Avaliação neurológica simplificada: auxílio no diagnóstico de Hanseníase / Simplified neurological assessment: aid in the diagnosis of leprosy

Apresenta dados da Hanseníase no Brasil no Mundo. Apresenta avaliação das Lesões dos nervos periféricos, na região nasal, olhos, Nervo Facial, Nervo Trigêmeo, Teste de Acuidade Visual, Nervo Auricular, Nervo Ulnar, Nervo Mediano, Nervo Radial e Radial Cutâneo, Técnica do Estesiômetro, Nervo Fibular Profundo e Superficial, Nervo Tibial Posterior, Estesiometria nos pés.

It presents data on Hansen's disease in Brazil worldwide. Presents evaluation of peripheral nerve injuries, in the nasal region, eyes, facial nerve, trigeminal nerve, visual acuity test, auricular nerve, ulnar nerve, median nerve, radial and radial cutaneous nerve, esthesiometer technique, deep and superficial fibular nerve, Posterior Tibial Nerve, Stoichiometry in the feet.

Presenta datos sobre la enfermedad de Hansen en Brasil en todo el mundo. Presenta evaluación de lesiones de nervios periféricos, en la región nasal, ojos, nervio facial, nervio trigémino, prueba de agudeza visual, nervio auricular, nervio cubital, nervio mediano, nervio cutáneo radial y radial, técnica de estesiómetro, nervio peroneo profundo y superficial, Nervio Tibial Posterior, Estequiometria en los pies.

Il présente des données sur la maladie de Hansen au Brésil dans le monde entier. Présente l'évaluation des lésions nerveuses périphériques, dans la région nasale, les yeux, le nerf facial, le nerf trijumeau, le test d'acuité visuelle, le nerf auriculaire, le nerf ulnaire, le nerf médian, le nerf cutané radial et radial, la technique de l'esthésiomètre, le nerf fibulaire profond et superficiel, Nerf tibial postérieur, stoechiométrie dans les pieds.

Correction of Diffuse Trichiasis Using Eyelid Margin Splitting Combined with Cilia Rotation Suture

PURPOSE: In the present study, we introduced and evaluated the effectiveness of eyelid margin splitting combined with cilia rotation suture performed in simplified steps resulting in minimized complications in diffuse trichiasis. METHODS: A retrospective review of medical records was performed on 31 eyelids of 21 patients with diffuse trichiasis. The patients had trichiasis of more than 1/3 of eyelid margin and received eyelid margin splitting combined with cilia rotation suture at our hospital. The patients did not have eyelid or lid margin abnormalities and were followed up more than 6 months after surgical correction. A telephone survey of the surgical outcomes including cosmetic satisfaction and recurrence was conducted in patients who did not visit at postoperative 12 months. Success was defined as complete resolution of symptoms and acceptable cosmesis at final visit. RESULTS: The patients included 2 males (3 eyes) and 19 females (28 eyes) with an average age of 54.5 ± 18.3 years (range, 19.2–82.4 years). The mean follow-up period was 15.3 ± 5.6 months (range, 10–35 months). Cornea or conjunctiva irritation symptoms by misdirected eyelash were resolved in all eyelids; 3 eyelids with recurred trichiasis required additional electrolysis to remove irritating cilia resulting in an overall success rate of 90.3%. CONCLUSIONS: For patients with diffuse trichiasis, an eyelid margin splitting combined with cilia rotation suture performed in simplified surgical steps showed excellent results resolving irritating symptoms with very low recurrence rate and high cosmetic satisfaction.

Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures / Abordagem via sulco palpebral superior para a rotação marginal no entrópio cicatricial tracomatoso sem o emprego de suturas externas

ABSTRACT Purpose: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Methods: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. Results: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. Conclusions: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

