Medial canthus retiform hemangioendothelioma.

Retiform hemangioendothelioma (RH) is a distinct entity in the spectrum of vascular tumors with a high local recurrence rate. It is considered a low-grade, well-differentiated cutaneous angiosarcoma with low metastatic potential. We report here for the first time a case of medial canthus recurrent RH. It may be helpful in our practice to include RH as a differential diagnosis of eyelid lesions. It is noteworthy that the progressive course and recurrence tendency of RH might be misdiagnosed as angiosarcoma or basal cell carcinoma (BCC), if not expected and carefully evaluated by the pathologist.

Evaluation of treatment modalities and prognostic factors in children with congenital nasolacrimal duct obstruction.

PURPOSE: To evaluate the success rates of probing and silicone intubation and risk factors for failure of these procedures. METHODS: This retrospective cohort study included patients who were diagnosed with congenital nasolacrimal duct obstruction (NLDO) and underwent probing or intubation as the primary procedure. Demographic data, clinical features, intraoperative, and postoperative data were evaluated. The patients were divided into four subgroups based on age: 12-24 months, 25-36 months, 37-48 months, and >48 months. The procedure was considered successful when all preoperative signs disappeared with normal dye disappearance test and a positive Jones primary dye test. Statistical analysis was performed to determine the risk factors for failure, and P < 0.05 was statistically significant. RESULTS: The cohort comprised 350 subjects (162 males [46%]) who underwent a total of 454 nasolacrimal duct surgeries. The mean chronological age at time of surgery was 32.6 ± 22.1 months (range, 12-132 months). The overall success rate was 84.8%. Probing was performed 188 times, with a success rate of 80.3%; intubation was performed 266 times, with a success rate of 88%. CONCLUSIONS: Intubation was more successful than probing in patients with bilateral congenital nasolacrimal duct obstruction, Down syndrome, history of acute dacryocystitis, lack of preoperative massage, or intraoperative observation of either a "tight" obstruction or obstruction at sites other than at the level of Hasner's valve. Primary nasolacrimal duct intubation should be considered in these higher risk patients.

Management of unilateral versus bilateral lacrimal drainage system dysfunction in Down syndrome.

PURPOSE: To evaluate treatment outcomes of unilateral versus bilateral congenital nasolacrimal duct (NLD) obstruction in patients with Down syndrome and highlight the effect of associated features that could result in poor outcomes. METHODS: A total of 34 lacrimal drainage systems (LDSs) were treated in 22 patients with Down syndrome who had a mean age of 47 (± 41.8) months. Charts of patients with Down syndrome with congenital NLD obstruction who had been treated in a university hospital with irrigation, probing, and intubation between 1998 and 2008 were reviewed. Clinical features were correlated to the documented intraoperative observations and postoperative results. RESULTS: Patients with unilateral disease had a higher success rate (n = 10; 90%) than bilateral cases (n = 24; 45.8%) regardless of the procedure type. Most of the treated LDSs in patients older than 64 months were successful (n = 11 of 12; 91.7%). Single LDSs that underwent irrigation only (2.9%) failed, probing had 60% success (n = 10; 29.4%), and intubation had 60.9% success (n = 23; 67.7%). Four LDSs were treated successfully by Y-V plasty simultaneously with intubation. Lower-end NLD obstruction at the level of Hasner's valve showed a 100% success rate (n = 7) compared with multiple obstructions with a 41.7% success rate (n = 27). CONCLUSION: Unilateral disease and lower-end NLD obstruction are good prognostic factors. Careful punctal evaluation and management is advisable, and a possible delay of operative intervention in bilateral cases in patients 5 years and older aimed at improving hypotonia may be a wise decision.

Periocular hidradenoma papilliferum.

Hidradenoma is a benign adnexal neoplasm originating from the apocrine sweat gland, and is almost exclusively detectable in the skin of the anogenital area of middle-aged white females after puberty. Ectopic hidradenoma papilliferum, which involves the skin away from the anogenital region, is exceedingly rare, and can also affect males. We report a female patient with a lesion (dating back to childhood) close to the medial end of the left eyebrow and overriding the anterior medial part of superior orbital rim. The lesion was completely excised and had not reoccurred during over four years of follow-up.