Nirmala Subramanian

Solitary fibrous tumor of the orbit: a clinicopathologic study of six cases with review of the literature☆

Solitary fibrous tumor of the orbit is a rare spindle cell neoplasm. There are 42 cases of solitary fibrous tumor of the orbit available in the literature. We present six more cases of orbital solitary fibrous tumors, which presented to our institute between 1999 and 2001. We highlight the need for clinical recognition of these tumors as a distinct entity and inclusion of this tumor in the etiological differential diagnosis of well-circumscribed orbital lesions presenting as unilateral proptosis in both children and in adults. The diagnosis may be suspected based on radiological features supported by histopathologic and immunohistochemical study. The strong CD34 immunoreactivity of this tumor supports its diagnosis. Complete surgical resection is the most important prognostic factor of this tumor.

Lacrimal Proline Rich 4 (LPRR4) Protein in the Tear Fluid Is a Potential Biomarker of Dry Eye Syndrome

Dry eye syndrome (DES) is a complex, multifactorial, immune-associated disorder of the tear and ocular surface. DES with a high prevalence world over needs identification of potential biomarkers so as to understand not only the disease mechanism but also to identify drug targets. In this study we looked for differentially expressed proteins in tear samples of DES to arrive at characteristic biomarkers. As part of a prospective case-control study, tear specimen were collected using Schirmer strips from 129 dry eye cases and 73 age matched controls. 2D electrophoresis (2DE) and Differential gel electrophoresis (DIGE) was done to identify differentially expressed proteins. One of the differentially expressed protein in DES is lacrimal proline rich 4 protein (LPRR4). LPRR4 protein expression was quantified by enzyme immune sorbent assay (ELISA). LPRR4 was down regulated significantly in all types of dry eye cases, correlating with the disease severity as measured by clinical investigations. Further characterization of the protein is required to assess its therapeutic potential in DES.

Cystic Schwannoma of the Orbit—A Case Series

A schwannoma is an uncommon benign orbital tumor that arises from Schwann cells in the peripheral nervous system. Schwannoma with cystic degeneration is an even more rarely reported entity. Clinical examination alone is inadequate for the diagnosis. Radiological examination, like computed tomography (CT) scans, can help in the diagnosis; however, the diagnosis can only be confirmed by histopathological examination (HPE) after excision biopsy. Here, the authors report four cases of orbital schwannoma with cystic degeneration that presented with proptosis and decreased vision. CT scans showed a well-defined non-enhancing intraconal mass with cystic spaces. The histopathological examination was diagnostic for orbital schwannoma with cystic degeneration. Schwannoma should be included in the differential diagnosis of cystic orbital lesions.

Reconstructions of eyelid defects

Eyelids are the protective mechanism of the eyes. The upper and lower eyelids have been formed for their specific functions by Nature. The eyelid defects are encountered in congenital anomalies, trauma, and postexcision for neoplasm. The reconstructions should be based on both functional and cosmetic aspects. The knowledge of the basic anatomy of the lids is a must. There are different techniques for reconstructing the upper eyelid, lower eyelid, and medial and lateral canthal areas. Many a times, the defects involve more than one area. For the reconstruction of the lid, the lining should be similar to the conjunctiva, a cover by skin and the middle layer to give firmness and support. It is important to understand the availability of various tissues for reconstruction. One layer should have the vascularity to support the other layer which can be a graft. A proper plan and execution of it is very important.

Malignant teratoma of the orbit: A clinicopathological study of a case

PURPOSE To present a case of malignant sarcomatous changes in an orbital teratoma with clinicopathological correlation. MATERIALS & METHODS Retrospective interventional case report. RESULTS A 10-month-old child presented with protrusion of the left eye of 8 months duration. Computerized tomography (CT) revealed a heterogeneous retrobulbar mass in the left orbit. Fine needle aspiration biopsy (FNAB) revealed sarcomatous cells. The child was treated with chemotherapy and radiotherapy with a provisional diagnosis of sarcoma. However, as the proptosis worsened, a repeat CT scan showed a possibility of an intracranial extension. Exenteration was done. Histopathological examination revealed a teratoma with (malignant) sarcomatous changes. The child is doing well at 3 years follow-up with no recurrences. CONCLUSION Orbital teratomas should be considered in the differential diagnosis of all neonatal orbital masses. Although rare, malignant changes can occur in teratomas. FNAB is not helpful in the diagnosis. Surgical excision of the mass is recommended for a definitive diagnosis. Although the prognosis of orbital teratoma is good, there is always a chance of vision loss.

