Kovacs, Kyle D.; Ehrlich, Michael S. M.D
A 65-year-old male with a history of trigeminal-nerve involving CNS lymphoma currently in remission following multiple rounds of chemotherapy and autologous stem-cell transplant subsequently developed trigeminal trophic syndrome. Trigeminal trophic syndrome is a rare consequence of trigeminal nerve damage that yields anesthesia, paresthesia, dysesthesia, and ulceration typically due to self-induced trauma. The patient had known tumor involvement of the right trigeminal nerve before treatment as identified by MRI. Biopsy of the skin lesion demonstrated acanthosis, hypergranulosis, and hyperkeratosis with fibrotic papillary dermis without evidence of organisms, all of which was felt to be consistent with lichen simplex chronicus with superficial erosion consistent with a history of chronic rubbing and irritation. The patient confirmed this suspicion with reports of picking and peeling the skin in the affected distribution to relieve the dysesthesias. The extensive nature of his trigeminal trophic syndrome caused total eyelid paralysis secondary to cicatricial changes of the eyelids and surrounding tissue. Trigeminal trophic syndrome can often result in eyelid involvement, typically manifesting as ulceration with corneal exposure that responds poorly to surgical intervention given poor tissue healing. Given this patient’s paralysis was protecting his cornea, he was observed with conservative measures only including topical mupirocin ointment and mirtazapine for neuropathic pain (Figs. 1–3).
Rodriguez, Maria E.; Burris, Christopher K.; Kauh, Courtney Y.; Potter, Heather D.
A 74-year-old man with no previous history of eye disease (Fig. 1A) presented with episodes of intermittent hemolacria occurring over a 5-month period. When the left upper eyelid was everted, a raised pigmented lesion was seen on the tarsal conjunctiva (Fig. 1B). Histopathology (H&E) revealed a conjunctival melanoma composed of nests within the substantia propria. Marked pleomorphism, atypia, mitotic figures, and multinucleated tumor giant cells (Fig. 1C, arrow) were seen. “Melanoma cocktail” immunohistochemical stain highlighted the tumor cells (Fig. 1D, asterisk). PET/CT scan and a sentinel lymph node biopsy were negative for metastatic disease.
Sultan, Harris; Malik, Amina; Li, Helen K.; Chévez-Barrios, Patricia; Lee, Andrew G.
A 50 year-old man on immunosuppressive agents presented with left eye vision loss, periorbital swelling, pain, and ophthalmoplegia. The patient was clinically found to have a central retinal artery and vein occlusion. A CT scan was performed which demonstrated intraorbital fat stranding, however the patient lacked sinus disease. The etiology of the orbital infection was held in question. The area was debrided in the operating room, and the specimen demonstrated group A streptococcal species consistent with necrotizing fasciitis. Periorbital necrotizing fasciitis should be suspected in patients with rapidly progressive orbital symptoms without sinus disease as lack of surgical intervention can result in poor outcomes. The unusual aspect to this case is the mechanism of vision loss, as the authors hypothesize that there was vascular infiltration of the infection resulting in the central retinal artery occlusion and central retinal vein occlusion which have not been previously reported secondary to necrotizing fasciitis of the orbit.
Christopher, Karen L.; Elner, Victor M.; Demirci, Hakan
The authors describe a 39-year-old woman treated with fingolimod for relapsing-remitting multiple sclerosis for 2 years who then developed a bilateral conjunctival mucosa-associated lymphoid tissue lymphoma. Fingolimod treatment for multiple sclerosis has been associated with lymphoma in 3 previously reported cases. This is the first case of ocular adnexal lymphoma presumed to be due to fingolimod. Given that ophthalmologists regularly monitor many patients on fingolimod for fingolimod-associated macular edema and ophthalmic manifestations of multiple sclerosis, the authors hope to alert physicians of the possibility of ocular adnexal lymphoma in these patients.
