Cemiplimab for metastatic squamous cell carcinoma of the orbit, periocular adnexa, and thigh.

The current case presentation highlights the potential of cemiplimab, a programmed cell death protein-1 (PD-1) inhibitor, as first-line treatment for periocular metastatic cutaneous squamous cell carcinoma (SCC) without requiring curative surgery or radiotherapy. A 64-year-old male presented with a progressing 4.5 × 3.0 cm left upper eyelid lesion initially diagnosed as psoriasis. Work-up revealed cutaneous SCC with tumor invasion into extraconal fat and lacrimal gland, and metastasis to the left parotid lymph node. The patient also presented with a suspicious lesion on his left medial thigh found to be a second primary on pathology. To avoid orbital exenteration and treat the multifocal disease, the patient was started on intravenous cemiplimab immunotherapy. Following six doses, repeated FGD-PET-CT revealed a complete response of the left eyelid lesion and residual low-grade hypermetabolic activity of the left medial thigh lesion. Biopsy confirmed chronic inflammation and fibrosis with no signs of malignancy. This unique case with dual primary cutaneous SCC provides support for cemiplimab in treating locally invasive periocular SCC, and potentially abrogating the need for highly morbid exenteration procedures to preserve binocular vision.

Evaluation of tearing in oculoplastics assisted by tear osmolarity measurement.

PURPOSE: To determine the tear osmolarity in patients with tearing secondary to dry eye and other pathologies, and to determine the prevalence of dry eye disease among patients with tearing in an oculoplastics setting. METHODS: 108 eyes of 54 patients with a chief complaint of tearing were prospectively recruited. Subjects were excluded if they used eye drops or contact lenses within 2 hours of assessment, had a history of refractive surgery, an active ocular allergy, or evidence of a systemic disease which affects tear production. A full medical and ocular history was taken with a complete eye exam pertinent to dry eye. Tear osmolarity was measured using the TearLab device. A clinical diagnosis of dry eye was made based on findings, without reference to tear osmolarity. RESULTS: Among 86 eyes symptomatic for tearing, 32 eyes had dry eye disease (37%). Patients with dry eye had a significantly higher median tear osmolarity compared to that in patients with other diagnoses (308 mOsm/L vs. 294 mOsm/L, p < 0.0001). At a cut-off of 308 mOsm/L, tear osmolarity resulted in a sensitivity of 50% and a specificity of 88% for the diagnosis of dry eye. CONCLUSIONS: A significant proportion of patients with tearing in an oculoplastics practice had dry eye disease. The high specificity of tear osmolarity may render it a useful tool to rule in dry eye disease and may assist the oculoplastic surgeon in more accurately determining the cause of tearing.

Severe visual loss and orbital infarction following periorbital aesthetic poly-(L)-lactic acid (PLLA) injection.

Visual loss following esthetic treatment of the face is a rare but devastating iatrogenic complication. The authors report a case of a 43-year-old man with blindness and ophthalmoplegia of the left eye following a treatment of the left periorbital region with the subcutaneous filler poly-(L)-lactic acid. The patient's symptoms began immediately following one of the tunneled injections. On presentation, the patient had clear signs of ocular and orbital ischemia. Angiography and further history suggested an embolic orbital infarction as the mechanism of injury. The increased usage of subcutaneous fillers for facial rejuvenation had introduced a small but proven risk of embolization of these viscous materials to the eye and orbit.