Granulomatous acne rosacea of the eyelids.

We describe the clinicopathologic features of the papular form of granulomatous acne rosacea of the eyelids. This unusual cutaneous disorder is typified by painless eruptions of reddish to yellowish brown, occasionally ulcerative papules symmetrically distributed around the eyelids, lower part of the forehead, nasolabial folds, and upper lip. Histopathologically, the lesions display caseating and noncaseating dermal granulomas that mimic those seen in tuberculosis, tuberculoid leprosy, sarcoidosis, and other diseases.

Diffuse malignant melanoma of iris with metastases.

A 66-year-old man had decreased visual acuity in the left eye. Slit-lamp examination showed hyperpigmentation of the periphery of the iris from 2:30 to 9 o'clock. Gonioscopy disclosed an ill-defined mass involving the angle and extending from 5 to 7:30 o'clock with diffuse pigmentation of the meshwork for 360 degrees.

The diagnostic utility of desmin. A study of 584 cases and review of the literature.

The diagnostic utility of several antibodies against desmin and their optimal staining conditions have not been systematically evaluated. Sections of paraffin-embedded tissues from 584 cases were stained with a monoclonal antibody against desmin (Clone DER 11 from DAKO), using an avidin-biotin-peroxidase technique. The results were tabulated and compared with those from previous reports.

A clinicopathologic study of three carcinoid tumors metastatic to the orbit. Immunohistochemical, ultrastructural, and DNA flow cytometric studies.

Three patients with histopathologically proven orbital metastatic lesions from a carcinoid tumor are reported. Computed tomography (CT) disclosed a well-circumscribed orbital mass in two of three cases. Each tumor was studied by both light and electron microscopy as well as immunohistochemistry and DNA flow cytometry.

Peripunctal melanocytic nevi. Distinctive clinical findings and differential diagnosis.

A peripunctal nevus is a rare lesion of the eyelid margin, six examples of which are included in this report. The lesions all involved the lower punctum and had been present for many years without producing epiphora. In addition to their variable clinical pigmentation and translucent appearance on biomicroscopy, all shared several other diagnostically useful clinical features: an overall dome-shape with a fine micronodularity; a prominent ramifying vascularity; and, most importantly, circumferentially swollen punctal lips that created a slit-like punctal orifice.

Nonmelanized macromelanosomes in a cellular blue nevus. Light and electron microscopic observations.

We noted nonmelanized and partially melanized macromelanosomes in a cellular blue nevus and studied their light microscopic and ultrastructural features. Numerous intracytoplasmic eosinophilic inclusions were found in the lesion; individual cells contained up to nine, although most cells demonstrated two or three. The "macromelanosomelike" inclusions ranged in size from 1 to 15 microns.

Demonstration of HIV-1 and HHV-6 in AIDS-associated retinitis.

Using an immunohistochemical technique and monoclonal antisera, HIV-1 and CMV antigens were demonstrated in lesioned areas of retinal tissues from selected AIDS patients. Polymerase chain reaction (PCR) was utilized to detect HIV-1 and HHV-6 DNA sequences in total retinal tissues from these patients. In this study of six eyes from four patients, two of the retinas contained three different viruses, HIV-1, HHV-6 and CMV.

Polychromatic corneal and conjunctival crystals secondary to clofazimine therapy in a leper.

A 67-year-old man had a diagnosis of dapsone-resistant lepromatous leprosy. He received clofazimine (Lamprene) at a dosage of 100 mg twice daily. After 3 years of therapy, results of slit-lamp examination disclosed myriad polychromatic crystals diffusely involving the cornea and perilimbal conjunctiva of both eyes.

Ligneous conjunctivitis after pingueculae removal in an adult.

A 45-year-old man who had uneventful excision of bilateral pingueculae developed bilateral membranous lesions involving the bulbar conjunctivae and corneas. Histologically, the membranes were composed mainly of large fibrinous deposits intermixed with acute and chronic inflammatory cells with areas of fibroblastic and capillary proliferation resembling granulation tissue. By electronmicroscopy the amorphous acidophilic masses were composed of electron-dense, fibrillar material with a periodicity of 10-12 mm, which was consistent with fibrin.

Endogenous endophthalmitis with lenticular abscess caused by Enterobacter agglomerans (Erwinia species).

We report for the first time a case of metastatic endophthalmitis caused by the gram-negative organism Enterobacter agglomerans (Erwinia species). One day following internal hemorrhoidal ligation, the patient developed anterior uveitis that progressed to panophthalmitis with a lenticular abscess and a necrotic retina. Despite aggressive surgery and appropriate antibiotic therapy, the affected eye lost useful vision.

Combined hamartoma of sensory retina and retinal pigment epithelium.

We report two cases of combined hamartoma of the sensory retina and retinal pigment epithelium (CHR-RPE) in which apparent growth of the lesion was observed. In case 1, the eye was enucleated with a presumed diagnosis of juxtapapillary malignant melanoma. Histopathologically, the enucleated globe showed an elevated peripapillary mass containing disorganized retinal tissue intermixed with vascular and glial elements as well as tubules of proliferating retinal pigment epithelium.

Neuroglial choristoma presenting as congenital lid tumor.

A 12-month-old boy presented with a diffuse solid tumor of the nasal portions of the lower lid, which had caused almost complete narrowing of the interpalpebral fissure since birth. Clinically, it was suspected to be a mesenchymal tumor. Radiological studies revealed no bony defects in the orbit.

Fungal keratitis in contact lens wearers.

