dr. bahram eshraghi

To focus on clinical manifestations and epidemiology of thyroid eye disease (TED) in Central Iran’s population.

In this retrospective case study, we analyzed all patients with TED who were referred to our oculoplastic clinic from 2015 to 2019. The patients’ epidemiological characteristics and clinical presentation were compared between different thyroid disease groups and genders.

Overall, 383 patients(155male; 40.5% and 228 female; 59.5%) were included. The mean age was 39.55 years(standard deviation ± 13.45, range 10–72). Most patients (89%) were hyperthyroid with the highest duration of ocular involvement among all categories (25.6 months). The most common signs on ophthalmic examinations were proptosis (80.4%), followed by eyelid retraction (72.3.0%). TED was classified as mild in 24.5%, moderate to severe in 67.6%, and sight‑threatening in 7.9%. Thirty patients (7.8%) had active TED.

This series with a relatively more significant number of TED cases in Central Iran found similar epidemiological and clinical characteristics of TED compared to other studies from Iran. Most of our patients were hyperthyroid, with more females compared to males. Proptosis and eyelid retraction were the most common manifestations. Most TED patients were classified as moderate to severe.

To report three cases of Horner syndrome associated with penetrating neck injuries and the result of surgery for correcting the resulting ptosis. This is a retrospective case series study of 3 patients with Horner syndrome with past history of penetrating trauma to the neck. The patients’ history and the surgical results are presented. Muller’s muscle conjunctival resection was successfully used to treat ptosis in traumatic Horner syndrome in two cases. In the clinical setting of acute traumatic injury to the neck, careful evaluation for signs and symptoms of Horner syndrome should be performed. Horner syndrome and associated ptosis can be effectively managed using Muller’s muscle conjunctival resection.

To evaluate the role of monocanalicular intubation (MCI) in congenital nasolacrimal duct obstruction (CNLDO) in children older than 5 years of age.

A retrospective case series study was done on children over 5 years of age diagnosed with CNLDO who underwent MCI. Success rates were evaluated subjectively by asking their parents about persistent symptoms and objectively using the dye disappearance test in clinical examination.

A total of 43 eyes of 37 patients with a mean age of 7.42 ± 2.33 (range, 5–15 years of age) were included. The success rate was 60.46%, and the rate of secondary surgical intervention was 25% of all cases (61.11% of failed cases).

Primary MCI maintains a reasonable success rate in incomplete complicated CNLDO regardless of age.

To evaluate the clinical characteristics, histopathology, and treatment outcomes in adult and pediatric patients with nonspecific orbital inflammation (NSOI).

This retrospective study evaluates 76 patients with NSOI. The patients were categorized in 9 groups according to the site of involvement and histopathology results. These groups included: anterior involvement, dacryoadenitis, myositis, perineural involvement, acute fat involvement, focal mass, orbital apex involvement, diffuse sclerosing form, and multiple tissue involvement. The course of the disease was categorized as acute, subacute, or chronic. The cases with symptom duration of less than 1 week were classified as acute, 1 week to 1 month as subacute, and more than 1 month as chronic.

36 (47.4%) patients were males. The mean age was 41.68 ± 17.62 (6e75) years. The most common signs and symptoms were periorbital pain, periorbital edema, decreased ocular movements or diplopia, and conjunctival injection. The most common group was dacryoadenitis in 29 (38.1%) cases. The most common form of disease was the acute involvement (50% of patients). Most of the patients were treated by oral corticosteroids. Duration of follow-up was 7.17 ± 6.26 months. Recurrence occurred in 9 (11.8%) of patients during the follow-up period.

This study presents a new categorization in which multiple tissue involvements were separated. Some of the NSOI features differ between adults and children. In most patients, treatment especially with corticosteroids, resolves the clinical findings.

The present was conducted to measure the sensitivity and specificity of imprint cytology (IC) and frozen section (FS) in the evaluation of margin involvement of periocular basal cell carcinoma (BCC).

This cross-sectional study was conducted on 36 patients who underwent an excisional biopsy of periocular BCC. The surgical margins of each excised mass were tested for involvement by tumoral cells using three pathologic methods as follows. Samples were obtained for IC from the marginal territory of the tumor. Then, FS samples were obtained and the tissue was prepared for permanent histopathologic evaluation, the results of which were considered as the gold standard to compare two other methods. Sensitivity, specificity, positive predictive value, and negative predictive value of each method were calculated accordingly.

Thirty-six patients (20 males and 16 females) with the mean age of 73±12 years who had periocular BCC were enrolled and a total of 121 samples were obtained from the margins. The sensitivity and specificity of FS were 94.3 and 97.7% and of IC were 51.4 and 84.9%, respectively. Also, Positive and negative predictive value for FS were 94.3 and 97.7 and for IC were 58.1 and 81.1%, respectively.

