Conjunctival Chemosis Research Articles

Early Tarsorrhaphy in Conjunctival Chemosis After Orbit Bone Reconstruction

Chemosis is a common occurrence after orbital reconstruction surgery by the transconjunctival approach. The authors propose an early tarsorrhaphy approach for treating severe conjunctival chemosis following orbital fracture repair. All severe conjunctival chemosis patients following orbital fracture repair were divided into 2 groups: tarsorrhaphy performed immediately when the eyelids could not close completely due to prominent conjunctival edema (early tarsorrhaphy, n = 10); and tarsorrhaphy performed 3 days after the appearance of severe chemosis (delayed tarsorrhaphy, n = 10). Once the conjunctiva subsided, the sutures were immediately removed. The duration of conjunctival edema was recorded. The average time to resolution of severe chemosis was significantly shorter in the early versus delayed tarsorrhaphy group (3.5 ± 0.5 versus 7.2 ± 1.73 days, P < 0.05). No recurrence of conjunctival edema occurred in any patient 4 months postoperatively. Early temporary tarsorrhaphy is a fast and effective method for the treatment of conjunctival chemosis following orbital fracture surgery. The sooner eyelid suturing is performed, the faster conjunctival chemosis will subside.

Saturday Night Retinopathy After Intranasal Heroin

Purpose: To describe the clinical features of a case of Saturday night retinopathy (SNR) following intranasal heroin use. Methods: Ophthalmological examination, including optical coherence tomography and fluorescein angiogram, was performed. Serial images were obtained at follow-up visits at 1 week and 1 month. Results: The visual acuity was no light perception vision and there was an afferent pupillary defect in the affected eye. There was also evidence of complete ophthalmoplegia, globe proptosis, conjunctival chemosis, and corneal epitheliopathy and funduscopic evidence of ophthalmic artery occlusion. Follow-up imaging showed choroidal and retinal nonperfusion. Magnetic resonance imaging demonstrated edematous extraocular muscles and a bilateral hippocampal ischemia. Conclusions: This is the first case of SNR following intranasal heroin use and opioid-associated hippocampal ischemia. As physicians witness the impacts of the country’s opioid epidemic, it is important to recognize SNR as a cause of acute visual loss.

Spontaneous suprachoroidal haemorrhage with exudative retinal detachment in pregnancy-induced hypertension

A 35-year-old woman at 26 weeks’ gestation presented with vision loss in the right eye (RE) and abdominal pain for 10 days. There was no fever. RE had conjunctival congestion...

Immunopathology of Allergic Conjunctivitis

Allergic conjunctivitis is predominantly an immunoglobulin E-mediated hypersensitivity reaction to environmental allergens. Allergic diseases affect &gt;30% of the world’s population, of which 40% report associated ocular manifestations. Cellular and soluble mediators play a major role in the pathophysiology of allergic conjunctivitis. Mast cells, which are major effector cells of allergic conjunctivitis, undergo activation and degranulation to release histamine, tryptase, prostaglandins, leukotrienes, and cytokines. These mediators play important roles in immunopathological mechanisms that generate the clinical manifestations of allergic conjunctivitis. These clinical features include conjunctival hyperaemia, chemosis, tearing, itching, papillae, mucus discharge, and eyelid oedema. Histamine mediates the early phase of the allergic immune response, whereas lipid mediators and cytokines are involved in the late phase of the immunopathology of allergic conjunctivitis. Current management of allergic conjunctivitis includes non-pharmacological approaches such as allergen avoidance and palliative therapy, whereas pharmacological therapeutic modalities may include antihistamine–mast cell stabiliser combination ophthalmic formulations and allergen-specific immunotherapy. Furthermore, as cellular and soluble mediators play a pivotal role in the immunopathogenesis and immunopathology of allergic conjunctivitis, development of immunotherapeutic and pharmacotherapeutic agents specific to these mediators can enhance the therapeutic index and safety profile of anti-allergy treatment.

