Alicia Galindo-Ferreiro

Basal cell carcinoma (BCC) is the most prevalent form of skin cancer.1 Due to ultraviolet B exposure being the primary risk factor, BCC occurs more frequently in sun-exposed areas of the body, with...

Purpose: To evaluate the impact of eyelid hygiene on conjunctival microbial species and ocular discharge in patients with ocular prostheses(OP). Methods: A prospective study included patients with unilateral anophthalmic sockets or phthisis bulbi using OP. Two visits were scheduled: baseline and 7 days later. At each visit, three samples were collected: lower tarsal conjunctiva of the affected eye, bulbar conjunctiva of the affected eye, and lower tarsal conjunctiva of the healthy eye. Patients followed one of two hygiene regimens: Ozonest ^® group (wipes and liposomal-ozonated-oil drops) or Lephanet ^® group (wipes and saline solution). Demographic data, clinically significant discharge(CSD), and eyelid cleaning habits were recorded. Statistical significance was set at P < 0.05. Results: Sixty-one patients (mean age 63.7 ± 15.5 years, 54.1% male) contributed 366 samples. 31 (50.8%) were in Ozonest and 30(49.2%) in Lephanet. Staphylococcus epidermidis (39%) and Corynebacterium macginleyi (24.6%) were most common. Positive cultures were higher in affected eyes (78.7%) than in healthy eyes (32.8%, P < 0.05). Tarsal conjunctiva cultures decreased with both Ozonest(64.5% to 51.6%) and Lephanet (56.7% to 46.7%). Overall CSD decreased from 47.5% to 16.4%, particularly in Lephanet (60% to 10%, P < 0.05). Conclusions: Positive cultures were more frequent in prosthetic eyes than in healthy eyes being with S. epidermidis and C. macginleyi being the most frequent microorganisms. Both hygiene regimens reduced positive tarsal conjunctival cultures and improved CSD.

Introduction: Rheumatoid nodules are one of the most common extra-articular manifestations in rheumatoid arthritis (RA) being extremely uncommon in the ocular and periocular area. To the authors’ knowledge, this is the second case of an orbital rheumatoid nodule. Case description: A 44-year-old woman with RA presented with a painful hard mass in the inferolateral right orbital rim causing mild lower lid retraction, ptosis and exophthalmos. Magnetic Resonance Imaging showed a extraconal mass involving the lower eyelid and fat tissue of the infratemporal fossa. An incisional biopsy demonstrated an orbital rheumatoid nodule. Conclusions: Rheumatoid nodule's should be considered as a differential diagnosis for an orbital tumour found in patients with RA.

This study aimed to evaluate the practices employed by oculoplastic surgeons in the assessment and management of anophthalmic sockets and external ocular prostheses. Oculoplastic surgeons from two countries, who specialized in the management of anophthalmic sockets, participated in a web-based survey. Data collected included demographics, types of surgery, implant use, external ocular prostheses management (including fabrication and cleaning), complications encountered, and follow-up times. The frequencies and distributions of the responses were statistically analyzed. A total of 177 oculoplastic surgeons participated, 113 (63.8%) from Brazil, the remainder from Spain. Evisceration was the preferred surgical procedure of 149 (84.2%) surgeons. The most commonly reported indication for enucleation was a painful blind eye (n=103, 58.1%; both Brazil and Spain, p<0.001). Brazilian surgeons preferred polymethyl methacrylate implants (n=65, 57.5%), while Spanish surgeons favored porous polyethylene implants (n=53, 82.8%; p<0.001). Discharge was the most frequently observed clinical feature during socket evaluation (n=164, 92.6%; p<0.001). Brazilian surgeons recommended daily (n=53, 46.9%) or weekly (n=41, 36.2%) cleaning of exter nal ocular prostheses, while Spanish surgeons more commonly recommended monthly cleaning (n=31, 48.4%; p<0.001). The majority of Brazilian surgeons (n=83, 73.4%) advised patients to remove their external ocular prostheses at night. Only a small number of Spanish surgeons (n=3, 4.6%) suggested this practice (p<0.001). Overall, the follow-up recommendations varied, with 70 (39.5%) surgeons recommending follow-up based on indivi dual case needs, and 59 (33.3%) suggesting annual visits (p<0.001). The primary indications for external ocular prostheses replacement were edge damage (n=75, 42.3%) and loss of volume (n=68, 38.4%). The replacement intervals given typically ranged from 1 to 5 years (n=92, 51.9%; p<0.001). Oculoplastic surgeons in Brazil and Spain demonstrated similar practices in the management of anophthalmic sockets. However, notable differences were observed in the choice of implant materials, cleaning protocols, and recommendations regarding external ocular prostheses removal during sleep.