Although less expensive and more feasible than FS, IC lacks diagnostic accuracy for demarcating the extent of resection of eyelid BCC.

In this report we present a case of severe facial injury due to a donkey bite. Immediate repair with surgical flaps was performed. No significant complication was observed at the time of surgery or during follow up and the result was acceptable. Animal bites are relatively frequent and most often are done by dogs. Besides dogs, other animals such as cats, horses and donkeys may be responsible for this type of injuries. Although donkey bites to the facial area are very rare, they can cause severe and life-threatening injuries. Early management of facial injuries caused by animal bites is acceptable nowadays and guarantees satisfactory outcome.

PurposeTo present the clinical, histological, and radiographic findings of a case of orbital myofibroma in an unusual location. The literature is reviewed and the clinical relevance discussed.
MethodsA 5-year-old boy was examined with a 1.5-month history of progressive swelling in the left supraorbital region.
ResultsExamination revealed a firm, painless mass in the supralateral region of the left orbit with slight reddish discoloration of the overlying skin. Computerized tomography (CT) scan images showed a well demarcated, homogenous, solid mass with extension to the lacrimal gland region and adjacent to frontal bone erosion. The mass was surgically excised and was confirmed to be myofibroma in diagnostic histological studies. There has been no evidence of recurrence in the first year after surgery.
ConclusionsClinical appearance and imaging findings are unspecific for this tumor, and histological examination still remains the definite method of diagnosis. Therefore, it is important to be able to differentiate myofibromas from other malignant tumors with a similar presentation in pediatric patients to avoid mismanagement.

To describe a case of trichoblsatoma on the eyelid.
Case Report: A 45‑year‑old woman presented with a recurring mass on her upper right eyelid. Histopathological examination revealed well‑circumscribed tissue composed of an aggregation of basaloid cells. Immunohistochemistry showed positive staining for CD34 and CD10. The patient underwent total excision of the recurrent mass.
Although rare, trichoblastoma should be considered in differential diagnosis of skin masses of the eyelids.

To evaluate the predictive factors for development of diplopia and extraocular muscle movement (EOM) limitations in the patients with isolated pure blow-out fracture.
One hundred thirty-two patients with isolated pure blow-out fracture were included. The diagnosis was done with computed tomography scan. Possible predictive factors were analyzed with logistic regression. The cases that underwent surgery were assigned in the surgical group, and other cases were assigned in the non-surgical group. Receiver operating characteristic (ROC) curve analysis was used in the surgical group to evaluate the power of time interval from trauma to the surgery to predict persistence of 6 months postoperative diplopia and EOM limitation.
At the first visit, 45 of 60 cases (75%) in the surgical group and 15 of 72 cases 20.8%) in the nonsurgical group had diplopia. After 6 months follow-up, 7 cases (11.7%) in the surgical group and 1 case (1.4%) in the nonsurgical group had persistent diplopia. Type of fracture was significantly associated with first visit diplopia (P ¼ 0.01) and EOM limitations (P ¼ 0.06). In the surgical group, type of fracture (P ¼ 0.02 for both) and time interval from trauma to the surgery (P ¼ 0.006 and 0.004, respectively) were significantly associated with 1 month diplopia and EOM limitations. Only time interval from trauma to the surgery (P ¼ 0.04) was significantly associated with 3 months EOM limitation. In the ROC curve analysis, if the surgery was done before 4.5 (sensitivity ¼ 87.5% and specificity ¼ 61.3%) and 7.5 (sensitivity ¼ 87.5% and specificity ¼ 66.9%) days, risk of 6 months postoperative diplopia and EOM limitation was reduced, respectively.
In the early postoperative period, a higher rate of diplopia was observed in the patients with combined inferior and medial wall fractures and longer time intervals from trauma to the surgery. The best time for blow out fracture surgery was within 4.5 days after the trauma.

To evaluate the results of conjunctival culture in fellow eyes of patients with unilateral nasolacrimal duct obstruction (NLDO) and its changes after successful dacryocystorhinostomy (DCR) surgery.
In this prospective study, 71 adult patients with unilateral NLDO and 41 age and sex-matched controls without NLDO were evaluated. The patients were divided into 2 groups based on clinical examination; group A with purulent regurgitation and group B without purulent regurgitation. They all underwent DCR. Before DCR surgery, microbiologic specimens were taken bilaterally from the conjunctiva of both eyes. Postoperative conjunctival sampling was continued weekly until the culture became negative or the colony count reached to the range of the control group.
There were 38 and 33 patients in groups A and B, respectively. Silicone tube was inserted for 17 patients (23.9%). The culture was positive for bacterial growth in 56 fellow eyes (79%). The conjunctival culture in the control group was positive in 17 eyes (41.4%). The mean count of colonies in a sample unit was 624.73 ± 2412.31, 195.75 ± 407.56, and 9.5 ± 1.5 for group A, group B, and controls, respectively. The mean time of normalization of specimens was 1.43 ± 0.69 weeks (range 1e4). Higher colony count at baseline and presence of silicone tube in infected eye were significantly associated with longer normalization time for fellow eye (P This study suggests that after successful DCR surgery, a waiting period of 4 weeks is needed for conjunctival bacterial cultures to become negative or reach the level of the normal eyes, in the fellow eyes of patients with unilateral NLDO.

