RESUMEN
PURPOSE: To report a series of lacrimal complications associated with a specific type of lacrimal plug (Herrick Lacrimal Plug; Lacrimedics Incorporated, Rialto, CA.) DESIGN: Retrospective, noncomparative case series and survey. METHODS: Members of the American Society of Ophthalmic Plastic and Reconstructive Surgery were asked to submit personally treated cases of patients referred for treatment of complications after placement of a Herrick Lacrimal Plug. MAIN OUTCOME MEASURES: Failure of the device to be removed by simple lacrimal irrigation. RESULTS: The clinical courses of 41 patients were analyzed. Patients ranged in age from 19 to 81 years, and all had symptomatic epiphora related to the presence of the lacrimal plug. Several interventions were used to treat lacrimal obstruction. Nasolacrimal duct probing with irrigation was used in 15 lacrimal systems, whereas six systems were probed and subsequently stented with silicone tubing. Eyelid margin cutdown was used in eight cases. Balloon dacryoplasty was performed in three systems, dacryocystorhinostomy in 18 instances, and conjunctivodacryocystorhinostomy in two patients. CONCLUSIONS: The Herrick lacrimal occlusion device sometimes cannot be removed by simple irrigation and is capable of inducing permanent, irreversible, symptomatic lacrimal drainage system obstruction.
Asunto(s)
Dacriocistorrinostomía/instrumentación , Enfermedad Iatrogénica , Obstrucción del Conducto Lagrimal/etiología , Conducto Nasolagrimal/patología , Prótesis e Implantes/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Obstrucción del Conducto Lagrimal/diagnóstico , Masculino , Persona de Mediana Edad , Conducto Nasolagrimal/cirugía , Estudios RetrospectivosRESUMEN
PURPOSE: We present a two-generation family with multiple endocrine neoplasia (MEN) type IIb diagnosed by their ophthalmologists based on characteristic ophthalmic findings. METHODS: A family consisting of a 33-year-old female proband and her 8- and 7-year-old children had prominent corneal nerves; eyelid, lip, and tongue nodules; and a characteristic facies. A polymerase chain reaction-based genetic assay was obtained to detect the genetic mutation most commonly associated with MEN type IIb. Serum calcitonin and urine catecholamine studies were obtained. RESULTS: Molecular genetic studies detected in all 3 patients a mutation at codon 918 of the RET proto-oncogene known to be present in 95% of the cases of MEN type IIb. Serum calcitonin was elevated in the proband and her son. Urine catecholamine levels were elevated in the proband. Surgical treatment and histologic analysis confirmed pheochromocytoma and medullary thyroid carcinoma (MTC) in the proband. Surgical exploration revealed the MTC to be metastatic to the liver. CONCLUSIONS: This family demonstrates the characteristic findings of MEN type IIb: prominent corneal nerves in a clear stroma and multiple submucosal neuromas of the conjunctiva, eyelids, lips, and tongue. Ophthalmologists have a critical role to play in recognizing these signs, because the early diagnosis of medullary thyroid carcinoma and pheochromocytoma may be life saving.
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Neoplasias de las Glándulas Suprarrenales/diagnóstico , Carcinoma Medular/diagnóstico , Proteínas de Drosophila , Neoplasias de los Párpados/diagnóstico , Neoplasia Endocrina Múltiple Tipo 2b/diagnóstico , Neuroma/diagnóstico , Feocromocitoma/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Adulto , Calcitonina/sangre , Catecolaminas/orina , Niño , Córnea/inervación , Análisis Mutacional de ADN , Femenino , Humanos , Neoplasias de los Labios/diagnóstico , Neoplasias Hepáticas/secundario , Masculino , Neoplasia Endocrina Múltiple Tipo 2b/genética , Mutación Puntual , Reacción en Cadena de la Polimerasa , Proto-Oncogenes Mas , Proteínas Proto-Oncogénicas/genética , Proteínas Proto-Oncogénicas c-ret , Proteínas Tirosina Quinasas Receptoras/genética , Neoplasias de la Lengua/diagnóstico , Nervio Trigémino/patologíaRESUMEN
Lower-lid defects can arise from many sources, but they are often the result of excision of lower-lid tumors. The excision of the lesion is often performed by means of a pentagonal wedge resection. After repair of the tarsus and reapproximation of the lid margin, the skin and orbicularis are usually closed in a vertical fashion, which is perpendicular to relaxed skin tension lines and may extend further down the lid than is optimal as a result of a dog-ear excision. The authors propose a new method for closure of skin and orbicularis muscle in repair of lower eyelid marginal defects. This method is simple and has several advantages over vertical closure: it follows relaxed skin tension lines, allows closure of the anterior lamella in the opposite direction from the posterior lamella, and leaves an infraciliary scar rather than a vertical scar extending down the cheek. This method has been used in over 100 patients during the past 8 years, and no significant complications have occurred. Potential disadvantages of the technique include increased vertical tension and a tendency for the lid to be pulled downward. For these reasons, the arrow-head flap would not be the best choice in patients with preexisting lower eyelid retraction, cicatricial ectropion, or vertically tight lower-lid skin.