RESUMO Objetivo: Descrever uma técnica de rotação marginal superior para a correção do entrópio cicatricial combinando incisão via sulco palpebral, tarsotomia e tração na lamela anterior sem o emprego de suturas externas. Métodos: Técnica cirúrgica. Os passos críticos da cirurgia incluem exposição completa da superfície anterior do tarso até a linha dos cílios e tarsotomia horizontal a 3 mm da margem palpebral, produzindo dois segmentos tarsais, marginal e distal. O fragmento distal é avançado sobre o marginal por meio de 3 suturas biagulhadas absorvíveis 6.0 passadas entre a margem do segmento tarsal distal e o músculo orbicular marginal. Dessa maneira, além da superposição tarsal as suturas tracionam o orbicular marginal evertendo simultaneamente a margem palpebral e a linha ciliar. Nenhum fio é exteriorizado. O retalho pretarsal miocutâneo era fechado com suturas de catugt 6,0. Resultados: Resultados: A técnica descrita foi utilizada em hospital terciário na Arábia Saudita, em 2013 e 2014. Sessenta pálpebras superiores de 40 pacientes (23 mulheres e 17 homens) foram operadas. A idade dos pacientes variou de 44 a 99 anos (média= 70,9 ± 13,01 anos). A cirurgia foi bilateral em 21 pacientes. O seguimento variou de 1 a 12 meses (média= 3,0 ± 2,71 meses). Em 24 pálpebras (40%) o seguimento foi superior a 3 meses. A posição da margem palpebral foi considerada boa em todos os casos. Somente 1 paciente com entrópio unilateral apresentou recidiva da triquíase (2 cílios). Conclusão: A margem palpebral de pacientes com entrópio cicatricial pode ser evertida utilizando-se incisão no sulco palpebral e suturas internas. A técnica descrita combina os princípios das cirurgias de Wies e Trabut e tem como principais vantagens incisão cosmética no sulco palpebral e o não uso de suturas externas. Adicionalmente, o acesso pelo sulco palpebral permite a correção de condições associadas, como dermatocálase, ptose ou retração palpebral.

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.

Lid Splitting with Lash Resection for Trichiasis in Long-Standing Leprosy / 나학회지

BACKGROUND: Trichiasis is the inward inversion of the eyelash, resulting in painful contact with the cornea, which is a common symptom of patients with leprosy seeking treatment in leprosy outpatient clinics. Recurrence rates are high when trichiasis is treated with conventional methods such as epilation and electrolysis. OBJECTIVE: To evaluate prospectively a more aggressive surgical technique, lid splitting with lash resection, for trichiasis in long standing leprosy as a pilot study. METHODS: During the past 10 months, we treated 12 leprosy patients (18 eyelids) for trichiasis by splitting the lid margin at the gray line with resection of the eyelash bearing portion to modify the anterior lamellar repositioning. RESULTS: In all patients, pain disappeared immediately and there were no complications. The low number of patients and relatively short follow-up period are study limitations. CONCLUSION: The lid splitting with lash resection for trichiasis in patients with long standing leprosy is a satisfied treatment method functionally and cosmetically.

Long-Term Evaluation of Tumor Removal at the Eyelid Margin Using a Radio-Frequency Electrosurgical Unit

PURPOSE: To evaluate the long-term follow-up results of the eyelid margin tumor resection using a radio-frequency electrosurgical unit. METHODS: We retrospectively reviewed the medical records of 53 patients (55 eyes) diagnosed with eyelid margin tumor and who underwent eyelid tumor resection using a radio-frequency electrosurgical unit more than 5 years prior. Age, gender, undergoing a biopsy, recurrence,- and complications were examined through phone questions and the out-patient department. RESULTS: The study included 23 eyes of 22 males and, 32 eyes of 31 females, (age range 8.6-76.8 years). Surgical success rate was 95% (52 of 55 eyes) and mean follow-up period was 8.9 years. Thirty-four of 55 patients underwent a biopsy, and the most common cases were intradermal nevus and compound nevus (13 cases each), 2 cases of basal cell carcinoma (5.9%), 2 cases of actinic keratosis (5.9%), and, 2 cases of chronic inflammation (5.9%). Other cases included 1 case of squamous papilloma (2.9%) and 1 case of fibrosis (2.9%). There were 3 cases of recurrence. Eyelash-related complications after surgery occurred in 3 cases of trichiasis or distichiasis. CONCLUSIONS: Eyelid margin tumor resection using a radio-frequency electrosurgical unit is simple and showed high success rate. Additionally, it is considered as an effective method in the eyelid margin tumor resection due to low recurrence and complication rates in the long-term follow-up.

