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PubMedDate not supplied

[Ocular changes in Down's syndrome].

The authors analyzed the kind of ocular changes and methods of therapy in 34 children, aged 5 months to 14 years, treated in the clinic in the years 1982-1992. The most frequent change was congenital cataract. The other signs observed were: Brushfield's spots, alternate esotropia, nystagmus, partial optic atrophy, retinal detachment, congenital glaucoma, ectropion and keratoconus. Occurrence of several anomalies were frequent. The adequate surgical treatment was applied depending on the kind of changes. Cataract extraction was made by aspiration method. Visual acuity improved in 58.8% of eyes.

Adolescent↗

PubMed1976

Overcorrections of the Wies procedure.

The Wies procedure may be complicated by an overcorrection, which is in effect a cicatricial ectropion. Four cases of such a complication are presented. The mechanism of an overcorrection is related to the level of the incision in the lid and to the suture placement. Correction of this complication primarily involves lysing cicatricial bands maintaining the overcorrection. Placement of sutures maintains the lid in a normal position.

Adult↗

PubMed1994

Prader-Willi syndrome.

BACKGROUND: First described in 1956, Prader-Willi syndrome is a neurogenetic condition characterized by infantile hypotonia, hypogonadism and obesity. Mental deficiency, behavioral abnormalities, and obvious dysmorphic features are frequently found as well. It is a relatively common condition, with an incidence estimated to be between 1 in 10,000 to 25,000 live births. Few studies have been published that investigated the ocular defects associated with this syndrome. METHODS: This case report discusses the systemic and oculo-visual abnormalities of a 34-year-old white male enrolled in the Easter Seal Society of Metropolitan Chicago/Illinois College of Optometry Eye Care and Treatment Program. Examination techniques commonly used for patients with cognitive/developmental dysfunctions were utilized. RESULTS: Our findings include ocular hypopigmentation with reduced visual acuity, a myopic refractive error, exotropia, corneal abnormalities, glaucoma, and other ocular and systemic health abnormalities. CONCLUSIONS: Reported ocular findings for patients with Prader-Willi syndrome include iris hypopigmentation with depressed visual acuity, moderate to high refractive error, and strabismus. Individual patients with this syndrome have also been reported with cataracts, congenital ocular fibrosis syndrome, diabetic retinopathy, and congenital ectropion uveal. The numerous ocular, systemic, and functional abnormalities of patients with Prader-Willi syndrome make it mandatory that all routinely receive primary optometric vision care.

Adult↗

PubMedDate not supplied

[The complications and outcomes of fractures of the orbital-maxillary-zygomatic complex].

Thirty-three cases of complicated zygomatic-maxillary complex fractures and their complications and sequelae are analysed. Permanent alterations in infraorbital nerve sensitivity (4 cases), amaurosis caused by enucleation of globus (2 cases), diplopia recovered in sixteen cases without treatment and after operation in two cases, ectropion (1 case), subcutaneous emphysema (1 case), scars (3 cases) have been surveyed.

Adult↗

PubMed1993

Miller postaxial acrofacial dysostosis. The phenotypic changes with age.

We report data on the clinical and psychological follow-up of a boy with Miller postaxial acrofacial dysostosis syndrome between the ages of 1 and 7 years. After an initial psychomotor retardation intellectual and social function improved significantly after the use of hearing aids (50-70 db bilateral hearing loss). The facial appearance changed with age: the face became asymmetric and triangular with more pronounced ectropion and fine, thin lips.

Abnormalities, Multiple↗

PubMed1996

[Diagnosis and treatment of conjuncitivitis].

Conjunctivitis is a frequent reason for consulting a doctor. Most often treatment consist of antibiotics, even though sensitive bacteria are only rarely demonstrated. In our part of the world conjunctivitis is self-limiting, and it may be worth considering the effect of treatment, if any. With this in mind, diagnosis and differential diagnoses are reviewed, and with regard to treatment distinctions are made between neonatal conjunctivitis (gonococcus, chlamydia, virus), conjunctivitis in children (symptoms of upper respiratory tract infections), and conjunctivitis in adults and the elderly (dry eyes, epiphora in ectropion).

Adult↗

PubMed1996

[Diagnosis and treatment of conjunctivitis].

Conjunctivitis is a frequent reason for consulting a doctor. Most often treatment consists of antibiotics, even though sensitive bacteria are only rarely demonstrated. In our part of the world conjunctivitis is self-limiting, and it may be worth considering the effect of treatment, if any. With this in mind, diagnosis and differential diagnoses are reviewed and with regard to treatment distinctions are made between neonatal conjunctivitis (gonococcus, chlamydia, virus), conjunctivitis in children (symptoms of upper respiratory tract infections), and conjunctivitis in adults and the elderly (dry eyes, epiphora in ectropion).

Administration, Topical↗

PubMedDate not supplied

[Closed hemorrhoidectomy].