Intraorbital Wooden Foreign Body with Intracranial Extension : A Case Report

&#x0D; &#x0D; &#x0D; Purpose : The aim of this study is to report a case of intraorbital wooden foreign body with intracranial extension to the frontal lobe and its management. Method : This is a descriptive study: A 53 year-old male referred due to wooden stick stucked in the orbital cavity causing protruding eyeball and vital sign instability. &#x0D; Result : Right eye examination revealed light perception visual acuity, with bad light projection and bad color perception, inwardly folded upper eyelid, proptosis, conjunctival chemosis, corneal erosion and edema, dilated pupil with sluggish pupillary light reflex and limited ocular movement in all direction. Vital sign was unstable with decreasing blood pressure, increasing temperature and heart rate. CT Scan showed complete fracture of the orbital roof due to penetration of the wooden stick, pneumoencephalus, cerebral edema and hematoma. Emergency craniotomy was performed to remove the penetrating wooden stick and bone segment in the frontal lobe and fracture repair. Ophthalmologist pulled the remaining stick, released the superior rectus muscle and repaired the lacerated eyelid. Outcome visual acuity was no light perception with lagophthalmos and limited ocular motility. Patient was admitted to Intensive Care Unit one day post-operatively and treated with systemic and topical antibiotic. &#x0D; Conclusion : Any case presenting with intraorbital foreign body must undergo immediate neuroimaging to exclude any intracranial extension, especially in patients with worsening general condition. &#x0D; &#x0D; &#x0D;

Odontogenic orbital cellulitis associated with cavernous sinus thrombosis and pulmonary embolism: a case report

BackgroundThis case illustrates the importance of prompt assessment and treatment of orbital cellulitis. In fact the ocular signs and symptoms may be associated with systemic complications which should be investigated and identified as soon as possible to avoid a poor prognosis.Case presentationA 46-year-old white woman presented to our emergency room with proptosis, ophthalmoplegia, and conjunctival chemosis of her left eye. An ophthalmologist, having diagnosed orbital cellulitis in her left eye, suspected a cavernous sinus thrombosis. Hematochemical and radiological examinations confirmed the cavernous sinus thrombosis and also showed septic pulmonary embolism. A blood culture indicated Streptococcus constellatus, which is a member of the Peptostreptococcus family, a saprophyte of the oral mucosa that can be pathogenic in immunocompromised persons. The odontogenic origin was then confirmed by dental radiography which showed a maxillary abscess. Her eye signs regressed after antibiotic and anticoagulant therapy.ConclusionsThis complex case shows the importance of a multidisciplinary approach for the management of orbital cellulitis, for the prompt diagnosis and treatment of eye injuries and possible complications, so as to avoid serious and permanent sequelae.

Effect of Mandarin Orange Yogurt on Allergic Conjunctivitis Induced by Conjunctival Allergen Challenge.

To evaluate the effects of mandarin orange yogurt containing nobiletin and β-lactoglobulin on the allergic conjunctivitis induced by a conjunctival allergen challenge (CAC). Experiment 1 was performed on 26 asymptomatic patients (age, 25.3 ± 5.3 years) with proven seasonal allergic conjunctivitis due to cedar pollen. We compared the degree of conjunctivitis induced by CAC before and after ingesting mandarin orange yogurt for 2 weeks. Experiment 2 was a double-blind, placebo-controlled trial performed on 31 patients (age, 32.5 ± 12.2 years). A diet containing mandarin orange yogurt was compared to a diet containing yogurt lacking the mandarin orange on the conjunctivitis induced by CAC. The temperature of the inferior bulbar conjunctiva was measured before and 20 minutes after the CAC with an ocular surface thermographer (OST). The degree of conjunctival injection and chemosis was graded by slit-lamp biomicroscopy. The changes in the symptoms were evaluated by a questionnaire. In experiment 1, the scores of redness (3.07 ± 3.03 vs. 1.05 ± 1.70), chemosis (2.84 ± 2.27 vs. 0.81 ± 1.11), itching (4.34 ± 3.05 vs. 1.39 ± 2.12), and temperature (0.73 ± 0.42°C vs. 0.45 ± 0.43°C) were significantly lower (P < 0.001) after a diet of mandarin orange yogurt for 2 weeks. In experiment 2, the scores of redness (1.03 ± 0.18 vs. 1.28 ± 0.52; P = 0.0156), itching (1.93 ± 1.92 vs. 2.82 ± 2.21; P = 0.0133), and surface temperature (0.54 ± 0.21°C vs. 0.31 ± 0.25°C; P < 0.001) were significantly lower in the mandarin orange yogurt group than in the control yogurt group. Mandarin orange yogurt can be an effective nutritional intervention for allergic conjunctivitis.

