Transient exotropia after posterior spinal fusion in a child: a new case.

Ocular complications after spinal surgery are rare, although ischemic optic neuropathy, occipital lobe infarcts, and central retinal vein thrombosis have been reported. Our purpose is to report a case of an acute, comitant, postoperative exotropia that rapidly and spontaneously resolved. This case is particularly interesting in that it may indirectly shed some light on mechanisms of vergence control.

Causes of involutional ectropion and entropion--age-related tarsal changes are the key.

PURPOSE: To measure tarsal plates across various age-groups, to determine whether tarsal size changes with increasing age and whether size correlates with involutional ectropion and entropion. METHODS: Comparative, observational, case-control study design. Data were obtained for length and height of tarsus in each of the four eyelids. The data were constructed to determine: (I) right-to-left-side comparison data, (II) sex difference data, (III) age normal data, (IV) involutional entropion data, (V) involutional ectropion data. RESULTS: (I) There is no difference in tarsal dimensions between right and left sides; (II) males have larger tarsal dimensions than females; (III) tarsal plates are on average smaller in older age ranges; (IV) patients with entropion have smaller than average age-normal tarsal plates; (V) patients with ectropion have larger than average age-normal tarsal plates. CONCLUSIONS: (I) Right and left tarsal plates have equal dimensions, and involutional changes likely occur on both right and left sides equally frequently; (II) males have larger tarsal plates than females and entropion is more frequent in females and ectropion in males; (III) tarsal plates may have a general tendency to atrophy or shrink with age; this may explain why some eyelids develop entropion and others ectropion; (IV) entropion results from the mechanical effect of an atrophied or smaller than age-normal, partially or fully disinserted, tarsal plate being overcome by the normal or increased tone of the preseptal/pretarsal orbicularis muscle; (V) ectropion results from an age-normal or larger than normal tarsal plate mechanically overcoming the normal or decreased tone of the preseptal/pretarsal orbicularis muscle in combination with medial/lateral canthal tendon laxity.

Aspergillus mycetoma in a secondary hydroxyapatite orbital implant: a case report and literature review.

OBJECTIVE: The authors describe the first case report of a fungal abscess within a hydroxyapatite orbital implant in a patient who had undergone straightforward secondary hydroxyapatite implant surgery. DESIGN: Case report and literature review. INTERVENTION: Four months postoperatively after pegging and 17 months after original implant placement, chronic discharge and socket irritation became evident. Recurrent pyogenic granulomas were a problem, but no obvious area of dehiscence was present over the implant. The peg and sleeve were removed 31 months after pegging (44 months after original placement of the implant). The pain and discharge did not resolve, and the entire hydroxyapatite orbital implant was removed 45 months after sleeve placement and 58 months after initial implant placement. The pain and discharge settled rapidly. MAIN OUTCOME MEASURES: Cultures and histopathology. RESULTS: Results of bacterial cultures were negative. Results of histopathologic examination of the implant disclosed intertrabecular spaces with multiple clusters of organisms consistent with Aspergillus. CONCLUSIONS: Persistent orbital discomfort, discharge, and pyogenic granulomas after hydroxyapatite implantation should cause concern regarding potential implant infection. The authors have now shown that this implant infection could be bacterial or fungal in nature. This is essentially a new form of orbital Aspergillus, that of a chronic infection limited to a hydroxyapatite implant.