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At least 595 records · Page 33Linked to original sources
PubMed2001

Trachoma: a review.

Trachoma is a leading cause of preventable blindness worldwide. The disease is caused by an intracellular epithelial gram-negative bacterium, Chlamydia trachomatis. The presence of children, overcrowding, and the lack of water in the household are factors that predispose to the transmission of the disease. The disease may remain asymptomatic but some patients many complain of redness, irritation, and ocular discharge. The principal initial clinical manifestation is a follicular conjunctivitis that may lead to conjunctival scarring, entropion, trichiasis, corneal thinning, and ulceration. Some patients develop corneal scars that lead to loss of vision. Despite the remarkable progress in our understanding of Chlamydial infections, the basic mechanisms involved in tissue damage and scarring remain to be elucidated. There are several effective therapeutic modalities for trachoma. Azithromycin oral single dose was found to be safe and effective in children with active trachoma. Conjunctival biopsy specimens obtained from adult patients receiving a single oral dose of azithromycin showed sustained high levels of azithromycin (above MIC of chlamydia) for up to 2 weeks after intake. These prolonged high levels of azithromycin in the conjunctival tissue following a single oral dose makes the drug suitable for the treatment of endemic trachoma.

Administration, Oral↗
PubMed1995

Conjunctivitis in a long-term care facility.

OBJECTIVE: To determine the prevalence, incidence, and etiology of conjunctivitis in residents of a long-term care facility. DESIGN: Prospective surveillance of episodes of conjunctivitis during two 6-month periods. SETTING: Three-building, 319-bed, multipurpose, long-term care facility including units for personal care, chronic care, palliative care, rehabilitation, respiratory rehabilitation, and chronic ventilator patients. RESULTS: The incidence of conjunctivitis on different units varied from 0.6 to 3.5 per 1,000 patient-days. One building had a significantly higher rate of acute conjunctivitis and, within that facility, the most highly impaired patients had significantly more disease. Patients with chronic conjunctivitis generally were admitted with conjunctivitis; institutionally acquired conjunctivitis proceeding to chronic conjunctivitis seldom was observed except on the chronic ventilator unit. Residents with chronic conjunctivitis were significantly more likely to have a diagnosis of glaucoma, ectropion, or entropion. Potential bacterial pathogens were isolated from 3 (21%) of 14 and 24 (38%) of 69 acute episodes for which cultures were available in the two study periods. Staphylococcus aureus was the most frequent pathogen isolated. Empiric therapy was usually with topical sodium sulamyd or gentamicin, with substantial interphysician variability in prescribing patterns. Symptom duration did not differ for episodes which did or did not receive topical antimicrobials. CONCLUSION: Conjunctivitis is common in this facility and occurs with increased frequency in more highly impaired residents. Most episodes may not be due to bacterial infection. Further study of optimal management approaches to conjunctivitis is necessary.

Acute Disease↗
PubMed2002

Ophthalmic surgery in dysthyroid ophthalmopathy.

The major focus of this study is to evaluate the ophthalmic surgery performed to treat patients with various eye changes of dysthyroid ophthalmopathy (DO) in Japan. The medical charts of DO cases that underwent eye surgery at the Olympia Eye Hospital in 1999 were reviewed. In 1999, 898 patients underwent ophthalmologic examination at the thyroid eye clinic in our hospital, and 51 cases were excluded out of the first visiting cases because they were hyperthyroid only and not associated with ophthalmopathy. This study consists of 847 cases (151 male, 696 female), mean age of 40.9 +/- 14.7 years, age distribution of 10-84 years. Surgical therapy was used on 129 eyes of 93 cases (11%) among the 847 patients. Orbital decompression was performed on 26 eyes of 15 cases. Most Japanese patients are not associated with a strong degree of proptosis, showing on average less than 20 mm. Cases with 25 mm of proptosis were scarcely observed. Extraocular muscle surgery was performed on 84 eyes of 60 cases (bilateral 17 cases, unilateral 33 cases). Types of diplopia are as follows: upward gaze, 28 cases; outward gaze, 10 cases; downward gaze, 2 cases; and complex type, 10 cases. Concerning the pathogenesis of diplopia in DO, fibrotic change plays a dominant role, in which cicatrical adhesion to the surface of the muscle is always observed in extraocular muscle surgery. After removal of cicatrical adhesion, the forced duction is completely recovered. This explains the precise mechanism of this involvement. Eyelid surgery was used on 39 eyes of 30 cases (upper eyelid, 33 eyes; lower eyelid, 6 eyes). Eyelid surgery was indicated for treatment of various anterior eye changes including upper eyelid retraction, entropion of eyelids. Better results and few complications are considered attributable to the stabilization of orbitopathy.