Safety and Efficacy Evaluation of rAAV2tYF-PR1.7-hCNGA3 Vector Delivered by Subretinal Injection in CNGA3 Mutant Achromatopsia Sheep

Applied Genetic Technologies Corporation (AGTC) is developing a recombinant adeno-associated virus (rAAV) vector expressing the human CNGA3 gene designated AGTC-402 (rAAV2tYF-PR1.7-hCNGA3) for the treatment of achromatopsia, an inherited retinal disorder characterized by markedly reduced visual acuity, extreme light sensitivity, and absence of color discrimination. The results are herein reported of a study evaluating safety and efficacy of AGTC-402 in CNGA3-deficient sheep. Thirteen day-blind sheep divided into three groups of four or five animals each received a subretinal injection of an AAV vector expressing a CNGA3 gene in a volume of 500 μL in the right eye. Two groups (n = 9) received either a lower or higher dose of the AGTC-402 vector, and one efficacy control group (n = 4) received a vector similar in design to one previously shown to rescue cone photoreceptor responses in the day-blind sheep model (rAAV5-PR2.1-hCNGA3). The left eye of each animal received a subretinal injection of 500 μL of vehicle (n = 4) or was untreated (n = 9). Subretinal injections were generally well tolerated and not associated with systemic toxicity. Most animals had mild to moderate conjunctival hyperemia, chemosis, and subconjunctival hemorrhage immediately after surgery that generally resolved by postoperative day 7. Two animals treated with the higher dose of AGTC-402 and three of the efficacy control group animals had microscopic findings of outer retinal atrophy with or without inflammatory cells in the retina and choroid that were procedural and/or test-article related. All vector-treated eyes showed improved cone-mediated electroretinography responses with no change in rod-mediated electroretinography responses. Behavioral maze testing under photopic conditions showed significantly improved navigation times and reduced numbers of obstacle collisions in all vector-treated eyes compared to their contralateral control eyes or pre-dose results in the treated eyes. These results support the use of AGTC-402 in clinical studies in patients with achromatopsia caused by CNGA3 mutations, with careful evaluation for possible inflammatory and/or toxic effects.

Salmonella Typhi Associated Endogenous Endophthalmitis: A Case Report and a Review of Literature

ABSTRACTAim: To report a rare case of Salmonella typhi associated endogenous endophthalmitis in an immunocompetent male and to review the available literature.Methods: Retrospective chart review.Results: A 28-year-old immunocompetent male presented with a 3-day-old history of pain, redness and diminished vision in his left eye. Conjunctival chemosis, corneal haze, and hypopyon were noted and yellowish exudates filled the vitreous cavity. A detailed elicitation of history revealed that patient had been treated for enteric fever that presented with diarrhea and fever, two weeks prior to current presentation. Blood and vitreous cultures grew Gram negative bacilli, identified as S. typhi. Despite intensive intravitreal and systemic antibiotic therapy, an evisceration had to be performed.Conclusions: Endogenous endophthalmitis can be one of the rare sequelae of enteric fever and may present in the acute and relapsing phases and often times have a rapidly fulminant course with poor visual outcomes.

