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Oculoplastic / Lacrimal /Orbit / Ocular Pathology / Oncology

Source: Am J Ophthalmol  
Long-term Follow-up of Punctal and Proximal Canalicular Stenoses After Silicone Punctal Plug Treatment in Dry Eye Patients
PURPOSE: To determine the clinical value and relevance of punctal and proximal canalicular stenoses after punctal plug therapy in moderate to severe dry eye syndrome.
DESIGN: Retrospective, observational case series.
METHODS: Seventeen eyes were determined to have punctum or proximal canalicular stenoses after spontaneous loss of a collared silicone punctal plug. After initial diagnosis all patients had 12 months or more of follow-up (mean, 39; range, 12 to 87 months). The clinical data collected included gender and age of patients, localization of the stenosis, plug size, duration of punctal occlusion, subjective symptoms, objective ocular surface disease parameters, and occurrence of complications.
RESULTS: A statistically significant correlation between localization of the stenosis and plug size, and localization of the stenosis and duration of punctal occlusion could not be found. At follow-up, subjective symptoms (P<.01) and frequency of artificial tear application (P<.001) were significantly reduced compared to data before plug insertion. Schirmer I test results (P<.001), corneal fluorescein staining (P<.01), and rose Bengal staining (P<.001) improved significantly, whereas tear break-up time (P<.2) and impression cytology scores of the conjunctival surface (P = .2) remained almost unchanged. Complications could not be found.
CONCLUSION: Within the observation period of up to seven years, all stenoses remained asymptomatic. Additionally, subjective symptoms and most dry eye parameters in our study population improved.
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Diagnosis and Management of Malignant Tumors of the Eyelid, Conjunctiva, and Orbit
Kaan Gündüz; Bita Esmaeli

Abstract and Introduction

Abstract
Ocular adnexal tumors are relatively rare but require unique diagnostic and treatment considerations given the functional importance of the eye and periocular structures and their unique metastatic behavior. In the following paper, we review the major malignant tumors of the ocular adnexa including the eyelid, conjunctiva and orbit. Frozen section control of the margins and, in selected cases, Mohs microsurgery have decreased the recurrence rate in malignant eyelid tumors. Intraoperative cryotherapy and postoperative topical mitomycin C have similarly contributed to better surgical outcomes in conjunctival malignant tumors including squamous cell carcinoma and malignant melanoma. Immunotherapy with CD20 antibodies is a developing treatment in ocular adnexal lymphomas.

Introduction

Malignant ocular adnexal tumors comprise a diverse group of disorders. The outline of the major malignant tumors discussed in this paper are given in Box 1 .

Box 1. Premalignant and Malignant Eyelid, Conjunctival and Orbital Tumors.

 
Premalignant and malignant eyelid tumors
• Basal cell carcinoma
• Keratoacanthoma
• Squamous intraepithelial neoplasia
• Actinic keratosis
• Squamous cell carcinoma
• Sebaceous cell carcinoma
• Cutaneous melanoma
• Merkel cell carcinoma
• Metastatic eyelid tumors

Premalignant and malignant conjunctival tumors
• Conjunctival squamous cell carcinoma
• Conjunctival primary acquired melanosis and melanoma
• Kaposi's sarcoma
• Lymphoid tumors

Malignant orbital tumors in adults
• Lymphoid tumors
• Epithelial lacrimal gland tumors
• Metastatic orbital tumors
• Secondary tumors

Malignant orbital tumors in children

• Rhabdomyosarcoma
• Granulocytic sarcoma (chloroma)
• Burkitt's lymphoma
• Metastatic orbital tumors

Malignant Eyelid Tumors & Predisposing Lesions
Basal Cell Carcinoma
Clinical Features.
Basal cell carcinoma (BCC) is the most common malignant eyelid tumor, accounting for 85% of all such tumors.[1] The tumor usually affects adults but may also occur in younger patients. Basal cell carcinoma arises in sun-exposed skin, implying that actinic damage is important in the pathogenesis.

Basal cell carcinoma involves the lower eyelid in 55% of patients, the medial canthus in 30%, the upper eyelid in 10% and the lateral canthus in 5%.[2] When BCC involves the eyelid margin, there is loss of lashes.

Clinically, there are two distinct types of BCC, nodular and morpheaform. The nodular type usually presents as an elevated mass with fairly well defined margins (Figure 1). Ulceration may develop. The morpheaform type, by contrast, has poorly defined borders and usually lacks ulceration. It is difficult to judge clinically where the margins of a morpheaform BCC are located.
 
Figure 1.  Nodular basal cell carcinoma of the lower eyelid

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