A deep penetrating facial congenital melanocytic tumor with bone involvement and ipsilateral eye blindness.

Bone involvement has been described in tumors with melanocytic differentiation such as melanotic neuroectodermal tumor of infancy, and very rarely in cellular blue nevi and neurocristic cutaneous hamartoma. We present an unusual case of facial congenital melanocytic tumor that involved the underlying bones and maxillary sinus and led to unilateral blindness. A newborn with a large red bluish patch with peripheral brown and black macules overlying marked swelling on the left side of his face was presented. The tumor was shown by magnetic resonance imaging, scintigraphy, and histopathology to invade the underlying bones and maxillary sinus and to compress the left eyeball resulting in blindness. Histopathology, immunohistochemistry, morphometric computerized microscopy, molecular genetic mutation analysis, and fluorescent in situ hybridization studies were more congruent with a melanocytic nevus. An 8.5-year follow-up was uneventful, with spontaneous partial shrinkage of the tumor.

Congenital combined orbito-nasal lipoblastoma: clinico-pathologic study.

The authors present the clinical picture, histopathologic findings and surgical treatment of an infant born with a lipoblastoma involving an unusual combined orbito-nasal location. To the best of our knowledge, this is the first report of congenital lipoblastoma extension from orbit to the nasal cavity. Transconjunctival orbitotomy with excisional biopsy of tumor was performed. Histology specimen that demonstrates the small embryonal fat cells in different stages of maturation and the characteristic lobulation of the fat tissue are presented. The embryonic origin, timing of development of the tumor during gestation, as well as the route of propagation from orbit to nose are discussed. The authors conclude that complete excision of this tumor, with preservation of normal tissue, may bring cure to the young patient without gross functional deformity.

Effect of timing of external dacryocystorhinostomy on surgical outcome.

PURPOSE: To present our experience with external dacryocystorhinostomy (DCR) outcome and to compare cases of early and late DCR. METHODS: Retrospective data review of all patients who had external DCR with silicone intubation in a 7-year period. Data were collected and analyzed concerning patients' preoperative and postoperative symptoms, and the lacrimal drainage system examination before, during, and after surgery. RESULTS: In all, 162 patients underwent 195 DCR surgeries for nasolacrimal duct obstruction. Success was achieved in 81% of surgeries. Success rates were higher in patients who had early DCR (tearing only or early inflammatory signs of the lacrimal sac, 84% success) than in cases that had late DCR (more than 6 months after inflammation started, 77% success). These differences were statistically insignificant. Failure of DCR was much higher in posttraumatic DCR than in DCR for other etiologies. Complications (in 9% of surgeries) were generally mild and infrequent, except 1 case of meningitis. CONCLUSIONS: In experienced hands, external DCR has good postoperative success with a low complication rate. Early DCR does not have a substantial advantage over late surgery with regard to surgical outcome.

Orbital fractures complicated by late enophthalmos: higher prevalence in patients with multiple trauma.

PURPOSE: To present our experience with orbital fracture treatment outcomes in patients with multiple trauma and those suffering localized orbital trauma. METHODS: Retrospective data review of all patients examined for ocular motility problems and/or enophthalmos following orbital trauma in a 4-year period. RESULTS: Forty-three patients were included in the study: 31 (72%) had localized orbital trauma (LOT) and 12 (28%) had concomitant traumatic insults to other organs (MT). More orbital walls were affected in MT patients than in LOT patients, and the incidence of zygomatic fracture was higher in MT patients. Late enopthalmos was much more prevalent in the MT group compared with the LOT group. Differences of outcome of extra ocular motility disturbance between groups in our series did not reach statistical significance. CONCLUSIONS: The findings of more walls affected and higher incidence of zygomatic fractures in MT patients probably represent a stronger impact of the original insult, causing both more damage to other organs and more severe damage to the orbit. The increased rate of late enophthalmos in MT patients may be associated with their primary presentation to the emergency room with potentially life-threatening injuries. Under such circumstances, thorough ophthalmologic examination is nearly impossible, both because the patient cannot cooperate sufficiently and because medical priorities dictate concentration on taking care of the injuries threatening life. The lack of a thorough ophthalmic examination prevents early comprehensive treatment.

