Objective Treatment of palpebral conjunctival lesions is problematic due to late diagnosis, difficult surgical approach, and the need to preserve eyelid integrity. We describe our treatment experience using plaque brachytherapy in the "sandwich technique.” Design A retrospective study. Participants We reviewed the medical records of patients treated by plaque brachytherapy for conjunctival lesions at the Hadassah Medical Center between January 1, 2013, and January 1, 2024, and included in the analysis patients treated for palpebral conjunctival lesions. Methods Ruthenium plaque was sutured to the palpebral conjunctiva. The matching nonradioactive “dummy” plaque was sutured to the external eyelid to flip the tarsal's curvature. Results The study cohort included 5 patients, 2 men (40%) and 3 women (60%) at a median age of 68.11 years (range: 47-79.7 years). Three patients had conjunctival melanoma (60%), 1 had sebaceous carcinoma (20%), and 1 had extensive carcinoma in situ (20%). All lesions were in the left upper eyelid. Median follow-up was 37.6 months (range: 18.7-110.6 months). Four patients demonstrated a complete response (80%), while one had a partial response (20%). There was local recurrence in 1 patient (20%), and 1 patient had new foci elsewhere (20%). All patients had full local control after adding local treatments. One patient developed metastatic disease and died (20%). All patients had manageable madarosis and conjunctival scars. Conclusions Treatment of palpebral conjunctival lesions using “sandwich” plaque brachytherapy is safe and effective. To the best of our knowledge, this treatment was never described before, and we believe it should be added to our armamentarium.

A 10-month-old female presented with a rapidly growing, painless mass in the right upper eyelid. Due to suspected malignancy, she underwent an urgent biopsy. Histopathological and immunohistochemical analyses revealed nodular fasciitis. Here, we describe the case and perform a literature review of orbital nodular fasciitis in the pediatric population.

Liesegang rings are laminated precipitation structures well recognized in the field of chemistry. We present a rare case of a 64-year-old man who sought examination for a conjunctival cystic lesion of several months' duration, located in the right nasal bulbar conjunctiva near the plica semilunaris. The lesion was excised completely and uneventfully under local anaesthesia. Histopathological examination revealed a large folded cyst in the substantia propria. The cyst contained multiple eosinophilic concentrically spherical and oval structures of variable size with an amorphous central core compatible with Liesegang rings. No fungal or parasitic organisms were identified. This is the first photographically documented case of Liesegang rings appearing in the conjunctiva. Liesegang ring formation should be taken into account during histopathological examination of a conjunctival cyst and not be misdiagnosed as a parasitic infection.

Pilomatrixoma is an uncommon benign neoplasm that originates from the matrix of the hair root. It occurs more frequently in the head and neck region of children and adolescents, often involving the eyelid or eyebrow. Pilomatrixoma is often misdiagnosed clinically and the correct diagnosis can be established only after excision and histological examination. Pathologic diagnosis of pilomatrixoma is based on the finding of large masses of shadow cells, combined with basophilic cells, inflammation, foreign body giant cells, calcification, and ossification. We report 16 cases of eyelid pilomatrixoma that were treated in our department, and review the relevant literature.

pressure, which would also explain intraoperative asystole induced by the oculocardial reflex. An operation lasting 5 hours was too long for recovering ischemic retinal tissue. Ophthalmoplegia may have been caused by intramuscular edema and hemorrhage and could, therefore, resolve completely. Besides high intraorbital pressure, low arterial blood pressure and shallow orbits may be additional risk factors. To prevent this disastrous complication, increased intraorbital pressure should be avoided by careful positioning of the patient and precautious preparation of the myocutaneous flap with respect to the patient’s physiognomy. In cases with increased risk, special eye shields may be used to avoid orbital infarction.

Paranasal sinus lymphoma is an uncommon malignancy and is often difficult to diagnose. Early diagnosis is essential for effective treatment. The tumour generally has poor prognosis. Ophthalmological symptoms and signs occur early in the disease process due to the close proximity of the orbit to the paranasal sinuses. Common presenting features include eye pain, proptosis, visual loss and diplopia. We report a case of frontal sinus lymphoma that presented as a superior-nasal orbital mass in an 84 year old man. CT scan demonstrated a mass occupying the frontal sinuses, with destruction of the anterior bony wall of the frontal sinus and extending to the right orbit. Histology revealed diffuse large B cell non Hodgkin's lymphoma. The tumor was treated with radiotherapy and showed regression; however the patient died 9 months later. Sinus tumours are encountered by ophthalmologists and should be considered in patients presenting with an orbital mass.

PURPOSE: To analyze the outcome of management of patients with basal cell carcinomas (BCCs) and squanous cell carcinomas (SCCs) in a tertiary referral eye center in Sydney, Australia.DESIGN: Retrospective case series.METHODS: Review of medical records of 485 consecutive cases (469 patients) with confirmed eyelid cancer. INTERVENTION PROCEDURES: Surgical excision with 3, to 5-mm clinically clear margins and histologic confirmation of the surgical margins. Frozen section histology or Mobs' micrographic surgery (MMS) was used for incompletely excised cases, and those located in the medial canthus or close to the lacrimal drainage system. Standard reconstruction techniques were employed. MAIN OUTCOME MEA, SURES: Survival period free of tumor, incomplete excision, recurrences, type of closure, and complications.RESULTS: Excision was initially incomplete in 25.4% of all tumors. Morpheaform type of BCC (chi(2) p < .001), and medial canthus location BCCs (chi(2) p < .05) were associated with a higher incomplete resection rate. A 35.9% incomplete excision rate was associated with a significantly higher recurrence rate compared with complete excision (8.4% and 4.6%, respectively, chi(2) p < .05). Twenty-seven patients (5.6%) had a recurrent tumor. After incomplete excision, there was no recurrence with MMS, but 4.7% recurrence rate when frozen section technique was used (P < .05). Local postoperative complications occurred in 41 patients (8.5%).CONCLUSIONS: In the setting of a tertiary referral center, incomplete primary resection of an eyelid skin cancer is the main risk factor for recurrence. Incomplete resection is significantly associated with medial canthus location and morpheaform type of BCC and with moderately differentiated SCC. MMS is the safer technique after incomplete tumor excision.