Purpose: We report a case of a primary mucinous adenocarcinoma of the lower eyelid diagnosed in patient with a painless mass.Case summary: A 62-year-old male visited our clinic with a painless mass of the left lower eyelid of increasing the size for 2 months. Orbital computed tomography and magnetic resonance imaging revealed an approximately 2 cm well-defined ovoid, homogeneous enhancing mass in the left lower eyelid. A biopsy was performed under general anesthesia, and histopathologic examination confirmed mucinous adenocarcinoma. Final diagnosis was made as primary mucinous adenocarcinoma since torso positron emission tomography and computed tomography found no abnormal findings and extensive resection was performed for complete resection of the tumor. Conclusions Primary mucinous adenocarcinoma that occurs in the eyelid is a very rare malignant tumor, and a systemic examination to determine whether it is metastatic is essential, and due to its high local recurrence, regular follow-up after extensive resection is required.

Purpose: Here, we report the clinical features and successful treatment of a very rare case of dacryocystocele due to secondary nasolacrimal duct obstruction by cavernous hemangioma in an adult patient.Case summary: A 78-year-old man had a painless mass on the right medial canthus and epiphora for 5-6 years. The mass on the lower area of the right medial canthus had a well-defined border, was fixed in position, and smooth. Lacrimal irrigation via the lower punctum showed reflux through the opposite punctum without nasal passage. Orbital computed tomography showed multicystic mass formation on the right lacrimal sac and a bony lesion with ground glass opacity on the anteromedial side of the right nasolacrimal duct causing duct narrowing. Orbital magnetic resonance imaging showed a multicystic, fluid-filled structure in the right lacrimal sac. An intranasal bony lesion 14 mm in diameter was also observed. The patient was diagnosed with dacryocystocele due to secondary nasolacrimal duct obstruction by an intranasal mass. Endoscopic transnasal removal of two lacrimal cystic masses and the intranasal mass, and dacryocystorhinostomy (DCR) were performed. Pathological examination revealed chronic inflammation with lymphoid follicles of the tear bag and cavernous hemangioma of the nasal cavity. Conclusions Acquired dacryocystocele in adults is most commonly idiopathic. Here, we report a case of a dacryocystocele due to secondary nasolacrimal duct obstruction by cavernous hemangioma that was treated successfully by endoscopic transnasal tumor removal and DCR.

Purpose: To report a case of actinomycosis infection originating in the orbitonasal cavity that quickly invaded the cerebrum.Case summary: A-57-year-old male with a history of right tooth extraction 7 days before the first visit presented with right eyelid swelling and pain that had developed 4 days prior to the visit and had become increasingly worse. The best-corrected visual acuity was light perception. The intraocular pressure of the patient was 37 mmHg in the right eye. Eyelid abscess, subconjunctival hemorrhage, and severe chemosis was observed. Orbital computed tomography showed multiple air pockets and enhancing soft tissue along the periorbital, maxillary, and ethmoid sinus. Emergent endoscopic sinus surgery, lateral canthotomy, and intravenous antifungal treatment were performed due to suspicion of mucormycosis infection. Two days after treatment, exenteration combined with otolaryngology and neurosurgery were performed, as brain magnetic resonance imaging scans indicated that intraorbital lesions had invaded the dura and frontal sinus. On Day 8 of treatment, Actinomyces odontolyticus was identified and intravenous Ampicillin was administered. Despite systemic antibiotic treatment, the infection could not be controlled. The patient died 28 days after treatment due to persistent intracranial hemorrhage and brain edema. Conclusions For patients with severe eyelid swelling with a history of tooth extraction, actinomycosis infection should be considered. Delays in diagnosis and treatment of this infection could lead to serious consequences.

