Alterações palpebrais: frequência de ocorrência e perfil dos portadores em amostra populacional brasileira / Eyelid disorders: frequency of occurrence and profile of carriers in a Brazilian population sample

Objetivo: Apresentar a frequência de ocorrência das alterações palpebrais em uma amostra populacional brasileira, assim como as características de seus portadores. Métodos: Estudo transversal utilizando amostra populacional aleatorizada, realizado nos anos de 2004/2005, em nove cidades da região centro-oeste do estado de São Paulo. Foram examinadas 7654 pessoas sendo os participantes avaliados segundo variáveis demográficas e exame oftalmológico completo. As alterações palpebrais foram avaliadas por meio de exame externo usando lanterna e lâmpada de fenda. Os dados obtidos foram analisados estatisticamente. Resultados: As alterações palpebrais como a triquíase e o ectrópio foram mais relacionadas às características homens, brancos, queixa de redução de acuidade visual para perto. Foi realizado tratamento cirúrgico em 72,7% das triquíases detectadas, assim como 28,5% dos ectrópios. Já os casos de ptose palpebral foram relacionados ao sexo feminino, brancas, com queixa de diminuição da acuidade visual para perto e 26,3% necessitaram de cirurgia. Entrópio foi detectado em um caso, masculino, branco e epibléfaro foi observado em um indivíduo do sexo feminino, parda. Conclusão: A alteração palpebral mais presente na população geral brasileira é a triquíase, seguida da ptose palpebral e do ectrópio. Os autores chamam a atenção para o fato de os portadores não possuírem queixas relacionadas às alterações palpebrais.

Purpose: to show the frequency of occurrence of the eyelid disorders in a Brazilian population sample, as well as the characteristics of the carriers. Methods: a transversal study using a random population sample was carried out in the years 2004/2005, involving nine cities of the middle west region of the State of São Paulo - Brazil. We had 7654 participants which were evaluated according to demographic variables and complete ophthalmological examination. The eyelid disorders were detected using a lantern and slit lamp. Data were statistically analyzed. Results: eyelid disorders such as of trichiasis and ectropion were more related to the characteristics men, whites, complaining of reduced near visual acuity and 72.7% of trichiasis underwent surgical treatment, as well as 28.5% of patients with ectropion. Ptosis was related to the females, whites, complaining of reduced near visual acuity and 26.3% required surgery. Entropion was detected only in one case, male, white and a case of epiblepharon was observed in a female, brown. Conclusion: the most frequent palpebral disorder observed in the Brazilian general population is trichiasis, followed by ptosis and ectropion. The authors call attention to the fact that carriers do not have complaints related to the eyelid disorders.

Perfil epidemiológico dos pacientes com ptose congênita no hospital regional de São José / Epidemiological profile of congenital ptosis pacients in the hospital regional de São José

OBJETIVO: Traçar um perfil epidemiológico dos pacientes com ptose congênita no Hospital Regional de São José (HRSJ), descrevendo as características gerais das ptoses congênitas, incluindo a coexistência de estrabismo e a prevalência de ambliopia. MÉTODOS: Foi realizado um estudo epidemiológico com delineamento transversal, baseado na análise dos prontuários de pacientes com ptose congênita atendidos no Departamento de Plástica Ocular e Órbita do HRSJ, no período de julho de 1998 a julho de 2008. RESULTADOS: Foram analisados 42 pacientes (56 olhos). A idade média foi de 7,2 anos e o gênero mais prevalente foi o masculino (66,7 por cento). Foi encontrado unilateralidade da ptose em 66,7 por cento dos casos, associação com estrabismo em 19 por cento e fenômeno de Marcus Gunn em 9,5 por cento. Ambliopia foi encontrada em 17 por cento dos olhos afetados. Na classificação, 38,5 por cento dos olhos tinham ptose severa e 63 por cento tinham excursão do elevador fraca ou ausente. A conduta foi cirúrgica para 57,2 por cento dos casos e a técnica mais prevalente foi elevação ao Frontal (75 por cento). CONCLUSÃO: No presente estudo, a prevalência de ambliopia nos pacientes com ptose congênita foi maior que da população geral, reforçando a importância de uma avaliação oftalmológica precoce destes pacientes.

