Centurion Syndrome: A Rare Cause of Epiphora

Centurion syndrome is a rare medial canthal tendon insertion anomaly that causes epiphora in young adults. The purpose of the current study is to describe the clinical signs and outcome of surgery in a 18-year-old male patient with Centurion syndrome. Ophthalmic examination revealed bilateral loss of lid globe apposition medially, with anterior displacement of the lacrimal puncta out of the tear lake and a prominent nasal bridge. The patient, whose findings were consistent with Centurion syndrome, underwent bilateral medial canthal tendon release and medial tarsoconjunctival resection. Tearing was completely resolved after surgery. Anterior medial canthal tendon release with medial conjunctivoplasty is an effective surgical approach in patients with Centurion syndrome. (Turk J Ophthalmol 2012; 42: 243-5

Rehabilitation of Eyelid Malpositions Secondary to Facial Palsy

Objectives: To evaluate patient satisfaction and outcomes of surgical treatment of eyelid malpositions secondary to facial palsy. Materials and Methods: Consecutive patients with facial palsy who underwent surgical treatment by the same surgeon at İzmir Katip Çelebi University Atatürk Training and Research Hospital between Jan 2007 and Dec 2012 were included in the study. Ophthalmic examination findings, surgical approaches, and their outcomes were evaluated. A successful result for upper eyelid position was defined as more than 50% reduction in lagophthalmos and induction of less than 2 mm of ptosis. A successful outcome for lower eyelid position was defined as the lower eyelid residing at or within 1 mm above or below the limbus. Linear visual analog scale 1 (VAS-1) (subjective complaints) and VAS-2 (cosmetic outcome), both ranging from 0 to 10, were used to compare preoperative findings with findings at last postoperative visit. Results: The mean age of the 14 female and 21 male patients was 54.5±19.9 years. Gold weight implantation (n=31), lateral tarsal strip (n=22), tarsorrhaphy (n=15), suborbicularis oculi fat elevation (n=16), hard palate graft (n=14), and eyebrow ptosis repair (n=6) were performed. Average follow-up time was 17.9±16.9 months (range, 2-60). Surgical success rates were 90% for upper lids and 75% for lower lids. Mean lagophthalmos decreased from 7.1±2.7 mm to 1.6±1.6 mm postoperatively (p=0.000). The use of lubricating drops and gels was reduced from average preoperative daily values of 5.3±2.5 drops and 1.3±0.6 gel applications to 4.4±1.4 and 0.6±0.6, respectively (p=0.003, p=0.001). Conclusion: An individualized surgical approach tailored according to each patient’s severity of facial palsy and associated malpositions resulted in both functional and aesthetic improvements in our patients

Marginal Entropion: A Frequently Overlooked Eyelid Malposition

Objectives: To evaluate the clinical findings and outcomes of surgical treatment in patients with marginal entropion. Materials and Methods: Patients with impairment of the natural square-shaped eyelid margin morphology, anterior migration of mucocutaneous junction and mild lid inversion toward the ocular surface were diagnosed as having marginal entropion. Patients with shortened fornices, cicatricial changes or subconjunctival fibrosis were excluded. Demographic characteristics, ophthalmologic examination findings, surgical procedures and follow-up data were evaluated retrospectively. Results: Twelve eyes of 11 patients were included in the study. Median age was 73 years (range, 49-84 years). All cases presented with signs of meibomianitis and were treated preoperatively with oral doxycycline and topical corticosteroids. Tarsal fracture procedure was performed for correction of lid malposition. In all patients, lid malposition was corrected and ocular irritation findings had regressed. No recurrences were observed in the follow-up period of mean 10 months (range, 5-16 months). Conclusion: Marginal entropion is a common malposition that is frequently misdiagnosed as trichiasis and is overlooked. Complications secondary to misdiagnosis can be avoided and a normal lid position achieved when the correct diagnosis is made. (Turk J Ophthalmol 2015; 45: 203-207

