ABSTRACT
Orbital emphysema commonly resolves with no morbidity. However, sight-threatening complications, such as central retinal artery occlusion and ischemic optic neuropathy, may occur, which can result in poor visual outcomes. Plain skull X-ray, which is widely available, is a useful tool in identifying orbital emphysema. We report a case of a 29-year-old gentleman with underlying allergic rhinitis who presented with a painless, progressively increasing periorbital swelling of the right eye, which was aggravated by nose blowing. He had a history of blunt trauma one day prior to the presentation. Visual acuity was unaffected and optic nerve function tests were unremarkable. There was right upper lid swelling with crepitations, right hypoglobus with restricted upward gaze movement, and right conjunctival injection. Intraocular pressure was within normal limits. The posterior segment examination was unremarkable. A plain skull radiograph revealed a "black eyebrow sign" over the right orbit with no obvious orbital wall fracture. Computed tomography of the orbit showed focal indentation over the right lamina papyracea with superior orbito-palpebral emphysema. Systemic antibiotics, steroid nasal spray, and oral antihistamines were initiated with the prohibition of nose blowing. On post-trauma day five, he made an uneventful recovery. High clinical suspicion and thorough clinical examination with the aid of a plain skull radiograph can diagnose orbital emphysema in order for prompt referral to be undertaken to prevent morbidity. Clinicians should consider orbital emphysema as a differential diagnosis for periorbital swelling, especially if there was a preceding trauma.
ABSTRACT
A 31-year-old male with no known medical illness presented with painless left eye protrusion for the past 2 years. Radiographic features were of an extraconal superior orbital mass with no invasion of adjacent structures. The patient underwent an excisional biopsy of the left superior extraconal mass a week later. The histopathological examination revealed a well-circumscribed lobulated mass with chondroid and myxoid stroma enveloping benign bland-appearing epithelial and myoepithelial cells. These pathological features were consistent with benign chondroid syringoma of the orbit. The patient had an uneventful recovery with no active ocular complaint post-operatively.Despite chondroid syringoma of the orbit being a rare tumour, it should be considered in the differential diagnosis of periorbital masses. Excision of the tumour remains the treatment of choice with histopathological examination as the gold standard of diagnosis. Regular follow-up is warranted in view of possible local recurrence or metastasis.
Subject(s)
Adenoma, Pleomorphic/surgery , Orbital Neoplasms/surgery , Adenoma, Pleomorphic/pathology , Adult , Biopsy , Diagnosis, Differential , Humans , Male , Orbital Neoplasms/pathologyABSTRACT
AIM:To evaluate the epidemiological and etiological factors of microbial keratitis seen in tertiary hospitals in West and East Malaysia.METHODS:A total of 207 patients were enrolled.Patients referred for microbial keratitis to Sungai Buloh Hospital and Kuala Lumpur Hospital in West Malaysia and Queen Elizabeth Hospital and Kuching General Hospital in East Malaysia were recruited.Risk factors were documented.Corneal scrapings for microscopy and culture were performed.RESULTS:The most common risk factor in West Malaysia was organic trauma (28.5％) followed by non organic trauma (18.3％);27.7％ of trauma cases was work related with 34.2％ involving male foreign workers.The most common risk factor in East Malaysia was contact lens wear (32.9％).Pseudomonas aeruginosa was the most common organism isolated in both places.The most common fungal pathogen in West Malaysia was Fusarium spp representing 60％ of all positive fungal cultures.CONCLUSION:In West Malaysia organic trauma was the most common risk factor seen in public hospitals here whereas,contact lens wear was the most common risk factor in East Malaysia (P＜ 0.05).Fungal keratitis was more commonly seen in West Malaysia.
ABSTRACT
PURPOSE: To describe a rare clinical case of biopsy-proven metastatic mesothelioma of the lacrimal gland which responded well to chemo and radiation therapy. METHODS: Interventional case report. RESULTS: A 55-year-old woman with an untreated malignant biopsy-proven pleural mesothelioma presented with right proptosis, diplopia and hypoglobus. Magnetic resonance imaging showed an aggressive lacrimal gland tumour with bony erosion. A biopsy concluded a diagnosis of metastatic mesothelioma of the lacrimal gland. Her lacrimal and lung tumours showed a marked regression following palliative chemo (carboplatin) and radiation therapy. CONCLUSIONS: Malignant pleural mesothelioma may metastasize to the orbit, including the lacrimal gland. A combined chemo and radiation therapy may reduce the size of the metastatic and primary tumour.
