We have presented an interesting case of an unexpected orbital tumor in a 5-month-old female healthy baby who presented initially with a 1-week history of acute left proptosis, swollen eyelid, conjunctival chemosis and exposure keratopathy. She was treated with intravenous antibiotics without any improvement and was referred for the drainage of the left orbital abscess. The procedure was performed with partial resolution, however the proptosis persisted and an underlying orbital pathologic lesion was suspected. Further exploring the left orbital revealed a partially cystic tumor. The histopathologic features were consistent with a mature teratoma. The case is presented with a brief discussion on this entity to attract the attention of general ophthalmologists to such tumors in the orbit.

Alveolar soft part sarcoma is considered as a distinct histopathological entity with rare cases reported from the orbit area. Two cases of alveolar soft part sarcomas occurring in the orbit of two patients along with their histopathologic findings are reported herewith. In both cases, the patients presented with eyelid swelling and proptosis. The diagnosis was made by incisional biopsies and histopathology. The literature is reviewed regarding occurrence of this tumor, its diagnosis and management.

Actinomycosis presents acutely as an abscess, or as a chronic lesion mimicking malignancy, tuberculosis, or aspergillosis. Most disease involves the mouth and its immediate site of lymphatic drainage, the anterior triangle of the neck. We present a case of actinomycosis at th e apex of th e posterior triangle, suspected of being a malignancy, and discuss the importance of being aware of this as a cause of neck lumps. The diagnosis is usually made late because of the difficulties in culturing the organism, or in identifying characteristic ‘sulphur granules’ in pus or biopsy specimens. For these reasons, the disease is underdiagnosed. When acute or chronic neck lesions prove difficult to diagnose, microscopy and prolonged anaerobi c culture of pus and biopsy specimens should be performed in addition to Ziehl-Neelsen staining, tuberculosis and fungal cultures. The tests should be repeated if negative. Specific treatment requires prolonged courses of antibiotics, despite adequate surgical excision, to prevent relapse.

BackgroundRadioactive iodine 131 (131I) therapy has long been used in the treatment of differentiated thyroid cancers (DTC). While salivary and lacrimal glandular complications secondary to 131I therapy are well documented, there is little in the literature addressing nasolacrimal duct obstruction (NLDO). We aimed to evaluate the frequency of 131I therapy-acquired NLDO, its correlation to 131I therapy doses, and the surgical treatment outcome of this rare side effect.MethodsFrom 2000–2012, a retrospective review of 864 among 1,192 patients with confirmed DTC who were treated with 131I therapy was performed to examine the frequency of NLDO, its causative factors, as well as imaging, surgical intervention, and outcomes.ResultsNineteen (2.2%) patients were identified with NLDO. The mean age was 51.9±10.5 years (range: 39–72 years). Fifteen (78.9%) were female and four were male (21.1%). The mean individual 131I doses were 311.1±169.3 millicurie (mCi) (range: 150–600 mCi). The mean duration between the date of 131I therapy and the occurrence of NLDO was 11.6±4.1 months (range: 6.5–20). Fourteen (73.7%) patients had bilateral epiphora. Computed tomography dacryography allowed for the detection of all NLDO. Eighteen (94.7%) patients underwent dacryocystorhinostomy. Complete recovery was obtained in 14 (73.7%) patients. Age >45 years and 131I therapy doses >150 mCi were significantly correlated with NLDO (P=0.02 and P=0.03, respectively).ConclusionNLDO is an underestimated complication of 131I therapy in DTC patients. Clinicians should be aware of this rare complication for prompt intervention.

Primary Diffuse Large B-cell Lymphoma (DLBCL) represents the 2nd most common lymphoma occurring in the orbit, after Mucosal Associated Lymphoid Tissue (MALT) lymphoma. A total of 5 cases of ocular adnexal DLBCL were diagnosed over 25 years of experience at our tertiary eye care center. Two cases involved the lacrimal sac and one case involved the lacrimal gland. In this paper we are presenting the remaining 2 non-lacrimal cases of DLBCL. The first case is a 32 year old male who was referred with a slowly growing, painless mass involving the left medial canthal area as a case of dacryocystitis. The mass was found to be extending into the orbit inferiorly with upward displacement of the left globe. The second case is a 65 year-old lady who presented with unilateral proptosis as a result of a right orbital mass extending to the orbital apex. Histopathologic examination and immunohistochemical analysis of the incisional biopsy in both cases confirmed the diagnosis of Diffuse Large B-cell Lymphoma (DLBCL).