The Influence of Prior Hyperthyroidism on Euthyroid Graves’ Ophthalmopathy

Background. To investigate the influence of previous exposure to elevated thyroid hormones in euthyroid Graves’ ophthalmopathy. Design. Retrospective, observational case series in university setting Median follow-up of 1 year with ranges of 0,8–7,6 years. Study performance of 10 years. Participants. We reviewed the clinical records of 731 Graves’ ophthalmopathy patients. There were 88 (12%) patients with onset of Graves’ ophthalmopathy during euthyroidism: 37 (5%) patients had ophthalmopathy without known history of thyroid dysfunction (group A) and 51 patients (6%) had onset of ophthalmopathy 6 months or more euthyroid after completion of antithyroid therapy (group B). Main Outcome Measures. Graves’ ophthalmopathy was graded using the EUGOGO severity criteria. Unilaterality was investigated. TSH receptor antibody and thyroid peroxidase antibody were measured as markers of Graves’ disease. Results. Group A had more often a normal ocular motility (46%) and less proptosis (14±4 mm) compared to group B (22%, 16±4 mm) (P=0.032 and 0.028, resp.). TSH receptor antibody was more frequently elevated in group B (94%) than in group A (17%) (P<0.001). Conclusion. Patients with euthyroid Graves’ ophthalmopathy present more often with ocular muscle restriction and proptosis when previously exposed to elevated thyroid hormones

Orbital Myositis: a tale of 14 muscles

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Jones lacrimal bypass tubes in children and adults

BACKGROUND/AIMS: Although a Jones tube is considered the mainstay for epiphora in patients with total blockage of the canalicular system, it has been discouraged in children for reasons of inadequate self-care and maintenance. The purpose of this study is to compare the long-term outcome of Jones tube surgery in paediatric versus adult patients. METHODS: Retrospective, interventional case series of a single academic institution. The medical records of all children (≤16 years old) and adults (>16 years old) who underwent conjunctivorhinostomy with placement of a 130° angled extended Jones tube were reviewed. The outcome measures were patency and anatomical position of the tube, type and frequency of complications and subjective relief of epiphora. RESULTS: The study included 10 children (11 eyes) (range, 5.1-16.0 years old) and 102 adults (127 eyes) (range, 19.7-82.4 years old). The success and complication rate did not differ between the two age groups. Tube dislodgement and obstruction occurred in 4 (36.4%) of the paediatric tubes with an incidence rate of 6.1%/year and in 47 (37.0%) of the adult tubes with an incidence rate of 9.3%/year (p=0.3867). Two adults required routine self-irrigation of the tube. The median follow-up was 6.7 years for the children and 8.7 years for the adults (p=0.3430). CONCLUSION: With a similar outcome profile and minimal self-care, young age is not a prognostic nor limiting factor for surgery with angled Jones tubes. Exchange with tubes of a longer length is not required during growth.status: publishe

Orbital inflammation: biopsy first

Orbital inflammation is a response of the immune system and not a diagnosis in itself. Exposing the underlying disease introduces a labyrynthine challenge owing to the broad array of possible causes ranging from infectious, structural, autoimmune, idiopathic to neoplastic origin. In this regard, and despite its unkown etiology, idiopathic orbital inflammation (IOI) intrinsically is a genuine diagnostic entity. Where clinical and radiological findings of an orbital inflammatory mass are inconclusive, pathological examination of the tissue biopsy-obtained by minimally invasive approach and local anesthesia-is advocated to work towards a diagnosis in a most timely and effective manner. A corticosteroid response can be observed in most orbital disorders with lymphocytic components, including IOI, and, accordingly, constitutes a paradoxical and weak tool to identify the diagnosis in orbital inflammation.publisher: Elsevier articletitle: Orbital inflammation: Biopsy first journaltitle: Survey of Ophthalmology articlelink: http://dx.doi.org/10.1016/j.survophthal.2016.03.002 content_type: article copyright: © 2016 Elsevier Inc. All rights reserved.status: publishe

Clinical Study The Influence of Prior Hyperthyroidism on Euthyroid Graves&apos; Ophthalmopathy

Background. To investigate the influence of previous exposure to elevated thyroid hormones in euthyroid Graves&apos; ophthalmopathy. Design. Retrospective, observational case series in university setting Median follow-up of 1 year with ranges of 0,8-7,6 years. Study performance of 10 years. Participants. We reviewed the clinical records of 731 Graves&apos; ophthalmopathy patients. There were 88 (12%) patients with onset of Graves&apos; ophthalmopathy during euthyroidism: 37 (5%) patients had ophthalmopathy without known history of thyroid dysfunction (group A) and 51 patients (6%) had onset of ophthalmopathy 6 months or more euthyroid after completion of antithyroid therapy (group B). Main Outcome Measures. Graves&apos; ophthalmopathy was graded using the EUGOGO severity criteria. Unilaterality was investigated. TSH receptor antibody and thyroid peroxidase antibody were measured as markers of Graves&apos; disease. Results. Group A had more often a normal ocular motility (46%) and less proptosis (14 ± 4 mm) compared to group B (22%, 16 ± 4 mm) ( = 0.032 and 0.028, resp.). TSH receptor antibody was more frequently elevated in group B (94%) than in group A (17%) ( &lt; 0.001). Conclusion. Patients with euthyroid Graves&apos; ophthalmopathy present more often with ocular muscle restriction and proptosis when previously exposed to elevated thyroid hormones

Chronic blepharitis

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Bespoke ocular prostheses

PURPOSE: To report the customized approach of patients with anophthalmia or microphthalmia with bespoke ocular prosthesis. METHODS: Retrospective analysis of case series. RESULTS: The study included cases with anophthalmia with upper eyelid deformity (one patient), microphthalmia and contralateral corectopia (one patient), microphthalmia with contralateral corneal graft (one patient), and congenital clinical anophthalmia with contralateral sclerocornea (one patient). Using techniques of embedded autologous hair and coating of adhesive pigment emulsion in the ocular prosthesis, the physical appearance of, respectively, an upper eyelid, corectopia, corneal graft, and sclerocornea was reproduced. CONCLUSION: Tailoring the ocular prosthesis to the distinct condition of the anophthalmic socket and contralateral eye adds to the success of rehabilitative prosthetic treatment of the patient.status: publishe

Diagnosis of orbital mass lesions: clinical, radiological, and pathological recommendations

The orbit can harbor mass lesions of various cellular origins. The symptoms vary considerably according to the nature, location, and extent of the disease and include common signs of proptosis, globe displacement, eyelid swelling, and restricted eye motility. Although radiological imaging tools are improving, with each imaging pattern having its own differential diagnosis, orbital mass lesions often pose a diagnostic challenge. To provide an accurate, specific, and sufficiently comprehensive diagnosis, to optimize clinical management and estimate prognosis, pathological examination of a tissue biopsy is essential. Diagnostic orbital tissue biopsy is obtained through a minimally invasive orbitotomy procedure or, in selected cases, fine needle aspiration. The outcome of successful biopsy, however, is centered on its representativeness, processing, and interpretation. Owing to the often small volume of the orbital biopsies, artifacts in the specimens should be limited by careful peroperative tissue handling, fixation, processing, and storage. Some orbital lesions can be characterized on the basis of cytomorphology alone, whereas others need ancillary molecular testing to render the most reliable diagnosis of therapeutic, prognostic, and predictive value. Herein, we review the diagnostic algorithm for orbital mass lesions, using clinical, radiological, and pathological recommendations, and discuss the methods and potential pitfalls in orbital tissue biopsy acquisition and analysis.status: publishe