Limitation Of Extraocular Movements Research Articles

AN UNUSUAL PRESENTATION OF ORBITAL PSEUDOTUMOR

The term orbital pseudotumor refers to a broad category of non-specic idiopathic inammations of the orbit, which may affect any orbital structure. A 28-year-old female presented with swelling in the right upper eyelid for 1 month associated with pain and mild redness of the eye. She was previously been seen by other ophthalmologists and diagnosed as Hordeolum Internum prescribed oral antibiotics and advised incision and drainage. She visited our OPD for secondary opinion and surgical treatment. Best Corrected Visual Acuity- R/E- 6/9, LE -6/6P. No Proptosis. No Limitation of Extra Ocular Movements. Considering the clinical presentation of the patient Computed Tomography orbit was advised, revealed abnormal soft tissue density in lateral aspect of right orbit within extraconal compartment suggestive of Orbital Pseudotumor. The patient was started on oral steroids and had a favourable outcome with no recurrence till date.

Management of unilateral ocular myasthenia gravis through Ayurveda therapies

Myasthenia gravis (MG) is a serious but treatable autoimmune condition characterized by muscle fatigue and weakness. Ocular MG is characterized by muscle weakness isolated to the eyelids and extraocular muscles. Unilateral ocular MG refers to a condition in which only one eye shows the cardinal features of ptosis and the restriction of extraocular movement. The management of ocular MG is mainly symptomatic and is aimed at curing muscle weakness. The closest approximation of ocular MG in Ayurveda is Vatahata Vartma, an incurable eyelid disease. A case of a 40-year-old man who was diagnosed with unilateral ocular MG and treated with Ayurveda interventions is presented here. In this case, the evaluation of the severity of ptosis revealed a 4 mm of ptosis in the right eye and 2 mm in the left eye; margin reflex distance of 1 mm in the right eye and 4 mm in the left eye; and a levator palpebrae superioris function of 2 mm in the right eye and 12 mm in the left eye. The absence of adduction, intorsion, and extorsion was noted in the right eye, whereas movements were normal in the left eye. Cogan’s sign and eyelid fatigue were present in the right eye and absent in the left eye. The patient underwent two courses of Ayurveda inpatient treatments with regular follow-ups in between. The treatment course included oral interventions (herbal decoctions, oils, and tablets), bio-purification therapies (nasal medication, the retention of medicine in the mouth), sudation (Nadi Sveda, Pinda Sveda), and external therapies for the eyes and head (ocular irrigation, massage, eye drops, irrigation over the head, the application of medicated paste over the head), along with lifestyle modifications. The Ayurveda treatment protocol was found effective in reducing the ptosis and improving the ocular movements. The relapse of the ptosis was observed after the discontinuation of the treatment. A long-term regular treatment strategy with regular inpatient therapies can improve the disease outcomes, despite not being able to produce a complete relief owing to the autoimmune nature of the disease.

Paediatric Supraorbital Mass: A Case of Langerhans Cell Histiocytosis

This is a case of 2-year-old boy who presented with painless right supraorbital swelling for 2 weeks. He had history of left humerus fracture and multiple scalp swelling. Examination revealed a hard, non-tender mass over right upper eye lid with downward placement of eye globe and limitation of extraocular muscle movement upon upward gaze. Systemic examination was unremarkable. MRI brain and orbit showed avid enhancing mass arising from right orbital roof. Histopathological examination of left humerus trucut biopsy revealed focal aggregation of histiocytes with scattered eosinophils. The diagnosis of LCH was further confirmed by positive CD1a and S100 protein staining on immunohistochemical studies. He was referred to oncology department for initiation of chemotherapy. Significant improvement was seen after the first cycle of chemotherapy. Keywords: Langerhans cell histiocytosis, supraorbital swelling

Late-onset retinoblastoma camouflaged with proven chronic uveitis: A case report

A rare case of a 16year old female, diagnosed elsewhere as chronic uveitis in the left eye positive antinuclear antibodies and Anti-SSA antibodies, treated with steroids and referred for cyclocryotherapy for a painful blind eye. On examination, the patient denied perception of light. There was proptosis, limitation of extraocular movements and corneal melting with no view of the posterior segment. Ultrasound B scan showed dense vitritis with doubtful specks of calcification. Magnetic resonance imaging revealed a soft tissue mass obliterating the vitreous and anterior chamber with retroscleral extension and involvement of the optic nerve. Extended enucleation was performed under General anaesthesia. Histopathological examination confirmed a well differentiated retinoblastoma with extrascleral and optic nerve involvement. Metastatic work up was normal. Intravenous Chemotherapy and post surgery radiotherapy to the socket was advised for further management. Late onset retinoblastoma mimicking ocular inflammation with positive antibody serology is rare and the report shows the need for imaging in refractory uveitis.