Ectopia cilia with pedigree analysis: Second case report in the world.

We present a case of ectopia cilia in a 28‑year‑old male patient. Ectopia cilia was were seen in the outer third of left upper eyelid. The patient’s maternal grandfather also had ectopia cilia of the left upper eyelid as reported by the patient’s mother. Ectopia cilia is a rare condition seen in humans. Only 12 cases of ectopic cilia in humans have been reported so far in the world. The present case of ectopia cilia is the second case report in the world with pedigree analysis.

The Effect of 0.02% Mitomycin C Injection into the Hair Follicle with Radiofrequency Ablation in Trichiasis Patients

PURPOSE: To investigate the inhibitory effect of 0.02% mitomycin C on eyelash regrowth when injected to the eyelash hair follicle immediately after radiofrequency ablation. METHODS: We prospectively included 21 trichiasis patients from June 2011 to October 2012. Twenty eyes of 14 patients were treated with 0.02% mitomycin C to the hair follicle immediately after radiofrequency ablation in group 1, while radiofrequency ablation only was conducted in ten eyes of seven patients in group 2. Recurrences and complications were evaluated until six months after treatment. RESULTS: One hundred sixteen eyelashes of 20 eyes in group 1 underwent treatment, and 19 (16.4%) eyelashes recurred. Eighty-four eyelashes of ten eyes in group 2 underwent treatment, and 51 (60.7%) eyelashes recurred. No patients developed any complications related to mitomycin C. CONCLUSIONS: Application of 0.02% mitomycin C in conjunction with radiofrequency ablation may help to improve the success rate of radiofrequency ablation treatment in trichiasis patients.

The Effect of 0.02% Mitomycin C Injection into the Hair Follicle with Radiofrequency Ablation in Trichiasis Patients

PURPOSE: To investigate the inhibitory effect of 0.02% mitomycin C on eyelash regrowth when injected to the eyelash hair follicle immediately after radiofrequency ablation. METHODS: We prospectively included 21 trichiasis patients from June 2011 to October 2012. Twenty eyes of 14 patients were treated with 0.02% mitomycin C to the hair follicle immediately after radiofrequency ablation in group 1, while radiofrequency ablation only was conducted in ten eyes of seven patients in group 2. Recurrences and complications were evaluated until six months after treatment. RESULTS: One hundred sixteen eyelashes of 20 eyes in group 1 underwent treatment, and 19 (16.4%) eyelashes recurred. Eighty-four eyelashes of ten eyes in group 2 underwent treatment, and 51 (60.7%) eyelashes recurred. No patients developed any complications related to mitomycin C. CONCLUSIONS: Application of 0.02% mitomycin C in conjunction with radiofrequency ablation may help to improve the success rate of radiofrequency ablation treatment in trichiasis patients.

Upper eyelid entropion and dry eye in cicatricial trachoma without trichiasis / Entrópio de pálpebra superior e olho seco no tracoma cicatricial sem triquíase

PURPOSE: to evaluate the position of the upper eyelid margin and eye surface status in cicatricial trachoma without trichiasis (TS). METHODS: Slit-lamp biomicroscopy was employed to evaluate the location of the upper lid mucocutaneous transition of 156 eyes of 78 patients with trichiasis and of 130 eyes of 65 control subjects. For each eye the position of the upper lid mucocutaneous junction was graded with respect to the line of meibomian gland orifices into 3 categories: a) anterior, b) at the line, and c) posterior to the line. Ocular surface dye staining with lissamine green was performed in all eyes. All participants answered a questionnaire with queries on the presence and intensity of dry eye symptoms. RESULTS: In the eyes with trichiasis the location of the mucocutaneous transition was posterior to the meibomian gland line in 55 (35.3%), at the line in 77 (49.4%) and anterior to the line in only 24 (15.4%). In the control group these figures were: 5 (3.8%); 42 (42%) and 83 (63.8%). Lissamine staining and dry eye symptoms were also associated with trichiasis. CONCLUSION: Different degrees of upper lid entropion are already present in cicatricial trachoma even in the absence of trichiasis. Trichiasis is associated with lissamine green staining and dry eye symptoms. Conjunctivalization of the upper lid margin may play a role in the development of trachomatous dry eye.

