Mucoid Discharge Research Articles

Horner’s Syndrome in a Child With Otitis Media: An Unusual Complication

Figure 1. Fat-saturated, contrast-enhanced T1 magnetic resonance image of the base of the skull. Avid contrast enhancement of the left petrous apex (arrow) is consistent with apicitis, along with thickening and enhancement of the left petrous internal carotid artery wall (black arrow). A pulsation artifact is present. A 7-year-old, previously healthy girl presented to her family physician with a 1-day history of rhinorrhea and mucoid discharge from the left ear. She was diagnosed with otitis externa and received topical antibiotics. The child was brought to the emergency department of our hospital on day 3 of her illness with a unilateral earache and discharge from the ear. Her temperature at presentation was 37.9 C. She was subsequently afebrile, and her blood pressure was normal. Examination of her ears presented evidence of inflammation of the left eardrum. No postauricular redness or swelling, no mastoid tenderness, and no protrusion of the ear were evident. She manifested ptosis of the left eye and a constricted left pupil. The drooping of her left eye had been observed by her parents on day 2 of her illness, 1 day before presentation at the hospital. Neurologic (including the cranial nerves) and general physical examinations were otherwise unremarkable. She was diagnosed with partial left Horner’s syndrome, secondary to acute otitis media. An otorrhea culture was positive for Streptococcus pyogenes (group A streptococci). She received oral amoxicillin and clavulanic acid (Augmentin; GlaxoSmithKline, Middlesex, UK) for 2 weeks. No previous history of otitis media was reported. Neuroimaging was requested. The child underwent a magnetic resonance imaging scan, followed by a computed axial tomography scan, 2 weeks after her initial presentation. Imaging revealed enhancing soft tissue material within the opacified mastoid air cell complex, middle ear cleft, and petrous apex surrounding the carotid canal on the left side, suggestive of complicated otitis media with mastoiditis, petrous apicitis, and secondary carotid involvement (Figs 1 and 2). Clinically, the partial Horner’s syndrome was unchanged, and the otorrhea had subsided. In view of the neuroimaging results, she received intravenous antibiotics for 14 days, i.e., cefotaxime for 1 week, changed because of mild thrombophlebitis to cefepime and vancomycin for the second week. A further 4-week course of oral cephalexin was prescribed (total duration of antibiotics, 8 weeks, consisting of 2 weeks oral, 2 weeks intravenous, and 4 weeks oral). A repeated magnetic resonance imaging scan 6 weeks later demonstrated a reduction in inflammatory activity in the left petrous temporal bone and a resolution of the narrowing of her

Neonatal lingual and gastrointestinal mucormycosis in a case of low anorectal malformation—a rare presentation

We report a 1.7 kg male infant with a low anorectal malformation treated at an outside facility and referred to us on postoperative day 11. At presentation, his upper abdomen was distended, and he had perianal mucoid discharge. The tongue had a blackish discoloration. An erect abdominal radiograph showed a few fluid-filled bowel loops in the upper abdomen with a gasless lower abdomen and pelvis, suggestive of upper small bowel obstruction. There were no specific radiological features of necrotizing enterocolitis. He underwent laparotomy and bowel resection for perforated jejunum. Histopathology of the tissue specimen was suggestive of mucormycosis. Postoperatively, he received intravenous amphotericin B (liposomal) and was started on liquid enteral nutrition after 2 weeks. However, the anterior two thirds of his tongue gradually sloughed off. He is awaiting reconstruction of the tongue. The purpose of this report is to emphasize that physicians should have a high index of suspicion for oral and gastrointestinal tract mucormycosis in neonates with metabolic disturbances who present with a discolored oral mucosa and an abdominal mass with intestinal obstruction. Early diagnosis and an aggressive approach of combined medical and surgical treatment may improve the outcome of patients with this potentially lethal invasive disease.

