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At least 667 records · Page 37Linked to original sources
PubMed2005

[Reconstruction of complex tissue loss of the medial canthus].

The medial canthus is an anatomic and surgical entity. Reconstruction after cancerological resection is complex. The purpose of this article is to report a reconstruction technique for massive loss of tissue of the medial canthus which was applied in 2 patients with 2 years follow-up. Anatomic reconstruction was achieved. Each element of the canthus was restored: skin using Mustardé temporojugal and frontal flaps, conjunctive using a palatine mucosal graft, lacrimal canal using conjuctivo-rhinostomy, the medial canthal ligament using a fascia lata graft and transnasal canthopexia. Both patients developed an ectropion which required revision surgery. At 2 years, the functional outcome is good. Reconstruction allowed adapted social life and the cancer was controlled successfully.

Adult↗
PubMed2006

[Lacrimal adenocarcinoma and anophtalmos].

INTRODUCTION: The classical symptoms of orbital tumors are modified in the event of an anophthalmic socket. CASE REPORT: We report a case of primary malignant neoplasm of the lacrimal gland in an enucleated 70-year-old women. DISCUSSION: Patients with an anophthalmic orbit often present postenucleation socket syndrome: problems of tolerance and rocking of the ocular prothesis, enophthalmos, ptosis, lower eyelid ectropion. Development of a malignant tumor of the lacrimal gland is however exceptional. An oversized lacrimal gland is suggestive of tumor development. Rigorous clinical and radiological follow-up (CT, MRI) is essential. We discuss diagnostic and therapeutic aspects including the type of exenteration, radiotherapy, and reconstruction technique.

Adenocarcinoma↗
PubMedDate not supplied

Botulinum-A toxin in the treatment of craniocervical muscle spasms: short- and long-term, local and systemic effects.

Botulinum toxin has become the initial treatment of choice for the management of essential blepharospasm, hemifacial spasm and other craniocervical dystonias. Numerous studies have confirmed a 90% to 95% response rate. Although a number of common side effects have been reported, the occurrence and incidence of rare local complications remains poorly understood. More importantly, the acute and chronic distant effects of botulinum toxin have not been clearly elucidated. A better understanding of such effects is essential if clinicians are to appropriately advise patients on the use of this therapeutic modality. This article is based on the Duke University experience in the management of over 500 patients with craniocervical spasm disorders, combined with a review of the published literature. These disorders include essential blepharospasm, oromandibular dystonia, hemifacial spasm, and torticollis. The incidence of side effects following more than 6000 treatments with botulinum toxin is presented. Pertinent research relating to the causes of these complications is also reviewed. The most common complications of treatment with botulinum toxin are related to acute local effects resulting from chemodenervation. The most important clinical effect in this group is weakening of the levator muscle resulting in ptosis, and the corneal consequences of lagophthalmos. The latter includes exposure keratitis, dry eyes, blurred vision, and hypersecretion epiphora. Less common local effects include facial numbness, diplopia, and ectropion. Some distant effects are being observed with increasing frequency. These include pruritus, dysphagia, nausea, and a flu-like syndrome. Most significant, however, are the rare reports of generalized weakness and the documentation of EMG abnormalities distant to the site of toxin injection. This has been seen with injections for both blepharospasm and torticollis. Until further studies on the long-term distant complications of botulinum toxin are available, it is recommended that patients receive as few life-time doses of toxin as possible, consistent with adequate management of their spasms. The practice of reinjecting patients routinely every three months, or at the first return of mild spasms should be discouraged.

Blepharospasm↗
PubMed2000

Chronic eyelid lymphedema and acne rosacea. Report of two cases.

OBJECTIVE: The authors describe the clinical findings and surgical treatment of two patients affected by chronic eyelid lymphedema associated with facial acne rosacea. DESIGN: Two interventional case reports. METHODS AND INTERVENTION: The clinical diagnosis of acne rosacea was based on the physical examination and confirmed by the histopathologic findings obtained from biopsy of the involved tissue. Surgical treatment was required to address the disfiguring chronic eyelid lymphedema and to correct the resultant mechanical lower eyelid ectropion in both patients. RESULTS: Surgical debulking of the affected soft tissue resulted in very satisfactory cosmetic and functional improvement in both patients. CONCLUSIONS: To our knowledge, this is the first series of cases of chronic eyelid lymphedema secondary to acne rosacea reported in the ophthalmic literature. Six similar cases have been described previously in the dermatologic literature; all of which had been treated medically without satisfactory results. Surgical debulking of the involved eyelids should be considered in patients affected by persistent symptomatic rosacea lymphedema.

