Eyelid Swelling Research Articles

Management of post-septal complications of acute rhinosinusitis in children: A 14-year experience in a tertiary hospital

IntroductionAcute rhinosinusitis accounts for most of the cases of orbital infections and is the most common cause of periorbital oedema in children. Up to 10% of patients with orbital complications of acute rhinosinusitis may experience vision loss and other complications such as meningitis, intracranial abscess or even death. Therefore, these patients require prompt diagnosis and proper treatment. ObjectivesThis study aims to report the clinical presentation and management of post-septal orbital complications of acute rhinosinusitis in the paediatric population. Materials and methodsA retrospective medical chart review of all children aged under 18 years old who were diagnosed with post-septal orbital complications of acute rhinosinusitis at a tertiary academic hospital, between 01/2007 and 12/2020. Patients were grouped according to the Chandler Classification (groups 2–5). ResultsFifty-five children (mean age of 6.91 ± 4.61 years) fulfilled the entry criteria for post-septal orbital complications of acute rhinosinusitis, based on clinical evaluation by an otorhinolaryngologist and CT-scan findings. Forty (72.72%) patients were also evaluated by an ophthalmologist. Most patients were male (76.36%). Twenty-four patients had post-septal cellulitis (43.63%), 21 patients had a subperiosteal abscess (38.18%) and 10 patients had an orbital abscess (18.18%). Eyelid swelling was the most frequent sign, followed by fever. Microbiology varied considerably and gram-positive agents were clearly predominant. Eighteen (32.73%) patients had been treated with oral antibiotics prior to hospital admission, exhibiting a significantly higher risk of recurrence of orbital infection (p = 0.020). Ethmoid and maxillary sinuses were the most involved paranasal sinuses (90.91%). Thirty-three patients (60%) were successfully treated medically, and 22 patients (40%) required surgical drainage. Seven patients (12.73%) developed further complications and six recovered without sequelae. The mean length of hospital stay was 8.0 ± 5.0 days and recurrence of orbital infection occurred in six patients (10.91%). The absolute neutrophil blood count was significantly different amongst Chandler groups (p = 0.021), with higher counts in patients with subperiosteal abscess. The duration of hospitalization was significantly higher in patients submitted to surgery (p < 0.001). ConclusionPost-septal orbital complications of acute rhinosinusitis are infrequent but dangerous events in the paediatric population. Close collaboration with Ophtalmology is paramount, as the child's vision is at risk. Eyelid swelling and proptosis are early signs. CT-scan imaging plays an invaluable role in the diagnosis and decision-making. Predictive indicators for surgery were not found. However, emergency endoscopic nasal surgery with abscess drainage should be considered whenever vision is at risk, if there is no improvement after aggressive medical treatment, and in cases of intracranial complications.

Immunoglobulin G4-related Ophthalmic Disease with Peripheral Eosinophilia and Elevated Immunoglobulin E Levels

Purpose: To report a case with peripheral eosinophilia and elevated immunoglobulin (Ig) E levels, subsequently diagnosed as IgG4-related ophthalmic disease involving the extraocular muscles.Case summary: A 56-year-old male visited the allergy department presenting with systemic urticaria and bilateral eyelid swelling that began 5 months prior. Laboratory examinations showed elevated levels of serum eosinophil and IgE, 1,309 IU/uL and 1,793 IU/mL, respectively. Orbital computed tomography revealed that all extraocular muscles and the bilateral exophthalmos were enlarged, and the patient was referred to the ophthalmology department. Eye alignment was orthophoric for all gaze directions, and limited abduction (-1) was noted in both eyes. An incisional biopsy of the extraocular muscles was conducted. Histopathological findings showed lymphoid aggregates, diffuse fibrosis, and an increased IgG4+/IgG+ plasma cell ratio of 40%, which led to the diagnosis of IgG4-related ophthalmic disease. An elevated IgG4 serum level (1,710 mg/dL) was also noted. The patient received high-dose intravenous steroids and eyelid swelling improved after two months. Levels of serum eosinophil, IgE, and IgG4 all decreased after three months.Conclusions: IgG4-related ophthalmic disease may be accompanied by eosinophilia and elevated IgE. These findings may facilitate future diagnoses of this disease.

