RESUMO
A 69-year-old male presented with a superior palpebral conjunctival white leukoplakic lesion. Excisional biopsy showed Langerhans cell histiocytosis. Positron emission tomography scanning revealed no lesions beyond this site. Native Langerhans cells are known to exist in the conjunctiva, yet only a few cases in the literature have described Langerhans cell histiocytosis of the conjunctiva, mostly in children. Conjunctival Langerhans cell histiocytosis has rarely been reported in an adult as leukoplakia. The authors advocate excisional biopsy for palpebral conjunctival Langerhans cell histiocytosis in older patients if the morbidity of closure is minimal, in addition to surveillance for multifocal disease.
RESUMO
A 50-year-old woman with a history of controlled Graves' disease without clinical ophthalmopathy presents with 2 months of left more than right periorbital swelling and proptosis. Her eye symptoms and signs began 3 days following her second vaccination against the COVID-19 virus. Orbital imaging, elevated thyroid stimulating immunoglobulin, and negative systemic work up for other diseases were consistent with a diagnosis of active thyroid eye disease. The temporal relationship to her vaccination was likely consistent with autoimmune/inflammatory syndrome associated with adjuvants. Clinicians should remind patients of the symptoms and signs of thyroid eye disease and to seek appropriate medical and ophthalmic advice if they occur after the COVID-19 vaccine.
Assuntos
COVID-19 , Doença de Graves , Oftalmopatia de Graves , Vacinas contra COVID-19 , Feminino , Doença de Graves/diagnóstico , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/etiologia , Humanos , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
A 91-year-old female with a history of chronic lymphocytic leukemia developed recurrent bouts of bilateral dacryocystitis. She underwent incision and drainage of the lacrimal sac with culture demonstrating the rare bacteria Stenotrophomonas maltophilia. She underwent subsequent dacryocystectomy with biopsy revealing bilateral involvement of chronic lymphocytic leukemia in the lacrimal sac. Stenotrophomonas maltophilia has been associated with immune suppression and is rarely seen in dacryocystitis. Local and/or systemic immune deregulation or suppression may play a role in lacrimal sac infection with this bacterium in some patients.
Assuntos
Dacriocistite , Dacriocistorinostomia , Doenças do Aparelho Lacrimal , Leucemia Linfocítica Crônica de Células B , Ducto Nasolacrimal , Stenotrophomonas maltophilia , Idoso de 80 Anos ou mais , Dacriocistite/diagnóstico , Dacriocistite/cirurgia , Feminino , Humanos , Doenças do Aparelho Lacrimal/cirurgiaRESUMO
Orbital involvement with histologic necrosis is a rare manifestation of systemic sarcoidosis. The authors present a case of necrotizing dacryoadenitis in addition to non-necrotizing granulomas in a hypertrophic scar that is consistent with a diagnosis of sarcoidosis. A 60-year-old female presented with 2 months of painless right upper eyelid fullness and ptosis. CT imaging demonstrated right greater than left lacrimal gland enlargement. A biopsy demonstrated necrotizing granulomatous inflammation of the lacrimal gland. Additional workup was negative for infectious or lymphoproliferative disease. On further investigation, the patient noted thickening of a longstanding abdominal scar, and a subsequent punch biopsy of the scar demonstrated non-necrotizing granulomas suggestive of scar sarcoidosis. CT chest identified mediastinal lymphadenopathy. A diagnosis of sarcoidosis was determined. The authors thereby present an unusual case of 2 histologic variants of sarcoidosis presenting with necrotizing granulomatous dacryoadenitis and non-necrotizing scar granulomas.
