Case Report: An Eyelid Nodule Caused by Candidatus Dirofilaria hongkongensis Diagnosed by Mitochondrial 12S rRNA Sequence.

A 59-year-old female living in Rayong Province, eastern Thailand, presented with painless, right upper eyelid nodule for 3 months. Upon removal of the eyelid mass, a well-circumscribed, firm globular mass with diameter about 1 cm was found. Histopathological examination revealed an immature female dirofilarial worm reminiscent of Dirofilaria repens, characterized by prominent sharp longitudinal ridges at external surface of the cuticle. Analysis of the mitochondrial 12S rRNA sequence showed that the worm belongs to Candidatus Dirofilaria hongkongensis. It is likely that some infections previously reported as D. repens based on histological examination may have actually been due to Candidatus D. hongkongensis.

Factors Associated with Visual Outcome after Primary Repair of Open-Globe Injury by Ophthalmology Residents in Training in a Tertiary Eye Center.

PURPOSE: To assess factors associated with visual outcome after open-globe injury (OGI) repair by trainees. METHODS: In this observational study, charts of OGIs repaired by trainees at King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok were retrospectively reviewed. Preoperative, intraoperative, and postoperative outcomes (day 1, month 1, and month 6 postoperation) were analyzed. RESULTS: A total of 78 OGIs presented in a 10-year period. A biphasic pattern was found among the young and the elderly. Approximately 73.6% of the cases had had surgical repair outside office hours. A majority of cases had been caused by machinery and hammers, and had visual acuity (VA) <20/200. Three cases were reported as having been unsuccessful intraoperatively for globe repair. A fifth of the cases required evisceration/enucleation within 2 weeks of presentation. Presenting VA worse than hand motion was associated with the risk of evisceration/enucleation (OR 14.5, P=0.013). VA improved at 6 months postoperation to the range of counting fingers and 20/200 (OR 15.6, P<0.01). High ocular trauma scores (OTSs) was associated with lower risk of evisceration/enucleation, and 12% retinal detachment (RD) was discovered, of which 90% occurred within 1 month after OGI repair. CONCLUSION: Most OGIs were efficiently managed by the trainees, seldomly requiring assistance from subspecialists. Poor initial VA was associated with high risk of visual loss, whereas higher OTSs were inversely related to lower risk of evisceration or enucleation. There was a higher percentage of participants with final VA of 20/100-20/20 than the preoperative period. Precaution and careful evaluation of RD in the early postoperative period is recommended.

Conjunctival sporotrichosis from cat to human: Case report.

PURPOSE: To report a case of conjunctival plaque infected from Sporothrix schenckii, which was possible transmitted from a cat. OBSERVATIONS: A case of Thai woman presented with chronic painless ulcerated conjunctiva with white plaque. The lesion was not healed for one month after excision. She became concerned of getting infection from her cat because it developed chronic and multiple skin lesions on its legs. Identification of Sporothrix schenckii by PCR method was confirmed in the tissues from her conjunctiva and cat's skin. CONCLUSION AND IMPORTANCE: The diagnosis of Sporothrix infection should be suspected in atypical conjunctival lesion in patient who had closed contact with infected cat. This brought awareness to doctors and cat owners, even though it was uncommon.

Cytokeratin-Negative Undifferentiated (Lymphoepithelial) Carcinoma of the Lacrimal Sac.

Epstein-Barr virus-associated undifferentiated (lymphoepithelial) carcinoma is a malignancy that most commonly arises in the nasopharynx but can also occur in other locations including the lacrimal sac. Generally, this tumor strongly expresses cytokeratin, making the diagnosis straightforward. In the absence of confirmatory immunohistochemistry, the diagnosis can be problematic, particularly for tumors arising in unusual locations. Only 3 cases arising in the lacrimal sac in association with Epstein-Barr virus have been reported in the English literature, and all showed typical pathologic findings. The authors report a fourth case, unique in that it showed negative immunostaining for all cytokeratins tested. The clue to the nature of the tumor came from identification of Epstein-Barr virus by in-situ hybridization and demonstration of tonofilaments by electron microscopy. This case demonstrates that a multimodal approach may be needed in the diagnosis of Epstein-Barr virus-associated carcinoma, especially when occurring in uncommon locations.

Orbital myeloid sarcoma in adult mimicking nasolacrimal duct obstruction: A case report.

