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PubMedDate not supplied

Pyogenic granuloma.

A retrospective review of cases of pyogenic granuloma seen at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 1984-1991 is described. Epidemiology and the factors that led to the granuloma formation were examined and only cases documented histopathologically were included in the review. Of the 110 cases, 80% developed the granuloma at the site of the previous surgery (especially entropion repair, and dacryocystorhinostomy with a stent tube or with a Jones tube) while 20% did not have a prior surgery. Recurrence occurred in 7% and these patients were in the group who had a prior surgery. Surgical procedures lead to an increased tendency for the formation of pyogenic granuloma due to different mechanisms acting via a mechanical or chemical irritation and an inhibition of re-epithelialization.

Adolescent↗
PubMed1988

Conjunctival lymphocyte subsets in trachoma.

Monoclonal antibodies were used to assess the lymphocyte populations in conjunctival biopsy specimens obtained from patients with trachoma (active or inactive) undergoing tarsotomy for the correction of trachoma-induced entropion and in three control patients. Peroxidase-labelled monoclonal antibodies OKT4 (identifies T-helper/inducer lymphocytes), OKT8 (identifies T-suppressor/cytotoxic lymphocytes), OKIal (identifies B-lymphocytes) and antisera specific for IgG, IgA and IgM were used to identify lymphocyte subpopulations and immunoglobulins in the conjunctival biopsy specimens. When grouped by disease activity, conjunctival tissue specimens revealed predominant T-helper/inducer lymphocytes in the substantia propria of patients with active trachoma while inactive trachoma patients had predominant T-suppressor/cytotoxic lymphocytes in the conjunctival biopsy specimens. B-lymphocytes were seen in moderate numbers in all conjunctival biopsy specimens from patients with active trachoma and all specimens from active cases stained for IgG, IgM, and IgA. Immunoglobulin staining was strongest with IgG and IgM.

Adult↗
PubMed1982

Tarsal ectropion from detachment of the lower eyelid retractors.

In 17 eyelids of 14 patients a disinsertion of the lower eyelid retractors from the lower tarsus was identified and repaired through the conjunctiva. The disinserted lower eyelid retractors were isolated in the inferior fornix with forceps, the redundant conjunctiva was excised, the lower eyelid retractors were reattached to the inferotarsal border, and the eyelid was tightened horizontally. During follow-up periods ranging from six to 26 months, there have been no recurrences and no cases of cicatricial entropion.

Adult↗
PubMed1982

Obtaining auricular cartilage for reconstructive surgery.

The cartilage in the scaphoid fossa between the helix laterally and the antihelix medially provides excellent underlying support for soft-tissue eyelid and nasal reconstruction. After subcutaneous infiltration anesthesia is administered through both the anterior and posterior auricular skin, an incision is made along the posterior rim of the helix. A dissection plane between the perichondrium and skin exposes the cartilage. The cartilage is removed without incising the anterior skin surface. This technique is particularly useful in cicatricial entropion, upper or lower eyelid retraction, eyelid reconstruction, and socket reconstruction.

Ear Cartilage↗
PubMed1984

Vertical tarsal buckling as a complication of levator aponeurosis repair for acquired blepharoptosis.

In two patients (a 60-year-old man and a 69-year-old woman) vertical buckling of the superior tarsus followed surgery to correct levator aponeurosis disinsertions for the management of acquired upper eyelid blepharoptosis. The superior tarsus rotated posteriorly and folded on itself because the sutures reattaching the levator aponeurosis to the tarsus were placed too low on the anterior tarsal plate. This complication can be prevented by placing the tarsal sutures above the vertical midpoint of the tarsus. If this complication develops, early correction is possible by revising the suture heights and keeping the tarsus flat with a symblepharon ring. This led to a satisfactory outcome in one of our cases. Late correction of vertical tarsal buckling requires excision of the buckled tarsus and repositioning the levator aponeurosis sutures. In one of our patients, an entropion developed as a result of insufficient vertical tarsal height that caused instability of the upper eyelid. The outcome was otherwise satisfactory.