OBJETIVOS: Avaliar a posição da margem palpebral superior e a superfície ocular no tracoma cicatricial sem triquíase (TS). MÉTODOS: A localização da transição mucocutânea da pálpebra superior foi avaliada com lâmpada de fenda em 156 olhos de 78 pacientes com triquíase e de 130 olhos de 65 controles. A posição da transição mucocutânea foi classificada em relação à linha das glândulas de Meibômio em três categorias: a) anterior, b) sobre a linha e c) posterior a linha. A superfície ocular de todos os olhos foi avaliada com verde de lissamina. Todos os participantes responderam ao questionário sobre a presença e intensidade dos sintomas relacionados ao olho seco. RESULTADOS: Nos olhos com triquíase a localização da transição mucocutânea foi posterior à linha das glândulas de Meibômio em 55 (35,3%), sobre a linha em 77 (49,4%) e anterior à linha em somente 24 (15,4%). No grupo controle essa distribuição foi 5 (3,8%); 42 (42%) e 83 (63,8%). A positividade ao corante de lissamina e sintomas de olho seco também foram associados à triquíase. CONCLUSÃO: Diferentes graus de entrópio de pálpebra superior estão presentes no tracoma cicatricial mesmo na ausência de triquíase. Triquíase está associada à positividade ao corante verde lissamine e sintomas de olho seco. A conjuntivalização da margem palpebral pode ser um fator no desenvolvimento do olho seco tracomatoso.

Trichiasis Surgical Coverage in Three Local Government Areas of Sokoto state; Nigeria

Background: Community-based lid surgery for trachomatous trichiasis (TT) is provided in 8 local government areas (LGAs) of Sokoto state since 2003 as part of a trachoma control programme. This study aims to assess the impact of community-based lid surgery on the magnitude of TT in 3 LGAs of Sokoto state. Materials and Methods: A population-based survey was conducted in persons aged 15 years and above. A stratified multistage cluster sampling with probability proportional to size was used. Trachoma was assessed using the WHO simplified grading system. Results: Despite high (13) refusals; 72of the minimum sample size was examined. The prevalence of blindness ranged from 1.3to 2.5in the LGAs while the prevalence of TT in persons aged 15 years and above was 2in the Silame; 2.7in the Wamakko and 5.6in the Kware LGAs; respectively. The prevalence of TT in females 15 years and above was 1.1in the Silame; 4in the Wamakko and 6.3in the Kware LGAs; respectively. The trichiasis surgical coverage is 9.5in the Kware and 12.5in the other LGAs respectively. The minimum number of TT lid surgery required to achieve the elimination level is 873 in the Silame LGA; 2611 in the Wamakko LGA and 4672 in the Kware LGA. Conclusion: The burden of TT is high in the study communities while the trichiasis surgical coverage is low. There is a need to strengthen the control programme to meet up with existing need

Lid surgery for trachomatous trichiasis is negatively associated with visual disabilities and visual impairment in Oman

Oman is at the threshold of eliminating blinding trachoma. We conducted a community-based survey in 2009-10 to study the association of trachomatous trichiasis [TT] status with visual acuity and blindness among the Omani population aged 40+ years. A total of 8191 eyes were examined and participants' demographic data were collected. TT was absent in 7890 eyes but 227 of these eyes had had lid surgery for TT in the past. TT was detected in 301 eyes, for the first time in 154 eyes and following lid surgery in 147 eyes. The rate of blindness was significantly lower in eyes that had undergone lid surgery in the past [OR = 0.54]. In regression analysis the predictors of blindness were participant's age [adjusted OR = 1.01], sex [aOR = 2.01], history of lid surgery [aOR = 3.09] and residence in a hyperendemic trachoma area [aOR = 10.6]. Promotion of TT surgery might be beneficial in reducing blindness

