Orbital invasion of a conjunctival atypical fibroxanthoma in a patient with systemic diffuse large B-cell lymphoma.

An 88-year-old male patient presented with a large mass on the left lateral bulbar conjunctiva. The tumor appeared two months after the resection of a conjunctival atypical fibroxanthoma (AFX) performed by a cornea specialist. Magnetic resonance imaging of the orbits showed deep orbital invasion along the lateral rectus muscle. The mass and the entire conjunctival sac were totally excised with lid-sparing orbital exenteration. Histopathological analysis confirmed that the mass was an extension of the AFX. Two weeks after surgery, large B-cell lymphoma was diagnosed in the oropharynx. Chemotherapy was initiated, and after seven months of follow-up, there was no recurrence of the AFX. The authors believe that this is the first report of orbital invasion by AFX.

Blink Lagophthalmos in Graves Orbitopathy.

PURPOSE: To investigate the relationship between the kinematics of spontaneous blinks and the anterior area of the levator palpebrae superioris muscle in patients with Graves orbitopathy (GO). METHODS: This is a case-control study. The authors measured the margin reflex distance of the upper eyelid (margin reflex distance 1), the kinematics of spontaneous blinks, and the anterior area of levator palpebrae superioris muscle in CT coronal scans of patients with Graves upper eyelid retraction (GO) and a control group. The eye with the greatest margin reflex distance 1 was selected for analysis in each group. RESULTS: A total of 68 participants were included, with 36 in the GO group and 32 in the control group. In the GO group, the mean margin reflex distance 1 measured 6.5 mm, while in the control group, it was 3.9 mm. Almost all parameters related to the closing phase of spontaneous blinking activity, including amplitude, velocity, blinking rate, and interblink time, did not differ between the two groups. However, the effectiveness of the blink's amplitude (ratio of blink amplitude to margin reflex distance 1) and the main sequence (relationship between amplitude and velocity) were significantly reduced in the GO group compared with the control group. The area of the levator palpebrae superioris muscle was significantly larger in GO than in controls, with 71.4% of patients' muscles outside of the maximum range of the controls. CONCLUSIONS: In patients with GO, there is a reduction in blinking effectiveness, also known as blink lagophthalmos, which is a factor in the common occurrence of ocular surface symptoms. The increase in velocity with amplitude is also reduced in GO.

Apical bleeding: a rare cause of blindness after orbital decompression / Sangramento apical: uma causa rara de cegueira pós descompressão orbitária

ABSTRACT Orbital decompression is widely performed for the management of proptosis for cosmetic and functional cases of Graves orbitopathy. The main side effects include dry eye, diplopia, and numbness. Blindness after orbital decompression is extremely rare. The mechanisms of vision loss after decompression are not well described in the literature. Considering the devastating effect and rarity of this complication, this study presented two cases of blindness after orbital decompression. In both cases, vision loss was provoked by slight bleeding in the orbital apex.

RESUMO A descompressão orbitária é uma cirurgia amplamente empregada para correção da proptose em casos cosméticos e funcionais da orbitopatia de Graves. Os principais efeitos colaterais induzidos pela descompressão são olho seco, diplopia e parestesias. Amaurose pós descompressão é uma complicação extremamente rara e cujos mecanismos são pouco discutidos na literatura. Considerando o efeito devastador representado pela perda visual e a escassez de relatos dessa complicação, os autores apresentam dois relatos de amaurose após descompressão orbitária. Nos dois casos a perda visual ocorreu devido a sangramento de pequena monta no ápice orbitário.

Apical bleeding: a rare cause of blindness after orbital decompression.

Orbital decompression is widely performed for the management of proptosis for cosmetic and functional cases of Graves orbitopathy. The main side effects include dry eye, diplopia, and numbness. Blindness after orbital decompression is extremely rare. The mechanisms of vision loss after decompression are not well described in the literature. Considering the devastating effect and rarity of this complication, this study presented two cases of blindness after orbital decompression. In both cases, vision loss was provoked by slight bleeding in the orbital apex.

