1/10. Conjunctival necrobiotic granuloma in xeroderma pigmentosum.PURPOSE: We report clinical and histopathologic findings of a conjunctival lesion associated with xeroderma pigmentosum. methods: A Saudi girl with known xeroderma pigmentosum presented with pain and photophobia of the right eye and an elevated temporally located perilimbal mass. RESULTS: The mass was resected successfully and has not recurred during 1-year follow-up. Histopathologic examination of the tissue showed a necrobiotic granuloma with associated histiocytic infiltration. The patient had no systemic disease, lipid was not detected in the histiocytic lesion, no Touton giant cells were present, and there was no evidence of elastolysis. CONCLUSION: Ocular malignancies occur in association with xeroderma pigmentosum, but benign lesions that mimic a malignancy may occur.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/10. The giant fornix syndrome: an unrecognized cause of chronic, relapsing, grossly purulent conjunctivitis.AIM: To describe a group of elderly patients presenting with chronic, relapsing, copiously purulent conjunctivitis, in which the condition was often perpetuated by the sequestration of a large number of bacteria on a protein coagulum lodged in the recesses of a large upper conjunctival fornix. patients AND methods: Retrospective review of a noncomparative case series, drawn from patients attending the lacrimal clinic at Moorfields eye Hospital. OUTCOME MEASURES: Characterization of this unrecognized syndrome and its response to treatment. RESULTS: Twelve patients (10 female) presented between the ages of 77 and 93 years (mean, 85; median, 86) with a history of chronic relapsing bacterial conjunctivitis affecting, with 2 exceptions, just one eye. All had experienced multiple episodes of markedly purulent conjunctivitis and chronic ocular discharge for between 8 and 48 months (mean, 23.5; median, 24) before referral, and the patients had received multiple courses of treatment. Three had successful external dacryocystorhinostomy (for nasolacrimal duct occlusion) before the final diagnosis of giant fornix syndrome was made, 9 had developed corneal vascularization and scarring before referral, and 5 had suffered prior spontaneous corneal perforation or thinning. All patients had deep upper conjunctival fornices in association with the changes of age-related dehiscence of the levator muscle aponeurosis. Copious amounts of thick, purulent debris and a yellow coagulum were lodged in the depths of the upper fornix-this debris universally culturing staphylococcus aureus. The condition settled rapidly on appropriate systemic antibiotics (ciprofloxacin or ofloxacin), intensive topical antibiotics, and high-dose, high-potency steroids; some patients required repeated treatment or needed to continue the use of a single drop of a combined steroid-antibiotic to prevent relapse. CONCLUSION: The capacious upper fornix of the elderly may harbor a coagulum colonized by S. aureus, leading to chronic conjunctivitis that may lead to severe sight impairment due to toxic keratopathy and secondary corneal vascularization.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
3/10. Splendore-Hoeppli phenomenon in the conjunctiva: immunohistochemical analysis.PURPOSE: To present two cases of conjunctival lesions exhibiting the Splendore-Hoeppli phenomenon, each with different immunohistochemical findings. DESIGN: Interventional case reports. methods: Two young males with conjunctival lesions underwent biopsy. Demographic data and timing of biopsy were extracted from the charts. The biopsy specimens were formalin fixed and paraffin embedded for light microscopy. Immunohistochemical staining using the peroxidase method was carried out on each for IgG, IgM, IgA, the C3 component of complement, and eosinophilic major basic protein. MAIN OUTCOME MEASURES: Presence of positive or negative staining for the various antigens. RESULTS: Both biopsy specimens exhibited the Splendore-Hoeppli phenomenon, a morphologically unique process consisting of an amorphous, eosinophilic material surrounded by epithelioid histiocytes, multinucleated giant cells, lymphocytes, and eosinophils. Two staining patterns were seen. One revealed predominately immunoglobulin deposition, whereas the other revealed primarily eosinophilic major basic protein. This is the first instance we are aware of in which eosinophilic major basic protein was the predominate finding in an ocular specimen. CONCLUSION: The composition of Splendore-Hoeppli phenomenon material varies and may be related to various factors, including timing of biopsy and prior treatment.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/10. Conjunctival granulomas caused by synthetic fibers: report of two cases and review of literature.PURPOSE: We sought to demonstrate the histopathologic and ultrastructural features of conjunctival foreign body granulomas because of synthetic fibers and to compare them to other cases published in the literature. methods: A 2- and a 7-year-old girl were referred for the surgical removal of slow-growing unilateral inferior conjunctival masses with a lack of primary trauma or surgery. In this report, we describe the light and electron microscopic findings of the 2 cases and review the literature of similar cases using the medline database. RESULTS: Histopathologic and ultrastructural examination of both specimens revealed a granulomatous inflammatory cell response, including histiocytes and multinucleated foreign body giant cells around acellular, uniform sized, oval to round birefringent fibers with manufacturing artifacts. Thirteen other patients with conjunctival synthetic fiber granulomas were identified from the literature. CONCLUSIONS: On the basis of the findings in our cases and the review of literature, it appears that conjunctival synthetic fiber granulomas are not a rare entity but are not recognized frequently by ophthalmologists. The most reliable clinical sign to suggest this diagnosis is the presence of a unilateral inferior conjunctival mass in a child or adolescent. Histopathologic and ultrastructural evaluation appears to be the only way to specifically diagnose this condition with certainty.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
