1/213. Congenital, paradoxical lower eyelid retraction on upgaze.PURPOSE: Active lower eyelid retraction on upgaze is a rarely described finding. The purpose of this study is to describe the clinical and operative findings in two patients with this unique eyelid movement disorder. methods: The authors identified active, unilateral lower eyelid retraction on upgaze in two patients who had no other ocular or systemic abnormalities. RESULTS: Surgical extirpation of the lower eyelid retractor complex was carried out in both cases. During one of the procedures, performed under local anesthesia, the lower eyelid retractors were observed to retract actively on upgaze. Postoperatively, lower eyelid retraction on upgaze was not present in either case. CONCLUSIONS: The authors are aware of only one other case report describing active, paradoxical lower eyelid retraction on upgaze. The mechanism of eyelid retraction in this previous report and in the two patients described herein is not known. The authors postulate that these unique cases may represent a previously unrecognized form of congenital, aberrant innervation of the oculomotor nerve.- - - - - - - - - - ranking = 1keywords = ocular (Clic here for more details about this article) |
2/213. Adverse periocular reaction after blood transfusion.PURPOSE: To describe a patient with an acute conjunctival and periocular reaction after blood transfusion. methods: Case report and literature review. RESULTS: A 67-year-old woman sustained a self-limited periocular reaction characterized by bilateral turgescence and redness of the conjunctiva and eyelids after blood transfusion. More than 100 similar reactions of this type have been reported by the Centers for disease Control and Prevention. CONCLUSIONS: The cause of this periocular transfusion reaction is unclear, but this type of reaction is being investigated by the Centers for disease Control and Prevention. This case suggests that mild transfusion complications, even if unusual, may be under-reported.- - - - - - - - - - ranking = 7keywords = ocular (Clic here for more details about this article) |
3/213. Chronic dacryoadenitis misdiagnosed as eyelid edema and allergic conjunctivitis.PURPOSE: To report the case of a 53-year-old woman with a 2-year history of episodic upper eyelid swelling and nonspecific complaints, who was diagnosed as having allergic conjunctivitis. methods: A complete ocular examination, orbital computerized tomographic (CT) scans followed by complete physical and systemic examinations. RESULTS: The results of physical and systemic examinations were unremarkable for systemic lymphoma and a primary focus of cancer. The results of the ocular examination were normal. CT scans demonstrated well-defined lesions bilaterally with a homogeneous internal structure in the lacrimal gland fossa, which suggested a diagnosis of chronic dacryoadenitis. The differential diagnosis included lymphoma and orbital metastases. The patient refused a biopsy and was started on a tapering dose of 60 mg oral prednisolone daily. The follow-up CT scans 1 month after cessation of 6-week oral corticosteroid treatment showed near complete resolution of the orbital lesions. CONCLUSION: This case demonstrates that orbital inflammation can be misdiagnosed as refractory allergic conjunctivitis.- - - - - - - - - - ranking = 2keywords = ocular (Clic here for more details about this article) |
4/213. Functional indications for enophthalmos repair.PURPOSE: In general, orbital augmentation to correct enophthalmos is pursued to prevent or address an aesthetic deformity. In some cases, however, functional deficits may accompany enophthalmos and may serve as an indication for surgical intervention. The authors describe a series of patients with such deficits. methods: A retrospective review at a tertiary health care center of all patients with enophthalmos was conducted to identify a subset of cases in which the enophthalmos was associated with nonaesthetic, functional deficits that could not be attributed to muscular or neural dysfunction, or soft tissue scarring. RESULTS: Six patients with either traumatic enophthalmos (orbital fractures) or non-traumatic enophthalmos (sinus disease and orbital soft tissue atrophy) demonstrated nonaesthetic ocular dysfunction, including gaze-evoked diplopia, eyelid retraction, lagophthalmos, and exposure keratitis. The symptoms and signs resolved in the three patients who underwent orbital augmentation. CONCLUSIONS: In some patients with enophthalmos and globe ptosis, globe malposition may alter the underlying eyelid mechanics or extraocular muscle alignment, resulting in functional as well as aesthetic problems. In these patients, restoring the native orbital anatomy through orbital augmentation can reverse eyelid malposition, ocular surface exposure, and symptomatic diplopia, avoiding the need for eyelid or strabismus surgery.- - - - - - - - - - ranking = 3keywords = ocular (Clic here for more details about this article) |
5/213. Kimura disease of the orbit and ocular adnexa.Kimura disease (KD) is a distinct clinicopathologic entity that has been the subject of considerable confusion and debate. Although common in Asia, KD rarely occurs in non-Asian patients. Kimura disease shares both clinical and histopathologic features with angiolymphoid hyperplasia with eosinophilia (ALHE). Because of this overlap and the rarity of KD in europe and the united states, KD and ALHE have been used synonymously in the Western medical literature, as they were thought to represent variations of the same disease. Some pathologic reports have called for distinguishing KD and ALHE as two separate entities, based on their histologic features. Kimura disease occurs most commonly in the head and neck region and has been described in the orbit, eyelids, and lacrimal gland more frequently than ALHE. Because both diseases can cause proptosis, lid swelling, ocular dysmotility, or a palpable mass, they should be considered in the differential diagnosis of orbital lesions occurring in adults. We report two cases of KD involving the orbit and ocular adnexa, and review additional cases reported in the literature. The ophthalmic literature does not clearly reflect the current understanding that KD and ALHE are best considered two separate clinicopathologic entities.- - - - - - - - - - ranking = 6keywords = ocular (Clic here for more details about this article) |