Assessment of a novel ophthalmology tele-triage system during the COVID-19 pandemic

BackgroundIn response to the COVID-19 pandemic, a web-based tele-triage system was created to prioritize in-person clinic visits and ensure safety at the University of Illinois at Chicago Department of Ophthalmology and Visual Sciences during a statewide shelter-in-place order. The aim of this study is to evaluate the impact of the tele-triage system on urgent visit volume and explore the characteristics of acute visit requests at a tertiary referral eye center.MethodsThis retrospective study analyzed acute visit requests between April 6, 2020 and June 6, 2020. Descriptive statistics, chi-square tests, ANOVA, and bivariate logistic regression were used to compare variables with a p-value of 0.05.ResultsThree hundred fifty-eight surveys were completed. Mean age was 49.7 ± 18.8 years (range 2–91). The majority of requests were determined as urgent (63.0%) or emergent (0.8%). Forty-nine patients had recent eye trauma (13.7%), and the most common reported symptoms were new onset eye pain (25.7%) and photophobia (22.9%). Most patients were self-referred (63.7%), though provider referral was more common in patients with symptoms of new onset lid swelling (p < 0.01), diplopia (p < 0.01), flashing lights (p = 0.02), or droopy eyelid (p < 0.01). Patients presenting with symptom onset within 48 h tended to be younger (45.8 years) versus those with symptom duration of 48 h to 1 week (49.6 years), or more than 1 week (52.6 years; p < 0.01).ConclusionThis novel tele-triage system screened out one-third of acute visit requests as non-urgent, which limited in-person visits during the initial shelter-in-place period of the pandemic. Tele-triage systems should be implemented in eye care practices for future emergency preparedness.

The clinicopathologic features and differential diagnosis of ocular Kimura disease and epithelioid hemangioma

Objective: To investigate the clinicopathologic features and differential diagnosis of ocular Kimura disease (KD) and epithelioid hemangioma. Methods: It was a retrospective case series study. The data of 10 patients with ocular KD and 3 patients with ocular epithelioid hemangioma from the Pathology Department of Eye & ENT Hospital of Fudan University from January 2010 to December 2019 were retrospectively analyzed, including clinical manifestations, morphology and immunophenotypes. Results: Among patients with ocular KD, there were 9 males and 1 female with an age from 7 to 75 years (mean, 30 years). There were 6 unilateral cases and 4 bilateral cases. The disease mainly involved the orbit in 3 patients, the lacrimal gland in 5 patients and the eyelid in 2 patients. The ophthalmic presentation included a palpable periorbital or eyelid mass with eyelid swelling and ptosis, proptosis and displacement of the eyeball, and ocular dysmotility. Three patients had a history of lymphadenopathy. The disease course ranged from 6 months to 7 years (mean, 34 months). All the patients had elevated peripheral blood eosinophilia. Three patients of ocular epithelioid hemangioma were all males with age from 25 to 60 years old. They were all unilateral cases with 1 right eye and 2 left eyes. The disease respectively involved eyelid and orbit, the eyebrow skin and the inner canthus skin. They presented with eyelid swelling, orbital mass or subcutaneous nodule for 5 months to 2 years. All patients (11 eyes) with KD underwent incisional or excisional biopsy. The histopathology revealed follicular hyperplasia of lymphoid tissue with active germinal centers in orbital fibroadipose tissue. There were massive interfollicular eosinophils with eosinophilic microabscesses. Some swelling endothelial cells of proliferating vessels were seen. All the 3 patients (3 eyes) with ocular epithelioid hemangioma underwent excision of the lesions. Histopathological examination showed proliferation of small and medium blood vessels. The vessels were lined by endothelial cells with abundant eosinophilic cytoplasm which protruded into the lumen. The endothelial cells were positive for CD31, factor Ⅷ-related antigen and E26 transformation-specific related gene immunohistochemically. There was a moderate amount of lymphocytes, plasma cells and eosinophils surrounding blood vessels without eosinophilic microabscess. Conclusions: Both ocular KD and epithelioid hemangioma are more commonly seen in males and share the common histopathological features of vascular proliferation, swelling endothelial cells and eosinophilic infiltration. KD is an allergic benign lymphoid tissue proliferation characteristic of massive eosinophilic infiltration, whereas epithelioid hemangioma is a benign neoplasm of blood vessels with plump and epithelioid endothelial cells. (Chin J Ophthalmol, 2021, 57: 689-695).

