was no history of trauma, discharge, or surgical interventions. Clinical examination showed a tender multilobulated, firm lesion on palpation. Ocular examination was normal. CT scan showed a hypodense and homogenous mass with multiple, well-defined internal septae, involving the medial lower lid and bony lacrimal fossa (Fig.B). The lesion also appeared to be in contiguity with the lacrimal sac and upper nasolacrimal duct without a clear plane of distinction (Fig.C). An impression of a possible lacrimal sac diverticulitis with multiple internal septae was made. Patient was started on conservative treatment to reduce inflammation, and a surgical exploration was planned. Lacrimal irrigation was suggestive of a right nasolacrimal duct obstruction while the left side was patent. Surgical exploration revealed the lesion to be a multilobulated dermoid cyst with focal areas of keratin leak (Fig.D). The medial aspect of the lesion was adherent to the lateral walls of lacrimal sac and upper nasolacrimal duct (Fig.E). The lesion was carefully separated along with the adherent perilacrimal fascia (Fig.F). Post excision, the lacrimal drainage irrigation was freely patent. The adherent nature of the dermoid cyst with the wall of lacrimal sac could be secondary to inflammation and hence appeared contiguous on imaging. This case demonstrates the differential diagnosis of a septate lacrimal fossa lesion, and both possibilities should be kept in mind when approaching such presentations.
Stevenson, Louis J.; McElnea, Elizabeth M.; McKelvie, Penelope A.; Hardy, Thomas G. Less
A 68-year-old female presented for assessment of a space occupying lesion of her right orbit, demonstrated on MRI. An upper lid crease anterior orbitotomy was performed and the lesion excised completely. Postoperatively, she had reduced sensation in the distribution of the supraorbital nerve. Histopathologic examination of the excised lesion revealed a hybrid neurofibroma/schwannoma. This represents the fourth reported case of such a lesion arising within the orbit.
Cheong, Timothy Z.; Davies, Rodger P.
An 81-year-old man with unilateral nasolacrimal duct obstruction underwent routine endonasal dacryocystorhinostomy and 2 days postoperatively developed a severe headache and rigors. Subsequent CT and MRI imaging demonstrated a defect in the floor of the right anterior cranial fossa, which possibly was damaged during the operation, and meningoencephalitis of the adjacent frontal lobe gyrus. Following intravenous antibiotic treatment, the patient made a full recovery with no ongoing sequelae, and his epiphora completely resolved. To the authors’ knowledge, this is the first report of meningoencephalitis following endonasal dacryocystorhinostomy. This complication should be considered in any patient with a febrile septic presentation or headache following endonasal dacryocystorhinostomy.
Charles, Norman C.; Jakobiec, Frederick A.; Ma, Lina; Belinsky, Irina
A yellow cystic lesion of the caruncle in a 23-year-old woman proved to be a solitary steatocystoma, a rare occurrence in that location. While the histopathologic diagnosis was evident from clusters of sebaceous cells within the cyst wall, a panel of immunohistochemical stains further distinguished the lesion from a keratinous cyst. The most useful stains for differentiating the two conditions were carcinoembryonic antigen, epithelial membrane antigen, cytokeratins 17 and 19, and calretinin. Only three previous cases of caruncular steatocystoma simplex have been reported, none of which included immunohistochemical studies. The current findings support the origin of the cyst from the small duct that connects the unilobular sebaceous gland associated with vellus hairs to the follicular canal.
Rai, Ravneet S.; Rowlands, Megan A.; Kally, Peter M.; Warren, Floyd
The authors describe the case of a 19-year-old female who suffered posttraumatic emphysema of the optic nerve sheath. She suffered massive head trauma requiring emergent neurosurgery and was incidentally found to have air in her optic nerve sheath on CT scan. At 6 weeks follow up, her visual acuity (20/25 uncorrected) and color perception in the affected eye were excellent. Her examination was notable for an afferent pupillary defect, mild disc pallor, and optic nerve atrophy on optical coherence tomography. This is a case of a patient with posttraumatic optic nerve sheath emphysema who recovered excellent visual function and received follow-up ophthalmic imaging.
Srinivasan, Archana; Tuluc, Madalina; Jordan, Arthur J. Jr; Curry, Joseph M.; Bilyk, Jurij R.
Integrase interactor 1 (INI1) is a tumor suppressor gene that is ubiquitously expressed in all nucleated cells. The loss of INI1 protein activity was first demonstrated in aggressive pediatric tumors, including atypical teratoid/rhabdoid (AT/RT) tumor of the central nervous system and malignant rhabdoid tumor of the kidney. Subsequently, INI1 deficiency was discovered in other pediatric and some adult neoplasms. The spectrum of INI1-negative tumors includes a wide variety of neoplasms that occur over a wide age range, are variably aggressive, and have a variable rhabdoid component on histopathologic evaluation. In this report, the authors describe a 27-year-old gravid woman with INI1-deficient carcinoma of the lacrimal gland, previously not described in this location.
Godfrey, Kyle J.; Tooley, Andrea A.; Kazim, Michael
Buphthalmos can create treatment challenges for socket rehabilitation following enucleation due to compression atrophy and mechanical stretching of adnexal tissues. The authors report a case demonstrating a surgical technique for simultaneous volume augmentation of the anophthalmic socket, expansion of the conjunctival fornix, and repair of lower eyelid retraction in a patient with history of buphthalmos and a previously placed 22 mm orbital implant at the time of enucleation. The authors utilized a single-stage, bipedicle dermis fat graft. Postoperatively, the patient demonstrated improvement in lower eyelid position, lower eyelid volume, improved prosthesis fit, improved three-dimensional projection of the ocular prosthesis, and an improvement in the superior sulcus deformity. Bipedicle dermis fat grafts are an option for surgical rehabilitation of the anophthalmic socket when orbital volume deficiency, conjunctival fornix contracture, and eyelid retraction are present and an adequately sized orbital implant has previously been placed.
Liou, Victor; Chisholm, Smith Ann; Logunova, Valentina; Havlik, Robert; Esmaili, Neda
Dermatofibroma sarcoma protuberans (DFSP) is a rare, locally aggressive soft tissue sarcoma with a tendency for recurrence after excision. Although reports of unilateral orbital and bilateral eyelid disease exist, there have been no prior reports of DFSP with bilateral orbital involvement and no previously described cases of DFSP associated with transient optic neuropathy. The authors present a case report of a 34-year-old woman with a giant scalp DFSP involving the bilateral orbits. Despite radical resection with 5 cm margins where possible, multiple positive margins remained including deep positive margins at the bilateral superomedial retroseptal soft tissue. The patient completed adjuvant radiation for surgically unresectable disease. This case highlights the challenge of achieving local control given the disease extent and infiltration of the bilateral eyelids and orbits. This is the first reported case of DFSP with bilateral orbital involvement and associated transient optic neuropathy.
Akella, Sruti S.; Lee, Thomas; Barmettler, Anne
This is the first reported case of lichenoid dermatitis erupting after surgical excision of basal cell carcinoma on the upper eyelid of an African-American woman. Lichenoid dermatitis is a common dermatologic diagnosis which may coexist with superficial malignancies, although the exact interaction between the 2 entities is not entirely known. The authors propose that successful treatment of basal cell carcinoma induces inflammation in the form of lichenoid dermatitis, which may play an adjunct role in eradication of the malignancy. The appearance of lichenoid dermatitis could theoretically represent a positive response to treatment; future studies are needed to establish this.