A 70-year-old man presented with diplopia, floaters, and restrictive ocular motility 5 months after orbital floor reconstruction using a titanium mesh implant for fibrous dysplasia. Orbital imaging revealed posterosuperi...A 70-year-old man presented with diplopia, floaters, and restrictive ocular motility 5 months after orbital floor reconstruction using a titanium mesh implant for fibrous dysplasia. Orbital imaging revealed posterosuperior migration of the implant, with impingement on the globe and suspected full-thickness scleral penetration. Intraoperative findings confirmed mesh erosion through the inferonasal sclera. The implant was removed, the scleral defect was sutured, and a concurrent retinal tear was treated with laser retinopexy. Postoperatively, the patient's symptoms resolved, and visual function was preserved. This case report highlights a rare but vision-threatening complication of early intraocular erosion associated with titanium orbital implants.
The authors report a case of a phenotypic shift of thyroid eye disease following treatment with teprotumumab. A 35-year-old female nonsmoker with Graves disease developed mild type I thyroid eye disease featuring unilate...The authors report a case of a phenotypic shift of thyroid eye disease following treatment with teprotumumab. A 35-year-old female nonsmoker with Graves disease developed mild type I thyroid eye disease featuring unilateral lid retraction and was treated with teprotumumab. Following completion of treatment, a reactivation was associated with progression to severe type II phenotype, with marked extraocular muscle enlargement, bilateral proptosis, and nonsteroid-responsive compressive optic neuropathy requiring orbital decompression. This case raises important questions regarding the potential influence of Insulin-like growth factor 1 (IGF-1) suppression on the phenotype of thyroid eye disease.
A 77-year-old male presented with a painless, raised, erythematous lesion of the left lower eyelid conjunctival fornix, found incidentally on routine ophthalmic examination. Further evaluation demonstrated a mobile, nont...A 77-year-old male presented with a painless, raised, erythematous lesion of the left lower eyelid conjunctival fornix, found incidentally on routine ophthalmic examination. Further evaluation demonstrated a mobile, nontender 5 × 4 mm injected mass without scleral or orbital extension. Excisional biopsy revealed dense infiltration of atypical plasmacytoid cells, strongly positive for CD138, MUM1, and CD56, with kappa light chain restriction and a Ki-67 index of 7% to 8%, consistent with a histopathologic diagnosis of plasmacytoma. Markers for melanoma, carcinoma, histiocytic/dendritic tumors, T-cells, and B-cells were not expressed. Systemic workup, including positron emission tomography/CT, serum and urine protein electrophoresis, and bone marrow biopsy, showed no evidence of systemic plasma cell dyscrasia, confirming a diagnosis of primary conjunctival extramedullary plasmacytoma. At 6-month follow-up, the patient remains free of local recurrence without adjuvant therapy. This case contributes to the limited literature on primary conjunctival extramedullary plasmacytoma and highlights the importance of including it in the differential diagnosis of atypical conjunctival lesions.
PURPOSE: This study investigates the role of tranexamic acid in oculoplastic surgery. METHODS: The authors searched PubMed, Embase, and Cochrane for randomized clinical trials comparing tranexamic acid (TXA) with placebo...PURPOSE: This study investigates the role of tranexamic acid in oculoplastic surgery. METHODS: The authors searched PubMed, Embase, and Cochrane for randomized clinical trials comparing tranexamic acid (TXA) with placebo. They used the R software, applying mean difference for continuous outcomes and standard mean difference for continuous outcomes assessed on different scales. RESULTS: The authors included 9 randomized clinical trials totaling 897 patients. Tranexamic acid did not reduce intraoperative bleeding, with a mean difference of -14.83 mL (95% confidence interval [CI]: -36.65 to 6.98). In the subgroup of patients undergoing dacryocystorhinostomy, there was a more pronounced trend, with a mean difference of -29.65 mL (95% CI: -61.07 to 1.76), though without statistical significance. In addition, TXA reduced the degree of periorbital ecchymosis, with a mean difference of -0.69 (95% CI: -1.13 to -0.25), and this reduction was more notable and only statistically significant with intravenous administration (mean difference of -0.78, 95% CI: -1.34 to -0.22). Regarding the surgeon's satisfaction with hemostasis and the visibility of the surgical field, only 2 studies demonstrated statistically significant results, both using intravenous TXA administration. The other 4 studies did not report any improvement: 2 used the subcutaneous route, and the remaining 2 used the intravenous route for TXA administration. Finally, no reduction in the surgical time was observed with the use of TXA in oculoplastic procedures. CONCLUSIONS: In conclusion, TXA did not reduce intraoperative bleeding. However, despite the weak evidence in this outcome, the drug significantly decreased the degree of periorbital ecchymosis in patients undergoing blepharoplasty using intravenous administration.
