Bilateral Panuveitis and Exudative Retinal Detachments Associated with Alpelisib.

We report a case of alpelisib-induced uveitis. A 68-year-old female who had recently been given alpelisib for metastatic breast cancer presented with a 2-week history of bilateral worsening vision with a corresponding acute hypermetropic shift. Her unaided visual acuity was 6/60 in both eyes, with bilateral anterior uveitis, non-granulomatous keratic precipitates, posterior synechiae, and limited fundal view. There was also a mild iris bombe configuration, although the intraocular pressures were normal. Ocular ultrasound revealed bilateral uveal effusion, ciliary body congestion, dense vitreous cells, and exudative retinal detachments. These findings were also confirmed on multimodal imaging with widefield fundus photography (Optos) and optical coherence tomography. Based on the clinical features above, a diagnosis of alpelisib-induced panuveitis was diagnosed. She was then admitted and treated with a 3-day course of intravenous methylprednisolone and intensive topical steroids. Her clinical signs and symptoms started to improve, and she was discharged 4 days later. At 1 week of follow-up, her best-corrected visual acuity was 6/12 in both eyes, with broken posterior synechiae and resolution of exudative retinal detachments. This case highlights the importance of early ophthalmology involvement by the oncology team as oncology therapy can have potential unexpected ocular manifestations.

The indications for and the diagnostic yield of imaging in neuro-ophthalmic and orbital disorders.

UNLABELLED: Correction: On 7th June, the first author's name was changed FROM Eli Ranjitkar Pradan TO Eli Pradhan Introduction: Neuro-imaging is an important method of investigation in neuro- ophthalmic and orbital conditions. These investigations are expensive and time consuming. This study describes the diagnostic yield of neuroimaging in patients referred from neuro-ophthalmic services. OBJECTIVE: To evaluate the diagnostic yield of neuroimaging in patients with neuro-ophthalmic and orbital disorders. MATERIALS AND METHODS: Retrospective review of records of 188 patients referred to radiology department for imaging by the neuro-ophthalmic servicesat University Hospital Coventry. MAIN OUTCOME MEASURES: Imaging findings were defined to be significant, if it led to changes in patient management, and as relevant, if the abnormal imaging finding related to the patient's neuro-ophthalmic complaint, examination finding or condition. The imaging findings were categorized into five groups based on significance and relevance as (a) significant and relevant, (b) significant and not relevant, (c) relevant and not significant, (d) not significant and not relevant, or (e) normal. The percentage of tests with a significant and relevant finding was defined as the diagnostic yield. The yield of the imaging test ordered was also analyzed based on neuro-ophthalmic examination findings and indication for imaging. RESULTS: One hundred and eighty eight neuro-imaging studies were analyzed. The majority of this referral was made for evaluation of the orbit (30%) and the anterior visual pathway (22%), followed by motility disorder (16%) and cerebro vascular accidents (11%). Hemifacial spasm, nystagmus and headache were less common indications for imaging referral. Sixty-one (32.4%) had significant and relevant findings to the patient's neuro- ophthalmic condition. In the majority (33/61, 54%), imaging was done to evaluate the orbit. CONCLUSION: Among the imaging referral from neuro-ophthalmic practice, request for evaluation of the orbit provides a higher diagnostic yield.

Floppy eyelid syndrome: the coventry experience.

PURPOSE: Floppy eyelid syndrome is a condition that is difficult to identify and diagnose and with no clear guidelines on its management. We propose a method of reliably grading this syndrome and have proposed a management algorithm based on the grading. MATERIALS AND METHODS: Retrospective data collection of patients diagnosed with Floppy eyelid syndrome and treated under the care of a single oculoplastic surgeon over a 9 year period. RESULTS: First, 102 patients were included and were classified into 3 groups. Grade 1 (F1) 7.5%, Grade 2 (F2) 36.5% and Grade 3 (F3) 56%. Only 12% of our cohort required surgery, and 92% of these patients demonstrated improvement in their symptoms. DISCUSSION: Clinical grading of Floppy eyelid syndrome patients will help determine patient's management plan. In our experience, operating on both upper and lower eyelids at the same time where indicated helps to maintain the normal anatomical relationship and improve epiphora.

Alfentanil sedation for oculoplastic surgery: the patient experience.