As the virus sowed, the fungus reaped! A comparative analysis of the clinico-epidemiological characteristics of rhino-orbital mucormycosis before and during COVID-19 pandemic.

BackgroundThe sudden surge of mucormycosis cases which happened during the second wave of COVID‐19 pandemic was a significant public health problem in India.ObjectivesThe aim of this study was to analyse the clinico‐epidemicological characteristics of the mucormycosis cases to determine the changes that had occurred due to COVID‐19 pandemic.MethodologyA retrospective cross‐sectional study was conducted at the Department of Otolaryngology Head and Neck Surgery, PGIMER, Chandigarh, India. Patients diagnosed with rhino‐orbital mucormycosis were categorised into the following groups: Pre‐pandemic(May 2019 to April 2020), Pandemic Pre‐epidemic (May 2020 to April 2021) and Epidemic (1 May 2021 to 12 July 2021). The epidemiological, clinical and surgical data of all the patients were retrieved from the hospital records and analysed.ResultsThe epidemic period had 370 cases, compared with 65 during pandemic period and 42 in the pre‐pandemic period. Diabetes mellitus was seen in 87% of cases during epidemic period, 92.9% in the pre‐pandemic period and 90.8% in the pre‐pandemic pre‐epidemic period. The proportion of patients suffering from vision loss, restricted extra‐ocular movements, palatal ulcer and nasal obstruction was higher in the pre‐epidemic groups, and the difference was significant (p, <.01). There was no history of oxygen use in 85.9% of patients and no steroid use in 76.5%. The death rates were the lowest during epidemic (10%).ConclusionCOVID‐19 has caused a statistically significant increase in the number of mucormycosis infections. The mortality and morbidity which showed an increase during the first wave of COVID‐19 decreased significantly during the epidemic period.

Thyroid eye disease with concurrent orbital lymphoma: a radiological surprise.

SummaryThyroid eye disease (TED) is the most common extra-thyroidal manifestation in Graves’ disease (GD). Additional/concurrent/synchronous pathologies may be present, especially in elderly patients who present with atypical features such as non-axial (or eccentric) proptosis, absence of lid lag and restricted superior extra-ocular movements. A 70-year-old female presented with progressive proptosis of her left eye and diplopia. She was diagnosed with GD a year prior and initiated on carbimazole. On examination, she had eccentric proptosis, restricted superior extra-ocular movements and a palpable mass in the supero-temporal quadrant of the left eye. Her T3 (1.33 ng/mL) and T4 (8.85 µg/dL) were normal with carbimazole. Thyroid-stimulating hormone (TSH)-receptor antibody was positive (3.15 IU/L, reference range <1.75). MRI revealed an enhancing lesion infiltrating the left superior rectus, with concurrent characteristic muscle belly involvement bilaterally. Orbital biopsy showed atypical lymphoid cells (CD20+), suggesting marginal zone lymphoma. CT thorax and abdomen, fluorodeoxyglucose-positron emission tomography and bone marrow examination were normal. The patient was administered orbital radiotherapy for her localised lymphoma and carbimazole was continued. TED is the most common cause of orbital involvement overall and in GD. However, additional or alternative pathology may be present which requires evaluation. MRI can be a useful adjunct in these patients. Orbital lymphoma needs to be staged with workup for disseminated disease. Radiotherapy is the treatment of choice for localized disease. The index case provides evidence for synchronous presentation of dual pathology and highlights the importance of astute clinical examination as well as keeps a low threshold for MRI in selected cases.Learning pointsThyroid eye disease can co-exist with other ocular pathology, especially in elderly individuals.Eccentric proptosis, absent lid lag and restriction of eye movements (suggesting tendon involvement) should alert towards the presence of alternative pathology.Orbital imaging using MRI not only has greater sensitivity in diagnosing radiologically bilateral disease in patients who have unilateral involvement clinically but is also useful to identify concurrent neoplasms.

