Spontaneous orbitofacial neurofibroma in a sow / Neurofibroma orbitofacial espontâneo em uma matriz suína

Neurofibromas are neoplasms derived from nerve bundles and are frequent in humans but not common in animals. This report described the macroscopic, histologic, and immunohistochemistry findings of an orbitofacial neurofibroma in a sow. The sow presented left eyelids with marked expansion, associated with severe ectropion and reddening of both conjunctival mucosae. The mass on the cutting surface was homogeneous, with a light tan, and shiny, measuring 9.0 x 7.0 x 7.0 cm in width, compressing the eyeball. Microscopically, there was paucicellular neoplastic proliferation of elongated cells amid the accentuated myxoid matrix. There were multifocal areas where well-differentiated nervous fascicles and skeletal musculature were seen. Neoplastic cells were immunostained positive for GFAP, neurofilament, S-100, Sox-10, and vimentin. Cytokeratin showed immunolabeling around primitive nerve bundles and desmin around neoformed vessels and muscle bundles within the tumor. Orbitopalpebral and orbitofacial neurofibroma, despite being common in humans, have not been described in domestic pigs and should be considered as a differential diagnosis in eyelid tumors in pigs.

Neurofibromas são neoplasias derivadas dos feixes nervosos e são frequentes em humanos, mas incomuns em espécies animais domésticos. Esse relato tem como objetivo descrever os achados macroscópicos, histológicos e imuno-histoquímicos de um neurofibroma orbitofacial em uma matriz suína. O animal apresentava as pálpebras esquerdas acentuadamente expandidas, associada a severo ectrópio e avermelhamento de ambas as mucosas conjuntivais. A tumoração palpebral, na superfície de corte, era homogênea, levemente acastanhada e brilhante, medindo 9,0 x 7,0 x 7,0 cm, e comprimia o globo ocular. Microscopicamente foi observada uma proliferação neoplásica pobremente celular de células alongadas no meio de uma acentuada quantidade de matriz mixoide. Havia áreas intratumorias multifocais onde fascículos nervosos bem diferenciados e musculatura esquelética foram observados. As células neoplásicas foram positivas na imuno-histoquímica para GFAP, neurofilamento, S-100, Sox-10 e vimentina. Citoqueratina mostrou uma imunomarcação ao redor de feixes nervosos primitivos e desmina ao redor de vasos neoformados e feixes musculares dentro do tumor. O neurofibroma orbitofacial, apesar de comum em humanos, nunca foi descrito em suínos domésticos e deve ser considerado um diagnóstico diferencial para neoplasias palpebrais em suínos.

Los desencadenantes reflejos en la epilepsia mioclónica juvenil / Reflex triggers in juvenile myoclonic epilepsy

Resumen Introducción : La epilepsia mioclónica juvenil (EMJ) es un síndrome epiléptico de inicio en la infancia y ado lescencia con mioclonías, convulsiones tónico-clónicas generalizadas y ausencias. Los estímulos reflejos como la sensibilidad a la luz o fotosensibilidad, la apertura y cierre palpebral y la inducción por praxias producen descargas epileptiformes y crisis. Estos desencadenan tes reflejos no son todos sistemáticamente estudiados. Objetivo : Examinar los rasgos reflejos en pacientes con EMJ. Métodos : Se evaluaron en forma consecutiva 100 adolescentes y adultos con EMJ que recibían diferentes tratamientos anticrisis. Se realizó un electroencefalogra ma standard con un protocolo de estimulación luminosa intermitente (ELI) y otro para la evaluación de las pra xias a través de una actividad neurocognitiva (ANC). El análisis estadístico fue descriptivo y de correlación. Se consideró significativa una p > 0.05. Resultados : La edad actual fue de 28+/-11 (14-67). Las crisis comenzaron a los 15 años +/-3 (Rango 8-25 años). EL 58% presentaron mioclonías y convulsiones tónico clónicas generalizadas. El 50% recibían ácido valproico y el 31% continuaban con crisis. Descargas epileptiformes en reposo 20%; hiperventilación 30%; apertura y cierre palpebral 12%; respuesta fotoparoxística en la ELI 40%; ANC 23%. Mayor porcentaje de descargas y demora en la realización de la ANC en los que presentaban crisis. El ácido valproico comparado con los otros fármacos no demostró superioridad en el control de las crisis. Conclusiones : Estos hallazgos confirman la importan cia del estudio de los rasgos reflejos para el diagnóstico, seguimiento y el control terapéutico.

