Introduction: Thyroid eye disease (TED) is a heterogeneous condition and the most common extrathyroidal manifestation of Graves’ disease. Although most cases are mild, disease progression may threaten vision and significantly impact quality of life. Methodology: We described four patients with active moderate-to-severe TED, highlighting their clinical characteristics, therapeutic approaches, and clinical outcomes. Results: Three males and one female patient were included in this descriptive study. Most were identified by the endocrine team. Their median age was 52.5 years (range 47–56 years). All patients had long-standing Graves’ disease (range 6–10 years). Two of them were active smokers. Their clinical activity score ranged from 3 to 5. Common presenting features included diplopia (60%), proptosis (60%), and ocular redness (60%). At the onset of active TED, all patients were euthyroid while receiving either antithyroid therapy or were maintained on stable levothyroxine following radioactive iodine treatment and thyroidectomy. Thyroid receptor autoantibodies were assessed in only two patients, with one elevated result. Orbital computed tomography, performed in 3 patients, demonstrated extraocular muscle enlargement consistent with TED, particularly involving the inferior and medial recti. All patients received standard-dose intravenous methylprednisolone (cumulative 3.5–4.5 g). They showed improvement in visual acuity following treatment, with partial improvement in ophthalmoplegia. Conclusion Clinical risk factors observed in this series were consistent with the literature. TED diagnosis relies heavily on recognition by the endocrine team, underscoring the importance of holistic Graves’ disease management. Highdose corticosteroids remain the mainstay of treatment in our setting, with generally favorable outcomes when timely multidisciplinary care is provided.
Graves Ophthalmopathy

Purpose: Worldwide, limited information is available on the psychosocial function and health-related quality of life (HRQoL) in children with congenital ptosis, nor the effect of corrective surgery on these parameters. This study aimed to evaluate the social anxiety and HRQoL of Malaysian children with primary simple unilateral congenital ptosis following ptosis surgery. Methods: A prospective cohort study was conducted among children with primary simple unilateral congenital ptosis and their parent/guardian who attended three tertiary hospitals from 2022 to 2024. The patients and their parents/guardians answered Spence Children’s Anxiety Scale-Social Anxiety and the PedsQL 4.0 Generic Core Scale, at the time of recruitment and 3 months after ptosis surgery. Results: This study involved 45 children, of which 26 (57.8%) were female. At enrollment, 18 (40.0%) had severe ptosis, and 15 (33.3%) had amblyopia. All surgeries were successful, with a mean margin to reflex distance (MRD) 1 and mean intereye MRD1 difference of 4.07 ± 0.62 and 0.29 ± 0.46 mm, respectively. Significant improvements in both social anxiety and HRQoL of children and parent were observed following surgery (p < 0.001). A decrease in intereye MRD1 difference postoperatively was the only significant factor affecting social anxiety of children with ptosis following surgery (p < 0.001). Together with the presence of amblyopia (p < 0.001), the intereye MRD1 difference was found to have a significant impact on the improvement in HRQoL (p = 0.021). Age, sex, and education level of parent/guardians were found to significantly affect the change in social anxiety following ptosis surgery (p < 0.05), while the factor most associated with improvement of parental HRQoL was an improvement in the MRD1 of the ptotic eye (p < 0.001). Conclusions Ptosis surgery significantly improved social anxiety and HRQoL in children with congenital ptosis and their parents/guardians. Psychosocial function should be a consideration when identifying indications for surgery in children with congenital ptosis.

Purpose: Worldwide, limited information is available on the psychosocial function and health-related quality of life (HRQoL) in children with congenital ptosis, nor the effect of corrective surgery on these parameters. This study aimed to evaluate the social anxiety and HRQoL of Malaysian children with primary simple unilateral congenital ptosis following ptosis surgery. Methods: A prospective cohort study was conducted among children with primary simple unilateral congenital ptosis and their parent/guardian who attended three tertiary hospitals from 2022 to 2024. The patients and their parents/guardians answered Spence Children’s Anxiety Scale-Social Anxiety and the PedsQL 4.0 Generic Core Scale, at the time of recruitment and 3 months after ptosis surgery. Results: This study involved 45 children, of which 26 (57.8%) were female. At enrollment, 18 (40.0%) had severe ptosis, and 15 (33.3%) had amblyopia. All surgeries were successful, with a mean margin to reflex distance (MRD) 1 and mean intereye MRD1 difference of 4.07 ± 0.62 and 0.29 ± 0.46 mm, respectively. Significant improvements in both social anxiety and HRQoL of children and parent were observed following surgery (p < 0.001). A decrease in intereye MRD1 difference postoperatively was the only significant factor affecting social anxiety of children with ptosis following surgery (p < 0.001). Together with the presence of amblyopia (p < 0.001), the intereye MRD1 difference was found to have a significant impact on the improvement in HRQoL (p = 0.021). Age, sex, and education level of parent/guardians were found to significantly affect the change in social anxiety following ptosis surgery (p < 0.05), while the factor most associated with improvement of parental HRQoL was an improvement in the MRD1 of the ptotic eye (p < 0.001). Conclusions Ptosis surgery significantly improved social anxiety and HRQoL in children with congenital ptosis and their parents/guardians. Psychosocial function should be a consideration when identifying indications for surgery in children with congenital ptosis.

