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Orbital floor fractures are among the most common facial fractures, yet no consensus guidelines exist for their management. Multiple surgeons from surgical specialties, including oculofacial plastic surgeons (OP), plastic surgeons, oral and maxillofacial surgeons, and facial plastic surgeons, routinely treat these injuries and may exhibit distinct clinical practice patterns. An anonymous electronic survey was distributed between 2022 and 2023 to members of the American Society of Ophthalmic Plastic and Reconstructive Surgery, the American Society of Maxillofacial Surgeons, the American Association of Oral and Maxillofacial Surgeons, and the American Academy of Facial Plastic and Reconstructive Surgeons. Respondents were queried about their clinical approaches to isolated orbital floor fractures. A total of 389 surgeons completed the survey. OP were significantly more likely to delay intervention until the development of clinically significant enophthalmos (P < 0.001) and favorited longer periods of observation across multiple clinical scenarios (P < 0.05). The most used surgical approach was transconjunctival preseptal approach (53.0%), and the most frequently selected implant material was porous polyethylene-titanium (49.6%). Most respondents did not routinely use intraoperative or postoperative imaging; OP were the least likely to do so (P < 0.001). OP were also the least likely to use prophylactic antibiotics (P < 0.001). Although general agreement exists among subspecialties regarding orbital floor fracture management, OP are more likely to delay surgery, forgo imaging, and avoid antibiotics. Areas of interspecialty variation highlight the opportunities for future research and the development of evidence-based guidelines.
Anaphylactic shock is a rare but life-threatening perioperative emergency characterized by bronchospasm, hypoxia, and hypotension. A 56-year-old woman underwent elective oculofacial plastic surgery and developed anaphylactic shock shortly after exposure to tetracaine eye drops; intravenous sedation with midazolam and propofol; and a local anesthetic mixture of lidocaine, bupivacaine, and epinephrine. Initial signs included facial flushing, hypotension, and oxygen desaturation. Intubation, epinephrine, steroid, and intensive care unit transfer were required. Blood tryptase drawn 2.5 hours after the onset of symptoms was within normal range, but subsequent allergy testing revealed positive reactions to both midazolam and tetracaine. The patient fully recovered and was discharged the following day. She underwent successful surgery 6 months later under general anesthesia. This case underscores the importance of early recognition of anaphylactic shock and the necessity of procedure rooms being well equipped to intervene. Vigilance is necessary even with agents not commonly associated with anaphylactic shock.
To describe a single academic institutional experience with ophthalmic Rosai-Dorfman disease (RDD) and to review the literature incorporating the revised 2016 classification of histiocytoses. The authors review all cases of RDD at a single institution over a 10-year period, extracting those with ophthalmic findings. In addition, they provide an exhaustive review of previously published ophthalmic RDD patients and utilize the revised 2016 histiocytosis classification system to categorize both groups. Forty-eight patients with RDD were identified, of whom 12 had ophthalmic findings, with a mix of cutaneous, nodal, and extranodal forms. Twenty-one previously published case series and 105 case reports were analyzed, showing a diverse range of presentation and RDD categories. Rosai-Dorfman disease is a rare benign disorder characterized by proliferation of histiocytes, often with emperipolesis. While commonly presenting with cervical lymphadenopathy, extranodal involvement, including the orbit and ocular structures, can occur. Initially described as a pseudolymphomatous entity, RDD has recently been reclassified to reflect increased understanding of cellular origins, molecular pathology, and clinical spectrum. In this study, we utilize the new classification system to describe 12 patients with RDD and orbital/ocular involvement identified at a single institution-the largest single institution series of orbital RDD in the United States to date. We also review existing published examples of ophthalmic RDD, regrouping them to reflect the revised categorization. Diagnosis continues to be challenging, and further studies are needed to improve pre-biopsy diagnostic accuracy.
