Orbital immunoglobulin IgG4-related inflammatory fibrosclerosing lesion treated with pentoxifylline and α-tocopherol: case report.

Immunoglobulin G4 (IgG4)-related disease is a distinct group of disorders that are characterised by intense infiltration of an organ with IgG4(+) cells, subsequent inflammation, fibrosis, and masses. We report a new treatment of orbital IgG4-related disease with pentoxyphylline and α-tocopherol, both of which are anti-inflammatory and antifibrotic agents.

Color Doppler imaging: methodology and preliminary results in glaucoma.

Color Doppler imaging (CDI) has recently been applied to investigation of the normal vascular anatomy of the eye and orbit as well as a variety of conditions in which vascular abnormalities are important. Combining B-scan ultrasonography and Doppler waveform analysis, CDI enables noninvasive serial examination of blood velocity and vascular resistance from the ophthalmic, short posterior, ciliary and central retinal arteries. This technology is being used to study the ophthalmic circulation of patients with primary open-angle or normotension glaucoma.

Eye injuries in indoor cricket at Wellington Hospital: a survey January 1987 to June 1989.

About 30% of all sports injuries to the eye seen at Wellington Hospital are due to indoor cricket. An analysis of 29 eye injuries, January 1987 to June 1989 was carried out. Traumatic iritis, mydriasis and commotio retinae were the common injuries. There were eight blow out fractures of the orbit. Only two patients had permanent loss of vision due to choroidal tears with best vision in the damaged eye reduced to 6/9. A total of 88 eye clinic visits and 24 inpatient days were involved. The incidence of these injuries could be reduced by wearing eye and/or facial protection.

Orbital colour Doppler imaging.

Colour Doppler imaging (CDI) is an ultrasonic method for qualitatively and quantitatively assessing blood flow. Recently this technique has been adapted for investigation of the orbital, optic nerve and ocular vasculature. We discuss the history, principles and methodology of this examination technique for ophthalmology. Also described are normal haemodynamic characteristics as well as the findings in common pathological states involving derangements of orbital blood flow. Although CDI is relatively new to ophthalmology it has already proved to be of benefit in conditions with altered orbital, ocular and optic nerve blood flow. In the future it is expected that the indications for the applications of CDI will become more clearly defined and that orbital CDI will be more widely available and utilised, especially in the investigation of vascular diseases of the orbit, optic nerve and retina.

Color Doppler imaging of the ocular and orbital blood vessels.

Color Doppler imaging (CDI) is a technique that provides color-encoded blood flow information on a gray-scale two-dimensional background. Although first reported in the investigation of orbital disease in 1979, it is only in the past 1 to 2 years that CDI has become established as a tool in the assessment of vascular disease of the eye and orbit. Discussed are clinical syndromes in which CDI has been shown to demonstrate abnormalities and also assist in diagnosis and determination of etiology.

Cast-forming Actinomyces israelii canaliculitis.

BACKGROUND: Primary chronic canaliculitis is an uncommon disease usually caused by Actinomyces israelii (streptothrix). Actinomyces israelii is a cast-forming Gram-positive anaerobe that is difficult to isolate and identify. We present a case that demonstrates the typical clinicopathological presentation of this unusual condition and discuss management options. METHODS AND RESULTS: A 10-year-old girl presented with a 6 month history of intermittent 'conjunctivitis' and discharge from her 'pouted' left lower punctum. Microbiology confirmed probable A. israelii infection, but topical treatment failed. Exploration under anaesthesia revealed a canalicular diverticulum and three canaliculiths. Histological examination of the canaliculiths demonstrated that they consisted of solid casts of Actinomyces. Punctoplasty, removal of the casts, and adjunct antibiotic therapy resulted in resolution of the canaliculitis. CONCLUSIONS: Primary chronic canaliculitis should be considered in any patient who presents with chronic or recurrent conjunctivitis and the eyelid should be inspected for a discharging and 'pouting' punctum. Failure of the condition to resolve on topical treatment requires surgical exploration of the canalicular system and removal of any casts. Extensive surgery is not always required.

Penetrating eye injury from a rigid infant pacifier.

BACKGROUND: The use of infant pacifiers (dummies) is common in Australasian communities and has been reported to be associated with various injuries, but to date ocular trauma has not been reported. CASE REPORT: A 14-month-old child sustained a penetrating eye injury from the infant pacifier that was in his mouth during a minor fall. Only a lid laceration was detected at the time. One week later he presented with mydriasis, heterochromia and a poor red reflex. Diagnosis of a penetrating eye injury was made by examination under anaesthesia, with B-scan ultrasonography demonstrating hypotony but no retinal detachment or intraocular foreign body. Funduscopy revealed a small inferior vitreous haemorrhage. Exploration of the globe adjacent to the lid wound showed a 6 mm laceration through the sclera plugged with prolapsed vitreous. CONCLUSION: Serious ocular injury may result after a minor fall with some designs of rigid infant pacifiers. Heterochromia and anisocoria noted by the mother heralded more serious ocular injury in this case. The delay in diagnosis of this injury emphasizes the importance of ocular examination to exclude eye trauma when injuries occur around the orbit.

Infectious mononucleosis presenting with dacryoadenitis.

BACKGROUND: A case of severe, bilateral, acute dacryoadenitis in a rarely reported association with infectious mononucleosis is described. METHODS: A 16-year-old girl had acute, bilateral, lacrimal gland enlargement demonstrated with computed tomographic scanning of the orbits. Clinical findings and laboratory investigations confirmed the diagnosis of infectious mononucleosis. Treatment with systemic steroids was initiated. RESULTS: There was rapid resolution of the clinical findings with systemic steroids. CONCLUSION: Dacryoadenitis is an uncommon presentation of infectious mononucleosis and may overshadow the other manifestations of this disease. The diagnosis of infectious mononucleosis should be considered in patients with acute dacryoadenitis. Systemic steroids play an important role in rapidly resolving the dacryoadenitis.

Bronchopulmonary atypical carcinoid tumour metastatic to the orbit.

BACKGROUND: Bronchopulmonary carcinoid tumours metastatic to the orbit are rare. A case is presented demonstrating presentation, histopathology and treatment. METHODS: A 64-year-old man with a history of bronchopulmonary atypical carcinoid presented with an orbital mass. The nature of this metastasis was confirmed with histology and it was surgically excised and, in addition, local radiotherapy and chemotherapy were administered. RESULTS: There was a good response to the treatment for the orbital mass but other metastases developed, causing death. CONCLUSIONS: In this case of atypical carcinoid, orbital metastasis was the first sign of disease progression. Histological confirmation of the diagnosis was important in this case to allow planning of oncological therapy and for appropriate patient counselling. A good local response was obtained with a combination of surgical excision, local radiotherapy and chemotherapy. The systemic prognosis remains poor in cases of metastatic bronchopulmonary atypical carcinoid tumour, in contrast to typical carcinoid.