Background/objectives To report the spectrum of fungal infections involving the orbit encountered in an Australian subtropical population with respect to presentation, host risk factors, involved pathogens, treatment and outcomes. Subjects/methods A retrospective chart review was performed on all adult patients with orbital mycosis treated by the senior author (TJS) from 1986 to 2017 in a tertiary setting. Results Thirty cases of fungal infection involving the orbit were included in this case series. Of these, 26 patients had invasive disease and four patients had non-invasive disease. Causative organisms included mucormycosis (16), aspergillus (8) and other fungi (7). Common risk factors included haematological disorders or malignancy, neutropenia, corticosteroid use and diabetes mellitus. Mucormycosis in three immunocompetent patients was caused by Apophysomyces elegans . Orbital apex syndrome was observed in approximately one third of patients at initial ophthalmological assessment. Amphotericin B was used in most cases of mucormycosis, while there was a more varied spectrum of anti-fungal use in other fungal infections. Seven patients with mucormycosis proceeded to orbital exenteration with a survival rate of 43%. No patients with other orbital fungal infections were exenterated. Conclusions Orbital mycoses are not only opportunistic but true pathogenic infections. While initial symptoms may be varied, the development of orbital apex syndrome should raise suspicion for this condition, regardless of patient immune status or age. Survival and visual outcomes are often poor with invasive disease. Multidisciplinary team management with early orbital specialist involvement is essential.

These findings indicate that irradiation of tarsal collagen leading to tissue stiffening could be a safe procedure for treating lax eyelid conditions in human patients.

Safe irradiation conditions are established for the exposure of ex vivo ovine tarsus to ultraviolet-A radiation as a potentially effective treatment for eyelid laxity in human patients. Purpose: A follow-up experimental study on the exposure of animal tarsal plate to ultraviolet-A radiation aimed at establishing an optimum range for safe irradiation conditions. Methods: Sheep tarsus specimens were excised postmortem and then subjected to irradiation with ultraviolet-A rays (wavelength 365 nm) at higher irradiances than those reported in an initial study, using a laboratory radiation source. The mechanical properties (tensile strength and Young’s modulus) of irradiated and nonirradiated samples were evaluated in a mechanical tester. The test and control specimens were examined histologically with an aim to assess the effects of radiation upon the meibomian glands and tarsal collagen networks, and to establish a safe range for the exposure irradiance level. Results: As expected, irradiation induced both stiffening and strengthening of the tarsal plate specimens. At an irradiance of 50 mW/cm2 for 3-minute exposure, these effects were at their maximum level, after which a decline in mechanical characteristics were observed. No destruction of the tarsal connective tissue or the meibomian glands were noticed up to an irradiance of 125 mW/cm2 for 3-minute exposure, corresponding to a fluence of 22.5 J/cm2. Histology revealed that the collagen network surrounding the glands were packed more compactly following irradiation. At a fluence of 45 J/cm2, massive destruction of periglandular collagen-rich network and meibocytes were demonstrated histologically. Conclusions: The study indicates that irradiation of tarsal collagen leading to tissue stiffening shall be carried out at levels of fluence between 10 and 15 J/cm2, a region that is deemed safe. The exposure time can be adjusted according to the surgeon’s decision.

Following ocular surgery, dressings are commonly applied to the surgical wound. These dressings need to combine medical properties with ease of use while maintaining comfort for the patient. For the ocular area, this means that the dressings need to act as a microbial barrier, allow good conformability to the contours of the eye, and provide evaporative cooling to the inflamed area. Furthermore, the dressings should be transparent to allow for the inspection of the wound site by healthcare professionals without the need for removal. In this paper, we investigate a blend of native agarose (NA) and carboxylated agarose (CA) for producing elastic hydrogels with high water content that can be supplemented with antibiotics. It was found that in comparison to pure agarose hydrogels, the NA hydrogels blended with CA had a reduced Young’s modulus, reduced evaporation rate when exposed to air, and accelerated release rate of antimicrobial agents, whilst maintaining the same degree of transparency. By altering the formulation from 2 wt.% pure NA to 1 wt.% NA blended with 1 wt.% CA, we were able to observe an approximately 55% reduction in Young’s modulus, 25% reduction in evaporation rate, as well as a significant acceleration in the release rate of cefazolin and doxycycline, making this hydrogel blend a potential material for topical treatment applications.