Invasive Klebsiella syndrome with coexisting fungal endophthalmitis.

Endogenous endophthalmitis accounts for approximately 5 - 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled diabetes mellitus who presented with fever and generalised body weakness for one week. He was diagnosed with invasive Klebsiella syndrome based on blood culture with presence of bilateral pleural effusion, liver abscess, renal impairment and sphenoidal sinusitis. The patient developed sudden bilateral painless reduced vision on day two of admission. Ocular examination revealed bilateral severe anterior chamber reaction and severe vitritis that obscured the view of the fundus. Ocular B-scan ultrasonography showed multiple loculations in the posterior segment in both eyes. There was soft tissue density with calcification in the left sphenoid sinus on computed tomography of the orbit. He was treated for bilateral endogenous endophthalmitis with multiple intravitreal antibiotic injections, but showed no improvement. Functional endoscopic sinus surgery was performed and revealed that the left sphenoid sinus was filled with fungal balls. Following drainage of sphenoidal pus, there was resolution of vitritis and fundus examination showed features of underlying fungal infection with a "string of pearls" present along the vascular arcade of both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. In addition to repeated intravitreal antibiotic injections, he was also treated with systemic and topical antifungal therapy. At three months post treatment, the infection resolved and his vision improved from counting fingers to 6/36 bilaterally. Key messages: A middle-aged gentleman presented with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. A high index of suspicion is required for early diagnosis of fungal endophthalmitis.

Eyelid Juvenile Xanthogranuloma: A Case Report and Literature Review.

Juvenile xanthogranuloma (JXG) is an uncommon condition affecting the eye. We herein report a rare case of eyelid swelling in paediatric age group. A three-year-old Malay boy presented with chronic painless left upper eyelid mass which did not resolve with topical steroid. Clinically, the mass was a non-tender and firm nodular swelling which located at the lateral 1/3 of the left upper lid. Total excisional biopsy of the swelling was done and histopathological findings were consistent with JXG. The systemic associations and the treatment options for ocular JXG are discussed.

Phosphatidylcholine for the treatment of prominent lower eyelid fat pads: a pilot study.

PURPOSE: To find out whether the off-label use of Lipostabil is as effective as advertised for the nonsurgical treatment of bulging lower eyelid fat pads. METHODS: This is a pilot, randomized, placebo-controlled, double-blind, comparative, single-center study. Participants were 45 patients with full lower eyelids who were injected with 0.5 ml of Lipostabil in one eyelid and 0.5 ml of isotonic saline in the opposite lower eyelid as a control. Inclusion criteria were healthy adults older than 25 years. Exclusion criteria included patients with a known bleeding tendency or bleeding disorder and patients addicted to "antiwrinkle" products. The main outcome measures were reduction of lower eyelid fat pads and the occurrence of ocular or systemic side effects. RESULTS: The pre- and postinjection pictures of the 23 patients who completed the study were examined by 3 masked observers. They failed to differentiate the Lipostabil from the saline-injected eyelids or even the pretreatment from the posttreatment pictures in the majority of patients. CONCLUSIONS: Mesotherapy is hailed in the media as the most exceptional discovery since the introduction of botulinum toxin. Unfortunately, we failed to observe any improvement in appearance or reduction of fullness after multiple injections. Further studies are needed to determine whether Lipostabil is indeed ineffective for the management of eyelid fullness or the dose the authors used has to be increased.

Surgical management of acquired socket contracture.

PURPOSE OF REVIEW: In a cosmetically oriented world, the inability to retain an ocular prosthesis remains a psychologically devastating problem for patients. This study reviews the recent advances in the management of acquired socket contracture. RECENT FINDINGS: For mild contracture, several recent studies describe the beneficial use of amniotic membrane as a substrate graft to allow the conjunctival epithelium to migrate and multiply. To correct moderately severe socket contracture, quilting sutures are typically used to ensure survival of mucous membrane grafts, which are required to provide adequate lining to the socket. In cases of severe socket contraction, irradiated sockets, and recurrent socket contraction, radial-free forearm flaps or a variety of other flaps in association with bone expansion osteotomies are on the rise. SUMMARY: Techniques to treat contracted sockets continue to evolve; however, large multicenter trials as well as an updated classification scheme are needed to devise standardized treatment protocols.

Scar sarcoidosis developing 16 years after complete excision of an eyelid Basal carcinoma.

A 56-year-old patient developed sarcoidosis on top of an old eyelid scar from previous removal of an eyelid basal cell carcinoma 16 years prior to presentation. An irregular, firm, ill-defined subcutaneous mass was palpable beneath an old minimally visible scar from the previous surgery. The patient had a strong family history of sarcoidosis and persistent dyspnea and cough for the past two years, which were only elicited after the histopathology results came out with multiple non-caseating granulomas with multi-nucleated giant cells. Sarcoidosis should be considered in the differential diagnosis of recurrent eyelid skin cancers especially if the external appearance or the duration after the initial surgery does not fit the criteria for recurrence.