Successful treatment of infantile haemangiomas of the orbit with propranolol.

BACKGROUND: Propranolol is a novel therapeutic agent in the treatment of cutaneous infantile haemangiomas. We assessed the effect of propranolol therapy in infantile haemangiomas of the orbit. METHODS: A case series of four patients with orbital infantile haemangiomas were referred for management in our tertiary referral hospitals. Two of the patients had inadequate responses to prior corticosteroid therapy. One of the patients was commenced on propranolol at 2.5 years of age when the lesion was not in the proliferative phase. This represented the first case report of propranolol treatment for infantile haemangioma outside infancy. The other three children were in their infancy when propranolol was commenced. The patients were treated with oral propranolol. RESULTS: All patients had significant improvement in their physical appearance, ocular examination findings and size of their lesions on radiological evaluation. No side-effects of propranolol treatment were observed. CONCLUSIONS: Propranolol is a promising treatment against infantile haemangiomas in the orbit, not only in infants but also in an older child with a stable lesion.

Selective embolization and resection of a large noninvoluting congenital hemangioma of the lower eyelid.

PURPOSE: To present a combined interventional radiologic and resection technique for the management of a large amblyogenic, highly vascular lesion of the lower eyelid associated with severe mechanical ectropion, conjunctival pyogenic granuloma, and recurrent, spontaneous conjunctival bleeding. METHODS: Preoperative selective embolization and coil placement were followed by resection of the tumor. RESULTS: Embolization, coil placement, and resection were uneventful with cosmetic and functional visual improvement obtained. Pathology indicated a noninvoluting congenital hemangioma. CONCLUSIONS: To the authors' knowledge, this is the first surgical technique reported in the ophthalmic literature for the selective embolization of a noninvoluting congenital hemangioma prior to its resection. Such a technique should be considered in the management of large lesions of this type.

Epiphora in the presence of a simulated mucocele secondary to nasal polyposis in a patient with samter triad.

A 69-year-old man was referred with epiphora and soft-tissue swelling in the left nasolacrimal sac region. Ipsilateral Jones 1 and 2 tests were negative. On attempting sac "wash out" via the left lower canaliculus, there was fluid reflux from the left upper canaliculus. CT revealed bony erosion of the lacrimal and frontal process of the maxillary bone by nasal polyposis. T2-weighted axial MRI demonstrated severe bilateral intranasal polyposis with those on the left pushing the lacrimal sac laterally and simulating a mucocele. Transnasal polypectomy re-established physiologic tear drainage and relieved the swelling in the region of the lacrimal fossa. This case emphasises the importance of routine nasal endoscopy as part of the assessment of the lacrimal system.

Scleral MIRAgel causing bony orbital erosion.

The authors report a case of hydrogel scleral explant (MIRAgel) causing an incomitant strabismus, diplopia, enophthalmos and a dehiscence in the roof of the orbit secondary to pressure-related atrophy due to swelling of the explant occurring 10 years after its placement.

Intraorbital glass foreign body missed on CT imaging.

A 36-year-old woman presented with a 7-week history of foreign body sensation in the superior right orbit after orbital trauma sustained during an accidental face-down fall onto a broken drinking glass. CT identified a 10.35 x 3.91-mm radiopaque foreign body in the right orbit superolateral to the globe. Orbital exploration superficial to the levator palpebrae superioris aponeurosis in close proximity to the site occupied by the CT-identified foreign body revealed an additional glass intraorbital foreign body, 4.0 x 2.5 x 0.25 mm in dimension. The second glass foreign body was entirely missed on the preoperative, 1-mm axial scans combined with sagittal and coronal reconstructed images and plain radiography.

Cavernous haemangioma in the orbital apex: stereotactic-guided transcranial cryoextraction.

A 55-year-old Caucasian woman presented with an orbital cavernous haemangioma superior to the optic nerve in the orbital apex. Preoperative imaging demonstrated a mass involving the superomedial and superolateral quadrants of the posterior orbit. A stereotactic fronto-orbital approach was performed by the neurosurgical team, and cryoextraction of the lesion was accomplished by the ocular plastic surgical team.