Riad N. Ma'luf

Orbital osteoma arising adjacent to a foreign body.

A 27-year-old man sustained a blast injury to the face in April 1996, with a resultant foreign body at the right medial orbital wall. He refused to undergo surgical removal of the foreign body at that time and was discharged on oral antibiotics. Five years later, he presented because of recurrent attacks of swelling, redness, and pain at the right medial canthal area. A repeat computed tomography (CT) scan revealed fragmentation of the original orbital foreign body and an adjacent radiodense lesion that appeared to blend smoothly with the orbital bone from which it arose. This lesion was not present on the initial CT scan done 5 years earlier immediately following the blast. The patient was started on oral antibiotics and surgical exploration was carried out. Three fragments of the foreign body were removed in addition to the adjacent orbital lesion, which proved to be an ivory-type osteoma on histopathology. We briefly review previously suggested factors in the pathogenesis of osteoma and present further evidence in favor of both traumatic and infectious factors.

Tick infestation of the eyelid

PURPOSE To report the rare occurrence of tick infestation of the eyelid margin. METHODS A 58-year-old woman was initially examined with a small yellow lesion of the left upper eyelid margin that appeared after she felt a sting near her eye. Close examination disclosed an insect body attached to the eyelid margin. En bloc excision of the insect with part of the eyelid was performed. RESULT Gross examination of the specimen identified the organism as the nymph stage of a bloated tick of the genus Hyalomma but of an uncertain species. CONCLUSION Ticks (Hyalomma) can become embedded in the meibomian gland orifice and manifest as a mass at the eyelid margin.

Involutional type of entropion in a child with cutis laxa

Editor,—The diffuse elastic tissue disease called cutis laxa (CL) is a serious, even lethal systemic illness, involving not only the skin but connective tissues throughout the body.1 The skin hangs in loose folds, producing the appearance of premature ageing. Internal manifestations such as emphysema, ectasia of the aorta, and multiple hernias are usually present. We report a child with cutis laxa, who presented with an unusual ophthalmic manifestation of the disease. ### CASE REPORT Our patient, who is now a 4 year old boy and the third child to a normal first degree cousin couple, was noted to have redundant skin and a hoarse cry at the age of 3 months. Skin biopsy was consistent with cutis laxa (elastin stain showed focal thickening of the elastic fibres with tapered ends). His 7 month old sister was also diagnosed as having cutis laxa at 3 months of age. Her ophthalmic examination revealed no abnormalities. Otherwise, the family history was negative for such skin problems. Recently, he presented to our clinic with a 2 month history of a red right eye. Examination revealed an entropion of the right lower lid (Fig 1 …

CORRECTION OF THE INADEQUATE LOWER FORNIX IN THE ANOPHTHALMIC SOCKET

Editor,—A well formed inferior fornix in the anophthalmic socket requires an adequate amount of conjunctival tissue and a deep recess. Obliteration of the fornix might occur either secondary to conjunctival shrinkage or as a result of obliteration of the inferior recess and inadequate fixation of the abundant conjunctiva.1 In the latter condition, the subject of this report, prolapse of the forniceal conjunctiva will result in anterior rotation of the inferior edge of the prosthesis and secondary laxity of the lower lid. This report presents a modification of the technique described previously by Neuhaus and Hawes for the correction of the above condition.1 ### CASE REPORT Twenty patients with an inadequate inferior fornix and sufficient amount of conjunctival tissue who presented over a period of 5 years were managed. They all complained of easy prolapse of the lower edge of the prosthesis and sagging of the lower lid. The procedure was done under …

Treatment of recurrent eyelid margin verruca vulgaris with mitomycin C.

A 62-year-old male presented with multiple bilateral eyelid margin verruca vulgaris. Treatment with surgical excision and cauterization of the bases was done twice, but the lesions recurred rapidly with more extensive involvement of the eyelid margins. Excision and intraoperative application of mitomycin C (0.2 mg/ml) for 3 minutes using Weck-Cel sponges resulted in no recurrence seen at the 8-month follow-up.

Reconstruction of Periocular War Injuries

This chapter presents our experience gained with management and reconstruction of the periocular region in a large number of warfare injuries during the ongoing war in Iraq and Syria. Most cases dealt with were subject to high-velocity projectiles and had devastating functional and esthetic consequences. The eye globes were either phthisical or evacuated at the combat zone without any orbital volume replacement. The patients presented to our center late with a delay of at least 2–3 weeks and had varying degrees of canthal dystopias, eyelid defects, and socket abnormalities. The major aim was to reposition the canthal angles, and recreate an eyelid with an adequate fornix to enable the patient to be fit with an ocular prosthesis.