PURPOSE: To draw an epidemiological profile of congenital ptosis patients in the Hospital Regional de São José (HRSJ), describing the general characteristics of congenital ptosis, including the coexistence of strabismus and the prevalence of amblyopia. METHODS: An epidemiological study with a cross-sectional characteristic was conducted, based on analysis of medical records of congenital ptosis cases treated on the Department of Ocular Plastic and Orbit of the HRSJ, from July 1998 to July 2008. RESULTS: A total of 42 patients (56 eyes) were analyzed. The mean age was 7,2 years and the most prevalent genre was male (66,7 percent). Unilateral ptosis was found in 66,7 percent of cases, association with strabismus in 19 percent and Marcus Gunn phenomenon in 9,5 percent. Amblyopia was found in 17 percent of the affected eyes. About the classification, 38,5 percent of eyes had severe ptosis and 63 percent had poor or absent levator excursion. The management for 57,2 percent of cases was surgery and the most prevalent technique was Frontal elevation (75 percent). CONCLUSION: In this study, the prevalence of amblyopia in congenital ptosis patients was higher than in the general population, showing the importance of an early ophthalmologic evaluation of these patients.

Sling materials for management of congenital ptosis - a major review

Blepharoptosis affects individuals of all ages, races and genders. It has a significant impact on a patient's functional and psychological status and may cause poor visual development in childhood. Since the Italian anatomist and surgeon Antonio Scarpa's publication of Practical Observations on the Principle and Disease of the Eye in 1806, ptosis surgery has undergone many revolutions as the knowledge of anatomy and physiology progressed and as types of materials expanded. It is essential that a multidisciplinary approach, encompassing pediatric ophthalmology, oculplastics surgeon, and orthoptic department work closely to optimize patient management. Correction of congenital ptosis is one of the most difficult challenges ophthalmologists face. Ptosis surgical correction techniques depend on the degree of ptosis and the levator muscle action. Multiple surgical procedures are available including frontalis sling, levator advancement, Whitnall sling, frontalis muscle flap, and Mullerectomy. In cases with severe levator muscle dysfunction, the choice of surgery is a sling procedure. Materials which have been used for this purpose are widely variable and divided into non synthetic and synthetic. Non synthetic include fascia lata [both autogenous and allogenic], palmaris longus tendon and temporalis fascia, while synthetic include mersilene mesh, silicone rods and sutures [prolene, nylon, silk and Gortex]

Efeitos adversos associados à aplicação de toxina botulínica na face: revisão sistemática com meta-análise / Adverse effects associated with facial application of botulinum toxin: a systematic review with meta-analysis

OBJETIVO: Verificar a ocorrência dos efeitos adversos relacionados ao uso da toxina botulínica na face, por meio de revisão sistemática, usando meta-análise. MÉTODOS: Foi realizada pesquisa eletrônica de artigos publicados no MEDLINE e Cochrane Library até setembro de 2007. A ocorrência dos efeitos adversos foi verificada pela freqüência relativa para os relatos de casos e do risco relativo para os estudos randomizados. A heterogeneidade foi avaliada pelo teste Q e pelo índice I². Foi utilizado o teste de significância de Egger para identificar viés de publicação e a análise de sensibilidade para verificar o efeito dos viéses de publicação. RESULTADOS: Oito estudos randomizados e treze relatos de casos preencheram os critérios de inclusão. Na revisão sistemática dos relatos de casos, 1.003 pacientes foram estudados, dos quais 182 (18,14 por cento) apresentaram efeitos adversos. O efeito adverso mais freqüente foi a ptose palpebral ocorrendo em 34 (3,39 por cento) pacientes dos relatos de casos. Na meta-análise dos estudos randomizados, o risco relativo global para os efeitos adversos como cefaléia, ptose palpebral, reação local e infecção foi 1,07, 3,25, 0,99 e 0,94, respectivamente. Para todas as comparações, o valor de P foi maior que 0,05. CONCLUSÃO: O efeito adverso mais freqüente e que apresentou o maior risco relativo relacionado ao uso da toxina botulínica na face foi a ptose palpebral. A padronização dos efeitos adversos relatados é necessária a fim de melhor estabelecer as características dos mesmos.

