• Description: Malignant tumor of the sympathetic nervous system, primarily affecting children. Symptoms include proptosis, eyelid swelling, and visual disturbance.

• Treatment: Chemotherapy, surgery, and radiation therapy.

• Emergency?: Yes, it's life-threatening and requires immediate oncologic evaluation.

• Helpful Testing: MRI.

• Differential Diagnoses:

  • Orbital cellulitis

  • Rhabdomyosarcoma

  • Lymphoma

  • Orbital pseudotumor

• Description: Viral skin infection caused by a poxvirus, characterized by small, dome-shaped, pearly lesions on eyelids or conjunctiva, often with inflammation.

• Treatment: Cryotherapy, curettage, topical imiquimod; surgical excision for conjunctival involvement.

• Emergency?: No, but may cause discomfort and risk of secondary infection.

• Helpful Testing: Potential referral for biopsy if atypical but generally not necessary. 

• Differential Diagnoses:

  • Chalazion

  • Sebaceous cyst

  • Squamous cell carcinoma

  • Viral conjunctivitis

Notes:

Disseminated molluscum contagiosum occurs in AIDS patients.

• Description: Partial or complete obstruction of the nasolacrimal duct at birth, leading to excessive tearing, chronic conjunctivitis, or dacryocystitis.

• Treatment: Lacrimal sac massage; probing or surgery if persistent.

• Emergency?: No, but requires monitoring and intervention if infection occurs.

• Helpful Testing: Jones I (see notes) but usually diagnosed based on clinical presentation and symptoms. 

• Differential Diagnoses:

  • Infectious conjunctivitis

  • Blepharitis

  • Epiphora from dry eye

Notes:

• Jones I test: fluorescein is instilled in conjunctival sac. Cotton tip applicator is used to attempt fluorescein retrieval via the external naris. Positive results indicate functional blockage.

• Jones II test: Nasolacrimal irrigation with saline after positive Jones I test; fluorescein retrieval is attempted once again. Positive test reveals anatomic blockage.