Aged↗
PubMed1992

Lateral canthotomy transconjunctival approach to the orbit.

Multiple surgical approaches to the orbits with the use of the eyelids have been used. The orbital rim incision fell into disfavor because of esthetic considerations. A subciliary approach supplemented by the lateral brow incision is currently the most popular method of approach to the orbital rim. It provides adequate access to the orbit, but it is not without inherent complications, such as unfavorable scarring, ectropion, and entropion. This article describes an alternate approach to the orbit by means of a transconjunctival incision with lateral canthotomy.

Bone Plates↗
PubMedDate not supplied

Botulinum A toxin (Oculinum) in ophthalmology.

Botulinum A toxin has been used to treat strabismus and a variety of spasmodic neuromuscular diseases. Botulinum toxin treatment of strabismus is not as definitive and stable as the traditional surgical approach, but it has been found most useful in postoperative overcorrection, small deviations, sensory deviations, and acute sixth nerve palsy. This toxin has been effective in the treatment of essential blepharospasm and hemifacial spasm, for which it produces temporary relief of symptoms. In addition, this treatment has been applied to lower lid entropion, myokymia, aberrant regeneration of the seventh nerve, lid retraction, corneal exposure, nystagmus, spasmodic torticollis, and adductor spastic dysphonia.

Blepharospasm↗
PubMed2004

Donor site morbidity in free tarsal grafts.

PURPOSE: To determine if harvesting free tarsal grafts from the upper eyelids is associated with significant morbidity. DESIGN: Prospective case series. METHODS: Consecutive patients managed with free tarsal grafts by three of the authors (D.S., D.G., R.G.) over a 4-year period. RESULTS: Ninety-one eyelids in 75 patients were operated on using the free tarsal graft for various eyelid pathologies. Mean follow-up period was 14.83 +/- 8.45 months (range, 4 to 42 months). Contour peaking in donor upper eyelid appeared in two eyelids (2.2%), lash ptosis in four eyelids (4.4%) of three patients, and donor site infection in one eyelid (1.1%). Four patients (5.3%) complained of a transient ocular discomfort. There were no cases of postoperative changes on the eyelid height, entropion, or keratopathy in the donor site eye. Most of the donor site complications were mild or transient and required no further surgery. In three patients who underwent subsequent surgery to treat preexisting ptosis or retraction of the donor eyelid, the results were less predictable and further procedures were required. CONCLUSION: Free tarsal grafts harvested from the upper eyelids, with preservation of at least 4 mm of the tarsal plate inferiorly, do not lead to significant donor site morbidity. However, subsequent procedures to alter the position of the donor eyelid may be less predictable.

Adult↗
PubMed2004

Combination of transconjunctival and endonasal-transantral approach in the repair of blowout fractures involving the orbital floor.

In the repair of orbital blowout fractures through eyelid or conjunctival incision, it is difficult to see the posterior edge of the fracture and the condition of the herniated tissue before reduction of the orbital contents. Prolapsed orbital tissue or infraorbital nerve and vessels may therefore be damaged in the reduction. The recently advocated combination of traditional transconjunctival approach and endoscopic transantral approach allows reduction and reconstruction under clear endoscopic vision without a facial skin incision. We modified this technique to make it less invasive and applied it to the repair of orbital blowout fractures involving the orbital floor. The use of a 70-degree straight endoscope through an enlarged ostium as for functional sinus surgery allowed clear sight of the roof of the antrum. During the repair of the orbital floor through a transconjunctival approach, reduction and reconstruction was assisted from the antrum. Twelve cases of fresh blowout fractures were treated with this approach. There were seven male and five female patients. Mean age was 23.5 years. Causes of injuries were fights, motor vehicle or bicycle accidents, and sports. Patients with concomitant fractures involving the orbital rim were excluded. Persistent diplopia was present in eight cases and enophthalmos of more than 2 mm was detected in five cases preoperatively. The average intervals from injury to surgery was 22.8 days.Exploration, reduction and reconstruction of the orbital floor fractures were precisely performed with this procedure. Large orbital floor defects were reconstructed with silicone sheets, thin iliac bone grafts or nasal septal cartilage. In all eight cases that showed diplopia, ocular movement recovered and symptomatic diplopia disappeared after surgery. Enophthalmos of more than 2 mm was also improved in all five cases. One early case showed temporary entropion. Transient numbness of the cheek appeared in five cases and temporary maxillary sinusitis recovered in one case. Postoperative infection was not observed.This method provides visualisation of posterior edge of the fracture and the condition of herniated orbital contents before initiation of reduction. Dual manipulation by two surgeons is also possible in reduction and reconstruction of the orbital floor.

