Immunoglobulin G4-positive lymphoplasmacytic infiltration in a sarcoidal eyelid mass.

A 62-year-old woman presented with a one month history of a hard, nonmobile subcutaneous mass along the right nasojugal fold. Hematological studies showed elevated serum immunoglobulin G4 levels. Histopathological examination of the biopsy sample disclosed immunoglobulin G4-positive lymphoplasmacytic infiltration with a storiform fibrosis, vein occlusion, and epithelioid granulomas with necrosis. Systemic review corresponded to a sarcoidosis. Without treatment, the eyelid mass did not recur six months after the excisional biopsy.

Migration of rigid gas permeable contact lens into the upper eyelid after trauma: a case report.

BACKGROUND: Migration of a rigid gas permeable (RGP) contact lens after trauma is rare, and its clinical characteristics have not been fully discussed. CASE PRESENTATION: A 36-year-old female showed mild swelling in the right upper eyelid. She lost her RGP contact lens seven months prior to her first visit, from trauma by her child's kick to the right eye. At the first examination, we felt a firm lump inferior to the right brow. Eversion of the upper eyelid also revealed a firm subconjunctival mass superior to the upper tarsus. After incising the conjunctiva, the RGP contact lens was found without a fibrous capsule and granulation tissue in the subconjunctival space. Three years after removal of the lens, the patient did not show any complications, including ptosis. CONCLUSION: The RGP contact lens in the present case migrated into the subconjunctival space superior to the upper tarsus without a fibrous capsule and granulation tissue. These findings are similar to those in previously reported traumatic cases but are different from those in some spontaneous migration cases. This difference may be caused by differences in the migration mechanisms.

Improved Vision from Severe Compressive Optic Neuropathy by Apical Cavernous Hemangioma.

A 59-year-old woman had a 1-year history of right vision loss. Her visual acuity was then 0.01 OD, and the critical flicker frequency (CFF) was 8 Hz OD. Goldmann perimetry examination showed inferior suppression of the right visual field center. Funduscopic examination revealed normal coloring of the right optic disc. Imaging studies showed an apical oval tumor. The optic nerve was compressed by both the tumor and the superior rectus muscle/levator palpebrae superioris complex. The tumor was dissected from the surrounding tissues and completely extracted. Histopathologic examination confirmed a cavernous hemangioma. The patient underwent three cycles of postoperative steroid pulse therapy. One year after the surgery, her visual acuity and CFF improved to 1.0 and 32 Hz OD, respectively. Her right visual field was within the normal range.

Involvement of inward upper eyelid push on the lower eyelid during eyelid closure in development of involutional lower eyelid entropion.

PURPOSE: To examine whether an inward upper eyelid push on the lower eyelid margin during eyelid closure is involved in involutional lower eyelid entropion. METHODS: This prospective observational study included 34 sides from 27 patients with involutional lower eyelid entropion. The positional relationship between the upper and the affected lower eyelid margins during eyelid closure were examined before and after posterior layer advancement of the lower eyelid retractors. In addition, we preoperatively examined whether the affected lower eyelid turned in during a voluntary maximum force eyelid closure from the normal position. We then held the upper eyelid away from the lower eyelid during a voluntary maximum force eyelid closure to eliminate the influence of an inward upper eyelid push on the lower eyelid margin. At the time, we investigated whether the affected lower eyelid turned in. All these examinations were performed from the normal lower eyelid position. RESULTS: Although the upper eyelid margin was on the lower eyelid margin before surgery, this was corrected after surgery in all patients. All affected lower eyelids turned in after voluntary maximum force eyelid closure. However, the lower eyelid margin did not show an inward rotation with holding of the upper eyelid away from the lower eyelid. CONCLUSIONS: These results indicate that an inward upper eyelid push on the lower eyelid is involved in development of an involutional lower eyelid entropion.

Myeloid Sarcoma in an Eyelid That Developed during Chemotherapy for Acute Myeloid Leukemia.

An 80-year-old female presented with a mass in the left upper eyelid margin that had developed during chemotherapy for acute myeloid leukemia. The mass was elastic, hard, and pinkish, with a relatively smooth surface but without madarosis. The histopathological findings corresponded to a myeloid sarcoma. No blast cells were shown in the peripheral blood at the time of biopsy, and she subsequently underwent an azacitidine injection regimen. The size of the eyelid tumor decreased 3 months after the biopsy, when the course of azacitidine injections was completed. However, acute myeloid leukemia recurred, and the patient died.

Lower incidence of chemosis with the Berke incision approach versus the swinging eyelid approach after deep lateral orbital wall decompression.