Adult↗
PubMed1995

Evaluation of adverse reactions of aponidine hydrochloride ophthalmic solution.

We prospectively evaluated the adverse reactions of apraclonidine in 20 normal volunteers by instilling a single drop of 1% apraclonidine in their right eyes. Examinations, including blood pressure, pulse rate, conjunctiva and cornea, intraocular pressure (IOP), pupil diameter, basal tear secretion and margin reflex distance of both upper and lower eyelids, were performed prior to entry and at 1, 3, 5 and 7 hours after instillation. The ocular hypotensive effects were statistically significant for apraclonidine-treated eyes throughout the study and also statistically significant for contralateral eyes from three hours after topical administration of 1% apraclonidine. Decreases in systolic blood pressure were statistically, but not clinically, significant. No significant changes in diastolic blood pressure, pulse rate and basal tear secretion were noted. Conjunctival blanching and mydriasis were commonly found. Upper lid retraction was frequently noted. While the elevations of the upper lid margin in most subjects were not more than 2 mm and did not cause noticeable change in appearance, one subject suffered from mechanical entropion and marked corneal abrasion 3 hours after instillation of the medication. This may well be a particularly notable finding in Asian people.

Adrenergic alpha-Agonists↗
PubMed2001

Experience in upper eyelid reconstruction with the Cutler-Beard technique.

Reconstruction of full-thickness upper eyelid defects has to supply a movable lid with perfect corneal protection, good aesthetic quality, and acceptable sequelae at the donor site. The Cutler-Beard procedure, a full-thickness cutaneoconjunctival inferior eyelid advancement flap, is a reliable method for reconstruction of total or partial upper eyelid defects. Especially in older individuals, the skin of the donor site is loose and provides sufficient tissue to stretch. Color and texture of the donor matches the recipient site perfectly. Destabilization or ectropion of the donor site, the lower lid, and retraction or entropion of the recipient site, the upper lid, are the main complications. Therefore, a modification of the classic technique should be considered by implantation of an enforcing inlay in the reconstructed lid (eye bank sclera, fascia lata, ear cartilage), especially in reconstruction of extended defects of the upper lid.

Aged↗
PubMed1985

The use of tarsus as a free autogenous graft in eyelid surgery.

This is a report of the use of autogenous tarsus as a free graft in 121 eyelid surgical procedures. Seventy-three operations were for reconstruction of full-thickness defects and 30 were for repair of eyelid retraction. The remainder were for repair of cicatricial entropion, symblepharon, distichiasis, and irregularity of the eyelid margin. No grafts failed. There were three complications to a donor eyelid. It is believed that donor eyelid complications are less likely when the graft is harvested so as to include the upper tarsal margin. The free autogenous tarsal graft was found to be effective in repairing a variety of eyelid defects.

Ankle↗
PubMed1990

Stevens-Johnson syndrome with associated nasolacrimal duct obstruction treated with dacryocystorhinostomy and Crawford silicone tube insertion.

Although Stevens-Johnson syndrome (SJS) has long been recognized as a cause of punctal and canalicular obstruction, nasolacrimal duct obstruction secondary to SJS is rare and has not been reported in the ophthalmologic literature. Keratoconjunctivitis sicca, entropion, and trichiasis are well-known complications of SJS that may require measures to supplement or preserve tears. Lacrimal drainage system obstruction may occasionally occur in the face of relatively normal tearing, resulting in clinically significant epiphora. We report two cases of SJS, one associated with epidemic keratoconjunctivitis, that led to nasolacrimal duct obstruction and canalicular obstruction or stenosis. Epiphora and, in one case, dacryocystitis, necessitated dacryocystorhinostomy and Crawford tube insertion.

