Left Eyelid Research Articles

CICATRICIAL ECTROPION REPAIR DUE TO TRAUMA : A CASE REPORT

Introduction : Cicatricial ectropion is a complication that can occur after trauma. Scar tissue formation causes anterior lamellae shortening (skin and orbicularis muscle), resulting in outward lid margins rotation.
 Case Illustration : A 16 y.o male patient came with complaints of the left upper and lower eyelids folding outwards since 3 months ago after trauma, watery eye. Examination VOD 20/20, VOS 20/50. Scar on the superior and inferior lids, the inferior lid margin is folded out, inferior tarsal conjunctiva is visible, lagophthalmus 4 mm, fissure palpebral vertical (FPV) 12 mm, margin reflex distance (MRD) 1 = 4 mm, MRD2 = 8 mm, fissure palpebral horizontal (FPH) 30 mm, conjunctival injection. Corneal (macular) scars central-peripherally at 3-6 o'clock. Patient was diagnosed with cicatrical ectropion with left eye corneal scar and ectropion repair was performed with full-thickness skin graft from retroarticular. One week and six weeks after surgery, FPV improved to 10 mm, MRD1 = 4, MRD2 = 6 mm, FPH 30 mm, and lagophthalmos 2 mm became 1 mm.
 Discussion : Cicatricial ectropion is usually treated in 3 procedures: release vertical scar traction, horizontal lid tightening, repair anterior lamella can be done with full-thickness skin graft. horizontal lid tightening in this case not carried out because of no laxity.
 Conclusion : Scar traction release and repair anterior lamella with full-thickness skin graft from retroauricular was choice in this case because extensive defect and ectropion grade 3. After surgery anatomical structure of the lids and looks better aesthetically.

Prospective Study on the Surgical Outcome of Eyelid Carcinoma

Abstract
 Introduction & Objectives : Introduction Resection of eyelid carcinoma may lead to a risk of recurrences which might increase if excision was incomplete. Risk factors of incomplete surgical removal and recurrences are deep infiltration, spreading outside the macroscopic border, eye socket penetration, and histological type of the eyelid carcinoma. Objective To evaluate the surgical outcomes of eyelid carcinomas.
 Methods : This is a hospital based prospective observational study involving 16 patients. Prior to the surgery patients were evaluated for visual acuity, intra ocular pressure, extra ocular motility, fundus examination, and local clinical examinations. The eyelid carcinomas were histological detected concerning carcinoma type and margin involvement. Local anesthesia was applied. Patients were evaluated 1 month, 3 months and 6 months after surgery for local complications, patients satisfaction on surgical results, and recurrences. The surgical technic applied in this study were also observed.
 Results : Dominant tumor type were basal cell carcinoma and squamous cell carcinoma (87, 44%). The locations were at right and left lower eyelid with percentage of 68. 7 % and 31. 3 % respectively. All patients satisfied on surgery outcomes (100%). Three patients (6. 25 %) with complications were found within 6 months after the surgery. There were no recurrences during follow up period. Surgery procedures applied were modified hughe’s procedure (56. 25%) and mass excision and reconstruction (43. 75%).
 Conclusion : There was less complications and no recurrences within 6 months after surgery. All patients satisfied with the surgical outcomes.

Customized Prosthetic Management for Post Orbital Exenteration Patient: A Case Report

Introduction : Orbital exenterations are performed to treat malignancies, orbital injury or other chronic conditions unresponsive to conservative therapy. Exenteration can result in depression, difficulties in daily activities, and aesthetic problems. Orbital prosthetic is an alternative therapy for aesthetic rehabilitation and protection of the orbital cavity.
 Case Illustration : A 46-year-old woman came with a chief complain of a black mass on the left lower eyelid ten years ago. Patient was diagnosed with basal cell carcinoma and underwent extirpation of the mass with skin graft reconstruction. On histopathological examination, it was discovered that the incision base was not free of tumor. Patient came two years later with recurrent black mass invaded cornea and sclera, and then underwent exenteration of the left eye (Figure 1). Patient completed 40 cycles of radiotherapy and then used spectacle retained orbital prosthetic (Figure 2 & 3).
 Discussion : Orbital prosthetics are synthetic replacement after exenteration that can restores orbit, eyelid, eye and periorbita anatomy. Orbital prosthetic retention can be aided by attachment to spectacle, use of magnets, adhesives or osseointegrated implants. Spectacle retained orbital prosthetic is the easiest and the most affordable prosthetic to construct.
 Conclusion : Orbital defects rehabilitation improves physical and psychological well-being. Due to the complexity of prosthetic fabrication and production cost, retention of the orbital prosthetic with spectacles is the most suitable alternative treatment option in some cases, it is also the easiest prosthetic to construct and inexpensive.