Purpose: Worldwide, limited information is available on the psychosocial function and health-related quality of life (HRQoL) in children with congenital ptosis, nor the effect of corrective surgery on these parameters. This study aimed to evaluate the social anxiety and HRQoL of Malaysian children with primary simple unilateral congenital ptosis following ptosis surgery. Methods: A prospective cohort study was conducted among children with primary simple unilateral congenital ptosis and their parent/guardian who attended three tertiary hospitals from 2022 to 2024. The patients and their parents/guardians answered Spence Children’s Anxiety Scale-Social Anxiety and the PedsQL 4.0 Generic Core Scale, at the time of recruitment and 3 months after ptosis surgery. Results: This study involved 45 children, of which 26 (57.8%) were female. At enrollment, 18 (40.0%) had severe ptosis, and 15 (33.3%) had amblyopia. All surgeries were successful, with a mean margin to reflex distance (MRD) 1 and mean intereye MRD1 difference of 4.07 ± 0.62 and 0.29 ± 0.46 mm, respectively. Significant improvements in both social anxiety and HRQoL of children and parent were observed following surgery (p < 0.001). A decrease in intereye MRD1 difference postoperatively was the only significant factor affecting social anxiety of children with ptosis following surgery (p < 0.001). Together with the presence of amblyopia (p < 0.001), the intereye MRD1 difference was found to have a significant impact on the improvement in HRQoL (p = 0.021). Age, sex, and education level of parent/guardians were found to significantly affect the change in social anxiety following ptosis surgery (p < 0.05), while the factor most associated with improvement of parental HRQoL was an improvement in the MRD1 of the ptotic eye (p < 0.001). Conclusions Ptosis surgery significantly improved social anxiety and HRQoL in children with congenital ptosis and their parents/guardians. Psychosocial function should be a consideration when identifying indications for surgery in children with congenital ptosis.

Purpose: Worldwide, limited information is available on the psychosocial function and health-related quality of life (HRQoL) in children with congenital ptosis, nor the effect of corrective surgery on these parameters. This study aimed to evaluate the social anxiety and HRQoL of Malaysian children with primary simple unilateral congenital ptosis following ptosis surgery. Methods: A prospective cohort study was conducted among children with primary simple unilateral congenital ptosis and their parent/guardian who attended three tertiary hospitals from 2022 to 2024. The patients and their parents/guardians answered Spence Children’s Anxiety Scale-Social Anxiety and the PedsQL 4.0 Generic Core Scale, at the time of recruitment and 3 months after ptosis surgery. Results: This study involved 45 children, of which 26 (57.8%) were female. At enrollment, 18 (40.0%) had severe ptosis, and 15 (33.3%) had amblyopia. All surgeries were successful, with a mean margin to reflex distance (MRD) 1 and mean intereye MRD1 difference of 4.07 ± 0.62 and 0.29 ± 0.46 mm, respectively. Significant improvements in both social anxiety and HRQoL of children and parent were observed following surgery (p < 0.001). A decrease in intereye MRD1 difference postoperatively was the only significant factor affecting social anxiety of children with ptosis following surgery (p < 0.001). Together with the presence of amblyopia (p < 0.001), the intereye MRD1 difference was found to have a significant impact on the improvement in HRQoL (p = 0.021). Age, sex, and education level of parent/guardians were found to significantly affect the change in social anxiety following ptosis surgery (p < 0.05), while the factor most associated with improvement of parental HRQoL was an improvement in the MRD1 of the ptotic eye (p < 0.001). Conclusions Ptosis surgery significantly improved social anxiety and HRQoL in children with congenital ptosis and their parents/guardians. Psychosocial function should be a consideration when identifying indications for surgery in children with congenital ptosis.

Purpose: Worldwide, limited information is available on the psychosocial function and health-related quality of life (HRQoL) in children with congenital ptosis, nor the effect of corrective surgery on these parameters. This study aimed to evaluate the social anxiety and HRQoL of Malaysian children with primary simple unilateral congenital ptosis following ptosis surgery. Methods: A prospective cohort study was conducted among children with primary simple unilateral congenital ptosis and their parent/guardian who attended three tertiary hospitals from 2022 to 2024. The patients and their parents/guardians answered Spence Children’s Anxiety Scale-Social Anxiety and the PedsQL 4.0 Generic Core Scale, at the time of recruitment and 3 months after ptosis surgery. Results: This study involved 45 children, of which 26 (57.8%) were female. At enrollment, 18 (40.0%) had severe ptosis, and 15 (33.3%) had amblyopia. All surgeries were successful, with a mean margin to reflex distance (MRD) 1 and mean intereye MRD1 difference of 4.07 ± 0.62 and 0.29 ± 0.46 mm, respectively. Significant improvements in both social anxiety and HRQoL of children and parent were observed following surgery (p < 0.001). A decrease in intereye MRD1 difference postoperatively was the only significant factor affecting social anxiety of children with ptosis following surgery (p < 0.001). Together with the presence of amblyopia (p < 0.001), the intereye MRD1 difference was found to have a significant impact on the improvement in HRQoL (p = 0.021). Age, sex, and education level of parent/guardians were found to significantly affect the change in social anxiety following ptosis surgery (p < 0.05), while the factor most associated with improvement of parental HRQoL was an improvement in the MRD1 of the ptotic eye (p < 0.001). Conclusions Ptosis surgery significantly improved social anxiety and HRQoL in children with congenital ptosis and their parents/guardians. Psychosocial function should be a consideration when identifying indications for surgery in children with congenital ptosis.

Actinomyces odontolyticus is a predominant Actinomyces species in the oral cavity, pharynx, and distal esophagus. We report a rare case of primary chronic lacrimal canaliculitis caused by A. odontolyticus. A 63-year-old woman presented with left eye epiphora for three years associated with medial upper lid swelling, redness, and chronic yellowish discharge. After clinical examination and investigations, she was successfully treated with topical cefuroxime 5%, topical fluorometholone 0.1%, and intracanalicular syringing with cefuroxime 5%. Spontaneous extrusion of canaliculiths led to complete resolution.