PURPOSE: To describe an orbital myeloid sarcoma in adult presenting with a swollen mass at inferomedial canthal area and epiphora which was misdiagnosed as nasolacrimal duct obstruction. OBSERVATIONS: A 45-year-old male presented with a swollen right lower eyelid around medial canthal area for 2 months with tearing for 6 month-period earlier. Eye examination demonstrated a high tear meniscus, slightly erythematous eyelid with palpable mass closed to the lacrimal sac along the inferior orbital rim. Computed tomography scan depicted infiltrative mass at the inferomedial aspect of right orbit with bony erosion, extended to adjacent paranasal sinuses. An incisional biopsy was performed. Histopathological study revealed soft tissue which was diffusely infiltrated by monotonous medium-sized round cells resembling blasts with lymphoglandular bodies, focally positive myeloperoxidase and negative lymphoid markers. The findings were consistent with myeloid sarcoma. No systemic involvement was found. The patient underwent chemotherapy and radiation without systemic leukemic disease progression. CONCLUSIONS AND IMPORTANCE: Although orbital myeloid sarcoma is rare and difficult to diagnose, it can mimic nasolacrimal duct obstruction. We should consider this condition in our differential diagnosis.

Case report of orbital cellulitis and necrotizing fasciitis from melioidosis.

A 48-year-old Thai male farmer presented with progressive swelling of the right eyelid and high-grade fever. His visual acuity declined and the right side of his forehead developed a necrotic skin lesion with a purulent discharge. CT of the orbits suggested orbital cellulitis with subperiosteal abscess. Intravenous ceftriaxone and clindamycin were given empirically but then switched to vancomycin and meropenem because of rapid deterioration together with clinical sepsis. Burkholderia pseudomallei was isolated from the blood 3 days after the treatment, and the antibiotics were then switched to intravenous ceftazidime. The liver enzymes were elevated, and imaging of the abdomen revealed liver and splenic abscesses. After 14 days, the patient showed marked clinical improvement, became afebrile, and regained his OD visual acuity. A repeat CT of the orbit showed improvement with no subperiosteal abscess. The antibiotic was then switched to oral trimethoprim/sulfamethoxazole in combination with doxycycline for 6 months.

Tarsal fracture operation in cicatricial entropion.

BACKGROUND: Cicatricial entropion is a common eyelid condition encountered by ophthalmologists. There is a variety of procedures to correct this condition, in which tarsal fracture procedure is one of them. However, recurrence has been a problem and success rate should be calculated. MATERIAL AND METHOD: This retrospective non-comparative interventional case series on patients with cicatricial entropion corrected by tarsal fracture technique was conducted at King Chulalongkorn Memorial Hospital between 2003 and 2007. The success rate was evaluated. RESULTS: Most patients were female (81%) with the mean age of 62.2 (SD 20.1) years old. The success rate of tarsal fracture was 74.2%. After the reoperations of the recurrent cases, the success rate reached up to 87.1%. CONCLUSION: Tarsal fracture is a simple, quickly-performed, and less time-consuming procedure. It should be considered as an initial operation for cicatricial entropion.

Efficacy of mitomycin C in endonasal endoscopic dacryocystorhinostomy.

OBJECTIVES/HYPOTHESIS: To evaluate the efficacy of intraoperative mitomycin C (MMC) in endonasal endoscopic dacryocystorhinostomy. STUDY DESIGN: Randomized controlled trial. METHODS: Fifty patients with primary acquired nasolacrimal duct obstruction were enrolled and randomly allocated into the treatment and control group. The patients underwent standard endonasal endoscopic dacryocystorhinostomy with mucosal flaps and mitomycin C or placebo on each group. The ostium size was measured at 3 months, 6 months, and 12 months to evaluate the effect of mitomycin C and placebo, and the patency of the lacrimal drainage system was assessed. RESULTS: There was no statistical significance in the success rate between the MMC group and the control group at 1-year follow-up (84.6% vs.79.2%, respectively, P = .59). At the 6-month and 12-month visits, the mean ostium size in the MMC group was 10.8 mm(2) (SD = 3.17) and 3.0 mm(2) (SD = 1.78), respectively, which were prominently larger than the control group at 7.1 mm(2) (SD = 2.62; P < .001, 95% CI, 0.84-5.45) and 1.6 mm(2) (SD = 1.18; P = .004, 95% CI, 0.49-2.38). CONCLUSIONS: There was no statistically significant difference in the success rates of both groups, but MMC seems to have a conspicuous effect on the healing process at the ostium.

Steatocystoma simplex of the eyelid.

A 47-year-old woman presented with a recurrent nodular lesion on the left upper eyelid that had been resected twice in the previous 5 years. Intraoperative findings showed a thin-walled cystic nodule containing a creamy substance. Histopathology identified steatocystoma; the diagnosis of steatocystoma simplex was further characterized by the absence of a family history and involvement of only one lesion. Steatocystoma is a cystic lesion that is often seen in dermatology practices but that has been reported rarely on the eyelid. Its clinical appearance is indistinguishable from other cystic lesions of the periorbital area and it should be considered in the differential diagnosis of eyelid lesions.

Orbital metastasis of hepatocellular carcinoma.