PURPOSE: Burkitt lymphoma (BL) is a highly aggressive B-cell malignancy with 3 recognized subtypes, of which the sporadic form is the most prevalent outside mainland Africa. Sporadic BL typically presents in the abdomen,...PURPOSE: Burkitt lymphoma (BL) is a highly aggressive B-cell malignancy with 3 recognized subtypes, of which the sporadic form is the most prevalent outside mainland Africa. Sporadic BL typically presents in the abdomen, with fewer than 9% of cases involving the head and neck region; orbital presentation is even rarer. The authors report 4 pediatric cases of orbital BL and provide a comprehensive review of the literature, focusing on clinical presentation, imaging features, histopathology, genetic findings, and treatment outcomes. METHODS: A multicenter retrospective case series combined with a literature review of pediatric BL cases with orbital involvement. RESULTS: The analysis includes 28 published cases and 4 additional cases from the authors' centers. Orbital BL typically presents with acute symptoms due to mass effect, such as proptosis, ophthalmoplegia, and periorbital swelling. All patients in the series were treated according to the French-American-British Mature B-Cell Lymphoma 96 protocol and are currently in remission. Poor prognostic indicators include elevated lactate dehydrogenase levels, central nervous system involvement, bone marrow infiltration, and disease relapse. CONCLUSIONS: Orbital involvement in sporadic pediatric BL is rare but should be considered in the differential diagnosis of a child presenting rapidly progressive proptosis. Prompt recognition and early treatment are associated with favorable outcomes.
Defects following skin cancer excision in the inner canthus pose a unique aesthetic and functional challenge. One undescribed option is the use of a sterile button. A button provides an optimal bolster material, because...Defects following skin cancer excision in the inner canthus pose a unique aesthetic and functional challenge. One undescribed option is the use of a sterile button. A button provides an optimal bolster material, because of its preexisting holes, and the variety of shapes allows for customization. The authors describe a case series of 6 patients in which a sterile button was used to recreate the medial canthal concavity. External photographs were obtained pre-operation and at postoperative month 3. Patient satisfaction scores were obtained through a standardized questionnaire. All 6 patients responded to the standardized questionnaire stating they were very satisfied with their postoperative outcomes. Surgeons specializing in periocular reconstructive techniques should be aware of the feasibility of button placement as to provide their patients with a surgical option that addresses both the aesthetic and functional nature of the medial canthal concavity.
A 28-year-old male presented with a 22 × 12 mm erythematous mass in his right upper eyelid for 1 year. The lesion clinically resembled a malignant neoplasm, but incisional biopsy revealed cutaneous leishmaniasis. To mini...A 28-year-old male presented with a 22 × 12 mm erythematous mass in his right upper eyelid for 1 year. The lesion clinically resembled a malignant neoplasm, but incisional biopsy revealed cutaneous leishmaniasis. To minimize potential scarring, the mass was excised without removing the overlying skin. The lesion was confined anterior to the orbital septum. Postoperatively, the patient received meglumine antimoniate for 15 days, with a rapid and uncomplicated recovery. Although rare, cutaneous leishmaniasis can mimic malignant eyelid tumors. In such cases, skin-sparing excision may offer a viable and effective treatment option.
A 59-year-old man presented with bilateral chalazia refractory to conservative management. Following excision, histopathology confirmed the diagnosis. Seven days postoperatively, he developed spontaneous, painless bleedi...A 59-year-old man presented with bilateral chalazia refractory to conservative management. Following excision, histopathology confirmed the diagnosis. Seven days postoperatively, he developed spontaneous, painless bleeding from the left upper eyelid. Follow-up examination suggested a small pyogenic granuloma, which was excised, but recurrent hemorrhage persisted. Further hematologic workup was unremarkable. A short course of oral tranexamic acid was initiated, leading to complete resolution of bleeding within 24 hours. Delayed hemorrhage following chalazion excision is rare, with limited cases reported, and this case demonstrates successful noninvasive management with oral tranexamic acid. While tranexamic acid is widely used in major surgeries, its role in minor ophthalmic procedures remains off-label. This case supports its potential utility as a hemostatic agent in select ophthalmic cases, warranting further investigation into its efficacy and safety in this context.