Revisiting the orbital complications of acute rhinosinusitis

Abstract Objective: The present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability. Methods: Clinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae. Results: 143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler's and Mortimore & Wormald's classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-value < 0.0001 ). Complications were present at higher rates in the OA group compared to the other three groups. Conclusions: ARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima's classification system proved valid, simple, and effective for categorizing orbital complications of ARS. Level of evidence: 3.

Revisiting the orbital complications of acute rhinosinusitis.

OBJECTIVE: The present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability. METHODS: Clinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae. RESULTS: 143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler's and Mortimore & Wormald's classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-value < 0.0001). Complications were present at higher rates in the OA group compared to the other three groups. CONCLUSIONS: ARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima's classification system proved valid, simple, and effective for categorizing orbital complications of ARS.

Computed tomography and magnetic resonance imaging of an unusual intraconal orbital osteoma.

We report the case of a 64-year-old male patient with a 5 month history of proptosis, motility limitation and vision loss in OD. Visual acuity (VA) was 20/200 in OD and 20/20 in OS. CT showed a large, round, intraconal lesion, with bony density and no apparent connection to adjacent orbital walls. MRI showed a T1-weighted hypointense lesion surrounded by a contrast enhancing capsule. The orbital tumor was excised through a lateral orbitotomy revealing a nodular, round, osseous structure. Histological examination disclosed well-formed lamellar bone trabeculae, with no necrosis or mitosis figures. Immunohistochemical staining was negative for MDM2 and CDK4. After 3 years, there was no evidence of tumor recurrence and VA had improved to 20/30. Intraconal osteomas with no clear attachment to orbital walls are extremely rare. We are aware of a few reported cases in the lid, hand, thigh, tongue, pterygopalatine fossa and brain. To the authors' knowledge, this is the first report in English literature of an orbital intraconal osteoma without any visible relation to the orbital walls.

Progressive chronic calvarial osteomyelitis in rhino-orbital mucormycosis associated with COVID-19.

We describe two cases of extensive indolent calvarial osteomyelitis after rhino-orbital-mucormycosis in diabetic patients previously diagnosed with COVID-19. Both patients presented with acute rhino-orbital symptoms about one month after being diagnosed with COVID-19. Treatment with intravenous liposomal Amphotericin B and prompt radical surgical debridement was instituted, but calvarial osteomyelitis ensued and persisted chronically despite maintenance of antifungal therapy and partial debridement of necrotic calvarial bone. The patients were discharged to continue antifungal therapy on a day-hospital regime. After more than 8 months of treatment, they remain with radiological signs of osteomyelitis but with no symptoms or intracranial extension of the infection. Calvarial indolent osteomyelitis secondary to mucormycosis is extremely rare, and little is known regarding its treatment. We believe it can be controlled with medical treatment and partial bony debridement although more studies are necessary to better define therapy.

Upper eyelid contour symmetry measurement with Bézier curves / Medida da simetria do contorno da pálpebra superior com curvas de Bézier

ABSTRACT Purpose: The purpose of the present work is to measure the interocular upper lid contour symmetry using a new method of lid contour quantification. Methods: The Bézier curve tool of the Image J software was used to extract the right and left upper eyelid contours of 75 normal subjects. Inter-observer variability of 29 right lid contours obtained by two independent observers was estimated using the coefficient of overlap of two curves and an analysis of the differences of the contour peak location. A two-way analysis of variance was used to test the mean value of the coefficient of overlap of the right and left contours in males and females and lid segments. The same analysis was performed to compare the location of the contour peak of the right and left contours. Results: The coefficient of contour overlap obtained by independent observers ranged from 93.5% to 98.8%, with a mean of 96.1% ± 1.6 SD. There was a mean difference of 0.02 mm in the location of the contour peak. Right and left contour symmetry did not differ between females and males and was within the range of the method variability for contour overlap and location of the contour peak. Conclusions: The upper eyelid contour is highly symmetrical. Bézier lines allow a quick and fast quantification of the lid contour, with a mean inter-observer variability of 3.9%.

