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At least 613 records · Page 34Linked to original sources
PubMed2003

Retrospective case series of therapeutic applications of lotrafilcon a silicone hydrogel soft contact lenses.

PURPOSE: To report a series of consecutive cases for which a lotrafilcon A silicone hydrogel soft contact lens was used in therapeutic applications. METHODS: Three practitioners in Spain, Denmark, and Germany supplied 41 consecutive case reports of 39 patients for whom a lotrafilcon A silicone hydrogel soft contact lens was used in therapeutic applications. Applications included erosion or recurrent erosion, bullous keratopathy, corneal edema, corneal dystrophy, neurotrophic corneal ulcer, entropion, and use after corneal surgeries. Practitioners reported their judgments of pain relief, change in corneal signs by slitlamp evaluation, additional complications, and success of therapeutic lens treatment. Twenty cases of completed treatment and 21 cases of ongoing treatment were reported. RESULTS: Complete pain relief was reported for 78% of all cases, with 94% of all cases reporting pain relief of 50% or higher. Corneal signs were restored to normal for 74% of all cases, with 100% of all cases showing at least partial improvement. No additional complications were reported in 83% of all cases. Therapeutic contact lens application was judged fully successful for 71% of all cases, with 93% of all cases showing at least partial improvement. CONCLUSION: The high-oxygen permeable (Dk) lotrafilcon A lens met or exceeded the outcomes reported from historic reports of therapeutic applications of low-Dk soft contact lenses. Although the case reporting conditions vary among the historic studies and from the current study, this study indicates that success may be improved with the lotrafilcon A high-Dk lens.

Adult↗
PubMed2004

Microscopic anatomy of the lower eyelid in asians.

PURPOSE: To study the microscopic anatomic relation of the capsulopalpebral fascia, orbital septum, and tarsus of the lower eyelid in Asians. The anatomic differences between the Asian and non-Asian upper eyelid have been well described by various authors, but the differences of the lower eyelid have not been well characterized microscopically. The microscopic anatomy of the lower eyelid in non-Asians was well studied, but in Asians, despite the presence of gross differences, there were very limited studies on the microscopic anatomy. A thorough knowledge of the Asian lower eyelid anatomy is essential for surgical exploration of the eyelid. It may also explain the higher prevalence of eyelid disorders such as epiblepharon and entropion in Asians. METHODS: Ten normal Asian lower eyelids from 10 formalin-fixed cadavers (mean age, 67.5 years) were harvested and studied with light microscopy after staining with Masson trichrome. RESULTS: There was no fusion of the orbital septum and the capsulopalpebral fascia at the lower border of the tarsal plate in 7 specimens and a very limited fusion of these tissues in 3 specimens. The average distance from the inferior tarsal border to the first observable smooth muscle nuclei of the inferior retractors was 1.44 mm. The average tarsal plate thickness was 1.36 mm and the average tarsal plate height was 4.12 mm. CONCLUSIONS: The Asian lower eyelid anatomy differs from its non-Asian counterpart. There was no consistent fusion between the capsulopalpebral fascia and the orbital septum inferior to the inferior tarsal border. No extension of the capsulopalpebral fascia to the skin was observed. The average distance between the inferior retractors and the inferior tarsal plate was 1.44 mm in the normal Asian lower eyelid.

Aged↗
PubMedDate not supplied

Frontalis muscle flap advancement with a pulley in the levator aponeurosis in patients with complete ptosis and deep-set eyes.

PURPOSE: To offer an alternative to frontalis sling techniques to achieve a more horizontal traction vector force with the frontalis muscle flap. The proposed technique avoids malpositions such as pulling the upper eyelid in an anterior plane during maximum opening and ptosis of the eyelashes. METHODS: The technique, performed in 5 patients with complete unilateral ptosis and an absence of levator function, consisted of advancing a flap of frontalis muscle and creating a pulley with the aponeurosis of the levator muscle. Mean follow-up was 12 months. RESULTS: Ptosis was corrected in all 5 patients, with good aesthetic outcome. There were no cases of anterior eyelid advancement, entropion, or eyelash ptosis. The only complication was 1 case of lagophthalmos with corneal erosion. CONCLUSIONS: In this preliminary series, the technique was safe and effective for correcting severe blepharoptosis, with good aesthetic and functional results even in patients with deep-set eyes and without the eyelid malpositions that commonly occur in frontalis sling techniques.