Aged↗
PubMed2001

Lower eyelid medial canthal tendon laxity grading: an interobserver study of normal subjects.

OBJECTIVE: To describe a simple grading system for medial canthal tendon (MCT) laxity and measure its reproducibility. STUDY DESIGN: Observational case series and interobserver variability study. PARTICIPANTS: Fifty subjects (100 lower eyelids) without eyelid disease. The age range was 19 to 98 years. METHODS: Subjects without eyelid pathology or previous surgery were selected. Two ophthalmologists assessed the position of the inferior punctum in relation to the cornea with the patient in primary gaze. Two measurements were made, the first with the lower eyelid at rest and then with the lateral distraction test. Both observers were masked to the other observer's measurements. MAIN OUTCOME MEASURES: Kappa statistics to show the strength of agreement between the two observers for the resting and lateral distraction eyelid positions. RESULTS: High kappa values were found for resting position (agreement in 92 of 100 eyelids) and for lateral distraction testing (agreement in 85 of 100 eyelids). The range of resting positions was from position -1 to position 1. The range of laterally distracted positions was from position 0 to position 5. Overall, a very high level of agreement was achieved between observers. CONCLUSIONS: This grading system for MCT laxity is simple, easy to learn and reproducible, easier than measuring in millimeters, and has an advantage over merely saying the tendon is "lax" or "not lax." We propose this standardized grading system in the evaluation of patients with entropion and ectropion to identify those patients who may benefit from MCT stabilization/plication.

Adult↗
PubMed2002

Diffuse iris melanoma: a report of 25 cases.

BACKGROUND: Diffuse iris melanoma is a rare variant of iris melanoma that has a flat growth pattern and often presents as unilateral hyperchromic heterochromia and glaucoma. There have been no large clinical reports of diffuse iris melanoma. DESIGN: Single-center retrospective case series. PARTICIPANTS: Twenty-five consecutive patients with diffuse iris melanoma. METHODS: A review of the clinical features, management, histopathologic analysis, and prognosis was performed. MAIN OUTCOME MEASURES: Clinical features, histopathologic features, management, and prognosis. RESULTS: At the time of diagnosis, the mean patient age was 49 years. The initial complaint was unilateral darker eye color in 13 cases (52%) and blurred vision in 6 (24%). Six patients (24%) were symptom free. On presentation elsewhere, the initial diagnosis was iris melanoma or nevus in 11 cases (44%) and glaucoma in 14 (56%), 8 (32%) of whom had prior laser or surgical treatment for glaucoma. The 25 patients were observed for a mean of 30 months before the diagnosis of melanoma was suspected and referral to our center for evaluation. The mean intraocular pressure at referral was 36 mmHg, and the mean number of clock hours involved by tumor was 11. Heterochromia iridis was present in all 25 cases (100%), corectopia in 23 (92%), and ectropion iridis in 21 (84%). Associated findings included unilateral cataract in 8 (32%), a prominent episcleral (sentinel) vessel in 7 (28%), and anterior chamber inflammation in 5 (20%), and synechiae (anterior or posterior) in none. The tumor was managed by enucleation in 22 cases (88%) and by plaque brachytherapy in 3 (12%). Five cases (20%) were classified as spindle melanoma, 17 (68%) as mixed cell type, and 3 (12%) as epithelioid cell type. Therefore, histopathologic examination showed that 80% of cases contained epithelioid cells. All 22 enucleated cases were found to have tumor invasion in the trabecular meshwork. Tumor invasion of Schlemm's canal was found in 18 (82%), minor pars plicata in 12 (55%), and episclera in 7 cases (28%). Of seven cases with episcleral invasion, four underwent surgical treatment for glaucoma. Excluding one recent case, the patients were observed for a mean of 78 months. Liver metastasis developed in 3 cases (13%). CONCLUSIONS: Diffuse iris melanoma is a serious ocular condition that causes unilateral hyperchromic heterochromia and secondary glaucoma, often leading to a delay in diagnosis. Local invasion of adjacent ocular structures is common, and distant metastasis occurs in 13% of cases at mean follow-up of 78 months.

Adolescent↗
PubMed1978

Evaluation of the blepharoplasty patient.

Since blepharoplasty can mean almost any surgery involving the eyelids, it is necessary that during the evaluation of the patient, his expectations be realistically correlated with the limitations and probable outcome of the operation. Specific examination points include scars, pigmentation, wrinkles, and symmetry of the brows and lids. Tone of the lower lids is checked to eliminate postoperative ectropion. Lastly, cosmetic vs functional blepharoplasty is defined.