PURPOSE: A number of agents have previously been reported to be safe and effective for sedation and analgesia in ophthalmic surgery under local anaesthesia, but there has been no previous patient-focused assessment of this form of conscious sedation. We present a patient satisfaction survey, including a validated pain score, for patients undergoing oculoplastic procedures under local anaesthesia with alfentanil sedation. METHODS: A prospective, non-randomized, questionnaire-based study of the experience, satisfaction and pain scores of consecutive patients undergoing oculoplastic procedures under local anaesthesia with alfentanil sedation at University Hospital, Coventry, UK, under the care of one Consultant Oculoplastic Surgeon between 2006 and 2009. RESULTS: Three hundred and sixty-seven patients were surveyed over the 3-year period. Overall, 52% were female and 89% of Caucasian ethnic origin. Mean duration of surgical procedures was 34 minutes (range 2-120 minutes). Over 90% of patients described a low pain score, both during the local anaesthetic injection and per-operatively, and 98% stated that they were happy to have this sedation technique for further oculoplastic surgery in future. Side effects related to sedation were reported in 5% of patients. There were no conversions to general anaesthesia and no day-case patients required an overnight in-patient stay. CONCLUSION: Conscious sedation with alfentanil for oculoplastic procedures under local anaesthesia results in low pain scores and high patient satisfaction with minimal complications.

A new technique of alfentanil-induced conscious sedation for oculoplastic surgery.

This technique describes a new painless method of injecting local anaesthetic in a highly pain-sensitive area of the body-around the eyes. We describe how a new technique using a bolus of intravenous alfentanil can help alleviate patient discomfort during the injection of the local anaesthetic and also reduce the amount of local anaesthetic injected. This also helps oculoplastic surgeons to work in a relaxed environment, whilst still utilizing the efficiencies that are provided by an ambulatory day surgery unit.

One stage management of a giant kissing naevus.

We report a one stage management of a Giant Divided Naevus of the eyelids with excellent cosmetic results.

Complications of Cicatricial Ectropion Repair with Pre-Auricular Wolfe Graft.

An 85-year-old lady presented with a severe cicatricial ectropion several months after a fall. The abnormality was corrected with a procedure that involved the use of a retroauricular skin graft. This provided resolution of her ocular symptoms. Several months later, she had noted significant hair growth on the graft, but elected for this to be managed conservatively. Careful harvesting of the graft from the non-hairy area between the ear and the hairline is essential to prevent unwanted transplantation of terminal hairs. Surgical success is also dependent on the final aesthetic outcome.

Molluscum Contagiosum-Induced Periocular Toxic Dermatitis.

This report describes an unusual case of a 9-year-old boy with a 6-month history of right lower eyelid lesion and excoriation of the adjoining skin that had not responded to topical treatment. The umbilicated lesion was electively excised and the base of the lesion was cauterized under general anesthesia, which resulted in complete resolution of the periocular dermatitis without additional treatment. It is important to consider molluscum contagiosum in the differential diagnosis in patients with periocular dermatitis, especially in the presence of an umbilicated vesicle, although it is classically taught that these lesions present with toxic conjunctivitis.

Excision of Xanthelasmata - clamp, shave, and suture.

Xanthelasma is a common disfiguring condition, which can be difficult to treat. Various treatments have been reported previously with varying degree of success. We report a simple yet effective technique of excision of the lesions with excellent cosmetic outcome.

Eyelid basal cell carcinoma with osteosarcomatous changes.

An 80-year-old woman presented with a lump in her left lower eyelid. Histopathology of the lesion supported the diagnosis of basal cell carcinoma with osteosarcomatous changes. The lesion was fully excised and the eyelid was reconstructed with a Hughes flap. There was no recurrence after 10 months of follow-up.

An arteriovenous malformation masquerading as a carotid-cavernous sinus fistula.

PURPOSE: To describe a case of an occipital arteriovenous malformation (AVM) presenting with unilateral signs mimicking a carotid-cavernous sinus fistula (CCF). DESIGN: Interventional case report. METHODS: A 67-year-old normotensive male presented with loss of vision, pain, and proptosis of the right eye. Best-corrected visual acuity was right eye 6/36 and left eye 6/5. Examination of the right eye revealed orbital congestion with arteriolization of the episcleral vessels and an intra-ocular pressure of 44 mm Hg which was refractory to medical treatment. RESULTS: Computed tomography (CT) angiogram and cerebral angiography found an occipital AVM draining into the right sphenoparietal sinus and thereafter the right ophthalmic vein, bypassing the cavernous sinus. Embolization followed by excision of the AVM resulted in recovery of vision, reversal of proptosis, and normalization of intraocular pressure. CONCLUSIONS: Rapid diagnosis and immediate intervention resulted in a rewarding visual recovery despite a persisting left homonymous hemianopia.