[Preliminary study of the quality of life of glaucoma patients in the district of Sousse (Tunisia): Sociodemographic and clinical associations]. / Étude préliminaire de la qualité de vie des patients glaucomateux dans la région de Sousse (Tunisie) : associations sociodémographiques et cliniques.

PURPOSE: To assess the vision-specific quality-of-life (VS-QoL) of glaucoma patients followed at Farhat Hached university hospital, Sousse-Tunisia, and identify clinical and sociodemographic factors potentially affecting it. METHODS: This was a cross-sectional study enrolling one-hundred twenty patients followed for primary open angle glaucoma (POAG). All the patients successfully responded to the Arabic version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ 25). Quality of life was quantified in terms of scores (0-100) and correlated with sociodemographic and clinical factors. RESULTS: One hundred and twenty patients were studied. The mean age was 62.38±10.68years. The global mean score (GMS) score was 70.11±18.45% ranging from 23.71 to 98%. Urban residence was associated with a better total score (P=0.01). Educational background was correlated with the subscale scores of distant activities (P=0.01), social functioning (P=0.03), physical activity limitations (P=0.01) and peripheral vision (P=0.01). The total NEI-VFQ 25 had a statistically significantly negative correlation with the duration of the glaucoma (P=0.002), the cup to disc ratio of the better and the worse eye (P<10-4), the visual acuity of the better and the worse eye (P<10-4), but not with the intraocular pressure. A higher number of glaucoma medications had a negative impact on the total score (P=0.03) and the subscales of physical activity limitations (P=0.04) and driving (P=0.002). CONCLUSIONS: Vision-specific quality of life of glaucoma patients, as measured by the NEI-VFQ 25, is correlated to many sociodemographic and clinical elements. QoL evaluation is an essential factor to be considered in the management of glaucoma patients. In our context, research should be directed first to the validation of a questionnaire in the local dialect.

[Orbital dermoid cysts: Clinical spectrum and outcome]. / Les kystes dermoïdes orbitopalpébraux : étude clinique et résultats thérapeutiques.

INTRODUCTION: Dermoid cysts are benign congenital orbital tumors, they are classified as choristomas. Clinical manifestations vary according to location and size. MATERIALS AND METHODS: We retrospectively analyzed 43 cases of dermoid cysts surgically treated between July 1998 and March 2009. RESULTS: Mean patient age was 18.64 years. Among patients, 48.83% were male. Preseptal location was most common (41 cases). One of the two cases of intraorbital location required orbitotomy. We observed no complications or recurrence. DISCUSSION: Dermoid cysts are most often seen in young patients. The mean age of our patients was relatively high. The majority of dermoid cysts are periorbital in location. Superficial orbital dermoid cysts are more frequent, present earlier in life and are more easily identified than deep dermoid cysts. Imaging plays a major role in the management of deep orbital tumors. Complete surgical excision has remained the mainstay of treatment. CONCLUSION: Dermoid cysts are benign orbital tumors. Superficial dermoid cysts are the most common type. Deeper cysts require a more challenging diagnostic and therapeutic approach.

[Clinical study and risk factors for recurrence of basal cell carcinoma of the eyelid: results of a Tunisian series and review of the literature]. / Étude clinique et facteurs de risque de récidive des carcinomes basocellulaires des paupières : résultats d'une série tunisienne et revue de la littérature.