Challenges in Diagnosing and Initial Treatment of Advanced Eyelid Basal Cell Carcinoma in Rural Area: A Case Report

Introduction : Basal cell carcinoma (BCC) is the most common non-melanoma eyelid cancer with a high risk of recurrence. This case report discusses the management of extensive BCC in a rural setting with limited resources.
 Case Illustration : A 62-year-old Timorese female, presented to the hospital with a mass on the left periocular region. It appeared as a mole in the lower left eyelid and extended to the surrounding tissues over nine years. As a farmer, she was frequently sun-exposed. A blackish mass was found at the left orbit, buccal, and entire nose (8 x 7.5 cm) with an ulcerated surface and attached firmly. The right eye had bedside visual acuity >6/60, with palpebral edema, free eye movement, hyperemia nasal conjunctiva, and transparent cornea. The left eye is difficult to examine. Two submandibular lymphadenopathies were palpated. A Head CT scan showed a suspected malignant soft tissue mass with irregular thickening of soft tissue with ill-defined borders. Histopathology examination revealed a nodulocystic type of basal cell carcinoma.
 Discussion : Locally advanced BCC cases need a multidisciplinary approach. In a limited resources setting, the treatment highlights are histological diagnosis, complete surgical excision, and exenteration with margin control. From a broader perspective, the role of primary health care in educating and revering for early treatment is paramount.
 Conclusion : Prevention and early treatment are the most important factors in managing locally advanced BCC.

RECURRENT CONGENITAL PTOSIS MANAGEMENT BY SUPRAMAXIMAL LEVATOR RESECTION TECHNIQUE

Introduction : Congenital ptosis is an abnormal low position of the eyelid since birth. Levator resection technique is one of the surgery technique for ptosis corection. Recurrence could be occured even after ptosis correction
 Case Illustration : A 22 year old male presented with a chief complaint of droopy left eyelid since birth. Visual aquity were 0,08 pinhole 0,2 and 0,25 pinhole 0,63 respectively. Opthalmology examination revealed interpalpebral fissure (IPF) 4 mm, margin reflex distance (MRD)1 0 mm, MRD2 4 mm and levator function test (LFT) 6 mm on the left eye (Figure 1). Levator resection technique was conducted on his left eye with a good result, MRD1 2 mm, MRD2 5 mm, IPF 7 mm. But the lid dropped again after3 months (Figure 2). Opthalmology examination of the left eye showed IPF 5 mm, MRD1 0 mm, MRD2 5 mm, LFT 2 mm and lagophtalmos 1 mm. Second surgery was done with supramaximal levator resection technique. Good result was achieved after second surgery, MRD1 3 mm, MRD2 5 mm, IPF 8 mm (Figure 3).
 Discussion : Recurrent ptosis could occured after ptosis surgery and had challenges due to scar from previous surgery. Frontal suspension technique was recommended for congenital ptosis levator function less than 4 mm. Supramaximal levator resection was done for this patient, with resection of 30 mm levator muscle, which had result as good as of frontal suspension technique.
 Conclusion : Levator resection technique could be repeated to repair recurrent congenital ptosis. Supramaximal levator resection technique is one of the option.

"Blue Scrub Lid Retraction": Changes in Eyelid Position on the Day of Surgery.

