Orbit-The International Journal on Orbital Disorders-Oculoplastic and Lacrimal Surgery最新文献

Purpose: The aim of this study is to evaluate the effect of blepharoplasty, ptosis or eyebrow surgery to quality of life and use of medication related to headache or eyelid skin disease.

Methods: A longitudinal, prospective study including 90 consecutive patients who underwent blepharoplasty, ptosis, eyebrow or combined surgery.  The quality of life related to headache was evaluated by HIT6™ and to eyelid skin disease by Skindex-Mini SDM. Use of medication was measured by number of days per week medication was used for headache or eyelid skin disease.

Results: Preoperatively 46 (51%) had headache, 4 (4%) eyelid skin and 2 (2%) headache and eyelid skin symptoms. The median HIT-6 difference was -21 (range -36-0; p < .0001) and the median SDM difference was -13 (range = -15 to -1; p = .036). The median difference in medication days/week related to headache was -1 (range -4-0; p < .0001) and to eyelid skin disease -1.5 (range -3 to -1; p = .034).

Conclusions: This study shows that after upper eyelid blepharoplasty, ptosis or brow ptosis surgery, headache or eyelid skin disease-related quality of life measures are significantly improved, and the use of headache or eyelid skin-related medication is significantly less.

Purpose: To describe four cases of non-infectious hypertrophic pachymeningitis (HP)-associated with orbital inflammatory disease (OID). This study summarises the clinico-radiological features, outcomes, and management of HP-associated OID.

Methods: Retrospective case-series of patients with radiological evidence of HP and OID. Comprehensive literature review of all published English-language non-infectious causes of HP-associated OID. Reference lists were screened for inclusion of relevant articles.

Results: Thirty-seven cases of HP-associated OID (Mean age: 49.2 ± 17.4 years old; Male: 15) were identified, including four cases from our institution. Aetiologies included ANCA-associated vasculitis (12/37), non-specific/idiopathic (11/37), IgG4/multifocal fibrosclerosis (11/37), neurosarcoidosis (1/37), inflammatory myofibroblastic tumour (1/37), and giant cell arteritis (1/37). Orbital pain, headache, visual deterioration, and cranial nerve palsies were common clinical presentations. Both "focal" and "diffuse" HP were observed, with the most common sign of orbital involvement being an inflammatory orbital mass, typically with orbital apex involvement. Orbital myositis and dacryoadenitis were less common. The cavernous sinus was the most common site of extra-orbital inflammation. There was no single differentiating specific radiological feature between non-specific and specific forms of HP-associated OID.

Conclusion: The clinico-radiological manifestations of HP-associated OID differ from those described in isolated HP or OID. There is no single specific radiological marker differentiating non-specific/idiopathic disease from secondary causes; however, the co-existence of HP in OID should prompt suspicion of an underlying cause. The disease may be refractory or resistant to initial treatment, although guidelines surrounding its management and the long-term prognosis remain to be determined.

A 66-year-old female with a history of sinusitis presented with persistent diplopia and worsening eyelid swelling. Examination revealed bilateral vision loss, cranial nerve palsies, left-sided chemosis, proptosis, and edema. Initial imaging showed sphenoid sinus opacification, bilateral ethmoid disease, lack of filling of bilateral cavernous sinuses, and partial thrombosis of the left superior ophthalmic vein. The sinus findings were evaluated with endoscopic sinus surgery, which was unremarkable. Subsequent orbital imaging suggested the lesions were in keeping with tumor thrombus as opposed to bland thrombus. CT scans revealed a large mass in the right axilla, which was biopsied and confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL). The patient was treated with anticoagulation, steroids, and chemotherapy resulting in marked improvement. Our report highlights a rare case of tumor thrombus from DLBCL causing bilateral cavernous sinus thrombosis and, to the best of our knowledge, the first documented case of superior ophthalmic vein thrombosis from tumor thrombus.

Leprosy, also known as Hansen disease, is an airborne spread disease caused by Mycobacterium leprae (M. leprae) which commonly presents with skin lesions, peripheral neuropathy, and ocular involvement. This report describes a patient who presented with epiphora secondary to chronic nasolacrimal duct obstruction four years after completing antimicrobial treatment for tuberculoid leprosy. At the time of endoscopic dacryocystorhinostomy (DCR), the lacrimal sac demonstrated chronic dacryocystitis with granulomatous inflammation and a Fite positive staining bacterial rod-like structure. Pathological examination of the surgical specimen demonstrated numerous non-necrotizing granulomas in a perivascular and neural distribution, compatible with sequelae of previously treated M. leprae infection. The patient has remained symptom free six months after surgery.