PURPOSE: To estimate the occurrence of adverse effects associated with the use of botulinum toxin by performing a systematic review and meta-analysis. METHODS: A systematic literature search of MEDLINE and Cochrane Library was conducted until September 2007. The occurrence of the adverse effects was estimated of the relative frequency for case report and of the relative risk for randomized trials. Heterogeneity was evaluated with the Q test and I² index. Egger's significance test was used to identify the publication bias. Sensitivity analysis was performed to evaluate the effect of the publication biases. RESULTS: Eight randomized trials and thirteen case reports filled the inclusion criteria. In the systematic review of case reports, 1,003 subjects were studied and 182 (18.14 percent) showed adverse effects. Eyelid ptosis was the most frequent adverse effect, presenting in 34 (3.39 percent) patients of the case reports. In the meta-analysis of randomized trials, the overall relative risk for adverse effects as headache, eyelid ptosis, local reaction and infection was respectively: 1.07, 3.25, 0.99 and 0.94. For all comparisons, P values were greater than 0.05. CONCLUSION: Ptosis was the most frequent adverse effect and showed the higher relative risk associated with botulinum toxin. It is necessary to perform a pattern of adverse effects related for better understanding the relationship between adverse effects and use of botulinum toxin.

Etiological pattern of blepharoptosis among patients presenting in teaching hospital.

The purpose of this study was to find out the etiological pattern of blepharoptosis among patients presenting in BPKLCOS, T.U. Teaching Hospital. This was a hospital based descriptive and cross-sectional study conducted from February 2003 to July 2004. A total of 125 patients with ptosis were evaluated. 78 cases (62.4%) were congenital and 47 cases (37.6 %) were acquired. Congenital simple ptosis and congenital complicated ptosis comprised of 58% and 42% respectively. Among the acquired cause, ptosis due to trauma was the commonest 32%, followed by third cranial nerve palsy 25.5%, myasthenia gravis 17%, aponeurotic 10.7%, chronic progressive external ophthalmoplegia 8.5% etc. Aetiology-wise, myogenic ptosis was the commonest (65.6%) which was followed by neurogenic (16.8%), traumatic (12%) and aponeurotic ptosis (5.6%). Congenital ptosis is more common than acquired ptosis. Myogenic ptosis is the most predominant type of ptosis. Among the congenital ptosis, congenital simple ptosis is more common than congenital complicated ptosis. Among the acquired cases trauma, third cranial nerve palsy and myasthenia gravis are the major attendees.

Blefaroptose em usuários de lentes de contato / Blepharoptosis in contact lens wearers

OBJETIVO: Investigar a freqüência de blefaroptose adquirida em usuários de lentes de contato. MÉTODOS: Avaliação prospectiva de 50 pacientes, usuários de lentes de contato, do Setor de Lentes de Contato do Serviço de Oftalmologia do Complexo Hospitalar Santa Casa de Porto Alegre, durante o período de abril a novembro de 2004. A distância reflexo-margem (MRD) foi avaliada em 99 pálpebras de usuários de lentes de contato e para as 52 pálpebras de controle. Pacientes cuja medida da distância reflexo-margem se apresentou inferior a 2 mm ou com assimetria de distância reflexo-margem maior ou igual a 2 mm foram considerados portadores de blefaroptose. Foram avaliados o tipo de lente de contato utilizada e o tempo de uso das mesmas. RESULTADOS: Cinco pacientes apresentaram ptose, todos eles eram usuários de lentes de contato rígidas, um com ptose bilateral e quatro, unilateral. A distância reflexo-margem dos pacientes usuários de lentes de contato foi, em média, 0,88 mm inferior aos não usuários. Os valores de distância reflexo-margem foram progressivamente decrescentes nos grupos estudados: controles, usuários de lentes gelatinosas e de lentes rígidas. CONCLUSÃO: O estudo sugere que os usuários de lentes de contato possuem alteração dos valores de distância reflexo-margem, principalmente os que usam lentes rígidas.