The aim of this study is to test the hypothesis that margin-reflex distance 1 (MRD1) on the day of surgery will be higher than the MRD1 measured at the in-clinic consult visit among patients undergoing blepharoptosis repair due to an increased sympathetic drive. Patients evaluated for involutional blepharoptosis repair were prospectively enrolled over a 12-month period in this single-center, self-controlled study. Three investigators independently determined MRD1 using cropped photos taken of patients at the in-clinic consult visit and on the day of surgery. A difference in height was tested for by using the 2-tailed Wilcoxon signed rank test. Evaluated in this study were 76 eyelids from 38 patients. Over 3-quarters of study participants had a higher MRD1 in the right and OSs on the day of surgery than at their in-clinic consultation visit (p < 0.001). The mean increase in MRD1 for the right eyelid and left eyelid was 1.0 mm (range: 0-3.15 mm) and 1.1 mm (range: 0-2.7 mm), respectively. In patients with involutional blepharoptosis, we conclude that MRD1 is higher on the day of surgery as compared with the in-clinic consult visit. This may be secondary to the stress of surgery and an associated increase in sympathetic drive. In some cases, this change in eyelid position led to resolution of apparent involutional ptosis altogether. Caution should be used when considering deferral of ptosis repair on the basis of exam findings present on the day of surgery.

Successful Multidrug Chemotherapy for Rhabdomyosarcoma in a Seven-Year-Old Girl: A Case Report

The most frequent soft tissue cancer in children is rhabdomyosarcoma (RMS). A diagnosis typically occurs between the ages of 5 and 6 in women. We report a seven-year-old girl was referred to Hospitals with complaints of a protruding left eye. The swelling was presented in July 2021, which was small earlier but has increased and become more prominent. An examination of the left eyelid showed a 2.5 x 2.5 x 1.5 cm solid mass with edema, erythema, and secretion in the superior and inferior affected eyelid. A Head CT scan revealed a left superolateral lacrimal duct tumour with a normal intracerebral structure. The histopathology examination found dacryoadenitis with an RMS tumour. This patient was treated using the RMS multidrug chemotherapy protocol (vincristine, actinomycin, and cyclophosphamide) for three sessions, which decreased tumour progressivity five months later. Early and appropriate treatment of this patient with chemotherapy regimens according to the protocol for RMS has a good prognosis.

Restoring vision after cat bite: a case report on successful diagnostic and therapeutic regimen for Capnocytophaga endophthalmitis

BackgroundCapnocytophaga is a bacterium frequently found in the oral flora of dogs and cats (e.g. Capnocytophaga canimorsus) and humans (e.g. Capnocytophaga gingivalis). Among Capnocytophaga related ocular infections, fulminant endophthalmitis is a rare but sight-threatening clinical manifestation.Case presentationA 35-year-old previously healthy patient presented after a cat bite into the left upper and lower eyelid and nasal part of the conjunctiva of the left eye. At initial consultation, the corrected visual acuity was 0.8 in decimal scale and a detailed clinical examination revealed no evidence of ocular penetration. However, daily follow-up examinations under local therapy revealed a progressive intraocular inflammation, therefore the decision was made to perform a diagnostic vitrectomy with intravitreal and systemic antibiotic treatment. Capnocytophaga felis was detected as the cause of endophthalmitis and the initiated treatment resulted in quick morphological and functional recovery of the left eye. After surgery of secondary cataract, visual acuity improved from hand motion preoperatively to 1.0 postoperatively.ConclusionsEarly recognition as well as prompt and effective treatment of animal bite associated endophthalmitis is essential for good visual recovery and functional outcome. Furthermore, this case highlights the importance of daily follow-up examinations, even in the absence of signs of ocular penetration and intraocular inflammation, to enable prompt and effective treatment initiation. Given the negative results in bacterial culture, we additionally emphasize the value of sequencing-based microbiological diagnostics in unclear cases.

Standardization of meibomian gland dysfunction in an Egyptian population sample using a non-contact meibography technique.

To develop normative data for meibomian gland dysfunction (MGD) parameters, using non-contact meibography technique of Sirius Costruzione Strumenti Oftalmici (CSO) machine, in an Egyptian population sample. Observational, cross-sectional, analytic study, in which 104 Egyptian volunteers were included. Both upper lids were examined, using "Sirius CSO" machine. Each eyelid was given a degree of meibomian gland loss (MGL), which was calculated by the software of the machine. Mean percentage MGL in right upper lid was of 30.9%±12.6%, and that of left upper lid was 32.6%±11.8%. Thirty-four volunteers (32.7%) had first-degree MGL in their right upper lid, and 67.3% had second-degree loss. One volunteer (1%) had zero-degree MGL in left upper lid, 28 (26.9%) had first-degree loss, and 75 (72.1%) had second-degree loss. Degree of MGL in right upper eyelid was not related to age, but degree of MGL in left upper eyelid increased with age. There was statistically significant difference between both genders for degree of MGL in right eye (P=0.036) and in left eye (P=0.027). Noncontact meibography is a useful non-invasive tool for diagnosing MGL. MGL is diagnosed in 100% of apparently normal individuals; 26.9%-32.7% of which have first-degree MGL, and 67.3%-72.1% have second-degree MGL.