Abstract Introduction : Juvenile myoclonic epilepsy (JME) is an epileptic syndrome with onset in childhood and adolescence with myoclonus, absences, and generalized tonic-clonic seizures. Reflex stimuli such as sensitivity to light or photosensitivity, eyelid opening and closing, and praxis induction produce epileptiform discharges and seizures. These reflex triggers are not all system atically studied. Objective : Examine reflex features in patients with JME. Methods : One hundred adolescents and adults with JME who received different anti-seizure treatments were evaluated consecutively. A standard electroen cephalogram was performed with an intermittent light stimulation (SLI) protocol and another for the evaluation of praxias through neurocognitive activity (CNA). The statistical analysis was descriptive and of correlation with a p > 0.05. Results : Current age was 28+/-11 (14-67). The seizure began at 15 years +/-3 (Range 8-25 years). They pre sented myoclonus and generalized tonic-clonic seizures in 58%. 50% received valproic acid and 31% continued with seizures. Epileptiform discharges at rest 20%; hy perventilation 30%; eyelid opening and closing 12%; photoparoxysmal response in SLI 40%; CNA 23%. Higher percentage of discharges and delay in performing CNA in those who presented seizures. Valproic acid com pared to other drugs did not demonstrate superiority in seizure control. Conclusions : These findings confirm the importance of studying reflex traits for diagnosis, follow-up, and therapeutic control.

Suspensión frontal con aponeurosis temporal en paciente con ptosis palpebral traumática recidivante crónica / Frontal suspension with temporal aponeurosis in a patient with chronic recurrent traumatic eyelid ptosis

La ptosis palpebral es una de las patologías más frecuentes en la consulta de oftalmología, tanto en urgencias como en el ámbito ambulatorio. El trauma del párpado superior puede provocar ptosis o retracción o una combinación de ambos. En este tipo de ptosis palpebral, su resolución mediante tratamiento quirúrgico, existiendo múltiples alternativas de procedimientos que se decidirá de acuerdo con la causas que las originan, así como la severidad de la ptosis. En este trabajo es a propósito de un caso clínico en el cual nos encontramos una paciente con ptosis palpebral traumática recidivante, utilizándose suspensión frontal con aponeurosis de músculo temporal, realizándose una variación de la técnica de Crawford disminuyendo la probabilidad de nueva recidiva

Palpebral ptosis is one of the most frequent pathologies in the ophthalmology consultation, both in the emergency room and in the outpatient setting Trauma to the upper eyelid can cause ptosis or retraction or a combination of both. In this type of eyelid ptosis its resolution by surgical treatment, there are multiple alternatives of procedures that will be decided according to the causes that originate them, as well as the severity of the ptosis, in this work is about a clinical case in which we find a patient with Recurrent Traumatic Palpebral Ptosis, using frontal suspension with aponeurosis of temporal muscle, performing a variation of the Crawford Technique decreasing the probability of recurrence.

Reconstrucción palpebral tras resección tumoral del globo ocular / Palpebral Reconstruction after Tumor Resection of the Eyeball

Los defectos palpebrales creados tras la resección tumoral pueden ser parciales o totales, afectar a la lamela externa, a la interna o a ambas y requerir diferente técnica reconstructiva, simple o compleja. El objetivo es presentar los resultados cosméticos y funcionales en una paciente que se le realzó una técnica combinada para resolver un problema complejo del aparato palpebral después de una enucleación. Se logró un aparato palpebral armónico, en el que sus estructuras tienen orden, funcionabilidad y simetría con el lado contralateral. La reconstrucción de los defectos complejos del aparato palpebral solo es posible con la combinación de varias técnicas. Se logró armonía, simetría contralateral y orden de las estructuras(AU)

The palpebral defects created after tumor resection can be partial or total, affect the external lamella, the internal lamella or both, and require different reconstructive techniques, simple or complex. The objective is to present the cosmetic and functional results in a patient who underwent a combined technique to solve a complex problem of the palpebral apparatus after enucleation. A harmonic palpebral apparatus was achieved, in which its structures have order, functionality and symmetry with the contralateral side. The reconstruction of complex defects of the palpebral apparatus is only possible with the combination of several techniques. Harmony, contralateral symmetry and order of the structures were achieved(AU)

