Poonam Sagar, Ravi Shankar, Vikram Wadhwa, Ishwar Singh & Nita Khurana
Tuberculosis is an airborne communicable disease primarily affecting lungs. Primary tuberculosis of the lacrimal sac is very rare. A 15-year-old girl presented with bilateral epiphora for 8 months. Examination revealed bilateral nasolacrimal duct obstruction. During dacryocystorhinostomy, bone over lacrimal sac was found partially eroded. Lacrimal sac was found filled with caseous white material. Biopsy from the lacrimal sac revealed tubercular granulomas. Patient improved after anti-tubercular therapy.
Michelle M. Maeng, Kyle J. Godfrey & Michael Kazim
Dermoid cysts are histologically defined as surface epithelium encapsulating an inner lumen. They are well described in the literature as discrete, single masses, either circumscribed or dumbbell-shaped, with or without a longstanding fistula. Chronic granulomatous inflammation is often a feature of dermoid cysts, contributing to local soft tissue and bony destruction. Isolated multicystic dermoids are not well described. We present a case of a multilobular dermoid characterized both radiographically and histopathologically. These findings may be attributed to repeated rupture and reformation of the dermoid cyst. When possible, our experience favours early excision of orbital dermoid cysts to minimize morbidity.
Michael C. Yang, Saba Al-Hashimi & Daniel B. Rootman
Salzmann’s nodular degeneration (SND) typically occurs in patients who are female, 50–60 years old, and have a history of corneal inflammation and irritation. Multiple case reports have documented associations between SND and trachoma, viral infections, trauma, contact lens wear, corneal surgeries and corneal exposure. The authors describe a patient with bilateral SND confirmed by anterior segment optical coherence tomography (OCT) imaging in the context of thyroid eye disease (TED) and history of LASIK. Treatment involved propylthiouracil (PTU), artificial tear use, loteprednol etabonate ophthalmic gel, eyelid taping and selenium supplementation and prospective superficial keratectomy with diamond burr polish.
Zubair A. Ansari, Catherine J. Choi, Andrew J. Rong, Benjamin P. Erickson & David T. Tse
A 20-year-old woman presented with loss of vision in her right eye and a “black nose” after receiving hyaluronic acid filler injections in her right glabella 1 month prior. Her vision was no light perception, and external examination revealed resolving skin necrosis at the nasal tip. A dilated fundus exam showed a fibrotic membrane emanating from a pale optic nerve and a diffusely atrophic retina with sclerotic vessels. An MRI demonstrated scattered right-sided parietal lobe infarcts. These findings were consistent with inadvertent cannulation of the supraorbital artery, followed by injection of filler into the internal carotid circulation. The product traveled in a retrograde fashion, occluding the right ophthalmic artery, right dorsal nasal artery, and arterial segments to the Circle of Willis. This case highlights the importance of understanding the complex vascular architecture of the periorbita and the mechanism by which such occlusions occur.
Nicholas A. Moore, Roxana Fu, Jeremy Clark, Mark Prendes, William R. Nunery, Richard A. Burgett & H.B. Harold Lee
Purpose: The anterior vestibule salvaging (‘Birdcage’) technique may limit orbital implant extrusion following evisceration.
Methods: A 10-year retrospective chart review from 2005 to 2015 of individuals who underwent evisceration procedures utilizing the vestibule salvaging technique was performed.
Results: A total of 96 patients (61 male; 35 female; average age 64 years; range 17–96 years) underwent evisceration with a technique avoiding anterior scleral relaxing incisions. Three (3.1%) patients had documented extrusion of the silicone implant. Time from evisceration to extrusion ranged from 26 to 372 days.
Conclusions: Maintenance of the anterior scleral vestibule during evisceration may decrease extrusion rates after surgery compared with traditional evisceration techniques that utilize anterior relaxing incisions.
Sergio Petroni, Paolo Capozzi, Rosa Parrilla, Gaetano Zinzanella & Luca Buzzonetti
Purpose: To evaluate the surgical outcome of a frontalis sling using deep temporal fascia in the treatment of severe congenital ptosis (SCP).
Methods: A retrospective, interventional case series was performed. The study involved 25 patients with SCP (>4 mm). All patients underwent frontalis sling surgery with deep temporal fascia between 2004 and 2012 with a follow-up period of 12 months at a minimum. Data regarding eyelid position, eyelid symmetry, cosmetic outcomes, and postoperative complications were evaluated.
Results: The mean age at surgery was 7.68 years (range 4–17 years) with an average follow-up of 60 months (range is 12–108 months). The functional success rate was 88% (22/25). Ptosis recurred in 8% (2/25) of patients, overcorrection was present in 4% (1/25) of patients. The patients with ptosis recurrence underwent reoperation.
The preoperative margin-to-reflex distance (MRD1) was −0.85±0.87 mm (range, −2.5 to + 0.5 mm), while the postoperative MRD1 was + 2.1 ± 1.05 mm (range, −1.5 to + 4 mm) (p < .0001). Lid symmetry (asymmetry < of 1 mm of MRD1 between the two eyes) was present in all the successful cases.
Postoperative complications included transient exposure keratopathy (32%) and inflammatory brow reaction (8%).
Conclusions: Frontalis sling operation with deep fascia temporalis is very effective in the treatment of SCP with excellent long-term functional and cosmetic successes.
David S. Curragh, Alkis J. Psaltis, Neil C. Tan & Dinesh Selva
Purpose: To report a case of a lacrimal sac tumour and describe a prelacrimal approach to the maxillary sinus to excise the nasolacrimal duct in its management. To our knowledge, this approach has not been adapted to remove the nasolacrimal duct for the management of pathological processes involving the nasolacrimal system.