5/10. Giant secondary conjunctival inclusion cysts: a late complication of strabismus surgery.PURPOSE: To present giant conjunctival inclusion cysts as a late complication of strabismus surgery. DESIGN: Retrospective case series of selected patients. PARTICIPANTS: Four patients with a history of strabismus surgery who had developed giant conjunctival inclusion cysts. methods: A chart review was performed. The patient's ocular history, ophthalmic examinations, and imaging (ultrasound/ultrasound biomicroscopy and/or computed tomography) were recorded. Surgical excision with subsequent histopathologic correlation was obtained in 3 cases. MAIN OUTCOME MEASURES: Clinical and imaging characteristics with histopathologic correlation. RESULTS: Four patients with giant conjunctival inclusion cysts had a history of strabismus surgery. Ultrasound biomicroscopy was performed in 3 cases and revealed large, cystic, well-circumscribed tumors with low internal reflectivity and hyperechoic components. Computed tomography of the orbits was used to evaluate posterior extension. Their size induced limitation in motility, strabismus, and problems related to chronic exposure. Histopathologic evaluations were consistent with benign inclusion cysts of the conjunctiva. CONCLUSIONS: Giant conjunctival inclusion cysts may appear decades after strabismus surgery. Tumor size, cystic nature, and involvement of underlying structures can be determined by ultrasonography and radiographic imaging. Complete surgical removal can be curative.- - - - - - - - - - ranking = 3keywords = giant (Clic here for more details about this article) |
6/10. Giant cysts of the conjunctiva following scleral buckling.Four patients developed giant conjunctival cysts following scleral buckling for retinal detachment. Histologically these cysts showed a core of fibrous tissue lined by stratified, non-keratinizing epithelium and with goblet cells. They probably arose from inadvertent implantation of epithelium during surgery. In three cases the cysts were surgically excised without recurrence. Alternate modes of therapy are discussed.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
7/10. Conjunctival sarcoidosis.A biopsy from the lower conjunctival fornix, whether or not taken from follicles, is a method which yields a positive result in /- 25% of cases of suspected sarcoidosis. We saw a patient with chronic recurrent follicular conjunctivitis of the upper eyelid, without further ocular symptoms. He was known to suffer from allergy and chronic respiratory disease. As the conjunctivitis did not improve a biopsy was taken from the conjunctiva of the upper eyelid. The specimen showed non-necrotizing epithelioid-cell granulomata with multinucleate giant cells and asteroid bodies, and an increase in reticular fibres. The diagnosis of sarcoidosis was confirmed by finding parabronchial granulomata and a raised level of angiotensin-converting enzyme in the serum. Prolonged local corticoid therapy then gradually cleared up the conjunctival condition.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
8/10. Actinic granuloma of the conjunctiva.The key histologic feature of pingueculas is the presence of actinic elastosis of the conjunctival connective-tissue fibers. We describe a patient who had a pinguecula that, on pathologic examination, exhibited a prominent foreign-body giant-cell reaction in association with the elastotic fibers. The term actinic granuloma has been coined recently to designate a similar reaction in sun-damaged skin. Because the nature of the inflammatory reaction may be misinterpreted on pathologic examination as indicating the presence of microorganisms or a foreign body, both the clinician and the pathologist should be aware of this peculiar inflammatory response, which has been described on two previous occasions in patients with pingueculas.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
9/10. Complications of exposed monofilament sutures.Exposed monofilament suture ends caused a variety of symptoms and signs in 18 patients. These included foreign-body sensation, pain, contact lens intolerance, giant papillary conjunctivitis, tarsal ulceration, conjunctival granuloma, corneal infiltrate, and corneal vascularization. These changes followed cataract surgery, corneal transplantation, and pars plana vitrectomy. Diagnoses in these cases were made by careful slit-lamp examination and by eversion of the upper eyelid. In every case, removal of the sutures or trimming the suture ends resulted in the immediate relief of all symptoms with complete resolution of all signs within two months.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
10/10. Case of sarcoidosis with uncommon tumorous mass formation in bulbar conjunctiva.A case of sarcoidosis with ocular involvement, including uncommon tumorous mass formation on the bulbar conjunctiva, was reported. The patient was a 62-year-old woman who had been suffering from chronic bronchiolitis for several years. The conjuctival masses, yellowish brown in color with localized injection and follicles, were found in both eyes. In addition to the conjunctival masses, the common manifestations of sarcoidosis were observed in the eyes, showing nodules on the iris and trabeculum, discrete fluffy "snowball" opacities in the vitreous, and perivascular nodules on the retinal vessels. Microscopically, the biopsy specimen obtained from he conjunctival masses was composed of epithelioid tubercles with Langhans type and foreign body type giant cells. Ziehl-Neelsen stain revealed no tuberculous bacilli. Transbronchial lung biopsy also revealed epithelioid tubercles. Both ocular and pulmonary lesions were observed to respond well to treatment with corticosteroid hormone. We emphasized that patients with interstitial pneumonitis or pulmonary fibrosis should be examined ophthalmologically, and recommended conjunctival biopsy in patients with suspected sarcoidosis.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
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