Proptosis in a Patient With Known Graft Versus Host Disease.

A retrospective review of the medical reports of a patient who was undergoing treatment for graft versus host disease following bone marrow transplant for acute myeloid leukemia was conducted. The patient presented with persistent ocular irritation and injection. For an unclear period of time, he developed proptosis and binocular diplopia with limitation of extraocular motility insidiously.

Methotrexate as an Adjuvant in Severe Thyroid Eye Disease: Does It Really Work as a Steroid-Sparing Agent?

Purpose: To compare the efficacy and safety of adjunctive oral methotrexate with intravenous pulsed methylprednisolone against methylprednisolone alone in the treatment of severe thyroid eye disease.

Methods: Retrospective review of clinical data of patients with severe sight-threatening thyroid eye disease with compressive optic neuropathy treated with methylprednisolone with and without methotrexate. Eye disease outcome measures (e.

The tear cytokine profile in patients with active Graves' orbitopathy.

Purpose: The primary aim of this study is to isolate cytokines specific for active Graves' orbitopathy (GO) in the tears of affected patients. The secondary aim is to identify other cytokines of interest and to look at the profile of their levels over time.

Methods: This is a prospective pilot study conducted at the Singapore National Eye Centre.

Clinical Features and Treatment Outcomes of Orbital Inflammatory Disease in Singapore: A 10-Year Clinicopathologic Review.

Purpose: 1) To assess the clinical profile and treatment outcomes of orbital inflammatory disease in the local population, and 2) classify patients using current histopathological criteria.

Methods: Ten-year retrospective clinicopathologic review of patients diagnosed with orbital inflammatory disease who underwent tissue biopsy from January 2001 to December 2011 at a tertiary referral centre in Singapore. Data collection included patient demographics, clinical presentation, investigations, systemic disease, histopathology review, clinical classification, medical and surgical management, response to treatment and recurrence rates.

"Walk the Rim, Feel the Bone" Technique in Superior Sulcus Filling.

Superior sulcus filler injection is a nonsurgical method to rejuvenate the upper face. Blindness and stroke are devastating complications of facial filler injection. This study describes an injection technique that minimizes the risk of blindness and includes a case study demonstrating the cosmetic benefits of this procedure.

Axial Globe Position Measurement: A Prospective Multicenter Study by the International Thyroid Eye Disease Society.

Purpose: Identify a reproducible measure of axial globe position (AGP) for multicenter studies on patients with thyroid eye disease (TED).

Methods: This is a prospective, international, multicenter, observational study in which 3 types of AGP evaluation were examined: radiologic, clinical, and photographic. In this study, CT was the modality to which all other methods were compared.

The Looi suture technique for anchoring the lateral tarsal strip to the lateral orbital wall.

Introduction: The lateral tarsal strip procedure (LTS) was first reported by Anderson and Gordy in 1979 for the management of paralytic or senile eyelid laxity. Since its description, the LTS procedure has been subject to several modifications by various authors. In this study, we described the Looi suture technique, a small modification in the technique of suturing the LTS to the lateral orbital wall periosteum.

Ocular manifestations and the clinical course of carotid cavernous sinus fistulas in Asian patients.

Purpose: To study the clinical course with regard to both the angiographic and visual outcomes of carotid cavernous fistulas (CCFs).

Background: Carotid cavernous sinus fistulas (CCFs) are conditions which often present with ocular signs and symptoms. The clinical presentation of CCFs is varied according to the anatomy, haemodynamics and size of the CCF.

Prospective audit of ptosis surgery at the Singapore National Eye Centre: two-year results.

Purpose: To evaluate the demographics, presentation, and surgical outcomes of patients undergoing ptosis surgery in an Asian population in a prospective manner.

Methods: A prospective ptosis audit was conducted over a 2-year period from January 2010 to December 2011 in a tertiary eye hospital in Singapore. All patients undergoing ptosis surgery by, or under the supervision of, an oculoplastic-trained consultant in the institution were included.

A survey of the histopathology of lacrimal gland lesions in a tertiary referral centre.

Purpose: To describe the histopathological distribution of biopsied lacrimal gland lesions in a tertiary referral centre in Singapore.

Methods: This was a retrospective chart review. Clinical records of patients who underwent lacrimal gland biopsy at a tertiary referral centre in Singapore between 2000 to 2010, were reviewed.

Osteotome as an adjunctive instrument in endoscopic dacryocystorhinostomy.

Purpose: To report the novel use of the osteotome as an adjunctive instrument in Endoscopic Dacryocystorhinostomy (DCR).

Materials And Methods: A retrospective interventional case series of 15 patients, underwent endoscopic DCR at the Singapore National Eye Centre, by a single ophthalmologist and rhinologist between April 2009 and April 2011.All patients' case records were reviewed and the information recorded included: patients' demographics, level of obstruction of the lacrimal system, operative time, postoperative symptoms and complications (if any), and the length of follow-up.

An unusual causative agent for an orbital abscess: Granulicatella Adiacens.

We present a patient who developed an orbital abscess secondary to a retained organic (wooden) foreign body after a fall. Clinically, he had a right sub brow fistula exuding purulent discharge, four millimetres of proptosis, limitation of ocular motility in all directions of gaze, but no signs of optic neuropathy. Preoperative computed tomography and magnetic resonance imaging of the orbits was performed to localise the abscess and to facilitate surgical planning.

