Nora Mahmoud, Mohammed,Mahmoud, Ahmed Kamal, Mohammed Ahmed, Abdelhafez,Mostafa, Mohammed Diab
To compare the functional and cosmetic outcomes of two different frontalis sling techniques for correction of severe unilateral congenital ptosis: single triangle and Fox pentagon techniques using expanded polytetrafluoroethylene (ePTFE) suture.
This randomized controlled trial included 60 eyes of 60 patients with severe unilateral simple congenital ptosis and poor levator function (≤4 mm). Participants were randomly assigned for either single triangle or Fox pentagon frontalis suspension using ePTFE suture. Functional outcome measures were margin reflex distance (MRD1), palpebral fissure height (VFH), and lagophthalmos. Cosmetic outcome parameters (lid contour, lid crease, and height symmetry) were graded as 3 (excellent), 2 (good), or 1 (poor), with a minimum of 18 months’ follow-up.
At final follow-up, there was a significant improvement in the MRD1 and VFH in both groups, with no statistical difference ( P = 0.9). Both groups showed comparative cosmetic results regarding lid height symmetry, crease, and contour. The patients in the single-triangle group showed more rapid recovery of postoperative edema and lagopthalmos with less visible forehead scarring. There were no serious ePTFE sling–related complications.
In our study cohort, the single-triangle and Fox pentagon frontalis suspension techniques had similar outcomes with respect to MRD1 and VFH and comparable cosmetic results. However, the single-triangle technique avoids two forehead incisions and was associated with less postoperative edema, lagophthalmos, and scarring.
Mariam S. Hamid, Daniel W. Steen, Adrian H. Ormsby, Xihui Lin, Kim H. Le
A 5-year-old boy presented with unilateral, focal superonasal conjunctival injection in the absence of vision changes or trauma. He was treated with a topical steroid for possible phlyctenule or episcleritis, but the lesion progressed to an elevated nodule, raising concern for nodular scleritis with no evidence of posterior involvement. Systemic work-up for underlying inflammatory conditions was unremarkable. There was some improvement in the level of injection with topical steroid, topical fluoroquinolone, and oral nonsteroidal anti-inflammatory drugs, but the nodular lesion persisted. Excisional biopsy revealed an inflamed dermoid cyst in the sub-Tenon’s space.
Lucas Bonafede,Michelle Go,Jeffrey Cheng,…Hesham Gabr,Sharon F. Freedman,Federico G. Velez
A 2-month-old boy developed a protuberant, blue nodule inferomedial to the left medial canthus. It was unresponsive to oral and intramuscular antibiotics. After developing difficulty breathing, he was admitted, with the diagnosis of a dacryocele, and, after an inconclusive ultrasound, underwent probing and irrigation with nasal endoscopy. Intraoperatively, the lesion appeared discontinuous with the nasolacrimal system and could not be decompressed. Postoperative magnetic resonance imaging suggested a hemangioma or possible collapsed dacryocele. Doppler ultrasound confirmed a perinasolacrimal duct hemangioma. Systemic propranolol treatment was initiated.
Douglas Matsunaga, Basil K. Williams Jr., Komal B. Desai, Carol L. Shields
A 16-year-old girl noted worsening redness and photophobia of the right eye that had previously been treated unsuccessfully with sequential courses of topical antibiotics and topical corticosteroids. Clinical examination revealed diffuse flakelike thickening of the iris surface, pupillary margin, and anterior chamber angle, suggesting diffuse iris melanoma. Anterior segment optical coherence tomography depicted the mass as an epi-iridic deposit with “stalagmite” surface appearance. Fine-needle aspiration biopsy confirmed an atypical histiocytic proliferative disorder consistent with juvenile xanthogranuloma. Aggressive topical corticosteroid treatment was started. There were no systemic findings. Following therapy, the lesion resolved completely.