Eyelids↗
PubMed1980

Correction of enophthalmos in the anophthalmic orbit.

Enophthalmos with an associated superior sulcus syndrome is a common finding in the anophthalmic socket. Two common causes are: (1) progressive relaxation of the lower eyelid leading to downward migration of the prosthesis and associated ectropion formation; and (2) decreased volume of the orbit. Relaxation of the lower eyelid is corrected with repair and support using autogenous fascia lata. Decreased volume of the orbit is corrected with implantation of RTV silicone. The surgical techniques, surgical complications, ocular prosthetic modifications and follow-up on 20 patients are discussed.

Eye, Artificial↗
PubMed1980

Carbon dioxide laser surgery of the eye and adnexa.

A carbon dioxide laser which functions in both rapid superpulsed and continuous wave mode for use in ophthalmic surgery is described. Rapid superpulsed mode was found more effective in the creation of trabeculectomy-like procedures in glaucomatous human eyes with satisfactory results in 12 of 14 eyes treated. Continuous wave energy was found to be superior when full thickness eye wall resection was performed. The carbon dioxide laser was found to be effective in hemostatic resection and ablation of skin lesions about the eye. Rapid superpulse was found to be more effective when puckering and tissue loss were to be minimized, while continuous wave was found to be effective when shrinkage of tissue, as in the performance of a Ziegler cautery type repair for ectropion, was preferred. Rapid superpulse was found to be more controllable in experimental phacovaporization in cats with anterior capsulotomy being easily performed. Continuous wave was found to be a more efficacious modality for corneal shrinkage although attempts at present to create permanent corneal alterations have been fruitless.

Animals↗
PubMed1980

Cryosurgery for malignancies of the eyelid.

The results of liquid nitrogen spray technique for 310 biopsy-proven eyelid malignancies are reviewed. The raw recurrence rate for basal cell carcinomas of the eyelids with a mean follow-up of almost three years is 4.2%, while the recurrence rate is 6% in 49 cases followed for five years. For all lid malignancies 10 mm or less in diameter, a 2.0% raw recurrence rate was obtained; however, in those lesions larger than 10 mm, this rose to 9.5%. With this form of therapy, basal cell carcinomas with infiltrative, nonelevated, indistinct borders had twice the recurrence rate than those tumors with elevated distinct borders. Twenty-one squamous cell carcinomas treated with cryosurgery with an average follow-up 21.6 months have yet to show a recurrence. Complications with cryosurgery include permanent loss of eyelashes and depigmentation lasting from six months to over six years. Depending on the extent and location of the tumor, eyelid defects occurred. To date, five plastic reconstructive procedures have been required for ectropion or lid defects; however, no lacrimal outflow surgery has as yet been required.

Adult↗
PubMed1980

Mustardé flap lower lid reconstruction after malignancy.

The Mustardé rotational cheek flap has been used to reconstruct the lower eyelids of 55 patients since 1964. Results and complications were well-documented with preoperative and postoperative photographs, and the patients have been followed from one to 14 years with a mean age follow-up of seven years. The most frequent complications were downward contraction and sagging of the flap and ectropion of the lid margin. To prevent them, the zygomatico-cheek flap must be carefully designed, rotated, and sutured as high as possible so that immediately postoperatively, the palpebral fissure is only a narrow slit. The flap's lining should be of nasal septal mucosa and cartilage joined with permanent sutures to the medial and lateral canthal tendons.

Adult↗
PubMed1983

The myofibroblastic component of rubeosis iridis.

Nineteen blind eyes enucleated for painful angle closure-glaucoma secondary to iris neovascularization (rubeosis iridis) were examined by scanning electron microscopy and correlative light and transmission electron microscopy. Fresh and deparaffinized tissue from patients with diabetes mellitus, central retinal vein occlusion, and retinoblastoma were studied. Scanning electron microscopy revealed extensive peripheral anterior synechia formation and flattening and effacement of the anterior iridic surface by a confluent fibrovascular membrane. New vessels on the anterior iris uniformly were hidden beneath a clinically inapparent, superficial layer of myofibroblasts, ie, fibroblastic cells with smooth muscle differentiation. Myofibroblasts may provide the motive force for synechial closure and ectropion iridis in neovascular glaucoma.

Fibroblasts↗
PubMed1983

Lower eyelid blepharoplasty by the anterior approach. Prevention of complications.