What's in an Eye?

What's in an Eye?

HL-143: Alarming Signs: Pediatric Lymphadenopathy Is Not Always Benign

<h3>Context</h3> Assessment of lymphadenopathy (LN) in children represents a diagnostic challenge because of the extensive differential diagnoses, including reactive and malignant conditions. <h3>Objective</h3> The present study was carried out to identify different etiologies of LN in children and assess parameters commonly associated with malignancy, with an emphasis on the role of the diagnostic workup. <h3>Design</h3> Four hundred fifty-three patients aged 2–16 years (median 6 years); 58% were males. Study duration was 2 years (2018–2020). They were sorted into neoplastic and non-neoplastic groups. Acute bacterial-related LNs were excluded (n=236), and 217 were enrolled. Of those referred to general pediatrics clinic (n=117), only 1.9% were malignant. Of those referred to pediatric oncology clinic (n=110, 20%) the following diagnosis were reported: leukemia (n=8), lymphoma (n=6), HLH (n=2), collagen (n=3), COVID-19 (n=1), and ALPS (n=2). <h3>Results</h3> Viral infection was the most common; 60% had EBV, and 20% had CMV infection. In only 56 patients, biopsy, whether fine-needle aspiration cytology, core-needle, or excision biopsy, was essential to reach the diagnosis. Affected children were most commonly younger than 8 years. Males were more affected. No difference was found in frequencies of the following symptoms: high temperature, sore throat, dyspnea, and respiratory symptomatology between examined children in both conditions, with differences in gastrointestinal symptoms, eyelid swelling, skin rash, and fatigue. Differences were not proven in the frequency of LN and hepato-splenomegaly between both groups. Odds ratio (4.5) for risk of leukemia (associated fever >1 week, purpura, bone aches, LNs). Generalized, non-regressive, firm, and non-tender were more at risk for non-infection (odds ratio 3.2). Delay in diagnosis was 4–42 days (median 18 days). Most reported investigations were CBC (100%), EB, CMV IgM (66%), ESR (50%), imaging (local ultrasound 80%, one-third repeated at 2 weeks), CT chest or abdomen in 25% (half were unnecessary or non-conclusive), and 10% were CT-guided. <h3>Conclusion</h3> EBV infection was the most common viral infection; leukemia was rare. Alarming signs were bone aches with non-regressive course of the disease. Malignancy should be suspected in the following conditions: generalized multiple LN, LN size >2 cm, blast cells in blood film, and elevated LDH level. In such cases, LN biopsy is recommended.

Re-evaluation of abusive head trauma in Norway appears flawed.

A review by Wester et al in Acta Paediatrica presented 17 adjudicated cases of Norwegian infants with abusive head trauma (AHT).(1) Their interpretation of the medical findings identified alternative diagnoses for 16 of the 17 children and suggested that the injuries were not inflicted and may have been the result of spontaneously occurring events. The authors stated that eight children had clinical and radiological characteristics consistent with external hydrocephalus, complicated by chronic subdural haematoma, and that six had findings compatible with hypoxic-ischaemic insults. Fractures were attributed to prematurity and sequelae from birth trauma. If their interpretations are correct, this study calls for a thorough review of how the medical community, forensic experts and the courts manage AHT cases. However, there are several elements of concern in the Wester et al study that we believe need clarification before a conclusion can be reached.

