[Ice pack test in the diagnosis of myasthenia gravis]. / Teste do gelo no diagnóstico de miastenia gravis.

PURPOSE: To demonstrate the sensitivity and the specificity of the ice test in the differential diagnosis of ptosis in myasthenia gravis. METHODS: Prospective trial with a control group. The patients were instructed to hold a frozen ice pack on the closed ptotic eyelid. They were divided into 2 groups, with group I consisting of patients with myasthenia gravis and group II (control) consisting of patients with congenital, non-myasthenic myogenic or aponeurotic ptosis. RESULTS: All patients in group I had increased palpebral fissure for at least 3 mm after the application of ice pack. No patient in group II showed increased palpebral fissure after the ice test. CONCLUSION: Ice test proved to be specific for the detection of myasthenic ptosis.

Metastatic eyelid disease associated with primary breast carcinoma: case report.

Metastasis confined to eyelids are rare, representing less than 1% of malignant eyelid lesions. More than 50% of all eyelid metastasis are reported to have the breast as the most common primary origin. Two cases of metastatic eyelid disease associated with primary breast carcinoma are described. These lesions were the first sign of metastatic systemic disease. Case 1: An 80-year old woman with no significant ophthalmological history complaining of a discrete painless lesion in the left upper eyelid. She had been diagnosed 10 years before as infiltrated ductal carcinoma of right mammary gland with no reference of metastatic disease. Case 2: A 77-year old woman who attends our ophthalmology service came complaining of a four-month history of a painless swelling and erythema of right lower eyelid. The past medical history was significant for infiltrated ductal carcinoma on right mammary gland 2 years before the ocular manifestation. Breast carcinoma is notorious for its presentation diversity. Metastatic disease should be considered as differential diagnosis of eyelid lesions. Although rare, these lesions can be an initial sign of systemic malignancy.

[Bipedicle myocutaneous flap for cicatricial ectropion correction]. / Retalho miocutâneo bipediculado para correção do ectrópio cicatricial.

PURPOSE: To evaluate the correction of lower eyelid cicatricial ectropion due to shrinking of anterior lamela with the surgical technique of bipedicle myocutaneous flap from the upper eyelid. METHODS: Prospective study with eight eyelids of six patients. There were two patients with unilateral ectropion who had received external local radiotherapy. RESULTS: There were three male and three female patients, with mean age of 72 years. One patient presented an incomplete blinking for one month that spontaneously resolved. Three eyelids of two patients maintained a residual ectropion; one of them had received local external radiotherapy. Follow-up ranged from 19 to 23 months (mean of 20 months) and all patients improved their ocular condition. CONCLUSION: The bipedicle myocutaneous flap is effective for correction of cicatricial ectropion due to shrinking of anterior lamella.