Ocular Manifestations of Paranasal Sinus Malignancies

PURPOSE: To investigate ocular complications that occur after orbital preservation surgery for paranasal malignancies and to identify the early clinical features of ophthalmic manifestations in paranasal malignancy patients. METHODS: We reviewed the clinical charts of patients following ophthalmic consultation after orbital preservation surgery for paranasal malignancies. We also investigated the early clinical features of ophthalmic manifestations in patients with paranasal malignancies. RESULTS: In our study, 54 patients had paranasal malignancies. Among them, 41 had undergone orbital preservation surgery, and 19 patients sought an ophthalmology consultation. There were seven patients who presented with eye symptoms caused by paranasal malignancies before the diagnosis. Paranasal malignancies included squamouscell carcinoma (13 cases), adenocarcinoma (3 cases), plasmocytoma (1 case), malignant schwannoma (1 case), and undifferentiated carcinoma (1 case). The locations of the origin of the tumor included the maxillary sinus (16 cases) and the ethmoid sinus (3 cases). The most common eye symptoms after orbital preservation surgery were enophthalmos, lid retraction, tearing, strabismus, inflammation, dry eyes, and cataracts, in order of frequency. Patients who visited the ophthalmic clinic due to paranasal malignancies had eye symptoms such as proptosis, nonspecific ocular pain, strabismus, tearing, eyelid swelling, and relative afferent pupillary defects, in order of frequency. CONCLUSIONS: Ocular complications were more common if the paranasal malignancy had invaded the orbital bone. However, many of the patients with disease invasion of the periosteum had no nasal or ocular symptoms upon presentation. Therefore, these patients should be managed carefully since symptoms may initially be vague and nonspecific.

An Anatomic Study of the Infraorbital Fat Compartments in Adult Cadavers

PURPOSE: This study investigated the anatomy of infraorbital fat and the relationship between surrounding structures and infraorbital fat. METHODS: Forty-one orbits from adult Korean cadavers were dissected. Among them 20 orbits were male and 21 orbits were female. The cadavers were perfused and embalmed in formalin solution. The skin and orbicularis oculi muscle were dissected to expose the arrangement and compartments of infraorbital fat. A punctal probe was used to find a deeper fat compartment lying under the another compartment. The width of each compartment and the distances from the inferior orbital rim and from the lower lid margin to the topmost point of each compartment were measured using a digital caliper. The distance from the top of the medial compartment and lower lid margin to the first appearance of the inferior oblique muscle, located between the medial and the central fat compartments, were measured, respectively. RESULTS: The width of the medial compartment was 11.49+/-2.54 mm, the central compartment was 21.78+/-5.69 mm, and the lateral compartment was 17.94+/-4.99 mm. The distance from the inferior orbital rim to the medial compartment was 8.13+/-2.72 mm, to the central compartment was 9.91+/-3.44 mm, to the lateral compartment was 9.58+/-3.76 mm. The distance from the lower lid margin to the medial compartment was 5.55+/-1.22 mm, to the central compartment was 7.09+/-3.22 mm, and to the lateral compartment was 5.41+/-3.07 mm. The distance from the inferior oblique muscle to the medial compartment was 9.09+/-2.63 mm, and to the lower lid margin was 13.60+/-2.27 mm. CONCLUSIONS: Our study evaluates the normal anatomy of the infraorbital fat compartments in Korean patients and suggests a useful index for lower blepharoplasty and lower orbital surgery.

Clinical Manifestation in Rhino-Orbito-Cerebral Mucormycosis

PURPOSE: To report upon several cases of rhino-orbito-cerebral mucormycosis with variable clinical manifestations including ocular symptoms. METHODS: We documented three patients with rhino-orbital-cerebral mucormycosis and uncontrolled diabetes. RESULTS: The patients presented variable ophthalmic symptoms including blepharoptosis, ophthalmoplegia, visual disturbance, visual field defect and ocular pain. Despite administration of an antifungal agent within two days, all of the patients died. CONCLUSIONS: We reported the cases of three patients with rhino-orbito-cerebral mucormycosis presenting ophthalmic symptoms with a literature review. Variable initial symptoms were emphasized in making diagnosis of rhino-orbito-cerebral mucormycosis.