To systematically describe the morphogenesis of the lacrimal system and its associated adnexal structures along the developmental timeline, from their earliest identifiable embryonic stages through fetal maturation, and to characterize postnatal anatomical and functional changes. The authors conducted an extensive review of classical and contemporary studies of the last 200 years (1837-2025) detailing the morphogenesis of the human lacrimal excretory system-including the puncta, canaliculi, lacrimal sac, and nasolacrimal duct-across embryonic, fetal, and postnatal stages. All cited sources, irrespective of their original language, were comprehensively incorporated. Texts in German, French, and Italian underwent meticulous translation by the authors to ensure linguistic accuracy and contextual fidelity. This systematic synthesis integrates anatomical, histological, and molecular data, with particular emphasis on epithelial-mesenchymal interactions and canalization dynamics. Controversial viewpoints regarding the origin and canalization of the nasolacrimal duct and punctal structures are critically appraised. Lacrimal excretory system development proceeds through 3 morphogenetic stages. Embryonic phase (weeks 1-8): Initiated by ectodermal thickening in the nasolacrimal groove, formation of the lacrimal lamina, and cellular proliferation into the lacrimal cord. Canaliculi arise from bifurcations at the proximal (lateral) end of the cord, while the distal end differentiates into the lacrimal sac and the nasolacrimal duct. Fetal phase (week 9-term): Canalization of the lacrimal cord begins around week 10, forming a continuous lumen. Horner-Duverney muscle fibers envelop the canaliculi, and the canalicular epithelium makes contact with the palpebral conjunctiva forming an imperforate double-layered epithelial lamina occluding the presumptive puncta that typically opens just prior to birth. The distal nasolacrimal duct forms a similar continuous imperforate double epithelial lamina with the nasal epithelium at the developing inferior meatus. Functional maturation of the lacrimal pump mechanism probably starts after eyelid separation (weeks 28-30 postfertilization). Postnatal phase: Tear drainage is physiologically active at birth in most infants, but the distal ductal membrane (valve of Hasner-better term is valve of Bianchi-Zinn) may not perforate until 6-12 months later in some infants. Lacrimal gland secretory function continues to mature for several years postnatally. Development of the lacrimal excretory system is a tightly orchestrated process requiring coordinated contributions from surface ectoderm, neuroectoderm, and cranial neural crest-derived mesenchyme. The various elements of the drainage system develop sequentially along the embryologic timeline from fertilization to early childhood. A foundational understanding of lacrimal excretory system morphogenesis is useful for elucidating the embryologic basis of congenital lacrimal disorders and for advancing therapeutic strategies. Purportedly, shared molecular pathways between fetal and adult lacrimal tissues (both secretory and excretory) suggest a future potential for regenerative therapies.
A survey-based pilot study using Delphi methodology was used to reach a consensus on scope-appropriate oculoplastic procedures for a graduating ophthalmology resident. An educational task force (ETF) based at the study institution recruited stakeholders for survey participation. A stakeholder group of practicing and board-certified ophthalmologists was recruited with diversity in training background, practice location and setting, and year of ophthalmology board certification. Three rounds of Delphi surveys were distributed to the stakeholder group via online questionnaires (Qualtrics). A Cronbach's alpha test was run to evaluate the internal consistency of the Likert data. Consensus was defined as ≥80% panelist agreement, average aggregate score of ≥4 on a Likert scale (5 equating to "strongly agree"), or Cronbach's alpha value of greater than 0.8. The educational task force generated a list of 28 oculoplastic procedure skills for the Delphi rounds. Thirty-four stakeholders were recruited. The response rate for the first survey was 91.2%. Eight procedures met the >80% threshold. Six additional procedures were recommended to be added. A software error resulted in no responses recorded for 3 procedures: botulinum toxin injection for benign essential blepharospasm, botulinum toxin injection for hemifacial spasm, and direct browplasty; thus, these procedures were not advanced to the next survey. The response rate for the second survey was 82.3%. Eight procedures met the ≥4 average Likert score threshold. The Cronbach's alpha was 0.90 for the second survey. The response rate for the third survey was 82.3%, and a final list of 13 oculoplastic procedures was generated. A list of 13 scope-appropriate oculoplastic procedural skills necessary and appropriate for a graduate of an ophthalmology residency was generated by Delphi consensus. This list is the sole work of the study institution and does not reflect the views of official organizations such as the American Academy of Ophthalmology, American Board of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgeons, or the Association of University Professors of Ophthalmology. This list requires further refinement and should not be used in isolation without further validation; however, it may aid in curricular development and be utilized to generate oculoplastic-specific competencies for ophthalmology residents.
