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PurposeTo assess whether transcutaneous retrobulbar amphotericin B injections (TRAMB) reduce exenteration rate without increasing mortality in rhino-orbital-cerebral mucormycosis (ROCM).MethodsIn this retrospective case-control study, 46 patients (51 eyes) with biopsy-proven ROCM were evaluated at 9 tertiary care institutions from 1998 to 2021. Patients were stratified by radiographic evidence of local orbital versus extensive involvement at presentation. Extensive involvement was defined by MRI or CT evidence of abnormal or loss of contrast enhancement of the orbital apex with or without cavernous sinus, bilateral orbital, or intracranial extension. Cases (+TRAMB) received TRAMB as adjunctive therapy while controls (-TRAMB) did not. Patient survival, globe survival, and vision/motility loss were compared between +TRAMB and -TRAMB groups. A generalized linear mixed effects model including demographic and clinical covariates was used to evaluate the impact of TRAMB on orbital exenteration and disease-specific mortality.ResultsAmong eyes with local orbital involvement, exenteration was significantly lower in the +TRAMB group (1/8) versus -TRAMB (8/14) (p = 0.04). No significant difference in mortality was observed between the ±TRAMB groups. Among eyes with extensive involvement, there was no significant difference in exenteration or mortality rates between the ±TRAMB groups. Across all eyes, the number of TRAMB injections correlated with a statistically significant decreased rate of exenteration (p = 0.048); there was no correlation with mortality.ConclusionsPatients with ROCM with local orbital involvement treated with adjunctive TRAMB demonstrated a lower exenteration rate and no increased risk of mortality. For extensive involvement, adjunctive TRAMB does not improve or worsen these outcomes.

Alternaria is a fungal genus that can cause opportunistic human infection in immunocompromised hosts. While the majority of clinical manifestations are cutaneous or subcutaneous infections, there are reports of oculomycosis, which is most commonly present as keratomycosis or endophthalmitis.Here, we present a rare case of Alternaria dacryocystitis with cutaneous fistula in a diabetic patient. The patient was referred with a non-healing medial canthal wound and an initial biopsy report showing "ruptured hair follicle;" re-examination of the biopsy specimen with fungal stains led to the diagnosis of alternariosis. The patient underwent surgical debridement and systemic antifungal treatment, with complete resolution of the infection. In order to initiate prompt treatment and prevent invasive disease, fungal infection should be considered in an immunocompromised patient with chronic dacryocystitis and cutaneous fistula or a nonhealing medial canthus wound. [ABSTRACT FROM AUTHOR]

Background: Telemedicine use expanded dramatically during the COVID-19 pandemic, including to surgical fields that had limited prior adoption of telehealth such as oculoplastic surgery. To assess telemedicine usage patterns, barriers to implementation, and satisfaction with telemedicine, we conducted a survey among members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Methods: We performed a Web-based, anonymous survey of ASOPRS members from November to December 2020. Statistical analyses were performed by using Fisher's exact and Chi-squared tests. Results: We received 196 unique survey responses from 963 invited participants (20.5% response rate). Among the 192 ASOPRS members who participated, the majority (79%) reported currently using telemedicine. Very few of those currently using telemedicine (14%) had used telemedicine before March 15, 2020 and a significant proportion (36%) were unsure or did not plan to use telemedicine post-pandemic. Telemedicine use was more common among participants with fewer years in practice (p < 0.01) and those who were university- versus self-employed (p < 0.01). The most common barriers to telemedicine use were technological issues, reimbursement concerns, and a perceived lack of patient acceptance. Nearly half of the surgeons reported being satisfied with telemedicine (48%), and the majority reported perceived patient satisfaction with telemedicine (74%). Discussion: Telemedicine adoption increased significantly among oculoplastic surgeons during the COVID-19 pandemic. However, many current users reported that they were unsure or did not plan to use telemedicine post-pandemic. Conclusions: Further research is needed to design sustainable telemedicine programs to enhance patient access to oculoplastic specialty care in the long term. [ABSTRACT FROM AUTHOR]

This report presents two cases of epidemic keratoconjunctivitis (EKC)-associated dacryocystitis. Both patients presented with preseptal edema. Orbital computed tomography (CT) scans were performed out of concern for orbital cellulitis and revealed soft tissue edema involving the preseptal aspect of the eyelids and also the lacrimal sac. Both patients were initially diagnosed with bacterial preseptal cellulitis with dacryocystitis and admitted for treatment with intravenous antibiotics. After no improvement on antibiotics, both patients were noted to have exam findings consistent with viral conjunctivitis, and one patient had a positive conjunctival swab for adenovirus. Both patients were subsequently treated with topical steroids, and symptoms improved. EKC has previously been identified as a cause of acquired nasolacrimal duct obstruction and canalicular stenosis, and acute inflammation of the lacrimal apparatus may explain this link. Dacryocystitis may also be contributory to the copious tearing seen in patients with epidemic keratoconjunctivitis. [ABSTRACT FROM AUTHOR]

A 59-year-old Caucasian woman with past medical history significant for Natural Killer (NK)/T-cell lymphoma of the right nasal septum in remission for nine months presented after surveillance PET-CT imaging revealed increased metabolic activity in the right nasolacrimal duct. She also reported ipsilateral epiphora starting around this time. The lacrimal sac and nasolacrimal ductal mucosa were biopsied via an external approach. Pathologic evaluation revealed a proliferation of lymphoid cells with necrotic tissue. Immunohistochemical staining demonstrated predominantly CD3+, EBER+, and CD56+ cells indicating recurrent NK/T-cell lymphoma. This case describes an unusual presentation of recurrent NK/T-cell lymphoma involving the lacrimal excretory system in a Caucasian adult. Recurrent malignancy should be considered in the differential of any patient with a history of a lymphoproliferative disorder near the lacrimal drainage system who presents with new onset epiphora. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus pandemic created large shifts in utilization of hospital resources, patient presentations, and delivery of medical care., Objectives: This retrospective study evaluated the ocular emergencies at a tertiary-care academic hospital in Wisconsin during the COVID-19-related "Safer at Home" order., Methods: Ophthalmology consultations performed March 23 through May 26, 2020, were compared to the same time period in the 4 preceding years and the subsequent year. Billing codes were obtained to evaluate the diagnoses and procedures performed during this time frame., Results: In 2020, 155 consultations were performed (42 emergency department, 113 inpatient), compared to a mean of 214 over the 5 other study years. The incidence rate ratio (IRR) of total consultations in 2020 was 0.72 ( P  ≤ 0.001) compared to previous years. Significantly fewer emergency department consultations were performed (IRR 0.62, P   ≤ 0.001), while inpatient consultations were similar (IRR 0.88, P   = 0.119). The most common diagnosis across all study years was fracture of the skull/orbit with injury to the eye/orbit. In 2020, 13% of consultations led to a procedure, compared to a total of 16% in the other years (IRR 0.59, P   = 0.018)., Conclusions: This study demonstrated a 28% reduction in ophthalmology consultations at a major university hospital in Wisconsin during the COVID-19-related "Safer at Home" order, though the number of consultations leading to surgery were stable. This suggests that while patients with less acute needs may have deferred care, those requiring urgent surgery still presented to the emergency department. These data may help hospitals appropriately allocate eye care resources during future public health emergencies., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)