RESUMEN
Ligneous conjunctivitis (LC) is a rare form of bilateral chronic recurrent disease in which thick membranes form on the palpebral conjunctiva and other mucosal sites. We report the clinical features and describe the management of two cases. Case 1 was an 8-month-old patient with bilateral membranous conjunctivitis. Case 2 was a 5-year-old patient with unilateral membranous conjunctivitis, esotropia, mechanical ptosis and complicated cataract, and had been treated with a number of medications. Histological investigation of the membrane in both cases showed LC. Treatments with amniotic membrane transplantation and institution of topical cyclosporine have shown good response. There has been complete resolution of the membranes with no recurrence at the end of 40- and 28-month follow-ups, respectively. No treatment related side effects were seen. Thus, it appears that amniotic membrane transplantation and topical cyclosporine are effective alternatives for the treatment of LC.
Asunto(s)
Amnios/trasplante , Conjuntiva/patología , Conjuntivitis/terapia , Ciclosporina/administración & dosificación , Administración Tópica , Biopsia , Preescolar , Conjuntiva/efectos de los fármacos , Conjuntivitis/diagnóstico , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Inmunosupresores/administración & dosificación , Lactante , Masculino , RecurrenciaRESUMEN
OBJECTIVE: Involutional ectropion and entropion are characterized by excessive horizontal eyelid length, which is thought to be secondary to laxity of the medial and lateral canthal tendons and to the stretching of the tarsus. Histopathological features of the surgical eyelid specimens from patients with involutional ectropion and entropion were evaluated. DESIGN: Prospective histopathological study. PARTICIPANTS: Eighteen full-thickness eyelid specimens from patients with involutional ectropion and entropion were obtained during horizontal eyelid shortening procedures performed at the Ministry of Health Ankara Training and Research Hospital. METHODS: All specimens were fixed in 4% formaldehyde solution and sectioned sagittally. Hematoxylin-eosin, periodic acid-Schiff, and Masson's trichrome staining were done for all specimens. Histopathologic alterations of the tarsal plate, the palpebral portion of the orbicularis muscle, and the conjunctiva were examined. RESULTS: The patients ranged in age from 60 to 80 years. The main histopathologic features of the ectropic eyelids included collagen degeneration and elastosis of the tarsal plate, increased amounts of adipose tissue in the distal tarsus, and subacute inflammation and epidermalization of the tarsal conjunctiva. Specimens from patients with involutional entropion generally had milder degrees of these histopathological features. CONCLUSIONS: The causes of the excessive horizontal length of the eyelid, which is thought to be secondary to laxity of the medial and lateral canthal tendons, may be collagen degeneration and elastosis of the tarsal plate and canthal tendons.
Asunto(s)
Ectropión/patología , Entropión/patología , Párpados/patología , Tejido Adiposo/patología , Anciano , Anciano de 80 o más Años , Enfermedades del Colágeno/patología , Párpados/cirugía , Femenino , Fibrosis , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Procedimientos de Cirugía PlásticaRESUMEN
PURPOSE: We aimed to report our observation regarding the long-term follow-up results of 2 cases with similar ophthalmic manifestations of 2 different porphyrias, congenital erythropoietic porphyria (CEP), and porphyria cutanea tarda (PCT). METHODS: Both patients presented with ocular pain and photophobia in both eyes. The patient with CEP had a scleral necrosis of 3 mm in diameter at the lateral limbus of the right eye and medial limbus of the left eye, accompanied with cicatricial ectropion and lid swelling OU. The patient with PCT had scleral necrosis in the interpalpebral area nasally, OU. RESULTS: Both patients were followed-up for 4 years. The patients received intensive topical lubrication and topical and oral immune-suppressive medication. They underwent amniotic membrane grafting, when required, and were advised to wear UV glasses. The case with PCT followed a more salient course and remained symptom free until the end of the follow-up period. In contrast, the patient with CEP developed further scleral necrosis, despite the treatment and evisceration surgery were inevitable owing to endophthalmitis unresponsive to the treatment. CONCLUSIONS: Ocular complications are rarely reported in porphyrias, and the studies on the long-term follow-up results are fewer. Despite careful follow-up and intensive treatment, scleral necrosis can be progressive and results in the loss of vision or even the loss of eye. Further studies regarding the care of patients with porphyrias are required to more effectively treat these rare ophthalmic conditions.