Conjunctival blue nevus associated with pyogenic granuloma.
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Aged↗
Biomedical subjects
J V Linberg
Publications and source records attributed to J V Linberg.
Relapsing polychondritis, another cause for a "salmon patch".
We present the case of a patient with long-standing relapsing polychondritis and, first, an orbital mass and, then, a "salmon patch" conjunctival mass. The histologic pathologic findings were similar on both occasions, showing an inflammatory process with reactive lymphoid hyperplasia. In both situations, the masses responded to a short course of systemic corticosteroids. Although ocular inflammatory changes from relapsing polychondritis have been well described, to our knowledge, there have been no previous reports of conjunctival changes in the form of a salmon patch lesion, as described here. Relapsing polychondritis may be added to the differential diagnosis of a conjunctival salmon patch lesion.
Conjunctival Diseases↗
Foreshortening of the inferior conjunctival fornix associated with chronic glaucoma medications.
The authors designed a device to measure the depth of the inferior conjunctival fornix at the slit lamp using topical anesthesia. The fornices of 179 glaucoma patients receiving topical medications for glaucoma and 420 control subjects who had no history of ocular disease were measured. These measurements were age-stratified by decade. A significant foreshortening of the inferior conjunctival fornix was found with aging (P less than 0.01). Patients in their sixth through ninth decades using miotics for 3 years or longer and patients using nonmiotic agents for 3 years or longer exhibited significant foreshortening of the inferior fornix when compared with age-stratified (by decade) control subjects (P less than 0.01). These observations suggest that increasing age and topical medications for glaucoma, or the preservatives, used for 3 years or longer, are independently associated with conjunctival shrinkage.
Adolescent↗
Comparison of nonabsorbable and absorbable sutures for use in oculoplastic surgery.
Nonabsorbable sutures are often recommended for use in oculoplastic surgery. This study compares the in vivo performance of nonabsorbable and absorbable sutures in an animal model and attempts to determine if one suture type is clearly superior for subcutaneous wound closure. The performance of each suture was evaluated using three surgical techniques. Comparison of results revealed that different techniques produce profoundly different results, independent of suture choice. Clinically, all suture types behaved similarly when used with the same surgical technique. Thus, absorbable and nonabsorbable sutures are equally effective under the conditions of these experiments.
Animals↗
Anatomy of the orbital septum and associated eyelid connective tissues. Implications for ptosis surgery.
The anatomy of the orbital septum and associated eyelid connective tissues was examined using cadaver dissection, histologic sections, surgical observations, and special radiologic imaging. The embryologic development of the eyelid connective tissues was also reviewed. Examination revealed a distinct layer of fibroadipose tissue in the eyelid and eyebrow posterior to the orbicularis and frontalis muscles, and anterior to the orbital septum. Fibrous septa within the submuscular fibroadipose tissue become contiguous with more compact lamellae of the orbital septum posteriorly imparting a multilayered quality to the orbital septum. Fat within the fibroadipose layer anterior to the orbital septum may be mistaken for the preaponeurotic fat pad by the unwary surgeon and may lead to surgical error. The orbital septum and the levator aponeurosis were found to join 2 to 5 mm above the superior tarsal border (average, 3.4 mm). Recommendations for ptosis surgery based on these anatomic principles are given.
Adipose Tissue↗
Outpatient dacryocystorhinostomy.
We report 105 dacryocystorhinostomy procedures in 87 patients performed on an outpatient basis. Seventy-six patients received local, and 29 received general, anesthesia. The patients left the hospital an average of 2.6 hours after surgery, but 14 were admitted after surgery--9 immediately, and 5 after some delay, primarily for epistaxis. There were no serious complications related to the outpatient nature of the surgery. The success rate was 94%. We conclude that outpatient dacryocystorhinostomy is successful, well accepted by patients, and safe, provided that inpatient care facilities are readily available should they be needed.
Adolescent↗
Spontaneous orbital hemorrhage associated with idiopathic inflammatory pseudotumor.
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Child, Preschool↗
Giant molluscum contagiosum following splenectomy.
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Adult↗
Anterior ethmoid anatomy facilitates dacryocystorhinostomy.
The ethmoid air cell labyrinth lies adjacent to the medial orbital wall, extending even beyond the sutures of the ethmoid bone. Its anatomic relationship to the lacrimal sac fossa is important in lacrimal surgery. We evaluated computed tomographic scans of 190 orbits with normal ethmoid anatomy to define the anatomic relationship of anterior ethmoid air cells to the lacrimal sac fossa. In 93% of the orbits, the cells extended anterior to the posterior lacrimal crest, with 40% entering the frontal process of the maxilla. This anatomic relationship may be used to facilitate the osteotomy during dacryocystorhinostomy. During a 10-year period (310 cases), one of us routinely entered the anterior ethmoid air cells to initiate the osteotomy during dacryocystorhinostomy. This technique has helped to avoid lacerations of the nasal mucosa.
Adolescent↗
Assessment of tear drainage after canalicular obstruction using fluorescein dye disappearance.
