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To study the clinical, microbiological profile and management outcomes of orbital abscess at a tertiary care center in South India. In a retrospective interventional case series, we reviewed all patients diagnosed with orbital cellulitis from 2000–2020. The data analyzed included demographic profile, clinical and radiological features, microbiological profile, and management outcome. A total of 921 cases of orbital and periorbital infections were reviewed. Seventy-two cases were diagnosed as orbital cellulitis. Thirty-four cases (47.22%) had radiological evidence of orbital abscess. The median age was 20.63 years. Three patients (8.82%) were neonates. A male preponderance was noted (23, 67.65%). Sinusitis (10, 29.41%) and diabetes (5, 14.7%), were the most common predisposing factors. Optic neuropathy was seen in 15 (44.11%) patients, cavernous sinus thrombosis in two patients (5.88%), and septicemia in one patient (2.94%) Multiple orbital abscesses were noted in 7 (20.59%) cases. All patients underwent surgical drainage. Methicillin-sensitive Staphylococcus aureus was the most common organism isolated in 14 patients (41.18%). Vision improvement or stabilization was seen in all except 3 (8.82%) Orbital abscess is a potential sight-threatening orbital infection. The infective process can spread and ascend up to involve cavernous sinus thereby becoming life-threatening. A timely diagnosis and intervention can halt the disease process and help restore vision in many cases. [ABSTRACT FROM AUTHOR]

To determine the factors predictive of outcome in canalicular laceration repair at a tertiary eye care centre. A retrospective review of the medical records of all primary canalicular laceration repairs managed at a tertiary eye care centre between the years 2006 and 2014 was done. Thirty-nine patients were included and majority were male (79.5%) with a mean age of 30.05 + 16.2 years (range 2–65). Most (n= 34) had monocanalicular laceration and 5 had bicanalicular laceration. All surgeries were done in the operating room setting. Overall patency by irrigation was seen in 74.4% at a median follow-up of 19.89 weeks (range 21–910). Anatomical outcome was different among the stents and best after Mini-Monoka monocanalicular stent (17/19; 89.5%) followed by bicanalicular annular stents (n= 6; 60%) and 20G Silicone rod (8/14, 57%). The factors predictive of poor outcome were related to the mode of injury [road traffic accidents; Hazard ratio (HR)19.57;p= 0.048] and the type of stent [20G silicone rod (HR 35.7; C.I 3.04 - 419.14;p= 0.004)] by multivariate analysis. Skill of the surgeon was critical as the outcome for fellows-in-training showed a trend towards failure (HR 6.66,p= 0.07). Complications included stent extrusion (n= 28.2%), punctal granuloma (n= 5.1%) and stent exposure (n= 2.5%). The mode of injury - road traffic accidents and type of stent - 20 G silicone rod were risk factors predictive of poorer outcome after canalicular laceration repair. Individual skill of operating surgeon may be a critical factor suggesting a review of training protocols. [ABSTRACT FROM PUBLISHER]

Purpose: To examine patients with persistent watery epiphora following patent external dacryocystorhinostomy (DCR) with magnetic resonance imaging dacryocystography (MR-DCG). Methods: Patients with unobstructed nasolacrimal irrigation following external DCR were included. Five patients with watery epiphora constituted the study group (SG). Five patients without epiphora constituted the control group (CG). All patients underwent MR-DCG following the instillation of artificial tears in the conjunctival fornix. The osteotomy site was identified in T1-weighted coronal images. Lacrimal flow was assessed with modified T2-weighted (True Fast Imaging Steady State Pulse, 'TrueFISP') coronal images before and 10 min after repeated blinking. Signal intensities at three regions of interest (ROIs), corresponding to the eyeball (ROI-1), conjunctival sac (ROI-2), and anastomotic site (ROI-3) were measured. Results: Differences in the diameter of both osseous and soft tissue ostia between SG and CG were statistically not significant. A post-blink increase in signal intensity at ROI-3 was noted in both groups, whereas differences in signal intensity for ROI-1 and ROI-2 were statistically not significant. The post-blink signal intensity increase in ROI-3 was significantly more pronounced in the CG, compared with the SG. Conclusions: The fact that signal intensity increase at ROI-3 was less pronounced in the SG, compared with CG, implies a compromised 'lacrimal pump' mechanism in the former group. The methodology presented may be used for the evaluation of post-DCR epiphora. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical features and surgical preferences of patients with neurofibromatosis. Methods: Histologically confirmed neurofibromatosis cases that underwent surgery during a 15-year period were retrospectively evaluated. The patients' demographics, severity of periorbital involvement, aim of surgery, surgery types, postoperative outcome, and complications were recorded. Results Nineteen patients with a mean age of 24.7 ± 21.2 years were included in the study. Nine were younger and 10 were older than 16 years. Seventeen patients had unilateral and two had bilateral involvement. Patients were followed for a mean of 5.8 ± 5.7 years. A total of 35 surgeries were performed. In 22 times the surgery was performed to improve vision, and in others to get a cosmetically acceptable appearance. Although there was an improvement in visual acuity, the difference was not significant (P = 0.085). Debulking of the tumor was performed in 100%, ptosis surgery in 90%, and lateral canthal fixation in 50% of surgeries. All patients showed improvement: at the last examination, six eyes had no ptosis, in 13 eyes ptosis not covering the pupil in primary gaze was observed on the involved side, and in only one eye the pupil was half covered. Conclusion In neurofibromatosis the treatment should be customized to each patient. As confirmed in our study, an open visual axis is the main goal in surgery, followed by cosmetic appearance. The authors believe that, with possibly multiple surgeries an acceptable result can be achieved. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have examined factors affecting the position of the eyeball to the orbit. This study examined the role of effective orbital volume (EOV), defined as the difference between orbital and eyeball volume, as a determinant of eyeball position, using MRI scans. Methods: Forty-six patients were recruited from the Department of Ophthalmology of the University Hospital of Heraklion, Crete Greece. Patients with a history of orbital disease were excluded. Distances between eyeball poles and orbital landmarks were measured in T1 weighted transverse, sagittal and coronal orbital images. The protrusion of the eyeball in the sagittal and transverse planes was recorded. The volume of the eyeball and bony orbit, the EOV, the volume of the extraocular muscles as well as clinical information (age, gender, Hertel exophthalmometry) were also recorded. Results: EOV was significantly associated with orbital volume but not with eyeball volume. EOV was also significantly associated with transverse and sagittal globe ptotrusions. Females displayed significantly lower orbital and eyeball volumes as well as EOV than males but higher transverse globe protrusion than males. Conclusions: Variations in EOV are associated with orbital volume rather than with eyeball volume. EOV is associated with globe protrusion and may be taken into account in the planning of various procedures, including orbital decompression, treatment of enophthalmos or the size of orbital implants following enucleation. [ABSTRACT FROM AUTHOR]

