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Although eyelid melanomas represent less than 1% of eyelid neoplasms, they have the worst prognosis. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are mainstay treatment options. We conducted a retrospective analysis to assess all-cause and cause-specific mortality rates in patients undergoing WLE or MMS for eyelid melanoma. A retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) registry was performed for eyelid melanoma treated with WLE or MMS. Cases were limited to American Joint Committee on Cancer (AJCC) stage T1 primary malignancies. A total of 45 cases of WLE were identified along with 48 cases of MMS for eyelid melanoma. There was no significant difference between subgroups in age group, sex, race, ethnicity, marital status at diagnosis, AJCC N stage, AJCC M stage, melanoma histology, chemotherapy use, and radiotherapy use. Among the cohort, all tumors were unilateral. Kaplan–Meier analysis with log-rank demonstrated no significant difference between MMS and WLE subgroups with regard to overall survival (P = 0.662) and cancer-specific survival (P = 0.494). Cox regression adjusting for variables with α<0.10 and found no significant difference in all-cause mortality (HR, 0.923; 95% CI 0.310–2.747; P = 0.885) or cancer-specific mortality (HR, 0.518; 95% CI 0.047–5.711; P = 0.591) when patients who underwent MMS were compared to those who underwent WLE. While our study is limited by a small number of patients, our analysis demonstrated no significant difference in all-cause or cause-specific survival for patients with eyelid melanoma treated with MMS compared with WLE. In areas requiring preservation of tissue due to cosmetic or functional purposes, MMS is a reasonable surgical approach. [ABSTRACT FROM AUTHOR]

Periorbital necrotizing fasciitis carries serious risks of loss of vision, eye, and life, and thus represents a true emergency. As such, clinicians must have an appropriate index of suspicion for necrotizing fasciitis and, upon recognition, need to address the disease rapidly and thoroughly. I review the classic features, systemic implications, and management paradigms of necrotizing fasciitis in the hopes of improving outcomes. [ABSTRACT FROM AUTHOR]

Sebaceous adenocarcinomas are rare and potentially aggressive tumors, which typically arise in the periocular region. Surgical treatments for eyelid sebaceous adenocarcinomas include Mohs micrographic surgery (MMS) and wide local excision (WLE). The objective of this study was to compare long-term survival outcomes of MMS versus WLE techniques for eyelid sebaceous adenocarcinomas. A retrospective analysis was performed using data obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer registry database. We analyzed cases diagnosed from 1998 to 2015 within the database. Patients diagnosed with sebaceous adenocarcinoma were identified using ICD codes. Cases were limited to primary sebaceous adenocarcinomas involving specifically the eyelid region. The main outcomes were assessed by Kaplan–Meier (KM) survival and Cox proportional hazards model. Sixty-seven cases of MMS were compared with 114 cases of WLE for eyelid sebaceous carcinoma. Overall KM survival rates for MMS compared to WLE at 5-year (75.6% vs. 70.3%) and 10-year follow-up (69.2% vs. 46.9%) did not show significant difference by logrank (P = 0.062). Similarly, after adjusting for demographic, tumor, and treatment characteristics, there was no significant difference in cancer-specific survival (HR 0.45, 95% CI 0.03–6.92, P = 0.57) and overall survival (HR 0.94, 95% CI 0.50–1.74, P = 0.83) when MMS surgical technique was compared with WLE techniques. Our adjusted analyses demonstrated no differences in overall survival or cancer-adjusted survival for patients with eyelid sebaceous adenocarcinomas treated with MMS compared with WLE. In areas requiring preservation of tissue because of cosmetic or functional purposes, MMS is a reasonable surgical approach. [ABSTRACT FROM AUTHOR]