To review and assess published imaging evidence for optic nerve stretch (ONS) in patients with dysthyroid optic neuropathy (DON), evaluating its prevalence, measurement methods, and potential association with disease pathophysiology. PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov were searched using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, for computerized tomographic or magnetic resonance imaging studies of ONS in thyroid eye disease. Data were extracted on imaging modality, ONS definition, and association with DON. Pooled proportions were calculated using random-effects models with logit transformation, and heterogeneity assessed with I2. Sixteen studies, comprising 1,277 orbits (508 DON and 769 non-DON), met the inclusion criteria. Five noncomparative studies, mostly earlier papers, report ONS in 43% (0%-100%) of 75 DON orbits. Eleven studies (1,202 orbits) compared orbits with and without DON: 6 studies examined optic nerve contour (317 DON and 435 non-DON) and reported ONS in 66% of DON and 37% of non-DON orbits. Only 2 studies reported ONS as being significantly associated with DON (74% and 64% of orbits), and both reported marked apical crowding (70% and 67%). The pooled ONS proportion was 56% (95% confidence interval: 37%-74%) in orbits with DON and 31% (95% confidence interval: 12%-59%) in non-DON orbits, with high heterogeneity (I2 > 80%). While optic-nerve stretch is frequently observed in DON, current evidence does not establish it as an independent cause. ONS may reflect geometric changes due to orbital soft-tissue expansion, and the principal mechanism for DON probably remains apical compression and microvascular ischemia of the optic nerve.
Postoperative nausea and vomiting remain significant concerns in surgical care, impacting patient recovery, satisfaction, and healthcare costs. This study evaluates the efficacy of 40 mg oral aprepitant in reducing postoperative nausea and vomiting incidence and severity compared with placebo. A randomized, double-blind study was conducted on patients undergoing oculoplastic procedures. Patients were assigned to receive either 40 mg oral aprepitant or placebo preoperatively. Postoperative nausea and vomiting severity was assessed postoperatively using the modified Baxter Nausea Scale, with additional data collected on rescue antiemetic and opioid use. Statistical analysis, including Fisher exact test and 95% confidence intervals, was performed using Microsoft Excel. Patients in the aprepitant group reported significantly lower nausea severity scores and a reduced incidence of vomiting compared with the placebo group. Additionally, patients receiving aprepitant required fewer postoperative doses of ondansetron and opioids. The safety profile of aprepitant was consistent with previous studies, with no significant adverse effects reported. Aprepitant demonstrated efficacy in reducing postoperative nausea and vomiting and decreasing reliance on rescue antiemetics and opioids. These findings support its potential integration into standard prophylactic regimens for postoperative nausea and vomiting prevention in oculoplastic surgery.
The purpose of this study was to evaluate reimbursement trends for the surgical management of chalazion for the years 2000 to 2023 based on Centers for Medicare & Medicaid Services values. Reimbursement rates for eyelid abscess blepharotomy and chalazion incision and drainage (Current Procedural Terminology codes 67700 and 67800) were queried from the Physician Fee Schedule Look-Up Tool for the years 2000 to 2023. The average reimbursement, the percent change, and the compound annual growth rate were calculated after adjusting for inflation using the consumer price index. Results were compared with reported reimbursement for other ophthalmic and general procedures. Reimbursement for facility and nonfacility fees for Current Procedural Terminology code 67700 was $130.84 and $328.41, respectively, in 2023. This corresponded to 9.23% and 11.76% percent changes in facility and nonfacility fees since 2000, adjusted for inflation. Reimbursement for facility and nonfacility fees for Current Procedural Terminology code 67800 was $104.87 and $133.95 in 2023. This corresponded to-20.48% and -57.95% percent changes since 2000, adjusted for inflation. The adjusted compound annual growth rates for code 67700 facility and nonfacility fees were 0.38% and 0.48%. The adjusted compound annual growth rates for code 67800 facility and nonfacility fees were -3.60% and -3.70%. While both procedure codes have decreased reimbursement over the last decade, code 67700 reimbursement has demonstrated growth above inflation from 2000 to 2023. This observed decrease in reimbursement can be attributed to Medicare budget policy changes in 2013, emphasizing the importance of Medicare reduction limits on the financial stability of certain procedures.
