Publications by authors named "Thomas G Hardy"

Article Synopsis
  • This study focused on identifying risk factors and management outcomes for patients with orbital cellulitis stemming from dacryocystitis, analyzing a group of 18 patients.
  • The majority of patients (56% female, mean age 62) experienced reduced visual acuity, but most showed improvement after treatment, with acute intervention helping in resolving acute cellulitis.
  • Key findings suggested that recurrent dacryocystitis and the presence of dacryoliths are significant risk factors, while immunosuppression worsens prognosis; successful long-term resolution typically requires dacryocystorhinostomy.
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Purpose: To characterise patterns of disease recurrence in idiopathic orbital myositis (IOM).

Methods: Multi-centre retrospective longitudinal study of IOM patients. Serial imaging was also analysed.

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Background: Idiopathic apical orbital inflammation (AOI) is used to describe inflammation involving the posterior third of the orbit where no specific cause can be identified. It is a rare entity in which the presentation can vary widely. We aim to describe a case series of patients with idiopathic AOI and their clinicoradiological features and visual outcomes.

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Purpose: Blepharocheilodontic (BCD) syndrome is a rare condition with eyelid ectropion, euryblepharon, lagophthalmos, congenital cleft lip/palate, and oligodontia. BCD syndrome is an autosomal dominant inherited disorder and has multiple associations with systemic diseases. We present three new cases of BCD syndrome and a literature review of the periocular manifestations of BCD and their management.

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Background: Endovascular embolization of carotid-cavernous sinus dural arteriovenous fistulas (CCFs) is most commonly performed via a transfemoral-transvenous approach. Surgical cut-down of the superior ophthalmic vein is an alternative, well-described route. When these prove inaccessible, a transorbital approach can be used to reach the fistula.

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Article Synopsis
  • Epibulbar choristoma is a benign congenital lesion with normal tissue but in the wrong location, categorized into three types based on histology: dermoid, dermolipoma, and complex choristoma.
  • In this case, a 9-year-old girl had a mass initially thought to be an epibulbar dermolipoma, which after surgery was revealed to be a complex choristoma upon histological examination.
  • The case highlights the need for orbital surgeons to recognize potential ossification in these lesions while providing clarity on the classification system for better diagnosis and management.*
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  • Juvenile xanthogranuloma (JXG) is a rare pediatric skin condition that usually appears as a single nodule, and orbital JXG is an even rarer form that affects the eye area.
  • A review of three cases of orbital JXG revealed a diverse range of symptoms and no clear consensus on the best treatment, though steroids are commonly used.
  • The classification of JXG is evolving, and it remains uncertain how orbital JXG fits into this classification, particularly regarding its biological mechanisms compared to cutaneous JXG.
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Purpose: To characterize the qualitative and quantitative features of idiopathic orbital myositis (IOM) on MRI.

Methods: This was a multicenter retrospective study of patients with active IOM with MRI. Patients with incomplete clinical records, poor-quality or interval scans without active myositis, and specific orbital myositis (i.

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Purpose: To determine the interrater reliability (IRR) of thyroid eye disease (TED) photographic assessment using the VISA classification. To assess whether a VISA grading atlas improves ophthalmology trainees' performance in photographic assessment of TED.

Methods: A prospective, partially randomized, international study conducted from September 2021 to May 2022.

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Background/objectives: To determine risk factors and treatment outcomes in dysthyroid optic neuropathy (DON) at a single tertiary ophthalmic centre.

Methods: Retrospective audit of DON patients who have received intravenous methylprednisolone (IVMP) therapy at Royal Victorian Eye and Ear Hospital, Melbourne, Australia from July 2015 to October 2021.

Results: Study included 24 patients (58% female) with an average age of 59.

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Peripheral ophthalmic artery aneurysm is a rare disease entity. We review the relevant literature and report a case of fusiform aneurysm involving the entire intraorbital ophthalmic artery in association with multiple intracranial and extracranial aneurysms, diagnosed on digital subtraction angiography. The patient suffered irreversible blindness secondary to compressive optic neuropathy which did not improve after a 3-day trial of intravenous methylprednisolone.

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Periocular haemorrhage without a preceding history of trauma, and in the absence of vascular malformations is rare. While acute proptosis is well described in the setting of orbital pathology, accompanying periocular haemorrhage has been rarely reported. We describe three cases with these concomitant presenting signs in orbital malignancies - metastatic small cell bladder carcinoma, haemangiopericytoma (solitary fibrous tumour) and myeloma.

