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Intraorbital foreign bodies (IOrFBs) are a significant cause of ocular morbidity. Although plastic IOrFBs are rare, the increasing use of plastic and polymer composites in motor vehicles will increase their prevalence. Although challenging to identify, plastic IOrFBs have unique radiographic characteristics. The authors describe a case of an 18-year-old man with a history of a motor vehicle accident and a left upper eyelid laceration. In retrospect, imaging suggested a plastic IOrFB, which was initially overlooked. A follow-up examination demonstrated persistent left upper lid ptosis with an underlying mass. Further work-up revealed a retained IOrFB, which was removed via anterior orbitotomy. Scanning electron microscopy of the material was consistent with a plastic polymer. This case demonstrates the importance of maintaining a high suspicion for IOrFBs in the correct clinical context, the need for increased awareness of plastic and polymer composite IOrFBs, and the use of diagnostic imaging for identification. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTopical chloramphenicol is one of the most ubiquitous antibiotics used in ophthalmology and oculoplastic surgery globally. It shows broad-spectrum activity against a variety of different pathogenic organisms, is well tolerated on the ocular surface and displays excellent topical pharmacokinetics. Chloramphenicol has been available for purchase over the counter in the United Kingdom since 2005. Despite this, the largest health economy in the world, The United States has had a de-facto moratorium on its use for the past 30 years. In this review, we aim to evaluate topical chloramphenicol in ophthalmology and oculoplastic surgery and to determine whether its reputation within the US is warranted and justified.We conducted a comprehensive literature review to evaluate the different facets of chloramphenicol, providing a detailed understanding of the drug, its historical context, the benefits and perceived risks, including safety concerns, and clinical perspectives of its use in clinical practice.The mechanism of chloramphenicol, the context around which the drug’s use in the US declined, and the drug’s evidence base and safety data, including published case reports of serious adverse events, were analysed. The perceived benefits of the drug, particularly in light of antimicrobial resistance and its economic impact, were reviewed. Finally, perspectives on its use in clinical practice in ophthalmology and associated allied specialities were presented.Chloramphenicol and its topical application have been misunderstood for many decades, particularly in the United States. Its demise across the Atlantic was due to an overzealous response to a dubious association with a weak evidence base. Numerous authors have since validated the safety profile of the and its safety has been borne out. The benefits of chloramphenicol, an effective broad-spectrum agent with a positive cost differential in the era of anti-microbial resistance and fiscal tightening, cannot be understated. Its likely effectiveness as a therapeutic topical agent in ophthalmic surgery makes it a valuable tool in the ophthalmic anti-microbial armoury. We would encourage the reinstatement of this valuable yet misunderstood drug as a first-line agent for simple ophthalmic infections. [ABSTRACT FROM AUTHOR]

We performed bilateral optic nerve sheath fenestrations on a patient with the syndrome of acquired hyperopia and choroidal folds. We are unaware of previous reports of this procedure being performed in this clinical setting. Despite the incomplete resolution of his posterior segment findings postoperatively, the results of the procedure, along with an understanding of the relevant anatomy, may help to shed light on the pathogenesis of this rare entity. [ABSTRACT FROM AUTHOR]

Aim To report a case series of patients with persistent temple-related problems following lateral wall rim-sparing (LWRS) orbital decompression for thyroid-related orbitopathy and to discuss their management. Methods Retrospective review of medical records of patients referred to two oculoplastic centres (Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK and Moran Eye Center, University of Utah, Salt Lake City, USA) for intervention to improve/alleviate temple-related problems. All patients were seeking treatment for their persistent, temple-related problems of minimum 3 years' duration post decompression. The main outcome measure was the resolution or improvement of temple-related problems. Results Eleven orbits of six patients (five females) with a median age of 57 years (range 23-65) were included in this study. Temple-related problems consisted of cosmetically bothersome temple hollowness (n=11; 100%), masticatory oscillopsia (n=8; 73%), temple tenderness (n=4; 36%), 'clicking' sensation (n=4; 36%) and gaze-evoked ocular pain (n=4; 36%). Nine orbits were also complicated by proptosis and exposure keratopathy. Preoperative imaging studies showed the absence of lateral wall in all 11 orbits and evidence of prolapsed lacrimal gland into the wall defect in four orbits. Intervention included the repair of the lateral wall defect with a sheet implant, orbital decompression involving fat, the medial wall or orbital floor and autologous fat transfer or synthetic filler for temple hollowness. Postoperatively, there was full resolution of masticatory oscillation, temple tenderness, 'clicking' sensation and gaze-evoked ocular pain, and an improvement in temple hollowness. Pre-existing diplopia in one patient resolved after surgery while two patients developed new-onset diplopia necessitating strabismus surgery. Conclusions This is the first paper to show that persistent, troublesome temple-related problems following LWRS orbital decompression can be surgically corrected. Patients should be counselled about the potential risk of these complications when considering LWRS orbital decompression. [ABSTRACT FROM AUTHOR]