Purpose: Study the effect on the tear film in blepharospasm (BEB), facial hemispasm (FH), or aberrant regeneration (AR) treated with Botulinum Toxin (BTX-A). Methods: A prospective study was used to evaluate the tear film in patients with BEB, FH, or AR treated with BTX-A. Schirmer tests, break-up time (BUT), optical coherence tomography (OCT) meniscus measurement, the Ocular Surface Disease Index (OSDI) questionnaire, and Oxford scale were documented before; 1 month after; and 3 months after BTX-A treatment. Comparisons were made with the Friedman test and Wilcoxon matched-pairs signed rank test was used. A p-value <0.05 was considered statistically significant. Results: A total of 35 eyes from 27 patients were included. The mean patient age was 66.81 ± 12.94 years and 18 (66.7%) were female. Ten (37%) patients had BEB, six (22.2%) had FH, and 11 (40.74%) had AR. BTX-A improved the lid spasms. One month after BTX-A, Schirmer tests showed slight increments (Schirmer 1 p = 0.009; Schirmer 2 p = 0.05) and at 3 months they became similar to pre-treatment ( p = 0.5). The BUT test was not significantly different at 1 month ( p = 0.450) or at 3 months. On OCT 1 month after BTX-A, there was an increase in tear meniscus area ( p = 0.004), height ( p = 0.007), and depth ( p = 0.004), and at 3 months the measurements also became similar to the pre-BTX-A values. No significant changes in the OSDI ( p = 0.717) and Oxford scale ( p = 0.255). Conclusion: OCT is a good tool to detect the increase in tear meniscus after periocular BTX-A in BEB, FH, and AR.

Purpose The occurrence of a hypersensitivity reaction with the injection of botulinum toxin type A (BTX-A) in cosmetic use is a rare complication. We report the largest case series of temporary delayed hypersensitivity reaction (DHR) with BTX-A following COVID-19 vaccination and the first cases to incobotulinum toxin A (incoBTX-A). Methods A retrospective multicentric case series of patients who developed a DHR to BTX-A after COVID-19 vaccination. Results Twelve patients were treated with BTX-A injections for the management of facial rhytids. The age range was between 29 and 45 years. Ten (83.3%) were female. Ten (83.3%) patients received incoBTX-A, and two received onabotulinum toxin A (onaBTX-A). All patients had COVID-19 vaccination (mRNA vaccine) between 1 and 7 months before. Within an average time of 24 h after BTX-A injection, all patients developed progressive facial swelling and erythema that were more prominent at the injection points. Intradermal allergic tests to BTX-A were performed in six (50%) patients, and the results were all negative. Adequate clinical control was achieved with systemic corticosteroids and antihistamines. After 1 year with no further vaccination, a new BTX-A treatment (provocation test) was performed in all patients with no secondary effects. Conclusion Previous COVID-19 vaccination and the absence of new adverse events with further BTX-A injections suggest a temporary DHR. Clinicians should be aware of the importance of immunization history and its potential post-vaccine immunogenic effects with BTX-A. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authorswww.springer.com/00266 .

Introduction We describe the first case of ALHE in the orbit with extension to the maxillary sinus and the importance of a multidisciplinary approach to achieve removal of the lesion. Case study A 72-year-old man presented with epiphora of the left eye and several episodes of recurrent acute dacryocystitis. Magnetic resonance imaging revealed a solid homogeneous mass located in the inferomedial region of the left orbit. In addition, it was associated with destruction of the adjacent ethmoidal wall and upper wall of the left maxillary sinus. Incisional biopsy of the orbital mass was compatible with ALHE. Results It was decided to perform surgery using an orbital floor approach, left medial wall via subconjunctival and caruncular approach together with an endoscopic nasal approach (ESS), achieving complete removal of the orbital mass and cleaning of the maxillary sinus. After one year of treatment, no tumor recurrence was evident through endoscopy and imaging tests and the patient is asymptomatic. Conclusions ALHE is a very rare benign vascular tumor that presents subcutaneous nodules in the head and neck region. We do not know of any case of ALHE in the paranasal sinuses described in the literature, either in isolation or together with orbital or cutaneous ALHE. In conclusion, ALHE disease should be considered as a diagnosis when faced with an orbital mass with extension to the paranasal sinuses, and a complete excision through a combined endonasal and orbital approach prevents recurrence in most cases.

