Electric cataract: a rare clinical entity

Bilateral crystalline lens opacities developed in a 39-year-old black male who had been involved in an electrical accident approximately 1 yr before our examination. The anterior subcapsular opacities had feathered edges and a slightly raised center. The typical appearance and progressive course of the opacities, as well as the history, led to the diagnosis of electric cataract.     

Ectopic intraorbital lacrimal ductal cyst: a case report

Lacrimal ductal cysts are uncommon lesions that can occur everywhere in and around the eye. Ectopic location is very rare and can be misleading in the differential diagnosis of orbital masses. In this article we present the case of a 61-year-old-man with a medial intraconal ductal cyst of his right orbit. The patient was successfully treated with surgical excision.     

Stones in the lacrimal gland: a rare condition

Purpose: Stones (dacryoliths) in the lacrimal drainage system are relatively common. However, stones in the lacrimal gland itself are very rare. We present three cases of lacrimal gland stones and describe the clinical and histopathological characteristics and composition of the stones. Methods: Three patients presented with swelling in the lateral canthal region of several months’ duration. Clinical examination in each case revealed a mass adjacent to the lacrimal gland. We carried out surgical excision, histological examination and Raman spectroscopy. Results: Histopathological examination of the excised material showed an eosinophilic, amorphic material organized in lamellae and localized in a ductule. The findings were consistent with a stone in the lacrimal gland in all three cases. All stones were composed of proteins of similar types. After surgery, the three patients healed without complications. Conclusions: Lacrimal gland stones represent a very rare but relevant differential diagnosis when a patient presents with unilateral persistent conjunctivitis or with a tumour in the lateral canthus. Treatment is excision under local anaesthesia.     

Lipoid proteinosis: A rare entity

Urbach–Wiethe syndrome or lipoid proteinosis is a rare autosomal recessive disorder characterized histologically by infiltration of Periodic acid Schiff-positive hyaline material in the skin, upper aerodigestive tract, eyelids, and internal organs. Classical clinical features include scarring of the skin, beaded eyelid papules (moniliform blepharosis) and laryngeal infiltration leading to hoarseness of voice. Lipoid proteinosis can lead to life-threatening conditions such as acute respiratory distress and seizures. Awareness among ophthalmologists about this rare entity is crucial for appropriate management of these patients.     

Expulsion of a lacrimal dacryolith by sneezing: a rare event

PURPOSE: To describe the case of a man presenting with intermittent epiphora of the right eye and a low grade dacryocystitis due to a dacryolith. METHODS/RESULTS: He was treated conservatively and was offered a Dacryocystorhinostomy. A few weeks before surgery, he developed swelling and pain over the right medial canthus followed by violent sneezing with spontaneous extrusion of the dacryolith. DISCUSSION: The authors propose that the dacryolith fragmented spontaneously and once it reached the nasal cavity, was expelled by violent sneezing to the nostril, a mechanism not previously reported. CONCLUSIONS: Reformation of dacryolith is a likely possibility, and recurrence of symptoms in such cases may ultimately require a Dacryocystorhinostomy.     

Acquired ptosis associated with a conjunctival cyst

A 44-year-old woman with a history of previous ptosis surgery presented with a moderate ptosis of the left upper eyelid and a large cystic mass extending over the length of that lid. The mass was excised completely and histologically found to be a conjunctival ductal cyst. The levator aponeurosis was disrupted by the cyst and required reconstruction. This case demonstrates an acquired ptosis associated with a large conjunctival cyst as a late complication of ptosis surgery.     

Orbital malignant meningioma: a unique presentation of a rare entity

An elderly female with progressive proptosis was found to have an aggressive retrobulbar solid orbital mass. The mass was distinct from the optic nerve sheath and intracranial meninges, and produced concave erosion of the sphenoid wing. Operative findings demonstrated an orbital mass adherent to the dura of the superior orbital fissure. The mass did not demonstrate meningeal violation, infiltrate the superior orbital fissure, or display intracranial spread. The dura remained intact after gross total resection. Histopathology revealed a malignant meningioma with papillary and focal rhabdoid morphology and bony invasion (WHO grade III). The patient received 2500cGy of stereotactic radiotherapy in addition to gross total resection. Postoperatively, the signs and symptoms of orbital mass effect resolved (proptosis, relative afferent papillary defect, and periorbital edema) and the vision improved. There was no orbital recurrence or intracranial extension. The follow-up time was limited to eight months secondary to the patient succumbing to metastatic lung adenocarcinoma, which was demonstrated to be a separate process from the orbital meningioma. We propose the etiology of this tumor to be most consistent with an orbital malignant primary extradural meningioma – the first case reported in the literature.     

罕见的眼睑毛发囊肿1例(英文)

患者,女,42岁,马来人,无痛性进展性右上睑肿胀2a就诊,无外伤史,身体其他处无同样病损。进行肿块切除活组织检查,组织病理学检查结果显示与毛发囊肿表现相符。毛发囊肿,尽管罕见,在眼睑病变中需要考虑到。     

Dermoid cyst of the lacrimal gland

The case of a 33-year-old-woman with a recent onset of left upper eyelid swelling is described. Imaging studies demonstrated a cystic lesion in the left lacrimal gland fossa. Excisional biopsy of the mass showed a dermoid cyst entirely surrounded by a thin layer of normal lacrimal gland tissue. The authors present a highly unusual case of a soft tissue orbital dermoid cyst arising from the lacrimal gland.     

Acquired capillary hemangioma in the lacrimal sac region

PURPOSE: To describe two cases of acquired capillary hemangiomas in adults, in the lacrimal sac region. DESIGN: Interventional case reports. METHODS: Review of the history, clinical examination, and pathologic findings. RESULTS: Two patients, an 80-year-old woman and a 50-year-old man, presented with a history of tearing and a slowly growing nodular mass in the lacrimal sac area. Probing and irrigation showed a patent drainage system in both cases. Both lesions were biopsied. Histopathologic examination of the specimens showed capillary hemangiomas. CONCLUSIONS: Capillary hemangiomas in the lacrimal sac area may present with clinical features of more common lesions such as dacryocystitis or mucocele, or rarer lacrimal sac malignancies. They should therefore be considered in the differential diagnosis of any nodular lesion in this area in adults, even at a very late age.     

Eosinophilic angiocentric fibrosis: an unusual entity producing complete lacrimal duct obstruction

Eosinophilic angiocentric fibrosis is an unusual fibrotic condition of unknown aetiology that tends to affect the upper respiratory tract. Twenty-one cases have been reported in the literature and only three have had ocular adnexal involvement. Despite characteristic histopathological and clinical findings, the diagnosis remains a challenge. Furthermore, its progressive nature with potential to invade adjacent structures and the lack of response to current treatment modalities make management difficult. We describe a case of sinonasal eosinophilic angiocentric fibrosis that presented with bilateral nasolacrimal duct obstruction.