OCULAR MANIFESTATIONS IN LABORATORY CONFIRMED COVID-19

Background: Scarce literature has been published thus far regarding ocular findings in the COVID-19.&#x0D; Methods: All patients were confirmed by SARS-CoV-2 real-time reverse transcriptase– polymerase chain reaction (RT-PCR) of nasopharynx or oropharynx swab specimens collected at an isolation facility, fever clinic, or hospital unit designated for suspected cases pending confirmation.&#x0D; Results: Overall, 25 patients (25.00%) had various ocular symptoms during COVID-19 infection. Among those with ocular symptoms, 19 patients (76.00%) presented with increased conjunctival discharge, including white mucoid (6 [24.00%]), thin watery (3 [12.00%]) and yellow-green purulent (11 [44.00%]) discharge, and with conjunctival congestion (2 [8.00%]). Other ocular manifestations contained ocular pain (3 [12.00%]), tearing (1 [4.00%]), and eyelid swelling (1 [4.00%]).&#x0D; Conclusion: We concluded that common ocular manifestations were conjunctival discharge, eye rubbing, and conjunctival congestion.&#x0D; Keywords: COVID-19, Ocular, Eye.

Sarcoidosis presenting as bilateral lacrimal gland swelling: a pediatric case report

BackgroundTo describe a case of pediatric sarcoidosis which initially presented as papillary conjunctivitis before manifesting as bilateral lacrimal gland swelling without other known systemic involvement.Case presentationA 10-year-old female presented to the pediatric ophthalmology clinic with complaints of bilateral eyelid swelling, tearing and itching for approximately 1 month. Her history and exam were most consistent with allergic conjunctivitis, for which she was started on a standard topical regimen. Despite initial improvement, she re-presented with significantly worsened eyelid swelling and minimal allergic symptoms. Enlargement of the lacrimal glands were palpable at this time. Lacrimal gland biopsy was obtained which demonstrated noncaseating granulomas. Systemic workup did not reveal evidence of disease involvement elsewhere.ConclusionsSarcoidosis in the pediatric population may present in a myriad of ways and is well-known to mimic other disease entities. We present a case of pediatric sarcoidosis which presented initially as papillary conjunctivitis before manifesting as bilateral lacrimal gland swelling without systemic involvement.

Post-COVID-19 rhino-orbito-cerebral mucormycosis: a new addition to challenges in pandemic control.

ObjectiveTo document and analyse demographic data, clinical presentation, possible interventions for early clinical detection and management of post-COVID-19 rhino-orbito-cerebral mucormycosis (ROCM).Method32 patients having history of SARS-CoV-2 infection with features of ROCM were observed in terms of their history, presenting features, clinical, microbiological examination, type of surgical intervention, surgical sites of involvement which were subsequently analyzed.ResultsThe mean (± S.D.) age of patients was 57 ± 13 years. All patients were diabetic. Mean (± S.D.) time of onset of ROCM symptoms, since onset of COVID-19 symptoms was 18 (± 4) days. 12.5% patients were fully vaccinated. 78.1% patients received steroid therapy; 28.1% received high flow nasal oxygen. 87.5% patients had blurring of vision, 65.62% headache, 59.37% cheek and eyelid swelling, 50% proptosis, 46.87% ophthalmoplegia, 40.62% ptosis, 40.62% loss of sensation over cheek, 25% orbital pain. Examination of specimen with KOH mount revealed Mucor spp. in all patients. 87.5% patients underwent endoscopic sinus surgery with debridement with/without orbital clearance; 56.25% maxillectomy; 25% orbital exenteration. 87.5% patients had paranasal sinus involvement, 43.75% orbit sparing orbital apex, 68.75% orbit with orbital apex. 81.25% patients had involvement of pterygopalatine fossa±infratemporal fossa. 50% patients had disease in Vidian canal and pterygoid wedge. 25% of patients had involvement of palate and 56.25% cheek and eyelid soft tissues.ConclusionA judicious COVID treatment protocol, high index of suspicion, close monitoring of high-risk patients and early institution of treatment can prevent case severity and reduce mortality.