RESUMO Objetivo: O objetivo do presente estudo é mensurar a simetria interocular do contorno da pálpebra superior por meio de um novo método de quantificação de contorno palpebral com curvas de Bézier. Métodos: A ferramenta de curva de Bézier do software ImageJ foi utilizada para extrair os contornos palpebrais direito e esquerdo de 75 sujeitos normais. A variabilidade interobservador de 29 contornos palpebrais do olho direito obtidos por dois observadores diferentes foi estimada pelo coeficiente de superposição de duas curvas e pela análise das diferenças das posições do pico do contorno. Análise de variância de dois fatores foi empregada para testar a média do coeficiente de superposição entre os contornos direito e esquerdo quanto ao sexo e segmento palpebral. A mesma análise foi utilizada para comparar a localização do pico do contorno dos olhos direito e esquerdo. Resultados: O coeficiente de superposição obtidos por observadores independentes variou ente 93,5% e 98,8% com média de 96,1% ± 1,6 DP. A diferença das médias da localização do pico do contorno palpebral foi de 0,02 mm. A simetria entre os contornos dos olhos direito e esquerdo não diferiu entre o sexo feminino e masculino e esteve na faixa de variabilidade do método para o coeficiente de superposição e localização do pico do contorno. Conclusões: O contorno da pálpebra superior é altamente simétrico. As linhas Bézier permitem uma rápida e prática quantificação do contorno palpebral com uma média de variabilidade interobservador de 3,9%.

Upper eyelid contour symmetry measurement with Bézier curves.

PURPOSE: The purpose of the present work is to measure the interocular upper lid contour symmetry using a new method of lid contour quantification. METHODS: The Bézier curve tool of the Image J software was used to extract the right and left upper eyelid contours of 75 normal subjects. Inter-observer variability of 29 right lid contours obtained by two independent observers was estimated using the coefficient of overlap of two curves and an analysis of the differences of the contour peak location. A two-way analysis of variance was used to test the mean value of the coefficient of overlap of the right and left contours in males and females and lid segments. The same analysis was performed to compare the location of the contour peak of the right and left contours. RESULTS: The coefficient of contour overlap obtained by independent observers ranged from 93.5% to 98.8%, with a mean of 96.1% ± 1.6 SD. There was a mean difference of 0.02 mm in the location of the contour peak. Right and left contour symmetry did not differ between females and males and was within the range of the method variability for contour overlap and location of the contour peak. CONCLUSIONS: The upper eyelid contour is highly symmetrical. Bézier lines allow a quick and fast quantification of the lid contour, with a mean inter-observer variability of 3.9%.

Orbital Bone Decompression for Non-Thyroid Eye Disease Proptosis.

PURPOSE: To report a multicenter large case series of orbital decompression for non-thyroid eye disease proptosis. METHODS: Retrospective chart review of cases of orbital decompression performed by 9 experienced orbital surgeons from different countries from 2014 to 2017 for non-thyroid eye disease proptosis. Patients were divided into 3 groups: 1) negative vector (high axial length or shallow orbit), 2) inflammatory, and 3) tumor. Types of orbital decompression and Hertel exophthalmometry (preoperative and minimum 6 months postoperative) were recorded. Charts were also assessed for serious complications. The amount of exophthalmometry improvement was recorded according to the above groups. RESULTS: The analysis included 41 orbits of 29 patients (14 women and 15 men) with a mean age of 38.9 years (ranging from 9 to 74; standard deviation (SD) 15.66). There were 17 orbits of 11 patients in the negative vector group, 16 orbits of 10 patients in the inflammatory group, and 8 orbits of 8 patients in the tumor group. The mean reduction of proptosis was 2.95 mm in the negative vector group, 2.54 mm in the inflammatory group, and 5.75 mm in the tumor group. There were no serious complications. CONCLUSIONS: Orbital decompression was safe and effective in reducing proptosis for non-thyroid eye disease indications in this series. The amount of exophthalmometry improvement was less in the inflammatory orbitopathy group compared with other proptosis etiology groups.Orbital decompression may have a role in improving proptosis in non-thyroid eye disease entities.