Adult↗
PubMed1990

The transconjunctival approach to the orbital floor and orbital fat. A prospective study.

The transconjunctival approach to the inferior orbit and orbital fat offers the potential advantage of avoidance of scar creation in the lower eyelid skin and anterior lamellae. Complications of this approach, including conjunctival fornix shortening and eyelid margin malposition, have been occasionally reported. We prospectively observed 25 patients undergoing transconjunctival blepharoplasty and orbital floor surgery. Fornix depth, eyelid margin position, and the presence or absence of eyelid retraction were measured preoperatively and at each postoperative visit. No significant permanent change in these parameters was observed. Temporary entropion was observed in two patients; this resolved with conservative treatment. On self-limited suture granuloma was observed. In a subgroup of six patients, the conjunctival incision was closed on one side and left unclosed on the other. No adverse healing was noted on the unclosed side. We conclude that the transconjunctival approach is associated with a low incidence of complications, and that it does not significantly alter the fornix depth or eyelid margin position. A skin incision is avoided. The inferior orbital septum is not violated, greatly reducing the risk of development of lower eyelid retraction.

Adipose Tissue↗
PubMed1991

Blepharochalasis. A review of 30 cases.

This paper presents the findings in a series of 30 patients with blepharochalasis, including the age of onset, sex, predisposing factors, symptoms and signs, frequency and duration of attacks, and length of the history. There were 16 bilateral and 14 unilateral cases. The condition can be divided into an active (early) and a quiescent (late) stage. The active stage is further subdivided into intumescent (hypertrophic) and atrophic forms. The sequelae included excess thin skin, fat herniation, lacrimal gland prolapse, ptosis, blepharophimosis, pseudoepicanthic fold, proptosis, conjunctival injection and cysts, entropion, and ectorpion. Surgery primarily involved blepharoplasty, ptosis correction, and lateral canthal reattachment alone or in combination. The pathology showed a variable picture of epithelial atrophy, vasculitis, and loss of elastic fibers, which did not greatly help to differentiate blepharochalasis from angioedema, lymphedema, dermatochalasis, tumors and infiltrations, and floppy lid syndromes. Blepharochalasis is probably a localized angioedema. The diagnosis depends on the clinical features of intermittent attacks of localized swelling affecting one or more eyelids associated with thinning of the skin giving either an intumescent (hypertrophic) or atrophic appearance in the active stage of the condition and progressing to atrophic changes in the quiescent (late) stage.

Adolescent↗
PubMed1997

Floppy eyelid syndrome and obstructive sleep apnea.

Floppy eyelid syndrome (FES) usually affects middle-aged obese men, presenting as a unilateral or bilateral chronic papillary conjunctivitis. The upper eyelid is lax, floppy, and easily everted. The laterality corresponds to the side the patient sleeps on. An association with obstructive sleep apnea (OSA) has been suggested. A personal series of 17 new cases is presented, and 79 previously reported cases are reviewed to give a detailed description of the syndrome. In addition to the classical presentation, patients may present with upper lid ptosis, lash ptosis or trichiasis, lower lid ectropion or rarely entropion, or corneal complications. Eight patients with FES were investigated for OSA. Twenty other patients with known OSA were examined for FES and other possibly associated ocular features. All eight patients referred for sleep studies were found to have OSA. One of the 20 patients with known OSA was found to have FES, and two had features of early asymptomatic FES. One patient with FES and OSA had normal tension glaucoma. Patients with FES should be considered for sleep studies because of the known morbidity of OSA. Simple screening of patients with OSA may detect FES and avoid late corneal complications that can compromise vision.

Adolescent↗
PubMed2001

Tarsorrhaphy: clinical experience from a cornea practice.

