- An 11-year-old male child presented with worsening vision in his left eye. Examination and imaging revealed a left optic nerve tumour causing mass effect and optic neuropathy, without systemic evidence of neurofibromatosis. In view of the significant risk to visual acuity, a biopsy was deferred and chemotherapy was commenced. After initial stability, continued visual decline necessitated incisional biopsy. Surgical navigation was used to facilitate minimal access surgery avoiding bone removal. The system also precluded biopsy of cystic parts of the tumour, allowing successful intraoperative frozen-section confirmation of lesional tissue.
- Orbital floor fractures most commonly occur as a consequence of trauma through either buckling or hydraulic forces acting on the orbit. Spontaneous orbital floor fractures have been described in the literature usually in the setting of thyroid eye disease (TED). We present the case of a patient with a history of a spontaneous floor fracture associated with anteriorly displaced ethmoid air cells. We propose a pneumatic mechanism of spontaneous floor fracture in patients with Haller cells.
- A 79-year-old otherwise healthy female presented to the emergency department with a 2-day history of a painful, necrotic left upper eyelid lesion. The lesion began 10 days earlier as a painless left upper eyelid “cyst” that enlarged and subsequently ruptured with purulent, foul-smelling drainage. The lesion then became crusted, necrotic, and painful. There was no history of skin cancer, weight loss, fever, night sweats, or recent illness. The patient also revealed that she had completed a short tapering course of oral systemic steroids prescribed by an outside physician after the onset of the initial lesion.