Apocrine Hidrocystoma- A Histological Diagnosis

An Asian female in her 20s, presented with a painless swelling in the left upper eyelid for 2 years. A cystic, non-tender, well defined swelling of 3 by 4 mm with a punctum was seen in the medial aspect of left upper eyelid. Best corrected visual acuity was 20/20 in both eyes, with anterior and posterior segment examination within normal limits in both eyes. Provisional diagnosis of Sebaceous cyst was made, excision of cyst was planned for cosmetic indication. Cyst removal in toto was done and sent for histopathological examination. HPE report was awaited and came the surprise report - APOCRINE HIDROCYSTOMA, a rare, benign, cystic tumor of the apocrine sweat glands. Since surgical excision is the treatment option for apocrine hidrocystoma, patient was informed of the same and reassured. The diagnosis is histological and hence apocrine hidrocystoma must be kept in mind while considering differential diagnosis of cystic lesions in ocular adnexa.

Recurrent Squamous Cell Carcinoma of the Upper Eyelid Treated With Combination Therapy of ALA Photodynamic Therapy and Surgery With Secondary Healing

Background. Cutaneous squamous cell carcinoma (cSCC) frequently occurs in photoexposed areas. Surgery remains the mainstay of treatment in attempts to reduce recurrence, but it must be combined with other therapy because of the limited excision possible in the region of the eyelid, lip, and nose. Photodynamic therapy (PDT) is a relatively new treatment modality that involves the administration of a photosensitizing drug and its subsequent activation by specific wavelengths of light to produce reactive oxygen species that specifically destroy target cells. Case Report. An 87-year-old female presented 4 weeks after initial resection with recurrent medium-differentiated cSCC measuring 5.2 cm × 3 cm × 2 cm in the left upper eyelid. Subsequent treatment involved palliative resection with an additional 1 cm at 3 margins of the tumor (excluding the bottom edge of the double eyelid line) and 3 applications of PDT using 5-aminolevulinic acid as the photosynthesizing agent in the open wound over a 2-week period. The wound healed well within 6 weeks. During the following 4 years, the patient showed satisfactory progress in both aesthetics and function, with no sign of recurrence or metastasis. Conclusion. Refractory cSCC was successfully managed using a combination of PDT and secondary healing, and functions of the head and face were well protected. These results suggest that such management warrants consideration in clinical settings.

Neurofibroma orbitofacial espontâneo em uma matriz suína

ABSTRACT: Neurofibromas are neoplasms derived from nerve bundles and are frequent in humans but not common in animals. This report described the macroscopic, histologic, and immunohistochemistry findings of an orbitofacial neurofibroma in a sow. The sow presented left eyelids with marked expansion, associated with severe ectropion and reddening of both conjunctival mucosae. The mass on the cutting surface was homogeneous, with a light tan, and shiny, measuring 9.0 x 7.0 x 7.0 cm in width, compressing the eyeball. Microscopically, there was paucicellular neoplastic proliferation of elongated cells amid the accentuated myxoid matrix. There were multifocal areas where well-differentiated nervous fascicles and skeletal musculature were seen. Neoplastic cells were immunostained positive for GFAP, neurofilament, S-100, Sox-10, and vimentin. Cytokeratin showed immunolabeling around primitive nerve bundles and desmin around neoformed vessels and muscle bundles within the tumor. Orbitopalpebral and orbitofacial neurofibroma, despite being common in humans, have not been described in domestic pigs and should be considered as a differential diagnosis in eyelid tumors in pigs.