Role of ultrasound and CT-scan in diagnosis of hydatid cyst of the orbit

Hydatid cyst of the orbit is a rare cause of proptosis, even in endemic countries like India. We report two histopathologically proven cases with ultrasonographic and computerized tomographic correlations. Both patients had marked dimness of vision and disc edema. One of them did not regain vision following cyst removal because of optic atrophy. The two cases indicate that hydatid cyst should be retained as a differential diagnosis of unilateral proptosis with disc edema. A combined ultrasound and CT-scan should be done to establish the diagnosis. An attempt should also be made at complete surgical removal of the cyst.

Adult onset Langerhans cell histiocytosis of the orbit - A case report

purpose To report an interesting case of adult onset Langerhans cell histiocytosis in a 41-year-old male with clinicopathological correlation. design Interventional case report. materials and methods A 41-year-old male presented with an ill-defined mass occupying the temporal quadrant of the left orbit. Computerized tomography revealed an ill-defined extraconal mass involving the superolateral aspect of the left orbit with areas of osteolysis involving the lateral and superior orbital walls. The mass excised at orbitotomy showed microscopic features consistent with Langerhans cell histiocytosis. Immunohistochemistry with CD-68 macrophage marker and S-100 was positive, confirming the diagnosis. Treatment included oral steroids and radiotherapy. At 6 months follow-up, he developed a punched-out lytic lesion in the left parietal calvarium. He again received external beam radiotherapy. At 14 months follow-up, he is doing well with no recurrences. conclusions Adult onset Langerhans cell histiocytosis, though rare, should be included in the differential diagnosis of lytic lesions of the lateral orbital wall in an adult patient.

Thrombosed orbital varix – a correlation between imaging studies and histopathology

A thrombosed varix in the orbit is comparatively rare. Clinical examination alone is often inadequate for diagnosis. Radio-logical examination, such as a computed tomography (CT) scan of the orbit, is extremely important. Histopathological examination (HPE) after excision biopsy can confirm the diagnosis. The present authors describe a case of proptosis in the left eye of a 45-year-old man. CT-scan and HPE supported the diagnosis of a thrombosed orbital varix. This paper discusses the use of radiological investigations to supplement a clinical suspicion and make the diagnosis. This entity needs to be included in the differential diagnosis of proptosis and requires a coordinated approach for establishment of the diagnosis.

Cryptophthalmos: reconstructive techniques--expanded classification of congenital symblepharon variant.

Purpose:To report the varied presentation and management of cryptophthalmos and further categorize grades of the congenital symblepharon variant based on the severity of the defect. Methods:The records of 34 eyes of 25 patients with cryptophthalmos who sought treatment at the authors’ tertiary eye care center over a period of 22 years were analyzed. Results:Of the 34 eyes, 25 belonged to the congenital symblepharon variant, which could distinctively be further classified in medial/mild (4), moderate (9), and severe (11) subgroups and the surgical management for each has been outlined. The associated corneal and facial anomalies have also been highlighted along with their management modalities when indicated. Conclusions:Although a rare clinical entity, this is the largest series of cryptophthalmos reported so far with a proposed classification scheme for the congenital symblepharon variant.

An unusual case of intraorbital foreign body and its management.

Intraorbital foreign bodies are usually the result of accidental trauma and can lead to considerable morbidity. We report an unusual case of an industrial injury in a plastic manufacuring unit wherein hot molten plastic splashed and solidified inside the orbit. The resultant increased intraorbital pressure led to loss of vision in that eye. The extreme temperature of the foreign body caused extensive thermal damage to the surrounding adnexal structures. Staged reconstructive surgery was undertaken to repair the damage, with an acceptable final cosmetic outcome. Employment of protective eye wear to prevent such accidents in high-risk occupations should be made mandatory.