ABSTRACT
Solitary plasmacytomas rarely develop in the skull, meninges, or brain. Ophthalmic signs as the initial manifestations of solitary intracranial plasmacytoma have rarely been described. We report the neuro-ophthalmologic, imaging, and pathologic findings for two patients. One patient presented with optic neuropathy, the second with bilateral sixth nerve palsies. Plasmacytoma is a treatable intracranial tumor that should be considered in the differential diagnosis of patients who present with optic neuropathy or sixth nerve palsy.
Subject(s)
Abducens Nerve Diseases/diagnosis , Brain Neoplasms/diagnosis , Optic Nerve Diseases/diagnosis , Plasmacytoma/diagnosis , Abducens Nerve Diseases/etiology , Brain Neoplasms/complications , Brain Neoplasms/pathology , Brain Neoplasms/radiotherapy , Combined Modality Therapy , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Optic Nerve Diseases/etiology , Plasmacytoma/complications , Plasmacytoma/pathology , Plasmacytoma/radiotherapy , Tomography, X-Ray ComputedABSTRACT
AIM: The purpose of this study was to investigate the hitherto undescribed effects of botulinum toxin A injected into the lacrimal gland in patients with functional epiphora. METHODS: A prospective non-comparative interventional case series study was designed to include patients with functional epiphora who presented to the Oculoplastic unit at the Wolverhampton and Midland Counties Eye Infirmary. Botulinum toxin A (2.5-5 units) was injected into the palpebral lobe of the lacrimal gland on the worst affected side via a transconjunctival approach under topical anaesthesia. Patients underwent a Schirmer test and provided a subjective evaluation of their epiphora symptoms, indoors and outdoors, at baseline and at 1, 4 and 13 weeks after injection. The mean score for symptoms indoors and outdoors was calculated. RESULTS: Fourteen patients agreed to take part in the study. Subjective epiphora scores improved in 8 out of the 11 patients (72.7%) who completed 13 weeks of follow-up. Schirmer test results showed objective reduction in tearing from baseline but did not strongly correlate with the subjective epiphora scores. Transient mild ptosis and diplopia were experienced by two patients. CONCLUSION: The results from this small pilot study are encouraging, although larger, controlled trials are needed to assess the optimal dose of BTX-A, its long-term efficacy and safety, and the role of multiple injections.