Solitary Sclerosis Presenting as Progressive Brainstem Symptoms

A woman in her 30s, presented with left facial weakness, left eyelid droop, left gaze diplopia as well as right facial and upper limb numbness; which progressively worsened over 1 month. She also developed dizziness, dysphonia, dysphagia, and an imbalanced gait. On exam, she had hoarseness, dysarthria, anisocoria; left pupil miosis, left eyelid ptosis, left gaze diplopia, left lower face weakness, deviation of the palate and uvula towards the left side, right eye nystagmus, right sided facial numbness, right upper limb numbness, right dysmetria, brisk reflexes all-over and an unsteady gait. The work up was positive for OCBs in the CSF analysis and MRI brain revealed a single progressive left medulla oblongata and left cerebellar peduncle hyperintensity lesion.

Unilateral Periorbital Necrotizing Fasciitis – A Case Report

IntroductionPeriorbital necrotizing fasciitis is rare due to the excellent blood supply to the area, but nevertheless can sometimes lead to death. Knowledge of the symptoms of the disease enables rapid diagnosis, which reduces the possibility of serious complications of the disease and its mortality. To date, few publications describing the disease entity have been presented.Patient descriptionA 70-year-old male patient was admitted to the hospital with necrotizing fasciitis of the left upper eyelid region, diagnosed on the basis of fulminant development of necrosis and a positive bacteriological test for S. pyogenes.ResultsContrast-enhanced computed tomography showed the presence of a pathological inflammatory infiltrate within the eyelid of the left eye and subcutaneous tissue at the preseptal level of the orbit and left cheek. Blood tests showed leukocytosis (total white blood cell count of 17.33 x 109/ L with 87.1% neutrophils) and elevated C reactive protein parameters (240.64 mg/ L). Empirical intravenous antibiotic therapy was administered: 1 g of amoxicillin with 200 mg of clavulanic acid every 8 hours, 500 mg of metronidazole every 8 hours, and ciprofloxacin into the left and right conjunctival sacs 3 mg/ml every 6 hours. Surgical debridement of upper eyelid necrosis was performed on the second day of hospitalization.ConclusionsThe peculiar anatomical structure of the periocular region promotes the dynamic development of necrotizing fasciitis. The close proximity of the central nervous system and the eyeball threatens irreversible consequences, including loss of vision or death. Early appropriate targeted treatment can effectively stop the development of the disease and prevent severe complications.

Compressive Optic Neuropathy (CON) Secondary to Inflammatory Polyp Mimicking Lymphoma: A Rare Manifestation

Introduction: Compressive optic neuropathy (CON) is the impairment of optic nerve function by space-occupying lesions that mechanically compress the optic nerve or optic tract. CON can arise from either intrinsic or extrinsic compression, and determining the underlying cause is important to approach the correct management. The objective of this case report is to present a rare case of CON secondary to an inflammatory polyp that mimicking lymphoma. Case Presentation: A 68-year-old male patient came to the neuro-ophthalmology clinic with a chief complaint of blurry vision in his left eye since three months ago that was getting worse until he lost his vision accompanied by drooping of the upper left eyelid. He also felt pain in his left eye, nausea, vomiting, and headache. Visual acuity of the right eye was 5/5 and the left eye had no light perception. Ocular motility of the left eye was restricted in all gaze. The pupil was 6 mm with no light reflex, and edema in the optic nerve head in the left eye was found from the posterior segment. The patient's MRI showed soft tissue thickening on the left orbital apex – left optic canal – left anterior cavernous sinus and enlargement of left medial rectus muscle with encasement of the left optic nerve, and from post-contrast showed contrast enhancement that suggested a lymphoma. He was diagnosed with CON secondary to lymphoma and was given Methylprednisolone 32 mg three times a day orally. Conclusions: Several differential diagnoses resemble the findings of CON secondary to inflammatory polyp. Some diagnostic examination must be done to exclude the other diagnosis to give a proper treatment for the patient.

Unilateral Horner syndrome and trigeminal palsy after lumbar epidural analgesia during labor

