Iris cyst simulating melanoma.

Congenital cysts of the iris stroma are extremely uncommon and only a few cases have been reported. The vast majority of reported cases have been found in infants or children as a unilateral, translucent mass in the middle or peripheral third of the iris. 1-3 Although these cysts may remain dormant for years, they have a tendency to enlarge, causing corneal decompensation, secondary glaucoma, and eye pain. 2 Occasionally, they have been mistaken for iris melanomas leading to enucleation. 4,5 We describe a 14-year-old girl with a congenital cyst of the iris stroma, which over a period of 8 years enlarged, became opaque resembling melanoma, and required surgical excision.

Case of complex craniofacial anomalies, bilateral nasal proboscides, palatal pituitary, upper limbs reduction, and amnion rupture sequence: disorganization phenotype?

We report a case of a dizygotic twin with complex abnormalities of head, body, and limbs. The anomalies include the following: lateral and midline cleft upper lip, ectopic palatal pituitary, natal teeth, bilateral nasal proboscides with an absent nose, left microphthalmia with conjunctival-lined cyst, right ocular dysgenesis, bilateral retinal dysplasia, platybasia with skull asymmetry, hydrocephalus secondary to aqueductal atresia, brain hemispheric asymmetry with a parietal-occipital cortical flap, agenesis of posterior corpus callosum, absence of the olfactory nerves and left anterior cerebral artery, leptomeningeal and intraventricular heterotopias, right radial longitudinal terminal meromelia with constriction rings of fingers, partial syndactyly of the third and fourth left fingers, dorsiflexed great toes and pes equinovarus bilaterally, and multiple skin tags with a sacral appendage. Additionally, this twin's placental disc and extraplacental membranes were devoid of amnion. We regard these anomalies as a possible expression of the human homologue of the disorganization phenotype or another gene mutation. Nevertheless, an abnormality of blastogenesis with early damage to organizing tissues of the frontonasal region and limbs, or a vascular disruption, cannot be excluded. Early amnion rupture sequence (possible extraamniotic pregnancy with amniotic bands, limb reduction defects with Streeter bands, and multiple skin tags tapering into amniotic bands) was also present in this case, and may have acted as a contributing factor.

Atypical presentation of a dacryolith.

PURPOSE: To describe the clinical features and management of a patient with an extralacrimal dacryolith. METHODS: Case report. RESULTS: A 43-year-old woman remarked at a routine eye examination that a small, firm mass located for several years on the right side of her nose had recently become slightly larger. The mass had remained firm and nontender during this enlargement. She explicitly denied having any past or current lacrimal outflow problems. Surgical excision disclosed a mass external to the lacrimal sac and duct, adherent to its lateral wall. The histopathologic features were consistent with a dacryolith surrounded by a chronic inflammatory reaction and no epithelial lining. CONCLUSION: We presume that the dacryolith must have formed within the lacrimal sac and then migrated laterally into the surrounding soft tissue.

Conjunctival epithelial cells can resurface denuded cornea, but do not transdifferentiate to express cornea-specific keratin 12 following removal of limbal epithelium in mouse.

Limbal stem cell deficiency contributes to recurrent corneal epithelial defects. We examined whether the conjunctival epithelium can transdifferentiate to corneal epithelium following surgically induced limbal stem cell deficiency. Mice were anesthetized by intraperitoneal injection of sodium pentobarbital. Partial or total epithelial removal was produced with a no. 69 Beaver blade under a dissecting microscope. The wounds were allowed to heal for 0-28 days, and the mice were examined every other day to evaluate re-epithelialization. Corneas were then subjected to histological, immunohistochemical studies and Western blot analysis with epitope-specific anti-keratin 12 antibodies. Partial epithelial defects re-epithelialized within 2 days and were normal in appearance and expressed cornea-specific keratin 12. In eyes with limbal deficiency, re-epithelialization progressed more slowly and was characterized by opacification; epithelial closure usually occurred by the 7th day. This epithelium differed from normal corneal epithelium in basic morphology, cell shape, and the presence of goblet cells at 2 weeks after injury. The epithelium at the center of injured corneas with total defect at 4 weeks had cornealike morphology and was devoid of goblet cells. These epithelial cells derived from conjunctiva did not express the cornea-specific keratin 12 as determined by immunohistochemistry, Western blot analysis and in situ hybridization. As evidenced by differences in morphology and the expression of cornea-specific keratin 12, conjunctival transdifferentiation does not occur in conjunctical overgrowth after the removal of limbal epithelium.

