Intrapalpebral migration of a rigid gas-permeable contact lens resulting in an eyelid mass.

PURPOSE: To report a case of an eyelid mass that was found to be a rigid gas-permeable contact lens that had migrated into the intrapalpebral tissue and to provide a brief review of the literature on intrapalpebral migration of contact lenses. DESIGN: Interventional case report and review of the literature. METHODS: The case is described, and the literature is reviewed. MAIN OUTCOME MEASURES: Clinical presentations and mechanisms of intrapalpebral contact lens migration are discussed. RESULTS: A patient had a mass on the left upper lid 3 years after she stopped wearing gas-permeable contact lenses. Orbital magnetic resonance imaging (MRI) showed a curvilinear signal in the area of the mass. Surgical exploration revealed a rigid gas-permeable contact lens entrapped within a fibrous capsule located within the eyelid tissue. A review of the literature revealed several reports of intrapalpebral migration of hard contact lenses, but to our knowledge, this is the first such migrated lens to be imaged on MRI. CONCLUSIONS: Intrapalpebral contact lens should be in the differential diagnosis of upper eyelid mass in patients with a history of contact lens wear. Magnetic resonance imaging may be a useful modality for imaging these rigid gas-permeable lenses.

Epibulbar osseous choristoma: case report and review of the literature.

Epibulbar osseous choristoma is a choristomatous lesion of the conjunctiva containing bone. Originally called epibulbar osteoma, this lesion was first described by von Graefe in 1863. We discuss a case of a 4-year-old patient who presented with an epibulbar lesion consistent histopathologically with an epibulbar osseous choristoma, and report a review of the literature. The differential diagnosis of osseous choristoma should include classical limbal dermoids, epithelial inclusion cysts, prolapsed orbital fat, papillomas, dermolipomas, and complex choristomas. Although the rarest of epibulbar choristomas, 51 epibulbar osteomas have now been reported in the medical literature. Most commonly, this variety of choristoma presents as an isolated epibulbar lesion within the supratemporal quadrant but may occur in other locations on the surface of the globe and possibly in conjunction with other choristomatous tissue as much as 10% of the time. Frequently, they may involve the muscle or have dense attachments to the underlying sclera. Osseous choristomas most likely represent congenital lesions with a potential for slow growth but may occur in association with trauma. Options for management include observation or surgical excision. When surgery is contemplated, preoperative radiographic imaging may be helpful for assessing adhesion to the sclera or extraocular muscles.

A comparison of rates of fibrovascular ingrowth in wrapped versus unwrapped hydroxyapatite spheres in a rabbit model.

PURPOSE: To compare the rate of fibrovascularization of wrapped versus unwrapped hydroxyapatite (HA) spheres in an animal model and to investigate how drilling small-diameter access holes at the time of implantation affects the rate of fibrovascular ingrowth in wrapped implants. METHODS: The right eyes of 20 New Zealand White rabbits were removed and a 12-mm HA sphere was implanted in each socket. The spheres were left bare in 8 of the animals. In the other 12, the implant was wrapped in an autologous sclera shell. In 4 animals from each group, a 1-mm diameter access hole was drilled into the spherical center of the implant at the sites of extraocular muscle insertion and at the posterior pole before implantation. All implants were explanted after 1 week. RESULTS: The mean depth of fibrovascularization in the bare group without access holes (n = 4) was 100% (SD = 0). The mean depth of fibrovascularization in the wrapped group without access holes (n = 8) was 30.1% (SD = 11.0). The difference between these two groups was statistically significant (P<0.001). The mean depth of fibrovascularization in the wrapped group with access holes (n = 4) was 91.5% (SD = 9.8). Compared with the wrapped group without access holes, the difference was statistically significant (P<0.001). The difference in the mean depth of fibrovascularization between the bare group without access holes and the wrapped group with access holes failed to reach statistical significance (P = 0.18). CONCLUSIONS: On the basis of this preliminary study, we conclude that whereas scleral wrapping does significantly slow the rate of fibrovascular ingrowth, the concomitant placement of access holes greatly improves the rate of fibrovascularization.