Purpose: To report a case of actinomycosis infection originating in the orbitonasal cavity that quickly invaded the cerebrum.Case summary: A-57-year-old male with a history of right tooth extraction 7 days before the first visit presented with right eyelid swelling and pain that had developed 4 days prior to the visit and had become increasingly worse. The best-corrected visual acuity was light perception. The intraocular pressure of the patient was 37 mmHg in the right eye. Eyelid abscess, subconjunctival hemorrhage, and severe chemosis was observed. Orbital computed tomography showed multiple air pockets and enhancing soft tissue along the periorbital, maxillary, and ethmoid sinus. Emergent endoscopic sinus surgery, lateral canthotomy, and intravenous antifungal treatment were performed due to suspicion of mucormycosis infection. Two days after treatment, exenteration combined with otolaryngology and neurosurgery were performed, as brain magnetic resonance imaging scans indicated that intraorbital lesions had invaded the dura and frontal sinus. On Day 8 of treatment, Actinomyces odontolyticus was identified and intravenous Ampicillin was administered. Despite systemic antibiotic treatment, the infection could not be controlled. The patient died 28 days after treatment due to persistent intracranial hemorrhage and brain edema. Conclusions For patients with severe eyelid swelling with a history of tooth extraction, actinomycosis infection should be considered. Delays in diagnosis and treatment of this infection could lead to serious consequences.

Purpose: To report a case of apocrine hidrocystoma in the lacrimal gland.Case summary: A 51-year-old woman presented with a left upper eyelid mass that occurred two years before presenting tohospital. Upon physical examination, a painless palpable mass on the left upper eyelid was observed. Based on slit-lamp examination,a pinkish mass with a well-circumscribed border on the left upper temporal conjunctiva was observed. Orbital computedtomography showed a well-defined contrast enhanced mass of 8 × 9 × 9 mm in the lacrimal lesion. The mass was removed completelyunder local anesthesia. Biopsy confirmed that the mass was an apocrine hidrocystoma. There was no recurrence at oneyear postoperatively. Conclusions This is the first report of an apocrine hidrocystoma in a lacrimal lesion in Korea. Apocrine hidrocystoma is rarelyfound on lacrimal gland lesions, but it should be considered in the differential diagnosis of a lacrimal gland mass.

PURPOSE: To report the clinical manifestations and computed tomography (CT) findings of patients with a trapdoor type medial orbital wall blowout fracture.METHODS: From March 2009 to October 2016, the clinical records and computed tomography findings of patients who underwent surgical treatment for a trapdoor type medial orbital wall blowout fracture were retrospectively analyzed.RESULTS: A total of eight patients (six males and two females) were enrolled with a combined mean age of 14.4 years. Clinical manifestations were eyeball movement limitation (abduction and adduction) and ocular motility pain (eight patients, 100%), diplopia (seven patients, 87.5%), and nausea and vomiting (four patients, 50%). On CT, the distance from the orbital apex to the fracture site was an average of 22.0 mm and occurred in the middle position of the entire wall. Two patients had missed rectus completely dislocated into the ethmoid sinus through the fracture gap and six patients had definite involvement in the fracture gap and edema of the medial rectus muscle. The medial rectus muscle cross-sectional area was 47.7 mm² which was edematous compared to the contralateral eye (40.1 mm²). Orbital wall reconstruction was performed an average of 4.1 days after the injury. In all patients with oculocardiac reflex-like nausea and vomiting immediately improved after surgery. Six out of eight patients who had eyeball movement limitations (abduction and adduction) preoperatively showed adduction limitation after surgery. The eyeball movement limitation and diplopia disappeared 11.7 days and 46.7 days after surgery, respectively.CONCLUSIONS: Patients with trapdoor type medial wall blowout fracture showed characteristic computed tomographic findings and clinical manifestations such as eyeball movement limitation, ocular motility pain, diplopia, and oculocardiac reflex. An understanding of clinical findings and quick surgical treatment are therefore required. The type of eyeball movement limitation was abduction and adduction limitation preoperatively and adduction limitation postoperatively.
Diplopia ; Edema ; Ethmoid Sinus ; Humans ; Male ; Nausea ; Orbit ; Reflex, Oculocardiac ; Retrospective Studies ; Vomiting

PURPOSE: We report a case of hemorrhagic lymphangiectasia of the conjunctiva with a 360° connected circumference, which recovered spontaneously.CASE SUMMARY: A 44-year-old female patient presented with congestion of the right eye 1 day prior to her visit. There was no history of any systemic disease or trauma, but she had experienced relapses of the same episode three times before the visit. There were no accompanying symptoms such as decreased vision or pain. Blood analysis, orbital computed tomography, and angiographic findings showed no remarkable finding. Slit lamp examination showed circumferential lymphatic dilatation extending 360° under the conjunctiva of the eye at a distance of about 6 mm behind the limbus of the right eye, which was accompanied by intralymphatic bleeding. Irregular local lymphatic dilatations were observed on the bulbar conjunctiva at 4 and 8 o'clock of the left eye. The bleeding spontaneously resolved in about 2 weeks, but the translucent enlarged lymphatic vessels were still observed on slit lamp examination and anterior segment optical coherence tomography.CONCLUSIONS: This is the first reported case of hemorrhagic lymphangiectasia involving 360° of the bulbar conjunctiva in Republic of Korea.

