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Biomedical subjects

R E Wesley

Publications and source records attributed to R E Wesley.

At least 37 records · Page 2Linked to original sources
PubMed1987

Management of orbital-cranial trauma.

Orbital-cranial injuries have the greatest potential for death and disability of any condition treated by the ophthalmologist. An object that penetrates through the orbit into the brain may leave only a small entrance wound. Patients can have normal vision, neurologic exam, and plain x-rays despite trauma that may lead to meningitis, brain abscess, or pneumocephalus. The CT scan greatly aids in both the early and late management of blunt and penetrating orbital-cranial trauma. The detection of pneumocephalus may be the only clue that intracranial penetration has occurred. Blunt trauma can cause vision loss, ophthalmoplegia, ptosis, and intracranial injury. Management of orbital-cranial trauma frequently requires a team approach by the ophthalmologist and neurosurgeon due to the complexity of these injuries.

Brain Injuries↗
PubMed1987

Orbital histiocytic lymphoma arising from the ethmoid sinus.

Histiocytic lymphoma has been reported previously as an orbital manifestation of systemic malignancy. We report herein a 49-year-old white male with orbital involvement from a sclerosing lesion in the ethmoid sinus that initially caused a biopsy-proven orbital inflammatory mass. This report of an orbito-sinus histiocytic lymphoma underscores the need to re-biopsy symptomatic orbital inflammatory lesions that continue to enlarge.

Biopsy↗
PubMed1987

Conservative treatment of orbital roof blow-in fracture.

A two-year-old boy with orbital roof fracture had resolution of motility restriction without traditional surgical exploration. Orbital roof fractures may occur via a blow-in mechanism rather than by direct transmission of an outside force. As is the case with those caused by floor fractures, motility disturbances from roof fractures merit clinical observation before surgery is performed, since some motility defects will resolve spontaneously.

Child, Preschool↗
PubMed1987

Central retinal artery occlusion.

Injecting steroid crystals into orbital inflammatory lesions produces a prolonged, high level of drug activity at the target tissue. This technique appears helpful in controlling orbital inflammations in problem cases while reducing the chance of steroid related systemic side effects. We report a patient who experienced central retinal artery occlusion from steroid particles injected into an orbit inflammatory mass. The mechanism of this complication and methods to reduce the chance of central retinal artery embolization are discussed.

Adult↗
PubMed1987

Painful orbital inflammatory lesions and mastocytosis.

A 15-year-old female patient developed painful nodules in an anophthalmic socket that were exacerbated by treatment with steroids and narcotics. Although orbit biopsy showed chronic inflammation, the diagnosis of mastocytosis was confirmed with skin biopsy and urinary levels of histamine. The patient responded to excision of nodules and treatment for mastocytosis. Painful orbital lesions associated with mastocytosis have not been reported previously.

Adolescent↗
PubMed1987

Upper eyelid retraction from inferior rectus restriction in dysthyroid orbit disease.

Findings from orbital computed tomography scans have shown inflammatory enlargement of the levator palpebralis superioris complex to be a likely cause of eyelid retraction in dysthyroid (Graves's) ophthalmopathy. We have studied a subgroup of nine dysthyroid patients in whom the eyelid retraction occurs as a relative malposition of the globe and eyelid due to inferior rectus restriction. Our explanation of this phenomenon in nine patients is based on Hering's law. Increased innervation required for a fixating superior rectus muscle to overcome a severely restricted inferior rectus muscle causes an unrestricted levator muscle to open the eyelid abnormally wide relative to the globe. The retraction is best demonstrated with fixation of the involved eye. We have performed inferior rectus recession to correct this type of eyelid retraction in three of our patients.

Adult↗
PubMed1986

Orbital pseudotumor of the levator muscle.

A 58-year-old white man with chronic progressive external ophthalmoplegia developed proptosis and an improvement in his ptosis from a mass in the superior orbit. A biopsy showed the mass to consist of an inflammatory mass of the levator palpebrae superioris muscle. As the inflammatory mass responded to periorbital and systemic steroids, the ptosis recurred. Inflammatory pseudotumor of the levator muscle is extremely unusual and has not been reported previously in patients with chronic progressive external ophthalmoplegia.

Adrenal Cortex Hormones↗
PubMed1986

Intranasal procedures for successful lacrimal surgery.

Successful lacrimal surgery requires specialized knowledge of intranasal surgical anatomy. The clearance of the lower nasolacrimal duct relative to the inferior turbinate and the relationship of dacryocystorhinostomy and conjunctivodac-ryocystorhinostomy sites to upper nasal septum and anterior middle turbinate are not encountered in traditional cosmetic rhinoplasty or procedures for nasal airway obstruction. Intranasal procedures to facilitate lacrimal surgery are described.

Dacryocystorhinostomy↗
PubMed1986

Orbital metastasis from cutaneous melanoma.

Although orbital extension from ocular melanoma occurs frequently in advanced cases, orbital metastasis from cutaneous melanoma has been reported but eight times previously. We have reported two such cases. One of the patients had three previous primary melanomas; the other had metastasis to the cauda equina. Both patients died when orbital involvement developed years after the initial lesions. Ours are the first cases to include CT and MRI findings in metastatic orbital melanoma.