PURPOSE: To report our results of treatment of eyelid basal cell carcinomas and evaluate risk factors for recurrence. PATIENTS AND METHODS: We carried out a retrospective study of 172 basal cell carcinomas in 168 patients, treated in the Ophthalmology department of Sousse University Medical Center (Tunisia), from January 1987 to July 2012. Initial treatment was surgical excision with a standard margin of 4mm or a single radiation treatment. When excision was incomplete, we had the choice between further excision, radiotherapy or a "wait and see" approach. Mean follow-up in our study was 11.5 months with range from 1 month to 14 years. RESULTS: We treated 169 tumors in 165 patients, with three patients out of 168 having refused the proposed treatment. Primary radiotherapy was performed in 4 cases in patients presenting with large tumors and refusing disfiguring surgery. For the 165 other tumors (95.9%), surgical excision was performed. Surgical margins were clear in 106 cases (64.2%) and positive in 37 cases (22.4%). No residual tumor was noted in 2 cases for which biopsy was initially performed, and margins could not be visualized in 20 cases (12.1%) due to the small size or fragmentation of the specimen. For the incompletely excised tumors, we performed a second excision in three cases (8%), radiotherapy in 11 cases (29.7%) and a "wait and see" approach in 22 cases (59.4%). The recurrence rate was 6.9%, with a mean time of 32.8 months until recurrence. CONCLUSION: Basal cell carcinoma represents the most frequent malignant tumor of the eyelids. Surgery remains the standard treatment. The "wait and see" approach offers an interesting option for the management of incompletely excised basal cell carcinoma, especially with low risk lesions.

[Ptosis associated with pachydermoperiostosis]. / Ptôsis associé à une pachydermopériostose.

INTRODUCTION: Pachydermoperiostosis or primary hypertrophic osteoarthropathy is a rare cause of ptosis. We report the case of a patient with pachydermoperiostosis and bilateral ptosis. The physiopathology and treatment of this ptosis are discussed. CASE REPORT: A 49-year-old patient was referred to our department with ptosis. He had pachydermia of the face, hands and the feet, digital clubbing and periostosis. Examination of the eyelids showed that palpebral apertures were reduced to less than 4mm bilaterally and that eyelids were markedly thickened. All theses features were consistent with the diagnosis of pachydermoperiostosis. Other secondary conditions were ruled out. Ptosis correction was performed by palpebral skin and orbicularis resection as well as tarsectomy. The aesthetic outcome was satisfactory. DISCUSSION: Pachydermoperiostosis is a rare inherited disease, characterized by pachydermia, digital clubbing and periotosis. Ptosis is the result of the palpebral hypertrophia. Excisions of skin, orbicularis muscle and tarsus often give good cosmetic outcomes. CONCLUSION: Pachydermoperiostosis is a rare cause of ptosis, which development is attributed to eyelid thickening. Surgical management has satisfactory cosmetic outcome.

[Senile scleral plaque associated with scleritis in a patient with rheumatoid arthritis]. / Plaque sclérale sénile associée à une sclérite chez un patient atteint d'une polyarthrite rhumatoïde.

Senile scleral plaque is an age-related, commonly asymptomatic hyaline degeneration of the sclera. We report a case of calcific scleral plaque associated with anterior scleritis in an elderly patient with rheumatoid arthritis. Response to anti-inflammatory treatment was favorable.

[Eyelid necrosis after injection of lidocaine with epinephrine]. / Nécrose cutanée palpébrale secondaire à une injection de xylocaïne adrénalinée.

Four patients (two women aged 50 and 67 years, a 36-year-old man, and a 5-year-old child) presented with necrosis of the eyelid after local anesthesia using 2% lidocaine with epinephrine. In three cases, the anesthesia was administered prior to suturing an eyelid laceration, and the necrosis involved the upper lid; in one case, the anesthesia was administered prior to temporal artery biopsy. Surgical debridement of the necrotic tissue was performed in all cases. Three patients developed a bacterial superinfection treated with systemic antibiotics with good results. Necrosis of the eyelid is a rare complication occurring after local anesthesia using lidocaine with epinephrine. Most dermatologists refrain from use of epinephrine with local anesthetics for digital blocks. Necrosis is due to prolonged vasoconstriction of arteries. It is observed especially commonly in patients at increased risk (arteritis, Raynaud's phenomenon and severe microvascular diseases). In the eyelid, few cases have been reported.

[Unilateral congenital ptosis with ipsilateral superior rectus muscle overaction]. / Ptosis congénital associé à une hyperaction du muscle droit supérieur.

