Color Doppler imaging provides accurate assessment of orbital blood flow in occlusive carotid artery disease.

Color Doppler imaging was used to evaluate the hemodynamics of the ophthalmic vasculature in a case of complete internal carotid artery occlusion. This procedure, which allows rapid, noninvasive imaging, showed a partial ophthalmic artery obstruction with absent flow in the central retinal artery, central retinal vein, and nasal posterior ciliary arteries. Although altered perfusion of the retinal vessels may be evaluated clinically, assessment of blood flow in the ophthalmic and ciliary arteries previously could be evaluated only indirectly by intravenous fluorescein angiography. The color Doppler imaging findings were confirmed by intravenous fluorescein angiography and carotid arteriography. Color Doppler imaging represents a noninvasive method to diagnose abnormal blood flow of the ophthalmic artery and its branches and to evaluate serial changes of the circulation in a noninvasive manner.

Enlargement of circumscribed choroidal hemangiomas.

The authors describe five patients with circumscribed choroidal hemangiomas. Fundus photography, fluorescein angiography, and ultrasound examinations showed progressive enlargement of these hemangiomas. In all cases, the extent of lesion enlargement was slight: the mean change in tumor size was 1.6 mm x 1.5 mm in basal diameters by 0.9 mm in thickness during a median interval of 52 months (range 33 to 100 months) between initial tumor diagnosis and detection of lesion enlargement. This series of cases demonstrates that circumscribed choroidal hemangiomas can enlarge slightly during long intervals between observations.

Retinal hemangioma-like lesions in eyes with retinitis pigmentosa.

The authors report two patients with bilateral vascular masses of the peripheral retina associated with primary pigmentary dystrophy of the retina (retinitis pigmentosa). Although they are most similar to the retinal capillary hemangiomas of von Hippel, the affected patients had no clinical history or clinical findings suggestive of that syndrome. They differ from the calcified retinal hamartomas that have been associated with retinitis pigmentosa because they do not show the extensive telangiectasia and exudation seen with the exudative retinopathy that has been described with retinitis pigmentosa. They do not show the fluorescein angiographic pattern that characterizes peripheral choroidal neovascularization. Their main complication seems to be vitreous hemorrhage rather than exudative retinopathy. The authors discuss the possible relationship of these acquired retinal vascular masses to the retinitis pigmentosa.

Merkel cell tumor of the eyelid: a review and report of an unusual case.

We describe a case of a Merkel cell tumor of the eyelid that manifested as a recurrent chalazion. This tumor had the classic characteristics of a Merkel cell neoplasm by light microscopy. Electron microscopy showed dense-core neurosecretory granules and perinuclear microfilaments consistent with the diagnosis. Because a Merkel cell tumor may manifest as a chalazion, pathologic evaluation of all atypical chalazia is essential. Merkel cell tumors are malignant, and they must be treated aggressively to minimize recurrence or metastasis.