1
|
Levinkron O, Schwalb L, Shoufani A, Gutovitz J, Krausz J, Briscoe D. Comparison of the clinical characteristics of benign and malignant eyelid lesions: an analysis of 1423 eyelid lesions, compared between ophthalmology department and plastics department. Graefes Arch Clin Exp Ophthalmol 2024; 262:615-621. [PMID: 37782346 DOI: 10.1007/s00417-023-06244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/29/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE Oculoplastic surgeons excise and reconstruct eyelid tumors, although plastic surgeons have traditionally managed these cases. Current demand of this surgery is growing, and planning referral services is a health management necessity. This pilot study retrospectively reviewed same population eyelid specimens excised by both disciplines comparing data. METHODS Clinical and epidemiologic features of 1423 eyelid lesions biopsied between 2015- 2020 in Emek Medical Center (EMC), Israel were reviewed. RESULTS Among 1423 specimens, 1210 (85.0%) were benign and 213 (15.0%) were malignant/pre-malignant. Mean age at diagnosis was significantly higher in malignant tumors than in benign tumors (76 and 59 years respectively, p value < 0.001). The most common benign eyelid lesions were soft fibroma (20.1%), seborrheic keratosis (11.0%) and melanocytic nevus (10.3%). The most common malignant/pre-malignant eyelid tumors were basal cell carcinoma (BCC) (9.2%), actinic keratosis (2.6%) and Bowen's disease (1.9%). Ophthalmology removed 37 malignant/pre-malignant lesions (5.4%) out of 683 compared to plastics removing 142 malignant/pre-malignant lesions out of 740 (19.2%) specimens. Eyelid malignancy in the plastics department was significantly higher than in the ophthalmology department (p value < 0.001). 270 (70.0%) lesions caused by UV exposure were removed by plastics and 116 (30.0%) were removed by ophthalmology (p value < 0.001). CONCLUSIONS Eyelid lesions in patients aged 76 or older are more likely to be malignant. Ophthalmology eyelid specimens in younger patients are more commonly benign and related to inflammation. Specimens from the plastics department are more commonly malignant, related to UV-exposure, and are from older patients. This difference may be due to a misconception that plastic surgeons have more eyelid cancer reconstruction experience than oculoplastic surgeons, or less awareness of the oculoplastic expertise available today.
Collapse
Affiliation(s)
- Oz Levinkron
- Department of Ophthalmology, Emek Medical Center, 21 Yitzhak Rabin Boulevard, 1834111, Afula, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Liat Schwalb
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Aziz Shoufani
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
- Department of Plastic Surgery, Emek Medical Center, Afula, Israel
| | - Joel Gutovitz
- Department of Ophthalmology, Emek Medical Center, 21 Yitzhak Rabin Boulevard, 1834111, Afula, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Judit Krausz
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
- Department of Pathology, Emek Medical Center, Afula, Israel
| | - Daniel Briscoe
- Department of Ophthalmology, Emek Medical Center, 21 Yitzhak Rabin Boulevard, 1834111, Afula, Israel.
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
2
|
Mor-Shaham M, Gutovitz J, Levinkron O, Krausz J, Briscoe D. Molluscum contagiosum presenting as periorbital abscess in immunocompetent children. Sci Rep 2023; 13:18059. [PMID: 37872236 PMCID: PMC10593814 DOI: 10.1038/s41598-023-45320-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023] Open
Abstract
Molluscum contagiosum presenting as a periorbital region abscess is unusual. The virus generally causes a self-limiting localized disease in children. Presentation as an abscess has been reported mainly in immunocompromised patients. We performed a retrospective study of ten children treated for Molluscum contagiosum infection presenting as periorbital abscess. Data investigated included age, immunocompetence, systemic antibiotic treatment, clinical findings, and histopathology. All children were immunocompetent. Bacterial cultures taken in six of the ten children were positive in two. Seven patients received oral antibiotics before presentation but required IV antibiotics on admission. One patient received IV antibiotics only. All antibiotic treatment had very limited effect. Two patients had no antibiotic treatment. CT imaging in one case where orbital cellulitis was suspected showed no significant intraorbital findings with anterior involvement only. Nine out of ten children had surgery and intra-operative cryotherapy at our center with immediate improvement and recovery. One child whose parents initially refused surgical excision had initial limited clinical improvement of periorbital swelling with antibiotics. However, the lesions were excised shortly following discharge from our hospital at another medical center with a complete cure. Molluscum is a cause of periorbital abscess in immunocompetent children which should be part of the differential diagnosis in periorbital/adnexal infection. Antibiotic treatment has a limited effect, and the abscess is most likely a virally triggered reaction. Surgical excision and intra-operative cryotherapy are curative of the disease in our experience.
