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The purpose of this study was to describe the histopathologic appearance of dermal eyelid fillers that were unexpectedly encountered in ophthalmic plastic surgery samples from patients with mild eyelid disfigurements, and to review eyelid cases with complications that had previously been described in the literature. A retrospective histopathologic study with Alcian blue, elastic, and Masson trichrome stains of 2 cases that were submitted to the Ocular Pathology Department was conducted, and a critical review of previously published cases of the histopathologic characteristics of dermal filler material in the periocular region was also conducted. Two periocular tissue samples were found to contain dermal filler material. In one case, porcine collagen appeared as amorphous or indistinctly microfibrillar aggregates that stained light blue with the Masson trichrome method. In the other case, hyaluronic acid gel appeared as vivid blue amorphous pools of material in extracellular locules after staining with the Alcian blue method. An inflammatory response was not observed in either case. Patients who undergo facial filler procedures may, at a later time, require a surgical excisional procedure from which a specimen is generated. Previously injected dermal filler that the patient neglected to mention may be present in the pathologic sample, potentially perplexing the unsuspecting pathologist. Both ophthalmic plastic surgeons and ocular pathologists should be aware of the histopathologic features of dermal fillers. It is helpful if a surgeon who submits a specimen to the pathology service makes note of any known prior use of facial filler material or is alert to its possible presence when unfamiliar foreign material is discovered in the dermis of the eyelids.

A 53-year-old man presented with smooth-domed, variegated cysts (polycystic disease) of all 4 eyelids, worse on the left side. Some of the cysts were clear, while others were creamy-white colored. In addition, multiple, very fine vesicopapules were noted along the eyelid margins. Histopathologic examination revealed a trichilemmal cyst, several pure apocrine hidrocystomas displaying multiple chambers, a hybrid cyst, and many small eccrine cysts of the deep dermis. The apocrine lesions, including the small ones at the eyelid margins, predominated. Smooth muscle actin sometimes positively stained outer myoepithelial cells in some of the apocrine cysts, which helped to distinguish them from eccrine cysts. Most noteworthy was the fact that the patient had been diagnosed with a prolactinoma 20 years earlier. There is only 1 previous report of multiple apocrine cysts and an antecedent prolactinoma in the dermatologic literature. This syndrome should be separated from that of Schöpf-Schulz-Passarge, which manifests multiple small eyelid apocrine cysts and other ectodermal dysplasias without any association with neoplasia, and from that of focal dermal hypoplasia (Goltz-Gorlin) syndrome with apocrine cysts but again without neoplasia.

Objective: To evaluate whether inhibition of the pro-inflammatory cytokines IL-1β or IL-17A by canakinumab or secukinumab, respectively, influence the signs and symptoms of dry eye. Design: A double-masked, placebo-controlled, outpatient clinical trial. Participants: Seventy-two patients with moderate to severe dry eye. Methods: Patients were randomized in a 1:1:1 ratio to the following three treatments: a single intravenous dose of canakinumab that neutralizes IL-1β, a single intravenous dose of secukinumab that neutralizes IL-17A, or an intravenous dose of placebo. The signs and symptoms of dry eye were evaluated on the treatment day and 1 week, 4 weeks, and 8 weeks after the treatment. Main Outcome Measures: The pre-specified primary efficacy endpoint was corneal staining in the study eye as measured by the NEI staining score 4 weeks after treatment. Secondary endpoints at that visit and 1 week and 8 weeks after treatment included tear production (Schirmer test), tear film breakup time, conjunctival redness, the ocular surface disease index (OSDI), the frequency of a desire for a topical ocular lubricant, and visual acuity. Results: Of the 71 patients included in the analysis of safety, the rate of adverse events was similar between treatment groups; in particular, there was no noteworthy excess of adverse events in the canakinumab and secukinumab groups compared with the placebo group. Sixty-nine patients appropriately completed the study and were included in the analyses of efficacy. The course of corneal staining scores from baseline to four weeks, respectively, were for canakinumab 1.46 to 1.33 (p = 0.62 compared to placebo), for secukinumab 1.46 to 1.23 (p = 0.22), and for placebo 1.68 to 1.42. There were no changes in the other measures of efficacy beyond what was within the range expected for stochastic day-to-day variation. Conclusions: Neither canakinumab nor secukinumab substantially improved the corneal staining score (the primary endpoint) or improved the other measures of the severity of dry eye. The results suggest that the inhibition of IL-1β or IL-17A obtained by systemic administration of neutralizing drugs does not influence the severity of dry eye.

PURPOSE Uveal leiomyoma is a rare, benign smooth muscle neoplasm usually diagnosed only after local resection or enucleation. We describe a single interventional case report with clinicopathologic correlation of an intraocular leiomyoma responding to proton beam radiation. CASE REPORT A 51-year-old woman presented with a choroidal mass in the left eye that was initially diagnosed as a choroidal melanoma. The neoplasm was treated with a total of 70 cobalt gray equivalents of external proton beam radiation in 5 fractions over 7 days. Biannual follow-up examinations over 3 years showed a funduscopically and ultrasonographically regressing tumor. The left eye was enucleated approximately 3 years postradiotherapy because of progressively increasing pain secondary to elevated intraocular pressure from neovascular glaucoma. Microscopic and immunohistochemical examination of the mass revealed a choroidal neoplasm expressing smooth muscle antigens consistent with a uveal leiomyoma. CONCLUSION Uveal leiomyoma appears to be responsive to proton beam radiation, and radiotherapy may serve as an alternative to primary enucleation or local resection. Additional studies are necessary to determine whether radiotherapy of smaller tumors might render better results for vision and globe preservation.