Radiological analysis of orbital lymphoma histological subtypes

ABSTRACT Purpose To characterise the radiological features of orbital lymphoma subtypes Methods This was a multicentre, retrospective study to analyse radiological and clinical characteristics of orbital lymphoma by histological subtype across two sites within Australia and the United States. Results A total of eighty-eight patients were included. The most common subtypes were extranodal marginal zone lymphoma [EMZL] (48, 54.5%), follicular lymphoma [FL] (16, 18.2%), and diffuse large B-cell lymphoma [DLBCL] (15, 17.0%). Clinically, significant associations were found between DLBCL and vision change (p < .01), pain (p < .01), extraocular movement limitation (p = .01), and optic neuropathy (p = .01). Radiologically, there was no significant difference between the individual histopathological sub-groups with respect to bone destruction (p = .30), optic nerve involvement (p = .30) and diffuse appearance (p = .84). However, if categorised as either aggressive or indolent, aggressive lymphoma subtypes were significantly more likely to demonstrate globe indentation radiologically than indolent subtypes (Odds Ratio = 5.5, 95% CI: 1.3, 23.3; p = .02). Conclusions DLBCL was significantly associated with vision change, pain, extraocular movement limitation and optic neuropathy clinically. Aggressive lymphoma subtypes were significantly more likely to demonstrate globe indentation radiologically. Otherwise, there were no significant differences between lymphoma subtypes and radiological findings on MRI and CT.

Ocular Manifestations, Visual Field Pattern, and Visual Field Test Performance in Traumatic Brain Injury and Stroke.

Purpose To analyze ocular manifestations, visual field (VF) pattern, and VF test performance in traumatic brain injury (TBI) and stroke patients. Methods This retrospective, cross-sectional study included 118 patients (236 eyes) with TBI and stroke who had undergone VF testing by standard automated perimetry with the central 24-2 threshold test. Clinical features including best-corrected visual acuity (BCVA), intraocular pressure (IOP), ocular manifestations, and VF test results including VF defect pattern, reliability, and global indices were analyzed and compared between the TBI and stroke patients. Results In TBI patients, ocular manifestations included strabismus (11.1%), cataract (4.2%), and glaucoma suspect (2.8%), whereas in stroke patients, cataract (15.2%), strabismus (8.5%), diabetic retinopathy (4.9%), extraocular movement (EOM) limitation (3.0%), glaucoma suspect (3.0%), nystagmus (2.4%), drusen (1.2%), and vitreous hemorrhage (1.2%) were found. The VF test results showed that 47 eyes (85.5%) in TBI and 86 (65.2%) in stroke had VF defect; in TBI, the scattered pattern was the most common (56.4%), followed by homonymous hemianopsia (14.5%), homonymous quadrantanopia (10.9%), and total defect (3.6%), whereas in stroke, homonymous hemianopsia was the most common (31.8%), followed by scattered pattern (16.7%), homonymous quadrantanopia (12.1%), and total defect (4.5%). Only 15 eyes (27.3%) in TBI and 32 (24.2%) in stroke showed reliable VF indices. The mean deviation (MD) was −10.5 ± 7.1 dB in TBI and −9.5 ± 6.8 dB in stroke, and the pattern standard deviation (PSD) was 4.9 ± 3.3 dB in TBI and 6.1 ± 3.9 dB in stroke, without statistically significant differences between the two groups. Conclusion Various ocular manifestations were found, and a considerable proportion of patients were experiencing VF defects and showed unreliable VF test performance. Our findings suggest that accurate evaluation and rehabilitation of visual function should be a matter of greater concern and emphasis in the management of TBI and stroke patients, besides systemic diseases.

Orbital Cholesterol Granuloma: A Rare Case Report

Orbital cholesterol granuloma is a rare entity which can cause proptosis, diplopia and extraocular movement restriction. It is often mistaken for other entities such as epidermoid, dermoid cysts and lacrimal gland tumours. Here authors report a case of a 36- year-old male who presented with proptosis of right eye and diplopia on upward gaze. Computed Tomography (CT) scan showed an extraconal lesion in superotemporal compartment of right orbit with erosion of bony wall. On imaging findings, epidermoid and dermoid cysts were considered as probable diagnoses. On histology, the lesion showed cholesterol clefts, foamy and haemosiderin laden macrophages and foreign body giant cells. Lesion was diagnosed as cholesterol granuloma. While being very rare at this site, this lesion carries a good prognosis with complete surgical excision. Patient showed marked postoperative improvement and was asymptomatic at discharge.

