Transorbital and endonasal resection of a rare orbital ectopic atypical meningioma.

A female patient in her early 20s presented with increasing proptosis of her left eye over 2 months. She had no other signs of diplopia, pain or visual loss on initial presentation. Subsequent imaging of her orbits revealed a medial rectus tumour. A transorbital open biopsy of this tumour was non-diagnostic/inconclusive, hence a combined transorbital and endonasal resection of this tumour was performed. Histopathology of the resected tumour revealed an unusual inflammatory-rich spindle cell neoplasm, which was determined to be a primary orbital ectopic atypical meningioma. These tumours are exceedingly rare, with only case reports/series reported in the literature. Complete surgical resection with margins is the proposed treatment. The role of radiotherapy is still controversial. More studies are required to improve our knowledge of this condition.

Malignant fibrous histiocytoma masquerading as pyogenic granuloma.

A 68-year-old gentleman presented with a lesion that resembled a pyogenic granuloma in his inferior fornix. The lesion was excised and biopsy demonstrated a proliferation of malignant spindle cells. Three weeks following initial excision, the lesion recurred and was removed via wedge excision of the eyelid. Definitive clearance was achieved through Mohs micrographic surgery. The patient received adjuvant postoperative radiotherapy and remains disease-free. This case demonstrates the need to consider sinister pathology in the setting of recurrent periocular lesions.

Scleral infiltration in orbitotemporal plexiform neurofibromatosis.

We report a case of severe orbitotemporal plexiform neurofibromatosis with a unique observation of clinically evident scleral infiltration, without uveal involvement, in a non-buphthalmic eye. We emphasize the importance of recognizing this before debulking surgery.

Corneal astigmatism with upper eyelid gold weight implantation using the combined high pretarsal and levator fixation technique.

PURPOSE: To evaluate corneal astigmatism with the combined high pretarsal and levator fixation gold weight implantation technique. METHODS: Twenty-one eyelids of 21 patients with facial nerve palsy were prospectively enrolled. All patients underwent upper eyelid gold weight implantation using the combined high pretarsal and levator fixation technique. Keratometry and automated refraction were performed preoperatively and postoperatively. Five patients were excluded from final analysis because of incomplete keratometry data. The data were analyzed looking for statistically significant changes in lagophthalmos, automated refraction, and keratometry. RESULTS: A statistically significant improvement in lagophthalmos with spontaneous blinking (p = 0.0014), and gentle (p = 0.0016) and forced (p = 0.0027) closure was noted postoperatively. No significant differences were found when comparing preoperative and postoperative automated refraction readings (p = 0.89, p = 0.88), automated refraction axis (p = 0.71), keratometry readings (p = 0.40, p = 0.77), or keratometry axis (p = 0.63). CONCLUSIONS: Implantation of a gold weight in the upper eyelid with the combined high pretarsal and levator fixation technique does not appear to cause a significant change in corneal astigmatism. This is contrary to data for pretarsal gold weight implantation, which does induce significant with-the-rule corneal astigmatism.

The transcaruncular approach to orbital fracture repair: ophthalmic sequelae.

The transcaruncular approach to the medial orbit is growing in popularity and although reported complications are minimal, ophthalmic and orthoptic sequelae can occur after any conjunctival surgery and nonophthalmic surgeons should be aware of these. This study aims to document these sequelae in a cohort of patients having transcaruncular surgery. A retrospective case series of all consecutive patients undergoing orbital fracture repair through a transcaruncular approach for medial wall and floor fractures in two centers over a 2-year period was examined. Computed tomography findings, pre- and postoperative ophthalmic and orthoptic findings, including ocular motility (with Hess chart evaluation), Hertel exophthalmometry, slit lamp biomicroscopy examination, follow-up time, and occurrence of complications were recorded. Thirteen patients, mean age 34 years (range, 18-82 years), underwent repair for medial wall (n=5) or combined medial wall and orbital floor (n=8) fractures with median a follow up of 7 months (range, 2-18 months). Preoperative ocular injuries included conjunctival chemosis, eyelid swelling, subconjunctival hemorrhage, retinal haemorrhage, traumatic uveitis and traumatic mydriasis, eye movement restriction, and enophthalmos (range, 3-4 mm). Postoperatively, corneal epitheliopathy with reduced vision (6/60), orbital inflammation, inferior oblique underaction, and superomedial fornix symblepharon at the caruncular incision sight each occurred in one patient along with extensive subconjunctival hemorrhage and a suture-related conjunctival granuloma in others. All patients experienced an improvement in diplopia and globe restriction. Ophthalmic complications can occur with this approach, and so it may be advisable to seek an ophthalmic opinion with the aim of comanagement in planning this approach.