Adolescent↗
PubMedDate not supplied

Botox: beyond wrinkles.

First used and approved over a decade ago for the treatment of strabismus (or misaligned eyes), botulinum toxin (BTX) has demonstrated efficacy in blepharospasm, hemifacial spasm, spastic lower eyelid entropion, and a number of other disorders seen in the traditional medical environment that are characterized by abnormal muscle contraction. Moreover, other conditions-notably some pain and gastrointestinal disorders-have responded to BTX injections.

Botulinum Toxins↗
PubMedDate not supplied

Botulinum toxin in ophthalmology.

Since its introduction into clinical medicine in 1980, botulinum toxin has become a major therapeutic drug with applications valuable to many medical sub-specialties. Its use was spearheaded in ophthalmology where its potential applications have expanded to cover a broad range of visually related disorders. These include dystonic movement disorders, strabismus, nystagmus, headache syndromes such as migraine, lacrimal hypersecretion syndromes, eyelid retraction, spastic entropion, compressive optic neuropathy, and, more recently, periorbital aesthetic uses. Botulinum toxin is a potent neurotoxin that blocks the release of acetylcholine at the neuromuscular junction of cholinergic nerves. When used appropriately it will weaken the force of muscular contraction, or inhibit glandular secretion. Recovery occurs over 3 to 4 months from nerve terminal sprouting and regeneration of inactivated proteins necessary for degranualtion of acetylcholine vesicles. Complications are related to chemodenervation of adjacent muscle groups, injection technique, and immunological mechanisms.

Botulinum Toxins, Type A↗
PubMed1993

Results of transantral orbital decompression in 428 patients with severe Graves' ophthalmopathy.

We reviewed records from 428 consecutive patients with severe Graves' ophthalmopathy to determine early and late results after transantral orbital decompression. Optic neuropathy was present in 217 (50.7%) patients. Post-operatively, 402 (89%) of 453 eyes with preoperative visual acuity worse than 20/20 improved or remained the same. Visual field scotomas improved or resolved in 245 (91%) of 269 eyes tested pre- and postoperatively. Preoperative papilledema resolved or improved in 99 (94%) of 105 eyes, and preoperative exposure keratitis improved or resolved in 178 (92%) of 195 eyes. Average proptosis reduction was 4.7 mm. Postoperatively, new diplopia developed in 74 (64%) of 116 patients who had no diplopia before orbital decompression, although 300 patients ultimately had strabismus surgery. At late follow-up (N = 293 patients), 226 (77%) had single vision and 44 (15%) had correction with prism. Complications included sinusitis (18 patients), lower eyelid entropion (38 patients), numb lip (23 patients), cerebrospinal fluid leaks (15 patients), and one frontal lobe hematoma (one patient). The average duration of follow-up was 8.7 years. Transantral orbital decompression effectively reduces proptosis and usually corrects optic neuropathy. In other circumstances, the benefits achieved and the side effects incurred must be carefully balanced for each patient before transantral orbital decompression is considered.

Adolescent↗
PubMedDate not supplied

Ligneous conjunctivitis: a case report.