To study the clinical course of rhino orbital mucormycosis in post COVID-19 patients: A case series

Rhino orbital cerebral mucormycosis is an opportunistic fungal infection with high morbidity and mortality which has seen the rise during the second wave of covid 19 in our country. Aim of our study was to study the clinical course, diagnosis and management of patient of rhino orbital mucormycosis in post covid phase presenting at our tertiary care centre. 4 cases of rhino-orbital mucormycosis who presented to us in post covid phase was followed and details recorded and analyzed to study its clinical course, diagnosis and management. 4 patients presented to us in post covid phase with signs of orbital cellulitis like periorbital swelling with pain, drooping of eyelids, proptosis, restriction of extraocular movements, decrease and loss of vision and sluggish reacting pupil. MRI/CT of the patients showed intraconal and extraconal involvement suggestive of orbital cellulitis. Diagnostic Nasal Endoscopy (DNE) was done and tissue sent for KOH mounting, culture and histopathology. After KOH mount showed fungal hyphae, patients were started on IV liposomal amphotericin B and retrobulbar amphotericin B. Patients were then taken up for endoscopic debridement and significant improvement in proptosis, ptosis, peribulbar swelling and pain was seen in immediate post op period. significant improvement was seen in patients with IV amphotericin B, retrobulbar amphotericin B and endoscopic debridement. Patients with rhino orbital mucormycosis can be managed with amphotericin and endoscopic debridement when exenteration is not possible.

Orbital lymphangioma: A rare case report

A 16 year old female resident of Arunachal Pradesh presented with the complaints of forward bulging of left eye for 1 year and diminution of vision since 4 months with V/A 6/6 in right eye and 4/60 in left eye. On examination, abaxial proptosis of around 15mm with inferior dystopia was present in left eye with restriction of extraocular movements in all directions. Fundus examination revealed clear media with blurring of disc margin alongdioptre. CT Scan oupto the orbital apex causing displacement of extraocular muscles and optic nerve that was found to be lymphangioma of orbit. She recievedintralesionalBleomycin alongin vision and regression of the tumor.

COVID-19 associated rhino-orbital-cerebral mucormycosis: An observational study from Eastern India, with special emphasis on neurological spectrum

Aims: 1Describe the epidemiology and determine risk factors for COVID-19 associated mucormycosis. 2Elaborate the clinical spectrum of Rhino-Orbital-Cerebral Mucormycosis (ROCM), pattern of neuroaxis involvement and it's radiological correlates. MethodsObservational study. Consecutive, confirmed cases of mucormycosis (N = 55) were included. A case of mucormycosis was defined as one who had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological examination (HPE). Data pertaining to epidemiology, risk factors, clinico-radiological features were analysed using percentage of total cases. ResultsMiddle aged, diabetic males with recent COVID-19 infection were most affected. New onset upper jaw toothache was a striking observation in several cases. Among neurological manifestations headache, proptosis, vision loss, extraocular movement restriction; cavernous sinus, meningeal and parenchymal involvement were common. Stroke in ROCM followed a definitive pattern with watershed infarction. ConclusionsNew onset upper jaw toothache and loosening of teeth should prompt an immediate search for mucormycosis in backdrop of diabetic patients with recent COVID-19 disease, aiding earlier diagnosis and treatment initiation. Neuroaxis involvement was characterized by a multitude of features pertaining to involvement of optic nerve, extraocular muscles, meninges, brain parenchyma and internal carotid artery.