Blepharoplasty↗
PubMed2007

Lower eyelid splinting: An alternative to the Frost suture.

OBJECTIVES: To describe a new method of postoperative eyelid suspension used for the prevention of eyelid malposition and to report its efficacy through an outcome study. STUDY DESIGN: An outcome study was performed on 10 patients who would potentially need postoperative eyelid suspension. Candidates included patients with entropion, ectropion, or orbital fractures requiring transconjunctival approaches. Patients were photographed pre- and postoperatively and followed for signs of eyelid malposition. METHODS: At the conclusion of the surgical procedure, a sheet of Xeroform gauze was folded into 6 overlapping layers and cut to conform to the shape of the inferior orbital rim. The superior edge of the gauze was sutured to the lower eyelid using interrupted 5-0 nylon suture. Sutures were placed at the medial and lateral canthi to raise the eyelid above the inferior limbus and along the inferior orbital rim. The splint was removed between postoperative days 7 and 14. RESULTS: There were no perioperative complications related to the surgery or placement of the splint. No cutaneous marks persisted after healing. No complications such as shifting of the splint, ocular damage, or recurrent eyelid malposition occurred. One patient had asymptomatic restriction of lower eyelid elevation on upward gaze, which resolved at 6 months. CONCLUSIONS: The lower eyelid splint appears effective in maintaining lower eyelid position postoperatively. There were no complications with its use, and the splint was tolerated well. Benefits of the splint over the Frost suture include less risk of corneal abrasion, ability to check visual function, and ability to use the splint bilaterally.

Adult↗
PubMed2004

Eyelid reconstruction: the state of the art.

PURPOSE OF REVIEW: The goals of eyelid reconstruction are corneal protection, restoration of the integrity of the lid lamellae, and improvement of facial symmetry. Inadequate reconstruction may lead to corneal exposure and sight-threatening keratopathy; in the younger patient, visual deprivation and amblyopia may also follow. The purpose of this review is to describe new materials and approaches used in reconstructing the damaged eyelid. RECENT FINDINGS: Although the surgical principles of lid reconstruction remain unchallenged, new materials and techniques have emerged. These include the use of both autogenous and cadaveric acellular dermis in the management of lower eyelid retraction, and amniotic membrane transplantation in the management of tarsal conjunctival disease. Recent work on upper facial nerve branch reinnervation in the animal model may also offer hope for eyelid reanimation after facial palsy. SUMMARY: The lid surgeon requires a sound knowledge of the principles involved in reconstructing the respective lamellae of the lid. Anterior lamellar reconstruction carries a significant risk of ectropion, and large defects may require several interposition flaps for optimum skin texture and color reconstruction. New materials (autogenous and cadaveric) for posterior lid reconstruction may reduce donor site morbidity and surgical time, but they may contract significantly after surgery. Recent experience with amniotic membrane transplantation may improve the prognosis for patients with entropion and symblepharon caused by conjunctival cicatricial changes.

Amnion↗
PubMed1998

Lacrimal canalicular obstruction associated with topical ocular medication.

PURPOSE: To describe the association between the use of various types of topical ocular medications and acquired lacrimal canalicular obstruction in 14 patients. METHODS: The records of all patients in the author's practice with either lacrimal canalicular or punctal occlusion associated with the use of topical ocular medication were reviewed. RESULTS: Fourteen cases were identified. The obstructions occurred at any point from the punctum to the common canaliculus, but most commonly occurred 2-5 mm from the lacrimal punctum. There was an association with various degrees of clinically apparent subconjunctival scarring maximal at the inner canthus, rarely to a severe degree, with symblepharon, medial canthal keratinization and cicatricial medial entropion. In some cases, no subconjunctival scarring could be clinically detected. Topical medications used were often multiple and included prednisolone acetate/phenylephrine hydrochloride (n = 5), timolol maleate (n = 5), pilocarpine (n = 3), dipivefrine hydrochloride or adrenaline (n = 3), chloramphenicol (n = 3), tobramycin (n = 3), indomethacin (n = 2), ecothiopate iodide (n = 1), betaxolol (n = 1), dexamethasone (n = 1), tropicamide (n = 1) and the long-term use of naphazoline and various artificial tear preparations (n = 1). The duration of exposure ranged from 3 weeks to 20 years, with seven patients having used drops for 3-6 weeks. Seven patients had surgical repair, three by dacryocystorhinostomy (DCR) and glass by-pass tube (all successful), three by canalicular repairs (one failed) and one by DCR and canalicular repair that restenosed at the puncta, who then had successful punctoplasty and silicone intubation. CONCLUSIONS: Lacrimal canalicular obstruction may occur after relatively short-term exposure to topical ocular medications or as part of a more widespread cicatricial reaction in patients on long-term medication. While a direct causal relationship cannot be confirmed, there appears to be a strong association and the site of the obstructions makes other causes unlikely.

