Pigmented Conjunctival Lesions as Presenting Signs of Vaginal Melanoma.

A 43-year-old woman was referred to an oculoplastic surgeon for the evaluation of 2 small pigmented lesions in the tarsal conjunctiva. She underwent a biopsy of the lesions, both of which were found to be consistent with metastatic melanoma. Follow-up with the patient revealed that she had been hospitalized for balance issues and headaches. An MRI of her brain revealed a hemorrhagic mass and several smaller foci suspicious for metastatic lesions. A thorough workup included an evaluation for bloody vaginal discharge. Biopsy of a pigmented portion of the vaginal mucosa lesion revealed BRAF-positive melanoma. This was determined to be the primary site of her malignant metastatic melanoma, which caused her death within 6 months of presentation.

Silicone oil migration into the orbit.

PURPOSE: To report a case in of intravitreal silicone oil migration into the inferior orbit. Silicone oil tamponade is commonly used in retinal detachment repair and extrusion into the orbital tissues is very rare. METHODS: A 70-year-old male with a remote history of repair of a right ruptured globe and retinal detachment surgery presented with progressive right lower eyelid edema. There was a known history of intravitreal silicone oil instillation and removal. An elective right inferior orbitotomy with excisional biopsy was performed. RESULTS: Histopathology confirmed the presence of silicone oil intermixed with necrotic fat. The patient had excellent cosmetic and functional outcome. CONCLUSION: The presence of silicone oil within the orbital fat may be a result of increased intraocular pressure and extrusion through presumably water-tight sclerotomy sites.

History of the American Board of Ophthalmology Oral Examination.

The oral examination has been an integral part of certification by the American Board of Ophthalmology (ABO) since its founding in 1916. An overview is provided regarding the history, evolution, and application of new technology for the oral examination. This part of the certifying process allows the ABO to assess candidates for a variety of competencies, including communication skills and professionalism.

Orbital Sarcoid-Like Granulomatosis After Inhibition of Tumor Necrosis Factor-α.

Pharmacologic inhibition of tumor necrosis factor-alpha (TNF-α) has been used in the management of a variety of inflammatory conditions. Recently, reports on the development of sarcoid-like granulomatous disease at multiple systemic sites after treatment with TNF-α inhibitors have emerged, although, to the authors' knowledge, orbital manifestations of this problem have not been previously described. A 48-year-old woman who received injections of adalimumab for the treatment of psoriatic arthritis developed right-sided orbital pain and inflammation. Orbital biopsy of a focal lesion demonstrated sarcoid-like granulomatosis, and a workup for other causes of this problem was noncontributory. This report represents the first documented case of this phenomenon in the orbit, and possible mechanisms are discussed in this presentation. Given the expanding role of TNF-α inhibitors and the increased frequency of their use, clinicians should be aware of this possible side effect.

Primary adnexal angiosarcoma masquerading as periorbital hematoma.

We report an elderly woman who was anticoagulated and presented with a recent history of right-sided orbital contusion and a periorbital hematoma without clinical or radiological evidence of focal mass or orbital involvement. She was initially treated conservatively. Continued progression of adnexal swelling and erythema prompted further investigation, however. There was no improvement with surgical drainage alone; biopsy revealed angiosarcoma. The discovery of this vascular tumor underscores the importance of a reconsideration of the diagnosis in the face of counterintuitive findings. Additionally, we emphasize the need to consider malignancy in the differential diagnosis of prolonged periorbital swelling, regardless of a history of recent trauma.

Fibrolipoma of the orbit.

Herein we present a retrospective case report of a very rare fibrolipoma originating in the orbit. Lipomas and related variants presenting in the orbit are very rare. Only 2 documented orbital fibrolipomas were noted in our review of literature. A 26-year-old woman presented with a growing mass below the left eyebrow 4 years after suffering facial trauma after being kicked in the face by a horse. CT demonstrated a hypodense nodule adherent to the orbital portion of the left frontal bone that was not encapsulated. An elective left anterior orbitotomy with excisional biopsy was performed, and fibrolipoma was confirmed on histopathologic examination. There was no evidence of tumor after 2-year follow up. The presence of a fibrolipoma in the periosteum of the orbital rim is very rare and might be a result of inflammatory transformation following facial trauma.

Metastatic synovial sarcoma to the orbit.

Synovial sarcomas are rare malignancies. Metastatic synovial sarcomas carry a particularly poor prognosis. While primary orbital lesions have been documented, the authors are aware of only one previous report of metastatic synovial sarcoma to the orbit. In this report, the second case of a metastatic synovial sarcoma to the orbit is described and the medical literature on this subject is reviewed.

Nasolacrimal duct obstruction with Urbach-Wiethe syndrome.

An 80-year-old woman presented with signs and symptoms consistent with bilateral nasolacrimal duct obstruction. She also was noted to have multiple eyelid margin lesions. She underwent bilateral dacryocystorhinostomy with biopsy of the nasolacrimal ducts and eyelid lesions. Her tearing resolved. Histopathology of the eyelid lesions was consistent with lipoid proteinosis. Nasolacrimal duct obstruction may occur in patients with lipoid proteinosis (Urbach-Wiethe syndrome).

Spermatic cord leiomyosarcoma metastatic to the orbit.

PURPOSE: To report a case of spermatic cord leiomyosarcoma metastatic to the orbit. DESIGN: Case report. METHODS: A 78-year-old man presented with progressive redness, proptosis, and decreasing vision of the left eye of 3 weeks' duration. Computed tomography revealed an intraconal mass (1.5 x 2 cm) inferior to and displacing the left optic nerve. RESULTS: A left lateral orbitotomy was performed, and a well-demarcated mass was removed from the surrounding tissue. A follow-up computed tomography of the chest and abdomen was consistent with metastatic disease to the lungs and liver. CONCLUSIONS: Spermatic cord leiomyosarcoma is a rare cause of metastatic lesions to the orbit.

Rapid recovery from acoustic trauma: chicken soup, potato knish, or drug interaction?

OBJECTIVES: To describe the phenomenology and consider possible mechanisms mediating rapid and unexpected recovery from acoustic trauma after ingestion of a food substance (potato knish). STUDY DESIGN: Single subject with repeated test measures. SETTING: Regional Veteran's Administration Medical Center, tertiary care medical center. METHODS: Pure-tone audiometry and distortion product otoacoustic emissions (DPOAEs) performed at 6 days, 21 days, and 1 year postexposure. RESULTS: Medical treatment with corticosteriods and a diuretic alone failed to improve auditory function and related symptoms (tinnitus and aural fullness) over a 2-week period. Rapid recovery of auditory function (dramatic improvement in pure tone thresholds; reappearance of DPOAEs) and abatement of related symptoms directly followed physiologic reactions from ingesting a food substance. CONCLUSIONS: Rapid recovery from acoustic trauma was temporally correlated with urodynamic and cardiovascular reactions from ingesting food containing sulfite preservative, a substance to which the individual was allergic. Factors that may have contributed to recovery of function include massive diuresis, increased heart rate, release of biochemical mediators, mediator-induced vasodilatation, and changes in vascular or cell membrane permeability. Establishing relationships that lead to recovery of function from acoustic trauma may facilitate research and aid in the development of new treatment options for this condition.