Orbital abscess with white eye in patients treated with oral antibiotics for orbital cellulitis.

PURPOSE: To report a case series of seven patients with late presentation of orbital/subperiosteal abscess following oral treatment of orbital cellulitis. METHODS: A retrospective case series of all patients presented with orbital abscess following oral treatment of orbital cellulitis from two tertiary-care eye centres in Riyadh, Saudi Arabia, was conducted. Demographic profiles, risk factors, initial clinical presentation, management regimens, and final outcome were analysed. RESULTS: Patients presented mainly with proptosis and limitation of extraocular motility without external ophthalmic inflammatory signs. Most patients needed surgical evacuation despite the appropriate initiation of intravenous antibiotics following presentation to our hospitals. CONCLUSION: Treating orbital cellulitis with oral antibiotics may lead to delayed presentation of orbital abscess without external ophthalmic inflammatory signs.

Eyelid Soft Tissue Chondroma: A Case Report.

Soft tissue chondromas are rare benign tumors that occur in extraosseous and extra-synovial locations. We report herein a rare presentation of eyelid soft tissue chondroma in a 45-year-old male presented with a 2-year history of a slowly enlarging subcutaneous firm mass on the left upper eyelid, and complete excision of the lesion followed by histopathological examination rendered the diagnosis of soft tissue chondroma.

Unilateral acquired blepharoptosis due to orbital metastatic disease as an initial presentation of an overlooked breast carcinoma - A case report.

INTRODUCTION AND IMPORTANCE: Orbital metastasis from breast cancer may be infrequently noted after the management of the primary lesion. It is rare in such cases to present with unilateral mechanical blepharoptosis without ophthalmoplegia. CASE PRESENTATION: We present a case of unilateral acquired blepharoptosis of the left upper eyelid without ophthalmoplegia or exophthalmos three years after the onset of a suspicious breast mass. The patient did not disclose a history of breast cancer nor any positive family history to the ophthalmologist and anesthesiologist. The radiology images revealed an ill-defined enhanced lesion at the superior medial aspect of the left orbit. The orbital biopsy of the lesion showed poorly differentiated carcinoma as per the initial histopathology report. Vigilant history-taking enabled us to get information about a previous breast lesion and to correlate this with specific histopathological findings. DISCUSSION: Management of orbital lesions might be challenging, and the approach should include detailed history and assessment. Biopsy and radio imaging are further needed to aid in providing the proper diagnosis. The clinicopathological correlation in our case has led to the final diagnosis of orbital metastatic breast cancer. CONCLUSION: Ophthalmologists should be aware of variable ocular presentations of malignancy and adopt a team approach to obtain a carefully detailed history from patients presenting with orbital diseases and communicate adequately with the ocular pathologists who are handling the biopsy. Long-term follow-up and enhancement of patients' awareness of possible late orbital metastasis are recommended in all patients with breast masses.

Presumed acute suppurative bacterial dacryoadenitis with concurrent severe acute respiratory syndrome coronavirus-2 infection.

Acute suppurative bacterial dacryoadenitis (ASBD) was not reported to occur following severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We are presenting a unique case of concurrent presumed ASBD with SARS-CoV-2 infection. A 23-year-old previously healthy male presented with right upper eyelid swelling and pain over the lacrimal gland area for 3 days. Before his visit, the patient was tested positive for SARS-CoV-2 infection after experiencing mild flu-like symptoms, despite being vaccinated 2 months ago. He was found to have clinical and radiological features highly suggestive of ASBD with concurrent SARS-CoV-2 infection. He was admitted and initiated on systemic and topical antibiotic, followed by incision and drainage of an abscess collection. The patient showed dramatic clinical improvement with no recurrent signs of infection during the follow-up period. This acute dacryoadenitis is presumed to represent a secondary bacterial infection possibly aided by immune-related factors that may coexist in SARS-CoV-2-positive patients.

Isolated eyelid coloboma in association with complex choristoma in a newborn: A case report.

Ocular choristomas are rare lesions that have been reported at the conjunctiva, sclera, orbit, or intraocularly with significant potential for visual disturbance. The complex type of choristomas shows a mixture of different cartilaginous, glandular, and muscular tissue in addition to fat. We present a patient with an associated eyelid coloboma and complex choristoma. A 12-day-old baby boy was referred to our hospital with an upper medial eyelid coloboma affecting almost two-thirds of the eyelid length with an additional sub-brow mass since birth. The baby also had secondary findings to the eyelid coloboma defect: temporal conjunctival symblepharon, vascularized cornea, and inferior pannus. The patient underwent an upper eyelid reconstruction with excisional biopsy of the sub-brow mass, which was diagnosed as a complex choristoma. This is the first case of an eyelid coloboma-associated with complex choristoma without any other systemic associations.

Prediction of retinopathy of prematurity using the screening algorithm WINROP in a Saudi cohort of preterm infants.

OBJECTIVES: To validate the web weight gain-based WINROP (weight, insulin-like growth factor I, neonatal, retinopathy of prematurity [ROP]) algorithm retrospectively to identify type 1 ROP in a Saudi cohort of premature infants.  Methods: The records of preterm infants (greater than 23 and less than 32 weeks gestation) born between August 2013 and October 2018, were reviewed. Birth weight, gestational age, and weekly weight measurements of the premature infants were entered online. Based on weekly weight gain, the WINROP algorithm alerted clinicians whether infants were at high-risk for vision­threatening type 1 ROP. Sensitivity, specificity, positive and negative predictive values were calculated. Results: The median gestational age of the infants at birth was 28 weeks, with median birth weight at 1085 g. Of the 175 infants included in the study, 13 (7.4%) developed type 1 ROP. WINROP positive alarm was triggered in 70.9% (124/175) of all infants and 100% (13/13) of those treated for type 1 ROP. The specificity of the algorithm was 31.5%. Positive predictive values was 10.5% and negative was 100%. Conclusion: The general WINROP sensitivity in identifying type 1 ROP was 100% similar to that reported in developed countries; however, its specificity was low at 31.5%. Tweaking of the algorithm based on the population may increase the specificity and promote the practical utility of this non-invasive screening tool for ophthalmologists and neonatologists in this population.