Dacryops and clinical diagnostic challenges

ObjectiveThe study aims to describe the clinical and histopathologic features of different types of dacryops and their clinical diagnostic challenges. MethodsThis is a retrospective cohort study of all surgically excised cases of dacryops in 2 tertiary eye hospitals in Riyadh, Saudi Arabia. ResultsThe study included 58 dacryops specimens from 55 patients with an average age of 41.2 years (range, 4–78 years). The most common location was the upper lid (60.3%), whereas the least expected location was the caruncle (6.9%). The most common site of dacryops occurrence was in the accessory lacrimal gland (55.2%), the main lacrimal gland (32.8%), and then ectopic dacryops (12%). All patients presented with lid swelling alone except for 3 patients who experienced secondary mechanical ptosis. On physical examination, conjunctival scarring existed in 4 patients (6.9%). Preoperative diagnosis of dacryops was accurate in 44.8% of the cases. Dacryops of the main lacrimal gland was accurately diagnosed clinically in all cases compared with other locations, which was statistically significant (p < 0.001). The causes of inaccurate clinical diagnoses were hidrocystoma (26.9%), inclusion cyst (11.5%), and dermoid cyst (7.7%), whereas the remaining cases were diagnosed as cysts without a specific subtype (53.9%). Recurrence of the lesion was observed in 2 cases (3.5%). No clinical or histopathologic factors were associated with a risk of recurrence. ConclusionDacryops can represent a diagnostic challenge to ophthalmologists. Familiarity with clinical presentations and findings is required to diagnose dacryops outside the main lacrimal gland.

Bilateral proptosis: an unusual primary presentation of scurvy\u2014a case report

BackgroundScurvy is a nutritional vitamin C deficiency disease which shows classical signs on radiographs most commonly along long bones with subperiosteal hemorrhage being a classical finding. Primary presentation of scurvy with orbital hemorrhage presenting as proptosis is however uncommon.Case presentationWe report an unusual primary presentation of scurvy in a 4-year-old boy with West syndrome and global developmental delay who presented to the emergency with complaints of bilateral proptosis and eyelid swelling (right > left) which on examination revealed bluish discolouration of bilateral eyelids. On further multimodality imaging investigation, orbital subperiosteal hemorrhages were identified as the cause, along with classical radiographic features of scurvy in bilateral lower limb long bones. The diagnosis was further bolstered by rapid resolution of periorbital ecchymosis after initiating oral vitamin C supplementation.ConclusionTo the best of our knowledge, primary presentation of scurvy in the form of bilateral proptosis due to orbital hemorrhages although uncommon can still be a manifestation of scurvy in addition to the more routinely detected subperiosteal hemorrhages along long bones. The significance of establishing the aetiology in such cases of orbital hemorrhage cannot be overemphasised, in view of drastic clinical recovery after starting vitamin C therapy.

Blindness Secondary to Odontogenic Orbital Cellulitis During the COVID-19 Dental Shutdown.

A 65-year-old man with history of right amblyopia presented with 2 weeks of oral pain leading to progressive midface and eyelid swelling, then 2 days of left eye vision loss. One-week prior, his dentist prescribed oral antibiotics after a telephone consultation; in person, dental examination was not performed due to COVID-19 ordinances. On presentation, visual acuity was 20/400 and no light perception, and intraocular pressures were 14 and 23, in the right and left eyes, respectively. Extraocular motility was severely restricted in all directions bilaterally. External examination demonstrated bilateral eyelid and midface erythema, edema, and desquamation overlying congested orbits (Fig. 1A–C). Posterior segment examination revealed optic disc edema and chorioretinal folds in the right eye (Fig. 1D) and was normal in the left eye. CT maxillofacial demonstrated multifocal, bilateral orbitofacial abscesses, and midface abscesses of the upper alveolar origin (Fig. 2A). CT orbits demonstrated proptosis and tenting of the right globe (Fig. 2B) and left preseptal and postseptal abscesses (Fig. 2C). The patient underwent emergent bilateral orbit and facial abscess drainage. Cultures revealed polymicrobial organisms consistent with oral flora. Intravenous antibiotics further remedied the cellulitis, but visual acuity at 8 weeks of follow-up was 20/150 and no light perception in the right and left eyes, respectively. Optical coherence tomography demonstrated severe retinal nerve fiber layer thinning in the left eye consistent with optic atrophy. This case highlights an indirect ophthalmologic consequence of the COVID-19 pandemic and illustrates the perils of dental management without adequate assessment.FIG. 1.: External photographs demonstrating bilateral eyelid and midface erythema, edema, and desquamation (A) with bilateral bullous conjunctival chemosis and injection (B, C). Right eye fundus photograph demonstrating optic disc edema and chorioretinal folds (D).FIG. 2.: CT maxillofacial demonstrating bilateral orbital cellulitis with midface abscesses of upper alveolar origin (A), right globe tenting (B), and left pre- and post-septal abscesses (C).ACKNOWLEDGMENT We thank the patient for granting permission to publish this case.

