Limbal Mass as a Presentation of Parotid Gland Undifferentiated Carcinoma: A Case Report

Metastatic neoplasms to the ocular surface are extremely rare. Here, we describe a case of A 56-year-old man developed simultaneously a limbal and parotid gland masses in his left side. He underwent excisional biopsy of limbal mass, parotidectomy, and systemic evaluation. Histopathologically, multislice sections of both limbal and parotidal masses disclosed an undifferentiated carcinoma of both sites. Further evaluation revealed no other site of involvement and metastasis. The patient underwent systemic chemotherapy and local radiotherapy for parotid gland tumor. Distal metastasis from undifferentiated carcinoma of the parotid gland to ocular surface is very rare and to the best of our knowledge has not been previously reported. This is the first report of the manifestation of metastasis from undifferentiated carcinoma of parotid gland origin to the limbus. The limbal mass may be the initial manifestation of metastasis from this origin and should be considered in the differential diagnosis of a metastatic limbal tumor

Topical Tacrolimus as an adjunct to Conventional Therapy for Stromal Herpetic Keratitis: a Randomized Clinical Trial

Purpose: This study investigates the effects of 0.05% topical tacrolimus as an adjunct therapy for patients with non-necrotizing herpetic stromal keratitis (HSK). Methods: Patients with non-necrotizing HSK, referred to the Cornea Clinic at Hospital in Rasht, Iran, between September 2016 and February 2018, were randomly assigned to two groups. The case group (N = 25) and the control group (N = 25) received conventional treatment with systemic acyclovir and topical prednisolone. The case group (N = 25) additionally received 0.05% tacrolimus eye drops four times a day for one month. Complete ocular examinations, including best-corrected visual acuity (BCVA) assessment, intraocular pressure (IOP) measurement, slit lamp biomicroscopy, and photo slit lamp imaging, were performed before treatment, and 3, 7, 14, 21, and 28 days after the intervention. Results: The mean age of the patients was 46.2 ± 12.9 years, and 70% of the patients were male. There was no difference between the groups in terms of age, sex, and baseline ocular measurements (P > 0.05). The case group had a lower mean logarithm of the minimum angle of resolution (LogMAR) for BCVA, lower grading scores, and steeper decreasing trends for corneal haziness, edema, neovascularization, and epitheliopathy compared to the control group after the second week (P < 0.05), while IOP remained unchanged between groups (P > 0.05). Conclusion: The addition of 0.05% topical tacrolimus enhances visual acuity and reduces corneal inflammation, neovascularization, and scarring; thus, it can used as an appropriate adjunct treatment for patients with HSK

Herpes Simplex Virus and Human Papillomavirus Coinfections in Hyperimmunoglobulin E Syndrome Presenting as a Conjunctival Mass Lesion

Hyperimmunoglobulin E syndrome (HIES) or Job’s syndrome is a rare immunodeficiency disease with less than 200 cases reported worldwide, among which few cases are reported with lesions due to herpes simplex virus (HSV) or human papillomavirus (HPV). This case study presents a rare case of HIES with coinfection of HSV and HPV. A 12-year-old boy, previously diagnosed with HIES, presented with a large conjunctival mass lesion. The presence of HPV in the lesion was confirmed by biopsy and by using the line-probe assay method to detect the HPV genome. However, the mass lesion did not respond to anti-HPV therapy with topical interferon-α2b (IFN-α2b) and oral cimetidine but improved promptly after intravenous (IV) acyclovir, which is often administered for cutaneous herpetic lesions. This suggested the presence of HSV in the conjunctival mass. Review of pathology and HSV immunohistochemical staining confirmed the presence of HSV as a coinfection. The likelihood that the mass arose from an abnormal host response to HSV and HPV due to HIES was considered, but coexisting infection with these two viruses and HIES has not been reported in the literature; therefore, such cases require further investigation

Comparison of free conjunctival autograft versus amniotic membrane transplantation for pterygium surgery

Purpose: To compare the recurrence rate and surgical outcomes of amniotic membrane transplantation (AMT) and free conjunctival autograft (CAT) for pterygium surgery. Methods: In this prospective study, 60 patients with primary pterygium were randomly assigned to two groups of CAT or AMT and were compared in terms of recurrence rate, mean healing time of corneal epithelial defects, the mean level of inflammation, and complications. Results: The mean ± SD age of patients was 48.98 ± 9.8 years (range, 27â71 years). 73.3% were men, and 26.7% were women. The groups did not differ with respect to demographic characteristics (P > 0.05). Patients were followed for an average of 12.6 ± 1.3 months. The recurrence rates were 6.7% and 3.3% in the AMT and CAT groups, respectively (P > 0.05). Comparison of mean inflammation score showed higher inflammation in the AMT group in the first, third, and sixth postoperative month (P < 0.05). Mean healing times of corneal epithelial defects were 2.5 ± 0.572 and 2.67 ± 0.479 days in the CAT and AMT groups, respectively (P = 0.173). Conclusions: No significant complication was observed during or after both surgical methods. No statistically significant difference was seen in visual acuity changes and epithelial healing in CAT and AMT groups, but more inflammation and recurrence rate were seen in AMT group. Keywords: Pterygium surgery, Conjunctival autograft, Amniotic membrane transplantatio

Investigating Ocular Diseases in Patients with Psoriasis

Background and purpose: Psoriasis is an inflammatory disease with skin and joint manifestations. This disease can be associated with ocular complications and reduce vision and quality of life. The aim of this study was to determine the prevalence and type of ocular involvement in patients with psoriasis to prevent unwanted complications by identifying the disease at the right time. Materials and methods: A cross-sectional study was carried out in 40 patients with psoriasis in Semnan Kowsar Clinic affiliated to Semnan University of Medical Sciences, 2019. The participants were selected via census sampling and underwent systemic and ophthalmic examination. Patients aging 10-80 years old with at least 6 months of disease onset were included. Results: The mean age of patients was 43.33 ± 17.05 years, and there were 17 (42.5%) males and 23 (57.5%) females. The ocular diseases included dry eye (57.5%), posterior blepharitis (50%), conjunctival hyperemia (27.5%), cataract (20%), and anterior uveitis (7.5%). The presence of ocular disease was found to be significantly associated with the duration of psoriasis (P = 0.03). Conclusion: In this study, ocular surface diseases such as dry eye and posterior blepharitis were common in patients studied and were associated with the duration of psoriasis. Therefore, patients with psoriasis should undergo periodic and regular eye examinations to identify ocular diseases in a timely manner and prevent unwanted complications