To evaluate the performance of deep learning models using optical coherence tomography (OCT) volumes, clinical photographs, and their multimodal fusion to classify eyelid lesions as benign or malignant, using histopathology as the reference standard. Prospective cohort study conducted between January 2023 and January 2025 at a single tertiary academic oculofacial plastic surgery center. A total of 65 patients with 71 periocular lesions undergoing routine biopsy were imaged with spectral-domain OCT and slit-lamp photography before biopsy. Images were processed into 3 Vision Transformer architectures: an OCT model, a photograph model, and a multimodal fusion model integrating both modalities. Classification performance for benign versus malignant lesions was evaluated with 5-fold cross-validation. Performance metrics included sensitivity, specificity, accuracy, kappa, and area under the receiver operating characteristic curve. Of 71 lesions, 52% were benign and 48% malignant. The OCT model achieved 73.9% accuracy, 74.4% sensitivity, and an area under the receiver operating characteristic curve of 82.5%. The photograph model reached 82.3% accuracy, 89.6% sensitivity, and an area under the receiver operating characteristic curve of 91.7%. The multimodal fusion model performed best, with 83.2% accuracy, 91.8% sensitivity, 81.1% precision, kappa of 0.68, and an area under the receiver operating characteristic curve of 92.1%. This study demonstrates the feasibility of analyzing OCT volumes using deep learning, with diagnostic accuracy improved through multimodal integration with clinical photography. These results suggest that multimodal artificial intelligence may serve as a scalable, noninvasive, and physician-independent tool to distinguish benign from malignant periocular lesions and streamline patient triage. As models evolve to identify histopathologic features more reliably, they may also reduce dependence on incisional biopsy prior to definitive treatment.
To describe a new diagnostic clinical feature-the "needle head sign" along with histopathology, immunohistochemistry, and electron microscopy of the medial canthal tendon in patients with Centurion syndrome (CS). Retrospective review of all cases diagnosed with CS and having external and closed eye photographs in their electronic medical records. Patients with missing or inappropriate photographs or those who had prior surgical interventions were excluded from the analysis. Data collected included demographics, history, presenting complaints, external and ocular examination, lacrimal examination, including the tear meniscus height, fluorescein dye disappearance test, and lacrimal irrigation. Photographs were reviewed for all signs of CS, along with the additionally described "needle head sign" for diagnosis of CS. Medial canthal tendons from patients with CS who underwent surgical intervention and normal tendon from a patient undergoing dacryocystectomy were obtained for histopathological analysis. 28 eyes of 14 patients with complete documentation were included for the analysis. Males (n=13, 92.86%) were more affected and the average age at presentation was 17 years (range= 5-32 years). Epiphora was the universal symptom and was present for an average duration of 43.06 months. Anterior placement of the medial canthal tendon and beak sign were universal (100%), followed by prominent nasal bridge in 92.86% (26 eyes), punctal dystopia in 82.14% (23 eyes) synophrys in 7.14% (2 eyes), epicanthal fold in 7.14% (2 eyes), ptosis in 3.57% (1 eye), lagophthalmos in 7.14% (2 eyes), and punctal agenesis in 1 eye of 1 patient (3.57%). The "needle head sign" was seen in 21 eyes of 14 patients (75%), bilateral in 64.28% (9 patients), unilateral in 21.43% (3 patients) and absent in 7 eyes of 5 patients (25%). The fluorescein dye disappearance test performed showed delay of >5 minutes in 21 eyes of 11 patients (95.45%). Tear meniscus height was raised in 25 eyes of 14 patients (89.29%). Irrigation was patent in all eyes. Histopathology and electron microscopy showed morphological changes in the tendons. The "needle head sign" is an additional sign that can be of adjunct value in the diagnosis of CS. The medial canthal tendons of CS demonstrate certain histopathological and ultrastructural changes, which need further evaluation.
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Periorbital measurements such as margin to reflex distances, palpebral fissure height, and scleral show are critical in diagnosing and managing conditions like ptosis and disorders of the eyelid. However, deployment of automated periorbital measurement algorithms in structured research workflows remains limited by the lack of integrated capture and data management infrastructure. We developed and evaluated Glorbit, a lightweight, browser-based application for automated periorbital distance measurement using artificial intelligence (AI). The objective was to evaluate end-to-end workflow feasibility of the platform under simulated, operator-run conditions. The application integrates a DeepLabV3 segmentation model into a modular image processing pipeline with secure, site-specific Google Cloud storage, supporting local preprocessing and cloud upload through Firebase-authenticated logins. The full workflow-metadata entry, facial image capture, segmentation, and upload-was tested. After the session, the participants completed a Likert-style survey. Glorbit successfully ran on all tested platforms, including laptops, tablets, and mobile phones across major browsers. A total of 15 volunteers were enrolled in this study in which the app completed predefined workflow steps in all simulated, operator-run sessions. The segmentation model produced outputs on all images, and the average session duration was 101.7 (SD 17.5) seconds. Simulated experience scores on a 5-point Likert scale were uniformly high. Glorbit is a cross-platform application that supports structured periorbital image capture and automated inference within a unified workflow. In simulated, operator-run testing, the platform demonstrated successful execution of predefined workflow steps across devices. These findings support the technical feasibility of the system as a research-oriented data collection framework and may inform future evaluations in broader research settings.
