Bilateral periorbital ecthyma gangrenosum

We describe a case of bilateral periorbital ecthyma gangrenosum in a diabetic patient with renal failure. Ecthyma gangrenosum is a cutaneous manifestation of Pseudomonas sepsis. We briefly review the pathogenesis of ecthyma gangrenosum and discuss previous reports of periocular involvement. In our patient, conservative measures and supportive care of the periorbital tissue resulted in a good outcome.

Intraorbital Heroin Injection Resulting in Orbital Cellulitis and Superior Ophthalmic Vein Thrombosis

A 47-year-old man with decreased vision, ophthalmoplegia, proptosis, and chemosis of his right eye admitted to injecting heroin directly into his orbit. He was placed on intravenous antibiotics for orbital cellulitis, and computed tomography and magnetic resonance imaging were performed. Superior ophthalmic vein thrombosis (SOVT) was noted on magnetic resonance imaging. The patient responded well to intravenous antibiotics, and his symptoms resolved with minimal deficits. Steroids and anticoagulants were not administered. We review the pathogenesis of septic SOVT and briefly discuss the role of anticoagulants and steroids in this setting.

Massive Subcutaneous Emphysema Mimicking Necrotizing Fasciitis After Dacryocystorhinostomy

We present a case of massive subcutaneous emphysema mimicking necrotizing fasciitis after uncomplicated dacryocystorhinostomy surgery. Subcutaneous emphysema progressing down fascial planes of the head and neck after dacryocystorhinostomy has not been reported in the literature. Using the clinical presentation and radiographic imaging, we briefly review the underlying cause of subcutaneous emphysema after dacryocystorhinostomy.

Jaw-winking ptosis in a patient with Kabuki syndrome

We present a case of a child with Kabuki syndrome and jaw-winking ptosis. Kabuki syndrome is rare and consists of a constellation of findings including mental retardation, characteristic oculofacial features, and skeletal abnormalities. The association of Kabuki syndrome and jaw-winking ptosis has not been previously reported.

Myoepithelioma metastatic to the orbit

PURPOSE

To report a case of myoepithelioma metastatic to the orbit in an 11-year-old boy.

METHODS

Interventional case report. An 11-year-old white male with a history of resection of a left thigh mass 10 months previously presented with a painless, rapid swelling of the left upper eyelid. Computed tomography scan and incisional biopsy of the orbital mass were performed.

RESULTS

Immunohistochemical stains of the tumor in the left orbit and the previously resected mass were consistent with myoepithelioma. As a result of widespread metastases, the patient died 4 months after initial presentation to the eye clinic.

CONCLUSION

Myoepithelioma should be included in the differential diagnosis of neoplasms that can metastasize to the orbit in the pediatric age group.

An anatomic and histologic study of the caruncle

PURPOSE

To describe the histologic features of the caruncle and to determine its anatomic relationship to the common canaliculus.

METHODS

Specimens from preserved and fresh-frozen cadavers were studied histopathologically.

RESULTS

The average distance between the external surface of the caruncle and the common canaliculus was 0.85 mm, whereas the shortest distance measured was 0.50 mm. Several histologic abnormalities (oncocytic change, apocrine metaplasia, and microscopic stones) were identified in specimens that appeared clinically normal.

CONCLUSION

Caution should be exercised when operations are performed on or near the caruncle to avoid inadvertent damage to the canalicular system.

Transcanalicular removal of silastic nasolacrimal tubes

Removal of nasolacrimal tubes is often an awkward procedure when performed transnasally, especially in children and apprehensive adults. We evaluated in a prospective fashion the transcanalicular route to retrieve nasolacrimal tubes. Overall, this technique was well tolerated by patients and easy to perform. Tube breakage during removal may be a complication.

A guinea-pig model of corneal jellyfish envenomations

Corneal jellyfish stings are painful, self-limited injuries which usually produce conjunctival hyperemia and chemosis, corneal edema, and mild iridocyclitis with resolution in 48 hr. We have developed a guinea-pig model of corneal jellyfish stings in order to study pathogenesis of human injury. Guinea-pig eyes were exposed to sea nettle (Chrysaora quinquecirrha) venom in vivo in the following ways: contact with live tentacles, intracameral injection of crude venom, and intracorneal injection of crude jellyfish venom. Slit lamp examination and histologic sections of the eye performed at intervals up to 8 days after exposure to the venom demonstrated conjunctival hyperemia and chemosis, corneal stromal inflammatory edema, anterior chamber inflammation, and opacities on the anterior capsule of the lens. Nematocysts adherent to the corneal epithelium were noted in eyes exposed to live tentacles.

Ocular jellyfish stings

BACKGROUND

Corneal stings from the sea nettle (Chrysaora quinquecirrha) indigenous to the Chesapeake Bay are usually painful but self-limited injuries, with resolution in 24 to 48 hours.

METHODS

Five patients who developed unusually severe and prolonged iritis and intraocular pressure elevation after receiving corneal sea nettle stings were followed for 2 to 4 years.

RESULTS

Decreased visual acuity, iritis, and increased intraocular pressure (32 to 48 mmHg) were noted in all cases. Iritis responded to topical corticosteroids and resolved within 8 weeks. Elevated intraocular pressure responded to topical beta blockers and oral carbonic anhydrase inhibitors. Mydriasis (4 of 5 cases), decreased accommodation (2 of 5 cases), peripheral anterior synechiae (2 of 5 cases), and iris transillumination defects (3 of 5 cases) also were noted. Mydriasis and decreased accommodation persisted for 5 months in 1 case and for more than 2 years in another. One patient has chronic unilateral glaucoma. Visual acuity returned to normal in all cases.

CONCLUSIONS

The precise relationship between sea nettle venom and the observed clinical responses is not known. Corneal jellyfish stings usually produce a brief and self-limited reaction, but they do have the potential for long-term sequelae.