Chronic Granulomatous Inflammation of the Eye lids

Granulomatous inflammation is characterized by granuloma formation with a cellular infiltrate of epithelioid cells, giant cells, and chronic inflam-matory cells.It could be diagnosed as a subtype of inflammatory pseudotumor when such identifiable causes of granulomatous inflammation have been ruled out. We performed excisional biopsy on 3 patients who complained of upper eyelid mass.The levator muscle was mainly affected in two patients and the lacrimal gland in one patient. Microscopic examination of the mass demonstrated chronic granulomatous inflammation including non-caseating necrosis, diffuse chronic inflammatory cell infiltrates, and granuloma com-posed of histiocytes, multinucleated giant cells, lymphocytes, and epithelioid cells in all 3 patients.There was no evidence of foreign material and infec-tion with tuberculosis, mycosis, and parasites.The diagnosis of sarcoidosis, connective tissue disease, and Wegener's granulomatosis could be ruled out through the basic hematological test, chest radiograph, and blood tests such as angiotensin converting enzyme, lysozyme, antinuclear antigen, and anti-neutrophil cytoplasmic antibody. We experienced 3 cases of chronic granulomatous inflammation of the eyelids without identifiable causes which responds to excision and postoperative steroid therapy without recurrences.

Langerhans'Cell Histiocytosis of the Orbit

Langerhans'cell histiocytosis[LCH], or histiocytosis X, is an uncommon multisystemic disorder of unknown etiology, which is characterized by accumulation of histiocytes in various tissues including orbit. We have recently experienced 4 cases of orbital LCH presenting with exophthalmos. Four patients[3 children and 1 adult]presented with exophthalmos that progressed over 2 to 3 weeks and were found to have orbital mass on ocular examination and orbital CT scan. Two children had concomitant hepatomegaly. Orbital CT scan showed a soft tissue mass with destruction of adjacent bones. Microscopic examination of the orbital mass showed a collection of Langerhans 'cells intermixed with eosinophils and other inflammatory cells. In two cases, immunohistochemistry revealed positive staining for S-100 protein. In three cases, a definite diagnosis was made by detection of Birbeck's granules by electron microscopy. Three children received chemotherapy and one adult had mass excision. The mass markedly decreased in size or nearly disappeared in all patients, and no recurrence has been noted for more than 9 months of follow-up.

Hard Palate Mucosa Grafts for Lower Lid Retraction

Lower eyelid retraction is usually managed by recession of the lower lid retractors and interposition of a spacer graft including ear cartilage, nasal septal cartilage, donor sclera or autogenous tarsoconjunctiva.We have used hard palate mucosa as a spacer in 10 patients (11 eyelids)with lower lid retraction.Average age at operation was 36 years with the range of 10 years to 59 years.Causes of the lower lid retraction were thyroid ophthal-mopathy (4 eyelids), strabismus surgery (2 eyelids), entropion repair (2 eye-lids), eyelid infection (2 eyelids), and trauma (1 eyelid).Of 11 eyelids, 7 eye-lids were combined with entropion due to the shortage of posterior lamella. The follow-up period ranged from 3 to 45 months (mean 17 months).Surgi-cal results in all 11 eyelids were satisfactory.There was no complication in donor site.Hard palate closely approximates lower lid tarsus in terms of contour, thickness, and stiffness, provides a mucosal surface and shows only minimal shrinkage. We suggest hard palate mucosal grafts as one of the best available spacer material for the treatment of lower lid retraction.

Silicone Intubation for Functional Nasolacrimal Duct Obstruction

Functional nasolacrimal duct obstruction refers to a situation in which the lacrimal system is patent to syringing in a patient complaining of tearing. From July 1995 to July 1998 we performed silicone tube intubation in 29 eyes of 22 patients with functional obstruction of the lacrimal drainage passages. Seventy-two percent of patients had resistance in the lacrimal passage atprobing and proximal nasolacrimal duct was the most frequent obstruction site.Epiphora has improved in 58.6% (17 eyes)after silicone intubation without any improvement in the remaining.Some even became aggravated. Most patients with functional obstruction had partial obstruction in the lacrimal passage and more than half of them became improved with the sil-So silicone intubation can be considered as an initial procedure prior to dacryocystorhinostomy