Coccidioidomycosis of the eyelid.

A 77-year-old woman presented with an ulcerated nodule on her right lower eyelid that was unresponsive to broad-spectrum antibiotics or incision and drainage. Coccidioidomycosis was suspected because of previous serologic testing and concurrent indurated cutaneous nodules. Although skin biopsies were not diagnostic, cultures from the eyelid were positive for Coccidioides immitis.

Systemic fat and thrombus embolization in patients undergoing total knee arthroplasty with regional heparinization.

A double-blind, randomized, controlled study was undertaken to determine if a technique of intraoperative anticoagulation would decrease the incidence or severity of venous embolization after tourniquet release during total knee arthroplasty. Sixty-six patients were randomized to receive either the heparin or placebo treatment. Transesophageal echocardiography was performed before and after tourniquet release to detect embolic material in the right atrium.

Unilateral proptosis in an immunocompetent man as the initial clinical manifestation of systemic Hodgkin disease.

Objective: Orbital involvement in Hodgkin disease (HD) is rare. Previously reported cases of HD in patients without the acquired immunodeficiency syndrome have been diagnosed late in the course of established systemic disease. The authors describe an immunocompetent man with orbital infiltration as the initial manifestation of systemic HD.

Transcanalicular neodymium: YAG laser for revision of dacryocystorhinostomy.

Background: Laser-assisted dacryocystorhinostomy (DCR) has failed to match the success rates of external DCR. It has been suggested that this technology may be best suited for revision of failed DCR cases. The authors prospectively evaluated the efficacy of transcanalicular laser-assisted revision DCR (TCLARDCR).

Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip.

Lower eyelid malposition is the most common long-term complication following transcutaneous lower eyelid blepharoplasty. The malposition may include rounding of the lateral canthal angle, lower eyelid retraction with inferior scleral show, or frank ectropion. The result is cosmetically unacceptable and may be associated with tearing, irritation, and other exposure keratitis symptoms.

Use of hard palate grafts for treatment of postsurgical lower eyelid retraction: a technical overview.

Lower eyelid retraction occasionally occurs following the repair of fractures involving the orbital rims, orbital floor, or complex zygomatic maxillary complex fractures. The surgical repair of these scarred eyelids has been historically difficult. The authors have utilized the principle of releasing the scar tissue and attempting to reposition the eyelid in its normal anatomic position by employing a hard palate mucosal graft spacer to correct the eyelid malposition.

Orbital infections in patients with human immunodeficiency virus infection.

Background: Opportunistic infections frequently involve the anterior and posterior segments of the eye but rarely occur in the orbit in patients with human immunodeficiency virus (HIV) infection. The authors managed eight patients with HIV and unilateral orbital infections who presented between July 1988 and March 1995.

Methods: Records of the patients were reviewed.

Angiocentric T-cell lymphoma presenting with multiple cranial nerve palsies and retrobulbar optic neuropathy.

Angiocentric T-cell lymphoma (lymphomatoid granulomatosis) may present with prominent central nervous system (CNS) findings with variable radiographic features. We describe a patient who presented with multiple cranial nerve palsies involving the left optic nerve, left facial nerve, left ocular motor nerves, and bilateral acoustic nerves. Enhancement of the right temporal meninges and a cavernous sinus mass were noted on magnetic resonance (MR) scan.

Low flow dural arteriovenous shunt: another cause of "sinister" Tolosa-Hunt syndrome.

A 73-year-old man developed acute, painful, ophthalmoplegia. The pain improved with oral steroids and a diagnosis of Tolosa-Hunt syndrome was made. Review of his angiogram revealed a low flow dural arteriovenous shunt that drained posteriorly.

Embryonal rhabdomyosarcoma of the orbit in a 35-year-old man.

A 35-year-old man had rapidly progressive proptosis of the right eye with associated chemosis over a period of several weeks. Computed tomography demonstrated a solid extraconal mass in the inferior anterior right orbit. Pathologic examination revealed the lesion to be an embryonal rhabdomyosarcoma.

Whitnall's sling with superior tarsectomy for the correction of severe unilateral blepharoptosis.

The management of severe unilateral blepharoptosis is problematic. In the presence of poor levator function, conventional surgical techniques frequently do not adequately elevate a ptotic eyelid. From May 1988 through July 1991, we used 4- to 5-mm external resections of the superior tarsus in conjunction with a maximal aponeurectomy (Whitnall's sling procedure) to augment blepharoptosis correction in selected cases of severe unilateral blepharoptosis.