Second Intention Healing after Shave Excision of Benign Tumors on the Lid Margin

BACKGROUND: Defects caused by excision of benign lid margin tumors are conventionally repaired by reconstructive surgery. However, second intention healing is another option for managing wounds on the lid margin. OBJECTIVE: To evaluate the effectiveness of second intention healing after a shave excision of benign tumors on the lid margin. METHODS: Lid defects following a shave excision of the lid margin tumor were allowed to heal by second intention in 25 patients (26 lesions). The epithelialzation period was calculated, and cosmetic and functional results and complications were evaluated by photographs and ophthalmological examination. RESULTS: The locations of the defects were as follows: upper lid (n=13), lower lid (n=11), and both upper and lower lids (n=1). The mean tumor size was 3.8x3.6 mm, and the mean epithelialization period by second intention was 6.1+/-1.2 weeks. Pathological examinations revealed intradermal nevus (12 cases), compound nevus (five cases), squamous papilloma (five cases), and epidermal cyst (three cases). No patients had a corneal erosion, trichiasis, or hypertrophic scar, except loss of cilia in two cases. The functional and cosmetic results were satisfactory in all patients. CONCLUSION: Healing by second intention is a safe and effective alternative to surgical reconstruction after a shave excision of benign lid margin tumors.

Effects of Mitomycin C on Eyelash-Regrowth in Epilated Rats

PURPOSE: The aim of the present study was to determine the effects of mitomycin C (MMC) on eyelash regrowth in rats. METHODS: Ten rats were subjected to bilateral eyelid epilation. One drop of 0.04% MMC solution and one drop of normal saline was then administered to the right and left eyelid, respectively. Three months post-epliation, the number of regrown eyelashes was counted, and a section of tissue from each eyelid was examined under light- and electron microscopies. RESULTS: The number of regrown long eyelashes was 1.0 +/- 0.81 on the right, and 12.5 +/- 1.08 on the left. The rate of regrowth was 7.35 +/- 5.55% on the right and 98.45 +/- 3.27% on the left. Histological examination revealed no significant differences between the right and left eyelids, except for the absence of any hair shafts in the follicles on the right. However, electron microscopy revealed mitochondrial damage in the follicles of the right eyelid. These changes were not observed in tissue from the left eyelid. CONCLUSIONS: The application of 0.04% MMC inhibited the regrowth of normal eyelashes in rats following simple epilation. These results suggest that MMC may be a novel therapy for replacing invasive surgery in trichiasis with no malpositioning.

Wies procedure combined with anterior lamellar recession in the management of cicatricial entropion of the upper eyelid

To evaluate the efficacy of the Wies procedure combined with anterior lamellar recession in the management of cicatricial entropion of the upper eyelid. Nineteen patients [24 upper lids] with severe cicatricial entropion, trichiasis, and tarsal shortening were included in this study. Previous Snellen's operation was recorded in 6 patients [8 eyelids]. All cases underwent anterior lamellar recession and wies procedure. No residual entropion [no lash-cornea touch] was recorded in all lids [100%]. All cases developed postoperative edema that subsided gradually within one week. Over correction occurred in 2 lids [8.3%], and three eyelids developed infection [12.5%], which healed in few days after antibiotic therapy. The mean follow up was 9 months [range; 6 to12 months]. Wies procedure combined with anterior lamellar recession in the management of cicatricial entropion of the upper eyelid are effective especially for recurrent cases and short tarsus; no lid shortening developed postoperatively, and gave cosmetically accepted results

Eyelash Ptosis in Hansen's Disease / 나학회지

BACKGROUND: Eyelash ptosis(ELP) is a common finding in patients with long-standing leprosy. However, it has rarely been reported in the literature previously, because it has been diagnosed as trichiasis or entropion. OBJECTIVE: To determine the prevalence of ELP in Hansen's disease. METHODS: We took both frontal and lateral photographs of eyes in 20 patients and evaluated the degree of ptosis using a 4-point rating scale, in which 0 indicates no ptosis; 1, minimal; 2, moderate; and 3, severe. The evaluation was also performed in 20 normal persons as control group. RESULTS: All patients demonstrated ELP. In general, severity of ptosis in patient group is greater than that in control group. While the mean eyelash ptosis rating was 2.0+/-0.6 in the latter, it was 0.6+/-0.4 in the former, which is statistically significant (p<0.01). CONCLUSIONS: ELP is common in the patients with Hansen's disease and moderate to severe forms occurred more commonly in disease group compared with control group. ELP must be considered as a characteristic ocular finding in long-standing leprosy.

