Solitary orbital plasmacytoma associated with chronic hepatitis C: a case report.

PURPOSE: To report a rare case of solitary orbital plasmacytoma associated with chronic hepatitis C. METHODS: We have reviewed the case of a man who presented with soft tissue mass in the superolateral orbit. Biopsy demonstrated immunohistochemical positivity of plasma cells for lambda light chains and CD56. Systemic evaluation was negative for multiple myeloma, and the diagnosis of solitary orbital plasmacytoma was made. RESULTS: We comment on the rarity of the case according to the reviewed literature. CONCLUSIONS: Given the correlation between hepatitis C and other lymphoproliferative disorders, we conclude hepatitis C may also be associated with solitary plasmacytomas.

Ptosis repair options and algorithm.

PURPOSE OF REVIEW: The treatment options for ptosis are strictly surgical. Each patient needs to be individually assessed and treated. A surgeon needs to be familiar with all types of surgical repair to choose the best possible option for his/her particular patient. RECENT FINDINGS: There are certain established surgeries in ptosis repair; however, there is no ideal surgical technique to treat every patient without any drawbacks. Several modifications of known techniques have been described to address the weaknesses of original applications. Also, new techniques such as orbicularis plication, levator readaptation, and new approaches in frontalis suspension surgery were presented. An algorithm showing the appropriate/most preferred ptosis surgery techniques is prepared based on the traditional knowledge and the latest publications. SUMMARY: There have been many modifications and new proposals in the management of ptosis. The surgeon needs to be familiar with an algorithm for the appropriate surgical method.

Intraoperative predictability of temporal artery biopsy results.

PURPOSE: To determine whether inflammatory/granulomatous changes of giant cell arteritis can be grossly identified by the surgeon during temporal artery biopsy to allow institution or discontinuation of steroid therapy without delay. METHODS: The records of 113 consecutive patients operated on by the same surgeon (R.C.K.) between November 2002 and June 2007 were reviewed. Demographic characteristics, date and site of the surgeries, surgical complications, surgeon's intraoperative presumption about the outcome (based on his assessment of the thickness, nodularity, tortuosity, and color/pallor of the arterial wall, blood flow, and the lumen size), and histopathologic biopsy results were collected from the chart review. The main outcome measure was the correspondence of the surgeon's intraoperative impression expressed in the operative note to the ultimate histopathologic diagnosis. RESULTS: After exclusion of 5 cases with incomplete data, the study consisted of 108 patients (78 females and 30 males) with an average age of 72.4 +/- 11.4 years (range, 45-93 years). There were no complications during or after surgery. The surgeon's comment was "grossly positive" in 17 cases, and 15 of these cases were pathologically positive. For all of the cases that the surgeon's impression was negative, the pathology was negative as well (100% negative predictive value). Overall, the surgeon's intraoperative comments had a 100% sensitivity to detect giant cell arteritis. The specificity and accuracy values were 97.9% and 98.2%, respectively. CONCLUSION: The surgeon's intraoperative evaluation of the temporal artery may be extremely valuable in predicting the biopsy result and may allow the surgeon to determine whether steroids could be discontinued in patients in whom the clinical history is not highly suggestive of giant cell arteritis.

A review of sclerosing idiopathic orbital inflammation.

PURPOSE OF REVIEW: Sclerosing idiopathic orbital inflammation is a rare, distinct subset of orbital inflammation. No consistent therapeutic regimen has been described and the majority of reports on this disease are case reports or small case series. This review looks at historical and current treatment modalities in an attempt to define the most current, effective management strategy for this disease. RECENT FINDINGS: Recently, the largest review to date of these patients was published, detailing clinical findings and responses to the various interventions. Two other case reports of patients who responded completely to therapy appeared in the literature. SUMMARY: Sclerosing idiopathic orbital inflammation is a rare disease with an unknown pathogenesis and poor prognosis. Current treatments are disappointing and often have little beneficial effect. There are anecdotal reports of success using combinations of immunosuppression, radiotherapy, and surgery, but a consistent, effective treatment course is lacking. Younger patients and those with a shorter duration of disease seem to have the best prognosis. Further research into the immunologic basis of the disease and a large, controlled study comparing the various sclerosing idiopathic orbital inflammation treatments are needed to determine the most effective treatment regimen.

What is new in the era of focal dystonia treatment? Botulinum injections and more.

