RESUMEN
PURPOSE: To determine whether patients with complete, acquired nasolacrimal duct obstruction may be treated with broad spectrum oral antibiotics and office lacrimal irrigation. METHODS: In a retrospective review, patients with complete, primary acquired nasolacrimal duct obstruction (NLDO) were divided by predominant symptoms and signs into two main groups: (a) those with tearing and/or mucous discharge and (b) those with previous acute dacryocystitis and/or lacrimal sac mucocele. All patients received a therapeutic trial of oral and topical antibiotics followed by lacrimal irrigation. RESULTS: Five of 55 patients with tearing and/or mucous discharge showed significant improvement after treatment with a mean follow-up of 16.5 months. A sixth patient with mucous and tearing had resolution of the mucous discharge but persistent tearing and blockage of the nasolacrimal system to irrigation. Two of 20 patients with lacrimal sac mucocele or history of acute dacryocystitis avoided surgery while 18 opted for early lacrimal surgical intervention. CONCLUSIONS: Conservative management of complete acquired NLDO consisting of oral and topical antibiotics and appropriately timed office lacrimal drainage system irrigation may be considered in selected patients.
Asunto(s)
Antibacterianos , Quimioterapia Combinada/uso terapéutico , Obstrucción del Conducto Lagrimal/tratamiento farmacológico , Administración Oral , Administración Tópica , Adulto , Dacriocistitis/etiología , Dacriocistitis/prevención & control , Quimioterapia Combinada/administración & dosificación , Estudios de Seguimiento , Humanos , Obstrucción del Conducto Lagrimal/complicaciones , Mucocele/etiología , Mucocele/prevención & control , Irrigación Terapéutica , Resultado del TratamientoRESUMEN
OBJECTIVES: To determine the effects of upper-eyelid surgery (limited myectomy, blepharoplasty, and levator aponeurotic advancement) on patients who demonstrated a suboptimal response or residual heaviness of the upper eyelids after botulinum toxin eyelid injections for facial dyskinesia. DESIGN: Retrospective study. SUBJECTS: Charts of 358 patients with a diagnosis of benign essential blepharospasm, Meige syndrome (with eyelid involvement), and hemifacial spasm were reviewed. METHODS: Data were retrospectively analyzed and included subjective and objective responses about botulinum toxin injections (number and duration of effect of injections before and after eyelid surgery). RESULTS: Of 358 patients with facial dyskinesias, 14 (3.91%) underwent upper-eyelid limited myectomy with or without upper-lid blepharoplasty (n = 5), upper-lid blepharoplasty alone (n = 6), or levator advancement with or without blepharoplasty (n = 3). Mean subjective improvement was 68.75% after limited myectomy combined with blepharoplasty and 58.33% after levator and/or blepharoplasty surgery. Average duration of effect of injections increased from 122.1 days in the patients prior to undergoing eyelid surgery to 210.5 days after surgery. CONCLUSIONS: Upper-eyelid surgery, including limited myectomy, enhanced the effect of the botulinum toxin in this small group of patients. Patients with a suboptimal response to injections in terms or moderate to marked dermatochalasis with subjective heaviness of the eyelids, upper-eyelid blepharoplasty, and/or limited myectomy should be considered.
Asunto(s)
Antidiscinéticos/administración & dosificación , Blefaroespasmo/tratamiento farmacológico , Blefaroespasmo/cirugía , Toxinas Botulínicas/administración & dosificación , Párpados/cirugía , Espasmo Hemifacial/tratamiento farmacológico , Espasmo Hemifacial/cirugía , Síndrome de Meige/tratamiento farmacológico , Síndrome de Meige/cirugía , Anciano , Blefaroplastia/métodos , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de TiempoRESUMEN
PURPOSE: To investigate the role of orbital computed tomography (CT) in the evaluation of patients after dacryocystorhinostomy (DCR). METHODS: Computed tomography scans of patients who underwent both successful and failed DCR were examined to determine the relationship of the soft-tissue changes to the surgical ostium, and the findings were correlated with postoperative results of office probing and irrigation. RESULTS: After a successful DCR (n = 7), a patent fistulous tract was confirmed by office probing and irrigation. A characteristic "Y-on-its-side" configuration of the soft tissue was noted on a CT scan. Total occlusion of the osteotomy by soft tissue on probing and irrigation corresponded to a mucocelelike soft-tissue density with a central lucency and soft-tissue obstruction (n = 2). Total occlusion of the osteotomy by inadequate excision of bone and adjacent soft tissue, visualized by CT imaging, was confirmed by palpation of bone by office probing (n = 1). Partial obstruction on probing and irrigation was associated on a CT scan with an increased soft-tissue density (n = 4) and bone in the region of the osteotomy (n = 3). CONCLUSIONS: Computed tomography allows visualization of a patent fistula after successful DCR as well as soft-tissue or bone obstruction of the surgically created fistula after failed DCR. When combined with probing and irrigation, CT helps to formulate a surgical plan after failed DCR.
