Congenital mucocele of the lacrimal sac.

Two infants had congenital mucocele of the lacrimal sac. The diagnosis of this condition was aided by ultrasound. Congenital mucocele is one of the few indications for immediate lacrimal system probing in the neonatal period. Probing in both patients was successful.

Adenoid cystic carcinoma of the lacrimal gland in a child.

An unusual case of adenoid cystic carcinoma of the lacrimal gland occurred in an 11-year-old child. Clinical, echographic, and histopathologic characteristics, as well as the management of this usually fatal disease, are discussed. The subtle signs and symptoms of this tumor were noted at the age of 9 years. A review of the literature reveals this to be the youngest patient in whom this tumor has been reported.

Axial length changes after retinal detachment surgery.

A-scan echography was an accurate method for detecting changes in the depth of the anterior chamber, lens thickness, and length of the vitreous cavity after retinal detachment surgery in 30 eyes. Approximately 60% of the eyes had significant alterations in axial lengths exceeding+/-0.36 mm in aphakic eyes and +/-0.54 mm in phakic eyes. However, the operation of scleral bucklingg with large segments of hard silicone rubber implants or explants supported by an encircling band failed to result in a significant predictable shift of axial change in phakic or aphakic eyes. A-scan echography showed significant shallowing of the anterior chamber, and scleral buckling significantly increases lens thickness for at least six weeks. This induced a minor myopic refractive change that may explain some of the difference in postoperative refracitons between phakic and aphakic eyes.

The diagnosis and prognosis of atypical carotid-cavernous fistula (red-eyed shunt syndrome).

Nineteen patients who complained of red eyes had the characteristic clinical signs of an atypical carotid-cavernous fistula. Episcleral veins were dilated, intraocular pressure and episcleral venous pressure were high, and blood filled Schlemm's canal during gonioscopy. Most of the patients had mild exophthalmos, but in none was the exophthalmos obviously pulsatile, and in only two patients could a bruit be heard. Orbital echography disclosed either a dilated superior ophthalmic vein or congestion of the orbital soft tissues. Selective carotid angiography, done in seven patients, disclosed the fistula to be a dural-cavernous fistula. The serious complication of the fistulas was open-angle glaucoma resulting from the high episcleral venous pressure. None of the fistulas was treated surgically, but six closed spontaneously and three closed soon after carotid angiography.

Maternal orbital hematoma associated with labor.

We examined two women with orbital hematomas that occurred during labor. Both women developed sudden diplopia, proptosis, and orbital pain. The location of the hematoma was confirmed by orbital echography and computed tomography. The patients were observed without surgical intervention. Neither patient developed clinical or echographic signs of compressive optic neuropathy. Clinical resolution occurred during the following two weeks. Serial standardized orbital echographic examinations documented resolution of the hematomas.

Standardized echographic-histopathologic correlations in liposarcoma.

A 57-year-old woman had metastatic liposarcoma of the left orbit that underwent transformation. The primary focus in the abdomen, resected in 1975, was a well-differentiated liposarcoma. Later metastases to the neck and orbit were poorly differentiated, pleomorphic, and highly anaplastic liposarcomas. The ultrasonographic and histopathologic correlations of the different stages of the tumor during the disease process were analyzed and compared. This patient's disease had echopathologic similarities to other orbital sarcomas and adult cavernous hemangiomas.

[Echographic differential diagnosis of optic nerve widening]. / Echographische Differenzialdiagnose von Optikusverbreiterungen.

INTRODUCTION: Standardized echography is a well-established examination technique in ophthalmology. Among other things one of the more important uses is the evaluation of the optic nerve and its abnormalities. One aspect is the use of the stretch-test (originally called the "30 degrees-test") for the differential diagnosis of optic nerve widening. Such widening can be caused by solid thickening of the optic nerve and/or its sheaths or by solid infiltration of the subarachnoidal space. More frequent is a widening of the optic nerve as a consequence of sheath distension by increased subarachnoidal fluid. PATIENTS AND METHODS: We present various cases of widened optic nerve patterns and explain the technique and diagnostic value of standardized echography, especially of the stretch-test. RESULTS: In widened optic nerve patterns due to fluid around the optic nerve parenchyma, a decreased optic nerve thickness will be found when performing the stretch-test (positive test result), whereas in solid lesions of the optic nerve no change of optic nerve thickness will be seen (negative test result). CONCLUSION: The stretch-test provides a reliable tool for the differential diagnosis of widened optic nerves.

Ophthalmic features of Alagille syndrome (arteriohepatic dysplasia).

Eight patients with Alagille syndrome (AGS) are reported. In addition to previously reported findings of posterior embryotoxon, pigmentary retinopathy, and choroidal folds, new findings include decreased axial eye lengths, small corneal diameters, and shallow anterior chambers. Optic disc swelling was noted ophthalmoscopically and abnormally increased orbital subarachnoidal fluid was detected through measurements of the arachnoidal diameters with standardized echography.

Echographic detection and classification of posterior hyphemas.