Clinical Effect of the Anterior Fascia of Tarsus Tightening Combined With Lower Eyelid Blepharoplasty for Senile Entropion.

A majority of patients with senile entropion have a lower eyelid pouch. This study aimed to explore a modified method to correct the entropion and enhance ophthalmic cosmetology. Patients with senile entropion and lower eyelid pouches, who underwent anterior fascia of tarsus tightening combined with lower eyelid pouch plastic surgery from 2018 to 2019, were enrolled in the study. The data on operation time, postoperative effect, degree of eyelid swelling after surgery, patient satisfaction, and recurrence rate were recorded. The lower eyelid entropion was well corrected in all of the 46 patients after the surgery, and the lower eyelid pouch and saggy skin were satisfactorily repaired. After 1-year follow-up, no recurrence of lower eyelid eversion and ectropion was observed. The shape of the orbital areas was natural in all the patients, the incision scar was hidden, and the patient achieved a high degree of satisfaction. In patients with senile entropion and lower eyelid pouch, anterior tarsal fascia tightening combined with lower eyelid blepharoplasty could not only increase the cure rate and reduce the recurrence rate but also achieve good appearance and improve patient satisfaction.

Новообразование орбиты у пациента с хроническим вирусным гепатитом С с системными проявлениями (клиническое наблюдение)

Aim. To present the case report of orbital tumor in patient with chronic hepatitis C with systemic manifestations, diagnostic and treatment approaches in such patients. Material and methods. We describe a clinical case of 48 y.o. female patient complaining of right-sided upper eyelid swelling and ptosis. According to MRI an orbital tumor was previously visualized in the location of right lacrimal gland. It was known, that the patient suffers from HCV infection since 1992. She was prescribed local and systemic immunosuppressive treatment with a positive effect, however due to hemorrhagic vasculitis development and eyelid swelling recurrence 2 weeks later she was admitted to the hospital. In diagnostic purpose the orbital tumor was surgically excised followed by morphological and immunohistochemical investigation. Results. A differential diagnosis between chronic dacryoadenitis, lymphoid tissue hyperplasia (due to longstanding antigene stimulation (MALT – tissue) and marginal lymphoma (MALT – lymphoma) was performed. Immunohistochemical staining and PET – CT failed to confirm the lymphoproliferative disease. However, in 1 year due to tumor recurrence, repeated biopsy followed by previously described analyses confirmed extranodal marginal zone B-cell lymphoma (MALT – lymphoma). Repeated PET-CT showed metabolic activity in the right orbit and in the location of paraesophageal lymph node. The patient received polychemotherapy inducting lymphoma remission. Conclusion. Current clinical case shows that differential diagnosis of orbital tumors in patients with chronic hepatitis C should include lymphoproliferative diseases. Key words: orbit neoplasm, dacryoadenitis, lymphoma, chronic viral hepatitis C.

Multiple facial candidal abscesses after self-administered acupuncture in a patient with undiagnosed diabetes mellitus: a case report

BackgroundFacial abscess caused by Candida albicans infection is a rare condition even in immunocompromised patients, and only a few cases have been reported. To our knowledge, this is the first case of multiple facial candidal abscesses caused by self-administered acupuncture in an undiagnosed diabetes mellitus patient.Case presentationA 57-year-old woman who had self-acupuncture treatment 2 weeks previously, presented with a 1-week history of progressive left eyelid swelling, erythema, and pain. Despite the antibiotic treatment, the lesion progressed. Surgical incision and drainage was performed and Candida albicans was isolated from the obtained pus culture. The patient was diagnosed with type 2 diabetes mellitus based on a random serum glucose level of 350 mg/dl and 9.2% HbA1c. The abscess resolved after seven incision and drainage cycles and 4 weeks of intravenous fluconazole treatment with an appropriate control of diabetes mellitus.ConclusionUnusual organisms and underlying immunocompromised condition should be suspected in cases of recurrent abscess showing an inadequate response to antibiotic treatment.

