Oncocytoma of the Eyelid

Purpose@#To report a case of oncocytoma of the eyelid.Case summary: A 70-year-old male visited the ophthalmic clinic, complaining of a mass on his right lower eyelid that had grown steadily in size over the period of 1 year. At the time of his visit, his best-corrected visual acuity was 0.8 in the right eye and 0.8 in the left eye. The eyelid mass had a shape similar to that of a conjunctival nevus, and there was neither pain nor discharge. The eyelid mass was excised under local anesthesia. The mass biopsy presented as oval polygonal cells rich in eosinophilic granules in the cytoplasm. Based on this finding, the patient was diagnosed with oncocytoma of the eyelid. The patient has been under follow-up without further treatment or recurrence. @*Conclusions@#Oncocytoma of the eyelids is rare and has not been reported in Koreans; however, very rare but aggressive forms have been reported. Thus, it is necessary to make an accurate diagnosis through biopsy and close follow-up.

A Case of Twice Recurring Ocular Thelaziasis from Thelazia callipaeda

PURPOSE: We report a case of recurrent ocular thelaziasis by Thelazia callipaeda. CASE SUMMARY: A 71-year-old male visited the ophthalmic clinic, complaining of itching, a foreign body sensation, and irritation in the right eye. He was previously diagnosed with Thelazia callipaeda infection, 3 months prior, at another hospital. A parasite, shaped like a thin small thread, was found in the conjunctival sac of his right eye, with active movement. The parasite was identified as Thelazia callipaeda by pathology. Four months after removal of the parasite, symptoms relapsed in the same eye. Two parasites were rediscovered and removed. Since then, no additional specific sign related to the parasite has been noted in follow- up examinations. CONCLUSIONS: Due to frequent recurrence of infections caused by the short life cycle of the parasite, monthly follow-up examinations are required for at least 1 year after discovery of the parasite.

Transient Inferior Oblique Muscle Palsy Following Transconjunctival Lower Lid Blepharoplasty / 고신대학교의과대학학술지

Although the inferior oblique (IO) muscle is positioned considerably deep in the orbit, transconjunctival lower lid blepharoplasty may affect it and transient or permanent IO muscle palsy might result. Therefore diplopia should be explained before cosmetic blepharoplasty performed with transconjunctival approach.

A Case of Orbital Invasion of an Ameloblastoma

PURPOSE: To report a case of orbital invasion of ameloblastoma. CASE SUMMARY: A 69-year-old male patient was referred to the ophthalmologist from an otorhinolaryngology clinic due to mass invasion of the orbit on computed tomography. The patient had a history of ameloblastoma of the left maxilla, which had been diagnosed in 1988, and for which he had undergone left maxillectomy. He was transferred from a private hospital because of suspected tumor after frequent epistaxis at the left nasal cavity of about 1 year. The biopsy report confirmed that the mass was a recurrence of the ameloblastoma, and a 17.4 × 22.7 × 23.5-mm-sized mass that filled the left ethmoid sinus and invaded the nasal side of the orbit was found on paranasal sinus magnetic resonance imaging. There was no limitation of eye movement in any field of gaze in the left eye even though the patient reported diplopia. After maximum resection of the tumor using a debrider with endoscope, the size of the tumor was reduced and the symptom of diplopia was resolved. The patient will undergo continuous follow-up. CONCLUSIONS: Ameloblastoma is rare among orbital tumors originating from the paranasal sinus. We experienced a case of maxillary ameloblastoma involving the orbit. However, close monitoring should be administered to patients with such a tumor.