Primary T-cell immunoblastic lymphoma of the orbit in a pediatric patient.

Background: The authors report a case of an 8-year-old pediatric patient with a 2-week history of painless periorbital swelling unresponsive to antibiotic treatment.

Methods: Computed tomography (CT) showed a large, lateral, anterior left orbital soft tissue mass with bony erosion into the anterior cranial fossa through the roof of the orbit laterally. Surgical exploration showed a hard white mass that had eroded through the roof of the left orbit and into the anterior cranial fossa, with herniation of the brain and associated dura through the defect.

Capnocytophaga endophthalmitis.

Purpose: This article presents three patients with endophthalmitis associated with infection with Capnocytophaga species.

Methods: The medical records of three patients with culture-positive Capnocytophaga endophthalmitis were reviewed. A panel of isolates of Capnocytophaga were then tested for sensitivity to third-generation cephalosporins.

Rearrangement of BCR genes in malignant lymphoma.

The Philadelphia chromosome, originally thought to be associated solely with chronic myelogenous leukemia (CML), has since been identified in acute leukemias and in some cases of lymphoma. The Philadelphia chromosome results from reciprocal translocation of genetic material between chromosome 9 and 22 involving the c-abl and BCR genes respectively. Southern blot analysis of the BCR genes was carried out on biopsy specimens from 49 patients presenting with malignant lymphoma without a previously documented CML phase.

The pigtail probe protected by silicone intubation: a combined approach to canalicular reconstruction.

We have devised a method of single-eyelid canalicular reconstruction using the pigtail probe to facilitate identification of the proximal canalicular segment following silicone stent intubation of the normal, uninjured canaliculus. A series of seven acute and two long-standing canalicular lacerations were successfully reconstructed using this technique, which minimizes the risks associated with the use of the pigtail probe.

Cosmetic eyelid surgery and the problem eyelid.

The human eyelid is an amazingly complex structure that is responsible for protecting, moisturizing, and reconstituting the external surface of the eye. Compromise of any of the tarsoligamentous supporting structures of the eyelids can result in eyelid malposition, corneal compromise, and even blindness. Failure to recognize these abnormalities in patients seeking cosmetic eyelid surgery can lead to disastrous results.

Eyelid necrosis and periorbital necrotizing fasciitis. Report of a case and review of the literature.

Necrotizing fasciitis is an uncommon and severe soft tissue infection characterized by cutaneous gangrene, suppurative fasciitis, and vascular thrombosis. The disease is usually preceded by trauma in patients that have systemic problems, most commonly diabetes and alcoholism. Streptococcus pyogenes and Staphylococcus aureus are the most frequent bacterial etiologies; however, combinations of numerous facultative and anaerobic organisms have also been isolated.

Keratoconus with acute hydrops and perforation. Brief case report.

Keratoconus is a corneal thinning disorder usually localized to the paracentral cornea. Though acute hydrops has been well described, perforation in keratoconus is an extremely rare event. We report a case of keratoconus with acute hydrops and perforation.

Establishment of a novel factor-dependent myeloid cell line from primary cultures of mouse bone marrow.

We describe here a novel myelomonocytic cell line (OTT1) obtained from primary cultures of mouse bone marrow cells infected with a retroviral vector carrying the mouse interleukin (IL)-1 alpha gene. OTT1 cells are dependent for their survival and proliferation on IL-3, granulocyte-macrophage colony-stimulating factor (GM-CSF) or, unexpectedly, IL-5. Despite their IL-5 dependency, OTT1 cells form colonies showing predominantly monocyte maturation when plated in methylcellulose.

The ocular manifestations of syphilis in the human immunodeficiency virus type 1-infected host.

Nine patients with active ocular or optic nerve involvement by syphilis who also had concurrent human immunodeficiency virus type-1 (HIV-1) infection are described. The ocular manifestations of syphilis led to the discovery of HIV-1 seropositivity in four of nine cases. Fifteen eyes were affected.

Immunobiology of Langerhans cells on the ocular surface. II. Role of central corneal Langerhans cells in stromal keratitis following experimental HSV-1 infection in mice.

Stromal keratitis is typically the consequence of infection with herpes simplex virus type 1 (HSV-1). The pathogenesis of this disease remains elusive, although it is generally believed that there is an important immunological component. It has been proposed that stromal keratitis is mediated by virus-specific T lymphocytes of the delayed hypersensitivity type.