Dk Sen

Tuberculosis of the Orbit and Lacrimal Gland: A Clinical Study of 14 Cases

Fourteen patients with tuberculosis of the orbit and lacrimal gland seen over a period of 20 years have been presented. The majority of them were between the ages of 4 to 15 years. Males were affected twice as frequently as females. Left side was affected four times as frequently as the right side. There were eight patients of periostitis of orbital margin, one patient of dacryoadenitis, three patients of tuberculoma of orbital tissues, and two patients of tuberculoma of maxillary sinus. One patient with periostitis had involvement of the greater and lesser wings of sphenoid in addition to the involvement of upper-outer orbital margin. Two periostitis patients had prolapse of the palpebral portion of the lacrimal gland. The clinical presentation and gross appearance of the tuberculoma of the lacrimal gland was similar to those found in benign mixed tumor. The patients with tuberculoma of orbital tissues presented as pseudotumors. The mimicry of tuberculoma of maxillary sinus to carcinoma has been mentioned. Associated tuberculous lesions were pulmonary in eight patients, cervical lymphadenitis in ten patients, intestinal in one patient, and caries spine in one patient. In two patients the disease developed in the absence of any other tuberculous lesion discovered in the body. The cases were cured by wide surgical removal of all the diseased tissues combined with antituberculous chemotherapy.

Immunoassay of Human Tear Lysozyme

We used a single radial immunodiffusion technique to determine the lysozyme content of human tears. The level in healthy subjects with this method was 1.3 mg/ml of tears. In patients with trachoma, the level was low, 0.9 mg/ml of tears. Detecting the reduction in lysozyme level in patients with trachoma proved the utility of this method.

Acute Suppurative Dacryoadenitis Caused by a Cysticercus Cellulosa

A case of acute suppurative dacryoadenitis caused by a cysticercus cellulosa in a male of 20 years is reported. The diagnosis was established by histopathologic examination of the cyst that escaped along with pus during drainage of the abscess. The abscess in the palpebral lobe of the lacrimal gland resulted from acute inflammation produced by the presence of an intact larva. There was no other focus of cysticercosis in the same eye, in the other eye, or anywhere else in the body. Postoperative recovery was uneventful and there were no sequelae. To our knowledge, this is the first case report of acute dacryoadenitis caused by a cysticercus cellulosa. As cysticercosis is still prevalent in the underdeveloped countries, it is to be kept in mind in the differential diagnosis of ocular and adnexal lesions in patients coming from these areas of the world.

The syndrome of Goldenhar (oculo-auricular dysplasia).

The syndrome of Goldenhar is characterized by a triad of anomalies comprising epibulbar dermoids, accessory auricular appendages and aural fistulae. The condition is unilateral, occurs only sporadically and is sometimes associated with other ocular anomalies like coloboma of the upper lid, microphthalmos and ocular colobomata. More rarely other facial and widespread nervous, muscular and skeletal anomalies may be in association with the ocular dermoids and aural deformities (Duke-Elder, 1964). Though external aural deformities are a part of this syndrome middle ear anomalies giving rise to congenital deafness must be very rare. We have not come across any reference to this in the literature available to us. Moreover, the association of congenital deafness and facial hemiatrophy has an interesting embryological explanation worth recording.

ORBITAL AFFECTION IN NASAL AND PARANASAL NEOPLASMS

Neoplasms of the nose and paranasal sinuses affecting the orbit comprise a heterogenous group which are encountered quite infrequently by the average practising ophthalmologist. Though such neoplasms usually affect the orbit in the late stages, involvement of it at an early stage is not unknown. The prognosis is much better where the orbital involvement is merely due to associated inflammatory reaction but in most cases the tumours grow to encroach upon the orbit or actually involve the orbital tissues. Eye findings are not only indicative of the extent but also of the site of the primary lesion which itself may be inaccessible to clinical examination. In some eases the orbital involvement is as a result of treatment of the tumour, surgical or irradiational, and it is the duty of the ophthalmologists to apprise their E. N. T. colleagues of such post-operative and post-radiational orbital and ocular complications that may accrue eventually.

Isolated Pupillary Paralysis in a Case of Herpes Zoster

The clinical findings in a 16-year-old boy with unilateral isolated pupillary paralysis in a case of herpes zoster ophthalmicus is described because of the extreme rarity of the condition. The condition appeared to be due to a partial third nerve lesion affecting only the fibers subserving the light and near reflexes.

Serum beta‐2 microglobulin level in acute idiopathic anterior uveitis

Abstract Serum beta‐2 microglobulin levels were measured in 68 patients with acute idiopathic anterior uveitis and 51 healthy subjects by ELISA technique. The levels were found to be significantly increased in moderate and severe types of uveitis despite a normal renal glomerular function in all patients. The parameters remained unaltered in mild types. Serum beta‐2 microglobulin levels closely paralleled the severity of the disease. The increased beta‐2 microglobulin level in serum showed a significant fall to normal levels on clinical improvement. The data further strengthen the hypothesis that acute idiopathic anterior uveitis is an immune mediated disease. It is proposed that serum beta‐2 microglobulin may be considered as a reliable parameter of the degree of severity of acute idiopathic anterior uveitis, as well as representing a useful tool for the evaluation of drug efficacy, especially in intractable cases.

Fibroma of the lacrimal sac.

A case of fibroma arising from the anterolateral wall of a healthy lacrimal sac on the left side in a 22-year-old male is reported. There was no epiphora. The tumor presented as a painless, nonreducible swelling in the lacrimal sac region. It was excised off leaving a patent sac. The diagnosis could be established only on histopathologic examination. Postoperative recovery was uneventful and there was no postoperative epiphora.

Paradoxical movements of the eyelid and eyeball.

Two cases of ptosis with paradoxical eye and lid movements have been reported. One of them was congenital, where there was narrowing of palpebral aperture on abduction and pseudo-Graefe phenomenon on looking down. The other case was acquired following head injury. Here there was narrowing of palpebral aperture on abduction and widening of palpebral aperture on adduction. Besides there was absence of elevation of the globe in looking up. The pseudo-Graefe phenomenon of lid retraction was present only on looking down and in and not on looking down and out. Probable causes of such associated movements have been mentioned.

Acute Lacrimal Abscess in Infancy: A Report of 22 Cases

Twenty-two cases of acute lacrimal abscess in infancy seen between 1959 and 1976 have been presented. Twelve of them had more han one attack at the time of reporting to this hospital. Initial treatment of the condition was medical, utilizing local and systemic antibiotics. If this did not produce a prompt response, incision and drainage of the abscess was done. The cases showed a preponderance of infections by mixed organisms. In three cases, blocked lacrimal passages opened up spontaneously while on medical treatment. In the remaining 19 cases, probing in an attempt to remove the obstruction in the nasolacrimal duct was performed as soon as the acute inflammation was controlled. Reprobing was needed in nine cases. Only two cases eventually required surgery to achieve a cure. The study indicates that early probing is successful in a high percentage of cases of acute lacrimal abscess including those coming with recurrent attacks.