PURPOSE: To evaluate indications, success rate, and complications of tarsorrhaphy in a cohort of cornea and external disease patients. METHODS: In this study, charts of patients who underwent tarsorrhaphies from January 1, 1995, to September 30, 2000, were retrospectively evaluated. Information reviewed included patient age and sex, indication for tarsorrhaphy, duration of signs and symptoms before tarsorrhaphy, time to epithelial healing after tarsorrhaphy, type of tarsorrhaphy (temporary/permanent), complications, timing of tarsorrhaphy removal, recurrence of signs and symptoms after complete or partial opening of the tarsorrhaphy, number of tarsorrhaphies needed to be replaced or extended, and duration of follow up. RESULTS: Seventy-seven patients were included in this study. Indications for a tarsorrhaphy were persistent epithelial defects or other ocular surface problems associated with neurotrophic ulcers, penetrating keratoplasty (PK), postinfection, exposure keratopathy, surgery other than PK, dry eye syndrome, radiation keratopathy, ocular cicatricial pemphigoid, Stevens-Johnson syndrome, entropion, and application of tissue adhesive. The epithelial defects in 70 (90.9%) of the 77 eyes completely resolved. Overall, the mean duration of signs and symptoms before tarsorrhaphy was 89.8 +/- 27.8 days, and time-to-healing after tarsorrhaphy was 18.0 +/- 2.0 days. The difference between the duration of the signs and symptoms before tarsorrhaphy and time-to-healing after tarsorrhaphy was statistically significant ( p = 0.01). Of the 77 tarsorrhaphies, 24 (31.2%) were temporary and 53 (68.8%) were permanent. Complications after tarsorrhaphy included trichiasis, adhesion between upper and lower lids after tarsorrhaphy lysis, premature opening of the temporary tarsorrhaphy, pyogenic granuloma, and keloid formation of the eyelid. CONCLUSION: Tarsorrhaphy is a very effective and safe procedure in the management of nonhealing epithelial defects and other surface problems, with a 90.9% success rate and only minor complications.

Adolescent↗
PubMed1998

Ocular cicatricial pemphigoid.

CP is a systemic disease of presumed autoimmune etiology that may involve the skin, conjunctiva, or any mucosal surface. As many patients present with ocular symptoms, ophthalmologists must inquire about signs of potential life-threatening esophageal and laryngeal involvement. Ocular involvement is a bilateral chronic cicatricial conjunctivitis that may result in fornix foreshortening, symblepharon formation, trichiasis, and entropion and keratinization of the eyelids and conjunctiva. These mechanical factors are responsible for progressive scarring and vascularization of the ocular surface. Successful systemic treatment of the autoimmune disease is now available; however, the condition often is not diagnosed until significant structural damage to the ocular adnexa has occurred. Our ability to rehabilitate visually patients with advanced disease by penetrating keratoplasty and associated techniques remains extremely limited. Hence, the focus of treatment in OCP should be on early detection of the disease, including conjunctival biopsy, prompt systemic treatment to prevent disease progression, and early aggressive treatment of secondary eyelid and conjunctival abnormalities to avoid the blinding keratopathy so prevalent in this disease.

Conjunctival Diseases↗
PubMed1997

Complications of gold weight eyelid implants for treatment of fifth and seventh nerve paralysis.

Complications occurred in six patients after gold weights were implanted into the upper eyelid tissues for fifth and seventh nerve palsies. These complications included implant infection without extrusion (in one patient); entropion with trichiasis and presumed inflammatory reaction to the gold weight material (in one patient); upper eyelid distortion and poor eyelid contour with corneal ulceration and scarring (in one patient); significant residual lagophthalmos with exposure keratitis (in one patient); and blepharoptosis obscuring the pupillary access (in two patients). Resolution of the complications required 1. implant removal in four of six patients without reinsertion of a second weight, 2. recession of the retractors of the upper eyelids with medial and lateral canthoplasty (in four patients), and 3. permanent tarsorrhaphy (in one patient). The authors conclude that complications may be minimized by careful preoperative determination of the optimum implant size, weight, and placement within the eyelid as well as meticulous attention to the surgical technique of implantation. The use of other eyelid protective procedures is often necessary to augment corneal protection especially in patients with combined fifth and seventh cranial nerve palsies. Endogenous implant infection without extrusion of the gold weight may be distinguished from presumed inflammation due to gold allergy by clinical response to antibiotics in the former and requirements of steroids or removal of the implant in the latter.

Adult↗
PubMed1985

Palatal grafts for eyelid reconstruction.