Asunto(s)
Dacriocistorrinostomía , Órbita/diagnóstico por imagen , Irrigación Terapéutica/métodos , Tomografía Computarizada por Rayos X , Antibacterianos/administración & dosificación , Glucocorticoides/administración & dosificación , Humanos , Obstrucción del Conducto Lagrimal/diagnóstico por imagen , Pacientes Ambulatorios , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
Complex orbital rim and fractures of the internal orbital skeleton (orbital walls) are best analyzed by high-resolution axial CT. Optic canal fractures are optimally visualized with thin 1-mm section high-resolution CT scanning. Spiral CT may be used in the acutely injured patient because of its rapid scan technique. This spiral technique provides smooth data sets for three-dimensional reformations and may demonstrate foreign bodies in more than one plane. Another advantage of spiral CT is the capability of CT angiography. MR imaging usually is not the initial modality for the assessment of orbital trauma, but it is helpful in evaluating vascular injuries such as carotid-cavernous sinus fistulas or post-traumatic pseudoaneurysms. In general, CT with contrast injection is not necessary except when traumatic vascular anomalies, such as carotid cavernous, dural fistulas, or thrombosis of the superior ophthalmic vein, are considered in the differential diagnosis.
Asunto(s)
Órbita/lesiones , Fracturas Orbitales/diagnóstico por imagen , Traumatismos de los Tejidos Blandos/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Aneurisma Falso/diagnóstico , Angiografía/métodos , Fístula Arteriovenosa/diagnóstico , Traumatismos de las Arterias Carótidas , Seno Cavernoso/lesiones , Diagnóstico Diferencial , Cuerpos Extraños/diagnóstico por imagen , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética , Órbita/irrigación sanguínea , Órbita/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Trombosis de la Vena/diagnósticoRESUMEN
The results of a "modified" levator aponeurotic advancement were reviewed to determine the appropriate indications and optimum timing for office revision after blepharoptosis repair. The levator advancement was modified as follows: 1) elimination of epinephrine from the local anesthetic so as not to stimulate the Müller muscle, 2) use of a 6-0 silk rather than a monofilament nonabsorbable suture to secure the advanced levator to avoid possible cheese-wiring and late recurrence, and 3) excision of a strip of preseptal orbicularis muscle just above the tarsal border to create surgically apposed "raw" surfaces for a firm attachment of the "advanced" levator. Office adjustments were delayed for at least 8 days after surgery and were performed as late as 14 days after surgery. Of the 122 consecutive aponeurotic advancements in 110 patients (12 bilateral cases), five (4.1%) patients were candidates for revision in that the operated eyelid was greater than 1 mm from desired height. All such eyelids were undercorrected by 2.0 mm to 2.5 mm. Four of the five underwent revision at 8, 11, and 14 days (two patients) after surgery. The fifth patient did not undergo revision. Four patients with overcorrections from 2.0 mm to 2.5 mm resolved with eyelid massage. It is concluded that the number of office revisions may be reduced if delayed for at least 8 days after surgery. This delay allows for resolution of postoperative edema and objective prediction of final eyelid position. The advantages of this "modified" levator advancement procedure are discussed.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Blefaroptosis/cirugía , Párpados/cirugía , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Recurrencia , Reoperación , Estudios RetrospectivosRESUMEN
UNLABELLED: The purpose of this study was to determine whether antidepressant, antimania, antipsychotic, antihistamine, or antiparkinsonian drugs are associated with eyelid and facial dyskinesias; whether discontinuing such drugs results in improvement in the facial dyskinesias; and whether response to botulinum toxin treatment is influenced by such medications. METHODS: A retrospective review was performed on a population of 238 patients with presumed benign essential blepharospasm and Meige syndrome. Types of drugs taken before the development of disease and clinical response to botulinum toxin injections were studied. RESULTS: Fourteen of 238 patients (5.9%) with facial dyskinesias had been prescribed a variety of antidepressants, antimania medications, antipsychotics, antihistamines, antiparkinsonian drugs, or a combination of these substances before their condition developed. The onset of blepharospasm varied from 2 months to 35 years after administration of the drug. Three of seven patients who discontinued the presumed responsible drug had improvement in their facial dyskinesias. Of the 11 patients who did not improve when their drugs were stopped or whose medication could not be stopped, all but one patient had a good response to treatment with botulinum toxin A. CONCLUSIONS: Drug-induced blepharospasm should be considered in all patients who present with facial dyskinesias, and such patients should undergo withdrawal of the medication when possible. When withdrawal of medication is not possible or does not result in improvement in the facial dyskinesia, treatment with botulinum toxin injections should be initiated. The possible role in the production of facial dyskinesias of antidepressants that block reuptake of serotonin requires further evaluation.