Intraconal gauze mass: An unusual complication of orbital fracture repair - a case report.

Gossypiboma and textiloma are terms used to describe tumor-like masses caused by retained gauze or surgical sponges after any operation. It is a rare surgical complication, usually difficult to diagnose due to its variable clinical presentation and nonstandard radiological appearance. We describe here a rare case of orbital gossypiboma in a child after surgical correction of an orbital blowout fracture.

Transvenous embolization of dural carotid cavernous fistulas: the role of liquid embolic agents in association with coils on patient outcomes.

INTRODUCTION: Transvenous embolization is the standard treatment for dural carotid cavernous fistulas (DCCF). Although various embolic materials have been used, the best embolic material for the treatment of DCCF is still unknown. OBJECTIVE: To assess the safety and efficacy of different embolic materials used for the endovascular treatment of DCCF. METHODS: A retrospective data analysis of a consecutive series of 62 patients presenting DCCF was performed. Clinical and radiological data from patients were assessed, and the embolic material used-coils or liquids-were compared between two groups of patients. RESULTS: Complete angiographic occlusion of DCCF after treatment was achieved in 83.9% of the patients (52/62). We found a higher rate of complete occlusion of DCCF when liquids were associated with coils than with coils alone (96.5% vs 71.8%, p=0.01), and no differences in complication rates or clinical outcomes were seen between the two groups. At the 6-month follow-up, we found a higher rate of improvement in ocular symptoms compared with cranial nerve palsy improvement (94.7% vs 77.7%, p=0.02). Two patients (3.2%) had treatment-related complications without clinical symptoms. CONCLUSION: In this study, in comparison with the use of coils alone, the association of transvenous embolization with liquid embolic agents for DCCF treatment resulted in higher rates of complete occlusion without increasing complication rates. The clinical outcome at the 6-month follow-up showed significant improvement in ocular symptoms over cranial nerve palsy regression, which was independent of the embolic agent chosen for treatment.

Intraocular Plasmablastic Lymphoma in a HIV Patient.

Plasmablastic lymphoma (PBL) is a rare B-cell lymphoma occurring mainly in HIV patients. The tumor frequently involves extranodal sites such as the oral cavity, nasal cavity, gastrointestinal tract, skin, and lungs. The neoplastic cells are characterized by a plasmablastic appearance and typical immunophenotype that indicates plasma cell differentiation. Herein, we report a case of intraocular involvement by plasmablastic lymphoma in a HIV patient with a long history of cytomegalovirus retinitis and loss of vision. After an evisceration performed to control the blind, painful eye a diagnosis of PBL was made by examining the eye contents. Two months later, a biopsy of cervical lymph node revealed nodal lymphoma of the same type. To the best of our knowledge, this is the second case of intraocular PBL reported in English literature.

Support to woman/nourisher in the advertising pieces of the World Breastfeeding Week. / Apoios à mulher/nutriz nas peças publicitárias da Semana Mundial da Amamentação.

OBJECTIVE:: to unveil the support to woman/nourisher in the advertisements of the World Breastfeeding Week. METHOD:: This is a descriptive, exploratory, documentary, qualitative study. Since the collection until the analyses of these advertisements, we adopted the methodological steps of Gemma Penn, based on the semiology of Roland Barthes. The results were interpreted by the theory of Social Network of Sanícola and of the five types of support: companionship, emotional, instrumental, informational, and self-supportive. RESULTS:: we identified actors of the social network of the woman/nourisher in nine advertisements of the 22 world breastfeeding weeks. In five of them, partner, grandmother, and brother showed emotional and companionship support to breastfeeding. We observed self-support in three posters; instrumental support in one; and informational support in none. CONCLUSION:: the support unraveled in only five advertisements included: emotional, companionship, instrumental, and self-supportive. In the others, there was no support. The set of supports was not revealed in any of them.

