Self-inflicted bilateral ocular and eyelid injuries in an unsuspected individual.

BACKGROUND AND AIMS: This report aims to illustrate a case of self-inflicted ocular and orbital injury, resulting in severe tissue loss and ophthalmoplegia in a patient with no known history of mental illness. METHODS AND RESULTS: A 71-year-old male initially presented to the emergency department with significant tissue loss from his left upper and lower lids, orbital tissue loss and complete ophthalmoplegia, after reportedly tripping and falling onto his desk. He subsequently attended the emergency department on two further occasions with similar injuries, affecting the same and contralateral eye, whilst maintaining a traumatic cause for his injuries. He was eventually admitted to a psychiatric ward for mental health assessment. This report covers his progress as well as illustrating his injuries with images. CONCLUSION: Self-harm is an important differential diagnosis in cases where the mechanism of injury does not correspond to the extent of injury or tissue loss. It can, however, be difficult to differentiate from accidental injury and even with repeated assessments, a formal psychiatric diagnosis may not be possible.

Idiopathic hypertrophic cranial polyneuropathy: a rare cause of orbital pain.

Hypertrophic cranial polyneuropathy (HCP) is sporadically encountered in clinical practice. Aetiologies of HCP have been classified as autoimmune, infectious and demyelinating. However, an accurate diagnosis remains elusive in some cases despite rigorous investigations. These cases represent idiopathic HCP. Given the high clinical variance in presenting symptoms, HCP often leaves medical practitioners in a diagnostic quandary. Here, we seek to expand current knowledge by reporting the first documented case of idiopathic HCP presenting atypically with unilateral orbital pain and exclusively involving the bilateral trigeminal nerves.

Lower eyelid retractor (white-line) advancement to correct tarsal ectropion.

OBJECTIVE: To describe a modification of trans-conjunctival, lower eyelid retractor advancement to correct tarsal ectropion. DESIGN: A retrospective case review. PARTICIPANTS: Consecutive patients with lower eyelid tarsal ectropion. METHODS: Cases of lower eyelid tarsal ectropion, surgically corrected by advancement of inferior retractor to the lower border of tarsus via a transconjunctival approach, were identified. Lateral tarsal strip was also performed simultaneously in all cases. RESULTS: Twenty patients (25 eyelids) were included in this study. There were 19 primary lower eyelid tarsal ectropion and 6 recurrent tarsal ectropion. Complete resolution of tarsal ectropion was achieved in all patients postoperatively. Mean follow-up was 8.4 months (range 1-36 months). There were no cases of overcorrection, recurrent ectropion, suture abscess, wound dehiscence, or inferior fornix shortening after surgery. CONCLUSIONS: Visualization of the lower eyelid retractor (white-line) and advancement to the inferior border of tarsus through a transconjunctival approach is effective in correcting both primary and recurrent cases of tarsal ectropion. This can be performed through a small conjunctival incision in the middle third of the lower eyelid, without the need for any excision of tissue or suture loop tie on the skin surface.