Ocular melanoma is a rare and quite deadly mutation in the eye located in the uvea or the conjunctiva, and its overall 5-year survival prognosis is around a dismal 24 months from the time of diagnosis. This report concerns a 12-year-old male presenting with secondary orbital melanoma of a previously excised conjunctival nevus. The progression of the tumor and treatment approaches are discussed, particularly in regard to the use of immunotherapy with checkpoint inhibitors such as Nivolumab. His first workup indicated a primary malignant melanoma and cervical lymph node metastasis that was suspicious and needed to be addressed via excisional biopsy and follow-up scans. While Nivolumab treated his initial symptoms of care quite effectively, subsequent treatment breaks led to complications, which necessitated a change to a mixed chemotherapy approach. Once Nivolumab was reinstituted, the patient improved significantly, which reinforces the idea that proactive management through surveillance and immunotherapy in combination can control ocular melanoma effectively.

Ecthyma gangrenosum is an uncommon cutaneous manifestation of Pseudomonas aeruginosa bacteremia, and even more rarely occurs in the periorbital region. Only a handful of prior case reports discuss lesions on the eyelid, often describing cases with rapid progression of necrosis requiring aggressive debridement. This series describes 2 cases of Pseudomonas-positive ecthyma gangrenosum on the eyelid margin in neutropenic patients, which were identified within 24 hours of lesion onset. Both cases were medically managed with rapid resolution of neutropenia and systemic anti-pseudomonal antibiotics, with no need for surgical debridement.

A 66-year-old female with a past medical history of psoriasis and chronic sinusitis presented with left orbital pain, proptosis, ptosis, and blurry vision, concerning for orbital cellulitis. Imaging revealed an enhancing soft tissue mass centered in the left anterior ethmoid cavity with extension into the nasolacrimal duct, with associated osseous erosion and orbital inflammatory changes consistent with ipsilateral orbital cellulitis. Endoscopic surgical resection was performed, and histopathology confirmed inverted papilloma without high-grade dysplasia or carcinoma. While orbital involvement has been described in prior reports, presentation with secondary infectious complications such as orbital cellulitis is rare. This case expands the limited, yet growing, body of literature on the various clinical presentations of orbital inverted papilloma.

An 80-year-old male had undergone extensive left upper eyelid reconstruction. Over the following 14.5 years, he had mild, minimally symptomatic lagophthalmos. He was then started on topical prostaglandin analogues and developed progressive eyelid retraction, lagophthalmos, and ocular exposure. The medication was discontinued, and the findings improved over the following 4 months.

A 2-year-old male presented to ophthalmology following a short admission for dacryoadenitis, with a background of 6 months of bilateral fluctuating upper lid swelling, obstructive airway disease, and enlarged tonsils. He had been treated for an allergy-related disease with little effect and, post-hospital discharge, continued in a similar fashion as prior. Given the poor response to escalating allergy medication, a biopsy was taken from the right lacrimal gland. This demonstrated an eosinophil-rich small vessel vasculitis with extravascular eosinophilic granulomas, consistent with a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss syndrome. The patient was placed on a tapering course of steroids and started on long-term mycophenolate immunosuppression. To our knowledge, this patient is the youngest case of EGPA with orbital involvement. The case and its heterogeneous presentation add to the growing knowledge of this rare condition.

Kikuchi-Fujimoto disease is a rare, benign, self-limited inflammatory disorder characterized by necrotizing lymphadenitis. Ocular manifestations are uncommon, and periocular involvement is rare. We report a 16-year-old male with a remote history of biopsy-proven Kikuchi-Fujimoto disease who presented with a 2-year history of recurrent left upper and lower eyelid lesions clinically diagnosed as chalazia. Despite multiple incision and drainage procedures, the lesions recurred and were associated with progressive eyelid thickening and mechanical ptosis. Magnetic resonance imaging demonstrated diffuse cervical, parotid, and supraclavicular lymphadenopathy with enhancement of the lacrimal glands and eyelids. Biopsy of the eyelid lesions demonstrated necrotizing lymphohistiocytic inflammation with characteristic histopathologic and immunohistochemical findings supporting extranodal Kikuchi-Fujimoto disease and excluding lymphoma, chalazia, or infection. Following incisional biopsy and intralesional corticosteroid injection, the patient demonstrated marked clinical improvement without recurrence at postoperative month 1. To our knowledge, this represents the first reported case of Kikuchi-Fujimoto disease presenting as chronic eyelid lesions mimicking chalazia and further expands the spectrum of ophthalmic manifestations associated with this uncommon disease.

Cerebrospinal fluid (CSF) leak during endonasal dacryocystorhinostomy is a rare, life-threatening, and underreported complication. We present 3 cases of 2 males and 1 female with an age range of 48 to 79 years. All cases involved patients with narrow nasal passages and were performed by early career surgeons. No intraoperative complications were noted in 2 cases, while severe epistaxis occurred in 1 case during superior osteotomy. All patients developed a headache within the first 48 hours, and cerebrospinal fluid rhinorrhea occurred in 1 case. Two patients developed bacterial meningitis and required intubation and ventilatory support, with 1 fatality. Imaging revealed pneumocephalus in all cases and a transverse venous sinus thrombosis in one. A break in the fovea ethmoidalis was identified in all cases, located posterior to the lacrimal sac. These defects were either at the vertical insertion of the middle turbinate or in association with an extended osteotomy superoposteriorly to the sac.

A 36-year-old woman at 36 weeks gestation presented with 5 months of pain on upgaze and 2 months of progressive vision loss in the right eye. Examination revealed 20/200 acuity, a relative afferent pupillary defect, proptosis, motility restriction, disc edema, and visual field loss. Noncontrast MRI showed a lobulated superolateral orbital apex mass, with differential diagnosis including an orbital vascular malformation enlarged by gestational hypervolemia versus a hormonally sensitive meningioma. Given severe vision loss and advanced gestational age, induced delivery was performed. Postpartum imaging and rapid partial visual recovery favored a vascular etiology. Because spontaneous resolution could not be reliably timed to prevent permanent damage, endoscopic transethmoidal posterior medial wall decompression was performed, restoring vision to 20/20-1 with subsequent lesion regression and normalization of examination findings by 4 months postpartum. Coordinated obstetric-ophthalmic management achieved excellent maternal and fetal outcomes.