Methods: A 58-year-old female patient presented with a 6-month history of epiphora. A lacrimal sac mass was identified, and a biopsy revealed squamous cell carcinoma. Surgical excision was performed via a combined external and endoscopic prelacrimal approach.
Results: A prelacrimal approach to the maxillary sinus to excise the nasolacrimal duct in combination with an external approach facilitated an en-bloc excision of the nasolacrimal apparatus. This allowed preservation on the entire inferior turbinate following reconstitution of the lateral nasal wall at the completion of the procedure.
Conclusion: The endoscopic endonasal prelacrimal approach to the maxillary sinus is a useful method to approach and excise the nasolacrimal duct in the management of nasolacrimal pathology.
Shoaib Ugradar, Robert Goldberg & Daniel Rootman
Purpose: To characterise variations in the location of the optic canal and its entry into the orbit in relation to the sphenoid sinus.
Methods: In this observational study, patients with high-resolution computed tomography (CT) scans seen by 2 specialists (RG and DR) over a period of 12 years were reviewed for study entry. The primary outcome measure was characterisation of the optic canal route in relation to the sphenoid sinus and the location of its opening within the orbit. Three-dimensional reconstructions of the bony orbits were created using the Mimics imaging software. Optic canals were classified according to the location of their entry into the orbit. Type 1 was defined as a canalicular course along the lateral wall of the sphenoid sinus and entry into the orbit through the medial wall. Type 2 was defined as a canalicular course in the superior wall of the sphenoid sinus with entry into the orbit through the roof. The angle of entry of each nerve into the orbit was calculated.
Results: One-hundred patients (52 females and 48 males) contributed 100 orbits to the study. Type 1 configuration was noted in 90 orbits, whereas Type 2 was noted in 10 orbits. The mean angle (SD) of entry of Type 1 optic nerves into the orbit was 61° (10.7), whereas the angle of entry of Type 2 nerves was 32.35° (6.8). The difference was significant (p < 0.01).
Conclusions: This study demonstrates variability of the path and outlet of the optic canal and presents a relatively common (10%) configuration in which the optic canal travels in the roof of the sphenoid sinus rather than the expected position in the lateral wall.
Mohammad Javed Ali, Tarjani Vivek Dave, Dilip Kumar Mishra & Milind N. Naik
Purpose: The aim of this study was to perform a histopathological assessment of the efficacy of sclerosing agents in dacryocystosclerotherapy (DCST) and to evaluate its role as an alternative to dacryocystectomy (DCT) in a specific group of patients.
Methods: Thirteen lacrimal drainage systems of 10 patients with primary acquired nasolacrimal duct obstruction (PANDO) were studied. All patients were awaiting a DCT, indications being repeated attacks of dacryocystitis with severe systemic or ocular co-morbidities and/or refusal for a dacryocystorhinostomy. Fluorescent labelled sodium tetradecyl sulphate (SDS) or bleomycin were used as sclerosing agents for a DCST taking specific precautions. All patients underwent a DCT after 4 weeks and histopathological evaluation was performed to assess the changes and extent of DCST.
Results: There were nine females and one male, and all patients were above the age of 60 years. Of the 13 lacrimal systems studied, the mean duration of PANDO was 1.3 years. All the patients had associated systemic and/or ocular co-morbidities. SDS and bleomycin were used in 6 and 7 lacrimal systems, respectively. The mean doses used for SDS and bleomycin were 0.26 and 0.31 cc, respectively. The post-injection phase was uneventful except for one patient who had a moderate inflammation, which resolved with low dose oral steroids. Histopathological features were more marked in the SDS group and included loss of epithelium, luminal closure, gross fibrosis across the lacrimal sac wall, congestion and hyalinization of blood vessels, and multiple areas of haemorrhages in the sac wall.
Conclusions: DCST is a safe and effective alternative to DCT in very carefully selected patients. Histopathology demonstrates SDS to be more effective as compared to bleomycin.
Lee J. Holland, Ken Mitchell Ranzcr, John D. Harrison, Damien Brauchli, Yun Wong & Timothy J. Sullivan
Purpose: The main objective was to report the epidemiology, clinical manifestations, angiography features, treatment modality and post-treatment outcomes in patients diagnosed with carotid cavernous fistulas (CCF).
Methods: A retrospective review of the medical imaging database in conjunction with medical records from 2004 to 2017 at the Royal Brisbane and Women’s Hospital (RBWH) was conducted.We identified 39 patients with CCF (16 direct, 23 indirect). A total of 37 diagnoses were confirmed by direct catheter angiography. The remaining two cases were diagnosed using magnetic resonance imaging/magnetic resonance angiography.
Results: Coils were deployed in 100% of direct and 83% of treated indirect fistulas that were treated. Other embolic agents were deployed alone or in combination with coils. Successful angiographic closure was achieved in 93% of direct and 92% of indirect fistulas. Multiple treatments were required in 33% of direct and 16% of indirect fistulas. Visual acuity improved in patients with direct fistulae(p = 0.02) and was preserved in those with indirect fistulae. Post-treatment diplopia persisted in six patients with direct fistulas and three patients with indirect fistulas. Four patients with indirect fistulas experienced persistent ocular hypertension post-treatment compared to two patients with direct fistulas.
Conclusions: Endovascular coils are the most commonly deployed treatment for CCF. Both indirect and direct fistulas achieved high rates of closure; however, indirect fistulas were less likely to require multiple treatments. Good post-procedural vision was achieved for both groups.