Orbital nocardiosis is an uncommon pyogranulomatous infection rarely reported in immunocompetent individuals. Trauma is a major predisposing factor. We describe three cases of orbital nocardiosis highlighting the clinical features, microbiological profile, and histopathological characteristics. This retrospective case series included patients with histopathological and microbiological confirmed orbital nocardiosis diagnosed between January 2016 and December 2025 across the L V Prasad Eye Institute network in India. Cases were identified through electronic medical records, and data on demographics, clinical features, imaging, and treatment were collected. Three immunocompetent patients (2 males, 1 female; age 34-58 years) presented with chronic orbital inflammation following remote trauma. Clinical findings included preseptal abscesses, diffuse orbital masses, discharging sinuses, bony erosions, and intracranial extension (in one case). Imaging showed ill-defined soft tissue lesions involving the lacrimal gland, paranasal sinuses, or orbital roof. Nocardia nova was confirmed by sequencing in one patient, and two patients had co-infection with Staphylococcus aureus. Treatment included surgical debridement, intravenous amikacin, and oral trimethoprim - sulfamethoxazole. Two patients achieved complete resolution, and one patient was lost to follow up. Orbital nocardiosis can occur in immunocompetent patients, particularly after trauma. Early suspicion, tissue diagnosis, and prolonged antimicrobial therapy are essential to improve outcomes.
We report a unique case of a 32-year-old woman with a 4-day history of painful right lacrimal gland swelling. MRI demonstrated enhancement and enlargement of the right lacrimal gland. There were nonenhancing, intraglandular foci, with low signal on T2-weighted sequences and marked restricted diffusion. Surgical excision revealed multiple dacryoliths centered on an impacted eyelash. Microbiological evaluation yielded Streptococcus pneumoniae and histopathology confirmed noncalcified ductal dacryoliths with a background of acute inflammation. At 1-month follow-up, symptoms completely resolved with no evidence of recurrence. Lacrimal gland dacryolithiasis is rare and usually presents as refractory conjunctivitis or a chronic lateral conjunctival or canthal mass, rather than acute dacryoadenitis. This case expands the clinicoradiological spectrum of this rare entity and highlights novel MRI patterns that may aid preoperative diagnosis and timely management.
To describe a novel technique of tragal cartilage contouring during facelift surgery and evaluate its effectiveness in preserving tragal contour and preventing postoperative tragal deformities. A retrospective chart review was performed of patients who underwent rhytidectomy with tragal cartilage contouring between January 2022 and December 2023 by a single surgeon. Following flap elevation and repositioning, the cephalic tragal rim was trimmed, vertically scored, then contoured with a horizontal mattress suture to support a convex surface postoperatively. Overlying soft tissue was anchored to the superficial musculoaponeurotic system to reduce tension. Standardized pre- and postoperative photographs were evaluated by 3 independent, blinded, oculoplastic surgeons using a 4-point Likert scale to assess tragal contour, peritragal contour, scar visibility, and overall aesthetic result. Patients also provided subjective ratings of their aesthetic outcome. Twenty-eight patients (24 women, 4 men; mean age 62 years, range 51-74) were included, with a mean follow-up of 8 months (range, 4-12). Independent reviewers rated all tragal contour outcomes as "good" or "excellent," with no cases rated "fair" or "poor." All patients rated their aesthetic outcome as "excellent." No complications or secondary interventions occurred. Tragal cartilage contouring is an effective technique that can be performed during rhytidectomy. By addressing cartilage shape and tension distribution, this method preserves tragal contour and prevents common postoperative deformities, supporting consistently favorable aesthetic results.
To develop a consensus-based photographic atlas tailored to East Asian patients to improve the consistency and clinical applicability of the Clinical Activity Score (CAS) in thyroid eye disease (TED), while maintaining compatibility with the established CAS framework. Under the auspices of the Korean Society of Ophthalmic Plastic and Reconstructive Surgery (KSOPRS), an expert Atlas Committee comprising eight TED specialists curated representative clinical photographs corresponding to the five sign-based CAS items: eyelid swelling, eyelid erythema, conjunctival redness, conjunctival swelling, and inflammation of the caruncle or plica. Images were categorized as CAS-positive or CAS-negative following multiple rounds of expert review and discussion. The finalized atlas was circulated to all KSOPRS members for consensus approval. The atlas provides standardized photographic panels and concise operational guidance for each sign-based CAS item. East Asian-specific considerations, including thicker eyelid skin, fuller preseptal and septal fat, and epicanthal folds, are incorporated to refine interpretation of inflammatory signs that may appear attenuated compared with photographic references derived from white populations of European ancestry. The atlas emphasizes pattern recognition, distribution of findings, and side-to-side comparison rather than absolute intensity of erythema or swelling, aiming to reduce false-negative judgments and improve inter-observer consistency. This ethno-specific standard photographic atlas enables endocrinologists and ophthalmologists to perform rapid and reproducible assessments in outpatient settings, facilitating the early identification of patients requiring referral or urgent treatment.