To describe a patient with Schwartz Jampel vel Aberfeld syndrome (SJS) who underwent orbicularis oculi myectomy as a treatment for blepharospasm.
Case Report: A 4‑year‑old child with SJS did not respond to an injection of a single dose of botulinumtoxin after one month, so orbicularis myectomy was then performed under general anesthesia. During the procedure, orbicularis vermiform movements were a useful guide for the extent of myectomy that the patient needed. He responded very well to this procedure and experienced significant relief of blepharospasm documented in follow‑up visits for up to 6 months.
Blepharospasm in patients with SJS can be treated with orbicularis oculi myectomy as a good functional method with faster and durable response in comparison to botulinum toxin injection.

We describe a case of transient visual loss following cataract surgery with unpreserved intracameral lidocaine.
A 50-year-old man with posterior polar cataract underwent phacoemulsification. Following capsulorhexis and hydrodelineation with 0.5 cc of unpreserved lidocaine 1%, a portion of fluid reached behind the crystalline lens and caused the posterior capsule rupture. Cataract extraction and anterior vitrectomy were performed. Anesthetic administration was repeated to relieve the discomfort felt by the patient. A threepiece hydrophobic acrylic intraocular lens was implanted in the ciliary sulcus.
On the first postoperative morning, the patient's vision was recorded as having no light perception. The relative afferent pupillary defect (RAPD) was found to be 4þ. The retina and optic nerve head appeared normal. In the afternoon, the visual acuity (VA) was improved to 3-m count-finger. On the second postoperative morning, the patient's VA was improved to 4/10. On the third postoperative day, his VA returned to normal at 20/20 without RAPD.
In the event of posterior capsular rupture, to reduce retinal toxicity risks, intracameral lidocaine should not be repeated.

To determine the prevalence of intraocular injuries in patients with blow-out fracture and also to evaluate the etiologic mechanism of orbital blow-out fractures This study is a consecutive case series analysis of 116 patients with orbital blow-out fractures. The patients were visited by an ophthalmologist within 24 hours of trauma. Ninety-one men and twenty-five women with mean age of 29.1±13.9 years were included for this study. Fist trauma and assault (54%) was the most common cause of orbital blow-out fractures. Inferior wall was involved more commonly (49%) than medial wall and combined form. Significant enophthalmos (>2 mm) was present in 26 cases. Orbital reconstruction surgery was performed in 34% of cases. Intraocular injuries were detected in 25% of patients. Hyphema (65%) and commotio retina (39%) were the most frequent detectable intraocular injuries. Intraocular damages were significantly less common in patients with large fractures (synchronous medial and inferior wall fractures or fracture size equal or more than 1/2 of orbital wall) in contrast to small size fractures (p=0.02). Ocular injuries are relatively common in blow out fractures and ophthalmic examination is mandatory. In our study ocular injuries were less frequent in large fractures than small size fractures that may indicate protective role of orbital integrity or other factors caused by fractures.

The nasal septal deviation (NSD) is one of the major causes of nasal obstruction. This condition increases upper airway resistance. In This study we evaluated the mean pulmonary artery pressure (MPAP) in patients with markedly deviated septum. Sixty two patients with NSD (Age range: 26-45 years, 34 men and 28 women) were included in the study. Mean pulmonary artery pressure was measured in preoperative period by Doppler echocardiography with the assistance of an expert cardiologist. The mean preoperative MPAP value (22.5 mmHg in men and 20.03 mmHg in women) of the patients in this study was higher than normal population (20 mmHg). The MPAP of nine patients (14.5%) was greater than 25 mmHg. This value was significantly higher than values for normal population. Markedly deviated septum had improper effects in cardiovascular system due to increase in MPAP.

To review periocular dermoid cysts to determine distribution of demographic factors, and tumor location In this retrospective, observational case series in a tertiary-care hospital, we reviewed all cases of histopathologically verified periocular dermoid cysts at our institution between 2003 and 2011. The study endpoints included: age, gender, and tumor location. Two hundred and thirty-nine patients entered the study; whose mean age at the time of surgery was 11.8 years (range 6 months-48 years, 54% male). The frequencies of dermoid cysts in supranasal and supratemporal locations were fairly equal (46% and 49.4% respectively). In contrast to previous reports, we reported fairly equal frequency of supranasal and supratemporal locations in an Iranian group of patients.