A Case of Metastatic Colonic Adenocarcinoma of the Eyelid

PURPOSE: To report a metastatic colonic adenocarcinoma in the left upper eyelid. CASE SUMMARY: A 73-year-old male presented to our clinic with a palpable mass in his left upper eyelid that had appeared 10 days prior. The patient had a history of colon cancer that was diagnosed 2 years previously with liver and lung metastases, and he had underwent colon resection followed by chemotherapy. A 10.7 x 14.7 x 9.0 mm mass was observed on orbital computed tomography and a biopsy confirmed that the mass was a metastatic colonic adenocarcinoma. Because radical resection of the mass could not be performed, a debulking surgery was performed instead. The patient was followed up while receiving conservative treatment, but he died 3 weeks after surgery. CONCLUSIONS: Metastatic tumors in the eyelids are very rare and colonic adenocarcinoma metastases in the eyelids are even less common. Thus, a biopsy examination and appropriate treatment should be administered to patients with a history of malignancy who present with an eyelid mass.

A Case of Histiocytoid Variant Eccrine Sweat Gland Carcinoma of the Orbit

A 79-year-old male presented with left ocular pain. Evisceration and silicone ball implantation were performed after a diagnosis of phthisis. He returned six weeks later because of left facial erythematous swelling, tenderness, mild fever, chills and cough. His condition was diagnosed as orbital cellulitis. Despite two weeks of empirical antibiotic therapy, the symptoms worsened. A subsequent orbital computed tomography scan revealed enhanced soft tissue infiltrations in his left orbit and eyelid. Biopsy showed a diffusely infiltrating tumor of signet ring cell cytology. A systemic evaluation revealed multiple bone metastases. Based on this evidence, the patient was diagnosed with a very rare case of histiocytoid variant eccrine sweat gland carcinoma with multiple bone metastases.

Changes in the Lacrimal Excretory System Depending on the Administration Mode of Brimonidine Tartrate: Spray vs. Irrigation

PURPOSE: To investigate the effects of 0.15% brimonidine tartrate ophthalmic solution spray on the luminal changes in the nasolacrimal excretory system. METHODS: A prospective study was performed on 52 eyes in 26 patients complaining of epiphora in both eyes. The randomly-assigned 26 test eyes (cases) received spray of the solution through the nasal cavity, and the other 26 eyes (controls) were irrigated with the same drug through the inferior calnaliculus. Dacryocystography was then performed to observe the luminal changes jn the nasolacrimal excretory system, patient symptoms and physiologic drainage functions. RESULTS: The changes in lumen width of the nasolacrimal duct (NLD) were noted, and the changes in lumen width of the lacrimal sac were not significant in either mode. The upper and middle parts of the NLD were widened more in the irrigation group, and the lower part of the NLD was widened more in the spray group. Though there was no significant difference in the physiologic drainage functions, the patients in both groups reported reduced symptoms. CONCLUSIONS: Brimonidine tartrate spray altered the width of the NLD and improved the subjective symptoms of patients. Therefore, the spray can be applied in functional NLD obstruction patients before the surgical procedure.

Effects in Lumen Width of Nasolacrimal Drainage System After Adrenergic Drug Irrigation

PURPOSE: The lacrimal sac and nasolacrimal duct are surrounded by a wide cavernous system of veins and arteries, and the blood vessels of the cavernous body are innnervated by the autonomic nervous system. The purpose of this study was to determine the effect of an adrenergic agonist on the lumen width of the nasolacrimal drainage system. METHODS: Dacryocystography was performed on 35 patients with only epiphora and not nasolacrimal duct obstruction. The anteroposterior (AP) diameters and the oblque diameters of the nasolacrimal ducts were measured. Next, 18 patients were infused with 0.5 ml Alphagan-P(R) (alpha-2 adrenergic receptor agonist), 17 patients were infused with 0.5 ml DL methylephedrine hydrochloride (alpha-1 and alpha-2 adrenergic receptor agonist), and dacryocystography was performed again to determine the change in the lumen width of the nasolacrimal drainage system. RESULTS: The alpha-adrenergics caused a significant increase in the lumen width of the nasolacrimal drainage system, and the changes were more pronounced in the nasolacrimal duct than in the lacrimal sac. Although the nasolacrimal duct widening was more notable in the Alphagan-P(R) infusion group than the DL methylephedrine hydrochloride infusion group, there was no significant statistical difference. Patients' subjective symptoms improved in both groups. CONCLUSIONS: The alpha-adrenergics constrict the blood vessels of the cavernous body, leading to the increase in the lumen width of the nasolacrimal drainage system. This effect was more significant in the Alphagan-P(R) infusion group. In conclusion, infusion of alpha-adrenergics in patients with functional nasolacrimal duct obstruction can be considered as an alternative to surgical management.