Blefaroplastia inferior transcutánea con fijación muscular orbicular externa en pacientes con deformidades del párpado inferior / Transcutaneous lower blepharoplasty with external orbicularis oculi muscle fixation in patients with lower eyelid deformities

Objetivo: Describir el resultado de la técnica de fijación muscular orbicular externa en la Blefaroplastia inferior. Método: Se realizó una investigación descriptiva, prospectiva en pacientes que asistieron a la consulta de Cirugía Plástica del Hospital "Camilo Cienfuegos" entre enero 2018 a enero 2019, la muestra estuvo constituida por 43 pacientes. Para diagnosticarlos se utilizó la clasificación de Ginsbach, con criterios de exclusión el hábito de fumar. Se tuvo en cuenta variables como edad, sexo, deformidad palpebral inferior, complicaciones en el post operatorio a las 24 h y a los 30 días, y grado de satisfacción de los pacientes intervenidos. Se utilizaron métodos de revisión documental, observación, análisis y síntesis y empírico (encuesta), utilizadas para evaluar los resultados. La investigación se realizó siguiendo procedimientos éticos. Resultados: Mostraron que la mayor cantidad de pacientes estuvo en el grupo edad entre 46-50 años todos femeninos, el exceso de piel y las patas de gallina fueron las deformidades que predominaron. La complicación que se presentó fue el sangramiento posoperatorio resuelto en las primeras horas, 42 pacientes refirieron estar satisfechos. Conclusiones: La blefaroplastia es una técnica que se ha venido modificando junto a la necesidad de brindar procedimientos que ofrezcan seguridad y efectividad, en cuanto a la corrección de deformidades en el parpado inferior, con un adecuado tiempo de recuperación, resultados con menor riesgo de complicaciones(AU)

Objective: To describe the outcome of the external orbicularis oris muscle fixation technique in lower blepharoplasty. Methods: A descriptive, prospective research was conducted in patients who attended the Plastic Surgery consultation of the Hospital "Camilo Cienfuegos" from January 2018 to January 2019, the sample consisted of 43 patients. In order to diagnose them, the Ginsbach classification was used, with smoking as exclusion criteria. Variables such as age, gender, lower palpebral deformity, postoperative complications at 24 h and 30 days, and degree of satisfaction of the operated patients were taken into account. Documentary review, observation, analysis and synthesis and empirical (survey) methods were used to evaluate the results. The research was carried out following ethical procedures. Results: They showed that the greatest number of patients was in the age group between 46-50 years old, all of them female; excess skin and goose bumps were the predominant deformities. The complication that occurred was postoperative bleeding resolved in the first hours, 42 patients reported to be satisfied. Conclusions: Blepharoplasty is a technique that has been modified along with the need to provide procedures that offer safety and effectiveness, in terms of correction of deformities in the lower eyelid, with adequate recovery time, results with lower risk of complications(AU)

The eye of the giant anteater (Myrmecophaga tridactyla): Ophthalmic examination findings and diagnostic tests.

OBJECTIVE: To describe ophthalmic examination and diagnostic values for Schirmer tear test (STT), intraocular pressure (IOP), corneal horizontal diameter (CHD), palpebral fissure length (PFL), fundoscopy, and palpebral conjunctiva microbiota from healthy giant anteaters. ANIMALS STUDIED: Twelve giant anteaters (Myrmecophaga tridactyla), 11 adults and one juvenile, five males and seven females. PROCEDURES: The animals were submitted to general anesthesia and ophthalmic evaluation with portable slit-lamp biomicroscope, Finoff transilluminator, and fundoscopy, as well as STT, bacterial culture from palpebral conjunctiva, rebound tonometry IOP, and measurement of PFL and CHD. Data compiled were analyzed with ANOVA and Tukey tests. RESULTS: The results (mean ± standard deviation) were as follows: STT 8.04 ± 6.21 mm/min; IOP 10.92 ± 2.45 mmHg; PFL 0.75 ± 0.11 cm; CHD 0.96 ± 0.10 cm. Out of the 24 eyes swab samples for bacterial culture, 17 were positive, with three genera of Gram-positive bacteria identified Staphylococcus spp., Bacillus sp., and Corynebacterium sp. Gram-negative bacteria were not isolated from any of the samples. CONCLUSIONS: As conservation work in this vulnerable species continues, this report on basic ophthalmic examination and diagnostic parameters will be helpful improve their treatment and care. More ophthalmic studies are encouraged in animals within the Pilosa order.