An adult female bearded dragon ( Pogona vitticeps ) presented to the University of Georgia Veterinary Teaching Hospital for an area of swelling affecting the left eye of approximately 3 years’ duration. Upon examination, the left eye could not be evaluated due to an extensive periorbital mass effect. Hematologic and advanced diagnostic testing were recommended, but due to financial concerns the owner declined. Ultimately, the patient was humanely euthanized and was submitted for necropsy. The mass was diagnosed via histopathology as a cystadenoma of the eyelid. Phthisis bulbi of the left eye with granulomatous inflammation was also observed. [ABSTRACT FROM AUTHOR]

Background: Pyoderma gangrenosum (PG) is a rare, ulcerative cutaneous disorder. Ophthalmic involvement in PG is atypical, but can have devastating consequences.Objective: We sought to characterize ocular PG to allow for earlier diagnosis and therapy. To our knowledge, this is the first systematic review summarizing this clinical variant.Methods: A systematic review was conducted using PubMed and Web of Science. Data were extracted and studies were qualitatively assessed and analyzed.Results: We identified all 34 cases of PG involving the eye and periorbital area, and categorized them into 4 different subtypes. Common presenting signs include ulceration, peripheral ulcerative keratitis, and decreased visual acuity. Although it is often difficult to biopsy ocular PG, histologic features are nonspecific. Combined therapy using corticosteroids and further surgical reconstruction as needed is the mainstay of treatment. Cases of the eye/orbit in particular should be treated aggressively, as these are more likely to relapse compared with cases of the periorbital area.Limitations: Use of case reports, paucity of ocular PG cases, and heterogeneity of studies are limitations.Conclusion: PG should be considered in the differential diagnosis of ulceration of ocular/periocular tissues. An aggressive, early, multimodal treatment strategy should be used to prevent relapse, especially in cases of the eye/orbit. [ABSTRACT FROM AUTHOR]

Introduction Paediatric periorbital cellulitis is a common condition. Accurate assessment can be challenging and appropriate use of CT imaging is essential. We audited admissions to our unit over a four year period, with reference to CT scanning and adherence to our protocol. Methods Retrospective audit of paediatric patients admitted with periorbital cellulitis, 2012–2015. Results Total of 243 patients included, mean age 4.7 years with slight male predominance, the median length of admission was 2 days. 48/243 (20%) underwent CT during admission, 25 (52%) of these underwent surgical drainage. As per protocol, CT brain performed with all orbital scans; no positive intracranial findings on any initial scan. Three children developed intracranial complications subsequently; all treated with antibiotics. Our re-admission rate within 30 days was 2.5%. Conclusions Our audit demonstrates benefit of standardising practice and the low CT rate, with high percentage taken to theatre and no missed abscesses, supports the protocol. There may be an argument to avoid CT brain routinely in all initial imaging sequences in those children without neurological signs or symptoms. [ABSTRACT FROM AUTHOR]

Orbital cellulitis predominantly affects children. This disease is potentially sight and life threatening and requires prompt recognition, investigations and treatment. An understanding of the anatomical features of the orbit its adnexa and neighbouring paranasal sinuses are essential in the evaluation and management of inflammations of the orbit. In this article we review the anatomy and discuss current thinking with respect to aetiological factors, the clinical presentation, the differential diagnosis, complications, investigations and management of orbital cellulitis. [ABSTRACT FROM AUTHOR]

