A Case-Control Study to Determine the Microbiological Spectrum and Antibiotic Sensitivity Patterns in Congenital Nasolacrimal Duct Obstruction.

Purpose: To analyze the microbiological spectrum and antibiotic sensitivity patterns in children with congenital nasolacrimal duct obstruction (CNLDO). Methods: One hundred thirty-four eyes of 123 children in the age group of 0-16 years with a diagnosis of CNLDO who underwent lacrimal surgical procedures were included in this prospective comparative study. Sixty-two children in the age-matched group planned for intraocular surgery with patent nasolacrimal duct were deemed controls. The conjunctival swab after performing Regurgitation on Pressure over the Lacrimal Sac in the CNLDO group and the conjunctival swab in controls were sent for microbiological analysis. Antibiotic susceptibility testing was done for commonly employed antibiotics by the Kirby Bauer disk diffusion method. Results: Of 134 samples collected in the CNLDO group, 111 (82.8%) samples were culture positive. There were 165 bacteria isolated, among which 139 (84.24% of isolates) were Gram-positive bacteria, and 26 (15.75% of isolates) were Gram-negative. Fungal isolates were obtained in 2.23% of cases. The most common Gram-positive isolate was Staphylococcus epidermidis (S. epidermidis) (n = 51, 30.9% of total isolates), and the most common Gram-negative isolate was Haemophilus influenza species (n = 9, 5.5% of total isolates). Gram-positive isolates were sensitive mostly to gentamicin and vancomycin (95.5% each), and Gram-negative isolates to amikacin (92.3%). Both Gram-positive and Gram-negative isolates were susceptible to gatifloxacin (80% each). Probing outcomes were similar among Gram-positive (success, 84.6%) and Gram-negative (success, 84.0%) organisms. Conclusions: There was a predominance of Gram-positive isolates in children with CNLDO with S. epidermidis being the most common. The microbiological profile did not have any effect on the outcomes of probing.

Clinical Spectrum and Management Outcome of Ocular and Adnexal Rhinosporidiosis.

Purpose: To describe the clinical spectrum and management outcomes of ocular rhinosporidiosis. Methods: All histopathologically diagnosed cases of ocular rhinosporidiosis between January 2000 and December 2016 were included in the study. The lesions were classified based on the site of involvement, namely conjunctiva, lacrimal sac, eyelid, and orbit. The frequency and percentages for each of the lesions and the different treatment modalities were noted and calculated. Any recurrence and its subsequent management were also noted. Results: A total of 34 patients were included with a male-to-female ratio of 2.7:1. Conjunctiva was the most common site involved (19, 55.8%), followed by lacrimal sac (11, 32.3%) and eyelid (3, 8.82%). One patient had orbital involvement secondary to sinonasal extension. The mean duration of symptoms was 14.8 ± 19.1 months (range, 1-84 months). Seven (36.8%) patients in the conjunctival group needed scleral patch graft. Five patients (45.4%) with lacrimal sac rhinosporidiosis underwent dacryocystectomy and modified dacryocystorhinostomy (DCR). The mean follow-up period was 5.43 ± 7.9 months (range, 1-36 months). Five (14.7%) patients (2 conjunctival, 2 lacrimal, and 1 eyelid) had recurrence. Conclusions: Conjunctiva is the most common site for ocular rhinosporidiosis, followed by lacrimal sac. While conjunctival lesions respond well to complete excision with cauterization of the base, lacrimal sac lesions can be managed by a modified DCR. Eyelid rhinosporidiosis can mimic a neoplasm and should be considered in differential diagnosis in suspicious lesions, especially in endemic areas.

Giant molluscum contagiosum presenting as lid neoplasm in an immunocompetent child.

A three-year-old boy presented to our oculoplastic clinic with complaints of painless gradually increasing right upper lid mass for the last 6 months. On examination a firm mass measuring roughly 1x1 cm was present on the upper lid. The mass was non tender with fine superficial vessels running over it. A differential diagnosis of epidermoid cyst, vascular malformation, pilomatrixoma, and juvenile xanthogranuloma was considered. The patient underwent excisional biopsy of the mass. On gross examination the mass had a brain like appearance. Histopathological examination confirmed the diagnosis of molluscum contagiosum. It is rare for molluscum contagiosum to present as a solitary lid tumor. A brain like appearance of the excised mass can provide a clue towards the diagnosis.

Management Strategies in Rosai-Dorfman Disease: To Do or Not To Do.

Rosai-Dorfman disease or sinus histiocytosis with massive lymphadenopathy is an extremely rare non-Langerhans cell histiocytosis. Orbital involvement is even rarer and may be accompanied by lymph node involvement. Treatment options range from systemic steroids and immunosuppressants to radiation and debulking. We present a rare case of bilateral orbital sinus histiocytosis with massive lymphadenopathy with cervical and circumaortic lymphadenopathy.

Cholesterol granuloma: a case series & review of literature.

BACKGROUND: Cholesterol granuloma (CG) is a foreign body reaction to crystallized cholesterol. Orbitofrontal CG is a rare entity with few cases reported in literature. It is usually seen in young to middle-aged males with a history of trauma. Computed tomography features include hypodense lesion-causing bone erosion. CG has typical histopathological features with cholesterol clefts, multinucleated giant cells, histiocytes, foamy macrophages, and altered blood pigments. Management is by total excision of the lesion with curettage of the underlying bone to prevent recurrence. MATERIAL & METHOD: We present an interventional case series of five patients of orbitofrontal CG, two of them females. RESULT: None of the patients gave a history of trauma. Management was by excision of the lesion and curettage confirmed with a 30° rigid endoscope. CONCLUSION: Cholesterol granulomas can present as superior orbital mass lesions in the absence of trauma.