In the closed hemorrhoidectomy wounds are completely sutured. Ferguson and Whitehead operations, the latter modified in order to avoid mucosal ectropion and stenosis, are the most performed closed hemorrhoidectomies. 15% Ferguson operations, 10% Whitehead-Rand operations, and 75% Milligan and Morgan operation were performed among 400 hemorrhoidectomies. Author discusses indications for closed hemorrhoidectomy; techniques are described, complications and results reported.

Hemorrhoids↗

PubMedDate not supplied

[Complications of the surgical treatment of hemorrhoids and its therapy].

Hemorrhoidal disease is a common problem in a proctological ambulatory. Surgery is the best therapy for fourth degree hemorrhoids and the complication rate is 10-20%: postoperative urinary retention etiology is unknown but it may be caused by dysfunction of bladder muscles in response to pain and by an excessive perioperative somministration of fluids; delayed hemorrhage (i.e., 7-10 days postoperative) needs an inpatient care and the treatment ranges from bedside and packing to hemorrhoid pedicle suture ligation in the operating room. Anal stenosis is most commonly a result of a prior improper hemorrhoidectomy: it may be mild, moderate or severe; V-Y and C-anoplasty are the best therapy, also for ectropion. Rubber band Ligation and Sclerotherapy are the most common treatment of internal hemorrhoids: external hemorrhoid trombosis and delayed hemorrage are frequent complications.

Anal Canal↗

PubMed1996

[Urethral prolapse in young black girls. Report of 12 cases].

While this benign tumor of female urethra is relatively rare, reported here are 12 cases of complete mucusa ectropion observed in female black girls. The cases were studied from January 1987 to May 1994, first in Gabon (7 cases) then in Niger (5 cases), all the cases concerned girls below 10 yrs old. The revealing symptom was vulvar bleeding (9 cases) or blood in the urine (2 cases). The remaining case was discovered incidentally. Diagnosis was done at the vue of a pinkish orange soft mass, found in the center of the meatic opening, and which frequently bled on contact. Treatment was exclusively surgical, consisting of a tumoral resection followed by success in all of the cases. This experience while insisting on the rareness of this tumoral illness, strongly suggests a possible predisposition in black girls, where the incidence is underestimated. A more certain diagnosis can be done after analysis of the histological aspects. Although the number of cases reported here is quite limited, the good quality of the results obtained by the treatment demonstrate the value of this surgical management, likewise, certain of its technical details are described in the article. Considering the relative simplicity of the technique, its rapid, long lasting efficiency, and the absence of post operative complications, the author concludes that surgical resection is the treatment of choice for the cure of this benign tumor.

Black People↗

PubMed1996

[Reinterventions in secondary incontinence].

Overlapping sphincter reconstruction for fecal incontinence due to perineal tears, trauma or iatrogenic injuries is the therapy of choice. If this technique fails repeatedly or more than half of the sphincter is destroyed, a gracilis muscle plasty is indicated. Incontinence caused by an ectropion must be treated by a skin flap procedure (Ferguson or VY-plasty). These techniques are described in detail. Results of 54 overlapping procedures carried out in 47 patients (30 females, 17 males, age 15-84, median 47 years) during the last 3.5 years are presented. The most frequent cause of incontinence was fistulectomy followed by perineal tears. Thirty-day success rate with excellent or good results (difficulty in controlling flatus) was 82%, decreasing to 70% at the end of follow-up. Complications were rare (7/54) and did not influence outcome except for wound healing by second intention, which resulted in a high failure rate. Superior results were achieved when the reason for incontinence was a perineal tear (81%, compared with fistulectomy (64%). In conclusion, overlapping sphincter reconstruction results in a high success rate, especially when fecal incontinence was caused by a perineal tear.

Adolescent↗

PubMed1996

Leaving the eyelid to its own devices.

As oculoplastic surgery is preferred for direct closure of lid defects, spontaneous wound healing after excision of lid tumors is not common. Thus, spontaneous reformation of lid defects as an alternative treatment to surgical procedures was investigated. In 12 patients with a clinical diagnosis of basal-cell carcinoma, lid tumors were removed surgically by full-thickness excision in 1 group (n = 6) or cutaneous excision only in the other group (n = 6). The mean follow-up period was 5 months in the first group and 9 months in the second group. Cosmetic and functional results were satisfactory in all patients. The scar tissue simulated the former tarsus. The wounds were completely covered by a normal-appearing epithelium. Spontaneous wound healing may lead to considerable stiffness of the lower lid and to an acceptable reformation of the lid margin. There was no elevation of the lid margin and, remarkably, no secondary surgery due to an entropion or an ectropion was necessary.

Adult↗

PubMed1996

Operative results of House advancement anoplasty.

A retrospective review of 29 patients who had an anoplasty using the sliding House advancement flap was carried out to evaluate the efficacy and safety of this new technique. Long-term symptom relief and late complications were determined by telephone interview. Indications for anoplasty were: stenosis (21 cases), ectropion (four), Bowen's disease (two), keyhole deformity (two) and perineal fistula (one). A single House flap was performed in most patients, but eight required multiple flaps. Lateral internal sphincterotomy was performed concomitantly in 16 of 21 patients with anal stenosis. Postoperative complications included donor-site separation (14), urinary retention (eight) and sepsis (four). At a median follow-up of 28 months, 26 of 29 patients had improved and 24 were completely satisfied. House flap anoplasty can be used to correct many anoderm deficiencies with a high rate of success and patient satisfaction.