Objectives Periorbital microcystic lymphatic malformations (LM) can cause severe symptoms, such as blepharoptosis, amblyopia, chemosis, strabismus, diminished vision, and blindness. The purpose of this study was to evaluate the clinical outcome in periorbital microcystic LM patients with blepharoptosis who underwent surgical treatment combined with intralesional bleomycin injection. Patients and methods A retrospective study including nine patients diagnosed as periorbital microcystic LM with blepharoptosis was conducted. All of the patients underwent surgical treatment and bleomycin injection from January 2010 to January 2014. The lesion was resected through the lower eyebrow and/or a coronal incision at the first stage, and levator resection was performed at the second stage. Any persistent lesion or its recurrence was managed by intralesional bleomycin injection. Results Blepharoptosis and visual obstruction were corrected in all patients. Mean follow-up was 24.6 months. Six patients had recurrence during the follow-up, and two patients who had partial eyelid closure after the second stage surgery recovered in three months. Amblyopia, astigmatism, and strabismus were not improved after treatment. All of the patients had excellent aesthetic improvement and corrected blepharoptosis. Conclusions Resection through a lower eyebrow and coronal incision and levator resection performed in two stages can quickly correct the visual impairment caused by periorbital microcystic lymphatic malformation with blepharoptosis. Intralesional bleomycin injection is a promising adjunctive therapy for residual or recurrent lesions after surgery. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Periorbital cellulitis is inflammation of the eye anterior to the palpebral ligament. The sequeale may be life or vision threatening. There is no consensus on the optimal management strategies. Methods: A two year retrospective case note analysis was performed on all hospital admissions to a tertiary children''s hospital with the diagnosis. Results: 226 notes were retrieved, 13 were excluded. The incidence of periorbital cellulitis was nearly 9 cases per month (8.875): the median length of stay was 2 days: all were treated with antibiotics. Only 7 children (3%) underwent surgical intervention. Discussion: Due to potentially serious intracranial and orbital complications, authors have previously argued that all patients with periorbital cellulitis need daily otorhinolaryngology assessment. This current review showed a much larger incidence than in the published literature, with the majority being managed by the paediatricians and ophthalmologists. Escalation to otorhinolaryngology when first line treatment has failed is a more appropriate use of resources. [Copyright &y& Elsevier]

Abstract: Juvenile dermatomyositis (JDM) is the most common inflammatory autoimmune myopathy in children. Most common presentations consist of heliotrophic rash and/or gottron''s papules in addition to proximal muscle weakness. A typical presentations have been reported. We present a 13-year-old African American male who presented with a two-week history of bilateral periorbital edema that was unresponsive to glucocorticoids. He had elevated transaminases but no detectable muscle weakness. A muscle biopsy was consistent with juvenile dermatomyositis. This case highlights the need to consider dermatomyositis in cases of facial swelling and the use of aggressive immunosuppressive therapies due to its associated vasculopathies. [Copyright &y& Elsevier]

Summary: Necrotising fasciitis is a rare severe infection of the soft tissues and deep fascia, which is associated with a significant level of mortality. Involvement of the head and neck is uncommon, and necrotising fasciitis of the periorbital area even rarer. We present a case of bilateral periorbital necrotising fasciitis following shingles in an otherwise healthy immunocompetent patient. [Copyright &y& Elsevier]

Abstract: Diseases of the periocular hair range from localized disease to systemic processes and may present challenging diagnostic questions. We present a comprehensive clinical guide to the evaluation and diagnosis of these disorders. Deficiencies in growth, excess production, changes in pigmentation, aberrant position, or abnormalities in form may affect this region’s hair. These range from benign to sight-, and even life-, threatening pathologies. [Copyright &y& Elsevier]

Summary: Purpose: To evaluate the efficacy and safety of the early surgical excision of periorbital haemangiomas with an ultrasonic scalpel in infants at risk of visual impairment. Study: A retrospective analysis of 67 infants diagnosed to be at risk of amblyopia from periorbital haemangiomas, treated consecutively with the Dissectron® between 1994 and 2005. Ophthalmic outcome parameters included the pre- and postoperative measurement of visual axis occlusion, strabismus, astigmatism, and degree of amblyopia. Results: Visual performance showed an overall improvement of 30% following treatment. Seventy-six patients were found to have abnormal ophthalmic examinations preoperatively, compared to 46 following surgery. After surgery, visual axis occlusion decreased from 73 to 6%; amblyopia decreased from 67 to 22%, strabismus decreased from 26 to 18% and astigmatism (>onedioptre) decreased from 66 to 31%. Mean astigmatism values decreased from 3.5 to 1.9dioptres. No new cases of astigmatism, strabismus or amblyopia were diagnosed postoperatively. Three minor complications resolved with conservative treatment. All patients were satisfied with the outcome of their surgery. Conclusion: Early surgical excision of periorbital haemangiomas using the Dissectron® in infants with an established risk of visual impairment is a safe and effective alternative to pharmacological therapy. The use of the Dissectron® is associated with reduced operative times and a shorter hospital stay. [Copyright &y& Elsevier]

