Case series of shrinking hydroxyapatite orbital implants.

BACKGROUND: An orbital implant is used after enucleation or evisceration surgery to replace the volume lost and to aid in prosthesis fitting and movement. Different materials have been used through the years. The authors noted that with bone-derived hydroxyapatite orbital implants, some patients lose their orbital volume. METHODS: The operating theatre record was searched to find patients who had their hydroxyapatite orbital implant removed at Dunedin Hospital, New Zealand, between 2011 and 2015. The original implant size and size at removal were noted. Histological results were noted. Medical notes were reviewed. RESULTS: A total of six patients had hydroxyapatite orbital implants removed during this time. Four patients had implants that were smaller than their original sizes. All specimens had fibrovascular infiltration noted, three had chronic inflammatory cells and one had osteoclastic activity. CONCLUSIONS: Bone-derived hydroxyapatite orbital implants can reduce in size, and this may occur due to osteoclastic activity. The surgeon must consider this scenario when choosing the type of implant to be used after enucleation or evisceration.

SLE dacryoadenitis.

In systemic lupus erythematosus, ophthalmic manifestations are noted in up to one-third of patients. We describe a patient with an unusual initial presentation of this disorder.

Snorkeling and Jones tubes.

We report a case of tympanic membrane rupture during snorkeling in a 17-year-old young man who had previously undergone bilateral Jones tubes placed for epiphora. To our knowledge, this phenomenon has not been previously reported.

Photographic essay: healing by secondary intention in oculoplastics.

This short report is written to demonstrate the usefulness of healing by secondary intention in oculoplastics. It shows photo strips of our patient outcomes, reflecting the excellent healing capacity of the face. The main point is to challenge misconceptions that healing by secondary intention is prone to infection and scarring, but instead, to show it is a safe and practical approach to our patients.

Primitive neuroectodermal tumor of the orbit in adults: a case series.

PURPOSE: To present the clinical, radiologic, and histopathologic features of orbital primitive neuroectodermal tumor (PNET) in 5 adult patients. METHODS: Retrospective case series of 5 adult patients with orbital PNET. Orbitotomy was performed in all cases. The authors report clinical findings, radiologic features, histopathology, immunohistochemical analysis, management, and outcomes for 5 patients with orbital PNET. RESULTS: Five adult patients presented with progressive unilateral proptosis and visual impairment. Common radiographic findings included a heterogeneous mass without associated destructive features, located in the superior and/or lateral orbit. Four cases demonstrated strong immunohistochemical staining for CD99 in a membranous pattern. One case required chromosomal analysis with fluorescence in situ hybridization to confirm the diagnosis. All patients received chemotherapy and/or orbital radiation with resolution of proptosis but no improvement of vision. One patient died of disease. CONCLUSIONS: To the authors' knowledge, this is the largest series of orbital PNET in adults. This tumor has an age demographic wider than previously believed and should be considered in the differential diagnosis of a hypercellular small round cell orbital tumor in both children and adults. Current treatment regimens are not standardized but typically use a similar approach to the treatment of Ewing sarcoma. Orbital PNET appears to have less propensity for metastasis compared with PNET in other locations. However, long-term aggressiveness remains to be proven.

The levator aponeurosis exposed.

A case of bilateral upper eyelid ptosis in an HIV-infected patient with severe antiretroviral-associated facial lipodystrophy is presented. The features, treatment, and outcome are discussed. Dehiscence of the levator aponeurosis may be directly associated with highly active antiretroviral therapy-induced lipodystrophy.

Absent upper eyelid skin crease: a sign of hypoglobus.

The association of an absent upper eyelid skin crease on downgaze with hypoglobus has not been described in the literature before. Herein a case of silent sinus syndrome that demonstrates this sign is described. The possible mechanism of such a sign is discussed.

Mycobacterium of an unknown strain causing a primary tumoral process of the orbital roof.

PURPOSE. To report an unidentified species of atypical Mycobacterium as the causative agent of a primary orbital roof infection. METHOD. Review of a case from the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. RESULTS. The patient had a negative history for eye trauma. Computed tomography (CT) of the brain and right orbit confirmed the presence of soft tissue swelling and erosive changes in the orbital roof bone, with intact globe and external ocular muscles. Biopsy of the lesion showed non-caseating, granulomatous osteomyelitis. Various stains of the sample were negative. Since our institution could not identify the causative organism, a biopsy sample was sent to Bioscientia Laboratory in Germany; the culture grew an atypical Mycobacterium of unknown species. Their sensitivity study showed the organism to be resistant to pyrazinamide, isoniazide and streptomycin, but sensitive to rifampicin, ethambutol, and prothionamide. Systemic checkup and investigation ruled out any other systemic involvement. CONCLUSION. A new species of atypical Mycobacterium was recovered from a primary orbital infection. The infection responded to combined antituberculous therapy.