Asunto(s)
Antiparkinsonianos/efectos adversos , Blefaroespasmo/inducido químicamente , Fármacos del Sistema Nervioso Central/efectos adversos , Discinesia Inducida por Medicamentos/etiología , Antagonistas de los Receptores Histamínicos H1/efectos adversos , Síndrome de Meige/inducido químicamente , Adulto , Anciano , Blefaroespasmo/tratamiento farmacológico , Toxinas Botulínicas Tipo A/uso terapéutico , Estudios de Cohortes , Discinesia Inducida por Medicamentos/tratamiento farmacológico , Femenino , Humanos , Masculino , Síndrome de Meige/tratamiento farmacológico , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The authors performed a retrospective clinicopathologic review of lymphoid tumors of the orbit and ocular adnexa. In addition, we used an immunohistologic marker for proliferating cell nuclear antigen (PCNA), an intranuclear protein with greatest expression in actively proliferating (dividing) cells, to determine whether levels of PCNA can be correlated with the presence or future development of systemic lymphoma. To the authors' knowledge, the present study represents the first in which PCNA indices, i.e., the number of cells that showed diffuse intranuclear staining for PCNA averaged per 10 high power field (HPF), were correlated with systemic disease in orbital and ocular adnexal lymphomas. The percentage of B- and T-cells in the tumor infiltrate was also determined. Followup data showed that two patients with eyelid involvement had preexisting systemic lymphoma, whereas another with bilateral lacrimal gland disease later developed systemic lymphoma. Followup times ranged from 24 to 42 months (mean 39.7 months). The mean PCNA level in three patients with systemic disease was 13.3 and in the six patients with no systemic disease was 33.8. These results suggest that PCNA alone cannot be used as a marker for the presence of, or development into, systemic lymphoma.
Asunto(s)
Neoplasias de los Párpados/patología , Enfermedades del Aparato Lagrimal/patología , Linfoma/patología , Neoplasias Orbitales/patología , Antígeno Nuclear de Célula en Proliferación/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales , Linfocitos B/patología , Estudios de Cohortes , Neoplasias de los Párpados/metabolismo , Femenino , Humanos , Técnicas para Inmunoenzimas , Enfermedades del Aparato Lagrimal/metabolismo , Metástasis Linfática/diagnóstico , Linfoma/metabolismo , Masculino , Persona de Mediana Edad , Neoplasias Orbitales/metabolismo , Estudios Retrospectivos , Linfocitos T/patologíaRESUMEN
The results of frontalis suspension (double rhomboid technique with preserved homologous cadaver fascia) were compared in two surgical groups: 1) patients in whom the fascia was sutured to the tarsus and 2) patients in whom the fascia was not sutured to the tarsus. The study was performed to determine the optimum surgical technique and to determine whether preserved cadaver fascia is a suitable suspensory material. All data retrospectively reviewed included 1) predisposing cause of severe blepharoptosis, 2) results in the two groups of patients, suture fixation and nonsuture fixation, and 3) surgical complications. Of the 27 patients (36 eyelids), the fascia was sutured to the tarsus in 15 patients (20 eyelids) and not sutured to the tarsus in 12 patients (16 eyelids). In the suture fixation group, no undercorrections occurred, but four of 20 eyelids had lower than expected eyelid creases and six had residual dermatochalasis. Six patients had lagophthalmos with corneal exposure that required intense corneal lubrication, and three such patients required temporary tarsorrhaphy for 3 weeks. In the group without suture fixation, two patients had undercorrection (one with ocular cicatricial pemphigoid and the other with myotonic dystrophy). The mean followup period was 44 months. We conclude that preserved fascia provides excellent results with or without fixation of the fascia to the tarsus. In patients with suture fixation, the eyelid crease may form just above the point at which the fascia is sutured to tarsus and result in a low eyelid crease. Excision of excess skin should be considered at the time of frontalis suspension in selected patients in whom the fascia is fixated to the tarsus or who have preexisting dermatochalasis. Patients with suture fixation may have significant temporary postoperative lagophthalmos.