[Globe subluxation in thyroid orbitopathy].

We report the clinical and radiographic findings of a female patient who presented to the emergency room in acute distress due to a subluxated globe. The patient had a 10 year history of poorly controlled Grave's disease and associated orbitopathy. In the past, one previous report dealt with this rare phenomenon in association with Grave's disease and attributed the mechanism of this acute event to enlargement of the orbital fat compartment and extensibility of nearly normal extraocular muscles ("lipogenic"--type I orbitopathy). To the best of our knowledge, this case is the first documented report of this unusual event occurring in a patient with significant involvement of the extraocular muscles which caused a resultant crowding of the orbital apex, disturbance to venous outflow and severe orbital congestion. In conclusion, acute globe subluxation may rarely happen in "myogenic" (type II) thyroid orbitopathy.

Delayed presentation of orbito-cerebral abscess caused by pencil-tip injury.

This report describes the clinical and radiologic findings of a child who was stabbed with a pencil tip in his right upper eyelid, in what initially appeared to be an innocuous injury. The child presented again 3 weeks later with a combined orbital and frontal lobe brain abscess. The mechanism of injury is discussed, the orbital and neuro-surgical interventions are detailed, and the medical treatment is presented. Ophthalmologists should have a high index of suspicion for orbital foreign bodies and possible intracranial injury in cases of penetrating eyelid trauma.

Epiphora (excessive tearing) and other ocular manifestations related to weekly docetaxel: underestimated dose-limiting toxicity.

PURPOSE: Epiphora due to canalicular stenosis is a recently described side effect of weekly docetaxel. We prospectively evaluated the incidence of this complication and other ocular manifestations in patients treated at our medical center. PATIENTS AND METHODS: Twenty-one consecutive patients (breast cancer: 14; metastatic non-small cell lung cancer: 6; metastatic nasopharyngeal carcinoma: 1) (female/male: 14/7; age range: 34-78 yr) were treated with weekly docetaxel (35 mg/m2/wk iv for 6 wk, cycles repeated every 49 d). A standard questionnaire regarding epiphora was completed before each dose of docetaxel. Patients who complained of excessive tearing underwent a thorough ophthalmologic evaluation before receiving the next dose. RESULTS: Epiphora due to stenosis of the lacrimal puncti and canaliculi developed in seven (33%) patients following a cumulative dose of 208-645 mg/m2 (median: 400 mg/m2). Two patients developed complete canalicular stenosis requiring surgery. Epiphora was accompanied by madarosis and ectodermalization of the palpebral and bulbar conjunctiva, complete in five patients. Treatment was discontinued due to epiphora in two (10%) patients. After a median follow-up of 11 mo, four patients still had epiphora. CONCLUSION: Epiphora due to canalicular stenosis is a frequent complication of weekly docetaxel and might be dose limiting. Irreversible damage requiring surgical intervention may develop despite close monitoring.

[Upper lid frontalis suspension as a treatment for essential blepharospasm].

BACKGROUND: Essential blepharospasm is a progressive disease of unknown etiology causing a significant decline in the quality of life of patients suffering from the disease. Currently used treatment for this condition is repeated injections of Botulinum toxin. Some of the patients' therapeutic response to Botox injections is insufficient, and some develop ocular complications. GOALS AND METHODS: This report presents our experience with sling frontalis suspension for essential blepharospasm in 4 patients with follow-up periods of six months to 2 years. A literature review is presented and discussed. RESULTS: A treatment trial with Botox injections was attempted in all four patients. Three of the patients showed insufficient treatment response. Three of the patients developed side effects of recurrent episodes of upper lid ptosis following injections. In all four patients that underwent operations significant reduction of blepharospasm was observed. In two of the patients Botulinum toxin could be discontinued, in one patient treatment intensity could be reduced, and in three--treatment complications were prevented. All four patients reported a high degree of satisfaction from treatment results. CONCLUSIONS: Our results indicate that sling frontalis suspension for essential blepharospasm is a safe and efficient treatment for essential blephrospasm with a high degree of patient satisfaction. Further large-scale studies are needed to substantiate our results.