Assuntos
Dacriocistite , Sarcoidose , Cicatriz , Dacriocistite/diagnóstico , Feminino , Granuloma/diagnóstico , Humanos , Hipertrofia , Pessoa de Meia-Idade , Sarcoidose/complicações , Sarcoidose/diagnósticoRESUMO
Purpose: To directly compare an algorithmic external levator resection technique with the choice of intraoperative adjustment to the same technique without intraoperative adjustments. Methods: A sequential controlled prospective comparative cohort study. Two cohorts were compared: a historical control adjustment, and an experimental non-adjustment group. Fourteen patients, 25 eyelids, were in the historical cohort; and 15 patients, 23 eyelids, were in the non-adjustment cohort. Primary acquired ptosis patients who met inclusion criteria were considered. All patients underwent a standardized external levator resection technique. Intraoperative adjustments were performed only in the historical cohort. Age, follow-up time, surgical time, and marginal reflex distance 1 (MRD1) were collected. Statistical analysis was performed using the Mann-Whitney U test. Statistical significance was p < 0.05. Primary and secondary outcome measures were postoperative MRD1 minus goal MRD1, and surgical time, respectively. Results: Twenty-five historical eyelids were compared with 23 non-adjusted eyelids. The average patient age was 68.4 years (range 19-84) and 59.3 years (range 24-83) for the adjusted and non-adjusted groups. Six-month postoperative (postoperative minus goal) MRD1 was -0.1 mm (95% CI -0.3-0.1) and -0.2 mm (95% -0.5-0.0) (p = 0.33), and surgical time was 13.8 min (95% CI 12.6-15.1) and 9.5 min (95% CI 9.0-10.1) (p < 0.001) for the adjusted and non-adjusted cohort, respectively. Conclusions: The external levator resection, utilizing a standardized algorithm approach, is an efficacious technique for involutional eyelid ptosis. With sound technique, this method can be performed without the need for intraoperative adjustment, thereby saving operative time and achieving similar results.
Assuntos
Blefaroplastia , Blefaroptose , Adulto , Idoso , Idoso de 80 Anos ou mais , Blefaroptose/cirurgia , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Suturas , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: Clinicians are becoming increasingly aware of the risks of opioid analgesics, and, consequently, are searching for alternatives to these agents. This review considers the existing literature regarding the management of pain after ophthalmic plastic surgery. METHODS: A literature search was performed through the PubMed database. Articles were assessed for relevance, and the appropriate data was extracted from the medical literature regarding pain management strategies after oculoplastic procedures. RESULTS: An emerging body of literature suggests the efficacy of a variety of non-narcotic agents in post-operative pain management. Many of these medications prevent the development of pain, and several have been studied in randomized trials. Specifically, pregabalin, ketorolac, acetaminophen, memantine, local anesthetics, and alternative therapies all have documented benefit in this setting. CONCLUSIONS: Several medications may prevent and treat pain after ophthalmic plastic surgery. These agents are well-tolerated, and many decrease the requirement for opioid analgesics. Clinicians should be aware of these therapies when considering non-narcotic pain management.
Assuntos
Cirurgia Plástica , Acetaminofen/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Cetorolaco/uso terapêutico , Dor Pós-Operatória/tratamento farmacológicoRESUMO
A 49-year-old otherwise healthy male presented with an odontogenic abscess and mild left facial swelling. CT imaging revealed gaseous hypodensities within the inferior orbital fissure and pterygopalatine fossa in addition to infection of the left masseter and temporalis muscle. Despite dental drainage, this rapidly progressed to orbital cellulitis with temporalis muscles abscess leading to compartment syndrome and globe tenting. He had an excellent outcome after canthotomy and cantholysis, urgent endoscopic and transconjunctival orbital decompression, temporalis muscle abscess drainage, and intravenous antibiotics. This case describes the use of bony orbital decompression for orbital compartment syndrome and globe tenting from odontogenic orbital cellulitis. In addition, this case radiographically demonstrates a transinferior orbital fissure passageway of an odontogenic abscess in the orbit.
Assuntos
Síndromes Compartimentais , Celulite Orbitária , Doenças Orbitárias , Abscesso/diagnóstico , Abscesso/cirurgia , Descompressão , Humanos , Masculino , Pessoa de Meia-Idade , Órbita/diagnóstico por imagem , Órbita/cirurgia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/cirurgiaRESUMO
Large cysts in the orbital lobe of the lacrimal gland are rare and are associated with Sjögren syndrome and B-cell mucosa-associated lymphoid tissue lymphoma. The authors describe 4 new cases of large orbital lobe lacrimal gland cysts. The first 2 patients, both with Sjögren syndrome, had unilateral cysts associated with chronic inflammation. Mucosa-associated lymphoid tissue lymphoma was also identified in the cyst wall of the second case and could not be completely excluded in the first case. The third patient, with a history of rheumatoid arthritis, had bilateral cysts, again associated with mucosa-associated lymphoid tissue lymphoma. The fourth patient, with no history of systemic disease, had a unilateral cyst associated with reactive lymphoid hyperplasia. Finally, the authors report the long-term outcomes of 3 previously reported cases.
