Warthin Tumor of the Caruncle: A Rare Case Report and Review of the Literature.

The authors describe a case of Warthin tumor arising in the caruncle of a 76-year-old man. Clinical examination identified a left medial canthus swelling that was treated by complete local excision. Pathologic examination revealed a benign epithelial tumor with diagnostic features of Warthin tumor. Clinical and histologic features, along with review of the literature, are discussed.

Retinal tear and raised intraocular pressure following unintentional intraocular botulinum toxin type A injection.

CASE REPORT: A 67-year-old woman with a 30-year history of dysthyroid orbitopathy and diplopia had an inadvertent injection of botulinum toxin type A into the vitreous cavity. Full pupil mydriasis and an intraocular pressure (IOP) of 50 mm Hg in the right eye were noted after the injection. An attack of acute angle closure was initially suspected despite a patent peripheral iridotomy (PI). The episode resolved with topical and intravenous IOP-lowering agents. Postoperative retinal examination revealed a retinal tear, which was successfully treated with laser photocoagulation. Visual acuity returned to baseline within 2 weeks, and the results of further retinal examinations remained stable. COMMENTS: This case supports the animal studies and human case reports that have demonstrated no retinal toxicity after intraocular injections of botulinum toxin type A. Temporary mydriasis and elevated IOP that may occur after injection do not appear to be detrimental and can be treated with topical and intravenous IOP-lowering agents. Transiently elevated IOP after injection is most likely due to volume increase, though acute angle closure with occlusion of the PI might be considered.

Modified technique and ptosis clamp for surgical correction of congenital pediatric ptosis by anterior levator resection.

Congenital ptosis is due to a dysgenesis of the levator complex with the levator muscle being replaced by fatty and fibrous tissue. This dysfunction of the levator muscle gives rise to the classic triad of findings in congenital ptosis, including ptosis in the primary position, lagophthalmos in downgaze, and a poorly formed eyelid crease. There are traditionally two ways to surgically correct congenital ptosis, levator resection and frontalis suspension (by utilizing a myriad of both autogenous and synthetic materials). Although frontalis suspension is the more utilized surgical option for the correction of congenital ptosis, the complication rate due to the use of synthetic materials is not insignificant. Many surgeons feel that the contour and appearance of the eyelid following levator resection is superior to the frontalis suspension technique. Thus, levator resection for congenital ptosis can be one of the most satisfactory and physiologically normal of the ptosis procedures. Surgery for congenital ptosis can however be unpredictable in outcome. We propose a modified technique for levator resection as well as a newly designed and modified Berke ptosis clamp for levator resection surgery. Postoperative results with the modified technique as well as clamp have been very encouraging with excellent postoperative lid contour and height. The author has utilized this clamp and modified technique in over 350 lid surgeries over the past ten years.

Restrictive strabismus following Jones tube insertion: a case series of 8 patients.

BACKGROUND: Restrictive strabismus and diplopia are an uncommon complication of conjunctivodacryocystorhinostomy, with insertion of the Lester-Jones tube. A literature review revealed only 4 published reports of this complication with a total of 4 patients affected. METHODS: We report on a series of 8 patients who presented with restrictive strabismus and diplopia following Jones tube insertion. RESULTS: Time to presentation was variable and was found to occur from several months to as long as 6 years after insertion. Treatment included topical steroid therapy initially. Surgery was done to release adhesions and scarring if topical treatment failed. Mitomycin C was used in 2 patients. Only 4 of the 8 patients had successful resolution of their diplopia with either therapy. INTERPRETATION: Diplopia following Jones tube insertion is an infrequent complication of surgery. Medical or surgical therapy can be help resolve symptoms but is often unsuccessful.

Periocular basal cell carcinoma arising in a site of previous trauma.

CASE REPORT: We report an incidence of basal cell carcinoma of the lower lid arising in an area of trauma 68 years after the initial injury. COMMENTS: Because patients may disregard the appearance of a wound in the setting of former trauma, medical practitioners need increased suspicion and surveillance of chronic nonhealing wounds.

Snip punctoplasty offers little additive benefit to lower eyelid tightening in the treatment of pure lacrimal pump failure.

Lacrimal pump failure refers to epiphora due to reduced tear outflow in the presence of a patent lacrimal drainage system and well-positioned puncta. This condition has been managed with dacryocystorhinostomy and lower eyelid tightening, which carry success rates of 50-94% and 84-91%, respectively. In this retrospective study, 23 eyes with symptomatic epiphora attributed to lacrimal pump failure underwent the lateral tarsal strip procedure and lower eyelid snip punctoplasty, and 20 eyes (87%) experienced complete or nearly complete resolution of tearing. This success rate is quite similar to that of prior studies of eyelid tightening alone for lacrimal pump failure, suggesting that the addition of the snip punctoplasty may not offer any additional benefit in patients with little or no punctal stenosis. All patients displayed some degree of lower eyelid laxity on lid distraction testing preoperatively, and those with only mild lid laxity responded at least as well as those with more severe laxity.

The incidence of fungal keratitis and endophthalmitis following penetrating keratoplasty.

PURPOSE: To determine the incidence of postkeratoplasty fungal endophthalmitis and keratitis at the New York Eye and Ear Infirmary. To determine whether there is a relationship between culture-positive corneoscleral donor material and postoperative infection. METHODS: The microbiologic records of corneoscleral donor rims submitted for culture following penetrating keratoplasty at the New York Eye and Ear Infirmary between January 1998 and January 2003 were reviewed. The incidence of rim cultures positive for fungi was tabulated. Clinical outcome measures were recorded for each patient receiving corneal donor tissue. RESULTS: Of 2466 donor corneoscleral rims cultured during the study period, 344 were positive for microbial growth (13%). Of those rims with positive cultures, 28 (8.6%) were positive for fungus. All fungi cultured were Candida species. Four of the 28 recipient eyes (14%) who received contaminated donor material went on to develop postkeratoplasty fungal infections. There were no cases of fungal infection in any postkeratoplasty patients in the absence of contaminated donor rims during the study period. Overall, there was a 0.16% incidence of fungal infection (4/2466) following penetrating keratoplasty. There were 18 positive donor rims identified in the first 4 years of the study, but there were 10 cases in the last 10 months of the study. CONCLUSIONS: The overall incidence of fungal infection following penetrating keratoplasty is low, but all cases in our study were associated with positive rim cultures. Whether prophylactic antifungal therapy would be of any benefit in the presence of a positive corneoscleral rim culture has not yet been determined.