Fayet, Bruno; Racy, Emmanuel; Bordonné, Corinne; Katowitz, William R.; Katowitz, James; Brémond-Gignac, Dominique
The authors report the case of a 7-year old child with failed probing with stent intubation, who was found to have an unusual curvature of the nasolacrimal duct on the symptomatic side. CT imaging revealed a permanent maxillary canine tooth adjacent to the duct. It appeared that the relationship of the tooth bud to the curved nasolacrimal duct was most likely responsible for the symptoms of epiphora on this anomalous side.
Dryden, Stephen C.; Fleming, James C.
This is the first reported case of necrotizing nasal and sinus herpes infection with orbital involvement. A 94-year-old male with a past medical history of hypertension, congestive heart failure, and chronic kidney disease presented with necrotic nasal cellulitis and a red left eye with blurry vision. Onset was 2 weeks prior with an upper lip fever blister. He was admitted to medicine and started on antimicrobials. Maxillofacial computed tomography scan revealed pansinusitis with involvement of bilateral medial orbital walls. Initial nasal biopsy was negative. Repeat biopsy was positive for herpes simplex virus 1. His nose was debrided with full-thickness skin grafting. While there are reports of necrotizing herpes simplex, none were to the extent of our patient nor raised suspicion for invasive fungal sinusitis. Differentiating is important as this patient made a full recovery in comparison to patients with mucormycosis where mortality is often as high as 80%.
Scofield-Kaplan, Stacy M.; Patel, Sagar Y.; Mancini, Ronald
Reconstruction of the orbital rim and floor following tumor excision is traditionally performed with bone grafts, vascularized grafts, or free flaps. The authors describe a case of an osteosarcoma of the maxillary sinus and a second case of an ossifying fibroma of the orbital floor, both of which required reconstruction of the orbital floor and rim. In both of these cases, reconstruction of the orbital floor and rim was performed with a titanium implant whose anterior portion was bent inferiorly to recreate the orbital rim. Acellular dermis was sutured over the anterior portion of the orbital implant to act as a barrier between the implant and the overlying eyelid tissues.
Men, Clara J.; Yang, Patrick; Gur, Zvi; Paik, Ji-Sun; Kikkawa, Don O.; Korn, Bobby S.
A 69-year-old woman presented to the oculofacial plastic service with a painless superotemporal subconjunctival mass in the OS. Over the past year, the lesion had been progressively enlarging, resulting in horizontal diplopia with lateral gaze. Visual acuity was within normal limits with no evidence of optic neuropathy. On examination, the lesion was tense, transilluminated, and was clinically consistent with a simple dacryops. Complete excision of the lesion was planned under local anesthesia with monitored care. To facilitate complete removal of the lesion, fibrinogen and a mixture of thrombin and trypan blue were injected to fill the cyst cavity. This blue-stained fibrin clot allowed for easy visualization of the border and ensured complete excision without collateral damage to surrounding normal tissue. Simple dacryops is often difficult to remove completely with its capsule intact and this technique allows for clear delineation of the cyst and preservation of epithelial integrity for complete and efficient removal.
Nadal, Jeremy; Daien, Vincent; Audemard, Didier; Jeanjean, Luc
Pourfour du Petit syndrome is an uncommon cause of eyelid retraction, associated with unilateral mydriasis and hemifacial hyperhidrosis. This syndrome is caused by hyperactivity of the ipsilateral oculosympathetic pathway and needs to be recognized because it has an opposite clinical presentation but the same topographic and diagnostic value as Horner syndrome. The authors report a rare case of Pourfour du Petit syndrome associated with cluster headache and discuss pathophysiological hypotheses, clinical presentation, complementary exams, pharmacologic testing, treatment options, and prognosis. Early detection of these symptoms may lead to swift diagnosis and treatment.
Carrere, Jonathan; Lewis, Kyle
A 9-month-old male presented with gradual right medial canthus swelling since age 3 months. On examination, there was a medial cystic orbital mass causing significant telecanthus and lateral displacement of the right globe (Fig. A). There was limited adduction of the right eye and exotropia. The patient was able to fix and follow a penlight. The pupils were briskly reactive in both eyes, and there was no relative afferent pupillary defect. The anterior and fundus examinations were normal in both eyes. Endonasal exam was unremarkable. An axial and coronal computed tomography scan (Fig. B,C) showed a large (3.7 × 2.3 × 3.5 cm) medial cystic lesion arising from the lacrimal system. There were no bony defects or encephalocele noted. The patient underwent nasolacrimal duct probing, which was unsuccessful as the probe was unable to pass into the nasolacrimal duct. Dacryocystorhinostomy resulted in decompression of the dacryocystocele and return of normal eye position.