We report a 74-year-old woman who presented with an orbital apex syndrome and pulsatile proptosis. CT showed a right orbital mass that destroyed the orbital sphenoid bone and extended intracranially. Biopsy revealed metastatic hepatocellular carcinoma (HCC), and subsequent investigations demonstrated a high level of serum-fetoprotein and a huge liver mass. The patient died shortly after the biopsy. Rarely reported in the English literature, metastatic HCC is common in Asia, perhaps because of a racial predisposition together with a relatively high prevalence of alcoholic cirrhosis, chronic hepatitis B and C, and exposure to aflatoxins.

Multifocal squamous cell carcinoma of the conjunctiva with intraocular penetration in a patient with AIDS.

PURPOSE: To describe the clinical findings and to study the histopathology of conjunctival masses in a patient with HIV infection. METHODS: A case report. RESULTS: The histopathology from a 38-year-old Thai female patient who presented with visual loss on the left eye was studied. She had been diagnosed with AIDS 3 years before and was treated with highly active antiretroviral therapy and anti-tuberculous drugs for 1 year. The left eye was blind and showed 2 separate whitish masses on the bulbar conjunctiva in adjacent to the inferomedial limbus. Multiple nodules under the conjunctiva were seen inferiorly. Computerized tomography of the orbit revealed slight thickening of the left lower eyelid but could not show any globe involvement. The patient underwent orbital exenteration. Gross pathology showed multiple areas of the tumor. Histopathology revealed dysplastic squamous epithelium invading into the substantia propria of the conjunctiva with intraocular penetration. The anterior surface of the iris was filled with tumor cells containing keratin pearls. CONCLUSION: Squamous cell carcinoma can be multifocal and aggressive in HIV-infected patients. Rapid progression to intraocular penetration can be observed.

Disappearance of primitive basaloid cells after external irradiation in adenoid cystic carcinoma of the lacrimal gland.

OBJECTIVE: To study the histopathological findings of basaloid adenoid cystic carcinoma after high dose orbital irradiation. MATERIAL AND METHOD: The histopathology study was done in a 38-year-old Thai female patient who had basaloid adenoid cystic carcinoma of the right lacrimal gland confirmed by incisional biopsy. After a 60-Gy external irradiation, the mass decreased in size and finally could not be palpated, but subsequent orbital imaging still showed infiltrative soft tissue mass at the right lacrimal gland with bony defects at posterosuperior and lateral walls without extraorbital extension. Orbital exenteration and lateral orbitectomy was performed. The specimen was submitted for histopathological examination. RESULTS: Microscopic examination revealed periglandular infiltration with chronic inflammation of the palpebral lobe of lacrimal gland. The orbital lobe was extensively replaced with fibrous tissue. There was only a small area of cribiform pattern of the adenoid cystic carcinoma left; no basaloid pattern was seen in the tissue. CONCLUSION: The primitive cells (basaloid pattern) disappear after orbital irradiation for adenoid cystic carcinoma of the lacrimal gland. Replacement with fibrous tissue is seen.

Folliculectomy: management in segmental trichiasis and distichiasis.

OBJECTIVE: To propose a new surgical technique as an alternative method for the correction of segmental trichiasis and distichiasis. MATERIAL AND METHOD: An interventional case series reviewed the segmental trichiasis and distichiasis patients who were treated with folliculectomy in the Ophthalmology Department, King Chulalongkorn Memorial Hospital. The data was collected from January 1997 to December 2002. The history, clinical features and treatments were reviewed. Patients with the initial diagnosis of entropion were excluded. RESULTS: Nine segmental trichiasis and distichiasis patients (13 eyes) were reviewed. Eight eyes underwent folliculectomy and one had folliculectomy with anterior lamellar recession. The follow-up time was 1-24 months. Nine of thirteen eyes (69.2%) were successfully treated with folliculectomy or folliculectomy with anterior lamellar recession. Four eyes needed second operations due to the recurrence of the eyelashes. CONCLUSION: Folliculectomy revealed good results in trichiasis and distichiasis. It should be considered as an alternative technique because it is a simple and fast procedure.

An unusual complication from esthetic injection of liquid silicone into the forehead.

PURPOSE: To report a case of migration of liquid silicone into the upper eyelid. DESIGN: Interventional case report. METHODS: A 32-year-old woman had an injection of liquid silicone into the subcutaneous tissue of the forehead. She developed a cystic mass in the upper eyelid 2 days postinjection. An excisional biopsy was performed. RESULTS: The mass lay in the Müller's muscle, and its base adhered to the tarsus. The mass ruptured during dissection, revealing a yellowish turbid fluid. Histopathologic findings showed lipogranulomatous reaction. CONCLUSIONS: Liquid silicone injection to the forehead may promote formation of a cystic mass in the upper eyelid.