Jakobiec, Frederick A.; Stagner, Anna M.; Lee, Nahyoung Grace
A 24-year-old man with a painful, recurrent left upper eyelid nodule underwent an excision. Histopathologic evaluation disclosed a granulomatous process, most likely in response to a ruptured epidermoid cyst. In the vicinity of the nodule were multiple eccrine sweat glands displaying a curious clear-cell appearance in the adlumenal cells, the first example of such a phenomenon in the eyelids. Alcian blue, periodic acid Schiff, and documented staining failed to disclose, respectively, any cytoplasmic mucosubstances, glycogen accumulation, or lipid in the adlumenal secretory cells. Cytokeratin 7 immunostained the adlumenal cells of the eccrine secretory coil, while cytokeratin 5/6 stained the ablumenal myoepithelial and ductular cells. Gross cystic disease fluid protein 15, normally demonstrable in the eccrine secretory cells, was not detectable. Clear-cell transformation should not be confused with syringoma of the lower eyelids, in which glycogen is responsible for the ablumenal clear-cell change.
Singh, Swati; Ali, Mohammad Javed; Naik, Milind N.
Incomplete punctal canalization is a form of punctal dysgenesis with membranous noncanalization and can be confused with punctal agenesis. The clinical and diagnostic features are known; however, familial incomplete punctal canalization has not been reported earlier. A family with 3 affected members is presented in this series with similar incomplete punctal canalization and nasolacrimal duct obstructions. After membranotomy and endoscopic dacryocystorhinostomy with bicanalicular intubation, all of them are free of epiphora at last visit.
Yazici Bulent; Orucov Nesimi; Ibrahimmzade, Gunay
Pseudomonas aeruginosa conjunctivitis, although rare in healthy infants, may cause serious ocular and systemic complications. A 30-day-old, otherwise healthy male infant was referred with the diagnosis of right orbital abscess. The patient had been diagnosed as having Pseudomonas conjunctivitis 9 days previously at the referring center. Despite antibiotic treatment, his ocular findings had worsened and marked proptosis had developed. Other examination findings were ptosis, restriction of eye movements, periorbital erythema, and chemosis. Radiologic studies showed a large, homogenous mass with a thick capsule in the lateral retrobulbar orbit. The abscess was drained through a lateral orbitotomy. A culture of the abscess yielded P. aeruginosa. After surgery, the ocular findings improved rapidly without any complication. No other focus of infection or immune system abnormality was found. The patient did not experience any other significant disease during a follow up of 23 months.
Konstas, Angelos A.; Rootman, Daniel B.; Quiros, Peter A.; Ross, Ian B.
Arteriovenous fistulae of the orbit are exceedingly rare. They are high-flow vascular malformations involving a fistula from the ophthalmic artery to one of the draining ophthalmic veins. Presenting symptoms can mimic those of carotid cavernous fistulae or of ophthalmic venous varices, and include diplopia, proptosis, chemosis, decreased visual acuity, and retro-orbital pain. Very few case reports are published on the treatment of this aggressive vascular malformation, and they uniformly describe techniques involving a transvenous access for the embolization of the fistula.1–6 To the best of authors’ knowledge, they report the first case of transarterial embolization of an intraorbital AVF.
Tse, Brian C.; McKeown, Craig A.; Tse, David T.
A 49-year-old woman with debilitating nystagmus and oscillopsia failed conservative therapy. A titanium T-plate was anchored to the lateral orbital rim and cantilevered into the orbit where it was secured to the inferior rectus muscle tendon with a suture. After the procedure was performed on both eyes, the patient had significant decreases in the amplitudes of her nystagmus and oscillopsia, thereby improving her daily function. She had sustained duration of effect through 7 years of follow up. This novel surgical technique holds promise in the treatment of acquired nystagmus and debilitating oscillopsia for which conventional therapy may be ineffective. The case report is in compliance with the Health Insurance Portability and Accountability Act.
Brown, Sebastian J.; McNab, Alan A.
A 55-year-old man presented with progressive “enophthalmos” of his ocular prosthesis, 12 years after secondary orbital implant placement following evisceration of a severe traumatic globe rupture. The medial orbital wall was found to be displaced inwards, associated with ethmoid sinus opacification, and consistent with post traumatic silent sinus syndrome affecting the ethmoid paranasal sinuses. The authors present the clinical and radiological findings, review the literature on silent sinus syndrome of nonmaxillary sinuses, and discuss the possible mechanisms for his presentation.