Asunto(s)
Blefaroptosis/cirugía , Párpados/cirugía , Músculos Faciales/cirugía , Fascia Lata/trasplante , Músculos Oculomotores/cirugía , Técnicas de Sutura , Adulto , Anciano , Cadáver , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Preservación de Órganos , Estudios Retrospectivos , Trasplante Homólogo , Resultado del TratamientoRESUMEN
Complications occurred in six patients after gold weights were implanted into the upper eyelid tissues for fifth and seventh nerve palsies. These complications included implant infection without extrusion (in one patient); entropion with trichiasis and presumed inflammatory reaction to the gold weight material (in one patient); upper eyelid distortion and poor eyelid contour with corneal ulceration and scarring (in one patient); significant residual lagophthalmos with exposure keratitis (in one patient); and blepharoptosis obscuring the pupillary access (in two patients). Resolution of the complications required 1. implant removal in four of six patients without reinsertion of a second weight, 2. recession of the retractors of the upper eyelids with medial and lateral canthoplasty (in four patients), and 3. permanent tarsorrhaphy (in one patient). The authors conclude that complications may be minimized by careful preoperative determination of the optimum implant size, weight, and placement within the eyelid as well as meticulous attention to the surgical technique of implantation. The use of other eyelid protective procedures is often necessary to augment corneal protection especially in patients with combined fifth and seventh cranial nerve palsies. Endogenous implant infection without extrusion of the gold weight may be distinguished from presumed inflammation due to gold allergy by clinical response to antibiotics in the former and requirements of steroids or removal of the implant in the latter.
Asunto(s)
Párpados/fisiopatología , Párpados/cirugía , Nervio Facial/fisiopatología , Oro/efectos adversos , Parálisis/fisiopatología , Parálisis/cirugía , Prótesis e Implantes/efectos adversos , Nervio Trigémino/fisiopatología , Adulto , Anciano , Femenino , Reacción a Cuerpo Extraño/etiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The main indication for dacryocystectomy (DCT) is excision of lacrimal sac tumors. DCT may be considered less invasive than dacryocystorhinostomy (DCR) because lacrimal bone and nasal mucosa are not violated. To determine other indications for DCT, we performed a retrospective review of all patients who underwent DCT from the Oculoplastics Division, Department of Ophthalmology, UMD-New Jersey Medical School from July 1983 through July 1994. Patients with lacrimal sac tumors were excluded from the study. All 25 patients in the study demonstrated complete nasolacrimal duct obstruction (NLDO) and dry eye with minimal preoperative complaints of tearing. Nine of 25 patients also had systemic medical problems making them at medical risk for local anesthesia with monitored sedation. Four of 25 patients had underlying medical conditions (ocular cicatricial pemphigoid [OCP], Crohn's disease, and systemic lupus erythematosus) that might predispose them to nasal scarring after standard DCR. None of the 25 patients required secondary hospital admission and no patient demonstrated or complained of significant tearing that affected daily function after DCT. Although DCR is the standard for improving lacrimal outflow, we conclude that DCT is a useful alternative to it in selected patients with underlying dry eye and other medical conditions.