Purpose: Orbital venous malformations (VM) pose challenges in complete resection due to indistinct borders and bleeding proclivity. Current methods for aiding surgical excision of distensible orbital venous malformations are inadequate. We investigated whether external neck compression could facilitate intraoperative distension of venous orbital lesions during surgical excision in patients diagnosed with VM.

Methods: Eighteen patients (8 males and 10 females) diagnosed with distensible venous anomalies were enrolled. Neck compression technology, was employed to distend the lesions before puncture embolization using n-butyl-2-cyanoacrylate glue under general anesthesia. The surgical process, along with preoperative to postoperative changes in ocular symptoms, were recorded.

Results: The average surgical duration was 95 min. A mean of 3.41 ml surgical glue was used for embolization. The compression belt maintained pressure at 35-40 mmHg. Total lesion resection was achieved in 12 patients, with 6 patients undergoing subtotal removal not requiring supplementary surgery. Symptoms were entirely alleviated in 17 patients, and signs of distensible lesions during the Valsalva maneuver were absent. One patient underwent secondary surgery for residual eyelid lesions. Minor complications included mild ocular movement restriction, residual subcutaneous induration, transiently increased orbital pressure, and lower lid ectropion in four, three, four, and one patient, respectively. Three patients experienced a mild post-operative visual acuity decrease, although none experienced vision loss.

Conclusions: Direct orbital embolization aided by a jugular vein compression device is safe and demonstrates satisfactory outcomes in orbital varicose vein treatment.

We present a novel case of intraosseous venous malformation of the frontal bone with dehiscence of the inner table of the frontal calvarium and extension into the frontal sinus and orbit. This case report discusses the surgical management of this intraosseous lesion achieved with a multidisciplinary approach involving otolaryngology and neurosurgical teams. We also present a review of the literature of the pathophysiology of venous malformations, the imaging modalities that aid in diagnosis of these lesions and the management options.

Purpose: The purpose of this study is to evaluate the usage of oxymetazoline hydrochloride ophthalmic solution, 0.1% in the treatment of Graves' disease to improve lid symmetry.

Methods: Fourteen patients were identified with unilateral upper eyelid retraction, secondary to Graves' disease. A phenylephrine test was performed to evaluate whether treating the unaffected (non-retracted) side would result in improved symmetry using Hering's law. Patients were prescribed oxymetazoline hydrochloride ophthalmic solution, 0.1% to instill into the unaffected eye. Marginal reflex distance 1 (MRD1) measurements were taken pre- and post-treatment and patient satisfaction surveys were completed.

Results: The average pre-treatment MRD1 difference between the right eye (OD) and the left eye (OS) was 2.46 [range 1.50-4.00]. The average post-treatment MRD1 difference between OD and OS was 0.39 [range 0.00-1.00]. One hundred percent of patients were satisfied or very satisfied with the improvement in symmetry.

Conclusions: Oxymetazoline hydrochloride ophthalmic solution, 0.1% is a potential method to improve symmetry in patients with Graves' disease and unilateral upper eyelid retraction via Hering's law, especially for non-surgical candidates or those who prefer non-surgical treatment. Our results indicate improved MRD1 differences between fellow eyes and patient satisfaction regarding the symmetry of the upper eyelids.

Primary basal cell carcinoma (BCC) of the conjunctiva is a rare tumor with only six cases reported in literature. We present the case of an 81-year-old male complaining of a slow-growing lesion in his right eye for the past 3 years. The lesion in the temporal bulbar conjunctiva was gelatinous and firmly adherent to sclera. Ultrasound biomicroscopy revealed apparent scleral thinning without invasion. Our provisional diagnosis was ocular surface squamous neoplasia; however, incisional biopsy for histopathological diagnosis revealed that it was a BCC. Due to scleral adhesion and thinning, the lesion was not amenable for surgical resection. Plaque brachytherapy was used to successfully treat the lesion. To the best of our knowledge, this is the first report of brachytherapy administration for treatment of this rare cancer. Previously reported cases were all nodular or pedunculated and treated with surgical excision. For flat, adherent, or invasive lesions, plaque brachytherapy is an effective primary treatment modality.

Congenital lacrimal drainage anomalies have several syndromic and non-syndromic associations reported in the literature. While the information is exhaustive, it may not be useful if someone wants to know the associations based on individual lacrimal anomalies quickly. For example, if someone wants to know the systemic associations of supernumerary punctum, it entails scanning of all the syndromes to note which of them reported the specific anomaly. Besides, several new associations have been reported in the last four years. Hence, the need was felt for a separate categorization in a catalogue form to access all the associations immediately, in an alphabetical order, and easily reference them. The present exercise allowed us to catalogue 73 systemic associations of CNLDO, 37 for punctal agenesis, 20 for punctal dysgenesis, 17 for congenital lacrimal fistulas, 9 for canalicular wall dysgenesis, and three each for supernumerary punctum and pediatric functional epiphora.