Treatment of Distichiasis or Trichiasis combined with Entropion

PURPOSE: To evaluate the clinical efficacy of a reverse eyelid splitting technique that we performed in cases of trichiasis or distichiasis combined with entropion. METHODS: The study comprised 43 eyes of 31 patients with trichiasis or distichiasis combined with entropion treated from November 2004 to December 2005. After skin incision, the muscular layer and tarsus were reversely dissected to find abnormal follicles. The abnormal hair follicle was cauterized under the muscular layer, and 2~3 rotating sutures were done with Ethilon 6-0 to fix the tarsus and skin. Success was defined as having the meibomian gland located in front of the junction of skin and mucosa, without an abnormal hair protruding into the eye for at least three months. RESULTS: Fifteen patients were male and sixteen patients were female. The mean age was 62.1+/-15.2 years. The patients were followed up for an average of 12.4+/-2.0 months after surgery. Surgery was successful in 74.4% (32 of the 43 eyelids) of the cases, and the recurrence rate was 25.6% (11 of the 43 eyelids). No severe complications occurred, such as infection, hemorrhage, wound dehiscence, or granuloma. However, foreign body sensation (1 eye) and eyelid notch (l eye) did occur. CONCLUSIONS: This reverse eyelid splitting technique produced satisfactory results in both cosmetic and functional aspects. Moreover, it resulted in a low recurrence rate and low complication rate in patients with trichiasis or distichiasis combined with entropion.

A Report of Localized Corneal Amyloidosis Secondary to the Trichiasis

PURPOSE: To report our experience in the diagnosis and treatment of a localized corneal amyloidosis secondary to trichiasis. METHODS: Case 1. A 55-year-old woman visited our clinic due to discomfort of her right eye. Thirty years previously, she received a lower lid blepharoplasty due to lower lid entropion. Biomicroscopy revealed some trichiasis and a 3 mm, grayish-white nodule at the center of the cornea. Case 2. A 30-year-old woman visited our clinic due to chronic irritation of both eyes. Ten and 3 years previously, she received a lower lid blepharoplasty. Biomicroscopy revealed some trichiasis of the right lower lid and a grayish-white, patch-like lesion at the inferior cornea of both eyes. Lamellar keratectomy and amniotic membrane transplantation with careful electrolysis were performed. RESULTS: Hematoxylin and eosin stain revealed a pink, amorphous, hyaline material under the epithelium, and Congo-red stain showed birefringence of the whitish lesion. Electron microscopy revealed multidirectional, fibrillar arrangement. Secondary, localized amyloidosis of the cornea was diagnosed without any systemic involvement. No clues to the origin of the amyloid were found by immunohistochemical staining. By the sixth month after operation, the patients showed favorable vision and no evidence of recurrence. CONCLUSIONS: In the identification of a corneal mass, a secondary, localized amyloidosis should be considered, which can be managed successfully.

A Case of Salzmann's Nodular Degeneration Caused by Chronic Irritation of Dry Eye and Trichiasis

PURPOSE: To report a case of Salzmann's nodular degeneration caused by chronic irritation from dry eye and trichiasis. METHODS: A 40-year-old female patient visited our ophthalmology clinic complaining of dryness in both eyes. History taking, measurement of visual acuity and intraocular pressure, and slit-lamp examination were performed. RESULTS: We found greyish white nodular opacities which protruded from the inferior corneal surface, and trichiasis at the lower eyelids. Epilation was performed, artificial tear, and lubricating ointment were prescribed, and therapeutic lens was applied. After 3 months of treatment, the symptom was relieved and nodular opacities diminished. CONCLUSIONS: Phlyctenular keratitis, vernal keratoconjunctivitis, trachoma, scarlet fever, postoperative corneal surgery, hard contact lenses, and keratoconus are well known for the course of Salzmann's nodular degeneration. The chronic irritation from dry eye and trichiasis could be the cause of Salzmann's nodular degeneration.