Efficacy of a Single Administration of 5% Povidone-Iodine in the Treatment of Adenoviral Conjunctivitis

To evaluate the safety and efficacy of a single, in-office administration of 5% povidone-iodine (PVP-I) compared to artificial tears (AT) for adenoviral conjunctivitis (Ad-Cs). Double-masked pilot randomized trial. Patients presenting with presumed adenoviral conjunctivitis were screened at 9 U.S. clinics. ≥18 years of age, symptoms ≤4 days, and a positive AdenoPlus test. thyroid disease, iodine allergy, recent ocular surgery, and ocular findings inconsistent with early-stage Ad-Cs. Randomization was to a single administration of 5% PVP-I or AT in 1 eye and examinations on days 1-2, 4, 7, 14, and 21 with conjunctival swabs taken at each visit for quantitative polymerase chain reaction. Primary outcome was percent reduction from peak viral load. Secondary outcomes were improvement in clinical signs and symptoms. Of 56 patients randomized, 28 had detectable viral titers at baseline. Day 4 posttreatment, viral titers in the 5% PVP-I and AT groups were 2.5% ± 2.7% and 14.4% ± 10.5% of peak, respectively (P=.020). Severity of participant-reported tearing, lid swelling, and redness as well as clinician-graded mucoid discharge, bulbar redness, and bulbar edema were lower in the 5% PVP-I group than AT group on day 4 (P < .05). After day 4, viral titers and severity of signs and symptoms decreased markedly in both groups and no differences between groups were detected. Pilot data suggest a single, in-office administration of 5% PVP-I could reduce viral load and hasten improvement of clinical signs and symptoms in patients with Ad-Cs.

Transconjunctival Lower Blepharoplasty Using Midcheek Spaces for Orbital Fat Transposition (S.O.F.T.).

The subperiosteum, supraperiosteum, and intrasuborbicularis oculi fat have been used as planes of dissection for orbital fat transposition in transconjunctival lower blepharoplasty. The steep learning curve due to the anatomic complexity in using any of the 3 planes may deter plastic surgeons from performing the procedure. We present the use of clear anatomical midcheek spaces, the premaxillary and prezygomatic spaces, as the plane for orbital fat transposition in transconjunctival lower blepharoplasty. We performed a retrospective study of 184 consecutive patients who underwent transconjunctival orbital fat transposition using the midcheek spaces from November 2013 to July 2019. Recorded data included the patient's age, duration of surgery, postoperative complications (chemosis; bleeding; lower eyelid swelling; orbital and/or lower eyelid infection; eye misalignment on primary gaze; binocular diplopia; numbness involving the lower eyelid, cheek, and upper lip; orbicularis oculi paralysis, inferior scleral show, and lower eyelid ectropion), aesthetic result, and patient satisfaction. The mean age is 35.48 ± 6.66 years. Significant aesthetic improvement was achieved not only for herniated orbital fat and prominent lid-cheek junction but also for midcheek depression over an average follow-up of 22.41 ± 16.04 months. The patient satisfaction score (98.91%) was high. No major complications occurred. The mean operating time was 46.74 ± 6.67 minutes. The natural midcheek spaces could be used as an ideal plane for orbital fat transposition in transconjunctival lower blepharoplasty. By using the midcheek spaces, transconjunctival orbital fat transposition can become a safe and effective technique without the steep learning curve.

Juvenile Dermatomyositis Presenting with Erythematous Swelling of the Upper Eyelid

Juvenile Dermatomyositis Presenting with Erythematous Swelling of the Upper Eyelid

Herpes Simplex Virus-Associated Keratitis.

A 58-year-old woman with a history of diabetes mellitus and hypertension presented to the Emergency Department (ED) with several weeks of right eye irritation, erythema, foreign-body sensation, and mild lid swelling. She gradually developed blurry vision and a watery discharge, which prompted her evaluation. She did not use corrective lenses and could not recall any trauma to the eye prior to symptom onset.