Asunto(s)
Dacriocistorrinostomía , Aparato Lagrimal/cirugía , Conducto Nasolagrimal/cirugía , Anciano , Anciano de 80 o más Años , Dacriocistitis/complicaciones , Femenino , Humanos , Obstrucción del Conducto Lagrimal/etiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Recurrencia , Estudios Retrospectivos , Técnicas de SuturaRESUMEN
PURPOSE: The purpose of the study was to determine long-term results of involutional entropion repair by a modified corncrib (inverted T) procedure with a Quickert suture. METHODS: A retrospective review of consecutive patients with involutional entropion who underwent repair by a modified corncrib procedure from January 1986 to July 1994 was performed. A full-thickness basedown triangle (corncrib) excised at the lateral limbus corrects horizontal laxity and everts the eyelid margin. The stem of the T is represented by the vertical closure of the eyelid margin and the tarsus. The top of the T is represented by the horizontal wound at the lower tarsal border after excision of an ellipse of skin and preseptal orbicularis muscle medial and lateral. The resultant horizontal scar prevents overriding of preseptal over pretarsal orbicularis oculi muscle. A translid double-armed Quickert suture preplaced 2 to 3 mm lateral to the punctum plicates the dehisced lower eyelid retractors and also prevents overriding of preseptal over the pretarsal orbicularis muscle. This suture pierces the conjunctival cul-de-sac and exits the skin just anterior to the lashes. RESULTS: In 63 eyelids of 59 patients (4 bilateral cases), there were no failures with a median follow-up of 49.3 months. Complications were minimal. CONCLUSIONS: The modified corncrib (inverted T) procedure is performed through a single surgical wound, requires minimal surgical dissection, and provides excellent long-term results.
Asunto(s)
Entropión/cirugía , Párpados/cirugía , Técnicas de Sutura , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The purpose of the present study was to determine whether proliferating cell nuclear antigen (PCNA), an immunohistochemical marker for a nuclear protein abundant in actively proliferating (dividing) cells, is useful as an aid in differentiating idiopathic orbital inflammatory syndrome (IOIS) from lymphoproliferative lesions (LLs). Records of all patients with IOIS and LLs were studied retrospectively. Tissue biopsy specimens from four patients with IOIS and nine patients with LLs were examined. The diagnosis in each case was based on presenting signs and symptoms, orbital computed tomography (CT) and/or magnetic resonance (MR) scans, histopathologic criteria, and follow-up data consistent with the entity. These findings were correlated with the percentage of B- and T-cells in the lesions as well as with the number of cells that demonstrated staining for PCNA in formalin-fixed tissue. PCNA activity was markedly increased in the higher grade (HG) lymphoma group as compared to that in the low grade (LG) lymphoma and idiopathic inflammatory group. Lymphoma cases showed a significantly increased B-/T-cell ratio compared to IOIS lesions. PCNA activity in conjunction with the ratio of B-/T-cells may be a helpful immunohistologic adjunct for differentiating purely inflammatory lesions of the orbit from lymphoid tumors. Further studies are necessary to compare PCNA activity in fresh frozen tissue with that in formalin-fixed tissue.
Asunto(s)
Linfoma/diagnóstico , Neoplasias Orbitales/diagnóstico , Seudotumor Orbitario/diagnóstico , Antígeno Nuclear de Célula en Proliferación , Linfocitos B/inmunología , Biomarcadores , División Celular , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Inmunofenotipificación , Linfoma/inmunología , Imagen por Resonancia Magnética , Neoplasias Orbitales/inmunología , Seudotumor Orbitario/inmunología , Estudios Retrospectivos , Linfocitos T/inmunologíaRESUMEN
AIMS: In order to determine the clinicopathological features and optimum management of a series of patients with adenoid squamous cell carcinoma of the conjunctiva, all cases of squamous cell carcinoma (SCC) of the conjunctiva and cornea on file in the registry of the ophthalmic pathology at the Armed Forces Institute of Pathology were reviewed. METHODS: On histopathological examination, a predominant adenoid or pseudoglandular pattern due to islands of neoplastic squamous or epidermoid cells surrounded by acantholytic cells was necessary for inclusion in the study. Histochemical and transmission electron microscopic studies (TEM) were performed. Clinical features of all the patients were extracted from the charts. RESULTS: The anatomical location of the 14 tumours was corneoscleral limbus (seven patients) and bulbar conjunctiva (seven patients). Eight patients presented with inflammatory signs and irritation (red eye, tearing, foreign body sensation), while six patients developed a slowly growing, painless mass. Histochemical and TEM studies showed extracellular hyaluronic acid and no intracellular mucin. Of the two patients initially treated by enucleation, one was free of disease after 2 years while the second patient had recurrence in the socket and died of brain metastases despite wide orbital excision and radiotherapy. All five patients with recurrent tumours initially had irritated red eyes and two required enucleation. One such patient, after orbital exenteration and radiotherapy, died of unrelated disease. CONCLUSION: The study demonstrates that adenoid SCC of the conjunctiva often presents with inflammatory signs. The tumour is locally aggressive and may metastasize and should, therefore, be histopathologically differentiated from the less aggressive conventional squamous cell carcinoma. Optimum treatment includes wide excision with documented histological clear margins of resection on permanent sections and frequent follow up.