Clinical Factors Affecting Recovery Periods of Vascular and Idiopathic Acquired Paralytic Strabismus

Purpose: Clinical factors affecting the recovery period in patients with vascular or idiopathic paralytic strabismus were evaluated.Methods: This study involved a retrospective review of medical records of patients diagnosed with vascular and idiopathic acquired paralytic strabismus. Vascular paralysis was defined in cases of hypertension, diabetes mellitus, or cardiovascular disease. The angle of deviation and limitation of extraocular movement were evaluated at each visit. Recovery was defined as the absence of diplopia and complete resolution of limitation of extraocular movement. Factors affecting recovery success and recovery period were analyzed.Results: We retrospectively reviewed data of 145 patients consisting of 87 with vascular paralytic strabismus (cranial nerve [CN] III: 21, CN IV: 28, CN VI: 38) and 58 with idiopathic paralytic strabismus (CN IV: 20, CN VI: 24, CN III: 14). The recovery rate did not significantly differ between vascular (60.9%) and idiopathic (63.8%) groups (p = 0.15). The recovery period was longer in the vascular group (130.1 ± 145.1 days) than in the idiopathic group (92.6 ± 76.6) (p = 0.02). Age at onset was significantly associated with the recovery period in both vascular and idiopathic groups. In the vascular group, the recovery periods were 107.4 ± 74.8 days in CN III palsy, 97.2 ± 51.9 days in CN IV palsy, and 159.3 ± 194.1 days in CN VI palsy. The recovery period was significantly longer in patients with CN VI palsy (p = 0.03). Hypertension was significantly influencing the recovery period in patients with vascular CN VI palsy (odds ratio = 2.54, p = 0.01).Conclusions: The recovery period was longer in patients with vascular paralytic strabismus than in patients with idiopathic paralytic strabismus. Recovery rates were not significantly different between groups. In patients with vascular CN VI palsy, a history of hypertension was significantly associated with the recovery period.

Dacryops of the lacrimal gland in an elderly woman: A case report.

IntroductionDacryops is a rare benign cystic lesion of the lacrimal gland often developing in the palpebral gland. The exact etiology of dacryops remains unclear. Diagnosis could be suspected clinically and established histopathologically. Treatment is commonly surgical.Presentation of caseWe report the case of a 75-year-old woman with past history of total conservative parotidectomy for a benign tumor 10 years ago. She presented to the Ophtalmology Department at Farhat Hached University Hospital of Sousse with a painful swelling of the left supero-external orbital angle. The patient underwent complete excision of the cyst using the conjunctival approach. Histopathological examination showed characteristic features of dacryops with foci of chronic inflammatory cell infiltrates.DiscussionDacryops is commonly seen in young adults or middle-aged individuals with a slight female preponderance. In some cases, cystic enlargement of dacryops can lead to mechanical ptosis, dystopia, limitation of extraocular movements, diplopia, and, in rare cases, blepharoptosis. However in this case, the patient was an elderly woman presenting a painless mass without ptosis. As in our case, excision using the conjunctival approach under microscope has excellent results without complications. Histopathological examination confirms the diagnosis and helps to rule out differential diagnoses.ConclusionAs reported in the present case, histopathological examination confirms clinically recognized or suspected dacryops. If untreated, dacryops may lead to ptosis, proptosis and/or dystopia. Complete excision of the cyst is often curative.

Orbital foreign body in a child presenting with cardiogenic shock

Orbital foreign bodies can have a variety of presentations like restriction of extraocular movement and orbital cellulitis. A child sustained injury to the right eye with a piece of wood. He had features of cellulitis but no signs of septicemia. The noncontrast computed tomography showed a hyperdense structure suggestive of a large foreign body located in the retro-orbital area upto the apex of the orbit. He presented with shock which was consistent with cardiogenic shock, probably secondary to oculocardiac reflex, as evident by the presence of bradycardia, systemic hypotension and low SpO2. On removal of the foreign body, the vitals improved.

Isolated Unilateral Ptosis Caused by Idiopathic Orbital Myositis

Idiopathic orbital myositis is considered as a subgroup of idiopathic orbital inflammatory disease. It is a non-infectious inflammatory disorder primarily affecting the extraocular muscles and causes various eye symptoms including pain, diplopia and limitation of extraocular movement. Cases of isolated ptosis by idiopathic orbital myositis have been very rarely described in the literature. We report a patient who developed unilateral painless ptosis caused by idiopathic orbital myositis. A 52-year-old man presented with drooping of the right eyelid for 3 days. There was no history of headache, double vision or any other complaints. Neurological examination revealed right ptosis without pupil and extraocular muscles involvement. Repetitive nerve stimulation test was normal. Ptosis did not improve after the neostigmine injection. Magnetic resonance imaging scan showed asymmetric enlargement of right superior rectus/levator palpebrae superioris muscle complex and medial rectus muscle. Ptosis resolved dramatically after oral corticosteroid therapy. Isolated unilateral ptosis can be caused by various etiologies. Idiopathic orbital myositis should be considered in the differential diagnosis of ptosis. Keywords: Orbital myositis, Blepharoptosis, Oculomotor muscles