Abstract: Many laboratories studying eyeblinks in unanesthetized rodents use a periorbital shock to evoke the blink. The stimulus is typically delivered via a tether and usually obliterates detection of a full unconditioned response with electromyographic (EMG) recording. Here we describe the adapter we have used successfully for several years to deliver puffs of air to the cornea of freely moving rats during our studies of eyeblink conditioning. The stimulus evokes an unconditioned response that can be recorded without affecting the EMG signal. This allows a complete analysis of the unconditioned response which is important for studies examining reflex modification or the effect of drugs, genetic manipulations, or aging on the unconditioned blink reflex. We also describe an infrared reflective sensor that can be added to the tether to minimize the number of wires that need to be implanted around the eye, and which is relatively immune to electrical artifacts associated with a periorbital shock stimulus or other devices powered by alternating current. The responses recorded simultaneously by EMG wires and the optical sensor appear highly correlated and demonstrate that the optical sensor can measure responses that might otherwise be lost due to electrical interference from a shock stimulus. [Copyright &y& Elsevier]

Summary: Background: Periorbital haemangiomas cause severe effects on visual development. They can be treated with some success, but there is currently no literature on the selection of patients for intervention. Our study aims to review all periorbital haemangioma cases in Edinburgh over the past 20 years, to set more stringent guidelines regarding the appropriate selection of patients for treatment and determine prognostic indicators of visual outcome. Methods: A review of 58 patients since 1980 with significant lesions, seen by ophthalmologists and/or plastic surgeons. Results: 82% of those presenting were female. The mean age of presentation was 4 months and 2 months in more serious cases. Mean follow up was for 5.6 (range 0–15) years. Loss of visual field was the most sensitive prediction of the development of visual complications (67%), but least specific (76%). Pressure on the globe and pupillary obstruction were more specific (77–100%), but less sensitive (33–50%). Conclusions: Loss of visual field, partial/complete pupillary obstruction and pressure exerted on the globe are all valuable prognostic indicators. The size and position of the lesion are also relevant, but are probably due to these factors. Based on these results we recommend specific guidelines for the selection of patients for intervention. [Copyright &y& Elsevier]

Summary: Haemangioma of infancy is a common birthmark. As spontaneous involution is the rule, it is usually treated conservatively. Periorbital haemangiomata may require intervention if symptomatic and this may be early or late, where plastic surgery may be required. It has not previously been recognised that deep periorbital lesions may lead to a baggy appearance of the eyelids because of excess fatty tissue. The management of this condition is described in different clinical presentations illustrated by three female patients with a history of infantile periorbital haemangioma. Two were treated by blepharoplasty, during which an excess of fatty tissue was found, deep to the orbital septum. Birthmark stigmata were eradicated and symmetry was achieved. [Copyright &y& Elsevier]

Summary: Dacryoadenitis is an unusual orbital infection that rarely involves acute suppuration. We describe what to our knowledge is the first reported case of bilateral lacrimal gland abscesses: a 9-year-old girl who presented with painful periorbital swelling and fever. The child was diagnosed with the abscesses by CT scan of the orbits with contrast, which was obtained when the patient''s periorbital swelling progressed despite intravenous antibiotics. Despite early drainage of the abscesses, the patient sustained a complicated hospital course with epidural and cerebral abscesses. The causes of dacryoadenitis as well as the mechanisms of infectious spread into the orbit are reviewed. This case as well as a review of the literature suggest that superolaterally located orbital abscesses are associated with an increased risk of intracranial infection and should be managed aggressively. [Copyright &y& Elsevier]