PURPOSE: To compare the incidence of chemosis following deep lateral orbital wall decompression using the Berke incision approach vs the swinging eyelid approach. METHODS: This study retrospectively reviewed 49 sides in 29 patients who underwent decompression via the Berke incision approach (Group A) and 122 sides in 71 patients who underwent decompression via the swinging eyelid approach (Group B). RESULTS: The incidence of chemosis was significantly lower in Group A (30.6%) compared with Group B (48.4%; p = 0.034). Although the period until subsidence of chemosis did not differ between the groups (p = 0.164), the ratio of sides that needed intensive postoperative care was lower in Group A than in Group B (p = 0.002). Chemosis tended to occur more frequently in sides with a history of steroid administration relative to those without previous steroid administration (Group A, p = 0.042; Group B, p = 0.059), although past radiation therapy and past combined radiation and steroid therapy did not influence the occurrence of chemosis (p > 0.050). Postoperative proptosis reduction was similar in both groups (p = 0.087). CONCLUSION: It was found that the Berke incision approach yielded a lower incidence of chemosis while achieving similar postoperative proptosis reduction in comparison with the swinging eyelid approach. These findings suggest that the Berke incision approach is an acceptable alternative procedure for deep lateral orbital wall decompression.

Two Types of the Sinus of Maier: An Anatomic Study.

PURPOSE: To show the morphological characteristics of two different types of the sinus of Maier, one with a lacrimal sac diverticulum supplied by separate canalicular openings, and the other with a terminal dilatation of the common lacrimal canaliculus. METHODS: Twelve coronal specimens (6 right and 6 left) from 6 Japanese cadavers (age range, 70-90 years at death) and 15 axial specimens of 11 Japanese cadavers (8 right, 7 left; age range, 45-89 years at death), fixed in 10% buffered formalin, were used. All specimens were stained with Masson's trichrome. RESULTS: The sinus of Maier, with a lacrimal sac diverticulum supplied by separate canalicular openings, was shown in one coronally sectioned group, with a diameter of 1.29 mm. The mucosa between both openings (0.282 mm length) comprised stratified squamous epithelia, which was characteristic of the lacrimal canaliculi. The diverticular mucosa was lined by a stratified columnar epithelium, which corresponded to the lacrimal sac. The sinus of Maier, with a terminal dilatation of the common lacrimal canaliculus and with a diameter of 0.51 mm, was demonstrated in one axially sectioned group. CONCLUSIONS: The morphological characteristics of two types of the sinus of Maier were described in this study. One type was the lacrimal sac diverticulum supplied by separate canalicular openings, and the other was the terminal dilatation of the common lacrimal canaliculus.

Axial Globe Length in Congenital Ptosis.

PURPOSE: To compare axial globe length between affected and unaffected sides in patients with unilateral congenital ptosis. METHODS: This prospective observational study included 37 patients (age range: 7 months to 58 years). The axial globe length, margin reflex distance-1 (MRD-1), and refractive power were measured. The axial globe length difference was calculated by subtracting the axial globe length on the unaffected side from that of the affected side. The relationships among axial globe length differences, MRD-1 on the affected sides, and patient ages were analyzed using multiple regression analysis. RESULTS: No significant differences were found in the axial globe length between sides (P = .677). The axial globe length difference was 0.17 ± 0.30 mm (mean ± standard deviation), and two patients (5.4%), aged 32 to 57 years, showed axial globe length more than 0.67 mm longer (corresponding to a refractive power of 2 diopters) on the affected side compared to the unaffected side. The multiple regression model between axial globe length difference, patient age, and MRD-1 on the affected sides was less appropriate (YAGL = 0.003XAGE-0.048XMRD-1 +0.112; r = 0.338; adjusted r2 = 0.062; P = .127). The cylindrical power was greater on the affected side (P = .046), although the spherical power was not different between sides (P = .657). CONCLUSIONS: No significant difference was identified in the axial globe length between sides, and only 5% of non-pediatric patients showed an axial globe length more than 0.67 mm longer on the affected side. Congenital ptosis may have little effect on axial globe length elongation, and the risk of axial myopia-induced anisometropic amblyopia may be low in patients with unilateral congenital ptosis.

Invasive Fungal Sinusitis Involving the Orbital Apex in a Patient with Chronic Renal Failure.

An 82-year-old man with chronic renal failure presented with invasive fungal sinusitis involving the right orbital apex. Intravenous liposomal amphotericin B was immediately administered with an intravenous sodium supplement. Subsequently, endoscopic sinus surgery was performed. Aspergillus fumigatus was detected in nasal discharge culture on day 12. Because the patient's renal function had deteriorated by this time, therapy was changed to nasal inhalation of amphotericin B, which was discontinued after 1 month, and oral administration of voriconazole, which was discontinued after 2 months. During 6-month follow-up, the patient did not show recurrence of sinusitis or further decrease in renal function.

Medial canthal support structures: the medial retinaculum: a review.

The medial canthus is supported by several structures with a complicated 3-dimensional arrangement in a narrow space. Although the medial canthal tendon occupies a major portion of the area, the medial canthal support structures include the following entities: Horner's muscle, the medial rectus capsulopalpebral fascia including the medial check ligament, the medial horn of the levator aponeurosis, the medial horn supporting ligament, the medial horn of the lower eyelid retractors, the preseptal part of the orbicularis oculi muscle, and 3 variations of the Lockwood's ligament. We named the composite of these structures the "medial retinaculum," which is similar to the "lateral retinaculum" of the lateral canthus. Profound comprehension and consideration of the medial retinaculum warrants safe and effective surgery in the medial canthal region.

