Tawfik, Hatem A. M.D.; Abdulhafez, Mohamed H. F.R.C.S.; Fouad, Yousef A. M.B.B.S.; Dutton, Jonathan J. M.D., Ph.D., F.A.C.S.
Purpose: To review the recent data about eyelid morphogenesis, and outline a timeline for eyelid development from the very early stages during embryonic life till final maturation of the eyelid late in fetal life.
Methods: The authors extensively review major studies detailing human embryologic and fetal eyelid morphogenesis. These studies span almost a century and include some more recent cadaver studies. Numerous studies in the murine model have helped to better understand the molecular signals that govern eyelid embryogenesis. The authors summarize the current findings in molecular biology, and highlight the most significant studies in mice regarding the multiple and interacting signaling pathways involved in regulating normal eyelid morphogenesis.
Results: Eyelid morphogenesis involves a succession of subtle yet strictly regulated morphogenetic episodes of tissue folding, proliferation, contraction, and even migration, which may occur simultaneously or in succession.
Conclusions: Understanding the extraordinary process of building eyelid tissue in embryonic life, and deciphering its underlying signaling machinery has far reaching clinical implications beyond understanding the developmental abnormalities involving the eyelids, and may pave the way for achieving scar-reducing therapies in adult mammalian wounds, or control the spread of malignancies.
Meisha L. Raven, DO, Roman I. Krivochenitser, MD, Mark J. Lucarelli, MD
A 42-year-old man presented with a left medial commissure lesion that progressed in size and pigmentation over 8 years (Fig 1, arrow). Clinically, the lesion appeared gray in color and mild telangiectatic vessels were seen. Histopathology revealed a large apocrine hidrocystoma with a circumscribed nodule composed of variably sized tubules adjacent to the cyst wall (Fig 2). The cells displayed abundant eosinophilic cytoplasm, uniform round nuclei, and apocrine snouting (Fig 3). Tubular apocrine adenomas are rare benign tumors with a predominance in females (2:1), and are most commonly seen on the scalp, cheek, axilla, and breast.
Catherine S. Choi, MD, Pedram Hamrah, MD, Nora Laver, MD
An 8-year-old Brazilian girl presented with a pigmented conjunctival lesion of her right eye since birth that had been progressively enlarging in size and darkening in pigmentation (Fig 1A). Anterior segment optical coherence tomography (OCT) (Fig 1B) was concerning for possible scleral invasion. The lesion was excised and histopathologic analysis (H&E) demonstrated cystic compound melanocytic nevus with nests of nevus cells in the junctional and subepithelial layers (Fig 1C). There was no evidence of malignancy based on Mart-1, Ki-67, and MITF-1 stains.
Stephen J. Goldie, Scott K. Lyons
Surgical excision of non-melanoma skin cancers is the mainstay of treatment, and a common procedure performed by clinicians from various backgrounds and training levels. Despite efforts to excise squamous cell carcinomas (SCCs) with a margin of normal tissue, some tumours are incompletely excised or cells are “seeded” into the wound allowing local recurrence. Following surgical oncology procedures many operators irrigate wounds or body cavities with water rather than saline. The logic being that water will induce an osmotic shift of fluid into the cells, causing them to lyse.
Shaheen Hasmat, Nigel H. Lovell, Gregg J. Suaning, Tsu-Hui (Hubert) Low, Jonathan Clark
The most devastating outcome of facial nerve paralysis is the inability to completely close the eye as it can lead to corneal ulceration and loss of vision. Gravity-assisted eye closure with upper lid loading is commonly used; however it is limited in replicating physiological eye closure to adequately lubricate the cornea. Superior results can be obtained using more advanced reconstructive approaches, however they depend on nerve regrowth which may be unpredictable and prolonged. This report describes a novel technique for creating an active eye closure using an implantable actuator. A generated magnetic field creates lateral movement in an electromagnet that is translated to the eyelid through a sling design. The device is powered wirelessly through a transcutaneous induction link and can be hermetically encapsulated for patient safety. The initial phase of device development is presented including data of a fully functioning prototype and the results of its application in animal and human cadavers.
Kyle J. Godfrey, MD, Michael Kinori, MD, Johnathan H. Lin, MD, Vivian S. Snyder, DO, David B. Granet, MD, Christopher W. Heichel, MD, Shira L. Robbins, MD
Benign hemangiomas are rare vascular tumors of the conjunctiva that typically present clinically in the first few weeks of life and resolve spontaneously. De novo presentation later in childhood has not been well documented. We present the unusual case of an 11-year-old boy with a rapidly growing benign de novo conjunctival hemangioma that was treated with surgical excision.
Lora R. Dagi Glass, MD, Alexandra T. Elliott, MD
Current techniques for repairing large eyelid colobomas require preparation of other tissue sites and occasionally more than one procedure. We present a technique that requires only one procedure and is limited to the colobomatous eyelid; in addition, it is specifically designed to help avoid postoperative astigmatic and obstructive amblyopia. Outcomes are demonstrated in 3 cases of hemifacial microsomia. Large colobomas on the upper eyelid can be successfully and aesthetically repaired with only one procedure, incising only the congenitally abnormal eyelid.