Ophthalmic Plast Reconstr Surg
· 2026 Mar-Apr 01 · PMID 41118484
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PURPOSE: Congenital anophthalmia/microphthalmia are developmental eye disorders with variable severity. The absence of a normal-sized eye can cause facial asymmetry. Outcome is often reported as relative horizontal palpe...PURPOSE: Congenital anophthalmia/microphthalmia are developmental eye disorders with variable severity. The absence of a normal-sized eye can cause facial asymmetry. Outcome is often reported as relative horizontal palpebral fissure (rHPF) and/or orbital dimensions. Yet, the predictive value of these measurements is unknown. This study aims to test the relation between facial and ultrasound measurements and subjective outcomes. METHODS: In this retrospective study, 3D facial scans of 31 patients with unilateral an/microphthalmia were analyzed. The scans were obtained using the Vectra scanner, and measurements were taken using GOM Inspect software. Various facial landmarks were identified, including horizontal palpebral fissure (HPF), lower lid, upper eyelid, lid crease, and inferior eyebrow margin. Orbital width, orbital height, and axial eye length were measured using ultrasonography. Ratios between the affected and unaffected sides were calculated from these measurements. Faces were also subjectively rated for the degree of asymmetry on a scale of 1 to 5. RESULTS: Average subjective judgment showed a significant association with, respectively, rHPF ( p < 0.001), caudal placement of the eye ( p < 0.001), orbital width ( p = 0.001), pretarsal show asymmetry ( p = 0.003), and axial length ( p = 0.003). After a forward selection procedure, only rHPF predicted the subjective outcome. rHPF was strongly correlated with the other significant factors. CONCLUSION: The results indicate that the rHPF is best associated with subjective outcome. The forward selection procedure showed that adding ultrasound or other facial measurements did not result in a better association.
PURPOSE: Alemtuzumab is a monoclonal antibody that targets CD52 and is commonly used to treat multiple sclerosis. Thyroid dysfunction occurs in 20% to 30% of patients treated with alemtuzumab. This may lead to thyroid-as...PURPOSE: Alemtuzumab is a monoclonal antibody that targets CD52 and is commonly used to treat multiple sclerosis. Thyroid dysfunction occurs in 20% to 30% of patients treated with alemtuzumab. This may lead to thyroid-associated orbitopathy (TAO), which can cause debilitating dry eye, diplopia, proptosis, ocular pain, and vision loss. This meta-analysis aims to quantify the incidence of alemtuzumab-induced TAO (AI-TAO) and to characterize its clinical features. METHODS: Studies were extracted from Cochrane, Embase (Ovid), Medline (Ovid), and additional gray literature. Using R version 4.4.1 on RStudio, the meta-analysis was conducted using the meta package. Depending on the level of heterogeneity, either a fixed-effects or random-effects model was used to pool the data. Funnel plots were used to assess publication bias. RESULTS: Meta-analysis of 1545 patients across 12 studies revealed that the incidence of alemtuzumab-induced Graves' disease was 25% (95% confidence interval [CI]: 11-46%) and AI-TAO was 6% (95% CI: 3-10%). Of the patients with established alemtuzumab-induced Graves' disease, 20% (95% CI: 12-30%) developed TAO. Pooled analysis of 8 studies (n = 556), revealed that the mean onset of AI-TAO was 37.38 months (95% CI: 28.90-46.76). In summary, 51/65 (78.5%) of TAO patients were managed conservatively, and 22/65 (33.9%) were managed surgically. Orbital decompression was required in only 5/65 (7.7%) patients. CONCLUSIONS: The incidence of AI-TAO is 6% which is less common than the estimated incidence of 20% to 30% of alemtuzumab-induced thyroid dysfunction. This finding emphasizes the need for patient counseling, baseline ophthalmic examination, and interdisciplinary follow-up for early detection and management of AI-TAO.