PURPOSE: To investigate the occurrence of acquired blepharoptosis in contact lens wearers. METHODS: Prospective analysis of 50 contact lens wearers being followed at the Contact Lenses Section of the Ophthalmology Service at the "Complexo Hospitalar Santa Casa de Porto Alegre" between April and November 2004. The margin reflex distance (MRD) was evaluated for the 99 eyelids of contact lens wearers and for the 52 eyelids of controls. A patient whose measurement was less than 2 mm or with an assymetry of margin reflex distance greater or equal to 2 mm were considered with blepharoptosis. The contact lens type and duration of contact lenses wear were evaluated. RESULTS: Five patients presented ptosis, all of them were hard contact lens wearers, one had bilateral and four had unilateral ptosis. The study shows that the contact lens wearers had the margin reflex distance 0.88 mm smaller than the non-wearers. The margin reflex distance values decreased progressively in the studied groups: controls, gelatinous contact lens wearers and rigid contact lens wearers. CONCLUSION: The study suggests that contact lens wearers have alterations in the margin reflex distance values, especially the rigid contact lens wearers.

[Prevalence of different types of ptosis at a referral hospital in Tehran, Iran]

To assess etiology, demography, surgical management and postoperative complications of ptosis in a referral ophthalmologic center. We reviewed records of 233 ptosis patients managed at Labbafinejad Hospital during 1998-2003. Etiology, age, sex, laterality, family history, amblyopia, past medical history, margin reflex distance and levator function, type of surgery, and postoperative complications were evaluated. The study included 117 female and 116 male subjects with mean age of 18.7 +/- 12.8 years. There was past ocular surgery in 85%, female history of ptosis in 3.4% amblyopia in 19.2% and strabismus in 6.9%. Ptosis was unilateral in 85% and bilateral in 15% and was congenital in 79%. The most prevalent type of ptosis is congenital therefore early ditection and referral of affected children is necessary to prevent amblyopi

Vision screening of preschool children in Riyadh

A total of 860 children attending preschools and nurseries in Riyadh and aged between 3 and 6 years were screened for various visual parameters relating to strabismus and amblyopia. Saudi nationals constituted 69% of the subjects, the other 31% originating mainly from the surrounding Middle Eastern countries. Of the total 860 children examined, 59 were referred to a hospital for further evaluation, representing a referral rate of 6.86%. Of these 59 children, 51 were actually examined at the hospital; 23 were found, upon detailed examination, to be within normal limits. The remaining 28 had positive ocular findings, including amblyopia [in 22 children, representing a prevalence of 2.6% in the total sample], refractive error [16 children = 1.9%], and strabismus [10 children = 1.2%]. The prevalence of strabismus and amblyopia in the tested children is essentially similar to that reported in the literature; that of refractive error does not reflect real levels in the population since refraction was only performed on those children who were seen at the hospital. There was an unusually high prevalence of ptosis in the examined sample [0.6%]

Blefaroptose pós-cirurgia de catarata e glaucoma; comparaçäo entre dermatocalase e bolsas palpebrais como fator de risco / Blefaroptosis after cataract and glaucoma surgery comparison between dermatochalasis and baggy lids as a risk factor

Os autores apresentam um estudo comparativo entre pacientes de um grupo controle, de um grupo portador de dermatocalase e outro grupo portador de bolsas gordurosas palpebrais. Concluem ser mais provável a ocorrência de ptose palpebral pós-retopexia no pós-operatório de cirurgia de catarata ou glaucoma em pacientes que apresentam bolsas gordurosas palpebrais prévias à cirurgia. (P<0,05)

Ptosis palpebral en la Fundacion Oftalmologica Colombiana: estudio retrospectivo de 148 casos. Medellin 1984-1988 / Blepharoptosis in Fundacion Oftalmologica Colombiana: retrospective study of 148 cases. Medellin 1984-1988

Se estudiaron las historias clinicas de 113 pacientes (148 ojos) con diagnostico de ptosis palpebral de un total de 40.000 historias de la consulta general en la Fundacion Oftalmologica Colombiana entre Junio de 1984 y Junio de 1988. En cada uno de estos casos se analizaron la hendidura palpebral y la funcion del musculo elevador del parpado superior como parametros basicos. La distribucion por sexo fue equivalente y en un poco mas de la mitad de los pacientes (54%), se pudo comprobar que eran congenitas. Solamente en 9 pacientes (7.9%) se encontraron antecedentes familiares de ptosis palpebral. Todos los pacientes fueron sometidos a examen oftalmologico completo, incluida refraccion cicloplejica. El 59.5% de los casos, presentaron ptosis leve con buena funcion del elevador; solo un 15% del total corregidos en cirugia lo cual no indica que la mayoria no sean quirurgicos