Inflammatory polyps of the nasal turbinates of cats: an argument for designation as feline mesenchymal nasal hamartoma

Inflammatory polyps of the nasal turbinates (IPNT) in cats are benign growths that are histologically distinct from feline nasopharyngeal polyps. Most cats with IPNT are presented at less than 1 year of age with sneezing, noisy breathing and epistaxis, but without mucoid or mucopurulent nasal discharge. Histologically, IPNT are characterised by the presence of woven bone as part of the proliferating stroma and erythrocyte-filled spaces. These unique histological features are analogous to nasal hamartomas (NH) of children, specifically chondromesenchymal hamartoma (NCMH) and sinonasal fibro-osseous hamartoma (SFOH), which also result in signs of nasal obstruction, sneezing and epistaxis. In our study, clinical and histopathological features in five cats with IPNT were compared with published descriptions of NH in children. We conclude that the terminology 'feline mesenchymal nasal hamartoma' provides a more accurate description of the disease currently termed IPNT, and has the added advantage of being consistent with its human counterpart.

Agenesis of the nasolacrimal duct

Abstract Congenital nasolacrimal duct obstruction results from anomalies of the distal and proximal portions of the canalicular system. Patients frequently present with persistent mucoid discharge from the affected eye. Maldevelopment of the nasolacrimal duct is a rare cause of obstruction. We report a case of complete absence of the intraosseus and membranous portions of the nasolacrimal duct. The patient underwent dacrocystorhinostomy and intubation with Crawford tubes which resulted in successful resolution of the obstruction.

Intravascular Lymphoma of the Inferior Turbinate: An Unusual Rhinologic Presentation of a Rare Neoplasm

Objective: To present a unique case of intravascular lymphoma of the inferior turbinate because of its rarity, unusual clinical presentation and difficulty in establishing a diagnosis. Design:      Case Report Setting:      A tertiary hospital Patient:      A 66-year-old male admitted to the hospital due to intermittent high grade fever of six months duration. Result:  The patient presented with fever of unknown origin, and exhaustive laboratory, ancillary procedures and biopsies to rule in/out infectious, autoimmune and oncologic causes were performed to arrive at a diagnosis. Nasal endoscopy revealed an enlarged, hypertrophied and violaceous right inferior turbinate with watery to mucoid discharge and septal deviation to the right confirmed by CT scans of the paranasal sinuses. Functional Endoscopic Sinus Surgery (FESS), septoplasty and turbinoplasty with biopsy revealed Intravascular Lymphoma. Chemotherapy was deferred due to the deteriorating medical condition and the patient expired 7 months after the initial onset of symptoms. Conclusion:  Patients who present with fever of unknown origin should undergo a thorough otorhinolaryngologic examination to exclude primary ENT conditions and ensure proper management. Given its rarity and multiplicity of presentation, it is extremely difficult to make a diagnosis of intravascular lymphoma. A high index of suspicion of Intravascular Lymphoma is necessary so that timely acquisition of tissue biopsy of any lesion involved will make a definite diagnosis. Keywords: Intravascular lymphoma, Fever, Fever of Unknown Origin

Quantitative Assessment of Bandage Soft Contact Lens Wear Immediately After LASIK

To evaluate the efficacy and tolerability of overnight bandage soft contact lenses applied immediately after LASIK. Bandage soft contact lenses were applied immediately following bilateral simultaneous LASIK in 161 consecutive patients. Signs and symptoms associated with contact lens wear were prospectively recorded at 1 hour, 4 hours, and the following morning, using a standardized questionnaire. Contact lenses were removed at 1 hour if patients were symptomatic of intolerance. If no signs of contact lens intolerance appeared at 1 hour, the lenses were removed the following morning. No contact lenses were applied in 61 patients after LASIK. One hour after the procedure, contact lenses were removed from 47 patients due to intolerance. In these patients, contact lens removal was associated with a significant decrease of the total score the next morning (0.31±0.55) compared to 1 hour (5.65±1.60, P<.0001). A similar decrease of the total score was noted in those patients who tolerated the contact lenses (0.20±0.52 vs 1.30±1.78) and those in whom the contact lenses were not applied (0.76±1.19 vs 3.24±1.93). Mucoid discharge at the lid margins was noted in 52.6% of patients and mild corneal edema was noted in 28.8% of patients with bandage soft contact lenses at 12 to 18 hours. Bandage soft contact lens application after LASIK is associated with significant reduction of symptoms during the immediate postoperative period. However, removal of these lenses may be necessary shortly after the procedure.