Omar Solyman, Abdelrahman M. Elhusseiny, Hisham A. Hashem
We present a case of bilateral ankyloblepharon filiforme adnatum in 1-day-old girl and describe our surgical approach. The bands connecting the upper and lower eyelids of both eyes were severed using blunt scissors. Point bleeding at the cut bands stopped in 1-2 minutes, without the need for cauterization or compression. The patient was able to open her eyes shortly after the procedure, as she woke up from anesthesia. Examination under general anesthesia showed normal eye examination appropriate for age. Postoperatively, the patient maintained open palpebral fissures. Visual development over 3 years’ follow-up was normal.
Teresa Salvá-Palomeque,Pablo Muñoz-Ramón,Nieves Alonso-Formento,Ana R. Albandea,Constanza Barrancos,Marco Sales-Sanz
We report the case of a 6-month-old boy with recurrent episodes of acute dacryocystitis from age 3 months to 1 year of age. The cause was determined to be congenital nasolacrimal sac diverticulum, a rare and commonly asymptomatic entity. An isolated diverticulectomy without dacryocystorhinostomy was performed because of lacrimal drainage system patency. At 6 months’ follow-up the patient remained asymptomatic.
Vibha Baldev, Shailja Tibrewal
A 24-year-old man with a deviation of the right eye noted since childhood presented with significant enophthalmos, limitation of elevation, and globe retraction on attempted elevation. A disproportionately small right hypotropia was suggestive of a restrictive pathology, and forced-duction testing confirmed tightness of the inferior rectus muscle. Clinical features resembled those of orbital floor fracture with inferior rectus entrapment. Computed tomography disclosed no fracture but did reveal an abnormal structure arising from the orbit adjacent to the inferior rectus origin and attaching to the globe close to the optic nerve in the inferolateral aspect.
YuePing Li, Yuchuan Wang, Wei Zhang
A 24-year-old woman presented with periorbital pain, progressive diplopia, and restricted eye movement. Routine blood testing was normal except for increased levels of thyroid peroxidase autoantibody (TPOAb) and thyroglobulin autoantibody (TGAb). Orbital computed tomography revealed fusiform thickening of the rectus muscles belly, with tendon sparing, as in thyroid eye disease. Rectus muscle biopsy revealed isolated amyloidosis. Further workup showed no evidence of systemic amyloidosis.
Raed Shatnawi, Samar A. Shweiki, Arif O. Khan
A previously healthy 11-year-old girl presented with bilateral orbital compartment syndrome secondary to retrobulbar hemorrhages requiring emergency cantholysis. Four days earlier she had sustained head trauma without symptoms until her acute presentation. A basic hematologic profile was remarkable for a prolonged partial thromboplastin time, which did not completely correct with a 1:1 mixing study. This result raised suspicion for the most common acquired deficiency of clot stability, acquired factor VIII deficiency (acquired hemophilia A). Low factor VIII levels and the presence of autoantibodies against autologous factor VIII were confirmed. The child was treated daily with fresh frozen plasma and showed marked improvement over the ensuing days and weeks.
Nita G. Valikodath, Samiksha Jain, Marilyn Miller, Lawrence M. Kaufman
Townes-Brocks syndrome (TBS) is a rare genetic syndrome associated with heterozygous mutations in SALL1 and characterized by abnormalities of the anus, ear, and thumb. Ophthalmic findings have been rarely reported and include congenital cataract, microphthalmia, optic nerve atrophy, coloboma, epibulbar dermoid, and dysinnervation patterns, such as Duane syndrome and gustatory lacrimation. We report a case of genetically confirmed TBS showing a spectrum of ocular anomalous innervations, including bilateral type 1 Duane syndrome and Möbius sequence, left-sided Marcus Gunn jaw winking, left eye gustatory lacrimation, and lack of emotional tearing bilaterally. Magnetic resonance imaging of brain and orbit showed absence of the abducens nerve bilaterally and of the left facial nerve.