Asunto(s)
Procedimientos Quirúrgicos Dermatologicos , Enfermedades de los Párpados/cirugía , Músculos Oculomotores/cirugía , Colgajos Quirúrgicos , Humanos , Procedimientos Quirúrgicos OftalmológicosRESUMEN
We prospectively studied 10 patients who were status postenucleation and primary placement of the hydroxyapatite orbital implant. Both the technetium-99m bone scan and gadolinium-enhanced magnetic resonance images (MRI) were obtained on the same day at variable time points in the postoperative period in order to assess the degree of vascularization. Up to 78% of the bone scans were interpreted as being completely vascularized, while only 10% of the corresponding MRI scans were consistent with complete vascularization. Cost analysis showed that MRI was cost-effective imaging modality. We conclude that contrast-enhanced MRI provides a more accurate assessment of vascularization of the hydroxyapatite orbital implant when compared to bone scan.
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Materiales Biocompatibles , Durapatita , Imagen por Resonancia Magnética/métodos , Neovascularización Fisiológica , Órbita/irrigación sanguínea , Órbita/diagnóstico por imagen , Prótesis e Implantes , Tomografía Computarizada de Emisión de Fotón Único/métodos , Adolescente , Adulto , Anciano , Niño , Medios de Contraste , Costos y Análisis de Costo , Enucleación del Ojo , Ojo Artificial , Femenino , Gadolinio , Compuestos Heterocíclicos , Humanos , Imagen por Resonancia Magnética/economía , Masculino , Persona de Mediana Edad , Compuestos Organometálicos , Oseointegración , Estudios Prospectivos , Pentetato de Tecnecio Tc 99m , Tomografía Computarizada de Emisión de Fotón Único/economíaRESUMEN
The authors reviewed 44 tarsoconjunctival grafts performed from 1983 to 1993 to determine the nature and severity of complications related to these grafts. Follow-up ranged from 3 weeks to 10 years, with a mean of 23 months. The complications were categorized as none, minor, or major. A complication was deemed major if it required a second surgical procedure for treatment. Eleven percent (5/44) of patients had major complications, including marked upper lid retraction after upper lid reconstruction (1), wound dehiscence (2), cicatricial ectropion (1), and excessive lower lid laxity (1). Seventy-three percent (32/44) of patients had minor complications. Minor complications included trichiasis (5), notching of the donor and/or recipient lid margin (9), mild lid retraction (3), contour deformity (2), granuloma (2), prolonged edema or erythema (4), symblepharon (1), mild ectropion (2), punctate keratitis (1), minimal ptosis (1), and epiphora (1). Sixteen percent (7/44) had no complications. Despite the frequent minor complications and the occasional major complications, the use of free tarsoconjunctival grafts remains a valuable procedure in the surgeon's armamentarium for reconstruction of major eyelid defects. Knowledge and early recognition of the possible complications may result in better patient care.
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Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Conjuntiva/trasplante , Enfermedades de los Párpados/cirugía , Neoplasias de los Párpados/cirugía , Párpados/trasplante , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Reoperación , Técnicas de SuturaRESUMEN
BACKGROUND: Fungal sinusitis typically occurs in immunocompromised patients. The authors report four cases of fungal sinusitis in immunocompetent young adults, all of whom had proptosis. METHODS: The diagnosis in all four patients was determined after orbital imaging and sinus biopsies. RESULTS: All four patients required surgical removal of the fungal source and anti-fungal chemotherapy postoperatively. CONCLUSION: Patients with proptosis, ocular pain, or other symptoms suggestive of orbital cellulitis unresponsive to antibiotic treatment should undergo radiographic imaging. If sinus disease is present, biopsy and culture may lead to the diagnosis of fungal disease. Surgical debridement and the appropriate systemic antifungal therapy usually lead to cure.
