Peripapillary Crescents and Halos in Normal-tension Glaucoma and Ocular Hypertension

In normal-tension glaucoma (“low-tension” glaucoma), 21 of 33 eyes (64%) had a peripapillary chorioscleral crescent or halo, compared with 13 of 38 eyes (34%) with ocular hypertension. The average area of bared choroid and sclera was greater in normal-tension glaucoma (5.8 arbitrary units of area) than in ocular hypertension (1.4 units). Myopic eyes were prevalent among the normal-tension glaucoma group. When eyes with more than 4 diopters (D) of myopia were exluded from the analysis, the difference in prevalence and size of chorioscleral crescents and halos remained. Thus, the presence of a crescent correlates with disc damage, but further work is needed to determine if the correlation represents peripapillary atrophy that accompanies glaucomatous nerve atrophy or represents a greater susceptibility of discs with preexisting peripapillary abnormality

The Use of the Enucleation Snare for Orbital Exenteration

TO THE EDITOR. —Exenteration is most commonly used in the treatment of malignancies arising from the eye, ocular adnexa, and paranasal sinuses that are not amenable to radiation, chemotherapy, or en bloc excision. Intraoperative considerations include optimal removal of orbital soft tissues, control of bleeding, and maintenance of an intact bony orbit to prevent postoperative sino-orbital fistula formation. During exenteration, a curved scissors is the instrument most commonly recommended for transection and removal of the orbital contents.1,2 The remaining stump of orbital tissue tends to bleed briskly, and some authors recommend cross clamping the tissues at the orbital apex prior to transection to improve hemostasis.2 We recently used an enucleation snare (Storz) for the removal of the orbital soft tissues in seven patients undergoing exenteration for primary malignancies of the eye, eyelid, or lacrimal gland. Advantages of the enucleation snare include decreased bleeding from the tissue stump

Ophthalmic Complications of Sinus Surgery

Seven patients with orbital complications of sinus surgery seen over a 10-year period are reported. Severe intraoperative orbital hemorrhage occurred in three patients while undergoing external or intranasal ethmoidectomy. In one patient, an avulsed anterior ethmoidal artery was identified as the source of bleeding, whereas in two others bleeding was due to snaring of orbital tissues. In two of these three cases, intraoperative recognition and prompt treatment of the expanding hematoma resulted in preservation of vision. Motility disturbances due to extraocular muscle injury occurred in two patients after intranasal ethmoidectomy and in one patient after a Caldwell-Luc procedure. Bilateral blindness resulted from transection of both optic nerves in one patient during bilateral intranasal endoscopic ethmoidectomies. Recommendations for prevention, intraoperative recognition, and management of such ophthalmic complications of sinus surgery are given

Lymphogranuloma Venereum Conjunctivitis with a Marginal Corneal Perforation

The authors have recently treated a case of Parinaud's oculoglandular syndrome due to Chlamydia trachomatis serotype L2, a causative agent of lymphogranuloma venereum (LGV). The ocular manifestations included a mixed papillary-follicular conjunctivitis with fleshy superior timbal lesions in both eyes. A superior marginal corneal perforation requiring a therapeutic corneal graft was present in the right eye. The patient had vaginitis, inguinal lymphadenopathy, a history of Sjögren's syndrome, and seropositivity to human immunodeficiency virus (HIV). The ocular disease resolved completely after 6 weeks of oral tetracycline therapy