RESUMEN
Monocular elevation deficiency poses a challenge to strabismus surgeons on account of its varied clinical presentations as well as management which often needs a tailored approach. We report on a young child who presented to us at 6 months of age with a clinical course marked by primary involvement of the inferior rectus muscle in one eye causing restricted elevation in all gazes and complete relief of hypotropia following disinsertion of the affected muscle but followed by recurrence and additional procedures (antimitotic application and superior rectus plication) for the same. She followed a recalcitrant clinical course which was marked by multiple recurrences requiring a tailored approach and finally managed successfully with a follow-up of 3 years, by now. This case demonstrates the almost intractable nature of restrictive pathology involving a single muscle warranting multiple surgeries and a close follow-up with good surgical outcome.
Asunto(s)
Enfermedades Orbitales , Estrabismo , Niño , Femenino , Humanos , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos , Recurrencia , Estudios Retrospectivos , Estrabismo/cirugía , Resultado del TratamientoRESUMEN
Orbit is an unusual and rare site for metastases from cancer. The most frequent site of a primary malignancy to metastasise to the orbit is the breast, followed by the lung. The malignant mixed mullerian tumour is a rare uterine and cervical carcinoma and accounts for <5% of uterine cancers. It is the primary tumour of the uterus, and de novo involvement of the cervix itself is extremely rare. We report the first case of cervical carcinoma with mixed mullerian aetiology to be associated with orbital metastasis and eventually leading to blindness and death.
Asunto(s)
Ceguera/etiología , Carcinoma/secundario , Enfermedades Orbitales/etiología , Neoplasias Orbitales/secundario , Neoplasias del Cuello Uterino/patología , Carcinoma/complicaciones , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Orbitales/complicacionesRESUMEN
BACKGROUND: A case of orbital emphysema associated with elevated intraorbital pressure, presenting as a complication of a paranasal sinus "blow-out" fracture after trauma to the orbit and globe is presented. CASE REPORT: A 45-year-old man developed left globe rupture with orbital emphysema after blunt trauma. A large air pocket in the superior orbit with medial wall fracture and globe tenting was identified on noncontrast computed tomography. Direct needle drainage was performed using a 23-gauge needle attached to a saline-filled syringe with the plunger removed. Rapid release of air bubbles with prompt alleviation of pressure symptoms was observed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early diagnosis and management of orbital emphysema can salvage useful function of the globe. The knowledge of this clinical entity and its management can prevent delay and unnecessary referral.
Asunto(s)
Descompresión Quirúrgica/métodos , Enfisema/cirugía , Hipertensión Ocular/cirugía , Enfermedades Orbitales/cirugía , Tratamiento de Urgencia/métodos , Lesiones Oculares/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Fracturas Orbitales/complicaciones , Resultado del Tratamiento , Heridas no Penetrantes/complicacionesRESUMEN
BACKGROUND: Delayed presentation of orbital trauma as an acute subperiosteal hematoma. CASE REPORT: A 12-year-boy developed sudden painful abaxial proptosis of the left eyeball 15 days after blunt trauma over the forehead. On contrast-enhanced computed tomography, a heterogeneous, hypodense, non-enhancing mass with biconvex contour was seen adjacent to the orbital roof. Direct needle drainage was performed and about 10 mL dark blood was aspirated. Proptosis reduced immediately and resolved completely at 2 weeks follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Sudden proptosis with no immediate history of trauma can be alarming for the emergency physician. Familiarity with this clinical entity and early drainage can decrease morbidity.
Asunto(s)
Hematoma/terapia , Agujas , Paracentesis/métodos , Corteza Prefrontal/lesiones , Niño , Traumatismos Craneocerebrales/complicaciones , Servicio de Urgencia en Hospital/organización & administración , Exoftalmia/etiología , Hematoma/complicaciones , Humanos , Masculino , Ultrasonografía/métodosRESUMEN
To estimate agreement in diurnal variations of intraocular pressure (IOP) by Tono-Pen (TP) and Goldmann applanation tonometer (GAT) in glaucoma patients on topical anti-glaucoma medication(s). IOP was measured at every 3 h from 7 a.m. to 10 a.m. in 50 eyes of glaucoma patients on topical medication(s). Diurnal fluctuation of IOP by each method was calculated as maximum-minimum IOP in a day. Central corneal thickness (CCT) was measured by ultrasonic pachymeter. There was good correlation between TP and GAT at all times during a day, minimum, and maximum IOPs during a day (Correlation coefficient, 0.706 at 7 a.m., 0.624 at 10 a.m., 0.682 at 1 p.m., 0.814 at 4 p.m., 0.652 at 7 p.m., 0.572 at 10 p.m., 0.668 minimum IOP, 0.689 maximum IOP). Mean IOPs by TP were always higher than GAT at all times during a day. Bland-Altman plots suggested a close relationship between the two sets of readings, and that this relationship was consistent at different times in a day, in maximum IOPs, minimum IOPs and also in fluctuation of IOPs. Linear regression analysis between the differences of diurnal fluctuation (diurnal fluctuation by GAT-diurnal fluctuation by TP) and CCT showed strong association (R 2 = 0.857, p < 0.001). The mean change in difference of diurnal fluctuation (GAT-TP) for a 10-micron increase in CCT was 0.69 mmHg. TP can be considered a reliable alternative to GAT in glaucoma patients for knowing the diurnal control of IOP; however these two methods should not be used interchangeably. Difference of diurnal fluctuation between two methods is dependent on CCT.