Reactions with Antisera and Pathological Effects of Staphylococcus aureus Gamma-Toxin in the Cornea

ABSTRACTPurpose: This study analyzed the toxicity of purified gamma-toxin from Staphylococcus aureus and the protectiveness of antisera to gamma-toxin in the rabbit cornea.Materials and methods: Gamma-toxin was purified from cultures of alpha-toxin deficient S. aureus strain Newman Δhla. Antisera to native gamma-toxin (Hlg) were produced in rabbits. These antisera and a commercial polyclonal antibody to recombinant HlgB (rHlgB) were analyzed for specificity and toxin neutralization. Heat-inactivated gamma-toxin, active gamma-toxin either alone or with antisera or with commercial antibody to rHlgB, was injected into the rabbit cornea to observe the pathological effects using slit lamp examination scoring (SLE) and histological analyses.Results: Eyes with intrastromal injection of gamma-toxin developed SLE scores that were significantly higher than eyes injected with heat-inactivated gamma-toxin (p ≤ 0.003). Slit lamp and histological examination of eyes revealed that gamma-toxin injected into the cornea mediated conjunctival injection and chemosis, iritis, fibrin accumulation in the anterior chamber, and polymorphonuclear neutrophil infiltration of the cornea and iris. Also, eyes injected with gamma-toxin plus antisera to native whole gamma-toxin or HlgB, but not with commercial antibody to rHlgB, yielded significantly lower SLE scores than eyes injected with gamma-toxin alone (p ≤ 0.003).Conclusions: This study illustrates that S. aureus gamma-toxin is capable of causing significant corneal pathology. Furthermore, the use of polyclonal antisera specific for native gamma-toxin was found to inhibit the damaging effects of the toxin in the rabbit cornea.

Effects of Exposure to Ozone on the Ocular Surface in an Experimental Model of Allergic Conjunctivitis.

Based on previous findings that ozone can induce an inflammatory response in the ocular surface of an animal model and in cultured human conjunctival epithelial cells, we investigated whether exposure to ozone exacerbates symptoms of allergic conjunctivitis. We evaluated the effects of exposure to ozone on conjunctival chemosis, conjunctival injection, corneal and conjunctival fluorescein staining scores, production of inflammatory cytokines in tears, and aqueous tear production in a mouse model of allergic conjunctivitis. To validate our in vivo results, we used interleukin (IL)-1α-pretreated conjunctival epithelial cells as an in vitro substitute for the mouse model. We evaluated whether exposure to ozone increased the inflammatory response and altered oxidative status and mitochondrial function in IL-1α-pretreated conjunctival epithelial cells. In the in vivo study, ozone induced increases in conjunctival chemosis, conjunctival injection, corneal and conjunctival fluorescein staining scores, and production of inflammatory cytokines, accompanied by a decrease in tear volume. In the in vitro study, exposure to ozone led to additional increases in IL-6 and tumor necrosis factor-α mRNA levels, which were already induced by treatment with IL-1α. Ozone did not induce any changes in cell viability. Pretreatment with IL-1α increased the expression of manganese superoxide dismutase, and exposure to ozone led to additional increments in the expression of this antioxidant enzyme. Ozone did not induce any changes in mitochondrial activity or expression of mitochondrial enzymes and proteins related to mitochondrial function, with the exception of phosphor-mammalian target of rapamycin. Treatment with butylated hydroxyanisole, a free radical scavenger, attenuated the ozone-induced increases in IL-6 expression in IL-1α-pretreated conjunctival epithelial cells. Therefore, we conclude that exposure to ozone exacerbates the detrimental effects on the integrity of the ocular surface caused by conjunctival allergic reactions, and further increases the inflammatory response in IL-1α-pretreated conjunctival epithelial cells.

Clinical Ocular Features in Children and Young Adults with Thyroid Diseases

The study of clinical ocular manifestations recruited 105 patients who presented to the Endocrine and Eye clinics of Lithuanian University of Medical Sciences with a history of thyroid diseases. The study comprised two groups of patients: the group I included 36 patients (under 18 years) and the group II-69 (from 18 to 34 years). As the control group, 25 children and 30 young adults of similar age without thyroid, eye and systemic diseases were selected. A comprehensive ophthalmic assessment including patient’s complaints, best-corrected Snellen visual acuity, ocular motility, proptosis measurements, intraocular pressure (IOP), eyelid signs (lid aperture, lid retraction), slit lamp and fundus investigation was performed. Our investigation confirms that in children with thyroid diseases ocular symptoms and signs such as upper eyelid retraction, stare and mild proptosis were predominant. Young adults with thyroid diseases complained of foreign body sensation, photosensitivity and pain. There was manifestation of eyelid retraction, eyelid oedema and redness, conjunctival redness and chemosis, eyelid retraction, proptosis and widened palpebral fissure. A small number of young adults with thyroid diseases suffered from severe ocular complications as keratopathy, diplopia. This examination may be useful in early diagnosis of ocular changes in children and young adults with thyroid diseases.