Assuntos
Doenças Autoimunes/complicações , Cistos/etiologia , Neoplasias Oculares/etiologia , Doenças do Aparelho Lacrimal/complicações , Aparelho Lacrimal/diagnóstico por imagem , Doenças Linfáticas/complicações , Linfoma de Zona Marginal Tipo Células B/complicações , Idoso , Doenças Autoimunes/diagnóstico , Doença Crônica , Cistos/diagnóstico , Neoplasias Oculares/diagnóstico , Feminino , Seguimentos , Humanos , Hiperplasia , Doenças do Aparelho Lacrimal/diagnóstico , Doenças Linfáticas/diagnóstico , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Trans-lamina cribrosa pressure has been postulated to be a contributor in the development of a glaucomatous optic nerve versus optic nerve edema, depending on the pressure gradient. Uncertainty remains in the therapeutic outcome of adjusting this gradient. CASE REPORT: We discuss a unique case of idiopathic intracranial hypertension presenting as asymmetric optic disc edema following trabeculectomy. It was treated via optic nerve fenestration due to the patient remaining symptomatic on maximum tolerated acetazolamide. Intraocular pressure stabilized into target range and the optic nerve edema resolved. CONCLUSIONS: Rarely, intraocular pressure reduction can unmask elevated intracranial pressure, leading to optic nerve edema. Optic nerve sheath fenestration is a practical therapeutic modality to consider when treating this occurrence.
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Nervo Óptico/cirurgia , Papiledema/etiologia , Papiledema/cirurgia , Trabeculectomia/efeitos adversos , Doença Crônica , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Hipertensão Intracraniana/etiologia , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Papiledema/fisiopatologiaRESUMO
Ocular adnexal lymphoma and intraocular lymphoma, whether occurring simultaneously or sequentially, are often similar to associated systemic lymphoma. We describe 4 cases of ocular adnexal lymphoma or intraocular lymphoma with a dissimilar systemic lymphoma. Two of the cases represent Richter transformation of chronic lymphocytic leukemia/small-cell lymphoma into diffuse large B-cell lymphoma. In the third patient, conjunctival extranodal marginal zone lymphoma developed following treatment for Hodgkin lymphoma. The fourth patient had a remote history of systemic diffuse large B-cell lymphoma with a subsequent diagnosis of orbital extranodal marginal zone lymphoma. Clinical-pathological correlation is reported for all cases in addition to pertinent review of the literature.
Assuntos
Neoplasias da Túnica Conjuntiva/patologia , Neoplasias Oculares/patologia , Leucemia de Células B/patologia , Neoplasias Orbitárias/patologia , Idoso , Feminino , Humanos , Leucemia Linfocítica Crônica de Células B , Linfoma de Zona Marginal Tipo Células B/patologia , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To investigate the effects of performing a previously described algorithmic levator resection for involutional ptosis with a blepharoplasty instead of through a small incision. METHODS: Eyelids with involutional ptosis and normal levator function were included in the study. An upper blepharoplasty was performed first. An external levator resection was then performed based on a described technique involving 2 mm resection of aponeurosis for 1 mm of desired lift, consistent tension on the aponeurosis between surgical cases, and standardized suture placement. RESULTS: Forty-one eyelids of 25 patients were included. Mean postoperative margin to reflex distance 1 (MRD1) was 2.98 mm, which was significantly higher than preoperative MRD1 (0.67 mm), but lower than the predetermined goal MRD1 (3.35 mm). Eight eyelids did not meet primary outcome of MRD1 within 1 mm of goal MRD1, with 5 undercorrections. There was no difference between the postoperative MRD1 compared with the same ptosis technique performed through a small incision only, but there were more intraoperative suture adjustments and fewer eyelids meeting the primary outcome when a concurrent blepharoplasty was performed. CONCLUSIONS: The addition of blepharoplasty with a previously described algorithmic approach external levator resection has an 80% success rate in achieving the primary outcome. When compared with a small-incision ptosis repair, concurrent blepharoplasty results in a less predictable outcome and an increased need for intraoperative adjustment. Performing an algorithmic technique for external levator resection with a blepharoplasty has less predictable outcomes, which raises the question of separating the procedures to improve patient care.