Administration, Topical↗
PubMed2005

Prevalence of cicatricial trachoma in an indigenous population of Central Australia: the Central Australian Trachomatous Trichiasis Study (CATTS).

BACKGROUND: Trachoma is one of the leading causes of blindness worldwide, resulting from conjunctival scarring, upper lid entropion and trichiasis, leading to corneal scarring and opacification. This study was designed to investigate the current prevalence of cicatricial trachoma in an indigenous population within Central Australia and help determine whether trachoma remains a public health issue. METHODS: Participants aged 40 and over were recruited from patients attending one of 16 remote ophthalmology clinics held at indigenous communities in Central Australia within the Northern Territory. Once informed consent had been obtained, each patient underwent examination for evidence of trachomatous scarring, trachomatous trichiasis and corneal opacities. Results were collated and compared with previous prevalence surveys. RESULTS: Among the sample (n = 181), there were 97 patients (54%; 95% CI 46.7-61.3) with trachomatous scarring, 15 patients (8%; 95% CI 2.8-13.2) with trichiasis and 5 patients (3%; 95% CI 0.5-5.5) with corneal opacities. CONCLUSION: This study suggests that, although the prevalence of the cicatricial and blinding consequences of trachoma may be decreasing in patients aged 40 years or greater, when compared with the current prevalence in other areas of Australia, trachoma still remains a public health issue in Central Australia.

Adult↗
PubMed2001

Auricular chondritis in a cat.

A four-year-old male neutered domestic shorthaired cat developed bilateral thickening of the pinnae, with slight curling, intense erythema and pain. No ear canal disease was present. The cat was negative for feline immunodeficiency virus, feline leukaemia virus and feline coronavirus. Biopsy of the ear lesion revealed auricular chondritis. In humans, histologically similar lesions may involve the pinnae, nose, trachea, joints, eyes and heart, and the disease is termed relapsing polychondritis. The cat reported had a history of corneal damage, resulting in corneal vascularisation and opacity, eyelid distortion, necessitating an entropion operation, and radiological evidence of mild cardiac enlargement. The ear disease responded rapidly to treatment with prednisolone and, apart from slight thickening and curling of the pinnae, the cat remained normal and pain-free. After two years, the prednisolone was withdrawn, and there was no recurrence of the condition in a follow-up period of 14 months.

Animals↗
PubMed1982

Cryosurgery in treatment of trichiasis.

Ten patients with trichiasis were treated with cryosurgery by the standard retinal probe with nitrous oxide. A double freeze-thaw method was used. Nine of the patients had trachomatous trichiasis and one had conjunctival scarring. In only the latter case were the lashes destroyed, and these grew again after 2 months. Trachomatous trichiasis is frequently associated with entropion. The tarsal plate in such cases is often thickened and distorted, with extensive conjunctival scarring. The success of cryosurgical treatment of trichiasis depends not only on the type of probe used but perhaps also on the aetiology of the disease. To our knowledge no similar trial of this form of treatment of trichiasis has been carried out in eye centres in Africa south of the Sahara. Cryosurgery is simple to perform and of great potential use, particularly in areas where there is a shortage of skilled surgeons to perform the delicate eyelid operations often required in trichiasis.

Cryosurgery↗
PubMed1989

National survey of blindness and low vision in The Gambia: results.

A population based survey of blindness and eye disease has been conducted throughout the whole country of The Gambia, and 8174 people were examined. The prevalence of blindness (best acuity less than 3/60) was 0.7% and low vision (6/24-3/60) 1.4%. The causes of blindness were cataract (55%), non-trachomatous corneal opacity/phthisis (20%), and trachoma (17%). An estimated 5500 people in The Gambia require cataract surgery, 4600 eyelid surgery for entropion, and 4600 people spectacles to correct a refractive error which causes a visual acuity of less than 6/18. More than half the current burden of blindness in The Gambia is potentially remediable through the provision of cataract surgery and aphakic spectacles.