Case report: The present case report explains a rare and unusual complication of self-limiting unilateral Horner syndrome and trigeminal palsy after Lumbar Epidural analgesia for Normal delivery. A 22-year-old healthy primigravida at 38 weeks gestation, with an unremarkable medical history and prenatal course, was admitted to the hospital in active labor. Epidural anesthesia was administered during the first stage of labor under oxytocin infusion. The procedure was uneventful, with the patient experiencing good pain relief and no motor block. However, approximately 25 minutes after epidural placement, the patient reported left eyelid heaviness, decreased sensation on the left cheek, miosis, ptosis, and redness in the left eye. Neurologic symptoms were limited to this presentation, and the patient's blood pressure dropped briefly but returned to normal with ephedrine. The patient's symptoms resolved after about 3 hours. Later, the epidural catheter was repositioned, and the patient experienced pain relief for a limited time before again developing eye symptoms. Despite stable hemodynamics, the infusion was stopped, and the patient received Entonox for pain relief. Due to a failure to progress, a cesarean delivery was performed, and the patient fully recovered from the epidural block. No further signs or symptoms of Horner's syndrome or trigeminal nerve palsy were observed postoperatively. Conclusion: This case underscores the importance of recognizing and managing rare neurological complications, such as Horner's syndrome and trigeminal nerve palsy, in the context of epidural anesthesia during labor. While the symptoms observed were transient and resolved postpartum, healthcare providers should remain vigilant and ready to respond to such adverse events, ensuring the safety and well-being of both the mother and the newborn.

Remote Blood Hemoglobin Monitoring with Hyperspectral Color Truthing for Advancing Sickle Cell Care

Introduction: An urgent need exists for a noninvasive telemedicine approach to alleviate the burdensome reliance on frequent invasive blood draws for monitoring blood hemoglobin (Hgb) levels in sickle cell disease (SCD) patients. SCD is the most common genetic blood disorder, impacting over 20 million people worldwide, resulting in frequent emergency healthcare use. A blood Hgb level is pivotal in managing SCD and understanding the pathophysiology of SCD including anemia. Even low blood Hgb levels may indicate painful vaso-occlusion crises (Blood 2021;137:2010). Thus, a remote noninvasive monitoring ability of blood Hgb in at-home settings can potentially enhance SCD management without iatrogenic blood loss. Advanced machine learning and spectroscopic analyses can enable digital colorimetric diagnostics for noninvasive blood Hgb quantification with high fidelity, empowering SCD patients. However, one of the key challenges in diagnostic photography is that clinical photos exhibit significant variations in colors, depending on devices, light conditions, and image file formats, hampering reliable colorimetric diagnostics. Methods: We have developed colorimetric analyses of peripheral tissue perfusion to offer remote monitoring and cost-effective blood Hgb readings for SCD patients. A specially designed diagnostic color reference chart, which is highly sensitive to blood Hgb and peripheral perfusion, allowed us to noninvasively predict blood Hgb levels from digital photos of the palpebral conjunctiva (inner eyelid) across diverse smartphone models, light conditions, and file formats. Specifically, a pilot human study of fifteen SCD patients aged 14 to 73 years generated 156 photos from both left and right eyelids juxtaposed with the diagnostic color reference chart, using Samsung Galaxy S21 and Apple iPhone 12 Pro, taken immediately before or after blood draws. Combining a blood Hgb computation (Optica 2020;7:563), blood Hgb levels were computed involving three primary machine learning algorithms (Figure 1): color recovery of the palpebral conjunctiva, hyperspectral learning to reconstruct a spectrum, and spectroscopic blood Hgb quantification. Results: Using our specially designed color chart (Figure 2a), the linear correlation between the computed blood Hgb levels and venous blood Hgb levels shows a high correlation coefficient of 0.88 and 0.81 for Samsung Galaxy S21 and Apple iPhone 12 Pro, respectively. The Bland-Altman plot as a non-parametric statistical method reveal that the 95% limits of agreement (95% LOA) are [-2.68, 2.10 g dL -1] and [-2.74, 3.19 g dL -1] for the two smartphone models. Conversely, when using a conventional color chart for general photography (Macbeth ColorChecker) (Figure 2b), the computed blood Hgb levels exhibit a low accuracy for both Samsung Galaxy S21 (correlation coefficient of 0.69, 95% LOA = [-5.05, 2.60 g dL -1]) and Apple iPhone 12 Pro (correlation coefficient of 0.57, 95% LOA = [-5.14, 5.87 g dL -1]). Conclusion: This study supports the feasibility of noninvasive blood Hgb assessments as colorimetric diagnostics for SCD patients in telemedical settings. The results correlate significantly with conventional laboratory tests based on venous blood draws and are highly comparable to capillary blood sampling (finger prick) tests (Respiratory Care 2019;64:1343). This study lays the foundation for realizing color accuracy in biological tissue for digital diagnostic colorimetric applications of blood Hgb.The proposed color accuracy-based digital health technology can potentially offer accessible, affordable, and reliable blood Hgb readings via smartphones in at-home or telemedicine settings.