Reconstruction of Contracted Anophthalmic Socket with Acellular Dermal Allograft

PURPOSE: To study the use of acellular dermal allografts for the reconstruction of contracted anophthalmic sockets. METHODS: A retrospective analysis was performed on 12 patients with contracted sockets who underwent reconstructive surgery using acellular dermal allografts from 2002 to 2006. RESULTS: The mean age of the patients was 44.4 years. The mean duration of conjunctival sac contracture after removal of the eyeball was 21.4 years. In 4 patients, acellular dermal allografts were used as spacer grafts to elevate the eyelids, and in 8 patients the allografts were used as a conjunctival grafting material. All patients were able to wear ocular prostheses comfortably 2.2 months after surgery with acceptable cosmesis. There were no serious complications, such as infections or graft rejections during follow-up period. CONCLUSIONS: When used as conjunctival grafting materials and tarsal substitutes to elevate patients' eyelids, acellular dermal allografts gave cosmetically and functionally acceptable results in the surgical rehabilitation of contracted sockets.

A Case of Imploding Antrum (Silent Sinus) Syndrome after Orbital Decompression

PURPOSE: Imploding antrum (silent sinus) syndrome has clinical features of enophthalmos and hypoglobus after a downward collapse of inferior orbital wall with an ipsilateral volume decrease of maxillary sinus. We present a case of imploding antrum syndrome after an orbital decompression surgery. CASE SUMMARY: A 26-year-old female underwent inferomedial wall orbital decompression surgery through a caruncular approach to reduce exophthalmos. At 14 months after surgery, her right eye showed 2 mm of enophthalmos and orbital CT scan revealed both maxillary sinusitis. At 28 months after surgery, 3 mm of enophthalmos and hypoglobus of the right were observed, and an orbital CT scan was taken. Orbital CT scan showed a downward collapse of inferior orbital wall, a volume decrease and inward bowing of the maxillary sinus, and a maxillary opacification on the right side, which are typical findings of imploding antrum (silent sinus) syndrome. CONCLUSIONS: Imploding antrum (silent sinus) syndrome after orbital decompression surgery is a rare complication. Considering that any prolapsed orbital fat after orbital decompression surgery could result in imploding antrum syndrome with hypoventilation of a maxillary sinus, care should be taken to keep the maxillo-ethmoidal interface (bony strut) intact, which helps maintain maxillary aeration.

Primary Yolk Sac Tumor of the Orbit

PURPOSE: To report a case of primary yolk sac tumor of the orbit. METHODS: A 15-month-old girl was referred for evaluation of ptosis and strabismus in the right eye which had developed over the previous two weeks. On examination, ptosis, exotropia, proptosis, and restriction of extraocular muscle movement of the right eye were noted. A computed tomography (CT) scan of the orbit showed a 2.4 cm x 3.4 cm-sized soft tissue mass in the posterior aspect of the right orbit which enveloped the optic nerve and invaded the maxillary sinus, posterior ethmoid sinus, nasal cavity, and intracranial space. Endoscopic biopsy of the nasal cavity mass was performed. RESULTS: Histologic evaluation revealed solid proliferation of germ cells with large, clear cytoplasm and intracellular, extracellular hyaline globules. Immunohistochemical staining for alpha-fetoprotein was positive. Results of further systemic evaluation were all negative. The tumor regressed after combined chemotherapy and radiotherapy. The patient has been disease free for 2 years. CONCLUSIONS: The possibility of yolk sac tumor should be considered in the differential diagnosis in a younger patient for an orbital mass with rapidly increasing size and adjacent bony destruction. Prompt diagnosis and appropriate therapeutic approaches are essential.

