A caruncular dermoid with contiguous eyelid involvement: embryologic implications.

An 11-year-old girl with a mass arising from the caruncle and the upper eyelid was examined for spontaneous epibulbar bleeding. Excision of the lesion involved reconstruction of the proximal nasolacrimal system, lid margin, and conjunctiva. The histopathologic diagnosis was consistent with a dermoid of the caruncle. This case is notable not only for a dermoid accompanied by epibulbar bleeding but for its caruncular origin and attachment to the upper eyelid. This case suggests that the caruncle and the upper eyelid arise from similar embryologic structures.

Changes in refraction and keratometry after surgery for acquired ptosis.

A retrospective study involving 47 lids in 26 patients was conducted to determine changes in refraction and keratometry after surgery for acquired ptosis. Refractive and keratometric data were obtained prior to and 6 months after levator surgery. Data were analyzed for changes in refractive sphere, cylinder, and cylindrical axis, as well as keratometry, toricity, and axis of toricity. Although patients noted subjective change in vision postoperatively and demonstrated changes in their refractive error, the changes were statistically insignificant. Consistency was noted; the cylindrical axis and the axis of toricity remained relatively stable after surgery.

Venous engorged tissue flaps treated with medicinal leeches.

We evaluated the ability of leeches to improve the tolerance of pedicle flaps to periods of venous congestion. Axial pedicle flaps were created on 14 rabbit ears; the venous circulation of each flap was compromised with a suture ligature. Medicinal leeches were applied to seven flaps; the other seven flaps were untreated. Tissue viability was assessed by both clinical examination and fluorometric analysis of fluorescein dye delivery. Leech-treated flaps showed poorer reperfusion than untreated flaps. No statistically significant difference was found in comparing the two groups.

Anaplastic carcinoma of the lacrimal gland presenting with recurrent subconjunctival hemorrhages and displaying incipient sebaceous differentiation.

Primary adenocarcinomas of the lacrimal gland rarely display sebaceous differentiation. An anaplastic lacrimal gland neoplasm manifesting this feature was excised from a 64-year-old man who initially appeared with recurrent painless subconjunctival hemorrhages. Globe displacement and tumor-induced hyperopia were later findings. Electron microscopic studies performed on the widely excised tumor documented prominent lipid vacuoles, desmosomes, scattered cytoplasmic filaments, and linear segments of basement membrane material. The patient refused radical surgery and instead opted for 6,000 rads of adjuvant radiotherapy. Eleven months postoperatively liver and bone metastases developed, but he was free of local orbital recurrence. Twenty-two months postoperatively he died from complications of his metastatic disease. This most unusual lacrimal neoplasm is discussed in terms of its initial signs and symptoms and its histopathology. When the current case is analyzed in combination with three earlier reports, there is evidence that primary lacrimal gland sebaceous carcinoma is probably among the most malignant orbital tumors due to its uniform early fatality.

Papillary oncocytoma of the eyelid. A previously undescribed tumor of apocrine gland origin.

Oncocytomas are uncommon tumors arising within the ductular cell lining of glandular structures. The oncocytic cells are characteristically large and rich in eosinophilic cytoplasm. Electron microscopic studies show densely packed mitochondria with irregular, whorled, or fragmented cristae. Ocular adnexal oncocytomas have been reported to arise in the caruncle, lacrimal gland, and lacrimal sac. The authors recently encountered an oncocytic tumor occurring in a most unusual location, the skin of the medial lid margin and commissure. Microscopically, the lesion was papillary and cystic in architecture, and arose from an adjacent apocrine gland of the eyelid margin (gland of Moll). Electron microscopic studies showed that the tumor cells were packed with malformed mitochondria to the exclusion of other organelles. This is the first report documenting an oncocytic lesion arising in the skin from an adnexal gland.