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.

Anesthesia in retinopathy of prematurity.

Retinopathy of prematurity (ROP) remains among the leading causes of childhood blindness. It affects mainly premature infants who tend to be systematically and clinically unstable and are more prone to complications and anesthesia related adverse effects when undergoing examination or treatment. A better comprehension of different analgesic and anesthetic methods used during screening and treatment may help in choosing a suitable option for ROP screening and treatment. An electronic search was done using MEDLINE, PubMed, and Embase databases. Search terms used included ROP, ROP, ROP screening, ROP treatment, analgesia, and anesthesia. All randomized clinical trials, large case series, and surveys were included in the review. Topical proparacaine is the most commonly used anesthesia during ROP screening and may significantly ease pain during ROP screening. Different comfort measures during screening may help infants recover faster but do not abolish pain. Topical tetracaine seems an effective pain-relieving option during intravitreal injections for ROP treatment. Photocoagulation of the peripheral retina under general anesthesia is considered the most common practice in the treatment of ROP. Further work is necessary to better understand the options of anesthesia methods offered for the treatment of ROP patients. This is a comprehensive review highlighting the available anesthetic methods for ROP patients to aid ophthalmologists in determining the most common and current anesthetic and analgesic practices.

An incidental finding of intraocular choristoma in an enucleated microphthalmic globe: A histopathologic case report.

INTRODUCTION AND IMPORTANCE: Choristomas are benign growth of normal tissue in abnormal location and in the ophthalmic practice, they are more commonly found in the epibulbar region. Intraocular choristoma has been reported in different ocular structures but it is very rare especially in association with microphthalmos. CASE PRESENTATION: We present a 13-month-old child with bilateral microphthalmia with the left side being more significantly smaller than the right that required enucleation for introducing a larger silicone implant. The histopathological examination revealed an intraocular choristoma consisting of chondroid and adipose tissue with surrounding fibrosis. Other areas in the globe were also underdeveloped and dysplastic including the optic nerve, which was replaced by dense wavy collagen fibers and fibrovascular tissue. DISCUSSION: Even though choristomas are benign, they may be extensive interfering with visual development especially the ones involving the epibulbar area. Systemic disease can have choristomas as an ocular feature such as in Goldenhar-Gorlin syndrome. Choristomas inside the eye are rare and they commonly involve the uveal tissue and the optic nerve head mostly in the form of ectopic glandular tissue and choroidal osseous choristoma. Our case is unique in its intraocular retrolental location, composition of chondroid tissue and fat, in addition to the fact that it was found within a microphthalmic globe with other interesting histopathological findings. CONCLUSION: We report a case of an incidental finding of intraocular choristoma with associated microphthalmia, genetic testing may be useful for establishing a genetic etiology in such cases even in the absence of dysmorphic features.

Prevalence of self-reported computer vision syndrome symptoms and its associated factors among university students.

PURPOSE: To determine the prevalence of symptoms of computer vision syndrome and to identify its associated factors. The secondary objective was to assess knowledge and practices related to preventing computer vision syndrome symptoms. METHODS: The data for this cross-sectional study were collected through a self-administered questionnaire distributed to 713 female undergraduates studying business and medicine in Saudi Arabia. The questionnaire included computer vision syndrome validated symptoms and factors associated with computer vision syndrome development. RESULTS: The most common symptom due to prolonged computer use was neck or shoulder pain, reported by 82.2% of the subjects. Overall, 66.5% of the subjects suffered from headache and 51.5% from dry eyes, in mild, moderate, or severe form. Business students were 1.6 times as likely as medical students to suffer from computer vision syndrome (odds ratio = 1.65; 95% confidence interval: 1.22, 2.24). The use of electronic devices for more than 5 h (odds ratio = 1.52; 95% confidence interval: 1.07, 2.16) was also associated with experiencing computer vision syndrome symptoms. Regarding computer vision syndrome prevention, factors such as hours of use, screen distance, screen brightness, and room illumination showed statistically significant difference between the two groups (p < 0.0001). CONCLUSION: The prevalence of computer vision syndrome symptoms was significantly higher among business students, who reported lower awareness and poor practice measures of computer use recommendations. Relevant awareness campaigns focusing on the appropriate use of computers are highly recommended.