6/213. Castleman disease presenting with ophthalmic signs and symptoms.PURPOSE: To describe a patient with multicentric Castleman disease who was initially examined with ophthalmic signs and symptoms. methods: Case report. A 71-year-old man was initially examined with swelling of both upper eyelids and diplopia of 2 months' duration. RESULTS: Medical evaluation and right axillary lymph node biopsy disclosed Castleman disease. Systemic corticosteroid treatment temporarily resolved signs and symptoms, but the patient died of recurrence with cytomegalovirus and aspergillus infection 10 months after initial examination. CONCLUSIONS: Multicentric Castleman disease is a rare but distinct disorder that may present initially with ocular signs and symptoms. This disease must be included in the differential diagnosis of orbital pseudotumor and lymphoma.- - - - - - - - - - ranking = 1keywords = ocular (Clic here for more details about this article) |
7/213. Presumed periorbital lupus vulgaris with ocular extension.OBJECTIVE: To report an unusual case of lupus vulgaris that spread to the left anterior ocular surface. DESIGN: Case report. PARTICIPANT: An 18-year-old woman presented with an 8-month history of an infiltrative skin lesion affecting the left lower eyelid and cheek area, left globe, right lacrimal sac area, together with a cystic lesion in the foot area. TESTING/INTERVENTION: The authors describe the clinical findings, radiologic study, and histopathologic study of the conjunctiva, skin, liver, and ankle lesion. The patient was treated with antituberculous medications for 3 months. MAIN OUTCOME MEASURES: Healing of the skin, conjunctival, and bone lesions. RESULTS: The lesion of the face healed, leaving scar tissue. The left eye showed symblepharon with loss of its anterior surface features. The right eye showed no symblepharon, the bones of the foot healed with no deformity, and the liver function test results normalized after 3 months of antituberculous medications. CONCLUSION: lupus vulgaris can be associated with multiple system involvement. Its clinical presentation and behavior depend on the patient's immunity and duration of the disease. early diagnosis and appropriate management may cure the disease with no life-threatening sequelae.- - - - - - - - - - ranking = 5keywords = ocular (Clic here for more details about this article) |
8/213. Congenital cystic eye: report of two cases and review of the literature.A 13-month-old boy and a 2-week-old girl, who were considered to be anophthalmic and who later each developed a cystic lesion in the left orbit with protrusion of the lower eyelid, were studied. The fellow eye in case 1 was subsequently found to be microphthalmic with cyst and was normal in case 2. Histopathologic study of each case revealed a cyst lined externally by dense fibrous connective tissue to which skeletal muscle and adipose tissue were attached. The inner aspect of the cyst was lined by neuroglial tissue, possible immature retinal tissue, and cuboidal epithelium. No fully developed ocular structures or microphthalmos were identified. Fourteen cases of congenital cystic eye, including our cases, have been published in the English-language literature since 1964. We discuss and illustrate the findings in our cases and 10 others in which histopathologic findings were reported. Congenital cystic eye, microphthalmos with cyst, and microphthalmos with cystic teratoma should be suspected in patients with a small or unrecognizable eye and an orbital cystic mass that is detected by palpation or visualization.- - - - - - - - - - ranking = 1keywords = ocular (Clic here for more details about this article) |
9/213. Preseptal cellulitis secondary to proteus species: a case report and review.BACKGROUND: Preseptal cellulitis is a serious ocular condition that--if left untreated--has the potential to cross the septal barrier, spread to the posterior orbit, and may result in fatal complications. Because it is difficult to determine the pathogen responsible for any cellulitis without aspirating a culture sample, treatment is usually instituted by an assumption of the most common causative organisms, staphylococcus or streptococcus. CASE REPORT: A 42-year-old black woman manifested signs and symptoms consistent with right preseptal cellulitis. Throughout treatment, visual acuity remained 20/20 for both eyes, extraocular muscles were unrestricted without pain, and anterior globe structures were clear. The patient was started on a regimen of 250-mg oral dicloxacillin four times a day. When no response was seen at 36 hours, the patient was changed to 500-mg oral ciprofloxacin every 12 hours. She responded to the 500-mg ciprofloxacin and recovered with no sequelae. An abscess, which had formed during the cellulitis, self expressed and this material was cultured. The cultures identified the responsible organism as proteus species, an unexpected pathogen in a well-groomed patient. CONCLUSION: This case demonstrates the need to consider alternate pathogens when treating preseptal cellulitis, change medications accordingly, and consider alternate treatments as needed.- - - - - - - - - - ranking = 2keywords = ocular (Clic here for more details about this article) |
10/213. granuloma annulare of the eyelid: a case report and review of the literature.granuloma annulare is a benign, relatively common dermatosis of childhood. Lesions typically occur on the extremities and resolve spontaneously over a period of several months to years. Localized facial involvement is rare. We report a case of granuloma annulare confined to the left eyelid. The literature on periocular granuloma annulare is reviewed. This diagnosis should be considered for any acquired papules of the periorbital area, especially if there is a history of antecedent trauma. Unnecessary surgical excision can then be avoided.- - - - - - - - - - ranking = 1keywords = ocular (Clic here for more details about this article) |
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