ABSTRACT
PURPOSE: To evaluate the effect of isolated medial and lateral rectus muscle surgery on eye lid position. DESIGN: Prospective, interventional case series. METHODS: We recruited 36 patients with strabismus with surgery performed on one horizontal extraocular muscle only. The width of the lid fissure and the position of the upper and lower lids in relation to the pupil center were measured before and 3 months after surgery. Regression analysis was used to evaluate the surgical effect. RESULTS: Recessions induced a widening of and resections a narrowing of the lid fissure, mainly because of changes of the lower lid position. The effect was statistically significant (change in lid fissure width, = 0.13 x surgical dose in millimeters; r(2) = .35; P = .0001). CONCLUSION: Patients should be informed about changes in lid fissure width after operations on horizontal extraocular muscles. If adequately integrated into the surgical plan, this side effect may alleviate pre-existing interocular differences in lid configuration.
Subject(s)
Eyelid Diseases/etiology , Eyelids/pathology , Oculomotor Muscles/surgery , Ophthalmologic Surgical Procedures/adverse effects , Strabismus/surgery , Adolescent , Adult , Aged , Child , Humans , Middle Aged , Prospective StudiesABSTRACT
PURPOSE: Retrobulbar irradiation is used as a standard therapy for thyroid-associated orbitopathy. The evidence of its effectiveness is, however, scarce. Doses from 2.5 to 20 Gy have been recommended. METHODS: Forty-three patients with active thyroid-associated orbitopathy were irradiated with 2.4 Gy and 43 with 16 Gy. Five measures of outcome were used: (1) appearance of the eye region, documented with photographs; (2) Hertel exophthalmometry; (3) range of vertical eye movements; (4) eye muscle thickness (sum of three MRI sections across the eight rectus eye muscles); and (5) complaints, indicated on a visual analog scale. RESULTS: At 3 and 6 months after irradiation, no difference between 2.4 and 16 Gy was found in any of the five outcome measures (p between 0.099 and 0.993; Kruskal-Wallis test, Holm correction). Most outcome measures were slightly, but not significantly, improved in both the 2.4 and the 16 Gy groups. Patient complaints had improved significantly in both groups and the eye muscle thickness was significantly reduced in the 2.4 Gy group after 6 months. CONCLUSION: The lack of a difference between 2.4 and 16 Gy is compatible with four different interpretations: (1) the irradiation could be ineffective; (2) the maximal effect could be already reached at 2.4 Gy; (3) the maximal effect could lie between 2.4 and 16 Gy; and (4) the effect could increase beyond a threshold of >or=16 Gy. From general experience with inflammatory disease, the last two possibilities are unlikely; only the first two interpretations carry some probability. Although the design of the study did not allow a distinction between these two possibilities, we conclude that retrobulbar irradiation for thyroid-associated orbitopathy should not exceed 2.4 Gy.
Subject(s)
Graves Disease/radiotherapy , Orbital Diseases/radiotherapy , Adult , Aged , Double-Blind Method , Female , Humans , Male , Middle Aged , Radiotherapy DosageABSTRACT
BACKGROUND: Idiopathic orbital pseudotumor is a rare disease. 10 % of the cases occur in children. In most of these juvenile cases, the swelling is bilateral, and histologically, eosinophilic granulocytes are found. In contrast to adults, children very rarely develop an associated systemic disorder. The disease is generally treated with steroids. Little is known about the natural course of idiopathic orbital pseudotumors in childhood. PATIENT: A 2S-year old girl presented with a unilateral swelling of the right upper lid. Four weeks later, a comparable swelling of the left side was revealed. We took biopsies of the lacrimal gland on both sides. Histology displayed an eosinophilic pseudotumor of the lacrimal gland. Steroid treatment was started, but after 4 weeks the parents refused to continue the treatment. During the following year, the bilateral swelling remained unchanged. Surprisingly, the bilateral swelling disappeared 3 years later and no systemic disorder had occured. CONCLUSIONS: Our case shows that spontaneous resolution of a juvenile eosinophilic orbital pseudotumor is possible. Treatment with steroids does not appear to be compulsory in all cases.