Apoios à mulher/nutriz nas peças publicitárias da Semana Mundial da Amamentação / Apoyos a la mujer/nutriz en las piezas publicitarias de la Semana Mundial de la Lactancia Materna / Support to woman/nourisher in the advertising pieces of the World Breastfeeding Week

RESUMO Objetivo: desvendar os apoios da rede social da mulher/nutriz nas peças publicitárias da Semana Mundial da Amamentação. Método: estudo descritivo, exploratório, documental, qualitativo. Desde a coleta até a análise dessas peças, foram adotados os passos metodológicos de Gemma Penn, fundamentados na semiologia de Roland Barthes. Os resultados foram interpretados pela teoria da Rede Social de Sanícola e dos cinco tipos de apoio: presencial, emocional, instrumental, informativo e autoapoio. Resultados: em nove peças publicitárias das 22 semanas mundiais da amamentação, identificou-se/identificaram-se ator(es) da rede social da mulher/nutriz. Em cinco delas, companheiro, avó e irmão demonstraram apoio emocional e presencial à amamentação. Percebeu-se o autoapoio em três cartazes; o apoio instrumental, em um cartaz; e o apoio informativo, em cartaz algum. Conclusão: os apoios desvendados em apenas cinco peças publicitárias incluíram: emocional, presencial, instrumental e autoapoio. Nas demais, não havia apoio. Em nenhuma delas, o conjunto dos apoios foi revelado.

RESUMEN Objetivo: desvelar los apoyos de la red social de la mujer/nutriz en las piezas publicitarias de la Semana Mundial da Lactancia Materna. Método: estudio descriptivo, exploratorio, documental, cualitativo. Desde la reunión hasta el análisis de esas piezas, se adoptaron los pasos metodológicos de Gemma Penn, fundamentados en la semiología de Roland Barthes. Los resultados fueron interpretados por la teoría de la Red Social de Sanícola y de los cinco tipos de apoyo: presencial, emocional, instrumental, informativo y auto-apoyo. Resultados: en nueve piezas publicitarias de las 22 semanas mundiales de la lactancia materna, seidentificó/se identificaron actor(es) de la rede social de la mujer/nutriz. En cinco de ellas, compañero, abuelo y hermano demostraron apoyo emocional y presencial a la lactancia materna. El auto-apoyo se vio en tres carteles; el apoyo instrumental, en un cartel; y el apoyo informativo, en ningún cartel. Conclusión: los apoyos desvelados en solo cinco piezas publicitarias incluyeron: emocional, presencial, instrumental y auto-apoyo. En las demás, no había apoyo. El conjunto de los apoyos no se reveló en ninguna de ellas.

ABSTRACT Objective: to unveil the support to woman/nourisher in the advertisements of the World Breastfeeding Week. Method: This is a descriptive, exploratory, documentary, qualitative study. Since the collection until the analyses of these advertisements, we adopted the methodological steps of Gemma Penn, based on the semiology of Roland Barthes. The results were interpreted by the theory of Social Network of Sanícola and of the five types of support: companionship, emotional, instrumental, informational, and self-supportive. Results: we identified actors of the social network of the woman/nourisher in nine advertisements of the 22 world breastfeeding weeks. In five of them, partner, grandmother, and brother showed emotional and companionship support to breastfeeding. We observed self-support in three posters; instrumental support in one; and informational support in none. Conclusion: the support unraveled in only five advertisements included: emotional, companionship, instrumental, and self-supportive. In the others, there was no support. The set of supports was not revealed in any of them.