Carolee M. Culter-Peck, Stephen C. Dryden, Brian T. Fowler, Dianne Kovacic, Andrzej Slominski & James C. Fleming
Purpose: To describe common risk factors in patients with Essential Skin Shrinkage (ESS) and identify corresponding histopathologic changes in lower eyelids.
Methods: A case-control study was performed after an Internal Review Board approval was obtained. Consecutive patients who underwent surgical repair for ectropion with ESS of the lower eyelid were enrolled along with 10 control patients. Informed consent was obtained on all patients. Fitzpatrick skin type, history of sun exposure and non-melanoma skin cancer was obtained along with relevant physical exam findings. Skin samples obtained during surgical repair were evaluated by light microscopy for the extent of dermal actinic change. Statistical analysis was performed.
Results: Sixteen study subjects and 10 control patients were enrolled. Subjects were found to be predominantly male, older than controls (p = 0.0011) and have Fitzpatrick skin type (FST) I or II while controls had type I, II or III (p = 0.0221). Hours of sun exposure reported by subjects ranged from 23,165 to greater than 125,000 h, versus 1,459 to 46,890 h in controls (p = 0.0002). Nine of 16 (56%) subjects had a history of skin cancer compared to only 3/10 controls (30%) (p = 0.2475). Histopathologic evaluation using the Fritschi scale for dermal actinic damage identified an average grade of 3.6 for subjects and 2.4 for controls (p = 0.0095).
Conclusions: ESS is predominantly seen in male individuals with FST I or II and a history of extensive sun exposure. Histopathologic evaluation shows moderate to severe actinic damage. These individuals frequently have concomitant non-melanoma skin cancer.
Sheel R. Patel, Priti Mishall & Anne Barmettler
Purpose: To evaluate a human cadaveric model in improving knowledge and comfort of ophthalmology residents performing a lateral canthotomy/cantholysis.
Methods: A prospective study was conducted in ophthalmology residents, who participated in a workshop including an interactive lecture followed by hands-on training on a human cadaver. The lecture consisted of the indications and techniques of lateral canthotomy/cantholysis, along with video-demonstration of proper technique. Residents practiced the procedure on cadavers under faculty supervision. Knowledge and comfort level of conducting the procedure was assessed pre- and post-workshop.
Results: Post-workshop, the residents showed a significant improvement in general knowledge regarding the technique of the procedure. Pre-workshop, the average knowledge score was 9 points out of 18 and this improved post-workshop to 12 points out of 18 (p < 0.0001). Residents showed a significant improvement in comfort levels performing the procedure. Using a Likert scale, the average comfort level of performing the procedure rose from 2.5 (Fair) prior to the workshop to 4 (Very Good) post-workshop (p = <0.01). All participants reported an average score of 4.91 (1 = Strongly Disagree, 5 = Strongly Agree) that the human model workshop was clinically applicable to their training and would impact the quality and safety of patient care.
Conclusion: The study demonstrated an increase in knowledge and comfort in performing lateral canthotomy and cantholysis using a cadaver model. With the time-sensitive nature of orbital compartment syndrome, it is imperative that physicians are comfortable in performing this procedure to prevent permanent vision loss.
Andrew W. Thorne & Daniel Benson Rootman
Purpose: Orbital decompression for thyroid eye disease (TED) has been noted to improve lower lid retraction by 0.5-1 mm. We hypothesize that orbital decompression via transconjunctival approach may lead to increased reduction in marginal reflex distance 2 (MRD2) as it involves division of the lower lid retractors. The purpose of this study is to evaluate relative changes in lower lid position for patients undergoing lateral and transconjunctival orbital decompression, respectively.
Methods: In this cross-sectional study, all TED patients managed with lateral or transconjunctival orbital decompression for a 3-year period were screened for inclusion. Photographs taken in the primary position preoperatively and three months postoperatively were utilized to evaluate the MRD2 from each patient. Measurements were made utilizing NIH ImageJ software standardized to a corneal diameter. Hertel measurements of proptosis were obtained pre and postoperatively. The primary outcome measure was MRD2 in operative eyes.
Results: A total of 131 (86 patients) operative eyes were included in the sample. Mean change MRD2 was not significantly different between the surgical groups (p = 0.07). In multivariate modeling, mean change in MRD2 was significantly associated with change in exophthalmometry, independent of surgical approach.
Conclusions: The association between decrease in Hertel measurement and decrease in MRD2 is consistent with the existing literature on the topic. It appears that transconjunctival division of the lower eyelid retractors provides no additional benefit in reducing lower lid retraction relative to change in proptosis.
Victoria S. Starks, Katherine L. Reinshagen, Nahyoung G. Lee & Suzanne K. Freitag
Purpose: The pathogenesis of dysthyroid optic neuropathy (DON) in thyroid eye disease (TED) is thought to be compression of the apical optic nerve by hypertrophied extraocular muscles. We correlated worsening DON to the area occupied by extraocular muscles.
