Challenges in diagnosis and management of pseudoptosis secondary to asymmetrical skin creases.

INTRODUCTION: Asymmetrical eyelid skin crease may be mistaken for ptosis due to apparent narrowing of the palpebral fissure in the eye without the skin crease. This study describes a series of patients who were mistakenly referred for ptosis operation as a result of absent skin crease. METHODS: Retrospective case review. RESULTS: A total of 8 patients (5 males and 3 females) were referred by the general ophthalmologists because of suspected ptosis. Although skin creases asymmetry was noted by the general ophthalmologists, the apparent narrowing of the palpebral fissure was thought to be caused by ptosis. However, measurement of the palpebral fissures in both eyes were normal. Creation of a symmetrical skin crease in the affected eye correct the appearent palpebral fissure narrowing. This could be achieved by either surgical or non-surgical means (tape or glue). CONCLUSION: Patients with asymmetrical skin crease of the upper eyelid can give rise to apparent differences in palpebral apertures which may be mistaken for ptosis. The treatment of choice is to create symmetrical skin crease in the eye with absent skin crease to correct the pseudoptosis. Recognition of this condition is important to avoid unnecessary ptosis surgery.

Orbital myxoma--an unusual cause of inferoorbital mass.

UNLABELLED: To describe a case of isolated infraorbital mass which had been present for the past 9 years in a young woman. Despite the size, the mass was successfully excised in total. METHOD: Case report. RESULT: Histologically, the tumour was found to be an isolated orbital myxoma. CONCLUSION: Isolated orbital myxoma is an exceedingly rare tumour of the orbit. The case shows the lesion could be excised in its entirety with good cosmetic result.

Chromosome 13q deletion with Cornelia de Lange syndrome phenotype.

A 3-year-old girl with facial dysmorphic features suggestive of Cornelia de Lange syndrome was seen in the ophthalmology unit for a right leukocoria. The leukocoria was found to be caused by a large retinoblastoma and the right eye was enucleated. Chromosomal analysis revealed partial chromosome 13q deletion involving band 14 which is associated with a high risk of retinoblastoma. This case shows that patient with chromosome 13q deletion syndrome cannot be diagnosed based on dysmorphic features only. Chromosomal analysis is warranted in all infants with facial dysmorphism suggestive of Cornelia de Lange syndrome so that those with chromosome 13q deletion can be referred early for early detection of retinoblastoma.

Uveitis and erythema nodosum in inflammatory bowel disease: clinical features and the role of HLA genes.

BACKGROUND & AIMS: There are few systematic studies on the natural history or immunogenetic associations of erythema nodosum (EN) or ocular inflammation in inflammatory bowel disease (IBD), but they are reportedly more common in patients with other extraintestinal manifestations (EIMs), particularly arthritis. Immunogenetic associations have previously been described in IBD arthritis and in EN associated with sarcoidosis. This study examined the clinical features and HLA-B, DR, and tumor necrosis factor alpha (TNF-alpha) associations of ocular inflammation and EN and their clinical and immunogenetic relationship to arthritis in IBD. METHODS: Details of EN and ocular inflammation were gathered by case-note review and questionnaire in 976 ulcerative colitis patients and 483 Crohn's patients. Sequence-specific PCR typing for polymorphisms in HLA-B, DR, and TNF-alpha was performed in 39 EN and 40 ocular patients. Results were compared with 490 IBD controls without EIMs, 38 patients with type 1 and 31 with type 2 peripheral arthritis, and 16 AS patients. RESULTS: EN and ocular inflammation were more common in women, were associated with IBD relapse, and recurred in approximately 30% of patients. They occurred more commonly with arthritis and AS than expected by chance. Ocular inflammation was strongly associated with HLA-B*27, B*58, and HLA-DRB1*0103. There is a weak association between EN and HLA-B*15 but a strong association with the -1031 TNF-alpha. CONCLUSIONS: EN, uveitis, and arthritis associated with IBD occur together commonly. They are associated with genes in the HLA region, and linkage disequilibrium between these genes may account for the clinical picture of overlapping but independent clinical manifestations.

Refractive changes following Nd:YAG capsulotomy.

PURPOSE: To investigate the effect of Nd:YAG capsulotomy on refractive changes and the need for a post-capsulotomy refraction. METHODS: Forty-two eyes with uncomplicated phacoemulsification and implant (AMO@Phacoflex II) were included. Autorefraction and subjective refraction were performed to get the best visual acuity before and after Nd:YAG capsulotomy. RESULTS: The spherical equivalent before the Nd:YAG capsulotomy was -0.61 +/- 0.90 and after the capsulotomy, -0.57 +/- 0.84. Using the paired Student's t-test there was no significant difference in the refraction following Nd:YAG capsulotomy. CONCLUSION: Routine refraction following Nd:YAG capsulotomy in patients who have had uncomplicated phacoemulsification using AMO@Phacoflex II intraocular lenses is not necessary.