Most complications in lower eyelid blepharoplasty by the anterior approach can be prevented if the surgeon has a thorough knowledge of the anatomy and physiology of the lower eyelid and anterior orbit, selects the proper procedure to correct the patient's specific problems, is meticulous in his technique, and provides appropriate postoperative management. Particular attention should be paid to hemostasis prior to wound closure and to avoiding postoperative ectropion or retraction of the lower eyelid.

Adipose Tissue↗
PubMed1984

Corneal endothelial overgrowth of angle and iris. Evidence of myoblastic differentiation in three cases.

Corneal endothelialization of the anterior chamber angle was observed in three cases of iris neovascularization and one case of post-contusion deformity. Scanning electron microscopy in two cases revealed a sheet composed of confluent fusiform cells forming a regular mosaic, growing in a tissue culture-like fashion, and extending over the anterior iris surface. Electron microscopy revealed an endothelial lining continuous with the corneal endothelium extending over the fibrovascular membrane which covered the anterior iris surface in the cases of iris neovascularization and partially extended over the trabecular meshwork in an eye with post-contusion deformity. These endothelial cells possess junctional complexes, apical villi, and prominent basement membrane. In addition, myoblastic differentiation with intracytoplasmic microfilaments, measuring 5 to 6 nm in diameter and often marginally located with fusiform densities, were observed. The presence of myoblastic features may play a role in the ability of corneal endothelial cells to migrate and participate in production of peripheral anterior synechia and ectropion of the iris.

Adolescent↗
PubMed1986

Light and electron microscopic findings with permanent eyeliner.

Pathologic studies were performed on two specimens of eyelid that had been treated with permanent eyeliner (tattooing with ferrous oxide), one specimen excised four days after injection of the pigment, and the other obtained 12 months later. Each patient had undergone an ectropion repair of the lower eyelid that provided the specimen. The specimen studied four days after injection revealed by light microscopy scattered pigment granules within the epidermis and fine granules and small aggregates dispersed within the dermis. No acute or chronic inflammatory cells were observed in relationship to the deposits. The specimen obtained 12 months after eyeliner injection was studied by both light and electron microscopy. No pigment particles were observed within the epidermis, but rather there were coarse clumps of granular material in the dermis. Apart from scattered mast cells, which occasionally contained fine granules, and apart from the macrophages which appeared to have ingested the pigment granules, no other acute and chronic inflammatory cells were found. Electron microscopy demonstrated that while most of the granular material had been phagocytosed by macrophages, occasional granules were found in small dispersions within the cytoplasm of mast cells and fibroblasts of the dermis. Minimal migration of pigment within macrophages occurred to locations around lymphatic channels and within the superficial orbicularis muscle connective tissue.

Aged↗
PubMed1988

Natural course of melanocytic tumors of the iris.

The authors received the charts and photographs of 175 patients who had suspicious melanocytic lesions of the iris and who were followed without treatment. Only eight (4.6%) of these lesions showed clinical evidence of enlargement during follow-up intervals of 1 to 12 years (mean, 4.7 years). Features that were associated with enlargement of the lesion included medial location of the mass on the iris and presence of pigment dispersion onto the adjacent iris and anterior chamber angle structures. Features that were unassociated with growth of the lesion included patient age and sex, intraocular pressure, iris color, tumor size and vascularity, and presence of pupillary distortion, ectropion iridis, and sector cataract. From these results, recommendations are made which can assist the ophthalmologist in the management of pigmented iris lesions.

Adult↗
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↗
PubMed1991

Orbicularis oculi muscle extirpation in a combined procedure for involutional entropion.

Many factors are important in the pathophysiology of involutional entropion, including defects of the lower eyelid retractors, canthal tendon laxity, and acquired enophthalmos. The role of the overriding preseptal orbicularis oculi muscle is often ignored in modern techniques of entropion repair. The author describes a technique of extirpation of the preseptal orbicularis oculi muscle combined with repair of the lower eyelid retractors and a lateral tarsal strip procedure for the repair of primary and recurrent involutional entropion. Lateral canthal tendon laxity is recognized in most patients in this age group and must be corrected to avoid postoperative overcorrection and ectropion. Removal of the preseptal muscle had no clinical effect on the lacrimal pump and did not cause any significant cicatricial eyelid abnormalities. This combined procedure has been used in 50 eyelids of 40 patients with excellent functional and cosmetic results. Orbicularis extirpation is not advocated in combination with a marginal rotation procedure.

Aged↗