To report a patient with orbital tuberculosis (TB) without any history of systemic involvement Case report: A 41-year-old Afghani man who presented with progressive painless swelling in lateral side of the left upper eyelid and diplopia. He did not have history of fever or pulmonary disease. Histopathology revealed a granulomatous inflammation with caseation necrosis. Microbiological studies for finding Acid-fast bacilli and Polymerase chain reaction (PCR) results were negative. The patient completely responded to a course of anti-tuberculous treatment. Although tuberculous dacryoadenitis is a very rare manifestation of TB, it is still important to recognize this presentation, specially when patient originating from endemic area.

To report a rare case of isolated orbital mucocele after trauma Case report: A 45-year-old man presented with swelling in the left orbital region. The only significant event in his medical history was trauma which occurred 25 years previously during the Iran-Iraq war. Computed tomography revealed a left medial intraorbital cystic mass lesion. The cystic mass was completely removed through the transcaruncular approach. The cystic mass was isolated in the orbital cavity. Histological examination confirmed the diagnosis of mucocele. Generally, mucocele is within the sinus cavities or its origin is from sinus cavity, but in the present case, the old trauma was the most likely cause of the mucocele that had caused sinus epithelium take access to the orbital cavity and grow there.

To report a patient with orbital pseudotumor masquerading as orbital cellulitis Case report: A 42-year-old woman was referred to orbit and oculoplastic clinic with 6 days history of left orbital pain, proptosis, lid edema and fever. Clinical finding included severe lid edema, chemosis, conjunctival injection and severe restriction in extraocular motility. She was diagnosed as orbital cellulitis and hospitalized for treatment with intravenous antibiotics. Because of no improvement, on the fifth day after admission, systemic corticosteroid, was prescribed. Diagnosis of orbital pseudotumor was made after significant response to systemic corticosteroids. Antibiotics were discontinued and systemic corticosteroid was tapered slowly during the 4 months. Orbital pseudotumor is an ophthalmologic condition that may mimic a variety of pathologic processes. Despite complete physical examination and appropriate imaging, sometimes correct diagnosis of the disease would be difficult.

To report an unusual case of dermoid cyst of the frontal bone Case report : We report a case of 28-year-old man with a history of painless progressive proptosis of the left eye. CT-Scan was showed a hypodense lesion that mainly located within the frontal bone with only a small intraorbital involvement. Excisional biopsy was performed and histopathologic examination was compatible with dermoid cyst. Dermoid cysts are the most common orbital cystic lesions in childhood which commonly present as a painless palpable mass in the superotemporal aspect of the orbit. Typically, orbital dermoids involved the orbital cavity and may compress the nearby structures or erode the orbital walls. Here we report an unusual case of dermoid cyst that mainly involved a bony orbital wall with only a small intraorbital extension. Appropriate diagnosis of unusual cases of dermoid cysts can lead to proper therapeutic approaches and prevention of complications.

report a case of total blindness a few hours after orbital blowout fracture repair; the visual acuity (VA) returned to normal after immediate reoperation.Case report: A 21-year-old man with obvious enophthalmos in the left side, 2 weeks after car accident, was candidate for orbital floor reconstruction surgery. Anterior orbitotomy from subcilliary incision was done and at the end of the surgery, titanium medpore inserted in orbital floor. Three hours after surgery patient complained of severe pain and a significant proptosis was noticed. VA was no light perception (NLP) and relative afferent pupillary defect (RAPD) was positive. The patient reoperated and medpore plate was removed. There was significant blood in orbital cavity that was totally removed. Three hours after reoperation proptosis disappeared and VA improved to 3M count finger. One week after the surgery the VA was raised to 20/20. Acute severe pain in the early postoperative period, may be a sign of the orbital hemorrhage. Awareness of the potential severity of this complication and execution of appropriate treatment with minimal delay, may result in rapid and complete visual recovery.

To report an association of ligneous conjunctivitis (LC) and congenital hydrocephalus Case report : The patient was a 3.5-year-old boy with a history of long standing conjunctivitis with copious ocular discharge and photophobia, waxing and waning for some time. He also had suffered from occlusive congenital hydrocephalus that required placement of a ventriculoperitoneal shunt. Conjunctivitis did not respond to topical medications and recurred after several excisions. Finally an intralesional methylprednisolone injection was performed. Significant resolution of the lesions was observed after one week and after one year, LC was relatively controlled and there was no need for more excisions. In patients with recurrent recalcitrant pseudomembrane, this treatment shortens the treatment period, evokes rapid visual rehabilitation and obviates the need for the future excisions. Also, this report reemphasizes the association of LC and congenital hydrocephalus, which maybe ignored.