A Case of Solitary Bone Plasmacytoma Presenting with Erythematous Swelling of the Upper Eyelid

PURPOSE: To demonstrate a rare case of orbital solitary bone plasmacytoma that presented with erythematous swelling of the upper eyelid. METHODS: A 64-year-old woman presented with a erythematous swelling of the right upper eyelid that persisted for 8 months prior to examination. There were 3 mm of proptosis in the right eye on ophthalmologic examination and an orbital tumor was detected on computed tomography (CT) scan, infiltrating the intracranial space and the sphenoid bone. Therefore, we performed incisional biopsy through the right upper eyelid. RESULTS: Histopathologic examination revealed the tumor to be a plasmacytoma (lambda light chain-type) and all the systemic work-ups (serologic and urinary protein immunoelectrophoresis, bone marrow biopsy, radiologic examination) to rule out multiple myeloma were negative. Because of these factors, a diagnosis of solitary bone plasmacytoma was made. Radiation therapy (5,000 Gy/25 fractions) was performed over 5 weeks and the size of the tumor was found to have markedly decreased on a follow-up CT scan. CONCLUSIONS: Solitary bone plasmacytoma is rare and has variable prognoses. This condition should be considered when the presenting symptom is eyelid swelling and proptosis.

Visual Loss due to Inflammatory Sinus Diseases

PURPOSE: Visual loss secondary to inflammatory sinus diseases is an infrequent but disastrous complication. We analyzed the clinical features of patients with paranasal sinusitis who had signs of optic nerve dysfunction. METHODS: Medical records of 10 patients (11 eyes), who presented with visual loss associated with inflammatory sinus diseases, were reviewed retrospectively. RESULTS: The mean age was 53.7 years (range, 33-68 years). Involved sinuses were the sphenoid (10 eyes) and posterior ethmoid (7 eyes). The radiological evidence of orbital apex infiltration was shown in 8 eyes. Headache was the most common presenting symptom. The mean symptom duration before their first visit was 51.4 days. The underlying sinus pathology included fungal infection (5) and mucoceles (5). Fungal sinusitis and initially lower visual acuity were associated with poor visual prognosis, while mucocele showed good prognosis. CONCLUSIONS: The inflammatory sinus disease could leave a permanent visual deficit, especially in cases of fungal sinusitis and initially lower visual acuity. Multidisciplinary diagnostic and therapeutic approaches are essential to prevent serious ophthalmic complications such as permanent visual loss.

Fine Needle Aspiration Biopsy of Posterior Orbital Tumors

PURPOSE: To evaluate the effectiveness and safety of fine-needle aspiration biopsies of mass lesions located in the posterior orbit. METHODS: Eight patients with mass lesions in the posterior orbit underwent fine-needle aspiration biopsy with 21-gauge needles using the freehand technique. RESULTS: Fine-needle aspiration biopsies were performed easily and safely. One patient developed subconjunctival hemorrhage following biopsy, but no major complications were observed. Diagnostic specimens were obtained in 6 patients (75%). Of these diagnostic cases, 3 were benign, and the other 3 were malignant. In 3 of 6 patients we performed surgical excisions, while in the others we performed radiotherapy and/or chemotherapy. In 2 patients (25%) the cytologic specimens were inadequate. CONCLUSIONS: Fine-needle aspiration biopsy is useful and safe in evaluating orbital mass lesions, especially when they are not surgically accessible due to their location in the posterior orbit.