A clinicopathological study of urethritis in males.

To determine the etiology and frequency of different types of urethritis in adult males. A case series. The Dermatology Department of PNS Shifa Hospital, Karachi, from June 2004 to December 2007. One hundred male patients having complaints of urethral discharge and dysuria reporting in the skin OPD were included in the study. Patients who had received systemic treatment for their complaints and those who had other systemic infections were excluded. A detailed history including history of sexual contact was taken. Dermatological examination including examination of external genitalia was also performed. All these patients were subjected to complete physical examination, complete urine examination, urethral pus for gram staining and culture, endo-urethral swab with urethral loop for seeing Chlamydia antigen by fluorescent microscopy, cultures for ureaplasma and Wet mount specimen microscopy for trichomonas along with HIV (serum ELISA) test. Non-gonococcal urethritis was diagnosed on the presence of more than five polymorphonuclear leucocytes per high power field in at least five fields of Gram stained urethral smear, in the absence of Gram negative diplococci. The mean age was 29.2 + or - 5.8 years. Seventy (70%) cases were diagnosed as gonococcal urethritis and 30 (30%) cases as non-gonococcal urethritis (NGU). History of illicit sexual exposure was available in 25 (25%) patients. The interval period between initiation of symptoms and reporting of patient in gonococcal urethritis was 4 to 30 days (mean 12.8 days) and 4 days to 2 months (mean 20.7 days) in non-gonococcal urethritis. The patients with gonococcal urethritis presented with purulent discharge in 66 (84%) cases, and dysuria in 49 (70%) cases. In the NGU group, 25 (80%) cases had mucoid discharge and 18 (65%) had dysuria. in 70%, Neisseria gonorrhoeae was isolated, Chlamydia trachomatis in 16%, ureaplasma in 8%, and Trichomonas vaginalis in 4%. No organism could be detected in 2% cases. HIV test was negative in all cases. Gonococcal urethritis was the commonest urethritis seen followed by Chlamydia infection in the studied group of adult males.

Unilateral Acute Conjunctivitis Due to Ophthalmomyiasis Externa Caused by Larva of Oestrus Ovis

&lt;h3&gt;To the Editors:&lt;/h3&gt; &lt;p&gt;A 15-year-old boy from rural south India presented with complaints of foreign body sensation in the left eye for 1 day, after a fly landed on his eye. On examination, his uncorrected visual acuity was 20/40, N6 in both eyes. Slit-lamp biomicroscopic examination of the right eye was normal. The left eye revealed conjunctival congestion, a small area of subconjunctival hemorrhage at the 11-o&amp;rsquo;clock position, mucoid discharge in the inferior fornix, and superficial punctate keratitis. There were 4 to 5 white worms with black frontal portion moving on the conjunctiva (Fig. &lt;a href="EditorPage.aspx?da=core&amp;amp;id=%7b9AAFB9E4-7723-42DE-901D-178F84938FBF%7d&amp;amp;ed=FIELD2486124684&amp;amp;vs&amp;amp;la=en&amp;amp;fld=%7b0564BFD8-9E7B-4050-89EF-344B2B7151EF%7d&amp;amp;so=%2fsitecore%2fsystem%2fsettings%2fhtml+editor+profiles%2frich+text+healio&amp;amp;di=0&amp;amp;hdl=H2486124727&amp;amp;us=sitecore%5cEAnderer&amp;amp;mo&amp;amp;pe=0#x01913913-20091104-15-fig1"&gt;1A&lt;/a&gt;). The rest of the examination was normal.&lt;/p&gt;