The influence of luminous intensity on the eyelid aperture and measurement of the margin reflex distance.

PURPOSE: To evaluate whether the flashlight feature of smartphones can be used to replace the traditional flashlight for measuring MRD and investigate the relation between increasing light intensities and MRD measurements. METHODS: A prospective clinical study was conducted with 40 individuals from Hospital de Clínicas de Porto Alegre. Outcome measures: MRD1, MRD2, and palpebral fissure height (PFH) were analyzed by photographic record using different intensity light sources. RESULTS: Flashlight (10 lux): MRD1 mean: 3.97 mm ±1.16; PFH mean: 9.87 mm ±1.53; Smartphone (100 lux) MRD1 mean: 4.02 mm ±1.17; and PFH mean: 9.62 mm ± 1.45 (p > .05). Using a dimmable source of light resulted in a mean reduction of the PFH of 0.75 mm with the highest light intensity (1200 lux). There was no statistically significant association between MRD changes and the iris color, age, and gender of the subjects. CONCLUSIONS: There was no statistically significant difference between the MRD measurements using traditional flashlights compared to higher intensity smartphone flashlight. Using a dimmable source of light, there is a statistically significant reduction in palpebral fissure with higher light intensity, which occurs mostly by upper eyelid lowering, probably due to orbicularis oculi muscle contraction. A smartphone with a built-in flashlight can be used to replace the traditional flashlight in clinical practice without prejudice to the evaluation of the MRD.

Oral selenium improved the disease activity in patients with mild Graves' orbitopathy.

BACKGROUND: Graves' orbitopathy (GO) is the most common extrathyroidal manifestation of Graves' disease (GD), an autoimmune disorder arising from the activity of T lymphocytes against antigens that infiltrate thyroid tissue, orbital tissue and extraocular muscles. An increase in oxidative stress has been discovered in autoimmune thyroid disease, encouraging investigation into new forms of treatment. Selenium has been described as a treatment option given its antioxidant properties. The present study evaluates the decrease of progression and inflammatory signs in patients with mild GO with oral selenium supplementation. METHODS: Controlled, randomized, single center trial at an ophthalmology referral center in Mexico City. Patients at least 18years of age with mild GO according to the CAS classification were included; exclusion criteria in addition to corticosteroid treatment included smokers or selenium allergy. Each patient was randomized into one of two groups. Group A took placebo tablets which consisted of 100µg of starch twice a day for 6months, and group B took a 100µg selenium tablet twice a day for 6months. The patients from both groups were examined and evaluated using a CAS score before and after the first, third and sixth month of treatment. RESULTS: Thirty eyes of 30 patients were studied. The pretreatment values showed no statistically significant differences between groups (P>0.05). Intergroup analysis showed statistically significant differences in palpebral fissure and CAS score between the pretreatment values and six months after treatment in the selenium group (P<0.05). No differences were found in any variables in the placebo group during the study period (P>0.05). No adverse events were reported. CONCLUSIONS: This is the first study in a Mexican population demonstrating that oral selenium decreases clinical activity and stops progression in patients with mild GO.

Resultados funcionales de la blefaroplastia superior / Functional results of upper blepharoplasty

Objetivo: Describir los resultados funcionales de la blefaroplastia superior. Métodos: Se realizó un estudio descriptivo longitudinal prospectivo de 99 pacientes (198 párpados) con diagnóstico de dermatochalasis de párpado superior, algunos asociados a ptosis palpebral y de la ceja, en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el período comprendido de febrero del año 2019 a enero de 2020. Resultados: El 85,8 por ciento fueron del sexo femenino y el 43,5 por ciento eran mayores de 62 años. Predominó la dermatochalasis del párpado superior y la ptosis palpebral en el 68,4 por ciento, así como la dermatochalasis y la ptosis palpebral severa, las cuales representaron el 47,5 y el 50 por ciento respectivamente. En el grupo de 56 a 61 años sobresalió la dermatochalasis del párpado superior y la ptosis de la ceja, con el 61 por ciento. En el 98 por ciento de los casos intervenidos se obtuvo la corrección total de la dermatochalasis del párpado superior, la corrección de la ptosis en el 86 por ciento y de la ceja en el 88 por ciento. No se presentaron complicaciones en el 94 por ciento de los párpados intervenidos. La complicación más frecuente fue el sangramiento, con el 2,5 por ciento. Conclusiones: El abordaje de la ptosis palpebral y de las cejas transblefaroplastia superior logra en la mayoría de los pacientes la corrección total de estas afecciones y de la dermatochalasis. Este procedimiento constituye una herramienta importante para el rejuvenecimiento facial(AU)