Orbital Apex Syndrome with Central Retinal Artery Occlusion Following Tooth Extraction

A 39- year-old male, known diabetic presented with drooping of upperlid and visual loss in the left eye (LE) along with pain in the eye and periorbital region. This was preceded by tooth extraction 2 days back. There was inaccurate projection of rays in the left eye along with complete ptosis, proptosis, relative afferent pupillary defect (RAPD) and limitations of ductions. Fundoscopy revealed features of papillitis with central retinal artery occlusion (CRAO). The examination of the right eye was within normal limits. Patient had high blood sugar levels. Contrast enhanced computed tomography (CECT) scan of brain and orbit was suggestive of left paranasal sinusitis. The clinical and the radiological findings were suggestive of orbital apex syndrome with central retinal artery occlusion of the left eye (LE). The case was managed conservatively with systemic antibiotics, non-steroidal anti-inflammatory drugs and injection human insulin. Pain, proptosis and conjunctival chemosis subsided within 2 days but other features remained static. Dentogenic cause of orbital apex syndrome is very rare. We intend to discuss clinical features and management of such case.

A systematic review of the efficiency and safety of intra-arterial chemotherapy for retinoblastoma

Background Retinoblastoma (RB) is the most common primary ocular malignancy in children.Many treatment modalities have been applied to RB.As an exciting option to reduce systemic adverse effects and increase the local drug concentration, intra-arterial chemotherapy (IAC) was introduced as an important treatment modality for advanced intraocular RB in recent years. Objective The aim of the study was to review the reported efficiency and safety of IAC in the treatment of RB. Methods Based on the established search strategy, we searched the electronic databases of PubMed, Medline, Embase, EBSCO, Web of Science, Wan Fang database, China National Knowledge Infrastructure, China Science and Technology Journal Database and China Biology Medicine disc.All the databases were retrieved from inception until April 2016.Study selection, data extraction, quality assessment and data analysis were performed according to preferred reporting items for systematic reviews and Meta-analyses (PRISMA) statement. Results We included 27 studies reporting more than 1 067 RB patients (1 314 eyes) and over 3 818 IAC treatments.The overall salvage rate achieved 70.3% for all eyes, 76.2% for first-line IAC, 57.5% for more advanced RB and 76.4% for patients who did not receive other treatments during or after IAC.Metastases were reported in 23 patients and deaths were reported for 21 patients.Minor systemic complications (such as nausea or vomiting, neutropenia) and local complications (such as retinal pigment epithelium change, conjunctival chemosis and retinal detachment) were frequently reported, but there were few serious systemic complications. Conclusions IAC is a promising salvage therapy for RB without serious systemic complications.However studies with prospective design and long-term follow-up are still needed to identify the proper indication of IAC. Key words: Retinoblastoma; Intra-arterial chemotherapy; Systematic review; Evidence-based medicine