CT and MRI Findings of Orbital and Paraorbital Dermoid and Epidermoid Cyts

Aim: The aim of this review was to present the radiological findings of patients with histopathologically proven dermoid and epidermoid cysts in periorbital and intraobital region. Methods: We evaluated 9 patients who underwent computed tomography (CT) or magnetic resonance imaging (MRI) of the orbit and were diagnosed with orbital dermoid and epidermoid cyts between August 2010 and March 2012. The radiological findings together with the histopathological findings were evaluated in light of the literature. Results: Three patients were women and 6 were men. The mean age of the subjects was 19.3 years (13-29 years). Before treatment, MRI or CT of the orbit was performed in all patients. The lesions were divided into two groups: superficially located and profoundly located. The radiological findings were evaluated according to the location of the lesions. Conclusion: Epidermoid and dermoid cysts are rare benign tumors, representing 3 to 9% of all orbital tumors. These tumors are most often located adjacent to the lateral orbital wall, and may rarely be found in deep orbital cavity. These lesions grow slowly and occasionally do erode adjacent bone and sutures. Radiological recognition of the lesions and to know possible complications are important in the diagnosis and follow-up. (The Me di cal Bul le tin of Ha se ki 2012; 50: 127-30

Outcome of Ptosis Surgery in Patients with Chronic Progressive External Ophthalmoplegia

Objectives: To evaluate the clinical features and the outcome of ptosis surgery in patients with chronic progressive external ophthalmoplegia (CPEO). Materials and Methods: The demographic features, surgical approaches, anatomic and functional outcomes, and complications were reviewed in patients with CPEO who had undergone ptosis surgery by a single surgeon between the years 2005 and 2013. The patients were asked to evaluate their postoperative result as either worse, no change, good, or very good. Results: Seven men and 5 women with an average age of 50±14.08 years (range: 28-72) were included in the study. Ragged red fibers (RRF) were identified in 5 out of 9 patients’ levator and orbicularis muscle biopsy specimens. Average levator function was 5.4±2.6 mm (range: 2-9). Frontalis suspension surgery with silicone rod was performed in 8 patients; two of those 8 patients had lower lid elevation with hard palate graft prior to ptosis surgery. The remaining 4 patients had levator resection. Postoperative margin reflex distance -1 was between +1 and +3 in all patients. One patient had punctate keratopathy following surgery, which responded rapidly to intensive use of lubricants. Head position was improved in all patients; postoperative result was rated ‘very good’. Conclusion: Eyelid elevation must be tailored to result in sufficient interpalpebral area so as to allow for normal visual function and avoid exposure keratopathy. Lower eyelid elevation with hard palate graft may help to achieve this goal by displacing the interpalpebral area superiorly without introducing additional risk for corneal exposure. (Turk J Ophthalmol 2014; 44: 379-83

Rhino-orbital Mucormycosis: Clinical Findings and Treatment Outcomes of Four Cases

In this case report, we present the clinical findings and therapeutic outcomes of four rhino-orbital mucormycosis patients. The four patients (1 female, 3 male; age range, 55-77 years) all had diabetes mellitus and two also had chronic renal failure. All patients exhibited proptosis, sinusitis, and dark-colored lesions on the nasopharynx and/or hard palate; three patients had ipsilateral peripheral facial paralysis. Visual acuity was no light perception in the two patients with severe orbital involvement and 0.8 in two patients with limited orbital involvement. Histopathological examination of the hard palate, nasopharynx or sinus biopsy revealed typical Mucor hyphae. Systemic liposomal amphotericin B was initiated in all patients. The patients with limited ocular involvement received amphotericin B both intravenously and by local irrigation; both patients had complete recovery. The other two patients underwent orbital exenteration; one patient died after declining systemic treatment postoperatively. Rapid diagnosis and treatment are important for the survival of rhino-orbital mucormycosis patients. With orbital involvement, surgical debridement and systemic and local treatment with antifungal agents may help avoid mutilating surgery like exenteration. (Turk J Ophthalmol 2015; 45: 169-174

Von Hippel-Lindau Disease: the Importance of Retinal Hemangioblastomas in Diagnosis