Comparative study of outcome of type I tympanoplasty in dry and wet ear

Chronic suppurative otitis media is a common condition seen in patients attending the otolaryngology clinic. The discharging ear presents the otologist with the dilemma of operating on it or not. This due to the widespread belief that the success rate while doing tympanoplasty on wet ears is decidedly inferior. To evaluate this fact we conducted a study to compare outcomes of type 1 tympanoplasty in dry and wet ears. Wet ear meant that the patient had a mild mucoid discharge which was negative on culture. Type 1 tympanoplasty was done in all patients under local anesthesia using temporalis fascia graft and by underlay technique. We conclude that the presence of discharge in the ear at the time of operation does not interfere with the results of tympanoplasty, but it should be mucoid and scanty.

Azithromycin Treatment Modulates Cytokine Production in Chlamydia trachomatis Infected Women

Chlamydial infection of the lower genital tract usually spreads to the upper genital tract and is then responsible for more serious consequences of chlamydial infection, such as infertility, ectopic pregnancy, pelvic pain and pelvic inflammatory disease [1]. Genital infection with Chlamydia trachomatis and the resulting cytokine environment largely determines the outcome of infection and disease [2–7]. Chlamydial infections are usually treated with Azithromycin or Doxycycline [8]. The immunomodulatory effects of macrolides have mainly been shown in vitro or in animal experiments. It has been reported that macrolide antibiotics can interfere with cytokine production in vitro [9–11]. Azithromycin has also been reported to inhibit the production of pro-inflammatory cytokines [12–17]. There is little evidence from the clinical arena that these immunomodulatory actions of antibiotics play a role in terms of outcome. Therefore, further studies to investigate the potential usefulness of azithromycin are necessary to elucidate its mechanism of action. The direct relevance of these findings for the treatment of infectious and inflammatory diseases will have to be tested in patients. The results of clinical trials have suggested that antibacterial activity of azithromycin is efficacious in the treatment of chlamydial cervical infection [18–20]. However, there are no human studies that have assessed antibacterial as well as anti-inflammatory effects of azithromycin treatment in different clinical conditions associated with the chlamydial infections. In a recent study on a Macaque model, azithromycin effectively prevented the progression of inflammation and fibrosis in both the lower and upper reproductive tract after repeated chlamydial infections suggesting that azithromycin may provide anti-inflammatory as well as antimicrobial properties and this combined activity may be particularly well-suited for the treatment of chlamydial infection [21]. Therefore, it might be possible that in immunopathological conditions like infertility and pelvic inflammatory disease, the anti-inflammatory property of azithromycin may act in the eradication of infection and disease. Hence, in the present study in order to examine the anti-inflammatory effects of azithromycin, we investigated the levels of interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-13, interferon-γ (IFN-γ) and tumour necrosis factor-α (TNF-α) in women representing different clinical conditions, that is, Chlamydiapositive fertile and infertile women with genital tract infection of C. trachomatis before and after treatment with azithromycin.

Efficacy and Safety of Argon Plasma Coagulation for the Treatment of Hemorrhagic Radiation Proctitis

Background: Radiation proctitis is the most relevant complication of radiotherapy for malignant pelvic disease and occurs in about 5% to 10% of all patients. It is characterized by bleeding, rectal pain, diarrhea, mucoid discharge and fecal urgency. There is no consensus for the management of this condition and many conservative treatment modalities have been proposed with varying success. Argon plasma coagulation is an effective treatment for hemorrhagic lesions of the gastrointestinal tract. Aim: The aim of this study is to assess the efficacy and safety of argon plasma coagulation (APC) applied endoscopically to treat hemorrhagic radiation proctitis (HRP).

