Dinesh Selva

Description:To evaluate the demographics, clinical features and response of orbital squamous cell carcinoma treated with immunotherapy in an Australian and New Zealand cohort. This is a multi-institutional, retrospective case series. Data was collected on patient demographics, clinical presentation, imaging findings, treatment course and outcomes. Details of post-immunotherapy surgical interventions were documented along with their histological findings. Ten patients were included. All patients had invasive orbital squamous cell carcinoma. Perineural spread was present in six patients. Seven patients received Cemiplimab, while three patients received Pembrolizumab. No patients experienced side effects requiring cessation of immunotherapy. One patient died during follow up due to an unrelated cause. Eight (80%) patients had measurable radiological response, whereas one (10%) patient had progressive disease. Two patients had orbital exenteration: one due to progressive disease and one due to residual disease on MRI. One patient had orbital mapping biopsies. Two (66%) patients that had tissue analysis following immunotherapy showed complete pathologic response. Our findings support the emerging role of immunotherapy in the management of invasive orbital squamous cell carcinoma.

Description:Objective: Bacterial dacryoadenitis with abscess is rare. There is limited evidence examining the clinical course, and there is no consensus on evidence-based management protocols. The authors aim to systematically review the current literature on bacterial dacryoadenitis with abscess, examining etiology, clinical and radiological features, management, and outcomes. Methods: A systematic search of the databases PubMed/MEDLINE, Embase, and CENTRAL was performed to July 2024, prior to data collection and risk of bias analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Twenty-five articles met the inclusion criteria. Fifty-one cases of bacterial dacryoadenitis complicated by abscess were identified, mean age 34.5 ± 22.3 years including n = 17 females (40.4%, subgroup with full demographic data, n = 42). Methicillin-sensitive Staphylococcus aureus was identified as the most common causative organism (25.4%), followed by methicillin-resistant Staphylococcus aureus (17.9%) and Haemophilus influenzae (12.8%). Clinical features included upper eyelid swelling (74.5%) and pain (39.2%), along with extraocular movement restriction (58.8%), gaze-evoked pain (39.2%), erythema (45%), chemosis (41.1%), and lacrimal gland protrusion (19.6%). A well-defined, rim-enhancing lesion within an enlarged lacrimal gland was typical on imaging (seen in 33.3%). The majority were managed with abscess drainage with concurrent intravenous antibiotics (66.6%). Only 1 patient among the included studies suffered a recurrence. Abscess drainage was not associated with patient age (p = 0. 8) or with Staphylococcus aureus as the causative organism (p = 0.7). Conclusions: Bacterial dacryoadenitis with abscess is a rare but potentially sight-threatening entity. Requirement for abscess drainage in bacterial dacryoadenitis was not associated with patient age, nor with the most common causative bacteria. Clinicians should be aware of the potential for compressive optic neuropathy, and alert to signs that may indicate surgical drainage, in particular, inadequate response to antibiotics.

Description:The authors present a case of an orbital apex venous malformation that presented with an intermittent oculomotor nerve palsy over a 15-year period. Radiologically, the lesion presented as a well-circumscribed orbital mass with T2 hyperintensity and enhancement that could only be demonstrated on 2-hour delayed phase imaging. The venous malformation was initially steroid-responsive but eventually became refractory to medical treatment alone. This necessitated a medial apical decompression, followed by a deep lateral orbitotomy 18 months later.

Description:Objective: To characterize the clinical, radiological, and pathological features of patients with metastases to the lacrimal gland from distant primaries. Methods: Multicentre retrospective case series and a review of the literature of cases of metastases to the lacrimal gland. Results: We present 4 cases of lacrimal gland metastases, with the primaries being renal cell (n = 2) and breast (n = 2) carcinoma. The literature review identified 40 additional cases (19 male, mean age, range 21-84 years) of lacrimal gland metastasis. Based on these 44 cases, including 4 from the present study, 2 patterns of metastasis were identified: 23 cases (52.3%, 23/44) with lacrimal gland enlargement without bony erosion, and 21 cases (47.7%, 21/44) with associated bony erosion of the superolateral orbit of whom 12 (57.1%, 12/21) had intracranial extension. The most common primary for lacrimal gland metastasis without bony erosion was breast cancer (56.5%, 13/23), whereas hepatocellular carcinoma was the most common cause of lacrimal gland metastasis with bony erosion (52.4%, 11/21). Lacrimal gland metastasis was the first presentation of cancer in 15 cases (34.1%, 15/44) and was the first presentation of metastasis in 12 cases (27.3%, 12/44). Conclusions: Metastasis to the lacrimal gland is a potential cause of lacrimal gland enlargement. It may be the initial sign of distal occult cancer or occult metastatic disease. Different patterns of metastasis may be seen with different underlying primaries.

Description:Hydrogel scleral buckles are a hydrophilic explant that may lead to significant delayed complications. They can insidiously enlarge over decades and may mimic an orbital tumor or cyst. The authors report a case of an expansive hydrogel scleral explant in a previously eviscerated socket. A 58-year-old male presented with a 2-week history of severe pain in his left anophthalmic socket. And 31 years prior, he had sustained OS trauma and undergone a series of surgeries. Details of these procedures were unavailable; however, he had ultimately proceeded to globe evisceration. MRI revealed a large lobulated cyst-like orbital mass with internal calcification, which had expanded the left orbit with erosion of the medial wall, lateral wall, and roof. It extended to involve the ethmoid and frontal paranasal sinuses. He proceeded to a lateral orbitotomy, revealing the lesion to be an expanded hydrogel scleral buckle explant. Postoperatively, there was a significant improvement in his pain.