Von Hippel-Lindau (VHL) hastalığı birden fazla sistemi ilgilendiren selim veya habis tümörlerle karakterize ailesel kanser sendromudur. Retinal hemanjiyoblastomlar genellikle hastalığın ilk bulgusu olup görme kaybına neden olabilmektedirler. Otuz iki yaşında erkek hasta sol gözünde 2 aydır olan görme kaybı nedeniyle kliniğimize başvurdu. Hastanın serebral hemanjiyoblastom nedeniyle daha önce opere olduğu, soygeçmişinde annesinin bir gözünde ileri görme kaybı bulunduğu ve böbrek kanseri nedeniyle kaybedildiği öğrenildi. Olgunun oftalmolojik muayenesinde her iki gözde çok sayıda retinal hemanjiyoblastomlar görüldü. Hastaya VHL gen dizi analizi yapıldı ve heterozigot p.R161X mutasyonu saptandı. Hastanın kız kardeşinde ve kızında da aynı mutasyon belirlendi. Hasta ve etkilenmiş aile bireyleri için izlem ve tedavi planı düzenlendi. Retinal hemanjiyoblastomların ayırıcı tanısında VHL hastalığının düşünülmesi bu hastalarda görülen hayatı tehdit eden tümörlerin erken saptanmasında önemli bir yere sahiptir.Von Hippel-Lindau (VHL) disease is a familial cancer syndrome characterized by benign or malignant tumors which may involve more than one system. Retinal hemangioblastomas are usually the initial manifestation of VHL disease and can cause vision loss. A 32-year- old man presented to our clinic with vision loss in the left eye for 2 months. He had a history of cerebral hemangioblastoma operation. Family history showed that his mother had unilateral vision loss and died because of renal cell carcinoma. Ophthalmologic examination revealed multiple retinal hemangioblastomas in both eyes. VHL gene sequencing was performed and heterozygous p.R161X mutation was detected. His sister and daughter were also found to have the same variant. A treatment and follow-up plan was initiated for the patient and affected family members. Considering VHL disease in the differential diagnosis of retinal hemangioblastomas has a very important role in the early detection of life-threatening tumors in these patients

Von Hippel-Lindau Disease: The Importance of Retinal Hemangioblastomas in Diagnosis

Von Hippel-Lindau (VHL) hastalığı birden fazla sistemi ilgilendiren selim veya habis tümörlerle karakterize ailesel kanser sendromudur. Retinal hemanjiyoblastomlar genellikle hastalığın ilk bulgusu olup görme kaybına neden olabilmektedirler. Otuz iki yaşında erkek hasta sol gözünde 2 aydır olan görme kaybı nedeniyle kliniğimize başvurdu. Hastanın serebral hemanjiyoblastom nedeniyle daha önce opere olduğu, soygeçmişinde annesinin bir gözünde ileri görme kaybı bulunduğu ve böbrek kanseri nedeniyle kaybedildiği öğrenildi. Olgunun oftalmolojik muayenesinde her iki gözde çok sayıda retinal hemanjiyoblastomlar görüldü. Hastaya VHL gen dizi analizi yapıldı ve heterozigot p.R161X mutasyonu saptandı. Hastanın kız kardeşinde ve kızında da aynı mutasyon belirlendi. Hasta ve etkilenmiş aile bireyleri için izlem ve tedavi planı düzenlendi. Retinal hemanjiyoblastomların ayırıcı tanısında VHL hastalığının düşünülmesi bu hastalarda görülen hayatı tehdit eden tümörlerin erken saptanmasında önemli bir yere sahiptir.Von Hippel-Lindau (VHL) disease is a familial cancer syndrome characterized by benign or malignant tumors which may involve more than one system. Retinal hemangioblastomas are usually the initial manifestation of VHL disease and can cause vision loss. A 32-yearold man presented to our clinic with vision loss in the left eye for 2 months. He had a history of cerebral hemangioblastoma operation. Family history showed that his mother had unilateral vision loss and died because of renal cell carcinoma. Ophthalmologic examination revealed multiple retinal hemangioblastomas in both eyes. VHL gene sequencing was performed and heterozygous p.R161X mutation was detected. His sister and daughter were also found to have the same variant. A treatment and follow-up plan was initiated for the patient and affected family members. Considering VHL disease in the differential diagnosis of retinal hemangioblastomas has a very important role in the early detection of life-threatening tumors in these patients