Supernumerary Nostril: A Case Report and Review

SUMMARY : Supernumerary nostril is a very rare congenital anomaly, whic h includes additional nostril with or without accessorycartilage. In the present case of the left supernumerary nostril, a small cavity of around 3 mm diameter and accessory lower lateralcartilage were present. The cavity was lined with mucous membrane and filled with mucoid discharge .Nasal endoscopy of accessorynasal cavity revealed that it was small as compared to normal nasal cavity and did not communicate with the ipsilateral nasal cavity. Thediameter of the normal anterior nasal opening was less on left side as compared to right side. Unilateral supernumerary nostril may occurbecause of the fissuring of the lateral nasal process during fetal growth. KEY WORDS: Supernumerary nostril; Congenital anomaly; Fissuring of nasal process. INTRODUCTION Supernumerary nostril is a very rare type of congenitalanomaly which includes additional nostril with or withoutaccessory cartilage. It can be unilateral or bilateral. Lindsey(1906) reported the first case of bilateral supernumerarynostril, in that case external openings of supernumerarynostrils were situated above the normal nostril and theaccessory nasal cavities communicated with the ipsilateralnasal cavities. Tawse (1920) reported a patient with a unila-teral supernumerary nostril that communicated with the na-sal cavity. Reddy & Rao (1987) reported a case of a thirdnostril that was situated below the left nostril. Sinha

Hypoglycemia and Hyperlactatemia Associated with Lymphoma in an Angus Cow

Hypoglycemia and Hyperlactatemia Associated with Lymphoma in an Angus Cow

A congenial cutaneous bronchogenic sinus of the abdominal wall in an infant

Cutaneous bronchogenic anomalies are very rare, and we report a child who presented with mucoid discharge from a small opening on her epigastrium that was present since birth. Diagnosis and treatment of congenital bronchogenic anomalies are important because surgical excision is needed to prevent the potential risk of infection and malignant degeneration. To the best to our knowledge, this is the first report of a congenital bronchogenic sinus of the abdominal wall.

Xanthogranulomatous inflammation: a rare cause of premature ovarian failure

Xanthogranulomatous inflammation is rare, mainly involving the kidneys, histologically characterized by partial or complete replacement of the mucosa by granulation tissue with an abundance of foamy histiocytes, siderophages and multinucleated giant cells. We report an unusual presentation of xanthogranulomatous inflammation of the genital tract in a young female presenting with premature ovarian failure. A 25-year-old unmarried female presented to the gynecology OPD with amenorrhea and lump abdomen for one and half years with weight loss and mucoid discharge per rectum for 2 months. On investigating, CECT showed a heterogeneously enhancing mass lesion with solid cystic components in pelvis. Cystic components showed enhancing walls and air fluid levels. Uterus and ovaries were not seen separately. There were multiple lymph nodes in retroperitoneum. Both LH and FSH were raised to post menopausal levels (FSH-69.35, LH-64.53). A provisional diagnosis of ovarian malignancy was made and a differential diagnosis of genital tuberculosis was kept and a decision for laparotomy was taken. Intraoperatively, there was a mass arising from the right side of fundus stuck to rectum. There was a pus pocket in the tumor. The final histopathological report was suggestive of endometrioma with xanthogranulomatous inflammation involving adjacent ovary and fallopian tube.

Repeat Laparotomy for the Treatment of Septic Peritonitis in a Bornean Orangutan (Pongo pygmaeus pygmaeus)

A 9-yr-old female Bornean orangutan (Pongo pygmaeus pygmaeus) presented with a 48-hr history of depression, lethargy, anorexia, and mucoid discharge from the rectum. Clinical, radiographic, and ultrasonographic examination demonstrated the presence of multiple distended loops of intestine, intestinal adhesions, and free gas within the abdomen. During exploratory laparotomy, fibrinopurulent diffuse peritonitis as a result of a ruptured intrapelvic abscess with associated large bowel adhesions was evident. The abdomen was thoroughly lavaged, necrotic debris and abscess wall removed, and fibrinous adhesions disrupted. The orangutan was kept sedated for 48 hr to allow for intensive care. Six months later, when the orangutan presented with similar clinical signs, ultrasonographic examination demonstrated the presence of a pelvic abscess. The previous procedure was repeated with the addition of a hysterectomy. This report is the first documentation of long-term management following surgical intervention for internal abdominal abscessation and septic peritonitis in a great ape.