PURPOSE: To evaluate the efficacy and safety of BOTULAX® in subjects with essential blepharospasm.METHODS: In this study, a total of 250 subjects with essential blepharospasm were enrolled at 15 investigational sites and a total of 220 subjects completed the study. The efficacy and safety were evaluated at weeks 4 and 16 after treatment compared with baseline. In total, 240 subjects were enrolled, treated with the investigational product, and evaluable for the primary efficacy assessment at week 4 after treatment; these subjects were included in the intention-to-treat (ITT) population. With the ITT set as the main efficacy set, efficacy assessment included Jankovic rating scale (JRS), functional disability score, investigator evaluation of global response and quality of life. Safety assessment including the incidence of adverse events was also performed.RESULTS: In terms of the primary efficacy endpoint (i.e., change in JRS total score at week 4 after treatment from baseline [ITT set]), mean change indicated a statistically significant reduction (p < 0.0001) and demonstrated the non-inferiority of the test drug to similar drugs. In terms of the secondary efficacy endpoints, mean change in JRS total score at week 16 after treatment and mean change in functional disability score at weeks 4 and 16 after treatment both exhibited a statistically significant reduction compared with baseline (p < 0.0001 for all). Among the 249 subjects treated with the investigational product in this study, 44 (17.67%) experienced 76 treatment emergent adverse events but no serious adverse events were observed.CONCLUSIONS: Based on the study results, BOTULAX® is considered to be an effective and safe treatment for essential blepharospasm.

Purpose: To report a rare case of bilateral optic nerve sheath meningocele diagnosed in a patient with exophthalmos.Case summary: A 33-year-old male visited our clinic with bilateral exophthalmos for 6 months. The patient had been diagnosed with hypertension 3 years previously; however, the condition had been poorly controlled. He also had a history of treatment associated with retinal vein occlusion, macular edema, and papilledema 2 years earlier. There was no limitation in his ocular movement. A Hertel exophthalmometry test showed bilateral exophthalmos of 20 mm in both eyes. Visual field tests showed an inferior arcuate visual field defect in the right eye and a superotemporal peripheral field defect in the left eye. In orbital magnetic resonance imagery, cerebrospinal fluid space widening along the optic nerve and flattening of the bilateral posterior pole of the eye were evident. The patient was diagnosed with optic nerve sheath meningocele. Conclusions Optic nerve sheath meningocele should be considered as a differential diagnosis of exophthalmos patients. Because it is a disease that can affect visual function in a manner similar to that of a visual field defect, rapid diagnosis through imaging study and thorough regular follow-up examinations are essential.

Purpose: To report a rare case of bilateral optic nerve sheath meningocele diagnosed in a patient with exophthalmos.Case summary: A 33-year-old male visited our clinic with bilateral exophthalmos for 6 months. The patient had been diagnosed with hypertension 3 years previously; however, the condition had been poorly controlled. He also had a history of treatment associated with retinal vein occlusion, macular edema, and papilledema 2 years earlier. There was no limitation in his ocular movement. A Hertel exophthalmometry test showed bilateral exophthalmos of 20 mm in both eyes. Visual field tests showed an inferior arcuate visual field defect in the right eye and a superotemporal peripheral field defect in the left eye. In orbital magnetic resonance imagery, cerebrospinal fluid space widening along the optic nerve and flattening of the bilateral posterior pole of the eye were evident. The patient was diagnosed with optic nerve sheath meningocele. Conclusions Optic nerve sheath meningocele should be considered as a differential diagnosis of exophthalmos patients. Because it is a disease that can affect visual function in a manner similar to that of a visual field defect, rapid diagnosis through imaging study and thorough regular follow-up examinations are essential.