Hanan Hussein Shehata, MD, Azza Hassan Abou Ghalia, MD, Eman Khairy Elsayed, MD, Azza Mohamed Ahmed Said, MD, Safaa Saleh Mahmoud, MD
To evaluate the diagnostic and prognostic values of survivin and transforming growth factor beta-1 (TGF-B1) expression in aqueous humor and serum of retinoblastoma (RB) in comparison to the conventional RB marker lactate dehydrogenase (LDH) and to elucidate a possible correlation between them and the clinicopathological features of the disease.
This prospective, comparative study included 88 newly diagnosed children with RB and 80 age-matched controls with ophthalmic conditions other than tumors prepared for intraocular surgeries. Concentrations of survivin, TGF-B1, and LDH were measured in serum and aqueous humor before and 6 months after completion of therapy.
High serum and aqueous humor concentrations of the three proteins were detected in RB patients before treatment compared to the control group (P < 0.01), with a significant reduction of serum concentrations after treatment (P < 0.01). For the highest sensitivity and specificity, the optimal cutoff values of serum and aqueous survivin were 12.9 pg/ml and 25.2 pg/mg, with a significant positive correlation between aqueous survivin and RB staging and presence of optic nerve infiltration (r = 0.43, P = 0.04); the best cutoff values of serum and aqueous TGF-B1, 370.7 pg/ml and 39.8 pg/mg, with a significant positive correlation between aqueous TGF-B1 and poor differentiation of the tumor (r = 0.69, P = 0.001).
The high sensitivity, specificity, and accuracy of serum and aqueous humor survivin and TGF-B1 proteins make them promising markers for early detection and follow-up of RB patients.
Yu-Yun Huang, Wei-Kuang Yu, Chieh-Chih Tsai, Shu-Ching Kao, Hui-Chuan Kau, Catherine Jui-Ling Liu
Aims To compare the clinical features and treatment outcome between lacrimal plug-related canaliculitis and primary canaliculitis.
Methods Patients with plug-related canaliculitis and primary canaliculitis between 2007 and 2014 in a medical centre were collected. Charts were reviewed for clinical features, microbiological profiles, time lapse between plug insertion and symptom onset, type of plug and outcomes.
Results Of 76 eligible cases collected, 13 were plug-related canaliculitis and 63 were primary canaliculitis. The most common presenting symptom was discharge in both groups (85% and 79%, respectively). The average time interval from plug insertion to symptoms onset was 5.5 years. Most canaliculitis developed in women, especially for plug-related canaliculitis, when compared with primary canaliculitis (100% vs 65.1%; p=0.015). The most common isolated microorganism was Pseudomonas aeruginosa in plug-related canaliculitis (46%) and Streptococcus in primary canaliculitis (28%), respectively
Isolation of Pseudomonas was significantly higher in plug-related canaliculitis than in primary canaliculitis (46% vs 12%; p=0.029). Most plug-related canaliculitis resolved after removal of plugs by canaliculotomy (12 cases, 93%). Most identified plug was SmartPlug (seven cases), followed by EaglePlug (two cases) and Herrick Lacrimal Plug (two cases). There was no recurrence in patients with plug-related canaliculitis, however, recurrence developed in seven patients (11%) with primary canaliculitis.
Conclusions In comparison with primary canaliculitis, plug-related canaliculitis appear to be more prevalent in women and show a different microbiological profile. Retrieval of infected plug by canaliculotomy and adequate antibiotics can achieve a good outcome. Long-term follow-up is required because canaliculitis may develop several years after plug insertion.
Yan Wei, Xiao li Kang, Monte A Del Monte
Purpose To review the prevalence of preoperative and postoperative intorsion in patients with strabismus and Graves’ eye disease (GED), and to correlate the intorsion with coexisting superior rectus (SR) and superior oblique (SO) muscle enlargement as a possible mechanism causing intorsion in these patients.
Methods Charts of consecutive patients with GED who underwent strabismus surgery between 1 January 2010 and 1 April 2013 were retrospectively reviewed. Of these, patients with orbital CT or MRI scan were identified for further analysis. Clinical characteristics documented included age, gender, horizontal and vertical deviation, subjective torsional deviation, specific extraocular muscles (EOMs) operated upon, EOM enlargement on CT/MRI scans and width and thickness of SO, SR group and inferior rectus (IR).
Results Charts of 45 patients (14 males and 31 females) were reviewed. Mean age was 56.8±12.5 years. Of these, seven (15.6%) patients demonstrated intorsion, and 38 (84.4%) patients demonstrated extorsion preoperatively. But after strabismus surgery, 15 (39.5%) of the 38 patients with preoperative extorsion demonstrated postoperative intorsion and 23 (60.5%) patients continued to show postoperative extorsion. On analysis of CT/MRI scans in these patients, only an increase in the thickness of SR group and the thickness/width of SO muscle were significantly associated with preoperative and postoperative intorsion; while age, gender, preoperative horizontal or vertical deviation and IR recession were unrelated to preoperative or postoperative intorsion. Postoperative intorsion was also associated with smaller degrees of preoperative extorsion (<3.5°).
Conclusions Preoperative SR and/or SO muscle enlargement appear to be a primary contributing factor relating to preoperative and postoperative intorsion in patients with GED-associated strabismus. Patients with only small amounts of preoperative extorsion (<3.5°) in the presence of tight IRs should be carefully evaluated for possible SR and/or SO involvement by CT or MRI scan to predict those at risk for and plan for prevention/treatment of postoperative intorsion.