Occult traumatic nasolacrimal duct obstruction causing anophthalmic socket contraction presenting 20 years later

Abstract Purpose To highlight undiagnosed nasolacrimal duct obstruction as a cause of multiple problems related to conjunctival cicatrisation of the anophthalmic socket and the importance of early diagnosis and treatment in their prevention. Methods Case report with high resolution digital clinical photography. Results We present a 43 year old Asian gentleman, who sustained penetrating trauma to the right globe and midface in 1984. At the time, he underwent primary repair of the globe, followed by enucleation. Over the next ten years, he suffered myriad problems with recurrent entropion and trichiasis of upper and lower lids, a dry socket with an uncomfortable artificial eye and chronic mucoid discharge. Twenty years later his initial diagnosis was revisited. On examination, he had a contracted socket with mucosal keratinisation, cicatricial entropion of the eyelids, forniceal shortening and mucoid discharge. There was also nasolacrimal duct obstruction with an occult mucoceole. He underwent external dacrocystorhinostomy with correction of the entropions and anophthalmic socket refashioning. He remains symptom free twelve months following surgery. Conclusion Contracted anophthalmic sockets can occur spontaneously or secondarily to a disease process. These may lead to changes in tear composition and have pro‐inflammatory effects on the ocular surface. We hypothesise that the chronic toxic tear film secondary to the mucocoele led to chronic conjunctivitis with cicatrisation over time and multiple structural lid &amp; socket problems that ensued. This case highlights the importance of looking for occult causes of chronic cicatrisation in the anophthalmic socket.

Transcanalicular-Endonasal Semiconductor Diode Laser–Assisted Revision Surgery for Failed External Dacryocystorhinostomy

To report the results of transcanalicular-endonasal revision dacryocystorhinostomy (DCR) with a semiconductor diode laser in cases of failed external DCR. Prospective, nonrandomized, interventional case series. Fifteen cases in 13 patients with failed external DCR underwent transcanalicular-endonasal DCR with a semiconductor diode laser. A functional successful outcome was defined as a patent nasolacrimal drainage system in nasolacrimal irrigation and a resolution of the symptomatic epiphora and/or mucoid discharge. The patients were followed for a mean postoperative period of 27.3 months (range, nine to 54 months). The mean duration of the surgery was 19.6 minutes. After the initial revision transcanalicular-endonasal DCR surgery, patency to irrigation was obtained in 12 cases (80%), and 15 cases (100%) after a second revision treatment. Three cases required repeated revision surgery, and three other cases were considered to be functional failures in spite of a patent lacrimal system after the final revision surgery. The overall functional success rate was 80% (12 cases) at the final examination (mean, 27.3 months after surgery), and there were no intraoperative and postoperative complications. The presence of a canalicular obstruction or granulation tissue was not significantly related to the success rates of the revision surgery. The length of time between the primary and revision surgery, gender, age, the duration of the first revision surgery, and the timing of stent removal were also not significantly related to the failed cases. Transcanalicular-endonasal DCR is a minimally invasive procedure and is recommended for patients as an alternative procedure for failed external DCR.