BACKGROUND: Ligneous conjunctivitis is a rare condition characterized by chronic, recurrent conjunctivitis associated with pseudomembrane, and it may involve other mucous membranes in the mouth, nasopharynx, trachea, and vagina. We examined and treated a case of presumed ligneous conjunctivitis. CASE: The patient was a 10-year-old boy. His chief complaints were visual impairment, discomfort, and discharge, but no itching in his eyes. His upper eyelids appeared thick without swelling. He had a past history of surgery for lid entropion. His two siblings had similar follicular conjunctivitis. OBSERVATIONS: This case exhibited several characteristics of ligneous conjunctivitis, such as large follicles, recurrent pseudomembrane and normal level IgE in the serum. Indispensable characteristics of vernal keratoconjunctivitis, strong itching, and extensive papillary formation, were not found. In spite of the lack of woody hardness of the conjunctiva, other clinical findings led to the diagnosis of ligneous conjunctivitis. Definite histological diagnosis was not obtained, because of the lack of common histological characteristics among previously reported cases with ligneous conjunctivitis. The boy had developed corticosteroid glaucoma after instillation of dexamethasone 0.1% for 7 months at a previous time. We successfully treated this case with combined instillation of fluorometholon and cyclosporin after trabeculotomy. CONCLUSIONS: Ligneous conjunctivitis must be considered as one type of differential diagnosis of vernal keratoconjunctivitis. Cyclosporin is an effective alternative for the treatment of ligneous conjunctivitis, especially in a case with a possible history of corticosteroid glaucoma.

Child↗
PubMed2003

The Cutler-Beard clamp for lid reconstruction.

PURPOSE: To analyze the use of the Cutler-Beard transmarginal rotation entropion clamp (Karl Ilg & Co., St. Charles, IL) in patients undergoing the Cutler-Beard procedure for repair of eyelid defects after tumor excision or trauma. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Twenty-five patients undergoing the Cutler-Beard procedure. RESULTS: The Cutler-Beard clamp (Karl Ilg & Co., St. Charles, IL) helps avoid the problems of a commonly used chalazion clamp. The clamp allows a skin orbicularis muscle incision to be combined with a conjunctival tarsal incision without the need to remove the clamp. It is also helpful in creating each of these incisions 4 mm from the eyelid margin to spare the marginal artery, which, if injured, could lead to loss of the eyelid margin. The clamp blades have multiple teeth to stabilize the eyelid and avoid slippage of the clamp. MAIN OUTCOME MEASURES: The incidence of intraoperative or postoperative complications. CONCLUSIONS: The transmarginal rotation clamp or Cutler-Beard clamp allows for the creation of a precise incision 4 mm from the eyelid margin with a high probability of avoiding injury to the marginal artery and is superior to traditional chalazion clamps.

Eyelids↗
PubMed1988

Episodic conjunctival inflammation after Stevens-Johnson syndrome.

The authors studied the histopathologic, ultrastructural, and immunopathologic characteristics of conjunctiva from patients with Stevens-Johnson syndrome (SJS). A small subset of SJS patients with recurrent conjunctival inflammation unassociated with external factors such as lid margin keratinization, sicca syndrome, trichiasis, or entropion was identified. The ultrastructural and immunopathologic characteristics of the conjunctiva from these patients were distinctly different from those of the conjunctiva from SJS patients without recurrent conjunctivitis, and suggested an active, immunologically mediated inflammation. Vasculitis or perivasculitis, immunoreactant deposition in vessel walls, vascular basement membrane disruption, thickening, and reduplication, and a preponderance of helper T-lymphocytes, macrophages, and Langerhans' cells were the notable distinguishing features in those patients with recurrent conjunctival inflammation. This rare clinical syndrome may represent the ocular counterpart to recurrent dermal or oral mucosal erythema multiforme.

Adolescent↗
PubMed1989

Transconjunctival lower eyelid blepharoplasty. Technique and complications.