Adult↗

PubMed1996

[Results with a new therapy concept in anal fistula: suture of the anal sphincter].

Eleven patients with suprasphincteric, translevatoric, or high transsphincteric fistula and 10 patients with low (transsphincteric or intersphincteric) fistula were treated by fistulectomy using sphincterotomy or a transsphincteric approach, with primary sphincter reconstruction. After a follow-up of 2-9 months one patient had a recurrence and in a further patient the internal anal sphincteric suture had become dehiscent, necessitating sphincteroplasty. 20 patients (95%) had a perfect anatomic and clinical functional result without recurrence. Fistulectomy with primary closure proved to be a safe treatment modality for primary and recurrent high and low fistula, with the advantages of rapid wound healing and of avoidance of continence disturbance due to sphincter division, anal canal deformity, or mucosal flap ectropion.

Adult↗

PubMed1997

[Inferior blepharoplasty: the transconjunctival approach].

Described in 1924 by J. Bourguet, the transconjunctival approach seems to have experienced a resurgence of interest in recent North American publications. The incision, made under local anaesthesia along the inferior border of the tarsal cartilage, provides a plane of dissection which can be either preseptal, in which the approach to the bags is made through the septum as in the classical approach, or alternatively retroseptal, a route which respects the integrity of the septo-orbicular suspension, and allows a direct approach to th bags. Removal of fat should be limited to the excess tissue which protrudes when pressure is applied to the globe, using the orbital rim as a landmark. After haemostasis, closure is provided by means of a gathering stitch which is removed on the 4th day. The indications are young patients who present with bags with no excess of either skin or muscle (preseptal approach), dark-skinned patients in whom there is a risk of scarring (keloid), and older patients (retroseptal approach) who present with hyperlaxity of the septo-ligamentous mechanism, and in whom the "round eye" or an ectropion might result from a classical approach. In this last group, the excessive skin may be excised a minima without undermining. Finally, in cases of fat remnants after the classical approach, the transconjunctival approach offers an easy solution. Complications are extremely rare. It is for this reason that the transconjunctival approach is tending to become the standard approach for many modern authors.

Eyelid Diseases↗

PubMed1996

Pre-septal cellulitis--varied clinical presentations.

Preseptal cellulitis has a typically benign course when treated with antibiotics, the clinical course depending on age of the patient, aetiology and the causative organism. In this study, 14 cases of preseptal cellulitis are documented with the age ranging from 2 to 55 years. The organisms isolated were Staphylococcus aureus (7 cases), Streptococcus pyogenes (2 cases) and Pseudomonas aeruginosa (1 case). In the remaining four patients no organism could be identified. All except four patients were cured within 6 weeks. Complications seen included lagophthalmos, lid abscess, cicatricial ectropion and lid necrosis in one patient each. The prognosis for preseptal cellulitis is good with appropriate antibiotics and surgical therapy.

Adolescent↗

PubMed1998

Missense mutation at the C terminus of the PAX6 gene in ocular anterior segment anomalies.

PURPOSE: To report a rare case of ocular anterior segment anomalies including uveal ectropion of the iris, invasion of the conjunctival epithelia into the cornea, and posterior embryotoxon with a missense mutation of the PAX6 gene. METHODS: The authors performed polymerase chain reaction-single-strand conformation polymorphism analysis and sequencing of the PAX6 gene using genomic DNA of family members and more than 100 control subjects. RESULTS: The A to G transition at nucleotide 1682 in exon 13 in the patient was identified in an allele that resulted in a Gln to Arg substitution (Q422R) at the C terminus of the protein. The mutation was not found in the parents, a sibling, or control subjects. CONCLUSIONS: The mutation indicates that the proline-serine-threonine-rich domain at the C terminus of the PAX6 protein plays a role in ocular anterior segment morphogenesis.

Anterior Eye Segment↗

PubMedDate not supplied

Lid surgery to reduce discomfort produces an unexpected improvement in visual acuity--a case presentation.

A significant cause of blindness in leprosy is corneal scarring secondary to corneal anaesthesia and lagophthalmos (Brand & ffytche 1985). Such patients may continue to experience considerable ocular discomfort, particularly when there is associated ectropion of the lower lid, with inflammation of the exposed tarsal conjunctiva (Courtright & Johnson 1991). Where visual outcome is no longer the primary consideration, one may hesitate to subject patients to surgery, particularly in relatively unsophisticated field conditions, attempting instead to relieve the patient's discomfort by conservative treatment such as frequent topical ocular lubricants, use of protective spectacles or eye shades etc. A case is presented here in which minor surgery aimed solely at relieving ocular discomfort resulted in an unexpected improvement in visual acuity. This suggests that there are instances where a more aggressive approach to treatment of even severely damaged eyes could prove more rewarding than anticipated.

Eyelid Diseases↗