Assessment of tear drainage impairment after monocanalicular obstruction can be difficult. The authors used fluorescein dye disappearance to evaluate tear drainage after experimental obstruction of upper, lower, neither, or both canaliculi in 20 subjects. Marked impairment was noted in all subjects when both canaliculi were occluded (P less than 0.004). Monocanalicular obstruction (either upper or lower) generally resulted in minimal or no impairment, though 10% of subjects showed marked impairment. Fluorescein dye disappearance proved a reliable, rapid method for assessing tear drainage and detecting lacrimal obstruction.
Fluorescein↗
Iontophoresis for eyelid anesthesia.
Local anesthesia is appropriate for eyelid surgery, but patients fear the pain of injections. We evaluated iontophoresis of lidocaine for eyelid skin anesthesia to pinprick pain sensation in normal subjects, and prior to regional infiltration of the anesthetic agent in patients undergoing eyelid surgery. After iontophoresis of lidocaine hydrochloride 4% solution to one randomly chosen eyelid, pinprick skin sensation was tested in a double-masked manner. Subjective pain scores of 10 subjects were significantly less (P less than .008) on the iontophoresis treated eyelids (0.25) than on the untreated eyelids (2.55). Nine patients undergoing bilateral upper eyelid surgery had iontophoresis applied to one randomly chosen eyelid prior to the usual anesthetic injections. In this double-masked evaluation, patients reported significantly less pain (P less than .02) on the treated eyelids (1.4) than on the untreated eyelids (4.7). We conclude that iontophoresis is effective for achieving short-term, superficial anesthesia of eyelid skin.
Anesthesia, Local↗
Quantitating the superior visual field loss associated with ptosis.
The effect of blepharoptosis on the superior visual field was assessed using a series of specially designed contact lenses to simulate ptosis in normal subjects. We found a progressive decrease in the superior visual field at the 90 degree vertical meridian, which was proportional to the degree of simulated ptosis. Our results were in close agreement with both a theoretical model and previous clinical observations. These results are important in evaluating patients contemplating ptosis surgery, as well as in visual field testing for neuro-ophthalmic disorders.
Adult↗
The anophthalmic socket and the prosthetic eye. A clinical and bacteriologic study.
Culture samples were obtained from the anophthalmic sockets of 40 consecutive patients using a prosthetic eye. We found an increased prevalence of bacteria in the conjunctivae of anophthalmic sockets. No significant differences in bacterial flora were observed between symptomatic and asymptomatic patients, suggesting that symptoms of irritation are not usually related to abnormal bacterial flora. Patients who frequently manipulated their prosthesis had a significantly higher proportion of gram-negative bacteria, suggesting that manipulation of the prosthesis should be avoided.
Bacteria↗
Factitious "calcification" in the lacrimal gland fossa.
Computed tomographic (CT) scans are valuable in the evaluation of lacrimal gland fossa masses. Calcification in this region is considered a sign of malignancy. Silicone implants are widely used in orbital surgery and may give the appearance of calcification on CT scan. These must be distinguished from true calcification by the proper choice of the CT scan window.
Adult↗
Adult vernier thresholds do not increase with age; vernier bias does.
Vernier acuity and vernier bias were examined in persons aged 20 to 79 years using a method of adjustments. Vernier bias (mean error) showed a sharp increase between 35 and 45. Vernier acuity (standard deviation or precision of alignment) did not vary significantly with age. These different results indicate the importance of separate evaluation of acuity and bias. Vernier acuity is little affected by minor optical changes that occur with age. Therefore, normal vernier acuity in older persons suggests that the neural substrates which underlie fine-grain discrimination of object location are unaffected by aging over the range investigated.
Adult↗
Orbital pseudotumor in a patient with AIDS.
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Acquired Immunodeficiency Syndrome↗
Symptoms of canalicular obstruction.
The need for surgical repair of monocanalicular lacerations is controversial. The authors used temporary punctal plugs of hydroxypropyl cellulose to assess the symptoms associated with upper and lower monocanalicular obstruction in 18 normal eyes. Fifty percent of those experimental obstructions resulted in mild intermittent symptoms of epiphora, increased tear film, discomfort, or blurred vision. Constant epiphora was not reported. The results suggest that a single upper or lower canaliculus is sufficient for drainage of minimally stimulated tear secretion but may not completely drain reflex tear secretion. This information may help patients and ophthalmologists reach an informed decision as to the need for surgical repair of a severed canaliculus.
Adult↗
Aponeurotic ptosis repair under local anesthesia. Prediction of results from operative lid height.
The unpredictability of acquired ptosis repair is a difficult problem. Aponeurotic ptosis repair may be performed under local anesthesia, and past reports have suggested that operative lid position may be used to predict the final result. The authors prospectively studied 20 aponeurotic repairs under local anesthesia for patients with acquired ptosis and normal levator function. Photographs were taken during surgery, 1 week after surgery, and 3 months after surgery. Statistical analysis of vertical lid fissure measurements demonstrated a linear relationship between operative lid position and the 3-month result. When operative lid height was significantly greater than 10 mm, then a slight postoperative rise was observed, but when operative lid height was significantly less than 10 mm, then a slight postoperative fall was observed. Lid position at 1 week proved to be an excellent predictor of the 3-month result, establishing a reasonable basis for intervention in cases of overcorrection or undercorrection.
Anesthesia, Local↗