Neuroendocrine tumors of the orbit--clinicopathological findings in 3 more cases of this rare entity and review of the literature.

Introduction: Neuroendocrine orbital tumors are rare occurrences. They are poorly characterized histologically and a spectrum of different cell types exists. This short case series studies the various tumor morphologies as well as the patients' clinical profiles.

A 5-year retrospective review of Asian ectropion: how does it compare to ectropion amongst non-Asians?

Introduction: This study reviews the differences in demographics and surgical outcomes between ectropion in Asian and non-Asian eyes.

Materials And Methods: Medical records of surgically corrected ectropion cases from January 2002 to December 2006 were reviewed. Preand postoperative lid-globe apposition was graded: grade 0 with normal lid-globe apposition, grade 1 with punctal ectropion, grade 2 with partial lid eversion and scleral show, grade 3 with conjunctival hyperemia and thickening and grade 4 as for grade 3 with exposure keratitis.

Modifying the upper eyelid crease in Asian patients with hyaluronic acid fillers.

Background: Preliminary experience with the use of hyaluronic acid fillers as a nonsurgical alternative in the management of upper eyelid crease asymmetry and superior sulcus hollowing in Asian patients has proven promising.

Methods: This retrospective, interventional case series included seven patients (11 eyes) of various Asian ancestries. All patients had eyelid crease asymmetry or undesirably elevated eyelid creases along with hollowing of the upper eyelids.

Bilateral orbital subperiosteal hemorrhage following labor.

A 27-year-old woman presented with 13 days of bilateral periorbital swelling, discomfort, and visual loss, which developed immediately after labor. She had significant blood loss requiring blood transfusion. There was bilateral proptosis, left optic neuropathy, and a superior visual hemifield defect in the left eye.

Nasolabial fold angle measurement using anterior segment optical coherence tomography in normal subjects.

Purpose: The human nasolabial fold angle (NFA) has been measured using MRI and photogrammetry and has been shown to decrease with age. The authors aimed to evaluate a novel method using optical coherence tomography to measure the NFA.

Methods: In this cross-sectional observational series, the authors used anterior segment optical coherence tomography (ASOCT) to image the NFA of both cheeks of 126 subjects aged 21 to 79 years.

Onodi sinusitis presenting with orbital apex syndrome.

This article reports the unusual presentation of a patient with an intraconal abscess secondary to sinusitis in an onodi cell in a healthy 63 year old Chinese female. She presented with limited extraocular movements, decreased corneal sensation, rapid drop in visual acuity and signs of optic neuropathy, in the absence of any inflammatory signs in the right eye. MRI scans showed a well-encapsulated mass in the posterior two thirds of the orbit, with the presence of an onodi cell on the right side.

Orbital cellulitis in children-medical treatment versus surgical management.

Introduction: Ophthalmologists differ in their threshold for surgical management in paediatric patients with orbital cellulitis. We studied the management choices and outcome of children admitted with this disorder.

Material And Methods: A retrospective review was performed on patients with orbital cellulitis admitted between January 2001 and December 2004 to a tertiary paediatric referral centre in Singapore.

Normative measurements of the Chinese extraocular musculature by high-field magnetic resonance imaging.

Purpose: To establish the normal measurements of diameter and cross-sectional area of the Chinese extraocular muscles (EOMs) and optic nerve-sheath complex (ON) as seen on high-field (3-Tesla; 3T) magnetic resonance imaging (MRI).

Methods: Coronal 3T MRI of the orbit (TR, 700 ms; TE, 15 ms; FOV, 160 mm; matrix, 256 x 256; slice thickness, 1 mm; and slice gap, 0) was performed on 80 normal Chinese volunteers. T1-weighted images were analyzed with computer-assisted segmentation.

Stereotaxy for surgical navigation in orbital surgery.

Purpose: Image guidance has been used in neurosurgery with great success. The authors illustrate the use of stereotaxy and neuronavigation in the surgical management of a cranio-orbital tumor and for orbital decompresson in thyroid orbitopathy.

Methods: Stereotactic image guidance was used in the surgical management of 2 patients, one with a large left sphenoid wing meningioma causing proptosis and visual loss from orbital extension, and the other with disfiguring proptosis due to thyroid eye disease.

Visual outcomes in patients with paranasal mucoceles.

Purpose: To describe the ophthalmic complications and visual outcome of patients with paranasal mucoceles.

Methods: This is a retrospective case series of patients with a diagnosis of paranasal mucocele. Their medical records were examined with particular emphasis on the location of the paranasal mucoceles, presence of inflammation (mucocele vs.

Angiolymphoid hyperplasia with eosinophilia of the eyelid with spontaneous regression.

A 53-year-old Chinese man presented with a painless left upper eyelid lump of 2 weeks' duration. Histopathology was consistent with angiolymphoid hyperplasia with eosinophilia, and also revealed neutrophilic infiltrate secondary to ulceration. After incisional biopsy, the residual lesion, which was not treated, developed surface keratinization over the next 2 weeks and sloughed off, leaving intact epidermis and no scar.