Severe Conjunctival Chemosis Research Articles

A case report of pituitary neuroendocrine tumor manifesting as severe conjunctival chemosis

BackgroundConjunctival chemosis (CC) is an extremely rare symptom of pituitary neuroendocrine tumor (PitNET). We report an extremely rare case of PitNET manifesting as severe CC.Case presentationA 48-year-old male was admitted to our hospital with severe CC, proptosis, and ptosis of the right eye. Magnetic resonance imaging demonstrated the tumor mass invading the cavernous sinus (CS) with cystic lesion. The patient underwent emergent endoscopic transsphenoidal surgery, and the pathological diagnosis was PitNET. CC of the right eye remarkably improved after the surgery. Glucocorticoid therapy was performed for right oculomotor nerve palsy, which rapidly improved. The postoperative course was uneventful and the patient was discharged from our hospital without hormone replacement.ConclusionsCC caused by CS invasion of PitNET can be cured by early surgical treatment. Therefore, PitNET is important to consider in the differential diagnosis of CC.

A Case of Spontaneous Bilateral Direct Carotid-Cavernous Fistula

A 92-year-old female with poorly controlled systemic hypertension presented with bilateral eye redness, lid fullness, conjunctival chemosis, ophthalmoplegia, and ptosis for two days. A neuro-ophthalmic evaluation revealed bilateral proptosis, severe conjunctival chemosis and congestion, and an almost complete bilateral ophthalmoplegia with a complete right superior eyelid ptosis. Computed tomography (CT) scans demonstrated bilateral dilation of the superior ophthalmic veins, and a CT angiography (CTA) showed a direct high-flow carotid-cavernous fistula (CCF) with secondary extraocular muscle enlargement. Clinicians should be aware that a typical direct high-flow CCF, although usually occurs after trauma and unilaterally, can present spontaneously without trauma and bilaterally.

Newborn with massive right eye proptosis revealing quintessence cystic orbital teratoma.

A full-term 2-day-old female neonate weighing about 2.17 kilogram, born by normal delivery at 37 weeks of gestation was referred to the ophthalmology with a massive mass of the right eye. On clinical examination, there was severe proptosis of the right eye with a positive transillumination test with normal left eye. The orbital mass was hard in consistency with few soft areas and it was covering the right midface. The eyeball was pushed on anteroinferior side with severe conjunctival chemosis and corneal erosion due to exposure to keratopathy with absent papillary reflex. For further routine investigation the baby was referred to the Department of Radiology for a B-scan ultrasound. On ultrasound, multiple anechoic cystic areas were seen anterior to globe pushing it anteroinferior, the hetero-echoic lesion was seen filling right eyeball and lesion was involving ocular muscles.

SAT-513 Thyroid Disease And Infrared Imaging Of Eyelids

Background: Thyroid eye disease is thought to present as proptosis and/or severe conjunctival chemosis. Severe dry eye disease and its symptoms of non-specific eye pain and foreign body sensation in the eye can be overlooked as an early biomarker of thyroid disease. New infrared imaging can be used to evaluate dry eye and eyelid gland anatomy. Infrared imaging and detailed history of thyroid eye symptoms may lead to subsequent testing of thyroid function and more referrals to thyroid specialists. Purpose: Using infrared photography to evaluate dry eye complaints in patients: do they have thyroid disease? Methods: A retrospective chart review (2017–2019) of patients with dry eyes, eyelid imaging with infrared photography and thyroid lab testing was performed. Infrared photography with 820 nm wavelength (Heidelberg Spectralis, Heidelberg, Germany). Percentage loss of Meibomian glands was identified for each eye, then analyzed, per patient. The control population consisted of patients with no dry eye complaints, no thyroid testing or thyroid history. Exclusion criteria: patients over the age of 90 years and patients with a history of glaucoma, diabetes, cataract surgery, and eyelid surgery. Age matching was done (±5 years). Results: n=48 patients, avg age=57.73 years (sd=16.81, range 21–85 years). Thyroid patients: n=24 patients, male=10, female=14, avg age= 57.12 years (sd=16.65, med=55.5, range 23–83 years). Controls: n=24 patients, male=9, female=15, avg age=58.33 years (sd=17.30, med=58, range 21–85 years). Loss of Meibomian glands: thyroid=40.94%, control=5.10% (p<0.0001, t-test). Dry eye complaints: thyroid = 16/24, control = 0/24 (p<0.0001, x2). Discussion: Meibomian glands are glands in the upper and lower eyelids. These glands provide the lipid component of the tear film, thus slowing the evaporation of the tears and stabilizing the tear film with each blink. Meibomian gland loss would explain the dry eye symptoms in an abnormal thyroid patient population. Infrared photography can be performed with a #87 camera lens filter (cost = $65). The loss of Meibomian glands may be an early sign for thyroid disease. Conclusion: Infrared photography may be helpful in identifying severe dry eye, thus leading to increased awareness of thyroid eye disease symptoms in our patients in ophthalmology, endocrinology, and primary care.