Asunto(s)
Carcinoma de Células Escamosas/patología , Neoplasias de la Conjuntiva/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/metabolismo , Neoplasias de la Conjuntiva/metabolismo , Femenino , Estudios de Seguimiento , Histocitoquímica , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: A retrospective review of 239 patients with benign essential blepharospasm and Meige syndrome was performed in order to determine patients' long term treatment preferences. METHODS: Of 239 patients evaluated, 228 received local injections of botulinum toxin, type A, into the eyelid and facial musculature over 11 years. RESULTS: Of 228 patients, 202 (72.1%) were still treated with botulinum toxin, type A. Eighteen patients (6.9%) no longer received botulinum toxin injections and sought no other treatment. Five patients (2.2%) had apparent remission of their disease after injection. Three patients (1.3%) ultimately obtained relief from orbicularis muscle extirpative surgery and required no additional treatment. Two of the 11 patients (4.6%) who chose not to receive botulinum toxin injections were successfully treated with other modalities: psychotherapy (one patient) and oral haloperidol (one patient). CONCLUSION: While botulinum toxin is the most highly effective treatment for benign essential blepharospasm and Meige syndrome over a long period of time, adjunctive oral drug therapy, including minor tranquillisers as well as eyelid surgery, may augment its effectiveness.
Asunto(s)
Antidiscinéticos/uso terapéutico , Blefaroespasmo/tratamiento farmacológico , Toxinas Botulínicas Tipo A/uso terapéutico , Síndrome de Meige/tratamiento farmacológico , Ansiolíticos/uso terapéutico , Antidiscinéticos/efectos adversos , Anticonvulsivantes/uso terapéutico , Benzodiazepinas , Toxinas Botulínicas Tipo A/efectos adversos , Estudios de Cohortes , Femenino , Humanos , Masculino , Relajación Muscular , Aceptación de la Atención de Salud , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
An 84-year-old woman developed a markedly proptotic right eye with external ophthalmoplegia and displacement of the globe into the superotemporal orbit. She had minimal pain and no history of the usual predisposing causes of orbital cellulitis. Vision was unaffected. Orbital computed tomography (CT) showed an extraconal inferomedial abscess with an adjacent intraconal component. A purulent abscess in the anterior inferomedial aspect of the orbit, which extended into the medial aspect of the intraconal space, was incised and drained. After surgery, the orbital inflammation and proptosis resolved, but an irreducible, nonpurulent lacrimal sac mucocele persisted. A dacryocystectomy was performed. Pathologic examination of the lacrimal sac biopsy specimen showed only chronic nongranulomatous inflammation. This case demonstrates that acute dacryocystitis may cause an intraconal orbital abscess with proptosis and complete external ophthalmoplegia, and represent a sight- and life-threatening condition.