Congenital ptosis may be frequently accompanied by weakness of the ipsilateral superior rectus muscle. We report a case of ptosis with ipsilateral superior rectus muscle overaction. The 45-year-old patient presented with unilateral congenital ptosis. Ipsilateral superior rectus muscle overaction was found in the upgaze, with an inferior sclera show. This can be found in 40% of congenital ptosis. The authors give two possible causes: either an exaggerated Bell reflex or misdirection innervations of the superior rectus muscle by the superior division of the oculomotor nerve, initially innervating the upper eyelid elevator muscle. Histological or electrophysiological studies can be useful to determine the physiopathology of this association.

[Oculopalpebral and facial synkinesis associated with ptosis: epidemiological, clinical, and therapeutic features]. / Les syncinésies oculo-facio-palpébrales associées au ptosis : aspects épidémiologiques, cliniques et thérapeutiques.

Synkinetic movements of the upper eyelids may be noted in association with movements of either extraocular muscles or other muscles of the face. Patients with oculopalpebral or facial-palpebral synkinesis may also have ptosis of the involved eyelid. The clinical and therapeutic features of this association are specific. We mainly distinguish two forms of synkinetic movements, characterized either by the elevation of the ptotic eyelid such as in Marcus Gunn phenomenon and in the Fuchs sign or by the falling of the upper lid such as in Marin Amat syndrome. Many surgical techniques have been used to correct the blepharoptosis and the synkinetic movement. Levator resection is often advocated for correction of blepharoptosis with a mild degree of synkinesis. However, when the ptosis is major, eyelid lag is a possible outcome. For moderate or major synkinesis, bilateral frontalis suspension with disinsertion of the levator has been suggested. This procedure generally provides satisfactory cosmetic results.

Les keratites amibiennes

L'objectif de cette revue generale est de decrire les caracteristiques des agents responsables des keratites amibiennes; les principes de leur diagnostic positif ainsi que les modalites de leur traitement.Les keratites amibiennes surviennent dans la majorite des cas chez des porteurs de lentilles de contact. Les manifestations cliniques peuvent etre atypiques. Les prelevements; en particulier corneens; permettent de rechercher les amibes par des examens directs et des cultures ou d'identifier leur acide desoxyribo- nucleique par reaction de polymerisation en chaine; cette derniere technique etant plus sensible. La microscopie confocale; permet par ailleurs; de rechercher in vivo des kystes amibiens. Le traitement medical; peut etre institue en cas de forte suspicion clinique du diagnostic. Les protocoles therapeutiques de premiere intention se basent sur l'association de collyres presentant une activite kysticide; le plus souvent un biguanide et une diamidine; pendant plusieurs semaines. Le pronostic visuel est lie a la severite du tableau initial et au delai de mise en route d'un traitement efficace. Les sequelles visuelles peuvent etre invalidantes d'ou l'interet de porter un diagnostic precoce

Uveitis responding on gluten free diet in a girl with celiac disease and diabetes mellitus type 1.

A 9-year old girl with a history of diabetes mellitus type 1, presented with visual loss of the left eye. The right eye examination was unremarkable. Slit-lamp examination revealed few small and fine keratic precipitates. We noted 2+ flare in the vitreous. There was no choroiditis, papillitis or retinal vasculitis. No aetiology was found. The patient was treated by topical and systemic corticosteroids without any improvement. Celiac disease was discovered by the presence of celiac antibodies in the work-up of joint pain and diabetes mellitus type 1. Antiendomysium antibodies and anti-transglutaminase antibodies were both positive. A small bowel biopsy confirmed celiac disease. A gluten free diet was set up and corticosteroids were tapered off. Recovery of the uveitis was obvious during gluten free diet and normalized within two months.

[Orbital metastasis from cutaneous melanoma]. / Métastase orbitaire d'un mélanome malin cutané.