A full-thickness graft of hard palate mucosa was used as the lining tissue for eyelid reconstruction in 11 patients over a 7-year period. An orbicularis musculocutaneous flap supplied cover and support. In all cases the mucosal graft was easily removed, convenient to handle, and took completely. The palate donor site reepithelialized by about 3 weeks postoperative and has remained healed and asymptomatic in all cases. In follow-up averaging 3 years, all the reconstructed lids have retained a stable and comfortable lid margin, with no instance of entropion or irritation. The outstanding virtue of palate mucosa for eyelid reconstruction is that it appears to retain most of its original size and stiffness over the long term and thus in a single layer can serve to replace both tarsus and conjunctiva.

Adult↗
PubMed1989

Distichiasis and cleft palate.

A patient with the unusual coexistence of distichiasis and cleft palate is described. Distichiasis is a rare congenital eyelid anomaly in which accessory eyelashes are present in the meibomian gland orifices. Its association with other systemic abnormalities is reviewed; the distinctions among distichiasis, trichiasis, entropion, and epiblepharon are outlined; and methods of treatment for distichiasis are described.

Abnormalities, Multiple↗
PubMed1998

Epicanthoplasty with modified Y-V advancement procedure.

The presence of epicanthal folds and lack of supratarsal folds are unique features in most Asian eyelids. Although many surgical procedures are available to eliminate epicanthal folds, scarring on the medial canthus is still an obstacle for surgeons to overcome. From January of 1989 to November of 1997, we used modified Y-V advancement procedures in 148 cases to correct epicanthal folds in Asian eyelids. Five of those cases involved congenital palpebral anomalies, including congenital entropion, congenital ptosis, and Down syndrome. There were few complications in our series. We believe that the modified Y-V advancement procedure causes minimum scarring on medial canthus in correcting Oriental epicanthal folds and congenital palpebral anomalies. This procedure can also be simultaneously combined with blepharoplasties and corrective procedures of eyelids.

Adolescent↗
PubMed2001

Endoscopically assisted repair of orbital floor fractures.

Traditionally, orbital floor fractures are repaired with standard transcutaneous or transconjunctival approaches. Complications such as external scarring, eyelid edema, ectropion, entropion, and granuloma formation have been associated with these open lid techniques. The endoscope has been used to assist in orbital floor exploration, to reduce entrapped orbital tissue, and to identify the posterior shelf for implant placement. However, an open lid incision is inevitable when implant placement is necessary. We present our experiences in repairing orbital floor fractures using transantral endoscopy without open lid incision.A 0-degree, 4-mm endoscope was placed through a 2 x 1.5-cm2 maxillary antrostomy to dissect the sinus roof. The endoscope was used to assist in the reduction of the floor fractures and prolapsed orbital tissue into the orbital cavity, if present. The orbital floor defect was reconstructed with titanium mesh or Medpor through the antrostomy under endoscopic control. This technique was applied to nine patients who had orbital floor fractures. Two of the patients had zygomatico-orbital fractures, whereas the rest had isolated orbital floor fractures. Three patients received Medpor reconstruction and the remaining six underwent titanium mesh reconstruction. The patients were followed up for 10 months on average. The enophthalmos was corrected in all patients but one, who suffered from mild enophthalmos because of uncorrected orbital medial wall fractures. Diplopia occurred in three patients preoperatively, which was resolved in two of them and improved in the other postoperatively. There have been no complications apart from transient anesthesia in the dermatome of the infraorbital nerve. The technique successfully reconstructed the orbital floor defects, minimized ocular globe manipulation, and eliminated a lower eyelid incision.

Adult↗
PubMed2001

Chronic cicatrizing conjunctivitis.

Conjunctival fibrosis may result from chronic inflammation and may lead to alterations of conjunctival architecture. This results in ocular dryness, entropion and trichiasis, and corneal complications. Causes of conjunctival cicatrization are not limited to autoimmune diseases, such as ocular cicatricial pemphigoid, a severe disease associated with poor ocular prognosis. Other well-known causes include thermal and chemical burns, postinfectious conjunctivitis, and Stevens-Johnson syndrome. Ocular rosacea and atopic keratoconjunctivitis often are underdiagnosed causes of conjunctival fibrosis. Medical history, physical exam, and laboratory tests often allow for diagnosis of the underlying disease. Medical management varies according to specific causes, and many surgical strategies are available to restore corneal transparency and normal palpebral architecture.

Animals↗