A rare case of neurofibromatosis with proptosis-orbital neurofibroma

Neurofibromatosis, an oculo-­?neuro-­?cutaneous syndrome is characterized by multisystem involvement. A 65 years old male patient came to the dept. of ophthalmology, S. V. R. R. Govt. General Hospital, Tirupati with the complaints of protrusion of his left eye, noticed by him 20 days back, with a history of drooping of left upper eyelid. On physical examination, the patient was short statured (Ht: 148cm) with scoliosis, there were multiple neurofibromas on the skin all over the body and face, freckles in the axillary region and cafe-­?au-­?lait spots over his trunk. On ocular examination, the patient had eccentric proptosis of left eye where the eyeball was shifted downwards (Hypotropia of 450) and forwards (24mm on exophthalmometry) with severe ptosis of left upper eyelid with restriction of extraocular movements. No palpable mass was noted. Finger insinuation between the orbital margin and the globe was possible. Right eye was normal. Slitlamp examination showed multiple Lisch nodules on the surface of iris in both eyes. Fundoscopy showed inferior coloboma choroid of left eye with normal fundus picture in Right eye Binocular diplopia was noted on elevating the upper eyelid of left eye. Forced duction test was positive. CT scan showed proptosis of left eye. Ultrasound B-­?scan of left eye showed a well defined mass lesion of 1.5x2cm size, slightly hyperechoic, with minimal vascularity, situated away from the globe, along the lateral aspect of the orbit suggestive of Orbital neurofibroma. The rare entity in the present case is the Localized form of orbital neurofibroma. Diagnosis in the present case is clinical. Linkage analysis using polymorphic DNA markers can be performed, allowing prenatal diagnosis or presymptomatic diagnosis. Keyword: Oculoneurocutaneous syndrome, Orbital neurofibroma, Lisch nodules

Predictors of Visual Functional Outcome Following Treatment for Cavernous Sinus Meningioma

Objective Cavernous sinus meningioma (CSM) can affect visual function and require expeditious treatment to prevent permanent visual loss. Authors of this retrospective study sought to determine the factors associated with visual functional outcomes in CSM patients treated with surgery, stereotactic radiosurgery (SRS), or stereotactic radiation therapy (SRT), alone or in combination. Methods Consecutive patients with CSM who had presented at an academic tertiary care hospital from 2000 to 2018 were identified through retrospective chart review. Visual function-visual eye deficit (VED), optic disc (OD) appearance, intraocular pressure (IOP), and extraocular movement (EOM)-was assessed before and after treatment for CSM. VED with visual acuity (VA) ≤ 20/200 and visual field defect ≥ -11 dB, pale OD appearance in the ipsilateral or contralateral eye, increased ipsilateral IOP, and/or EOM restriction were defined as a poor visual functional outcome. Multivariable logistic regression was used to evaluate the associations between pretreatment visual functional assessment and posttreatment visual outcomes. Results The study cohort included 44 patients (73% female; median age 55 years), with a median clinical follow-up of 14 months. Ipsilateral VED improved, remained stable, or worsened, respectively, in 0%, 33.4%, and 66.6% of the patients after subtotal resection (STR) alone; in 52.6%, 31.6%, and 15.8% after STR plus radiation treatment; in 28.5%, 43.0%, and 28.5% after gross-total resection (GTR) alone; and in 56.3%, 43.7%, and 0% after radiation treatment (SRS or SRT) alone. Contralateral VED remained intact in all the patients after STR alone and those with radiation treatment (SRS or SRT) alone; however, it improved, remained stable, or worsened in 10.5%, 84.2%, and 5.3% after STR plus radiation treatment and in 43.0%, 28.5%, and 28.5% after GTR alone. EOM remained intact, fully recovered, remained stable, and worsened, respectively, in 0%, 50%, 50%, and 0% of the patients after STR alone; in 36.8%, 47.4%, 15.8%, and 0% of the patients after STR with radiation treatment; in 57.1%, 0%, 28.6%, and 14.3% of the patients after GTR alone; and in 56.2%, 37.5%, 6.3%, and 0% of the patients after radiation treatment (SRS or SRT) alone.In multivariable analyses adjusted for age, tumor volume, and treatment modality, initial ipsilateral poor VED (OR 10.1, 95% CI 1.05-97.2, p = 0.04) and initial ipsilateral pale OD appearance (OR 21.1, 95% CI 1.6-270.5, p = 0.02) were associated with poor ipsilateral VED posttreatment. Similarly, an initial pale OD appearance (OR 15.7, 95% CI 1.3-199.0, p = 0.03), initial poor VED (OR 21.7, 95% CI 1.2-398.6, p = 0.03), and a higher IOP in the ipsilateral eye (OR 55.3, 95% CI 1.7-173.9, p = 0.02) were associated with an ipsilateral pale OD appearance posttreatment. Furthermore, a higher initial ipsilateral IOP (OR 35.9, 95% CI 3.3-400.5, p = 0.004) was indicative of a higher IOP in the ipsilateral eye posttreatment. Finally, initial restricted EOM was indicative of restricted EOM posttreatment (OR 20.6, 95% CI 18.7-77.0, p = 0.02). Conclusions Pretreatment visual functional assessment predicts visual outcomes in patients with CSM and can be used to identify patients at greater risk for vision loss.