Acute Angle-Closure Glaucoma from Spontaneous Massive Hemorrhagic Retinal Detachment

PURPOSE: To report a case of acute angle-closure glaucoma resulting from spontaneous hemorrhagic retinal detachment. METHODS: An 81-year-old woman visited our emergency room for severe ocular pain and vision loss in her left eye. Her intraocular pressures (IOPs) were 14 mmHg in the right eye and 58 mmHg in the left eye. Her visual acuity was 0.4 in the right eye but she had no light perception in the left eye. The left anterior chamber depth was shallow and gonioscopy of the left eye showed a closed angle. In comparison, the right anterior chamber depth was normal and showed a wide, open angle. Computed tomography and ultrasonography demonstrated retinal detachment due to subretinal hemorrhage. After systemic and topical antiglaucoma medications failed to relieve her intractable severe ocular pain, she underwent enucleation. RESULTS: The ocular pathology specimen showed that a large subretinal hemorrhage caused retinal detachment and pushed displaced the lens-iris diaphragm, resulting in secondary angle-closure glaucoma. CONCLUSIONS: Prolonged anticoagulant therapy may cause hemorrhagic retinal detachment and secondary angle-closure glaucoma. If medical therapy fails to relieve pain or if there is suspicion of an intraocular tumor, enucleation should be considered as a therapeutic option.

The Objective Change of the Eyelid after Upper Blepharoplasty

PURPOSE: To evaluate the morphological changes in the external eyes after upper blepharoplasty. METHODS: Twenty-six eyes of 13 patients undergoing upper blepharoplasty from May 2002 to May 2003 were selected. All surgeries were performed by one surgeon. MRD1, MRD2, interpalpebral fissure height, and levator function test were each measured twice, and the averages were calculated. Likewise, significant changes were checked before and after the operation. The subjects were divided into two groups. For group A (n=12), a double line suture was stitched at the levator aponeurosis, which was directly superior to the tarsal plate. In group B (n=14) the suture was stitched at a levator aponeurosis 3 mm superior to tarsal plate. The delta levator function (postoperative mean levator function minus preoperative mean levator function) measurements were calculated and compared between the two groups. RESULTS: The MRD1 was 2.04+/-0.75 (mean+/-SD) before the operation, and 2.0+/-0.81 after the operation. MRD2 was 5.23+/-0.75 before the operation, 5.35+/-0.54 after operation. Interpalpebral fissure height was 7.27+/-0.38 before the operation and 7.35+/-0.63 after the operation. There were no statistically significant factors before and after the operation in MRD1, MRD2 and interpalpebral fissure height. The levator function was 14.04+/-1.80 before versus 16.19+/-1.58 after. This increase was statistically significant (p<0.01, Wilcoxon signed ranks test). The delta levator function was 1.58+/-0.90 for group A and 1.96+/-1.36 for group B. CONCLUSIONS: After upper blepharoplasty, the measurement of levator function increased significantly.

Visual Acuity Prediction with the Illuminated Near Card in Cataract Patients

PURPOSE: To determine the accuracy of predicting potential visual acuity in cataract using the illuminated near card (INC). METHODS: Thirty-nine eyes (34 patients) having cataract were studied prospectively by comparing the postoperative distance Snellen acuity to the visual acuity (VA) obtained preoperatively using the INC viewed through a pinhole. RESULTS: The INC predicted postoperative acuity within two Snellen lines in 20 of 39. The accuracy between predicted and achieved acuities was follows: 61.5% in patients with a preoperative acuity of better than 0.3, 53.8% of better than 0.1, 50.0% of better than 0.05 and 28.6% of worse than 0.05. The disparity between INC results and postoperative VA was 3.89 lines (cortical opacity, nucleosclerosis, subcapsular opacity), 2.48 lines (cortical and subcapsular opacity), 2.08 lines (cortical opacity, nucleosclerosis), 1.8 lines (nucleosclerosis only), 3.3 lines (nucleosclerosis, subcapsular opacity), 1.6 lines (subcapsular opacity) and 3.0 lines (the others). CONCLUSIONS: The INC is easy to use and is a fast and accurate measurement instrument for predicting postoperative VA after cataract operation.