Orbital cellulitis in a child with sickle cell anemia

PurposeOrbital cellulitis and preseptal cellulitis are the major infections of the ocular adnexal and orbital tissues. Orbital cellulitis is an infection of the soft tissues of the orbit, posterior to the orbital septum.The purpose of this text is to point out sickle‐cell disease as an important risk factor in a 2‐year‐old boy with sinusitis.MethodsWe evaluated a 2‐year‐old boy with sickle‐cell disease and sinusitis treated with oral amoxicillin (80 mg/kg/day). He presented a remarkable proptosis, intense ophthalmoplegia and conjunctival chemosis, with a temperature of 39°C and leukocytosis with left shift. We treated him with clindamycin 30 mg/kg, cefotaxime 200 mg/kg and prednisolone IV.ResultsAxial image CT scan demonstrated sinusitis of the left ethmoid sinus. Furthermore, there was a left sided subperiosteal abscess between the medial wall of the left orbit and the left medial rectus muscle. Due to the bad evolution and the CT scan image, the sinus was drainage in a surgical procedure under general anesthesia. Appropriate patient evolution was achieved without the need for additional therapy.ConclusionsPatients with sickle‐cell anemia show anincreased risk of severe bacterial infections due to loss of functioning spleen tissue. Daily penicillin prophylaxis is the most commonly used treatment during childhood. Orbital cellulitis can result in orbital and intracranial complications. Blindness may occur secondary to elevated intraorbital pressure. This is the reason we must control the patient at least daily and evaluate the antibiogram. Finally, when medical treatment is not working and there is an elevated intraorbital pressure with involvement of the eyeball, the surgery cannot be postponed.

Conjunctival Chemosis as a Specific Feature of Pseudomonas aeruginosa Corneal Ulcers.

Timely identification of a bacterial agent and its corresponding antibiotic sensitivity pattern is paramount in the management of infective corneal ulcers. Isolating the microbiological agents can take time; during this time, the initial therapy used is a chosen form of broad-spectrum antibiotics. There are no specific features of bacterial corneal ulcers that aid in identification of the involved pathogen with certainty. A clinical "marker" would undoubtedly be useful in the management of corneal ulcers. Early clinical photographs and clinical notes of 62 cases with confirmed infective corneal ulcers were examined by a masked reviewer. Conjunctival chemosis was observed in 14 out of 16 cases of Pseudomonas aeruginosa-related corneal ulcers, as compared with 6 out of 46 cases caused by other organisms. The association between conjunctival chemosis and Pseudomonas aeruginosa is statistically significant, with P value <0.000001 and odds ratio 42.0 (7.2-470) using the Fisher exact test. Our findings suggest that conjunctival chemosis could be a useful marker to predict the presence of Pseudomonas aeruginosa in bacterial corneal ulcers.

Periocular Melanoma In Situ Treated With Imiquimod.

To evaluate the efficacy of topical 5% imiquimod cream in the treatment of periocular melanoma in situ (lentigo maligna). Retrospective case series. There were 12 patients in this series, and the mean patient age was 77 years. The anatomical locations were the lower eyelid (n=5), upper and lower eyelid (n=4), lower eyelid including the eyelid margin (n=1), brow (n=1), and the medial canthus (n=1). Topical 5% imiquimod cream was used as a primary treatment (n=6) or as an adjunctive therapy following local excision (n=2), cryotherapy (n=2), or excisional biopsy with cryotherapy (n=2). Twelve patients with periocular melanoma in situ were treated with topical 5% imiquimod cream daily for a mean treatment period of 3.9 months. The clinical features of the patients and the responses to treatment were evaluated in a retrospective case series. Histologic clearance of atypical melanocytes. Eleven patients achieved complete histologic clearance of atypical melanocytes on post-treatment biopsy. One patient could not tolerate local irritation from imiquimod and stopped in the first month of therapy with residual disease. The median follow-up time was 1.5 years. Side effects included redness (n=12), discomfort (n=6), swelling (n=4), ectropion (n=1), and conjunctival chemosis (n=1). The patients experienced no systemic side effects from the treatment. Topical 5% imiquimod cream is an effective option as primary or adjunct therapy in the treatment of periocular melanoma in situ.

Colored corn starch dust explosion-related ocular injuries at a Taiwan water park: A preliminary report from a single medical center