To investigate whether cataract surgery is a risk factor for developing new-onset thyroid eye disease in patients with preexisting thyroid disorders using a large, population-level database. The study utilized a large database of deidentified electronic health records. Patients who underwent cataract extraction were divided into 2 cohorts and were balanced using propensity score matching for demographic factors and comorbidities, including age, sex, race, diabetes mellitus, hyperlipidemia, and nicotine dependence. The incidence of thyroid eye disease-related outcomes was assessed at 3-time intervals following the surgery date: up to 3 months, 3-6 months, and 6-12 months. The need for orbital decompression surgery was also assessed. A secondary sensitivity analysis was conducted for patients with hyperthyroidism. After propensity score matching, 87,179 pairs were analyzed. Patients with thyroid disease had a significantly higher risk for the composite thyroid eye disease outcome at all time intervals: 0-3 months (risk ratio [RR]: 1.30, 95% confidence interval [CI]: 1.12-1.51), 3-6 months (RR: 1.30, 95% CI: 1.12-1.51), and 6-12 months (RR: 1.51, 95% CI: 1.33-1.71). The risk was even more pronounced in the hyperthyroid subgroup (n = 8,381), reaching a 103% increased risk at 6-12 months (RR: 2.03, 95% CI: 1.39-2.95). While no significant difference was observed for orbital decompression surgery in the immediate postoperative period, a significantly increased risk emerged at the 6-12-month interval (RR: 1.59, 95% CI: 1.13-2.24). Cataract surgery is associated with a significantly increased risk of developing thyroid eye disease-related outcomes in patients with underlying thyroid disease. While the overall incidence may be low, the potential consequences can be serious, highlighting the importance of clinical awareness, patient counseling, and close postoperative monitoring for this at-risk population.
Acute corneal injuries vary greatly in morbidity, but can cause severe cases of vision loss. Among these injuries are mechanical corneal traumas and acute chemical burns. The current standard of care in the acute phase of management is aimed at reducing the offending agent, pain management, and infection prevention; however, corneal scarring and limbal stem cell deficiency may result even after the acute management of severe corneal injuries. In the most serious cases, surgical intervention, including cornea or stem cell transplantation, may be required to restore functional vision. As such, there is a great need for additional therapies in the acute phase of management that can help to reduce long-term, vision-reducing outcomes. Certain endogenous agents have emerged as a therapeutic class that may be used for the promotion of corneal wound healing with the goal of reducing the odds of requiring invasive surgery. In this review, we provide an overview of novel endogenous therapeutic agents for the treatment of acute corneal trauma and acute chemical burns. The endogenous therapeutic agents explored include amnion, exosomes, stem cells, platelet-rich plasma, peptides, growth factors, and umbilical cord serum. The results of these studies indicate encouraging potential for endogenous agents to facilitate corneal recovery and vision preservation. However, because many of these agents are in the early stages of development and clinical trials, further research is required to understand their efficacy in the clinical setting.
Castleman disease constitutes a rare spectrum of conditions with rheumatologic, hematologic, and oncologic features. Orbital involvement is extremely rare with only several cases involving the lacrimal gland. This report describes Castleman disease in a 15-year-old patient who presented with progressive left eye bulging and intermittent periorbital pain. Neuroimaging demonstrated a well-defined, enhancing, homogeneous left lacrimal gland mass with decreased diffusivity, smooth bone remodeling, and anteromedial globe displacement, and no other systemic findings. The lesion was excised in toto and histopathology revealed features of hyaline vascular-type Castleman disease. This is the first reported case of Castleman disease in a pediatric patient with an isolated lacrimal gland lesion. It emphasizes the importance of considering Castleman disease among other lymphoproliferative diseases in the differential diagnosis for patients presenting with a well-circumscribed, homogeneous orbital mass associated with decreased diffusivity and bone remodeling.