The Effects of Intraoperative Tarsorrhaphy on Conjunctival Chemosis During Orbital Fracture Repair Surgery

We employed intraoperative tarsorrhaphy depending on the degree of edema to treat moderate conjunctival chemosis during orbital fracture repair surgery. This is a retrospective case review of 1367 patients (1384 eyes) who underwent orbital fracture repair surgery by a transconjunctival approach. All cases of moderate conjunctival chemosis during surgery were included and were divided into 2 groups. In one group, intraoperative tarsorrhaphy was performed immediately the chemosis reached a moderate degree and the conjunctiva was incarcerated by the lower eyelid margin; once severe chemosis developed, stitches were added to cover all of the prolapsed conjunctiva with a palpebral margin. In the second group, moderate chemosis was treated with bandage pressure without stitches even after appearance of severe chemosis. The time course of conjunctival edema was recorded. The incidence of moderate conjunctival chemosis in orbital reconstruction surgery by the transconjunctival approach was 9.4%. The average time for resolution of moderate chemosis in the tarsorrhaphy group (3.5 ± 1.4 days) was obviously shorter than in the bandage group (6.2 ± 1.9 days). The incidence of severe chemosis in the intraoperative tarsorrhaphy group (14.1%) was significantly lower than in the bandage group (31.8%). Overall, the total duration of severe chemosis in the tarsorrhaphy group was obviously shorter than that of the bandage group. Intraoperative tarsorrhaphy was a highly effective method of treating moderate chemosis and preventing severe conjunctival chemosis during orbital fracture repair surgery.

Early Tarsorrhaphy in Conjunctival Chemosis After Orbit Bone Reconstruction

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

Double Trouble: Entropion Repair Complicated by a Conjunctival Neurofibroma

While ocular involvement is well documented in association with neurofibromatosis type 1 (NF-1), conjunctival neurofibromas are very rare. We describe a challenging NF-1 case of a patient with a conjunctival neurofibroma in association with lower lid involutional entropion and severe conjunctival chemosis. A 65 year-old male presented with age-related left lower lid laxity, retractor dehiscence, inferior conjunctival chemosis and significant ocular discomfort. The patient underwent a left lower lid lateral tarsal strip procedure with retractor plication without much improvement in the chemosis and discomfort. However post-operatively it became evident that an injected mass was present in the left inferior fornix. Surgical debulking of this mass allowed for resolution of the patient’s signs and symptoms as well as proper lower lid alignment. Histopathologic diagnosis with S100 and CD34 positivity confirmed a conjunctival neurofibroma. Although uncommon, it is important to consider the possibility of a conjunctival mass in a patient with persistent chemosis and recurrent lower lid instability, particularly when confronted with a neurocutaneous syndrome.

