Location of the myoneural junction of the inferior oblique muscle: An anatomic study.

PURPOSE: To examine both the horizontal and vertical locations of the myoneural junction of the inferior oblique muscle (IOM) in reference to the ala nasi, IOM origin, and inferior orbital rim. MATERIALS AND METHODS: Fifty-six orbits from 56 Japanese cadavers (15 male and 41 female cadavers; average age at time of death, 86.5±9.4 years) were used in this experimental anatomical study. The inter-alae-nasi distance and the horizontal distances from the ipsilateral ala nasi to the IOM origin (ala-nasi-origin distance) and to the myoneural junction (ala-nasi-junction distance) were measured. The horizontal distance from the IOM origin to the myoneural junction (origin-junction distance) was calculated by subtraction of the ala-nasi-origin distance from the ala-nasi-junction distance. The vertical distance from the inferior orbital rim to the myoneural junction (rim-junction distance) was also measured. RESULTS: The ala-nasi-junction, origin-junction, and rim-junction distances were 12.2±3.2mm, 10.6±3.2mm, and 3.4±1.0mm, respectively. Males had a longer inter-alae-nasi distance than females (P<0.001), although the other distances did not show statistically significant sex-related difference (P>0.050). The ala-nasi-junction distance tended to be negatively correlated with the inter-alae-nasi distance (r=-0.222, P=0.050). CONCLUSIONS: The ala-nasi-junction distance can be affected by the inter-alae-nasi distance, which was found to be longer in males. Therefore, the IOM origin and the inferior orbital rim can be considered as more practical and reliable reference points to predict the location of the myoneural junction during the posterior inferior orbitotomy, irrespective of sex.

Asymmetric lacrimal gland enlargement: an indicator for detection of pathological entities other than thyroid eye disease.

PURPOSE: To examine the clinicopathological characteristics of patients with thyroid eye disease (TED) who showed asymmetric lacrimal gland enlargement. METHODS: Sixteen patients were included in this retrospective, observational case series. The following data were collected: sex, age, laterality, past medical history, laboratory results for thyroid function and other autoimmune disorders, pathological results, other systemic lesions related to lacrimal gland pathology, and the clinical course after treatment. RESULTS: The results of pathological examinations were consistent with non-specific dacryoadenitis in seven patients, immunoglobulin G4-related dacryoadenitis in four patients, sarcoidosis in two patients, and xanthogranuloma in one patient, respectively. The remaining two patients were proven to be extra-nodal marginal zone lymphoma of mucosa-associated lymphoid tissue type (MALT lymphoma). One patient with sarcoidosis was noted to have another related systemic lesion. After treatment or observation, the lesions were either improved or stable in almost all patients, except for the two patients with MALT lymphoma. CONCLUSIONS: Patients with TED who present with asymmetric lacrimal gland enlargement need to be further evaluated. Biopsy of the lacrimal gland and full systemic work-up should be considered as these may lead to detection of other pathological entities, especially malignancies, which could help in saving patients' lives.

Immunoglobulin G4-Related Periorbital Soft-Tissue Destruction.

A study on immunoglobulin G4-related ophthalmic disease (IgG4-ROD) with destructive changes in periorbital soft tissues was presented. The patient was an 89-year-old-man who developed a left-sided orbital lesion involving the globe, lacrimal gland, and extraocular muscles. A diagnosis of definite IgG4-ROD was made based on clinical and histopathologic findings. The patient was started on oral prednisolone, which afforded good response initially. However, when tapering was initiated, full-thickness destruction developed on the lateral half of the lower eyelid margin. Steroid dose was increased, and the patient underwent a series of surgeries (suspension of the lower eyelid and lateral tarsorrhaphy, subtotal exenteration, and debridement and endonasal sinus surgery) in an attempt to manage the progression and recurrence of the condition. Medical management consisting of antibiotics and anti-fungal was administered to control the disease process. With close follow-up, repeated ancillary testing, and continuous management, the periocular and systemic findings were stable for 3 months after the last surgery.

Epibulbar osseous choristoma within a dermolipoma: case report and literature review.

A healthy 18-year-old girl presented with a superotemporal epibulbar mass that was present since birth. Computed tomography revealed a cystic mass with fat-like low-density and a central oval-shaped mass that was isodense to the bone in the superotemporal region of the globe. Histopathology of the excised tumour revealed osseous choristoma and dermolipoma. Our review of literature yielded nine reported cases of epibulbar osseous choristoma within a dermolipoma and we reviewed these cases.

Mantle Cell Lymphoma of the Lacrimal Gland.

The authors present 2 female patients of mantle cell lymphoma (MCL) involving the lacrimal gland. The patients include a 75-year-old female and a 59-year-old female. Both patients presented with palpable upper eyelid masses. The first patient was previously diagnosed with gastric and ileocecal MCLs and underwent chemotherapy with remission. The second patient had distant lesions in the muscular limbs that were confirmed to be MCL after the diagnosis of lacrimal gland MCL. Both patients underwent chemotherapy with complete remission.

Dacryoendoscopy-assisted nasal endoscopic marsupialization for congenital dacryocystocele.

OBJECTIVE: To examine the surgical outcome of dacryoendoscopy-assisted nasal endoscopic marsupialization for congenital dacryocystocele. METHODS: This is a retrospective, observational study that included 7 sides of 6 patients with congenital dacryocystocele. The surgical indication in 5 of the patients was acute dacryocystitis while one of the patients had no spontaneous resolution after long-term observation. Dacryoendoscopy was used for visualisation of the lacrimal cavity, direct probing of the obstruction at the common canaliculus, and localisation of a deflated intranasal cyst after an initial incision of the cyst. Surgical success was defined when the following postoperative conditions were satisfied: no epiphora, normal tear meniscus height, and complete clearance of the dye 5 min after instilling a drop of 2% fluorescein solution into the inferior conjunctional fornix. RESULTS: Out of 6 patients, 2 patients were noted to have membranous common canalicular obstruction. Postoperative follow-up ranged from 11 days to 3 months. Surgical success was achieved in all patients without any complication. CONCLUSIONS: Dacryoendoscopy-assisted nasal endoscopic marsupialization is an effective surgical management for congenital dacryocystocele.

Periocular Necrotizing Fasciitis with Toxic Shock Syndrome.

PURPOSE: To report a case of periocular necrotizing fasciitis with toxic shock syndrome. METHODS: This is a case report of a previously healthy 69-year-old woman with left preseptal eyelid infection that spread rapidly and deteriorated into necrosis of the eyelid with toxic shock syndrome. She was admitted to intensive care unit for hemodynamic stabilization. RESULTS: Intravenous antibiotic and high-dose immunoglobulin were administered followed by surgical debridement. Rehabilitative eyelid reconstruction was performed after acute episode, resulting in patient satisfaction in relation to periocular function and appearance. CONCLUSION: We reported a case of periocular necrotizing fasciitis with toxic shock syndrome that necessitated early aggressive medical treatment and adequate surgical intervention to decrease morbidity and mortality. A high level of suspicion of periocular necrotizing fasciitis is necessary to make a prompt diagnosis.