Asunto(s)
Absceso/etiología , Dacriocistitis/complicaciones , Enfermedades Orbitales/etiología , Absceso/diagnóstico por imagen , Absceso/cirugía , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Dacriocistitis/diagnóstico por imagen , Dacriocistitis/cirugía , Dacriocistorrinostomía , Exoftalmia/etiología , Femenino , Humanos , Enfermedades del Aparato Lagrimal/diagnóstico por imagen , Enfermedades del Aparato Lagrimal/etiología , Enfermedades del Aparato Lagrimal/cirugía , Oftalmoplejía/etiología , Enfermedades Orbitales/diagnóstico por imagen , Enfermedades Orbitales/cirugía , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND OBJECTIVE: To determine (1) whether a modified monocanalicular silicone stent fixated to the peripunctal tissues by a 6-0 polypropylene suture is a practical alternative to bicanalicular intubation for canalicular reconstruction, and (2) whether this technique is superior to previously described methods of monocanalicular intubation. PATIENTS AND METHODS: The charts of patients from the Oculoplastics Division of the Ophthalmology Department at the UMDNJ Medical School who had undergone insertion of a modified canalicular stent were retrospectively reviewed from April 1, 1991, to April 1, 1995. RESULTS: The technique was used successfully in 33 eyelids (32 patients) for the following conditions: (1) unicanalicular (17 eyelids) and bicanalicular lacerations (1 eyelid), (2) reconstruction of a single canaliculus after eyelid tumor resection (5 eyelids), (3) after canaliculotomy for canaliculitis refractory to medical treatment (3 eyelids), and (4) after punctal plasty for congenital punctal agenesis and after a three-snip procedure for acquired punctal stenosis (6 eyelids). Tubes were maintained in position for a median of 11.5 weeks. Complications included erosion of the anterior aspect on the lid margin (1 eyelid) and premature tube extrusion (1 eyelid) that required reinsertion of another monocanalicular stent. All patients had normal results on dye disappearance tests after surgery and no patients experienced postoperative tearing. CONCLUSIONS: The monocanalicular silicone stent is technically simple to perform and is an effective method of monocanalicular intubation that may avoid the need for bicanalicular intubation in certain circumstances.
Asunto(s)
Párpados/cirugía , Enfermedades del Aparato Lagrimal/cirugía , Conducto Nasolagrimal/cirugía , Siliconas , Stents , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Enfermedades del Aparato Lagrimal/etiología , Masculino , Persona de Mediana Edad , Polipropilenos , Estudios Retrospectivos , Técnicas de SuturaRESUMEN
BACKGROUND AND OBJECTIVES: Medial canthoplasty surgically fuses the upper and lower lids medial to the puncta. The authors modified the procedure by inserting a temporary lacrimal stent in order to avoid kinking and scar contracture of the canaliculi. PATIENTS AND METHODS: A medial canthoplasty successfully corrected lower eyelid laxity in 14 patients with the following conditions: (1) exposure and/or neurotrophic keratitis with medial ectropion and/or retraction of the lower eyelid (11 patients), and (2) inability to retain a prosthesis because of lower eyelid ectropion and contracture of the inferior conjunctival fornix (3 anophthalmic patients). RESULTS: All patients had a satisfactory cosmetic result despite minimal vertical and horizontal narrowing of the palpebral fissure. Complications included partial wound dehiscence and pyogenic granuloma. CONCLUSION: The modified medial canthoplasty described in this article corrects medial ectropion with minimal cosmetic deformity.
Asunto(s)
Enfermedades de los Párpados/cirugía , Párpados/cirugía , Tendones/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Ectropión/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , StentsRESUMEN
Sixteen patients with combined paresis and restriction of extraocular muscle(s) orbital fracture repair were studied before and after in order to determine the clinical features and management of such patients. All 16 patients showed limited ductions of the involved eye in the field of action of the entrapped, paretic muscle and of the antagonist muscle after orbital fracture. Single extraocular muscles (13 patients) and two extraocular muscles (three patients) were demonstrated adjacent to the fracture site on orbital computed tomography (CT). In three patients prior to orbital surgery, a deviation in primary position was present. After fracture repair with release of the entrapped muscle in all patients, evidence of paresis of the muscle was demonstrated by underaction in its field of action and overaction in the field of its antagonist. There was a resultant manifest tropia or phoria in the primary position. In seven patients, the paresis gradually improved with no tropia and little diplopia in the functional fields of gaze. Three patients had minimal deviations and required no further treatment. Six patients with significant deviations required prisms (three patients) or strabismus surgery (three patients). The latter three patients had two muscles involved. Results of this study demonstrate that the ophthalmologist must appropriately diagnose patients with paresis and restriction of an extraocular muscle and counsel them that "new" diplopia may occur after orbital fracture repair and that this diplopia may require additional therapy.