A 'posterior hyphema' (in analogy to the classic hyphema seen in the anterior chamber) is a collection of liquid blood at the bottom of a fluid-filled space in the posterior segment of the eye. The horizontal surface of a posterior hyphema produces strong signals echographically which, at first glance, may be confused with signals from a retinal detachment or a preretinal membrane. With the patient being examined in a supine position, a retinal detachment of the inferior posterior fundus involving the macula is suggested. Such a misdiagnosis would have serious consequences for the management of a patient and must be avoided. A simple, quick and effective (both highly sensitive and specific) echographic (A-scan and B-scan) shift technique clearly differentiates a posterior hyphema from a retinal detachment and a preretinal membrane. This shift method has been applied successfully in 62 consecutive cases of posterior hyphema. These represent 20% of 304 cases with severe posterior segment hemorrhages examined echographically in a 3-year period. With echography, the height of a posterior hyphema can be measured precisely and its consistency ranging from very liquid ('thin' hyphemas) to highly viscous ('thick' and 'sticky' hyphemas) can be determined. Thus, echography contributes important information about this special kind of posterior segment hemorrhage, particularly useful in previtrectomy evaluations.

[A new echographic sign for the reliable diagnosis of graves' disease (author's transl)]. / Ein neues echographisches Merkmal zur verhässlichen Differentialdiagnostik des endokrinen Exophthalmus.

With standardized echography, an ultrasonic method specifically designed for tissue differentiation, Graves' orbitopathy can be diagnosed reliably and accurately even when the clinical picture and thyroid tests are not typical for this condition (e.g., with unilateral exophthalmus, lack of lid signs, euthyroid status). A new echographic criterion of Graves' orbitopathy, i.e., the heterogeneous and high-reflective structure of the diseased muscle tissue, plays a key role in the differential diagnosis.

Ten-year study on clinical echography in intraocular disease.

During the past 10 years, clinical echography has been developed to a valuable and even indispensable examination method with which more than 25 various conditions and diseases or groups of lesions within the globe can be differentiated (the majority of them with a high degree of realiability and accuracy). Two signigicant steps to this end were the optimizing of both instrumentation and examination techniques as well as the standardization of the A-scan method. A few of the major conditions and diseases of the posterior segment of the globe, e.g. retinal detachments and retinoblastomas, are discussed in detail in this study, while ocular foreign bodies, malignant melanomas and other choroidal tumors and pseudo-tumors are discussed in two other studies presented in these proceedings (see pp. 109,141). At the end of this 10-year period, clinical echography, although quite mature, is still a very young examination method which can and will be further improved to an even more reliable and at the same time easier technique. Both A-and B-scan techniques are important for the diagnosis of intraocular diseases: the (standardized) A-scan method for a reliable detection as well as quantitative and kinetic evaluation, the B-scan technique for a better demonstration of the shape and topographic relationship of lesions in the vitreous and at the posterior pole.

Ultrasonic evaluation of salivary glands.

Diagnostic ultrasound was used to study 40 patients undergoing excision of a major salivary gland for various disease entities. Findings were as follows: Malignant lesions showed low reflectivity and attenuation with poorly outlined or diffuse borders. Inflammation demonstrated high reflectivity and attentuation with diffuse borders. Echographic patterns from mixed tumors showed either high or medium to low reflectivity; all demonstrated low to medium attenuation and were well outlined. It appears that various diseases of the major salivary glands have different echographic patterns. An attempt to correlate the echographic patterns with the histology of the disease process was made.

Metastatic carcinoid unresponsive to radiation therapy presenting as a lacrimal fossa mass.

A case of metastatic carcinoid tumor presenting as a lacrimal fossa mass is described. This appears to be only the fourth case report of metastatic carcinoid to the orbit and the first to include ultrasound evaluation. the tumor mass did not regress despite radiation therapy as documented on serial ultrasound examinations. Therapeutic implications of this finding are discussed. Metastatic carcinoid tumors are reviewed.

Cavernous hemangioma of the orbit. A differential diagnosis in clinical echography.

Cavernous hemangiomas of the orbit produce echographic A-scan patterns which allow their detection, localization, measurement, and differentiation from all other orbital lesions with a high degree of accuracy. Specific echograms, however, of these tumors can only be obtained with optimized and standardized A-scan instruments providing specific settings of the sensitivity, amplifier characteristics, dynamic range, expansion of the screen display, filtering, etc. When instruments other than these are used, both differentiation and detection of this tumor become difficult or impossible. The more an A-scan instrument differs from the optimized and standardized type, the less successful the diagnosis of cavernous hemangiomas becomes, B-scan techniques add to the A-scan examination by better demonstrating the round shape and the topographic relationship to the globe, the optic nerve and the orbital wall.

Acute promyelocytic infiltration of the optic nerve treated by oral trans-retinoic acid.

BACKGROUND: Oral trans-retinoic acid has recently been shown to be an effective treatment modality for acute promyelocytic leukemia. This type of drug differs from traditional tumoricidal agents by promoting differentiation of the malignant, immature cells. METHODS: The authors describe a patient with optic nerve infiltration by acute promyelocytic leukemia documented ophthalmoscopically and confirmed by standardized echography and magnetic resonance imaging. High-resolution chromosome banding revealed the patient had a 15;17 chromosomal translocation known to be associated with acute promyelocytic leukemia. Treatment was instituted with oral all trans-retinoic acid without adjuvant radiotherapy or intrathecal chemotherapy. RESULTS: Results of serial bone marrow examination showed progressive differentiation of malignant cells with complete bone marrow remission. Results of serial ophthalmic examinations showed complete resolution of the leukemic optic nerve head infiltration. CONCLUSION: All trans-retinoic acid alone can be an effective treatment for optic nerve head infiltration in acute promyelocytic leukemia. This case suggests that radiation therapy may not be necessary in acute promyelocytic leukemia with optic nerve infiltration.