Topical Adrenaline (1: 1000) for the Management of Severe Tarsal Conjunctival Chemosis.

Severe, refractory tarsal conjunctival chemosis developed in a severely autistic 9-year-old boy with a history of allergic conjunctival chemosis. The child was initially treated with topical and oral antihistamines, topical steroids, lubricants, and topical phenylephrine 10% with worsening of condition until complete eyelid eversion secondary to gross conjunctival chemosis with total obstruction of vision in the affected eye. Subsequently, he was successfully treated with topical adrenaline (1:1000) with rapid and lasting effect. The authors suggest that topical (1:1000) adrenaline is an effective therapy when other conservative therapies fail and can be useful in avoiding examination under general anesthetic and invasive intervention. Such a case has not been previously reported in the literature.

Ethmoidal air cell schwannoma presented as a fronto-ethmoidal mucocele.

AIM: To report a rare case of a fronto-ethmoidal mucocele secondary to an ethmoidal schwannoma. To our knowledge this is the first reported case of an ethmoidal schwannoma, a tumour of the peripheral nerve sheath originating from an area not believed to contain peripheral nerves that has presented as a fronto-ethmoidal mucocele. CASE REPORT: Our patient is a 23-year-old male presented with a one-year history of progressive proptosis and vertical diplopia with restriction of upgaze. Orbital imaging demonstrated a mass in the right medial ethmoidal air cells extending to the frontal sinus and orbit, consistent with a mucocele. Patient underwent endonasal decompression of the right fronto-ethmoidal mucocele. Histology confirmed a schwannoma and repeat imaging post-operatively revealed residual mass originating from the ethmoidal air cells. A right upper eyelid skin crease approach anterior orbitotomy was performed to successfully excise the mass via the lamina papyracea. Post-operatively the patient's proptosis and diplopia resolved, with a full range of ocular movements. Post-operative imagining at 3 months did not show any residual tumour. COMMENT: Mucocele formation may be secondary to an underlying schwannoma obstructing the fronto-ethmoidal foramen. In such cases we recommend an open-sky technique for full visualisation and improved chance of total removal.

A suggestion for royal jelly specifications.

This article proposes guidelines for quality standards of royal jelly. The proposals are based on two sets of data; the first from our study of the factors that may affect the royal jelly's chemical composition (protein and sugar supplementation of beehives) and the second on the analysis of a great number of samples from across Greece to establish natural variability of this product. We compared our findings with the adopted national limits, the proposals of the working group of the International Honey Commission (IHC), and the draft proposal of the International Organization of Standardization (ISO). The studied parameters included moisture, total proteins, sugars (fructose, glucose, sucrose, total sugars), and 10-hydroxy- 2-decenoic acid (10-HDA). Our results indicate that the limits for royal jelly in some countries should be amended and the proposals of the IHC and the ISO reviewed in view of recent data on variability. We believe that our proposals could be considered for setting global standards for royal jelly, as they incorporate national legislations, proposals of scientific groups, experimental data, and updated information.

Dexamethasone implants in retinal vein occlusion: 12-month clinical effectiveness using repeat injections as-needed.

OBJECTIVE: To report the 12-month outcomes of the dexamethasone intravitreal implant in retinal vein occlusion (RVO), using an as-needed repeat injection protocol. DESIGN: Retrospective consecutive case series of 51 eyes of 49 patients with macular oedema as a result of RVO that received an intravitreal dexamethasone implant and were followed up for at least 12 months. RESULTS: 70% of patients responded to dexamethasone implant injection with an improvement in visual acuity (VA) and macular oedema within 3 months of injection, but only 30% of eyes gained ≥15 letters. The mean change in VA letter score at 12 months compared with baseline for branch RVO (BRVO) and central RVO (CRVO) was 5.7±2.3 and 11.5±11.0 EDTRS letters, respectively. 56% of patients relapsed, with the median time to relapse being 17 weeks for patients with branch RVO and 18 weeks for patients with CRVO. Repeat injections achieved similar VA gains, but the duration of effect of repeat dexamethasone implants was much shorter at 10 weeks. 14 eyes (27%) developed a significant rise in intraocular pressure, and three of these required treatment with oral acetazolamide. Four eyes with CRVO developed neovascular glaucoma during the study. CONCLUSIONS: The intravitreal dexamethasone implant does not last the 6 months implied by the retreatment protocol in the GENEVA trial, and improved results can be achieved with an as-needed retreatment protocol, particularly in CRVO. However, visual outcomes remain similar to those previously seen with triamcinolone in the SCORE study and neovascular complications remain a feature of CRVO.

Tick infestation on the lower eyelid: a case report.

BACKGROUND: The tick infestation of the lower lid is a quite rare condition. CASE PRESENTATION: We report a case of a 40 years old caucasian female who presented with the above condition after camping in the Norfolk area, UK. CONCLUSION: Tick bite can be responsible for many diseases the most common being Lyme disease which can affect the eyes in several ways. It is still debatable whether or not prophylactic treatment is needed after tick bite.