Adolescent↗
PubMed1994

Cryotherapy for trichiasis in ocular cicatricial pemphigoid.

Trichiasis is a common and potentially sight threatening complication of ocular cicatricial pemphigoid and is usually secondary to cicatricial entropion. This study aimed to assess the success and complications of eyelid cryotherapy for trichiasis in a group of patients with long term follow up. The case records of all patients with ocular cicatricial pemphigoid that attended the external disease clinic at Moorfields Eye Hospital from 1980 to 1992 were reviewed. Each eyelid was divided into three horizontal zones. Cryotherapy was delivered with an Amoilette cryoprobe for approximately 30 seconds. Failure of the cryotherapy was defined as a regrowth of the eyelashes within the treated zone that either required epilation for symptom control or caused keratopathy. Ninety two lid zones were treated, involving 25 lids of 12 patients. The cumulative chance of success decreased rapidly to 40% over the first year. Thereafter, the chance of success declined slowly to 34% at 4 years. Complications included lid notching (n = 2), tarsal atrophy (n = 1), altered lid contour (n = 1), and temporarily raised intraocular pressure (n = 1). All patients had quiescent disease at the time of the cryotherapy and no patients showed increased conjunctival disease activity after treatment. Six patients were taking systemic immunosuppression medication. When ocular cicatricial pemphigoid is quiescent, lid cryotherapy has an acceptable complication rate. The major reason for recurrence of the trichiasis was attributed to inadequate follicle freezing.

Aged↗
PubMed2003

Histological and morphometric analysis of the effects of argon laser epilation.

AIM: To analyse the location and extent of tissue damage induced after argon laser epilation. METHODS: Laser burns were applied to the lid margins of four patients before excision for entropion ("live tissue") and the lid margin of one patient was lasered after an excision for ectropion ("dead tissue"). The laser burns were directed towards the lash follicle and between 10 and 50 burns were applied with an argon blue-green laser set at power 0.9-1.0 W, at 0.1-0.2 second duration and a 100 micro m spot size. The tissues were processed for conventional histology. Serial sections were obtained and used for area measurements and three dimensional reconstructions of the burns to determine the volume and location of tissue destruction. RESULTS: The laser created a cone-shaped region of tissue ablation with surrounding coagulative necroses. Maximum burn depth was 1.2 mm in dead tissue and 0.8 mm in live tissue. Maximum necrosis depth was 1.4 mm in dead tissue and 0.9 mm in live tissue. Follicle depth ranged from 0.8 mm to 1.9 mm. Some of the burns had been misdirected in the dermis leaving target hair follicles intact, despite being of adequate depth. CONCLUSIONS: The argon laser has some potential for ablation of lash follicles, but accurate placement of the burn is essential and energy levels greater than those currently recommended should be applied. The treatment is ineffective in patients unable to remain immobile.

Aged↗
PubMed1999

Reconstruction of the eyelids of a dog using grafts of oral mucosa.

A five-month-old English cocker spaniel with distichiasis had been treated four times surgically by a tarsomeibomian resection technique. As a result, three-quarters of the margins of its upper eyelids had been eliminated and the lower eyelids had become considerably thinner. The dog had developed upper entropion and upper eyelid trichiasis, and keratoconjunctivitis sicca. It was treated medically and grafts of oral mucosa were used to reconstruct its upper eyelids. A year after surgery, the new palpebral margin was completely functional and cosmetically acceptable. The dog's eyes appear normal and only require treatment with artificial tears.

Animals↗
PubMed1996

Low-dose methotrexate as an adjunctive therapy with surgery for ectropion complicating dermatomyositis.

We describe the clinical and histopathologic features of a 44-year-old woman who developed bilateral lower eyelid ectropion and upper lid entropion presumably secondary to dermatomyositis. A variety of inflammatory, infiltrative and/or scarring dermatoses have been associated with ectropion. Chronic inflammation, poikilodermatous change and mucinous infiltration of the eyelids due to dermatomyositis are the postulated mechanisms leading to ectropion in our patient. This case is unique in that neither dermatomyositis nor papular mucinosis has previously been reported as a cause of ectropion. Also interesting was the adjunctive effect of methotrexate therapy.

Adult↗
PubMed1979

Retraction of the lower eyelid.