PURPOSE: We report the case of a patient presenting with a one-sided orbital metastasis from a cutaneous melanoma, and analyze clinical features, diagnostic difficulties and prognosis of such metastasis. CASE REPORT: We report the case of a woman aged 70 years, who presented with a right one-sided proptosis associated to a decrease of the vision. The clinical features were: visual acuity at 2/10, an axile proptosis and a papillary sectorial temporal atrophy. The computed tomography (CT) disclosed an intraorbital mass with double tonality, rounded and well limited driving back the optic nerve and erasing the limits of the lateral rectus muscle. The orbital magnetic resonance imaging (MRI) showed an intra-conal fusiform mass with an heterogeneous signal in T1 and T2, heightening intensely and heterogeneously after the injection of Gadolinium. Otherwise, the patient presented with an associated respiratory failure, and thoracic CT has disclosed diffuse metastases. It was then noted that a cutaneous melanoma of the left foot had been operated ten years before. The patient died during the following month. DISCUSSION: The cutaneous melanoma is a rare cause of orbital metastasis. The diagnosis is often easy, when a primitive tumor is known, but it remains uncertain for a long time. CONCLUSION: Orbital metastases from cutaneous melanoma are rare, generally occurring at the late stage of the disease with a life expectancy not passing one year.

[Craniofacial fibrous dysplasia: a case report]. / La dysplasie fibreuse cranio-faciale. A propos d'un cas.

Fibrous dysplasia is classified among benign bone tumors. It is a bone development anomaly characterized by hamartoma proliferation of fibrous tissue within the medullary bone, with secondary bony metaplasia, producing immature, newly formed and weakly calcified bone, without maturation of the osteoblast. It can be monostotic or polyostotic. The craniofacial localization occurs in 10%-25% of cases in monostotic forms and in 50% of cases in polyostotic forms. Fibrous dysplasia essentially affects children and young adults, with no sex preference. Its diagnosis is not always straightforward because the functional symptomology is often absent or not specific. Medical imagery is necessary and in difficult cases a bone biopsy. The major complication of the illness remains sarcomatous degeneration. Only symptomatic forms are treated. We report an observation of craniofacial fibrous dysplasia affecting a child and discovery of proptosis, with no other ocular or general functional signs.

[Human subconjunctival dirofilariasis: two Tunisian case studies]. / La dirofilariose sous-conjonctivale humaine. A propos de deux cas tunisiens.

Two new cases of human subconjunctival dirofilariasis are reported in Tunisia. Dirofilaria immitis was identified in the first case and Dirofilaria repens in the second. Diagnosis was made by histological examination of excised nodules. We note that the patients are young (8 and 10 years, respectively) and that cases of human dirofilariasis caused by Dirofilaria immitis are present in Tunisia.

[Congenital obstruction of lacrimal ducts in 578 children]. / Obstruction congénitale des voies lacrymales chez 578 enfants.

BACKGROUND: Congenital obstruction of the nasa lacrimal ducts is a frequent problem in infancy. Its management is still controversial. REPORT: 578 children aged 6 weeks to 3 years were treated in our department between 1980 and 1987. Congenital obstruction of the nasa lacrimal ducts was bilateral in 172 of them, so that a total of 750 ducts were obstructed. All the infants were treated with antibiotics until they are 2 months old. Permeability was obtained in 97% of the 750 obstructed ducts: this was spontaneous in 38.7%, after a single wash in 3%, and by probing under general anesthesia in 55.3%. The percentage of cases requiring surgery increased with age at time of diagnosis. CONCLUSIONS: The best results are obtained in infants 2 to 4 months old.

[Optic neuropathy of dental origin. Apropos of 4 cases]. / La neuropathie optique d'origine dentaire. A propos de quatre observations.

The optic neuropathy due to dental affection is rare but functionally serious. Authors report four cases of patients who have an acute dental infection with unilateral inflammation of the optic nerve. The first symptom was in all cases a sudden fall of visual acuity. The visual field is always altered. Papilloedema is observed in three eyes. The treatment is of the dental infection at first, secondly, corticosteroïds are associated. An improvement is noticed in three cases. The authors discuss the physiopathology of the affection, its symptoms and treatment.