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

Objectives: To investigate nocturnal lagophthalmos after levator surgery for simple congenital ptosis, focusing on its correlation with office-based (clinical) lagophthalmos and factors contributing to clinical-nocturnal discrepancy.

Methods: A retrospective review was conducted on 109 children (median age, 7 years) who underwent unilateral levator surgery between 2021 and 2024. Lagophthalmos was evaluated clinically in the office and nocturnally using photographs obtained during sleep. Bell's phenomenon was assessed during daytime examination by observing upward and outward globe rotation on attempted eye closure, and nocturnal photographs were reviewed for globe position. Margin reflex distance 1 (MRD1), levator function (LF), and corneal fluorescein staining were recorded. Associations with demographic variables, ptosis severity, surgical type, and exposure keratopathy were analyzed.

Results: Sixty-five percent of patients underwent levator resection and 34.9% levator plication. At a median follow-up of 20 months (range, 5.1-58), median clinical lagophthalmos was 0 mm (range, 0-2.9) compared with 3.1 mm nocturnally (range, 0-8.3) (p < 0.001). Preoperatively, Bell's phenomenon was good in 99.1% of eyelids and remained good in 85.3% postoperatively. Nocturnal evaluation revealed scleral show in 13.8%, corneal show in 36.7%, and pupillary show in 22.9%. No significant associations were found between lagophthalmos change and demographics, ptosis severity, surgical type, MRD1, LF, or follow-up duration (p > 0.05). Greater changes were correlated with corneal staining (p < 0.001) and symptom severity (p < 0.001).

Conclusion: Significant nocturnal lagophthalmos with corneal exposure is common after levator surgery for congenital ptosis despite near-complete eyelid closure on clinical assessment. No visually threatening corneal complications were observed.

Purpose: We present a review of viral lacrimal drainage infections.

Methods: A literature review was conducted using Medline and Embase databases following PRISMA guidelines. Twenty-seven studies met the inclusion criteria and were synthesised narratively. Data obtained include demographics, clinical presentation, types of viral infection, location of the infection, investigations, medical and surgical treatment, symptom resolution, complications, and infection sequelae.

Results: Four hundred and fifty-five cases of viral lacrimal drainage infections have been reported so far.  The majority of viral lacrimal drainage infections were secondary to herpes simplex virus (HSV) (83.1%, 378/455), followed by adenovirus (11.9%,54/455), varicella zoster virus (VZV) (2.2%, 10/455), and Epstein-Barr virus (EBV) (2.0%, 9/455). The majority [47.5% (216/455)] involved the canaliculus only. Of the 16 patients with nasolacrimal ductobstruction, all cases were related to adenovirus, EBV or VZV infections, not HSV. Where specified, 100% (10/10) cases of EBV-related lacrimal drainage infections and 75% (3/4) VZV-related lacrimal drainage infections completely resolved following conservative treatment alone. In contrast, only 1.1% (2/186) cases of HSV-related lacrimal drainage infection, and 5% (1/20) of adenovirallacrimal drainage infections, improved following conservative treatment alone.

Conclusion: Viral lacrimal drainage infections are relatively uncommon but should be suspected in patients presenting with new onset epiphora in the context of recent viral infections. Of these, the majority are likely to be related to HSV followed by adenovirus, which seem to be associated with a higher risk of permanent epiphora from scarring, compared with VZV and EBV infections, where the symptoms may be more likely to resolve through conservative treatment alone.

Sweet syndrome (SS), or acute neutrophilic dermatosis, is a dermatologic condition characterized by fever and neutrophilia with tender papular or plaque-like eruptions; diagnosis is confirmed histologically and the disease typically responds to systemic corticosteroids. Ocular associations include conjunctivitis, peripheral ulcerative keratitis, scleritis, uveitis, glaucoma, and retinal detachment, with occasional periocular involvement. A rare clinical variant, necrotizing Sweet's syndrome (NSS), closely mimics necrotizing fasciitis (NF). While NF requires urgent, extensive surgical debridement, NSS requires tissue biopsy, systemic corticosteroid therapy, and systemic evaluation to rule out underlying malignancy; misdiagnosis can therefore lead to inappropriate surgery and delayed treatment. We present three patients with isolated periocular SS. One had the classical form, while two were subsequently diagnosed with hematologic disease. All three exhibited features of NSS and underwent limited surgical debridement with microbiological and histopathological work-up, which confirmed SS. Collagen sheet grafting was used for wound coverage; two patients achieved rapid and cosmetically favourable recovery, while in one patient with full-thickness margin necrosis collagen alone was insufficient and an acquired eyelid coloboma remained. These cases underscore the need to distinguish NSS from NF: despite similar clinical appearance, the management is diametrically opposite.