Periorbital dirofilariasis.

A differential diagnosis of inflammatory periocular soft tissue masses includes sarcoidosis, ruptured dermoid cyst, infectious abscess, metastatic neoplastic disease, and idiopathic pseudotumor. The authors present the case of a 42-year-old woman with a periocular inflammatory mass caused by dirofilaria of a nematode classification as Dirofilaria tenuis. The extraction of the worm was curative and the patient has been symptom-free for the ensuing 12 months. This zoonotic infection, spread by mosquito vectors from animal hosts to humans, is rarely encountered in the United States as a cause of periorbital inflammation. A history of migratory swelling and residence in, or travel to, endemic areas (the southeastern United States) should suggest the possibility of Dirofilaria infection.

Cell density dependency of vitreous fibrosis induced by monocytes and lymphocytes.

The possible roles of monocytes and lymphocytes in vitreous fibrosis were examined by injecting various numbers of the peripheral cell types into the rabbit vitreous. Our results indicated that the degree of vitreous fibrosis and the presence of traction retinal detachment corresponded to the number of cells injected. It was suggested that these findings are probably similar to vitreous membrane formation and retinal detachment in various clinical ocular diseases or inflammations in humans.

Ophthalmia nodosa caused by tarantula hairs.

A young woman presented with ocular discomfort after handling her pet tarantula. Multiple fine hairs were detected on the eyelids, in the palpebral and bulbar conjunctiva, and in the corneal epithelium and stroma. In addition, foreign body granulomas were found in the conjunctiva. Six months later, peripheral chorioretinal lesions were seen. The clinical and histologic findings in this case closely resemble the findings in ophthalmia nodosa caused by caterpillar hairs.

Change in vitreous collagen after penetrating injury.

Following controlled ocular penetrating injuries in rabbits, autologous blood was injected into the vitreous. All animals were examined with ultrasonography, ophthalmoscopy and photography. After 3 weeks the animals were sacrificed and serial histologic sections were made on the enucleated globes. Fibroblasts and collagen were found in the vitreous. In additional eyes, the altered vitreous was removed and examined by gel electrophoresis following limited pepsin digestion. Type I collagen was an important component of vitreous fibrosis. In contrast, only type II collagen was detected in normal vitreous. The collagen formation after hemorrhagic injury may follow a similar process of wound healing in other tissues.

Skin tumors and trephines.

Outmoded glaucoma and corneal trephines may be used to obtain incisional and excisional biopsies from eyelid lesions. The wounds created in doing the incisional biopsy are ignored and those created by doing excisions are closed by grafts using the same trephine.

Peripheral retinal neovascularization in sarcoidosis with thalassemia.

A black youth with peripheral retinal (sea fan) neovascularization had both sarcoidosis and alpha-thalassemia. The possibility that both of these disease entities were responsible for the observed pathology is explored. Most of the pathology present, the stasis, the hypoxia, and the vasoproliferation, is presumed to be due to the sarcoidosis. No definite relationship was established in this case for the alpha-thalassemia, a rare genetic abnormality of hemoglobin production.

Multiple myeloma. Orbital involvement in a youth.

Orbital involvement by multiple myeloma is rare and affects older individuals usually. The youngest reported patient in a recent series that cites a median age of 56 years is 30 years of age. The present case involves a 19-year-old pregnant black female subject who complained initially of diplopia and whose presenting sign was proptosis. An extensive medical work-up and electron microscopic study were necessary to establish the diagnosis.

Cystic retinoblastoma.

A grossly cystic retinoblastoma, presumably a form of the diffuse infiltrating type, mimicked uveitis in an 81/2-year-old boy. A review of 44 cases indicated that grossly (clinically) detectably cysts are rare in this neoplasm, although microcysts are relatively common. Lesions of this nature, especially if presenting with a history of trauma, as in our patient, may lead the ophthalmologist to diagnose uveitis. The diagnosis of retinoblastoma may thus be unduly delayed.