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Article Synopsis
  • The authors report a unique case of primary extradural ectopic meningioma located in the orbit of a 13-year-old girl, highlighting its rarity in pediatric cases.
  • The surgical excision was performed successfully, marking an important addition to the limited medical literature on this diagnosis in children.
  • This case is the second noted instance that shows radiological changes in the gyrus rectus and olfactory bulb, but unlike previous cases, no visible connection was found in this case.
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Purpose: The paramedian forehead flap (PMFF) is a reconstructive option for large eyelid defects and orbital exenterations. We report a series of cases where PMFF reconstruction was carried out at various institutions in Australia.

Methods: This study was a multi-centre, retrospective, non-comparative case series investigating the clinical outcomes of the PMFF for reconstructing periocular defects and orbital exenterations.

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Article Synopsis
  • - Lymphoma is the most common type of cancer found in the orbit (the eye area) and usually shows up as swelling or bulging of the eye (proptosis), requiring imaging and a biopsy to confirm.
  • - A rare case is described where a patient had bilateral enophthalmos (sunken eyes) and symptoms of secondary entropion (inward-turning eyelids) caused by bilateral non-Hodgkin's lymphoma, leading to a buildup of abnormal B cells in the orbital fat.
  • - Treatment included low-dose radiation directed at the orbit and surgery for the entropion, which successfully alleviated the patient's symptoms.
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Objectives: To describe the features, management approaches, and outcomes of orbito-cranial schwannomas.

Methods: Retrospective review of ten patients with orbito-cranial schwannomas managed in six orbital services over 22 years. Data collected included demographics, presenting features, neuroimaging characteristics, histology, management approach, complications, and outcomes.

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Lemierre's syndrome is a triad consisting of oropharyngeal infection, internal jugular vein thrombophlebitis, and systemic embolisation typically involving lung and brain. Orbital involvement in this life-threatening condition is rare but potentially blinding and may be an indicator of intracranial involvement. We describe a case of odontogenic Lemierre's syndrome complicated by extensive orbital and intracranial septic venous thrombosis, with optic and cranial neuropathy resulting in monocular blindness and ophthalmoplegia.

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Purpose: Orbital amyloidosis of the extraocular muscles (EOMs) is a rare condition, and its clinicoradiological features are not well elucidated. This study describes the characteristic clinical signs, MRI features, and potential treatment options.

Methods: Retrospective multicenter case series and literature review of EOM amyloidosis.

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Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an inflammatory neuropathy, which commonly causes peripheral neuropathy. It has rarely been associated with cranial nerve hypertrophy and neuro-ophthalmic manifestations. Proptosis secondary to cranial nerve hypertrophy has been reported in association with CIDP.

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Purpose: To review the imaging features of the broad range of nonmeningioma lesions of the greater wing of the sphenoid (GWS) bone and adjacent orbit to assist clinicians in differentiating these lesions from each other and from the most common lesion of the GWS and adjacent orbit, meningioma.

Methods: We reviewed 32 cases of spheno-orbital lesions involving the GWS from our own practice, as well as 109 published cases (total 141), with emphasis on available imaging features on computerized tomography (CT) and MRI. Features that might assist in differentiating meningioma from its mimics were analyzed for each lesion, including the presence of an osteoblastic or hyperostotic response, bone erosion or osteolysis, homogeneous hypo- or hyperintensity on T2-weighted MRI, leptomeningeal involvement, and the absence of a "dural tail" on contrast-enhanced MRI.

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We present a case of orbital giant cell myositis (OGCM), presenting with bilateral subacute progressive ophthalmoplegia and optic nerve dysfunction. An early extraocular muscle biopsy confirmed the diagnosis and guided appropriate management. Comprehensive investigation excluded any underlying systemic disease, including myocarditis.

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Purpose: In assessing epiphora, dacryocystography (DCG) is often performed to determine the presence of any structural anomaly of the nasolacrimal drainage apparatus. We describe an anatomical variation of the nasolacrimal duct, termed high sac-duct junction (HSDJ) morphology, that is seen on DCG, which could lead to more difficult, and possibly unsuccessful, intubation of the nasolacrimal duct (NLD).

Methods: This was a multi-center, retrospective, observational case series.

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Purpose: To investigate the efficacy of Permacolâ„¢, a decellularized porcine dermal-derived membrane, as a spacer in the management of lower eyelid retraction. The efficacy of sizing and insertion was investigated, as well as complications. The literature was also reviewed to compare this material with other porcine-derived grafts in use for the management of lower eyelid retraction.

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