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Exoftalmia/diagnóstico , Infecciones Fúngicas del Ojo/diagnóstico , Inmunocompetencia , Micosis/diagnóstico , Sinusitis/diagnóstico , Adulto , Antifúngicos/uso terapéutico , Aspergillus/aislamiento & purificación , Exoftalmia/microbiología , Exoftalmia/terapia , Infecciones Fúngicas del Ojo/microbiología , Infecciones Fúngicas del Ojo/terapia , Femenino , Humanos , Masculino , Hongos Mitospóricos/aislamiento & purificación , Micosis/microbiología , Micosis/terapia , Mucosa Nasal/microbiología , Órbita/diagnóstico por imagen , Órbita/patología , Senos Paranasales/diagnóstico por imagen , Senos Paranasales/efectos de los fármacos , Senos Paranasales/microbiología , Senos Paranasales/cirugía , Sinusitis/microbiología , Sinusitis/terapia , Tomografía Computarizada por Rayos X , Agudeza VisualRESUMEN
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.
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Conjuntiva/cirugía , Enucleación del Ojo , Ojo Artificial , Órbita/cirugía , Femenino , Humanos , Persona de Mediana Edad , Falla de Prótesis , Estudios RetrospectivosRESUMEN
The transconjunctival inferior fornix incision provides access to the floor, rim, lateral, and inferior medial walls of the orbit. Complications of this surgical approach to the orbit are known to be rare but heretofore have not been clearly defined. Over an 8-year period, in an estimated 1200 cases, the authors have encountered cicatricial entropion, lower eyelid retraction, canthal dehiscence, lower eyelid avulsion, canalicular laceration, buttonhole laceration of the lower eyelid, conjunctival chemosis, and lacrimal sac laceration. Attention to anatomic landmarks and sound surgical execution will prevent these complications in most patients.
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Conjuntiva/cirugía , Fracturas Orbitales/cirugía , Complicaciones Posoperatorias/etiología , Adulto , Entropión/etiología , Oftalmopatías/etiología , Hemorragia del Ojo/etiología , Párpados/lesiones , Femenino , Humanos , Complicaciones Intraoperatorias/prevención & control , Masculino , Persona de Mediana EdadRESUMEN
Transient epiphora following rhinoplasty or intranasal procedures is a common occurrence. Permanent nasolacrimal duct obstruction, however, is rare. This article documents four cases of nasolacrimal duct obstruction following intranasal antrostomy. Three patients were cured by dacryocystorhinostomy and a fourth refused surgery. The anatomy of the nasolacrimal duct in the inferior meatus has considerable variation. Although the duct typically opens in the inferior meatus immediately under the insertion of the inferior turbinate, the orifice can be a single hole, a slit, multiple holes, or a trough, and can be located anywhere from 30 to 40 mm dorsal to the anterior nares. We review the embryology and anatomy of the nasolacrimal orifice in the nose and make recommendations for safe surgery in the inferior meatus.
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Obstrucción del Conducto Lagrimal/etiología , Cavidad Nasal/cirugía , Complicaciones Posoperatorias , Adulto , Anciano , Dacriocistorrinostomía , Femenino , Humanos , Masculino , Conducto Nasolagrimal/lesionesRESUMEN
Patients who have a paranoid disorder have a general expectation of being exploited or harmed. Assessment of personality and mental health is an important aspect of the preoperative patient evaluation. Paranoid patients can be troublesome or even physically dangerous, but may be difficult to detect preoperatively. We recount our experiences with such a patient and suggestions are made for detecting these patients and managing them. Care should be taken to avoid cosmetic facial surgery on such patients.
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Trastornos Paranoides/diagnóstico , Pacientes/psicología , Procedimientos Quirúrgicos Operativos , Adulto , Párpados/cirugía , Femenino , HumanosRESUMEN
Cherubism is a rare, fibroosseous lesion of the jaws that may have orbital manifestations of proptosis, lower eyelid retraction, superior globe displacement, and visual loss. Management of the orbital tumors in two cases from the same family is described. The original description of the disorder is reviewed. The inheritance pattern is autosomal dominant. Pathology findings show multinucleated giant cells in a vascular fibrous stroma. Teeth are often missing or displaced. Radiographic studies show symmetric cystic lesions in the jaws and sometimes involvement of the orbital floor and lateral orbital wall. Fibrous dysplasia is in the differential diagnosis, but can be distinguished by clinical characteristics. Treatment may involve curettement or recontouring of the bony lesions.
