Ophthalmic Manifestations of Allergic Fungal Sinusitis.

PURPOSES: To study the ophthalmic manifestations of patients with allergic fungal sinusitis (AFS) and evaluate the importance of early diagnosis and management in preventing the possible future complications of AFS. METHODS: Retrospective chart review of 100 patients with the diagnosis of AFS from a single institution was performed. Age, gender, clinical presentation including ophthalmic and radiological findings, immune status, patterns of sinus involvement, medical and surgical intervention needed, laboratory results, and the course of the disease were evaluated. RESULTS: The mean age at presentation was 19.8 years (range, 10-42 years) with no clear gender predominance (52% of patients were female).The most common sinuses involved were ethmoid and maxillary sinuses. All patients underwent functional endoscopic sinus surgery and received systemic and topical steroids. There were no intervention-related complications. Thirty-four of 100 patients had ophthalmic consequences of AFS. The most common ophthalmic presentation was proptosis (n = 21, 61.7%), followed by epiphora (n = 5, 14.7%), visual loss (n = 4, 11.7%), diplopia (n = 3, 8.8%), and dystopia (n = 1, 2.9%) in addition to 1 patient having ptosis beside proptosis. CT scans of these 34 patients showed that 82.3% had nonhomogenous opacification of sinuses, 52% had erosion of lamina papyracea, 17.6% had intraorbital extension, and 8.8% had intracranial extension. CONCLUSIONS: Ophthalmologists may be the first who encounter these patients which necessitates familiarity with AFS presentations and complications. In cases of sudden visual loss, early intervention may prevent permanent vision loss. Functional endoscopic sinus surgery and postoperative systemic and topical steroids resulted in dramatic improvement of ophthalmic symptoms and signs.

Variable ptosis after botulinum toxin type a injection with positive ice test mimicking ocular myasthenia gravis.

We describe a patient who received cosmetic botulinum toxin type A injections to the brow and subsequently developed unilateral ptosis that was variable during examination and was transiently improved after the ice pack test. Ptosis gradually resolved spontaneously over approximately 3 months. This is the third patient to have variable ptosis documented after botulinum toxin type A injection to the brow and the second to have a positive ice test. The ice test is not completely specific for myasthenia gravis but may, at times, improve ptosis resulting from other defects at the neuromuscular junction. Wound botulism now is much more common because of illicit drug use, and the ice test also might be positive in this setting.

Solitary presumed choroidal tuberculomas masquerading as choroidal tumors.

The ocular involvement of tuberculosis is not uncommon but diverse. Rarely, patients initially present with ocular signs that simulate intraocular malignancy. We report 3 cases of isolated presumed choroidal tuberculoma masquerading as intraocular tumor. Two patients had no systemic evidence of tuberculosis with strongly positive purified protein derivative skin test and one patient had evidence of inactive old pulmonary tuberculosis demonstrated by chest computed tomography. Antituberculous regimen including isoniazid 5 mg/kg/day, rifampicin 600 mg/day, ethambutol 15 mg/kg/day, and pyrazinamide 30 mg/kg/day were employed in all cases for 9 months. In addition, oral prednisone 1 mg/kg/day has been given until clinical response was seen, then slowly tapered over 4 months until discontinued. All cases responded well to treatment without complications. Ocular tuberculosis may show challenging clinical presentations, and proper diagnosis and treatment can save the patient's eye and even life.

Diffuse large B-cell lymphoma of the orbit: A tertiary eye care center experience in Saudi Arabia.

Primary Diffuse Large B-cell Lymphoma (DLBCL) represents the 2nd most common lymphoma occurring in the orbit, after Mucosal Associated Lymphoid Tissue (MALT) lymphoma. A total of 5 cases of ocular adnexal DLBCL were diagnosed over 25 years of experience at our tertiary eye care center. Two cases involved the lacrimal sac and one case involved the lacrimal gland. In this paper we are presenting the remaining 2 non-lacrimal cases of DLBCL. The first case is a 32 year old male who was referred with a slowly growing, painless mass involving the left medial canthal area as a case of dacryocystitis. The mass was found to be extending into the orbit inferiorly with upward displacement of the left globe. The second case is a 65 year-old lady who presented with unilateral proptosis as a result of a right orbital mass extending to the orbital apex. Histopathologic examination and immunohistochemical analysis of the incisional biopsy in both cases confirmed the diagnosis of Diffuse Large B-cell Lymphoma (DLBCL).

Unilateral eyelid swelling, proptosis and diplopia as initial manifestation of acute myeloid leukemia.

Myeloid sarcoma is a tumor of immature myeloid cells occurring in many extramedullary sites, orbit being one of them where the tumor may occur prior to or after the diagnosis of underlying disease. We report a case of a 17-year-old male who presented with upper eyelid swelling, proptosis and diplopia after presumed blunt trauma without any other clinical signs and symptoms. Initial imaging suggested possibility of subperiosteal hematoma. Magnetic resonance imaging studies demonstrated a solid tumor. Complete excision of the tumor and histopathologic diagnosis revealed evidence of acute myeloid leukemia (AML). There were no other sites indicating any tumoral process; however, bone marrow aspirate revealed an evidence of systemic disease. After chemotherapy and allogenic bone marrow transplant, the patient had complete remission of his disease. An episode of graft vs host reaction resulting in severe dry eyes along with skin eruptions was treated successfully by immunosuppression and topical lubrication without any visual or systemic sequela. This case emphasizes on the need for an aggressive work-up for any unusual orbital lesion in the absence of any explainable etiology. Further, AML may be suspected in the cases of orbital tumors even in the absence of systemic manifestations of leukemia at any age.