PURPOSE To describe the clinical presentation of cutaneous benign mixed tumor of the eyelid and its management options. METHODS Periocular cases of cutaneous benign mixed tumor were gathered from members of an oculoplastics specialty Internet discussion group. A total of 9 patients are described in this retrospective, interventional case series. The clinical presentation, histopathology, and management of these lesions is reviewed. RESULTS Patients were typically asymptomatic, presenting with a slowly enlarging, nontender nodule of 2 to 8 years' duration. The lesions ranged from 4 mm to 17 mm in greatest dimension. Four of the lesions were on the eyelid margin, three in the sub-brow area of the upper eyelid, and two in the central lids. All six cases not involving the brow were fixed to the tarsus; one brow lesion was believed to be adherent to the skin. None of the lesions was associated with significant changes of the overlying epidermis, although one lesion showed overlying pigmentation. All patients underwent excisional biopsy for diagnostic or cosmetic reasons. On histopathologic examination, the tumors were biphasic, with an epithelial component exhibiting apocrine or hair follicle differentiation and a myxoid, adipocytic, chondroid, and/or fibrous stroma. The pathologic diagnoses were all consistent with cutaneous benign mixed tumor (chondroid syringoma, pleomorphic adenoma). Follow-up ranged from 2 weeks to 12 months, although several patients failed to keep scheduled follow-up appointments. No clinical recurrences were identified. CONCLUSIONS Cutaneous benign mixed tumor may occur in the eyelid, and, although uncommon, should be included in the differential diagnosis of firm, nodular eyelid tumors. The histopathologic features are similar to those seen in this tumor type arising in other areas of the body. Preoperative consideration of this diagnostic possibility may allow the surgeon to plan for complete excision, thereby reducing the possibility of recurrence or malignant transformation.

We reviewed cases of a paraneoplastic syndrome in which uveal melanocytes proliferated and led to blindness. Eighteen cases were derived from the literature, and two were taken from our institution. The average patient age at the time of the diagnosis was 63 years (range, 34-89 years). There were 13 women and 7 men. In approximately half of the cases, the ocular symptoms antedated those of the inciting tumor. Most of the inciting tumors were poorly differentiated carcinomas. The most common tumors were from the female genital tract (ovary and uterus) among the women patients and from the lung among the men. Tumors from the breast were rare (one possible case), and tumors of the prostate were conspicuously absent. All five inciting tumors whose histopathology was reviewed expressed neuron-specific enolase, but none prominently expressed antigens more specific for neuroendocrine carcinomas such as chromogranin or synaptophysin. It is our experience that many general pathologists are not aware of this unique paraneoplastic syndrome. Our report is the first to document a statistically significant association between this syndrome and gynecologic cancers.

In one family with low-penetrance retinoblastoma, a germ-line deletion is shared by affected and unaffected, obligate carriers. The deletion encompasses exon 4 of the retinoblastoma gene and corresponds to a mutant protein without residues 127-166. In a second family, RFLP analysis shows that two distant relatives have independently derived mutations. These families, together with others reported elsewhere, indicate that attributes of alleles at the retinoblastoma locus specify penetrance.

Our discussion of adenocarcinomas arising from the ciliary and iris epithelium, based upon a case report and a review of the literature, attempts summarize what little is known about these tumors. In most instances, the tumors arise from previously healthy eyes in middle-aged people. There appears to be no known way to make the diagnosis preoperatively. As long as the tumor has not extended outside the globe at the time of removal, the prognosis is excellent. The morphology of the tumors is virtually identical to those arising from the retinal pigment epithelium, with anaplastic epithelioid cells often forming tubes, cords, and acinuslike structures. In a few cases, tumors with these traits have extended from the globe and have eventually resulted in the death of the patients; one of these cases unquestionably arose from the iris and ciliary body epithelium. Knowledge of these tumors is in a primitive stage, and much clinical and pathological information is needed in order to determine their casue, diagnostic clinical features, and proper treatment.

A number of patients with retinoblastoma have a deletion of chromosome 13. Comparison of the deleted segments from different individuals reveals that all deletions involve chromosome band 13q14. This observation has lead to the hypothesis that in this region is a gene of genes important in the etiology of retinoblastoma. As a first step toward understanding those genes, the authors successfully isolated five DNA fragments from chromosome 13 using recombinant DNA techniques. The DNA fragments from chromosome 13 will be useful in identifying DNA polymorphic sites that are linked to the retinoblastoma locus tentatively assigned to 13q14. Such DNA polymorphisms will be important in the genetic counselling of families with retinoblastoma. These chromosome 13q14 fragments also may be useful in searching for microdeletions of 13q14.