Hepatitis C virus infection may be implicated in 12.7% of ocular adnexal marginal zone lymphomas. We present the first case of an orbital-systemic mucosa-associated lymphoid tissue lymphoma that responded to hepatitis C virus medical treatment. A 62-year-old male with a right-sided orbital mass was diagnosed with stage IIA orbital marginal zone lymphoma in addition to hepatitis C virus infection based on clinical, imaging, laboratory, and histological examinations. The systemic and orbital responses were achieved 1 year after undergoing hepatitis C virus treatment with glecaprevir/pibrentasvir. The association between the hepatitis C virus infection and orbital-systemic mucosa-associated lymphoid tissue lymphoma is relevant. Accordingly, patients with orbital mucosa-associated lymphoid tissue lymphoma should be assessed for hepatitis C virus seroreactivity for therapeutic and prognostic purposes.

Purpose To analyse the ocularist’s perspective on the management of the anophthalmic socket and external ocular prosthesis (EOP). Methods Ocularists from two countries were invited to participate in an online questionnaire. Data were collected on demographics, anophthalmic socket and EOP management (manufacturing, use, cleaning), complications, follow-up visits and multidisciplinary care. The frequency and proportions of the responses were statistically analysed. Results The questionnaire was addressed to 20 Brazilian and 17 Spanish ocularists, obtaining a response rate of 65% and 64.7%, respectively. 62.5% of respondents were men. The most common cause of anophthalmia in Brazil (69.2%) and Spain (36.4%) is an eye disease (chi square: p = 0.188). Polymethylmethacrylate (PMMA) is the most commonly used material in EOP manufacture (chi square: p = 0.448), and 70.8% reported using customized EOPs (chi square: p = 0.069). Deposits are frequently observed in both countries (chi square: p = 0.157). Changing the prosthesis is recommended after 5 to 10 years by Brazilian ocularists, and after less than 5 years of use by Spanish ocularists (81.8%) (chi square: p = 0.041). Annual follow-up is recommended by Spanish ocularists (45.5%), while semestral (38.5%) and case-dependent (38.5%) follow-up is recommended by Brazilian ocularists (chi square: p = 0.267). Daily cleaning is advocated by 61.5% of Brazilian ocularists and once a month by 45.5% of Spanish ocularists (chi square: p = 0.098), with 75% of ocularists from both countries not recommending EOP removal at night (Fisher´s exact test: p = 0.166). Good communication between ocularists and ophthalmologists was reported by 87.5% of our responders (chi square: p = 0.642). Conclusion Although there are no unified protocols on the management of EOPs, Brazilian and Spanish ocularists follow similar guidelines. Differences between countries were the patients´ referral and the prosthesis´ useful life.

Objetivo: La orbitopatía tiroidea (OT) es una patología autoinmune de etiología desconocida. Se trata de una enfermedad edematosa e inflamatoria crónica y a veces subaguda o aguda, cuyas características principales son edema palpebral, úlceras corneales, hipertensión ocular, exoftalmos generalmente bilateral, estrabismo restrictivo, diplopía y neuropatía óptica. El objetivo principal es realizar una revisión y actualización acerca del enfoque diagnóstico y terapéutico de la OT. Realizar una revisión y actualización acerca del enfoque diagnóstico, terapéuticos de la OT. Métodos: Revisión de la literatura publicada referente a la OT y manera actual de enfocar esta patología. Resultados: La OT es una enfermedad inflamatoria orbitaria con un posible origen autoinmune y que suele asociarse a trastornos metabólicos de la glándula tiroidea. Fisiopatológicamente su mecanismo no está claro. Afecta mayormente a mujeres y está negativamente influenciada por factores como el tabaquismo, la edad, el sexo y la raza. Es imprescindible clasificarla en cuanto a su severidad y su actividad para un correcto manejo. Conclusiones: El conocimiento clínico de OT es esencial para el diagnóstico precoz de la enfermedad. El tratamiento médico, en caso de OT activa, debe ser precoz, agresivo y acorde a la fase en que se presente el paciente con el fin de evitar las graves consecuencias de la OT. El tratamiento quirúrgico deberá ser lógico y ordenado, pero a su vez rápido, con el fin de devolver al paciente al entorno laboral, social y familiar.