Biomedical subjects
Publications and source records attributed to D R Jordan.
Twenty-four children with classical chickenpox were referred for ophthalmic assessment because of lesions on the lids and in the eye. The appearance of these lesions, their treatment, and their complications are discussed. Twenty-five percent of these children were documented to have an anterior uveitis.
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A 58-year-old man with multiple myeloma presented with a 3-month history of a sensation of occipital pressure, transient blurring of vision and increased bone pain. Funduscopic examination revealed disc swelling, tortuous veins and superficial retinal hemorrhages simulating early hyperviscosity syndrome. Clinical investigation and computerized tomography, however, indicated that an intracranial plasmacytoma was the cause of his papilledema. Cobalt 60 beam therapy and vincristine were added to his treatment regimen. Seven weeks later the intracranial tumour had almost totally disappeared. Symptomatic cerebral compression from an intracranial plasmacytoma associated with systemic disease is uncommon. The diagnosis and management are reviewed.
Sanguineous lacrimation is an unusual clinical entity that may be caused by a wide spectrum of abnormalities. Disorders of the conjunctiva or of the blood clotting mechanism are the most common underlying problems. This paper describes a bizarre case in which a 16-year-old girl used food colouring to simulate blood in the tears. The appropriate steps in the investigation of a patient's complaint of bloody tears are reviewed.
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Essential blepharospasm is an idiopathic disorder of progressive involuntary spasms of the orbicularis oculi and upper facial (corrugator, procerus) muscles. Blepharospasm literally means spasm of the eyelids; however, most patients with blepharospasm also have or will develop squeezing in the lower face and neck muscles (Meige's syndrome, orofacial dystonia, or oromandibular dystonia). Some patients develop dystonic, uncontrolled movements in areas outside the facial nerve distribution (segmental cranial dystonia or craniocervical dystonia). Chronic, forceful squeezing by the periocular muscles becomes debilitating for the patient and leads to functional and cosmetic eyelid deformities. Treatment has included a variety of modalities and oral medications that are of limited efficacy. Botulinum-A toxin injections have delivered the best temporary relief from this disorder, while the periorbital myectomy operation has been shown to give the best long-term results.
Pegging hydroxyapatite implants may lead to improved prosthetic eye movement but may also be associated with complications that may occasionally require peg removal. Removing the peg and leaving the peg hole to spontaneously granulate in, is one technique to deal with the remaining implant hole. The author describes a simple technique to fill the peg hole that provides a smooth implant-conjunctival-prosthesis interface and may potentially allow repegging.
Microblepharon is a rare congenital anomaly manifested by a vertical shortening of the eyelids. We describe the clinical presentation and surgical outcome of a patient with trisomy 21 and microblepharon. Microblepharon occurs in varying degrees and must be distinguished from ablepharon and cryptophthalmos. A variety of surgical options are available depending upon the degree of lid involvement.
During an orbital dissection in a 60-year-old white male, we came across a very well defined superior and inferior component of Whitnall's ligament (Figure 1). The superior component of Whitnall's ligament is well described and well known to ophthalmologists performing eyelid surgery. The inferior component, however, is not well recognized or described. This cadaver dissection illustrates both Whitnall's components well.
Silicone stents are commonly used in dacryocystorhinostomy to help maintain a patent mucosal passageway into the nose. It is not unusual for a tube to become displaced and migrate laterally (stent prolapse), and, at times, it may be difficult to reposition it. We describe how stent prolapse may be prevented by using aneurysm clips to secure the silicone stents once they are in place.
Alveolar soft-part sarcoma is a malignant soft tissue neoplasm that involves mainly the deep soft tissues of the extremities, particularly the thighs and the buttock. Involvement of the orbit is uncommon. We describe a young child with such a tumor and illustrate the characteristic features.
Microplating and miniplating systems are widely available for repairing fractures involving the orbit, face, cranium, and mandible. These plates are superior to traditional wiring techniques because the fractured bones are held in position immediately after the plates have been screwed into position (rigid fixation). Recently, we have found the T-shaped microplate quite helpful in securing the prefabricated subperiosteal orbital floor implants commonly used to augment orbital volume in anophthalmic sockets.
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Reconstruction of posterior lamellar eyelid defects requires a tissue substitute that is either identical to the tissue lost (ex. surrounding or nearby tarsus) or donor tissue from another site that serves the same supportive role. Irradiated homologous tarsal plate and irradiated homologous aorta are potential posterior lamellar substitutes. Each provides a structural framework for the surrounding lid tissues to grow upon and are incorporated into the normal eyelid anatomy. Both the tarsal plate and aorta can be harvested, irradiated and stored in a refrigerator, ready to be utilized in those selected cases with severe tissue loss. They may also be utilized as a donor material in more routine lid reconstruction as an alternative. We discuss our experience with these materials.