In a retrospective review from 1972 through 1987 of patients with microbial keratitis, fungal infection occurred in four (4%) of 90 cosmetic or aphakic contact lens wearers and in four (27%) of 15 patients using a therapeutic soft contact lens. Predisposing factors included improper lens care by the refractive lens wearers and a chronic epithelial defect with topical corticosteroid use among the therapeutic lens wearers. The responsible organisms in the refractive lens group were Fusarium solani (two patients) and Cephalosporium and Paecilomyces (one patient each), and in the therapeutic lens group Candida (three patients) and Aspergillus (one patient).

Diffuse uveal melanoma in a 5-year-old child.

A 5-year-old white boy developed a gray-tan discoloration with nodular thickening of the iris stroma in his left eye six weeks earlier. Ophthalmologic examination demonstrated keratic precipitates, peripheral anterior synechiae, and several pale-tan choroidal infiltrates in the involved eye. Cytologic examination of the aqueous humor and results of iris biopsy were interpreted as malignant melanoma of the iris, predominantly of the epithelioid cell type.

Pulmonary blastoma with rhabdomyosarcomatous differentiation: an electron microscopic and immunohistochemical study.

Pulmonary blastoma is a rare lung tumor composed of epithelial and mesenchymal elements; the latter element may show various patterns of differentiation toward mature tissue, such as cartilage, smooth muscle, and bone. Rhabdomyoblastic differentiation in pulmonary blastoma is quite rare; only five such cases have been reported. We report two cases of pulmonary blastoma with rhabdomyoblastic differentiation documented for the first time by electron microscopy and immunohistochemistry including documentation for myoglobin, actin, vimentin and desmin.

Nocardial endophthalmitis: report of two cases studied histopathologically.

We report two cases of nocardial endophthalmitis. Case 1 is a 66-year-old man whose left eye was enucleated about one month after onset of decreased vision. Ophthalmoscopic examination disclosed multiple choroidal masses.

Malakoplakia of the eyelid. Clinical, histopathologic, and ultrastructural characteristics.

A 56-year-old man had a slowly growing, elevated mass excised over the right medial canthus of the right eye. Results of histopathologic examination disclosed a dermal infiltrate of histiocytes ("von Hansemann histiocytes") containing the characteristic laminated, basophilic inclusions (Michaelis-Gutmann [M-G] bodies). Results of histochemical studies showed that the M-G bodies stained positively for calcium, iron, and mucopolysaccharides.

Intraosseous capillary hemangioma of the frontal bone.

A 31-year-old woman with a history of slowly progressive proptosis associated with blepharoptosis was found radiographically to have a lytic lesion of the frontal bone. Complete surgical excision of the bony mass was performed. Histopathologically the tumor was a capillary hemangioma.

Endogenous Clostridium panophthalmitis.

Acute visual loss, pain, and redness in the left eye developed in a 61-year-old diabetic man. Results of ophthalmologic examination showed 4+ conjunctival hyperemia and chemosis, no light perception, and restricted ocular motility. Through a hazy cornea, a gas bubble was visualized filling about 50% of the anterior chamber.

Heterotopic brain tissue in the orbit.

A 3-month-old female infant with Turner's syndrome was noted to have progressive swelling of the left upper lid at the age of 1 month. A computed tomogram demonstrated a well-circumscribed, low-density, homogeneous orbital mass. Initially, the main clinical differential diagnosis included dermoid cyst, hemangioma, and encephalocele.

Nevus sebaceus associated with major ophthalmologic abnormalities.

Nevus sebaceus rarely occurs as part of a syndrome consisting of central nervous system and ophthalmologic abnormalities. We describe a case of nevus sebaceus associated with an epibulbar complex choristoma and colobomas of the optic disc and peripapillary choroid, and review the dermatologic, ophthalmologic, and neurologic literature on the nevus sebaceus syndrome. When associated with other developmental abnormalities, nevus sebaceus and epidermal nevus have erroneously been considered to be a single entity.

Corneal immunoglobulin deposition in the posterior stroma. A case report including immunohistochemical and ultrastructural observations.

Corneal buttons from a patient with bilateral, central, deeply located white corneal deposits that resembled the clinical description of filiform dystrophy were examined by means of light microscopy, immunohistochemistry, and electron microscopy. With light microscopy, the acidophilic fusiform deposits were seen to be oriented parallel to the stromal lamellae and were mostly in the pre-Descemet region. Immunohistochemical studies disclosed that the stromal lesions stained positively for IgG and lambda light chain.

The value of calcofluor white in the diagnosis of mycotic and Acanthamoeba infections of the eye and ocular adnexa.

In search of an easy and quick method for the diagnosis of fungal and Acanthamoeba infections of the eye, the authors have used calcofluor white (CFW), a fluorescent brightener with marked affinity for chitin and cellulose which are present in the cell walls of fungi and cysts of Acanthamoeba. Paraffin-embedded tissues containing mycotic organisms were stained with CFW and examined under a fluorescent microscope. Several fungi such as Candida sp, Aspergillus sp, Phycomycetes, Fusarium solani, Histoplasma capsulatum, Cryptococcus neoformans, Rhinosporidium seeberi, and others were studied.

The autoimmune nature of aqueous tear deficiency.

Twenty-two patients with aqueous tear deficiency (ATD) were examined for the presence of the following autoantibodies: immunofluorescent antinuclear antibody (ANA) and Sjögren's syndrome antibodies A and B (SS-A and SS-B). These autoantibodies were found in 17 (82%) patients but not in control subjects, and they correlated with the severity of symptoms and ocular surface changes. Bacterial keratitis, often recurrent and bilateral, and progressive sterile corneal stromal melting developed in six autoantibody-positive ATD patients.