Methods: Records of adults with TED DON evaluated from 1/1/2013 to 1/1/2018 were retrospectively reviewed. Each patient’s visual field with the worst mean deviation (MD) was selected. Orbit CT scans were reviewed. Reformatted oblique coronal images were created perpendicular to the optic nerve. The cross-sectional area (CSA) of the orbit and each muscle group was measured and expressed as ratios of the CSA of the orbital apex. Univariate and multivariate analysis was performed for predictors of HVF MD.
Results: 34 orbits with TED DON were analyzed. On orbital CT, the superior muscle complex occupied 15% of the apex (range 6–26%), inferior 18% (range 6–33%), lateral 10% (range 4–18%), medial 17% (range 8–27%), and all combined 61% (range 28–80%). Increasing total muscle area and superior complex area correlated with worsening MD. In multivariate linear regression, the superior muscle complex remained a significant predictor of MD (p = 0.01) over total muscle area (p = 0.25).
Conclusions: Enlargement of extraocular muscles is common in TED, but DON occurs in only 6%. Our findings demonstrate that as DON worsens, as quantified by visual field MD, the superior muscle complex crowds the apex. This is consistent with the typical inferior visual field findings seen in TED DON. Hypertrophy of the superior rectus and levator palpabrae superioris complex may be predictive of worsening DON.
Johnathan V. Jeffers, Shehzad Qayum, Asim V. Farooq & Hassan A. Shah
Johnathan V. Jeffers, Shehzad Qayum, Asim V. Farooq & Hassan A. Shah
No abstract available
Yağmur Seda Yeşiltaş, Melek Banu Hoşal, Meltem Kurt Yüksel & Aylin Okçu Heper
Mycosis fungoides is a cutaneous T-cell lymphoma that has been rarely reported to involve ocular structures. Ophthalmic manifestations usually appear in advanced disease. A case of a 58-year-old man presenting with progressive, full thickness, giant upper eyelid mass is presented. The patient had a long history of recurrent tumoral lesions on the trunk and limbs, previously diagnosed as mycosis fungoides. The histopathological examinations of eyelid tumor supported the diagnosis of mycosis fungoides. The mycosis fungoides was stage as IIB (T3N0M0B0) by TNMB classifications and referred to the Hematology and Radiation Oncology clinics. The importance of ophthalmic involvement is being seen in advanced or refractory cases, and there is a possible relation between mycosis fungoides and poor prognosis by being an early indicator of systemic involvement.
David Gallagher, Barry Power, Emily Hughes & Tim Fulcher
Conjunctival epithelial inclusion cysts are an infrequent complication in anophthalmic sockets. The ocular prosthesis may become difficult to retain or it may cause local discomfort. Treatment options described include surgical resection, marsupialisation, and the use of injected sclerosing agents. We present a case of a 27-year-old female who developed a conjunctival epithelial inclusion cyst two years after a left eye evisceration. This invariably caused the ocular prosthesis to become cosmetically unacceptable. Trichloroacetic acid 20% (TCA) was injected intracystically as a minor procedure at the slit lamp. Four months later there was no recurrence of the cyst and the prosthesis retained an excellent position in the socket. This case highlights the successful treatment of a conjunctival epithelial inclusion cyst with TCA (20%) without the need for a surgical procedure.
Chloe FT Ting, Jonathan Lam & Con Anastas
Subgaleal haematoma in adulthood and periorbital necrotising fasciitis are unusual occurrences that have not been reported together. We discuss the first observed case of a 35-year-old female with periorbital necrotising fasciitis postulated to be caused by subgaleal haematoma following head trauma that was successfully managed with antibiotics and surgery.
Pornpattana Vichitvejpaisal, Lauren A. Dalvin, Sara E. Lally & Carol L. Shields
Purpose: To report a case of delayed implant infection with Cutibacterium acnes (C. acnes, previously known as Propionibacterium acnes) 30 years after silicone sheet orbital floor implant.
Methods: Case report with orbital imaging.
Results: A 61-year-old male with a history of traumatic orbital floor fracture right eye (OD) repaired using a silicone sheet orbital floor implant 30 years prior, presented with 6 months of painless blepharoptosis and diplopia OD. On examination, there was 3 mm right upper eyelid blepharoptosis and hyperglobus. There was no globe proptosis, dysmotility, or compression and no cutaneous erythema, hyperthermia, discharge, or tenderness to palpation. Orbital magnetic resonance imaging (MRI) revealed a cystic mass in the inferior orbit in the region of the floor implant, measuring 25 mm in diameter and 10 mm in thickness. By MRI, T1-weighted images revealed a hypointense signal within the mass and T2-weighted images showed hyperintense signal with a flat hypointensity centrally representing the floor implant. Microbiologic cultures grew C. acnes.
Conclusions: C. acnes can manifest several decades after placement of an orbital prosthetic implant, leading to delayed infection.