Rukaiya Malik , James English & Thomas G. Hardy
Conjunctival orbital cysts are rare; they are typically either conjunctival dermoid or conjunctival epithelial cysts – congenital or acquired (inclusion). We describe the case of a 15-month-old girl presenting with strabismus and proptosis who had a retrobulbar intraconal cystic lesion displacing the optic nerve, with an adjacent middle cranial fossa anomaly. Aspiration of the orbital cyst tested positive for asialotransferrin, raising the suspicion of a direct communication with cerebrospinal fluid (CSF). Subsequent fine cut CT scanning disproved any connection with the intracranial space, and the cyst was excised complete and intact. Histopathology showed a conjunctival epithelial cyst. To our knowledge, this is the first case report in the literature of an asialotransferrin positive pediatric orbital conjunctival epithelial cyst. It is of clinical relevance as it explores the possibility of either a false positive asialotransferrin or potentially a prior developmental communication with the subarachnoid space. These two diagnostic possibilities are discussed.
Shahid Alam & Madhuri V. Thallam
Mohmad Uzair, Deepak Varma
A 46-year-old female presented with a small yellowish lesion since 3 weeks on the lateral aspect of right upper eyelid margin [Figure 1]a. Slit lamp examination revealed live tick attached [Figure 1]b. Tick was successfully removed using toothless forceps [Figure 1]c and was sent to the Microbiology lab and identified Dermacentor variabilis (American dog tick). Ticks must be removed as soon as possible, as animal and human studies have shown that the risk of disease transmission increases after 24 h of attachment and significantly increases after 48 h. The careful, mechanical extraction of ticks using blunt, curved, medium point forceps is recommended as safe and effective.
Akshay Gopinathan Nair, Ronnie Jacob George, Sundaram Natarajan, Vandana Jain
Purpose: To report the clinical outcomes of 0.5% timolol maleate eye drops for the treatment of conjunctival pyogenic granuloma (PG) and its effect on intraocular pressure (IOP). Methods: In this retrospective study, consecutive patients with conjunctival pyogenic granuloma between January 2019 and September 2019 were prescribed 0.5% timolol maleate eye drops twice a day and followed up for 8 weeks. IOPs were measured before treatment, while on treatment and 6 weeks after treatment. Results: A total of 12 patients with conjunctival PGs were treated with 0.5% timolol maleate eye drops. Patients ranged from 7 to 72 years with a mean age of 31.1 years. Eleven (11/12; 91.6%) patients had complete resolution of pyogenic granulomas after a mean duration of treatment of 4.4 weeks (range: 3–6 weeks). One patient had a persistent PG, which showed sub-optimal resolution at 6 weeks of treatment and was surgically excised. The mean IOP of the affected eye at presentation was 15.1 mm Hg (range: 10 to 20 mm Hg; SD: ±2.9 mm Hg). One week after initiating therapy, the mean IOP was 12.1 mm Hg (range: 8–16 mm Hg; SD: ±2.4 mm Hg). The mean reduction IOP compared to the baseline IOP was statistically significant (p = 0.02). No adverse events were noted in any of the patients. Conclusion: Topical timolol is effective in the treatment of conjunctival pyogenic granulomas with no major side effects. There is a significant reduction in IOP while on treatment which is reversible and returns to baseline following completion of therapy.
Ozturk Karabulut, Gamze; Fazil, Korhan; Karaagac Gunaydin, Zehra; Serefoglu Cabuk, Kubra; Onmez, Funda Ebru; Taskapili, Muhittin
To evaluate surgical outcomes of Müller muscle conjunctival resection surgery for reoperation of residual ptosis after external levator advancement in patients with aponeurotic ptosis.
A total of 23 eyes of 23 patients who had undergone Müller muscle conjunctival resection for residual ptosis between January 2016 and July 2018 were reviewed retrospectively. Margin reflex distance (MRD), interlid crease, and show distance measurements were performed with a ruler in millimeters during the office examination, and the photographs of patients were taken before the procedure and on the 10th day, at the first, third, and sixth months after the procedure. The successful outcome was described as MRD1 between 3 and 5 mm, interlid MRD1 difference ≤1 mm, interlid crease difference ≤2 mm, interlid show difference ≤2 mm, and the presence of symmetrical lid contour.
The mean increases in MRD1 were statistically significant at the first, third, and sixth months postoperatively when compared with preoperative values both before external levator advancement and before Müller muscle conjunctival resection (p = 0.000). There was statistically significant decrease in interlid MRD1 difference, interlid crease difference, and interlid show difference relative to preoperative values. Interlid crease and show difference within the range of successful outcome criteria were achieved in all patients. However, interlid MRD1 difference exceeded 1 mm in only 1 patient who had overcorrection.
In patients who have residual ptosis without contour abnormality following external levator advancement, and positive response to phenylephrine testing, Müller muscle conjunctival resection is an effective approach.
Bum-Joo Cho, Youn Joo Choi, Min Chul Shin, Suk-Woo Yang & Min Joung Lee
Childhood blepharoptosis may cause cosmetic and functional problems in children, but there is a paucity of studies about its epidemiology. This study aimed to investigate the prevalence of childhood blepharoptosis and associated risk factors in a representative Korean population.
This cross-sectional nation-wide study analysed the data set acquired from the Korea National Health and Nutrition Examination Survey 2008–2012. A total of 8218 children aged 3–18 years were included. The prevalence of childhood blepharoptosis, defined as a margin reflex distance (MRD) of < 2 mm in either eye, was estimated, and the risk factors were identified using multivariate logistic regression analysis.
The mean age of participants was 11.3 ± 0.1 years, and 52.8 ± 0.6% were boys. The overall prevalence of childhood blepharoptosis in Korea was 8.0% (95% CI, 6.9–9.1%). Boys exhibited a higher prevalence of blepharoptosis than girls at most of ages. Levator function increased with age in the normal general population. The proportion of subjects exhibiting MRD1 ≥ 4.0 mm also increased significantly with age (p < 0.001). Male gender, higher body mass index, and urban residency were significantly associated with childhood blepharoptosis.
The prevalence of childhood blepharoptosis is higher in urban obese boys. The increase of levator function with age should be considered in evaluations of childhood ptosis.