Ocular and orbital symptoms are among the most common presenting signs in granulomatosis with polyangiitis (GPA). This report describes a patient with bilateral anophthalmos presenting with several weeks of left socket pain that was unresponsive to analgesics and low-dose oral steroid, without periorbital inflammation or orbital lesions on imaging. She was initially diagnosed with orbital neuralgia secondary to extensive prior orbital fractures and hardware and was scheduled for hardware removal. While awaiting surgery, she was admitted 1 month later for pneumonia and was diagnosed with GPA following an extensive systemic work-up. After commencing systemic treatment for the GPA, her left socket pain resolved. Therefore, GPA should be considered in the differential diagnosis of anophthalmic socket pain, even without periorbital inflammation or orbital lesions.

Purpose: To report the presentation, management, and outcomes of paediatric frontoethmoidal mucoceles causing epiphora.

Methods: Retrospective, interventional study involving six paediatric patients with paranasal sinus mucoceles presenting with epiphora over 13 years at a tertiary dacryology centre. Demographics, meticulous history, visual acuity, ophthalmic evaluation, lacrimal irrigation, and endoscopic evaluation of the nostril were documented. Computed tomography scans were performed in all patients. All patients underwent an endoscopic endonasal marsupialization of the mucocele. Functional improvements in epiphora and external signs were analysed.

Results: Six paediatric patients with a mean age of 12.83 years and equal sex distribution were included. The main presenting complaint was epiphora in all children and proptosis in one over an average period of 2.4 years. One child had history of trauma. External examination showed a telecanthus in all children and proptosis or dystopia in four. One child with prior trauma had a secondary acquired nasolacrimal duct obstruction (SALDO), while the others had freely patent irrigation. Four patients had ethmoidal and two had fronto-ethmoidal mucoceles, compressing the lacrimal drainage passage. After the endoscopic endonasal marsupialization of the mucocele, five children had relief from the epiphora with reduction in the proptosis and telecanthus. The patient with traumatic SALDO underwent additional endoscopic dacryocystorhinostomy and did well.

Conclusions: Paediatric sinus mucoceles are rare cases with very subtle signs, often presenting first to an ophthalmologist. Thus, vigilance and knowledge about the entity is necessary to identify and manage it in early stages.

Filariasis is a parasitic infection that mostly involves the skin and ocular surface, although all layers of the eye and orbit can be affected. We report a case of a 42-year-old woman with Loa loa infection manifesting as a sequential bilateral forehead Calabar swelling, severe orbital cellulitis and thereafter mimicking a conjunctival tumor. Anterior segment optical coherence tomography helped to differentiate between a neoplasm and the filarial worm and show typical features such as longitudinal and cross-sections of the parasite. The worm was surgically removed and microbiologists confirmed the diagnosis of a subconjunctival Loa loa infection. The patient was successfully treated with diethylcarbamazine (DEC) and ivermectin without adverse events. Parasitic orbital cellulitis is rarely reported and this case highlights the importance of considering loiasis in unexplained orbital cellulitis in patients with hypereosinophilia and a history of residence in endemic areas.

Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis that may involve the central nervous system, most frequently as hypertrophic pachymeningitis. We report the case of a 49-year-old woman who presented with bilateral, painless visual loss as the initial manifestation of GPA. Imaging revealed hypertrophic pachymeningitis with bilateral optic canal involvement. Despite extensive investigation, the diagnosis was only confirmed 3 years later through lacrimal gland biopsy, which demonstrated granulomatous inflammation with necrosis and vasculitis. The patient was treated with cyclophosphamide and later azathioprine, achieving clinical stability, though without recovery of vision. This case highlights that optic neuropathy due to pachymeningitis may precede classic systemic features of GPA, reinforcing the importance of early suspicion to prevent irreversible complications.

Purpose: To compare race, sex, and ethnicity of thyroid eye disease patients who were and were not prescribed teprotumumab.

Methods: This retrospective, comparative study used TriNetX health record database to compare race, sex, and ethnicity distributions between patients who were and were not prescribed teprotumumab from 2020 to 2025. Patients with at least one thyroid eye disease sign (exophthalmos, eyelid retraction, strabismus) and elevated thyroid stimulating immunoglobulin (≥1.30 index value) were included. Subanalysis examining 2020-2023 and 2023-2025 periods was conducted.

Results: There were 293 patients prescribed teprotumumab and 4125 controls. Significant racial disparities existed between controls and teprotumumab patients (χ² = 25.1414, p < 0.0001). Odds of White patients receiving teprotumumab were 2.52 (99% CI: 1.51-4.21) times higher than Black patients but not significantly different from patients of other races. Subanalysis showed significant racial disparities from 2020 to 2023 (χ² = 23.5221, p < 0.0001), but these differences were not statistically significant from 2023 to 2025 (χ² = 4.0007, p = 0.1353). No significant ethnic- or sex-based disparities were found.

Conclusions: White patients were disproportionately more likely to be prescribed teprotumumab than Black patients, potentially due to prescriber bias, socioeconomic challenges, and medical distrust. Trends show progress towards more equitable distribution.