PurposeTo elucidate the manifestations of ocular injuries in the colored corn starch dust explosion at a Taiwan water park. MethodsThis is a retrospective, non-comparative, consecutive-interventional case series. Fifty explosion-injury patients on 27 June 2015 treated at Chang-Gung Memorial Hospital, Linkou, were included. Thorough ophthalmic examinations were based on emergent triage and consecutive ophthalmological consultations. Multiple ocular and systemic parameters were assessed. ResultsOf the 100 eyes in the 50 cases reviewed, 22 cases were male and 28 cases were female. The mean age was 22.08±4.64 years, and the mean burn total body surface area (TBSA) of patients was 45.92±20.30%. Of the 50 patients, 20 had Grade 1 ocular burns, and the others were without ocular involvement. Two of the 20 cases that presented Grade 1 ocular burns died within 1 month due to other systemic complications. The most common ocular manifestations among those with ocular injuries included periocular swelling (75%), followed by conjunctival chemosis (65%), conjunctival hyperemia (50%), singed eyelashes (20%), cornea epithelial defects (10%), and punctate keratopathy (5%). It is worth mentioning that one patient developed herpes simplex keratitis due to stress 3 weeks after being burned. Half of the 50 patients had facial burns. Specifically, the patients with a greater TBSA presented more significant ocular-burn manifestations than those patients with lower TBSA. ConclusionPrompt ophthalmologic consultations are particularly necessary for mass burn-casualty patients with facial burns, inhalation injuries, and greater TBSA. The inspection and control of all ignition sources and the manipulation of dust with low concentrations and in an open space are crucial factors to prevent future dust explosions.

Orbital Inflammation in Pregnant Women

To analyze overlaps between pregnancy and orbital inflammation (OI). Retrospective observational case series. Eight new cases from 1997 to 2015 and 2 previously published cases were identified for inclusion in this investigation to provide the fullest clinical picture. Medical records, imaging studies, and the results of biopsies were reviewed. Three categories of association were discovered: (1) OI arising for the first time during pregnancy (5 cases); (2) OI arising within 3months of delivery (2cases); and (3) previously diagnosed OI reactivated or exacerbated by pregnancy (3 cases). One patient had a preexistent systemic autoimmune disease and another's was later diagnosed. One patient had attacks during sequential pregnancies. Findings included eyelid swelling and erythema, conjunctival chemosis, pain on eye movement, minimal diplopia, the usual absence of proptosis, and general preservation of visual acuity. Imaging studies disclosed extraocular muscle swelling (8 cases), most frequently of a single lateral rectus muscle. There were 2 cases of dacryoadenitis; 1 of these and an additional case displayed inflammation of the retrobulbar fat. Corticosteroids effected resolution of most symptoms. Singleton births were normal with the exceptions of an intrauterine fetal demise owing to acrania and a molar pregnancy. OI usually affects a single rectus muscle (typically the lateral) and, less often, the lacrimal gland and is often mild when it arises during or after pregnancy. Independent systemic autoimmune disease is an uncommon feature. Corticosteroids were efficacious except in 1case with severe orbital scarring. No definitive causal relationships between pregnancy and OI could be established based on the clinical data.

Isolated Orbital Aspergillosis in Immunocompetent Patients: A Multicenter Study

To report clinicopathologic features, radiologic findings, and treatment outcomes of isolated, orbital aspergillosis. Multicenter, retrospective case series. setting: Multicenter. There were 8 lesions in 8 eyes of 8 patients with isolated, orbital aspergillosis. Review of medical records and histopathology slides. Disease control. Of 34 patients with orbital aspergillosis, 8 (23.5%) had isolated orbital involvement at presentation. The mean age at presentation was 34.5 years (median, 43 years: range, 0.5-72 years). Gradually progressive proptosis and eyelid swelling were the most common presenting features (each 4/8). Proptosis ranged from 4mm to 9mm (median, 5.5mm; mean, 5.75mm). Restriction of ocular motility was seen in all 8 patients. Other examination findings included palpable mass (2/8), conjunctival chemosis (2/8), hyperglobus (1/8), hypoglobus (1/8), and resistance to retropulsion (1/8). Microbial culture results were available in 1 patient and showed Aspergillus fumigatus. Two patients were treated with complete surgical excision alone while 6 were treated with antifungal medications. Complete resolution of proptosis and restoration of ocular motility were seen in all patients following treatment. Visual disturbances present in 1 were corrected following treatment. Recurrence was observed in 1 patient. Isolated orbital aspergillosis, though rare, should be considered in the differential diagnosis of a patient presenting with a gradually progressive orbital mass, especially in Asian individuals. Early recognition will help reduce the morbidity and mortality associated with this disease.