No histological evidence of orbicularis oculi muscle hypertrophy in congenital epiblepharon.

BACKGROUND: To analyse the microscopic anatomy of the orbicularis oculi muscle in patients with congenital epiblepharon and to determine whether hypertrophy of the orbicularis oculi muscle, which is considered as a possible cause of this eyelid malposition, exists. METHODS: Sixty-seven eyelids with congenital epiblepharon of 41 Japanese patients, as well as 30 control eyelids of 24 Japanese patients with other eyelid pathologies (upper eyelid: fourteen blepharoptosis, one trichiasis and two retractions; lower eyelid: five involutional entropions, one trichiasis and seven retractions) were analysed. These controls contained no orbicularis pathology such as cicatrization or orbitopathy. The muscle specimens were obtained from the central part of the pretarsal orbicularis oculi muscle during surgery. The specimens were stained with haematoxylin & eosin. Only specimens with cross-sectional areas that included large muscle fibres were selected. In each section, 10 muscle fibres were measured across their smallest diameter, thereby avoiding inaccurate measurements of muscle kinking occurring during the processing or by any obliquity of the plane of section. Measurements of the muscle fibre diameter were made with a digital measure. RESULTS: There were no significant differences in the average diameter of the muscle fibres between the patients with congenital epiblepharon and the control group. CONCLUSIONS: There was no evidence of orbicularis oculi muscle hypertrophy in congenital epiblepharon.

Lateral canthal anatomy: a review.

The anatomy of the lateral canthus is analogous to that of the medial canthus, but with a less defined structure. Although the lateral canthal tendon occupies the major part of the lateral canthal anatomy, the lateral rectus capsulopalpebral fascia and other structures also play a significant role. Appropriate comprehension and consideration of the lateral canthal anatomy enable safe and effective performance in the lateral canthal surgeries. In this review, we present the lateral canthal anatomy along with updated topics. We discuss the lateral canthal tendon, lateral orbital thickening, lateral palpebral raphe, lateral canthal muscle, lateral rectus capsulopalpebral fascia, lateral check ligament, lateral retinaculum, and orbitomalar ligament.

Upper eyelid retraction disclosed after edrophonium chloride administration in a patient with Graves' orbitopathy and myasthenia gravis.

Patients with Graves' orbitopathy have a higher probability of myasthenia gravis than does the normal population. Overlapping clinical features cause diagnostic confusion in such a situation. We herein report a patient with Graves' orbitopathy and myasthenia gravis (GO-MG) with normal left eyelid height, but in whom upper eyelid retraction was shown after edrophonium chloride administration. Upper eyelid retraction in GO-MG is occasionally masked by a myasthenia effect. The upper eyelid height must be carefully monitored in patients with Graves' orbitopathy to detect the presence of concomitant myasthenia gravis.

Levator aponeurosis sandwich flap for reconstruction of upper eyelid defect.

A 72-year-old woman suffered from a sebaceous gland carcinoma on her left upper eyelid. The tumour was 13 × 5 mm without metastasis. The tumour was excised with a 5-mm safety margin, resulting in a large, full-thickness defect in which almost all of the tarsal plate, approximately half of the orbicularis oculi muscle, and part of the levator aponeurosis were lost. Reconstruction of the upper eyelid was successfully performed with a levator aponeurosis sandwich flap, upon which the posterior lamella was covered by a free tarsal graft with medial and lateral periosteal flaps, and a skin graft from the contralateral upper eyelid for the anterior lamella. No lagophthalmos was demonstrated after the operation. Six months postoperatively, there was no tumour recurrence, no ocular complications, and good cosmetic results.

Anatomical relationship of Horner's muscle origin and posterior lacrimal crest.

PURPOSE: This study was designed to examine the distance from the posterior lacrimal crest to the posterior margin of the Horner's muscle origin (the PLC-HMO distance), considering their complex anatomical relationship. METHODS: Eight macroscopic specimens from 8 Japanese cadavers and 7 microscopic specimens from 7 Japanese cadavers, fixed in 10% buffered formalin, were analyzed. Macroscopically, the PLC-HMO distance was measured at 2 mm superior to the most posterior point of the muscle origin (Group A), directly at the most posterior point (Group B) and 2 mm inferior to the most posterior point (Group C). Microscopically, the PLC-HMO distance was measured in axial sections at 1 mm above the upper eyelid margin (Group 1), 1 mm below the lower eyelid margin (Group 2), and 3 mm below the lower eyelid margin (Group 3). RESULTS: In the macroscopic study, the average PLC-HMO distance was 2.94, 2.57, and 2.05 mm for Groups A, B and C, respectively. The distance for Group C was significantly smaller than that of Group A (p = 0.006). In the microscopic study, the average PLC-HMO distance was 3.62, 3.74, and 3.14 mm for Groups 1, 2 and 3, respectively (no significant difference). CONCLUSIONS: The PLC-HMO distance was approximately 2-4 mm with some specimens showing a smaller distance inferiorly.