Quantified Values of Anterior Segment in Normal Adult Koreans Using Ultrasound Biomicroscopy

PURPOSE: To establish quantified values for anterior segment of normal adult Koreans using ultrasound biomicroscopy (UBM) in relation to age and sex. METHODS: Anterior segment images were obtained in 114 normal Koreans (54 males and 60 females) using UBM. Six different parameters (central corneal thickness, anterior chamber depth, scleral thickness, trabeculariris distance, angle-opening distance 500 and anterior chamber angle) were measured by the same examiner in central chamber image and angle image. Among the parameters, anterior chamber depth was compared with that measured by A-scan. RESULTS: Average central corneal thickness was 495.2 +/- 29.6 micro meter in male and 488.8 +/- 20.6 micro meter in female, anterior chamber depth 2.997 +/- 0.297 mm in male and 2.763 +/- 0.314 mm in female, anterior chamber angle 38.86 +/- 3.62 degrees in male and 36.01 +/- 3.23 degrees in female and angle-opening distance 500 316.2 +/- 52.4 micro meter in male and 290.9 +/- 54.4 micro meter in female, respectively. Anterior chamber depth, anterior chamber angle, trabecular-iris distance and angle-opening distance 500 were smaller in female than male. Anterior chamber depth showed a significant decrease in relation to age in male and female. Values of anterior chamber depth were statistically significantly correlated between UBM and A-scan. CONCLUSIONS: Quantified values were established for anterior segment using UBM in normal adult Koreans. In the future, they will be useful in evaluating the anterior segment structures and diseases.

Hematologic Risk Factors in Young-Aged Retinal Vein Occlusion

PURPOSE: To determine the prevalence of hematologic abnormalities in patients with retinal vein occlusion (RVO) less than 55 years of age. METHODS: Medical records of twenty-three patients with RVO less than 55 years old were reviewed to evaluate the results of CBC, ESR, homocysteine, Protein C, Protein S, antithrombin III, anticardiolipin antibody, lupus anticoagulant and lipid profile. Patients were considered to have a positive test if the results were outside the laboratory's established range. RESULTS: Four patients had ischemic central retinal vein occlusion (CRVO), 8 non-ischemic CRVO, and 11 branch retinal vein occlusion (BRVO). The prevalence of AT III and protein S deficiency were 4.3% and 13.0% respectively. The prevalence of homocystinemia, lupus anticoagulant, hyperlipidemia were 8.7%, 4.3% and 26.1% respectively. There was no positive finding in anticardiolipin antibody or protein C deficiency. CONCLUSIONS: Hypercoagulability may play a role in the pathogenesis of RVO in patients less than 55 years old, especially in those who had no systemic risk factors. The authors recommend examining systemic risk factor evaluation and hematologic evaluation to rule out thrombophilia. Those who show positive findings should be given a consultation with a hematologist for the proper management.

Efficacy of Occlusion Therapy in Amblyopia: Type, Depth and Timing of Amblyopia

PURPOSE: To study the effect of occlusion therapy in amblyopia according to the beginning time of occlusion therapy, type and depth of amblyopia. METHODS: The total 92 children, who had been treated with occlusion therapy were included in this study. Patients were divided into two groups according to the age when occlusion therapy was started: those with less than 7 years vs 7 years or older. Patients were also divided into three groups according to the type of amblyopia and depth of amblyopia: mild amblyopia with visual acuity 0.6 or more , moderate amblyopia with between 0.2 and 0.5 , and severe amblyopia with 0.1 or less. RESULTS: The children under 7 years old were 58 patients and 7 years or over was 34 patients. In patients less than 7 years, 70.7% achieved a successful treatment and in patients 7 years or more, 67.6% was in success. There was no significant difference between two groups. Among the moderate and severe amblyopic patients, 72.1% of patients under 7 year-old and of 44.4% of over 7 year-old achieved a successful treatment. According to the type of amblyopia, there was no significant difference between the groups. According to the depth of amblyopia, success rate of occlusion in mild, moderate and severe amblyopia was 80.6%, 67.9%, and 37.5% respectively. CONCLUSIONS: The success rate was higher in younger group than older group in moderate and severe amblyopia. The depth of amblyopia affected the final visual outcome, and occlusion therapy was more effective in less severe amblyopia.