Listeria monocytogenes encephalitis in a donkey foal

SummaryThis is the first known case report of encephalitic listeriosis in a donkey (Equus asinus). A 5‐day‐old female donkey foal presented for fever, progressive weakness and loss of suckle reflex. Upon arrival, its vital parameters were normal, but the foal was collapsed. It had horizontal nystagmus, front limb paddling, minimal response to stimuli, prolapse of the left third eyelid and curling the neck to the left when in sternal recumbency. Samples collected for diagnostic evaluation included blood and cerebral spinal fluid. The cerebrospinal fluid (CSF) showed a pleocytosis consisting mainly of nondegenerative neutrophils and a normal protein concentration. Bacteria were not seen on Gram stain. After 24 h of treatment with intravenous fluids, anti‐inflammatories, antibiotics, nasogastric feedings of the dam's milk and supplemental nasal oxygen, little improvement was observed and the owners elected to euthanise the foal. Post‐mortem examination revealed multifocal, irregularly distributed hepatic necrosis and multifocal lymphohistiocytic encephalitis. Listeria monocytogenes was isolated from a section of brainstem.

Transient Postinflammatory Hyperpigmentation Following Eyelid Surgery.

The authors' aim was to describe a rare mild complication of eyelid surgery presenting as transient hyperpigmentation along the suture lines. A retrospective case series of 6 patients experiencing transient hyperpigmentation following eyelid surgery. Each patient underwent either blepharoplasty alone or blepharoplasty with ptosis repair utilizing Müller muscle conjunctival resection. Data including surgery type, hyperpigmentation laterality and location, time to diagnosis, follow-up time, and outcome were assessed. All 6 patients with hyperpigmentation were females. All patients underwent blepharoplasty, including 1 upper eyelid blepharoplasty and 4 with both upper and lower eyelid blepharoplasty. One patient underwent bilateral upper blepharoplasty with concurrent posterior approach ptosis surgery repair of the left upper eyelid. Hyperpigmentation was bilateral in all 5 blepharoplasty cases and unilateral in the ptosis repair case. Hyperpigmentation included the medial portion of the operated upper eyelid in all cases. Time to diagnosis ranged from 1 to 4 weeks postoperatively, and follow-up time ranged from 3 to 5 months. Management was conservative in all cases. Five patients experienced complete resolution, and 1 patient experienced near-complete resolution on a 3-month follow-up. Transient hyperpigmentation is a rare posteyelid surgery complication, generally with an excellent outcome not requiring additional intervention.

A Case of Orbital Infarction Syndrome in a Patient with Hemophagocytic Lymphohistiocytosis

Purpose: To report a case of orbital infarction syndrome in a patient with hemophagocytic lymphohistiocytosis (HLH).Case summary: A 70-year-old woman with diabetes mellitus and hypertension was referred to the Department of Ophthalmology for sudden-onset left upper eyelid ptosis after being diagnosed with HLH. After 3 days, the best corrected visual acuity in the right eye was 0.8, while there was no light perception in the left eye. In the left eye, the ocular motility examination showed limitations in all fields of gaze. On fundus examination, optic disc pallor, retinal hemorrhage, and narrowed retinal arteries were observed in the left eye. Fluorescein angiography showed no blood flow in the retinal arteries and veins in the left eye. On neck computed tomography angiography, the left distal internal carotid artery was narrowed. Orbit computed tomography showed exophthalmos and extraocular muscle hypertrophy in the left eye. Orbit magnetic resonance imaging confirmed optic nerve edema, enhancement of the optic nerve sheath, and high signal intensity of the intraocular fat in the left eye. Slit-lamp examination revealed ischemia of the anterior segment and ischemic necrosis of the eyelid in the left eye. The patient was diagnosed with orbital infarction syndrome.Conclusions: Several factors may lead to ischemia of the orbital tissues in patients with HLH, including coagulopathy, an increased incidence of blood clots, and inflammation in the orbit. It is necessary to consider the possibility of orbital infarction syndrome when HLH patients present with visual loss, ocular movement limitations, and anterior segment ischemia.