Collapse
Affiliation(s)
- Moran Mor-Shaham
- Department of Ophthalmology, Emek Medical Center, Afula, Israel
- Technion, Israel Institute of Technology, Haifa, Israel
| | - Joel Gutovitz
- Technion, Israel Institute of Technology, Haifa, Israel
| | - Oz Levinkron
- Department of Ophthalmology, Emek Medical Center, Afula, Israel
- Technion, Israel Institute of Technology, Haifa, Israel
| | - Judit Krausz
- Department of Pathology, Emek Medical Center, Afula, Israel
| | - Daniel Briscoe
- Department of Ophthalmology, Emek Medical Center, Afula, Israel.
- Technion, Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
3
|
Feldman I, Krausz J, Levinkron O, Gutovitz J, Edison N, Cohen E, Krauthammer M, Briscoe D. Is Demodex Blepharitis Connected With Cataract Surgery? Am J Ophthalmol 2023; 254:31-35. [PMID: 37257549 DOI: 10.1016/j.ajo.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/20/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE To determine whether there is an increased incidence of Demodex of the eyelashes among patients after cataract extraction surgery. DESIGN Prospective, noncomparative clinical study. METHODS A cohort of patients who underwent cataract extraction surgery had several eyelashes removed preoperatively that were examined independently by the hospital laboratory for the presence of the Demodex mite. This was repeated 3 weeks after surgery. During several postoperative weeks, patients received the standard treatment of steroid drops alone for a period as individually required. RESULTS A total of 62 patients were included in the study (31 men and 31 women), with a mean age of 71.04 years (range, 47-87). In the group positive for Demodex, the male-to-female ratio was 2:3 (P = .2772). Demodex colonization was observed in 22.58% of samples before cataract surgery and in 32.26% after cataract surgery and topical postoperative steroid therapy (P = .0143). CONCLUSIONS There is a statistically significant increase in Demodex colonization of eyelashes after cataract surgery and postoperative topical steroid treatment. Although Demodex colonization does not necessarily cause blepharitis, our findings of increased colonization should raise the possibility of Demodex blepharitis being considered by ophthalmologists in patients with chronic postoperative eye discomfort after cataract surgery. This study was carried out at the Emek Medical Center.
Collapse
Affiliation(s)
- Ilan Feldman
- From the Department of Ophthalmology, Emek Medical Center, Afula, Technion, Faculty of Medicine, Israel (I.F., O.L., J.G., D.B., N.E.)
| | - Judit Krausz
- The Tissue Diagnostics and Cancer Research Institute, Emek Medical Center, Afula, Technion Faculty of Medicine, Israel (J.K. N.E.)
| | - Oz Levinkron
- From the Department of Ophthalmology, Emek Medical Center, Afula, Technion, Faculty of Medicine, Israel (I.F., O.L., J.G., D.B., N.E.)
| | - Joel Gutovitz
- From the Department of Ophthalmology, Emek Medical Center, Afula, Technion, Faculty of Medicine, Israel (I.F., O.L., J.G., D.B., N.E.)
| | - Natalia Edison
- From the Department of Ophthalmology, Emek Medical Center, Afula, Technion, Faculty of Medicine, Israel (I.F., O.L., J.G., D.B., N.E.); The Tissue Diagnostics and Cancer Research Institute, Emek Medical Center, Afula, Technion Faculty of Medicine, Israel (J.K. N.E.)
| | - Eyal Cohen
- Division of Ophthalmology, Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (E.C., M.K.)
| | - Mark Krauthammer
- Division of Ophthalmology, Sourasky Medical Center affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (E.C., M.K.)
| | - Daniel Briscoe
- From the Department of Ophthalmology, Emek Medical Center, Afula, Technion, Faculty of Medicine, Israel (I.F., O.L., J.G., D.B., N.E.).
| |
Collapse
|