A novel surgical correction technique of involutional entropion by combined triangular tarsectomy, orbicularis muscle tightening and inferior retractor plication.

PURPOSE: Describing a novel collective technique for treatment of involutional entropion of the lower eyelids in patients aged 55 years old or more. METHODS: A prospective comparative study included 56 patients (69 eyelids), recruited from the outpatient clinic of Tanta University Eye Hospital, presented with involutional lower eyelid entropion either primary or secondary. They were divided into: 1- Group A 42 eyelids with excessive horizontal lid laxity (pinch test > 8.0 mm), who underwent Combined tarsectomy of a triangle with base down and horizontal tightening of orbicularis muscle. 2- Group B: 27 eyelids with excessive horizontal lid laxity (pinch test < 8.0 mm) who underwent vertical tightening of orbicularis muscle. Follow up of the patients up to 12 month and satisfaction recording were done. RESULTS: The mean age of Group A was 60.08 ± 8.38 and of Group B was 55.10 ± 7.40. An overall high success rate (91.07%) and a low recurrence rate (8.92%) with a high post-operative satisfaction, both functionally and cosmetically (96.42%), were reported. CONCLUSION: Combined procedures with addressing the horizontal tightening was associated with a higher success rate and a lower recurrence rate.

A new treatment modality for the enlarged extraocular muscles.

PURPOSE: evaluation of the role of combined injection of triamcinolone acetonide with 5 Fluorouracil in treatment of the enlarged extraocular muscles secondary to chronic non-specific non-infectious inflammation. METHODS: injection of 0.1 ml of triamcinolone acetonide 40 mg/ml and 0.1 ml of 5 Fluorouracil 50 mg/ml in the enlarged extraocular muscles secondary to chronic non-specific non-infectious inflammation in 6 patients, after the confirmation of the histopathological diagnosis of these patients by revising their medical records. RESULTS: There was a significant improvement in the visual acuity, in addition to a significant improvement also in the clinical and the radiological features in the patients who were consented for the trial of the new injection protocol. However, there was failure of clinical and radiological improvement in one case presented with sever fibrosis. There was a significant absence of the side effects in all patients except for one patient that reported discomfort near the inner canthus. CONCLUSION: The new protocol of the treatment is a promising modality that can be used in the chronic non-infectious inflammation without extensive fibrosis.

Role of muscle biopsy in diagnosis of extraocular muscles enlargement.

PURPOSE: To study the role of muscle biopsy in patients with enlarged extraocular muscles. METHODS: A retrospective review of 31 patients who underwent biopsy for extraocular muscle enlargement. Characteristics, including signs, symptoms, imaging findings, and histopathological assessment were examined. RESULTS: Chronic inflammatory disorders represented the most common cause of the muscle enlargement followed by malignancy/metastasis. Multiple muscle involvement was more consistent with benign diseases, whereas single muscle involvement was more consistent with malignant causes. Positive predictive value of muscle biopsy was 0.52 for determining a specific cause of the muscle enlargement. CONCLUSIONS: Muscle biopsy is the standard for diagnosis in patients with extraocular muscle enlargement. This diagnostic test should be performed in every case of non-resolving muscle enlargement, with a specific diagnosis being made in over half of cases.

Clinical and imaging characteristics of orbital metastatic lesions among Egyptian patients.

PURPOSE: The aim of the study was to review the demographic, clinical, and imaging features of Egyptian patients with orbital metastases. METHODS: The study was a retrospective study of patients with orbital metastatic lesions over the last 15 years. RESULTS: The study included 37 patients. Male patients represented 54.1%. The primary tumor was breast carcinoma in 21.6% of patients, with hepatocellular carcinoma (HCC) in 16.2% and cutaneous malignant melanoma in 13.5% of patients. Bronchogenic carcinoma, prostatic carcinoma, and thyroid adenocarcinoma was the primary tumor in 8.1% of cases each. The most common primary tumor in children was neuroblastoma (42.9% of pediatric patients). In 24.3% of patients, there was no history of cancer, and the orbital metastatic lesion was the first presentation of the disease. Proptosis and/or globe displacement was the presenting feature in 78.4%, followed by diplopia and limited ocular movements in 35.1%, inflammatory manifestations in 10.8%, and ptosis in 5.4%. In 54.1% the lesion involved the right orbit and in 5.4% bilateral involvement was found. Orbital imaging showed infiltrative lesion in 62.2%, mass lesion in 21.6%, isolated muscle thickening in 10.8%, and bone metastasis in 5.4%. All cases of HCC showed osteoclastic changes, and all cases of prostatic carcinoma were osteoblastic lesions. CONCLUSION: Orbital metastasis from HCC represented a higher incidence when compared to previous studies, probably due to the increased incidence of HCC found in the Egyptian population. Orbital metastasis can display a variety of clinical and imaging features, and a high index of suspicion is required, as 24.3% showed negative history of cancer.

Lacrimal fossa lesions: a review of 146 cases in Egypt.

PURPOSE: The incidence and clinical and imaging criteria of different pathological forms of lacrimal fossa lesions in the Delta region of Egypt were studied. METHODS: A retrospective study of patients with lacrimal fossa lesions for the past 10 years was conducted. A total of 146 cases were identified. Their medical records were reviewed for clinical and imaging data (computed tomography scan, magnetic resonance imaging scan, or both). A definitive diagnosis based on pathological examination of biopsies was also reviewed. RESULTS: Among the patients reviewed, 43.15% had inflammatory lacrimal gland lesions, 26.71% had lymphoproliferative lesions, and 21.92% had epithelial lesions; 8.22% had rare lesions (5.48% were dacryops and 2.74% had hemangioma). The study included 71.92% benign lesions and 28.08% malignant lesions, which were distributed between 19.18% malignant lymphoma and 8.9% malignant epithelial tumors. According to the pathological origin of the lesions, they may be classified into 78.08% nonepithelial lesions and 21.92% epithelial lesions (16.44% epithelial tumors, and 5.48% dermoid cysts). CONCLUSION: Lacrimal fossa lesions show a wide pathological range. Inflammatory lesions are most frequent, followed by lymphoproliferative and epithelial lesions. Analysis of clinical and radiological criteria is helpful in the differential diagnosis of lacrimal gland lesions.

Orbital metastasis from hepatocellular carcinoma: report of 6 cases.

A series of 6 consecutive cases of orbital metastasis from hepatocellular carcinoma (HCC) were reported in the last 5 years. All patients were men. The age of patients ranged between 47 and 70 years. Four patients presented with recent onset of unilateral proptosis, 1 patient presented with inflammatory manifestations, and 1 patient presented with unilateral ptosis. Pain was present in 4 patients. Three patients had a previous history of HCC, while the orbital affection was the first manifestation of the disease in 3 cases. All patients had chronic hepatitis C. CT scan of 5 patients showed a mass in upper lateral orbital quadrant, and 1 patient had the mass in the upper central orbit. Bone changes (thinning, notching, or erosion) were detected in all patients. Diagnosis was confirmed by incision biopsy in all cases. Life span of 5 patients in the study had a mean of 10.2 (±2.3) months.