J. B. Lasky

Household objects as a cause of self-inflicted orbital apex syndrome

This report describes two cases of self-inflicted penetrating nonprojectile orbitointracranial injury. Suicide attempts caused by these types of injuries are very rare. An understanding of the orbital and intracranial anatomy and the avoidance head turn help to predict potential injury sites. Computed tomography and cerebral angiography were helpful in the treatment of these two cases.

Osteosarcoma of the orbit associated with Paget disease.

Osteosarcoma is a common primary bone malignancy most often involving the long bones and occurring in the second decade of life. Orbital involvement in this disease process is rare and is usually due to extension of the tumor from an adjacent sinus cavity. Orbital osteosarcoma arising from preexisting Paget disease is exceedingly rare. We report the case of a 78-year-old female patient with Paget disease of the forehead who presented with rapidly increasing bilateral proptosis and visual loss for several months. Examination showed bilateral aphakia, decreased motility, proptosis with resistance to retropulsion, and tumorous infiltration of the eyelids and periorbital soft tissue. Fundus examination showed marked bilateral scleral indentation without overlying serous retinal detachment. A computed tomographic (CT) evaluation of the orbits demonstrated extensive soft tissue involvement of the paranasal sinuses, nasal cavity, periorbital soft tissue, and orbits, with compression of the optic nerve and globe bilaterally. Biopsy of the periorbital soft tissue demonstrated osteosarcoma. Radiation therapy failed to stem the progression of the disease process, and the patient died approximately 4 months later. Although osteosarcoma of the orbit associated with Paget disease is unusual, it should be considered in the differential diagnosis of older patients with a rapidly progressive orbital mass.

Platinum spatula versus mini-tip culturette in culturing bacterial keratitis

Purpose To compare the traditional method of culturing bacterial keratitis (platinum spatula) with the use of a commercially available Mini-tip Culturette (Becton-Dickinson, Cockeysville, MD, U.S.A.). Methods An experimental model of bacterial keratitis was created in rabbit corneas by intrastromal injection of bacteria. Cultures were taken of rabbit corneas with both the Mini-tip Culturette and the platinum spatula. Culture results were compared with corneal colony counts. Humans with community-acquired presumed bacterial keratitis were cultured with both the Mini-tip Culturette and the platinum spatula. The sensitivity and specificity of the Mini-tip Culturette method was determined and compared with the platinum-spatula technique. Results Rabbit keratitis model: 100% of corneas had established infections by colony count. Each ulcer was culture positive with platinum spatula, moist Mini-tip Culturette, and dry Mini-tip Culturette. Human keratitis: Seven patients had culture-negative keratitis with both the Mini-tip Culturette and the platinum spatula. Five patients were culture positive with both the Mini-tip Culturette and the platinum spatula. One of the positive cultures had growth of multiple organisms by using the platinum spatula but not with the Mini-tip Culturette. The sensitivity of the Mini-tip Culturette was 83.3%. The specificity of the Mini-tip Culturette was 100%. Detected organisms included group A ß-hemolytic Streptococcus, S. aureus, coagulase-negative Staphylococcus, Serratia marcescens, and Pseudomonas aeruginosa. Conclusion The Mini-tip Culturette is a highly specific and moderately sensitive method for culturing bacterial keratitis.

Ocular surface upregulation of intercellular adhesive molecule-1 (ICAM-1) by local interferon-gamma (IFN-γ) in the rat

Inflammatory mediators such as interferon-gamma (IFN-gamma) are known to induce the expression of class II HLA (HLA-DR) and intercellular adhesion molecule 1 (ICAM-1) in a variety of cell types including epithelial cells. The coexpression of ICAM-1 and HLA-DR has been implicated in the pathogenesis of immune mediated ocular disease. We investigated the expression of ICAM-1 on the ocular surface of the rat eye following subconjunctival administration of IFN-gamma. A dose response study was performed using 100, 1,000 and 10,000 IU IFN-gamma/dose. The presence of ICAM-1 was determined using a standard immuno-peroxidase staining technique. The cornea, limbus, and conjunctiva were evaluated. The degree of reaction product in each area was graded by a masked observer. We found constitutive expression of ICAM-1 on the conjunctiva but not on the cornea. There was a significant relationship between the dose of IFN-gamma and the intensity of ICAM-1 staining on the conjunctiva (p < or = 0.05) and on the limbus (p < or = 0.04). Subconjunctival IFN-gamma had no effect on the expression of ICAM-1 in the cornea.