"Surgical technique: Lateral canthal tendon relieving incisions in lower lid reconstruction." Orbit, 37(1), pp. 76–77

METHODS:We present a rare case with atypical presenting features of unilateral CPEO with a false positive Acetylcholine Receptor Antibody (AchRA) test resulting in diagnostic delay. We illustrate the unilateral nature of this case and demonstrate the caveats of performing myogenic ptosis correction in such patients. We also discuss the differential diagnosis of false positive AchRA, a test commonly performed in the investigation of ptosis.RESULTS:A 34-year old female presented with a more than 3-year history of slowly-progressive, unilateral, right-sided restriction in eye movements and ptosis. Clinical examination showed EOM were grossly restricted in the right eye with a ptosis and normal in the left eye. Serum AchRA was positive on serum enzyme-linked immunosorbent assay (ELISA) however, following two months of oral pyridostigmine therapy there were no signs of clinical improvement. The initial serum sample sent was retested for AchRA by radio-immunoassay (RIA) which came back negative. Subsequently a muscle biopsy was requested which showed the presence of ragged red fibres.CONCLUSION:Unilateral ptosis and ophthalmoplegia is an unusual presentation for CPEO which characteristically produces bilateral symmetrical motility defects. In addition to Myasthenia Gravis elevated AchRA levels have been reported in other autoimmune conditions such as Primary biliary cirrhosis, Eaton Lambert syndrome and Graves's ophthalmopathy. We also highlight the superiority of RIA versus ELISA in the detection of AchRA and illustrate the diagnostic challenge of investigating and managing myogenic ptosis in this complex cohort of patients.

Serratia liquefaciens is a rarely encountered gram-negative organism in ophthalmology practice. The only reported ocular infections are from contamination of contact lenses. The authors report the first case of a patient who developed orbital cellulitis secondary to severe S. liquefaciens microbial keratitis.

Aims: To report a rare case of isolated diffuse episcleral neurofibroma and to discuss possible differential diagnoses.Case report: A 37 year old Caucasian female was found to have an epibulbar tumour arising from the superior aspect of her left eye. Clinical examination revealed a 12 mm × 8 mm “salmon pink” coloured lesion.Results: A biopsy was performed and histopathologic examination and subsequent systemic evaluation showed it to be a rare case of isolated diffuse episcleral neurofibroma.Conclusion: There are many differential diagnoses for an epibulbar lesion and neurofibroma should be added to these. Even though a small risk of malignant transformation exists, we recommend a conservative approach for slow growing lesions.

Purpose: Intracanalicular plugs are commonly used in the management of dry eyes. The authors report 3 cases of complications associated with intracanalicular plugs.Methods: Clinical findings and the management of these patients are presented.Results: The first patient (case 1) is a 47-year-old female with severe dry eyes. Six months after insertion of intracanalicular Form fit hydrogel plugs (OASIS® Medical) she developed canaliculitis with Klebsiella oxytoca. The second patient (case 2), a 33-year-old female, who developed left canalicular abscess 5 months following the insertion of bilateral, intracanalicular Form fit hydrogel plugs (OASIS® Medical). The third patient (case 3) a 33-year-old female had granulation tissue formation within the left lower canaliculus, 5 years after insertion of intracanalicular plug. The symptoms in the three patients resolved after they underwent canaliculotomy with removal of the plugs.Conclusion: Complications of intracanalicular plugs can sometimes outweigh their benefits. These plugs can lodge in the lacrimal outflow system and cause pyogenic granuloma formation and canaliculitis. To our knowledge, until now there have been no reports of complications associated with Form Fit hydrogel plugs (OASIS® Medical) and its infective complication with Klebsiella oxytoca.