Asunto(s)
Trastornos de la Motilidad Ocular/etiología , Músculos Oculomotores/fisiopatología , Oftalmoplejía/etiología , Fracturas Orbitales/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Preescolar , Diplopía/etiología , Diplopía/fisiopatología , Diplopía/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Motilidad Ocular/fisiopatología , Trastornos de la Motilidad Ocular/cirugía , Oftalmoplejía/fisiopatología , Oftalmoplejía/cirugía , Neuritis Óptica/etiología , Neuritis Óptica/fisiopatología , Neuritis Óptica/cirugía , Fracturas Orbitales/diagnóstico por imagen , Fracturas Orbitales/cirugía , Tomografía Computarizada por Rayos XRESUMEN
A retrospective study of patients with hemifacial spasm (HFS) was performed in order to determine long-term treatment choices: local botulinum toxin, type A, injections, oral pharmacologic agents, and surgery (neurosurgical decompression of the seventh nerve at the brainstem level and upper eyelid blepharoplasty). Of 119 patients with diagnosed hemifacial spasm in the Oculoplastics Division of the Department of UMD-New Jersey Medical School, Newark, NJ from September, 1983, to June 1, 1994, 108 were initially treated with 735 botulinum toxin injections. Forty-seven of the 108 patients (43.5%) initially treated at our institution received 459 injections for a median treatment period of 59 months per patient. Eight patients (7.4%) continued treated elsewhere and four other patients were injected at our institution until their death from other causes. Twenty-two patients (20.4%) were lost to followup after receiving 117 injections. Five patients (4.6%) had spontaneous resolution of their condition after botulinum toxin therapy and nine patients (8.3%) chose not to receive any additional injections or other treatment. Thirteen patients (12.0%) did not respond adequately to botulinum injections and 10 such patients obtained relief from treatments other than botulinum toxin: oral pharmacologic agents (two patients), neurosurgical decompression of the seventh nerve (two patients), and upper eyelid blepharoplasty (one patient). In addition to botulinum injections, 15 patients required adjunctive minor tranquilizers and/or antiseizure medications. Botulinum A toxin is an excellent long-term treatment of hemifacial spasm. This condition may occasionally spontaneously resolve after botulinum therapy.
Asunto(s)
Blefaroespasmo/fisiopatología , Nervio Facial/fisiopatología , Edad de Inicio , Anciano , Blefaroespasmo/tratamiento farmacológico , Toxinas Botulínicas/administración & dosificación , Toxinas Botulínicas/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVE: This study was designed (1) to determine the overall success of patients who underwent external dacryocystorhinostomy (DCR) using a modified Kasper technique without lacrimal sac and nasal mucosal sutured flaps, and (2) to investigate the possible impact of intraoperative petroleum jelly gauze nasal packing as compared with gelatin sponge nasal packing on the surgical results. PATIENTS AND METHODS: A retrospective review of 122 consecutive patients who underwent external DCR using a modified Kasper technique was performed. Patients were divided into two groups based on use of petroleum jelly gauze packing or gelatin sponge packing. Criteria for successful surgery included resolution of the main symptom(s) of tearing, chronic mucous discharge (chronic dacryocystitis), and/or recurrent acute dacryocystitis; and patency of the reconstructed lacrimal system. RESULTS: Ninety-four of 96 patients who had petroleum jelly gauze packing had successful DCRs, whereas only 21 of 26 patients who had gelatin sponge packing had successful DCRs (P < .005). Soft tissue rather than bony obstruction of the rhinostomy was the most common cause of DCR failure, as confirmed by office probing, endoscopy, and computed tomography. Three patients in the gelatin sponge packing group who experienced failure subsequently had bacterial sinusitis. CONCLUSION: This study strongly suggests that gelatin sponge nasal packing, at least when used for patients who undergo DCR without sutured mucosal flaps, may be associated with an increased number of failures as a result of scar tissue formation at the rhinostomy site, as compared with petroleum jelly packing. Petroleum jelly gauze nasal packing may enhance surgical results by reducing scarring between the lacrimal sac fistula and the nasal structures.