Lacrimal ductal cyst of the medial orbit: a case report

BackgroundThe lacrimal ductal cyst (dacryops) is an uncommon clinical entity. It occurs anywhere that lacrimal gland tissue is present but most often appears as an expanding mass in the region of the lacrimal gland. The presence involving the medial part of the orbit is rare, ectopic location can be misleading in the differential diagnosis of orbital masses. The authors report a 53-year-old man who presented with dacryops occurred in an unusual location with significant clinical presentations.Case presentationA 53-year-old man had a painless mass located in the right superomedial orbit accompanied with foreign body sensation and lachrymation for two months, which had rapidly grown within 10 days. Decrease of visual acuity, high intraocular pressure (IOP) and limitation of extraocular movements in the right eye were present. The result of visual evoked potential (VEP) test suggested the impaired function of the optic nerve. Magnetic resonance imaging (MRI) studies revealed the presence of an isolated cystic lesion. The mass was completely removed via a transcutaneous approach, histopathologic findings were consistent with the lacrimal ductal cyst. The ocular motility and high IOP returned to normal. There had been no post-operative complications or signs of recurrence over five months follow-up.ConclusionLacrimal ductal cysts can present in the medial orbit, clinicians should include this entity in the differential diagnosis of orbital masses and be aware of its variable presentations such as high IOP in this case. We comment on the fact that many reported cases of ectopic dacryops may be an extension of normal lacrimal gland tissue.

Neurogenic Blepharoptosis After Medial Orbital Wall Reconstruction.

Neurogenic blepharoptosis after orbital wall reconstruction is a rare complication. It can either present as an isolated blepharoptosis, or accompany with other ocular symptoms. The authors introduce 4 cases of post-operative neurogenic blepharoptosis after reconstruction of medial orbital wall via transcaruncular approach.Immediately after the surgery, 2 adolescent patients experienced unilateral islolated complete blepharoptosis with no other ocular symptoms. The other 2 adult patients presented unilateral complete blepharoptosis accompanied by lateral displacement of the globe and evident extraocular movement limitations. The 2 adolescent patients were observed with no particular treatment, whereas the other 2 adult patients were treated with intravenous systemic steroids. The blepharoptosis symptom began to improve at 2 weeks post-operatively and completely recovered within 3 to 4 months in all patients, while the globe displacement and extraocular movement limitation started to improve at 4 weeks after the surgery and fully recovered within 6 months.Although neurogenic blepharoptosis after medial orbital wall reconstruction is a very rare complication, it can be critical once it occurs. According to the author's experience, it fortunately shows a favorable clinical course of spontaneous recovery. Post-operative neurogenic blepharoptosis usually recovers between 2 weeks and 4 months and other ocular symptoms related to oculomotor nerve injury recovers within 6 months after the surgery.