Adult↗
PubMed1986

Spontaneous enophthalmos from chronic maxillary sinusitis.

Spontaneous enophthalmos has been reported to occur after demineralization of the orbital floor from chronic maxillary sinusitis. We report a 24-year-old female who developed spontaneous enophthalmos without demineralization of the orbital floor. A contracture from the maxillary sinus apparently pulled the orbital floor downward. Release of the fibrous tissue through a combined orbital and sinus approach produced satisfactory correction of the enophthalmos without the use of alloplastic implants. This case suggests that fibrotic contraction in the maxillary sinus pulling the floor of the orbit downward can produce spontaneous enophthalmos without boney destruction.

Adult↗
PubMed1986

Acute frontal sinusitis after lacrimal surgery.

Acute frontal sinusitis occurred in four patients who required removal of the anterior portion of the middle turbinate to provide adequate intranasal drainage during lacrimal surgery. Three patients with redness and swelling around the wound were initially thought to have wound infection, but localized tenderness to percussion of the frontal sinus and air fluid levels on x-rays indicated acute frontal sinusitis. Treatment with antibiotics and steroids gave relief. Use of unipolar electrocautery to excise the middle turbinate probably caused acute inflammation of the frontonasal duct. We recommend simple excision without electrocautery in those cases requiring removal of turbinate for successful lacrimal surgery.

Acute Disease↗
PubMed1985

Inferior turbinate fracture in the treatment of congenital nasolacrimal duct obstruction and congenital nasolacrimal duct anomaly.

A group of 52 pediatric patients with lacrimal obstruction were considered to be high risk since they had been previously probed (27 patients) or were older (average age 23 months). At the time of probe and irrigation, a small, straight hemostat was placed into the nose to grasp the inferior turbinate and rotate it a full 90 degrees inward. All cases of congenital nasolacrimal duct obstruction (49) resolved following this maneuver. A small muscle hook with the tip directed upward was placed underneath the inferior turbinate to identify three patients with congenital nasolacrimal duct anomaly (absence or atresia of the nasolacrimal duct) who would not have benefitted from further probings and responded to dacryocystorhinostomy. Even though the results of our uncontrolled surgical trial cannot be compared to other treatment methods, the data suggest that even very difficult cases of congenital nasolacrimal duct obstruction will respond to a simple turbinate fracture with a hemostat without the necessity of complicated tubes or stents. A small muscle hook can be used to identify those rare cases of congenital nasolacrimal duct anomaly who may require specialized procedures such as dacryocystorhinostomy or inferior turbinectomy.

Child, Preschool↗
PubMed1985

Dapsone in the treatment of presumed brown recluse spider bite of the eyelid.

Brown recluse spider bites occur commonly in the Southern United States but eyelid bites are rare. Management of eyelid bites is difficult because the initial spider bite is frequently unnoticed, surgical and medical treatments are ineffective, and even a small area of necrosis affects the appearance and function of the eyelid.

Adult↗
PubMed1985

Carbon dioxide laser in ophthalmic plastic and orbital surgery.

The CO2 laser cuts tissue by flash boiling extracellular or intracellular water molecules in contact with the beam. This vaporization sterilizes the tissue and seals capillaries. The CO2 laser seems most useful in ophthalmology to vaporize lymphangiomas and capillary hemangiomas and to provide hemostasis in patients with bleeding disorders. The cutting beam of the CO2 laser can be attached to the operating microscope to facilitate surgery deep within the orbit. The effectiveness of the CO2 cutting action depends upon water content of the tissue rather than tissue color as with argon and krypton lasers. Skin incisions show less scarring when made with conventional scalpel, but more precise surface cutting lasers may allow more precise microsurgical excision of eyelid tumors than can now be accomplished with a scalpel.

Eye Diseases↗
PubMed1984

Seminoma metastatic to the orbit.

Testicular cancer is the most frequent malignancy in young adult males. Seminoma, the most frequent cell type, causes exophthalmos on a hormonal basis; actual tumor invasion of the orbit has been reported once. We report here a second case of orbital invasion by seminoma. When tumor has spread beyond the retroperitoneum, treatment with chemotherapy is usually recommended. A biopsy of the orbital metastatic tumor may be the technique with least morbidity to document tumor state prior to committing the patient to systemic chemotherapy.

Adult↗
PubMed1983

McCord procedure for ectropion repair.

The McCord technique of ectropion repair was used on 85 eyelids of 77 patients who have been observed for six to 34 months. In each instance the ectropion was corrected by resecting part of the stretched lateral canthal tendon and reattaching the tarsus to the lateral orbital rim with a permanent suture. The incision at the lateral canthus avoids lid notching, trichiasis, corneal irritation, and the added stress on the lateral canthal tendon that may occur with conventional wedge sections. The lid position was revised in six patients. A lateral canthal granuloma developed in four patients. One patient had late infection from the permanent stitch. This procedure is particularly useful for patients with ectropion who have an artificial eye or for ectropion after blepharoplasty. Additional steps may be added for more complicated cases, such as skin grafting for cicatricial ectropion or reattachment of the lower lid retractors for tarsal ectropion.

Ectropion↗