Congenital dacryocystocele is seen in the setting of nasolacrimal duct obstruction in the neonatal period. As in this case, goblet cells lining the lacrimal sac can continuously secrete mucous and cause dacryocystocele enlargement over time. Complications include infection, intranasal extension, airway obstruction (if bilateral), and rarely intraorbital extension. Massive orbital extension of a dacryocystocele can mimic other orbital masses, including encephalocele, dermoid cyst, or neoplasms, and may require adjunctive imaging for diagnosis.
Williams, Katherine J.; Weber, Adam C.; Yen, Michael T.
A 79-year-old man was referred with acute left upper eyelid droop and binocular diplopia without headache, nausea, or changes in visual acuity.
The patient had a history of pituitary adenoma resection 16 years before and recent bladder carcinoma treated with immunotherapy.
Visual acuity was 20/30 in the right eye and 20/25 in the left eye. There was a pronounced left upper eyelid ptosis with margin reflex distance of 1 mm and decreased levator function. Extraocular motility was notable for a slight limitation in upward duction of the left eye. There was no hypoesthesia or anesthesia of the face.
There was strong suspicion of a left-side partial third-nerve palsy. An urgent MRI was obtained and showed a sellar and suprasellar mass, measuring 2.0 × 3.5 × 2.0 cm. The mass invaded bilateral cavernous sinuses without mass effect on the optic chiasm (Fig. A, B). The mass appeared to contact and partially encase the bilateral cavernous internal carotid arteries, as well as the basilar artery and bilateral posterior cerebral arteries.
Surgical excision confirmed a mucocele extending from the sphenoid sinus.
Pituitary apoplexy has previously been reported as a cause of third-nerve palsy; however, mucoceles as a cause are poorly represented in the literature to date. While oculomotor nerve deficit is a rare known complication of transsphenoidal surgery for pituitary adenomas, patients with new-onset diplopia and ptosis even many years after their initial resection should be carefully evaluated with imaging for recurrence or new masses when clinical findings warrant. Clinicians should also be mindful that late-onset problems after surgery can develop.
Kalin-Hajdu, Evan; Kersten, Robert C.
Although generally safe, hyaluronic acid rejuvenation of periorbital tissue has been reported to cause minor and major adverse events. The authors document a case of nasolacrimal duct obstruction due to hyaluronic acid rejuvenation of the tear trough. Nasolacrimal duct obstruction immediately resolved following irrigation of hyaluronidase into the affected lacrimal system. To the authors’ knowledge, this is the first reported case of nasolacrimal duct obstruction due to filler injection.
Joganathan, Varajini; Norris, Jonathan H.
Epidermal growth factor receptor tyrosine kinase inhibitor therapy has been increasingly employed in the treatment of a variety of tumors. The authors report the rarely documented side effect of trichiasis with the use of Afatinib in a patient with spinal chordoma and review-related literature. A 67-year-old lady was referred to the oculoplastic service with a 3-month history of ocular irritation and pain associated with blurred vision. She has a 4-year history of spinal chordoma treated with daily Afatinib 50 mg over the past 6 months. Clinical examination revealed trichomegaly and trichiasis affecting all 4 eyelids associated with blepharitis, conjunctival, and corneal abrasion on fluorescein staining. Hypertrichosis of the eyebrow bilaterally was also present. Afatinib and other epidermal growth factor receptor tyrosine kinase inhibitor–associated changes to eyelash and eyebrow hair is a result of epidermal growth factor receptor pathway activation in keratinocytes results in remodeling of the hair follicle. This results in the variation in the severity of clinical presentation of trichiasis.
Harris, Brandon F.; Harris, Justin P.; Ducey, Timothy J.; Boden, John H.; Yakopson, Vladimir S.
The authors report a case of phakomatous choristoma presenting as an orbital tumor with involvement of the inferior oblique muscle. This is the only known case of this rare tumor directly invading and incorporating the inferior oblique. This tumor should be included in the differential of eyelid tumors and orbital tumors in infants. Finally, the authors review the histopathological and embryological characteristics of this lenticular tumor.