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Key points: Penetrating orbital trauma from marine creatures, especially needlefish, should be considered after injuries sustained in open water.Advances in endoscopic sinus surgery have enabled surgeons to remove certain orbital foreign bodies through endoscopic endonasal approaches.3D segmentation is a valuable pre‐operative tool in complex endoscopic orbital cases. [ABSTRACT FROM AUTHOR]

Purpose: To assess the evolution of proptosis asymmetry during the active phase of bilateral thyroid eye disease (TED). Methods: A retrospective study was conducted on patients with bilateral, active TED. Patients were measured by a single observer, using Hertel exophthalmometry from the time of initial presentation, during the active phase of TED, to the stable phase, 24-months later. Asymmetric proptosis was defined as a >2 mm intra-orbital difference in Hertel measurements. Results: Fifty-one patients were enrolled. Patients presented at a mean time of 1.1 ± 2.9 months following the onset of TED symptoms. Stability of TED was established at 15.7 ± 12.3 months. At initial presentation, 41% of patients demonstrated asymmetric proptosis. Upon reaching the stable phase, asymmetric proptosis persisted in only 22% of patients. A decline in the rate asymmetric proptosis was greatest within the first 3 months of the active phase. Conclusions: Asymmetric proptosis is common in the setting of early active TED and decreases by 50% when the stable phase is reached. Therefore, diagnostic imaging is not routinely required to exclude alternative pathology in the cases of asymmetric TED. Perhaps more importantly, this finding supports the surgical paradigm of stable phase, graded orbital decompression, performed when the ultimate globe positions are achieved to avoid late postoperative asymmetry, resulting from the unanticipated evolution of proptosis when surgery is performed during the active phase of TED. [ABSTRACT FROM AUTHOR]

To examine the clinical and histopathologic characteristics of lacrimal gland biopsies at a tertiary academic center. A retrospective chart review of patients undergoing lacrimal gland biopsy or excision between 1962 and 2017 was performed via the ocular pathology specimen log. All cases were reviewed for demographics, clinical presentation, and histopathologic diagnoses. Four hundred and two eyes in 356 patients were included in the analysis. Median age was 49 (range 5–91) with a female predominance (255, 72%, p <.001). Most had unilateral involvement (308, 86.5%) and visual acuity of 20/50 or better (332 eyes, 83%). Limitation in extraocular motility was present in 71 eyes (18%), relative afferent pupillary defect in 10 eyes (2.5%), and intraocular pressure 20 mmHg or above in 80 eyes (20%). The pre-operative radiology report commented on the enlargement of the lacrimal gland in 236 eyes (58.7%), and lack thereof in 73 eyes (18.2%). The most common histopathologic diagnoses were nonspecific inflammation or orbital pseudotumor (170, 42%), lymphoma (65, 16%), pleomorphic adenoma (22, 5.5%), adenoid cystic carcinoma (19, 4.7%), granulomatous inflammation (19, 4.7%), and normal lacrimal gland (16, 4%). Three hundred and seven cases were benign (76%) and 95 malignant (24%). The biopsy specimen was diagnostic in 343 (85%), and non-diagnostic in 59 (15%). This is a comprehensive review of one of the largest ocular pathology databases of lacrimal gland lesions. This study confirms the wide range of inflammatory and neoplastic conditions affecting the lacrimal gland and highlights the nuances of histopathologic diagnoses and diagnostic yield of biopsies in clinical practice. [ABSTRACT FROM AUTHOR]

An individual's functional vision may be measured via visual assessment and performance on mobility tasks. Since traditional mobility performance tests neglect to examine the effects of illumination on performance, the multi-luminance mobility test (MLMT) was designed to quantitatively assess the effects of illumination levels on an individual's mobility performance. In this chapter, we describe how the MLMT is conducted and scored in order to properly evaluate a participant's mobility under various light conditions., (© 2023. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To characterize patients with coronavirus disease 2019 (COVID-19) in a large New York City (NYC) medical center and describe their clinical course across the emergency department (ED), inpatient wards, and intensive care units (ICUs)., Design: Retrospective manual medical record review., Setting: NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC., Participants: The first 1000 consecutive patients with laboratory-confirmed COVID-19., Methods: We identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record., Main Outcome Measures: We describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition., Results: Among the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital., Conclusions: Hospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset., Competing Interests: Conflict of Interest Disclosures: All authors have completed the ICMJE uniform disclosure form and declare: no support from any organization for the submitted work; no competing interests with regards to the submitted work. MMS reports grants from Amgen, outside the submitted work. JJC reports personal fees from Allergan, outside the submitted work. RGB reports grants from Alpha1 Foundation and COPD Foundation, outside the submitted work. GH reports grants from Janssen Research, outside the submitted work. The remaining authors MGA, SLB, CLS, JRT, KN, RC, MRB, BPC, NG, PG, AMM, AAP, MSR, NWS, SS, MDS, KN, PAA, FMB, RB, MFC, MIC, LAC, JHD, LBD, SAD, KAE, ZPG, DTG, AAH, NH, SH, LEK, EL, AL, AYS, ACS, ZES, CPS, YX, HWZ, and RL have nothing to disclose.