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Querubismo/patología , Enfermedades Orbitales/patología , Adolescente , Querubismo/genética , Femenino , Humanos , Persona de Mediana Edad , Enfermedades Orbitales/genética , LinajeAsunto(s)
Intubación/instrumentación , Aparato Lagrimal , Preescolar , Diseño de Equipo , Femenino , Humanos , Lactante , MasculinoRESUMEN
A syndrome of the typical patient with a dacryolith in the lacrimal sac or nasolacrimal duct is described, based on review of 107 consecutive patients undergoing dacryocystorhinostomy (DCR) and 43 patients with a history of dacryocystitis. The incidence of dacryolithiasis was 14% of all patients having a DCR. The typical patient with a dacryolith was 45 years old, had a 4.8 year history of intermittent epiphora, had at least one episode of acute dacryocystitis, and could be irrigated with some fluid getting into the nasopharynx. Patients undergoing DCR with a history of acute dacryocystitis had a nine times higher likelihood of having a dacryolith than DCR patients without a history of acute dacryocystitis. DCR was curative in all 15 patients with a dacryolith.
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Cálculos/complicaciones , Enfermedades del Aparato Lagrimal/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cálculos/epidemiología , Cálculos/patología , Cálculos/cirugía , Niño , Preescolar , Dacriocistitis/complicaciones , Dacriocistorrinostomía , Femenino , Humanos , Incidencia , Lactante , Enfermedades del Aparato Lagrimal/epidemiología , Enfermedades del Aparato Lagrimal/patología , Enfermedades del Aparato Lagrimal/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SíndromeRESUMEN
Classical techniques of reconstruction of large eyelid defects require temporary occlusion of the eye. Use of a free autogenous tarsoconjunctival graft with a skin-muscle flap is described. Twelve patients were operated with ten good, two fair, and no poor results. This method can be used to repair medial, lateral, and central defects of the upper and lower eyelids.
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Neoplasias de los Párpados/cirugía , Párpados/trasplante , Adulto , Anciano , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Complicaciones Posoperatorias , Cirugía Plástica/métodos , Colgajos QuirúrgicosRESUMEN
Traumatic avulsion of the common canaliculus was repaired in one patient by using a segment of the angular vein as an autograft. The vein graft served as a functional anastomosis between the lacrimal sac and both upper and lower canaliculi. The technique is a viable alternative for functional repair of the acutely lacerated lacrimal drainage system in which canalicular tissue is missing.
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Aparato Lagrimal/cirugía , Venas/trasplante , Adulto , Anastomosis Quirúrgica/métodos , Humanos , Aparato Lagrimal/lesiones , MasculinoRESUMEN
In this series of 24 patients with 28 canalicular lacerations, bicanalicular silicone intubation is found to be an effective technique with 95% anatomic success. No statistically significant difference is noted in successful repair when comparing proximal, mid, and distal lacerations. There are no recognized cases of iatrogenic injury to either the injured or the uninjured canaliculus in this series. The repair of all canalicular lacerations is advocated.
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Intubación , Aparato Lagrimal/lesiones , Adolescente , Adulto , Niño , Preescolar , Lesiones Oculares/cirugía , Lesiones Oculares/terapia , Femenino , Humanos , Lactante , Aparato Lagrimal/cirugía , Masculino , Persona de Mediana Edad , Pronóstico , Elastómeros de Silicona , Procedimientos Quirúrgicos Operativos/métodosRESUMEN
51 patients with orbital floor fractures were studied retrospectively to evaluate results in relation to time of surgical repair and fracture size. Early repair (less than 2 months) gave better results than late repair (greater than 2 months) in regard to both enophthalmos and extraocular muscle dysfunction. Large fractures (greater than one-half floor or greater than or equal to 15 fracture volume units) were most likely to be associated with significant enophthalmos after surgery. We recommend tomography when necessary to estimate fracture size, and advise early repair of large fractures, preferably within two weeks after injury. Patients with significant extraocular muscle dysfunction due to tissue entrapment, regardless of fracture size, should be repaired early, preferably within 2 weeks after injury, if improvement does not occur spontaneously by that time.