Palpebral dacryoadenectomy for epiphora.

The efficacy of palpebral dacryoadenectomy (PDA) to relieve epiphora was studied in 37 patients. Symptomatic relief and postoperative Schirmer testing was used in the evaluation. The technique is described. All patients had patent lacrimal excretory systems: 62% of patients undergoing lacrimal lobectomy had complete relief of epiphora; 19% had some improvement, but incomplete relief; 76% had postoperative decrease in their Schirmer testing; and 14% had postoperative foreign body sensation and some degree of dry eye.

Lacrimal gland duct cysts.

Lacrimal gland duct cysts develop insidiously in the superotemporal cul de sac. They may be preceded by trauma, infection, or inflammation of the conjunctiva. They are often asymptomatic but may induce discomfort, a sensation of fullness, a visible mass, lid distortion or ectropion. Fluctuation in size with weeping or environmental stimuli is seen. Histopathology is variable. Six cases are described to demonstrate the features. Complete excision of each cyst by meticulous dissection through a conjunctival approach was performed. Total resection is the optimal technique to prevent recurrence.

Embolic retinopathy due to Corynebacterium minutissimum endocarditis.

Infective embolic retinopathy as a sequela of bacterial endocarditis is described in a 31-year-old woman with mitral valve prolapse. The infective organism, Corynebacterium minutissimum, has not been previously found to cause ocular or multisystem diseases. It is a common mucocutaneous inhabitant which causes erythrasma. In our case report both ocular involvement and septicaemia were present. The infection was confirmed by positive serial blood cultures. Mitral valve prolapse was confirmed by echocardiography. On clinical examination the retinopathy consisted of white intraretinal lesions which resolved with antibiotic therapy. By fluorescein angiography focal areas of hypofluorescence corresponding to the white fundus lesions were present. Optic disc oedema was also seen.

Double sphere orbital implantation in enucleation and evisceration.

A simple technique of orbital implantation of two hollow spheres at enucleation or evisceration is described. The procedure sufficiently replaces lost volume in the enucleated or eviscerated orbit, facilitates prosthesis motility, and diminishes simulated enophthalmos and superior sulcus depression. The risk of implant migration or extrusion is not increased.

Orbital abscess.

Although orbital or subperiosteal abscess may originate from a number of sources, paranasal ethmoidal sinus disease is the most common source of infection, particularly in children. Prompt diagnosis and treatment are necessary to prevent severe visual loss and even death. The authors review the five-group classification of orbital abscess and summarize data regarding source, bacteriology, treatment and visual results from 13 series reporting 148 patients. Four new cases are presented in detail. Diagnostic procedures, including laboratory testing, sinus radiography, ultrasound and CT scanning, are discussed and recommendations are given for medical and surgical management.

Mucoepidermoid carcinoma of the palpebral mucocutaneous junction. A clinical, light microscopic and electron microscopic study of an unusual tubular variant.

An 81-year-old man developed a left lower lid lesion. The lid margin was red, thickened, and indurated with foci of ulceration and telangiectasia on the palpebral conjunctiva. The initial clinical impression was either a chalazion or sebaceous carcinoma, and an incisional biopsy was performed. By light and electron microscopy, the tumor demonstrated infiltrating cords of cells with an admixture of epidermoid and mucus-secreting elements arranged in a distinctive elongated tubular fashion. The involved lid was resected and reconstructed by a Hughes' tarso-conjunctival graft with marsupialization of the canaliculus. No recurrence has been encountered after a year. Mucoepidermoid carcinoma of the conjunctiva is a rare, locally aggressive neoplasm characterized in all seven previously reported cases by recurrence within 6 months, and a high incidence of intraocular or orbital invasion.

Epibulbar subconjunctival fibroma. A tumor possibly arising from Tenon's capsule.

A fibroma, a benign neoplasm arising from the periorbita or tendon sheaths, is described in a 74-year-old woman as an indolent, lobular tumor situated in the episcleral and subconjunctival connective tissues with superior limbal fixation. Because most fibromas arise from tendon sheaths or fascial planes, we speculate that our lesion arose from Tenon's capsule. The rarity of periocular fibroma is documented by a review of the modern ophthalmic literature. Histopathologically, the tumor was composed of a paucicellular population of fibroblasts, sometimes displaying hyperchromatic nuclei and widely separated by abundant broad bundles of collagen. Mast cells were infrequently dispersed in the lesion. A wide local excision was performed, and no recurrence has developed during an 18-month follow-up period.

Carbon dioxide laser surgery in hemophilia.

We used a carbon dioxide laser to remove a subcutaneous lipoma from the brow of a patient with classical hemophilia A. This technique made the cosmetic procedure safe and effective in a patient for whom surgery would otherwise have held a greater risk.