Chronic Inflammation in an Anophthalmic Socket due to a Room Temperature Vulcanized Silicone Implant

Eye Conformers as Socket Expanders in Children: Experience at a Tertiary Eye Hospital in Central Saudi Arabia

Purpose To share our experience with pediatric orbital expansion using eye conformers for anophthalmia and microphthalmia and parental feedback on outcomes. Methods Cases of congenital anophthalmia and severe microphthalmia were managed with eye conformers for orbital expansion and formation of lid fornices at the anaplastology clinic of King Khaled Eye Specialist Hospital, Saudi Arabia. Data were collected on the globe adaptation process and the perceived achievements by the parents at different follow-up visits. Parental feedback was collected on their acceptance of eye conformer use to address anophthalmia and microphthalmia. Results The anophthalmia/microphthalmia annual prevalence was 1.7 per 10,000 live births in Saudi Arabia. Of the 45 sockets treated for orbital expansion since 2014, 15 children were managed by using eye conformers. Six children had a bilateral birth defect. Severe microphthalmia was in seven children while eight children had anophthalmos. At the first visit, small eye conformers (nine), stem eye conformer (four), symblepharon ring (one), and hydrogel eye conformer (one) were fitted. After multiple visits and follow-ups, at the two-year follow-up, seven (46.7%) children were fitted while three (20%) were under the process of prosthesis fitting, as volume expansion was satisfactory. Parents of these children replied that they prefer this method over others and would recommend others to follow the same. Conclusions Orbital expansion and lid fornices formation by using an eye conformer is effective, easy, and acceptable to parents. It can be initiated in the early months of a child's life.

Granulomatous reaction to migrating silicone oil clinically mimicking a xanthelasma: A case report

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Distant silicone oil migration may occur following retina surgery.

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Silicone oil in periocular tissue results in granulomatous reaction.

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It may resemble a periocular xanthelasma-like skin lesion.

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Tissue diagnosis is essential for confirmation in such cases.

Introduction

Silicone oil has been used for many years in retinal surgeries for retinal detachment. One of its reported complications is oil migration to the periorbital area, resulting in granulomatous reaction.

Presentation of case

A 56-year-old lady, with history of retinal detachment that was repaired by vitrectomy, silicone oil removal and epi-retinal membrane peeling, presented to us with unilateral ptosis and a skin lesion that resembled xanthelasma.

Discussion

Histopathology of this lesion showed silicone oil infiltrating the surrounding connective tissue and fat with absence of foamy histiocytes.

Conclusion

We are reporting a case of silicone oil migration with pseudo-xanthelasma lesion. This has been reported only twice to the best of our knowledge in the English-written literature.

Persistent socket pain postenucleation and post evisceration: a systematic review

PURPOSE

To investigate causes, diagnostics and treatment modalities for persistent socket pain (PSP) after enucleation and evisceration.

METHODS

A systematic search was undertaken in accordance with the PRISMA Statement, in PubMed, Embase.com and Thomson Reuters/Web of Science. We searched for relevant papers until the 28th of July 2016. Inclusion criteria were (1) patients with a history of enucleation or evisceration, (2) PSP, (3) report of the cause and/or used diagnostics and/or treatment modality, (4) full text in English, Dutch or Spanish language. Excluded were (1) review articles, (2) comments, and publications concerning, (3) nonhumans, (4) exenterated patients, (5) acute postoperative pain, or (6) periorbital pain without pain in the socket. Given the lack of high quality evidence from randomized controlled trials, we examined all available evidence from primary observational studies and assessed quality within this lower level of evidence.

RESULTS

A total of 32 studies were included. Causes of PSP found were prosthesis-related (n = 5), dry socket (n = 2), trochleitis (n = 3), compression of the trigeminal nerve (n = 2), implant-related (n = unknown), inflammation (n = 5), surgery-related (n = 4), neuromas (n = 8), malignant tumours (n = 3), psychiatric/psychosocial (n = 2), phantom pain (n = 149), rarer entities (n = 3) or unknown (n = 14). Nonsurgical treatments suffice for conditions as trochleitis, prosthesis-related pain, dry socket and for phantom pain. Other causes of pain may require more invasive treatments such as implant removal.

CONCLUSION

Careful history and examination can give some direction in the diagnostic procedure; however, PSP is probably multifactorial and the specific origin(s) may remain uncertain. Implant replacement can be an effective treatment. Studies to identifiy less invasive procedures are required.