PURPOSE OF REVIEW: The treatment options for the management of dystonias continue to evolve and improve. Clinical outcomes, however, are not predictably consistent using a single treatment regimen in all patients. RECENT FINDINGS: Botulinum toxin is still considered the best treatment option for the treatment of focal dystonias: blepharospasm, hemifacial spasm, and apraxia of eyelid opening. New findings indicate that physicians may be a little more aggressive with the dosage when the disease progresses. A new formulation of botulinum toxin has been produced that includes no proteins and may address the immunoresistance that can occur with prolonged use. Additional systemic medications may be helpful as adjuncts only in selected cases. Improved surgical techniques are now more successful and cause fewer complications. Therefore, many refractory cases are now offered a surgical approach alone or in combination with botulinum toxin. SUMMARY: There have been recent therapeutic developments in the treatment of ocular dystonias.

Sclerosing idiopathic orbital inflammation.

A 5-year-old girl referred for orbital cellulitis was found to have a right orbital mass. Computed tomography revealed a mass occupying the inferotemporal orbit, extending into the maxillary sinus. Biopsy yielded a diagnosis of sclerosing idiopathic orbital inflammation. She was successfully treated with prednisone.

Isolated medial orbital wall fractures with medial rectus muscle incarceration.

PURPOSE: To retrospectively review and analyze cases of isolated medial orbital wall fractures with medial rectus muscle incarceration presenting to a tertiary ophthalmic plastic surgery practice from 1997 to 2005. METHODS: Retrospective chart review and literature review. RESULTS: Nine cases of isolated medial wall fracture with medial rectus muscle incarceration are presented. The most frequently encountered clinical feature was adduction deficit on the affected side. Extraocular motility improved in all patients who underwent surgery, and mean postoperative enophthalmos was minimal. CONCLUSIONS: Isolated medial orbital wall fractures with medial rectus muscle incarceration are rare. Ocular motility abnormalities were the only indication of underlying fracture in the majority of our cases. Clinicians should be alerted to the anticipated presentation of medial wall fractures with incarceration of the medial rectus muscle, including the possibility of a "white eye" and normal abduction of the traumatized eye.

A case of primary adenocarcinoma of the lacrimal sac.

PURPOSE: To present a rare case of adenocarcinoma arising from the lacrimal sac. DESIGN: Interventional case report. METHODS: Report of a new case of primary lacrimal sac adenocarcinoma. RESULTS: The clinical presentation, workup, surgical treatment and pathology of a case of adenocarcinoma of the lacrimal sac are described. CONCLUSION: Although very rare, these tumors should be in the differential diagnosis of any lacrimal sac mass, especially those presenting above the medial canthal tendon. Other common features include expressible blood from the punctum, lack of pain, and a history of chronic epiphora or intermittent dacryocystitis. Local destruction and metastatic spread can be prevented by a high index of suspicion and early intervention.

Bowen disease of the eyelid successfully treated with imiquimod.

We present a case of Bowen disease affecting the eyelid that was successfully treated with imiquimod. The clinical presentation, histopathology, and treatment of this case are presented. The tumor was treated with imiquimod for 3 months, leading to complete resolution of the disease both clinically and histopathologically. There was no evidence of recurrence 5 months after treatment cessation. Imiquimod was safely used on the eyelid in this case and may avoid extensive periocular tumor excision and reconstruction in Bowen disease.

Primary Nocardia brasiliensis of the eyelid.

PURPOSE: To report a rare case of lymphocutaneous Nocardia brasiliensis originating in the eyelid. DESIGN: Observational case report. METHODS: The clinical presentation, workup, and treatment of a case of lymphocutaneous Nocardia brasiliensis originating in the eyelid are presented. RESULTS: The patient presented with a preseptal cellulitis from an abrasion of the eyelid that progressed to submandibular lymph node suppuration. Culture was performed, and a diagnosis of lymphocutaneous Nocardia brasiliensis was made. CONCLUSION: Nocardia brasiliensis may cause a lymphocutaneous infection of the face and must be considered in the differential diagnosis of preseptal cellulitis.

Malignant mesenchymoma of the orbit: case report and review of the literature.

OBJECTIVE: Malignant mesenchymoma are rare tumors of the orbit. From 1961 using English-language literature, we present the sixth such case and the first case with three malignant components. DESIGN: Interventional case report. METHODS: The clinical presentation, workup, surgical treatment, and pathology of a case of malignant mesenchymoma of the orbit are presented. RESULTS: Although very rare, these tumors should be in the differential diagnosis of any tumor of the orbit. The prognosis is unknown because of the lack of follow-up of reported patients. CONCLUSIONS: This malignant orbital mesenchymoma, an entity not accepted by all pathologists, was more complex than cases previously reported in the English literature in demonstrating rhabdomyosarcomatous, chondrosarcomatous, and osteogenic differentiation.