Retraction of the lower eyelid is a useful sign of disease. It is an early manifestation of weakness of the facial muscles, occurring with myopathies, myasthenia, and upper and lower motor neuron facial paresis. Rarely, lower and upper lid retraction occur without proptosis in patients with Graves disease. Lower lid retraction occurs in proptosis and varies directly with the degree of proptosis. It is also seen with senile entropion or ectropion, after eye muscle or orbital surgery, and with contraction of lid tissues. Apparent retraction results when the contralateral lower lid is pathologically elevated, as in Horner syndrome, in enophthalmos, or with vertical deviations of the eye.

Exophthalmos↗
PubMed1996

Blindness and low vision in southeast Turkey.

In preparation for the planning of a regional prevention of blindness programme, a population-based survey of blindness and eye disease was conducted in two provinces (Diyarbakir and Mardin) of southeast Turkey. A stratified cluster random sampling procedure was used to select 8,571 persons. The main objectives of the survey were to assess the population need for basic ophthalmic services, both in rural and in rapidly growing urban communities, and to secure baseline data for subsequent evaluation of the programme. The prevalence of visual impairment (best binocular vision poorer than 6/ 18) was estimated at 1.9% with 95% confidence limits of 1.6% and 2.1%, amounting to 29,400 +/- 4500 visually imparied persons in the regional population of 1.6 million. The prevalence of blindness (best vision poorer than 3/60) was 0.4%, and an estimated 1.5% had low vision (best vision poorer than 6/18, but not blind). Compared to the blindness prevalence of 0.2% in the European Economic Community (EEC), the age-standardised prevalence of blindness in southeast Turkey was 8 times as high. The main causes of blindness in the sample were cataract (50%), corneal opacity (15%), glaucoma (12%), phthisis (6%) and optic atrophy (6%). Cataract and refractive errors were responsible for 52% and 26% of the low vision, respectively. Acute inflammatory trachoma was prevalent in a number of rural and urban communities, affecting an estimated 25,900 people in the region. The need for basic ophthalmic services was estimated for the two provinces. Some 26,600 were in need of cataract surgery, 4,400 needed eyelid surgery for trachoma-induced entropion, and 28,600 required spectacles to improve their visual acuity to 6/18 or better. More than half of the current burden of severe visual loss in the two provinces of southeast Turkey is potentially remediable through the provision of cataract surgery and of spectacles to correct aphakia. The survey findings suggest that as the age structure of the regional population approaches that of the EEC through the "ageing trend', a four-fold increase in the burden of blindness might be expected, unless improvements are made in curative and preventive ophthalmic services in parallel with the general development that improves survival.

Adolescent↗
PubMedDate not supplied

Excision of individual follicles for the management of congenital distichiasis and localized trichiasis.

This paper presents a brief review of the literature regarding congenital distichiasis. The literature is confusing regarding the term distichiasis. Distichiasis should be utilized to describe congenital partial or complete accessory rows of eyelashes which exit from the posterior lid margin behind the meibomian gland orifices. The term acquired trichiasis and congenital distichiasis are significantly different. This paper also describes a new method for microscopically dissecting and excising the follicles of distichiatic eyelashes. The technical details of the surgical procedure are described with appropriate illustrations. This procedure can also be utilized for removal of localized areas of acquired trichiasis. The advantage of this procedure over previously utilized procedures for congenital distichiasis is the lower incidence of recurrent distichiatic lashes, combined with complete preservation of normal eyelashes and essentially no risk of cicatricial entropion following this procedure.

Eyelashes↗
PubMed2005

Botulinum toxin in ophthalmic plastic surgery.

Botulinum toxin chemodenervation has evolved greatly over the past 30 years since its introduction in the 1970s for the management of strabismus. Among ophthalmic plastic surgeons, botulinum toxins are often used as the first line treatment for facial dystonias. These toxins are also efficacious for the temporary management of various other conditions including keratopathies (through so called chemo-tarsorraphy), upper eyelid retraction, orbicularis overaction-induced lower eyelid entropion, gustatory epiphora, Frey's syndrome, and dynamic facial rhytids such as lateral canthal wrinkles (crow's feet), glabellar creases and horizontal forehead lines. This article describes the pharmacology, reconstitution techniques and common current applications of botulinum toxins in ophthalmic plastic surgery.

Botulinum Toxins↗