Purpose: Indications for orbital exenteration performed over a 10-year period from a tertiary eye care center in Western India. Method: Retrospective review of medical records of all patients who underwent exenteration of orbit over a period from January 1999 to April 2009, at a tertiary eye care center in western India. Result: Out of total 236 major orbital surgeries performed, 15 (6%) underwent orbital exenteration. Age ranged from 19 years to 75 years. Of these 9 were male and 6 female. Except for one case all exenteration were for malignant neoplasm. Lesions originated from eyelid in 8 (54%) cases, orbit in 5 (33%) cases and bulbar conjunctiva in 2 (13%) cases. Histopathological classification of the neoplasm were sebaceous carcinoma (4 cases), basal cell carcinoma (3 cases), squamous cell carcinoma (3 cases), adenoid cystic carcinoma (1 case), transitional cell carcinoma (1 case), malignant fibrous histiocytoma (1 case), lymphoma (1 case) and mucormycosis (1 case). Conclusion: Majority of exenterations performed were for neglected ocular or adnexal malignant lesions that could have been avoided provided patients reported earlier for treatment. Exenterations can be reduced by aggresive patient education about eye malignancy. [ABSTRACT FROM AUTHOR]

Purpose: Intracanalicular plugs are commonly used in the management of dry eyes. The authors report 3 cases of complications associated with intracanalicular plugs. Methods: Clinical findings and the management of these patients are presented. Results: The first patient (case 1) is a 47-year-old female with severe dry eyes. Six months after insertion of intracanalicular Form fit hydrogel plugs (OASIS® Medical) she developed canaliculitis with Klebsiella oxytoca. The second patient (case 2), a 33-year-old female, who developed left canalicular abscess 5 months following the insertion of bilateral, intracanalicular Form fit hydrogel plugs (OASIS® Medical). The third patient (case 3) a 33-year-old female had granulation tissue formation within the left lower canaliculus, 5 years after insertion of intracanalicular plug. The symptoms in the three patients resolved after they underwent canaliculotomy with removal of the plugs. Conclusion: Complications of intracanalicular plugs can sometimes outweigh their benefits. These plugs can lodge in the lacrimal outflow system and cause pyogenic granuloma formation and canaliculitis. To our knowledge, until now there have been no reports of complications associated with Form Fit hydrogel plugs (OASIS® Medical) and its infective complication with Klebsiella oxytoca. [ABSTRACT FROM AUTHOR]

Heavy eye phenomenon can be cosmetically unaccepted due to significant pseudoproptosis and hypotropia. We highlight the salient features of this condition, and report successful cosmetic outcome following a staged procedure comprising orbital decompression and horizontal recti surgery. [ABSTRACT FROM AUTHOR]

A 31-year-old Black man presented with two oval masses in his right conjunctiva. The tumors were completely excised and histology showed that the inferior lesion was a conjunctival squamous papilloma with pigmentation while the superior one was an inverted conjunctival papilloma, which grew in an endophytic manner. Follow up examination one year later showed no recurrence. Literature search revealed no previous report of simultaneous appearance of these types of papilloma in the same eye. Management of conjunctival squamous papillomas is difficult and is complicated by multiple recurrences in contrast to inverted conjunctival papillomas where no recurrences have been reported after complete excision. Thus, histopathology is an absolute necessity even when papillomas appear in the same eye. [ABSTRACT FROM AUTHOR]

We report a 37-year-old patient with the history of bilateral epiphora, who was referred to our department for dacryoscintigraphy imaging. The patient had bilateral obstruction of the lacrimal apparatus at the sac-duct level on the scintigraphy images. Delayed imaging showed Tc-99m pertechnetate uptake in the thyroid due to systemic absorption of the tracer from the conjunctiva. We recommend using tracers with large particle size and lower possibility of mucosal absorption for dacryoscintigraphy in order to decrease unnecessary thyroid radiation. [ABSTRACT FROM AUTHOR]