Ulcus Vulvae Acutum in a 13‐Year‐Old Girl After Influenza A Infection

A 13-year-old otherwise healthy premenarchal girl presented with acute onset of painful vulvar ulcerations. One day before developing vulvar ulcerations, she experienced flu-like symptoms, including a low-grade fever, cough, sore throat, and myalgia. Results of a throat swab were positive for influenza A infection (polymerase chain reaction [PCR] assay), and the patient was treated with oseltamivir. The patient's constitutional symptoms improved slightly, but within 2 days after her initial presentation, she returned to her primary care provider and described 24 hours of dysuria and vulvar swelling. She had a history of herpes labialis (cold sores) and rare episodes of minor oral aphthae (canker sores) that occurred less than twice a year. The patient denied a history of sexual activity, sexual abuse, or physical trauma. Physical examination showed ulceration and swelling of the labia minora, and the patient received an empiric dose of acyclovir (200 mg 4 times daily) for presumed autoinoculated herpes simplex virus (HSV) infection. An ulcer swab was performed, and urinalysis revealed no evidence of infection. Two days later, the patient presented to the emergency department with increasing vulvar pain and vaginal discharge. The previous ulcer swab findings were negative for HSV (PCR assay), and consequently, acyclovir was discontinued after 1 day of therapy. She received topical viscous lidocaine and an empiric dose of oral fluconazole. The lidocaine provided temporary symptomatic relief. Results of DNA amplification studies were negative for Chlamydia trachomatis and Neisseria gonorrhoeae. A potassium hydroxide preparation was negative for fungi, and an ulcer swab for bacterial culture revealed usual flora. Of note, the PCR assay for Epstein-Barr virus was not performed on ulcer cells. The patient was referred to the department of dermatology, and results of a physical examination showed copious white mucoid discharge and a 2-cm ulceration of the left labia minora (Figure, panel A). Two smaller pinpoint ulcerations and swelling of the left labia minora were also noted. The lesions were clinically indistinguishable from the genital aphthous ulcers of patients with complex aphthosis (recurrent, severe aphthous ulcers on oral or genital mucosa). A diagnosis of ulcus vulvae acutum was made, and treatment was started with clobetasol 0.05% ointment (4 times daily) and lidocaine gel as needed. Four days later, the patient reported marked symptomatic improvement. Physical examination showed near resolution of the large vulvar ulceration (Figure, panel B). The patient tapered use of clobetasol ointment over the next several days until the ulcerations healed completely. Two months after her initial episode, the patient again had 3 small vulvar erosions after symptoms that included low-grade fever, malaise, and vomiting. She did not receive oseltamivir for this illness; clobetasol ointment was applied 4 times daily, and the vulvar erosions ameliorated within a few days. Her constitutional symptoms resolved without treatment. The patient has not experienced any further episodes of vulvar ulcerations in the 18 months after the most recent treatment.

Occult traumatic nasolacrimal duct obstruction causing anophthalmic socket contraction presenting 20 years later: a case report

Purpose: To highlight undiagnosed nasolacrimal duct obstruction as a cause of multiple problems related to the anophthalmic socket and the importance of early diagnosis and treatment in their prevention. Methods: Case report with high resolution digital clinical photography. Results: A 43-year-old Asian gentleman sustained penetrating trauma to the right globe and midface in 1984. At the time, he underwent primary repair of the globe, followed by enucleation. Over the next ten years, he suffered a myriad of problems with recurrent entropion and trichiasis of upper and lower lids, a dry socket with an uncomfortable artificial eye and chronic mucoid discharge. Twenty years later he had a contracted socket with mucosal keratinization, cicatricial entropion of the eyelids, forniceal shortening and mucoid discharge. There was also nasolacrimal duct obstruction with an occult mucoceole. He underwent external dacrocystorhinostomy with correction of the entropions and anophthalmic socket refashioning. He remains symptom free twelve months following surgery. Conclusion: Contracted anophthalmic sockets can occur spontaneously or secondarily to a disease process. These may lead to changes in tear composition and have pro-inflammatory effects on the ocular surface. We hyphothesize that the chronic toxic tear film secondary to the mucocoele led to chronic conjunctivitis with cicatrisation over time and multiple structural lid & socket problems that ensued. This case highlights the importance of looking for occult causes of chronic cicatrization in the anophthalmic socket.