The transconjunctival lower eyelid blepharoplasty is extremely effective at reducing lower lid fullness due to prominent orbital fat. The authors performed 122 consecutive transconjunctival blepharoplasties over a 24-month period. Four patients had skin excision via the pinch technique in conjunction with the transconjunctival fat excision. The main complication was under excision of fat which occurred in nine patients (7.4%). Moderate postoperative wound hemorrhage without hematoma formation occurred in one patient (0.8%). There were no cases of lid retraction, ectropion, entropion, inferior oblique palsy, or over excision of fat. The main advantage of this technique is that it avoids the most common complication of transcutaneous lower eyelid blepharoplasty, namely lower eyelid retraction.

Adipose Tissue↗
PubMed1992

Inadequate inferior cul-de-sac in the anophthalmic socket.

A retrospective review of preoperative findings and postoperative results of conjunctival cul-de-sac fixation surgery performed on 12 patients with acquired anophthalmos and an inadequate inferior conjunctival cul-de-sac was performed. Patients with inadequate conjunctiva or other subconjunctival cicatricial shortening of the inferior cul-de-sac were not suitable candidates for conjunctival cul-de-sac fixation surgery and therefore were excluded from this retrospective study. Only those patients with adequate conjunctiva and loss of inferior cul-de-sac fixation to the lower eyelid retractor complex were selected. Clinical evaluation and theoretical anatomical analysis of this group preoperatively suggested that the absent inferior conjunctival cul-de-sac fixation could allow the intraconal orbital fat to migrate anteriorly, compromising the inferior fornix and prolapsing the conjunctiva of the cul-de-sac superiorly. Surgical correction required direct fixation of the conjunctival cul-de-sac to the periosteum immediately posterior to the inferior orbital rim. No externalized sutures or stents were needed to recreate the inferior conjunctival cul-de-sac. All 12 patients had improved ability to retain a prosthetic eye postoperatively. However, two patients had minimal postoperative lower eyelid retraction and an additional two patients had minimal lower eyelid entropion after surgery. Secondary surgery was not required in any patient.

Conjunctiva↗
PubMed1998

Chronic keratoconjunctivitis associated with congenital dyskeratosis and erythrokeratodermia variablis. Two rare genodermatoses.

OBJECTIVE: The purpose of the study was to report the ocular manifestations and immunohistopathologic description of two rare forms of genodermatosis: congenital dyskeratosis (CD) and erythrokeratodermia variabilis (EKV). DESIGN: Case reports. PARTICIPANTS: Two patients with CD and EKV presenting with chronic keratoconjunctivitis were studied. INTERVENTION: Clinical photography to show ocular manifestations and dermatologic findings was performed. Conjunctival biopsy was performed to determine the histopathology and immunohistopathology. RESULTS: In the patient with EKV, the eyelid skin was dry, erythematous, and thickened. The lid margins showed plugging of some of the Meibomian glands, madarosis, and occasional trichiasis. The epibulbar conjunctiva was injected and had a moderate papillary reaction. Both corneas had pronounced vascularization and stromal scarring. Conjunctival biopsy results disclosed a striking number of degranulating mast cells and moderate numbers of plasma cells. Immunohistopathology showed pronounced immunoglobulin G (IgG)-positive cells in the stroma and immunoglobulin A (IgA) positivity in the epithelium. There was scattered immunoglobulin M (IgM) and moderate C3 and C4 positivity in the stroma. In CD, the patient had keratinized lid margins, entropion formation, trichiasis, cicatrizing conjunctivitis, and symblephra formation. The corneal surface was keratinized, with deep and superficial vascularization. Conjunctival biopsy specimens showed pronounced epithelial keratinization and squamous metaplasia. Degranulating mast cells and eosinophils were prominent in the stroma. Immunohistopathology showed C4 and immunoglobulin D positivity on the keratinized epithelial surface with rare foci of immunoglobulin E-positive cells. Basal epithelial cells were positive for IgA and IgG, and a large number of IgA and IgG plasma cells were present in the substantia propria. CONCLUSION: To the authors' knowledge, these case reports represent the first clinical description of the ocular manifestation of EKV and the first immunohistopathologic description of the affected conjunctiva in EKV and CD, both of which should be considered in the differential diagnosis of genodermatosis associated with chronic keratoconjunctivitis.

Adolescent↗