A Quantitative Rabbit Model of Vaccinia Keratitis

The goal of this study was to use multiple quantitative disease measures to evaluate the effect of various viral inocula on the development of vaccinia keratitis in rabbits. Trephined eyes of female rabbits were infected with 10(4), 10(5), 10(6), or 10(7) plaque-forming units (pfu) of the Dryvax strain of the vaccinia virus and scored daily for disease for 14 days according to a modification of the MacDonald-Shadduck scoring system. Ocular viral titers and vaccinia-specific antibody titers were determined by plaque assay and ELISA, respectively. The amount of virus used for infection affected the severity of disease, with 10(4) pfu eliciting milder keratitis after delayed onset compared with higher amounts of virus. At inocula above 10(5) pfu the course and severity of corneal disease was not significantly different. The time to reach peak titers was delayed in the 10(4) group but peak titers were similar in all groups. Severe conjunctival chemosis interfered with scoring in animals infected with 10(6) or 10(7) pfu. Virus-specific antibody titers were similar in all groups at day 14. Body weights decreased less than 10% in all groups. The course of vaccinia keratitis in rabbits paralleled that in humans. A viral inoculum of 10(5) pfu/eye was determined to be optimal for use in further studies of vaccinia keratitis.

Anterior segment optical coherence tomography–aided diagnosis and primary posterior chamber intraocular lens implantation with fibrin glue in traumatic phacocele with scleral perforation

We describe the case of a middle-aged woman who presented to us after injury from a clenched fist 3 days previously. The diagnosis was occult scleral perforation, severe conjunctival chemosis, and traumatic aphakia. However, the lens could not be localized during posterior segment examination. An anterior segment optical coherence tomography (AS-OCT) examination showed scleral discontinuity and a heterogeneous reflection in the subconjunctival area, suggesting a possible phacocele. Surgical exploration confirmed these findings. Aphakia was managed using the "glued intraocular lens" technique in the same sitting. This case highlights the use of AS-OCT in noncontact exploration of the traumatized anterior segment and in diagnosis of a possible phacocele along with an occult scleral perforation with uveal prolapse. To our knowledge, this is the first report of successful implantation of a glued IOL as a primary procedure combined with scleral perforation repair.

Visualization of conjunctival cyst by indocyanine green

PURPOSE: To report complete removal of conjunctival cyst using indocyanine green solution to facilitate visualization. DESIGN: Interventional case report. METHODS: A 71-year-old woman referred with the diagnosis of severe conjunctival chemosis of her right eye of several months’ duration was found to have a large conjunctival cyst. After informed consent was obtained, surgical resection of the cyst was performed. RESULTS: Under topical anesthesia, indocyanine green solution was injected through a 27-gauge needle into the conjunctival cyst. This achieved excellent visualization of the cyst outline and facilitated complete resection. During the resection, staining of the cyst wall remained despite a small perforation in the capsule, and complete resection was achieved without difficulty. CONCLUSION: Injection of indocyanine green solution into a conjunctival cyst may be used to facilitate visualization and aid in complete resection of the cyst wall.

Exophthalmos in Myelodysplastic syndrome

A case of myelodysplastic syndrome (MDS) who suffered alternating proptosis was reported. A 57-year-old Japanese man with MDS developed acute painful left proptosis with eyelid edema, conjunctival injection, visual disturbance, and restriction of eye movements. This lasted for 3 weeks. Computerized tomography (CT) showed swelling of the lateral and medial rectus muscles and the optic nerve, as well as a retrobulbar mass. Later, a similar painful right proptosis with severe conjunctival chemosis developed. CT showed only bilateral mild optic nerve swelling. The visual acuity of the right eye decreased to null even after remission of the proptosis. The patient died due to myocardial infarction and underwent autopsy. The right optic nerve stroma was found to be increased over that of the left. Cellular infiltration was noted in the left optic nerve and the retrobulbar connective tissue. This self-limiting and relapsing proptosis was apparently related to MDS. This is only the second MDS case with such severe ophthalmological symptoms reported in the literature.

Foudroyante Gasbrand-Panophthalmie nach perforierender Skleraverletzung

A 13-year-old boy developed Clostridium perfringens panophthalmitis due to a penetrating scleral injury. The characteristic symptoms were unusually severe periocular pain, lid edema, decreased motility and protrusion of the eye, severe conjunctival chemosis, pus covering the conjunctiva and cornea, green-brown hypopyon, gas bubbles in the anterior chamber, and amaurosis within 60 hours. In view of the patient's ocular status and impaired general condition enucleation was unavoidable. The results of laboratory workups are reported in addition to the clinical and ophthalmologic findings.