Objective: Describe the functional results of upper blepharoplasty. Methods: A prospective longitudinal descriptive study was conducted of 99 patients (198 eyelids) diagnosed with upper eyelid dermatochalasis, in some cases associated to eyelid and eyebrow ptosis. The study was carried out at Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2019 to January 2020. Results: Of the total patients studied, 85.8 percent were female and 43.5 percent were aged over 62 years. Upper eyelid dermatochalasis and palpebral ptosis prevailed with 68.4 percent, whereas severe dermatochalasis and palpebral ptosis represented 47.5 percent and 50 percent, respectively. A predominance was found of upper eyelid dermatochalasis and eyebrow ptosis in the 56-61 age group (61 percent). Total correction of upper eyelid dermatochalasis was achieved in 98 percent of the cases intervened, eyelid ptosis correction in 86 percent and eyebrow ptosis correction in 88 percent. No complications appeared in 94 percent of the eyelids intervened. The most common complication was bleeding with 2.5 percent. Conclusions: In most cases, management of palpebral ptosis and upper eyebrow transblepharoplasty achieves total correction of these disorders and dermatochalasis. The procedure is an important tool for facial rejuvenation(AU)

Ocular examination findings and measurements of tear production and tonometry of ring-tailed coatis (nasua nasua).

OBJECTIVE: To describe ocular anatomical features and to determine tear production and tonometry in normal anesthetized ring-tailed coati (Nasua nasua). ANIMALS: Eight male and seven female ring-tailed coatis (30 eyes) were evaluated, with ages ranging from 7 months to 10 years old. PROCEDURES: The animals were anesthetized with isoflurane and had STT 1, rebound and applanation tonometry, and palpebral fissure length (PFL) measured in both eyes. Rebound tonometry was measured with both TonoVet® and TonoVet Plus®. All eyes were evaluated with slit-lamp biomicroscopy. Following pharmacological mydriasis, direct fundoscopy was performed. ANOVA and Tukey tests were used for the data analysis. RESULTS: There were upper and lower eyelids, as well as a third eyelid. Eyelashes were present on the upper eyelid, while meibomian glands openings were visible on both. The bulbar conjunctiva was pigmented. The pupil was obliquely horizontally ovoid and teardrop shaped when miotic. The color of the iris and tapetum lucidum varied with age. The optic disk was round, and the retina was holangiotic. The mean ± standard deviation values obtained were as follows: STT: 2.50 ± 2.39 mm/min; rebound tonometry: 9.50 ± 2.43 mmHg (TonoVet®, calibration P), 14.60 ± 2.82 mmHg (TonoVet®, calibration D), 18.93 ± 3.99 mmHg (TonoVet Plus®, calibration dog); applanation tonometry: 18.66 ± 4.16 mmHg; PFL: 10.98 ± 1.67 mm. CONCLUSIONS AND CLINICAL RELEVANCE: Anatomical and clinical ophthalmic data presented in this study are unprecedented for this species. The results can be used as clinical reference parameters, allowing for better care of these species. The lack of data for the Procyonidae family must be regarded as an incentive for more studies.

Morphometric analysis of the palpebral fissure and canthal distance in Serbian young adults / Análisis morfométrico de la fisura palpebral y la distancia cantal en adultos jóvenes serbios

SUMMARY: Frontaly and anteriorly the orbit is closed by a skin-muscular closure of eyelids. The eyelids limit the palpebral fissure, which is subject to geographical, racial, and age variations. As a part of the face, eyelids and palpebral fissure play a very important role in the attractiveness of the individual, but al so in the diagnosis of certain local and systemic pathological processes. The aim of the study was to perform a morphometric analysis of the palpebral fissure in a young population without pathological conditions and syndromes. The study was conducted on 90 subjects (45 male and 45 female) aged 19.28±0.69 years. Subjects were photographed with a Nikon D3400 camera, and the morphometric parameters were measured with the ImageJ 1.48v software. Statistical analysis of the data was performed in Windows Excel. The measurements in the study were the distance between the mid-points of both pupils, distance between both external canthi, distance between both internal canthi, palpebral fissure width and palpebral fissure height at three points. The average height of the palpebral fissure to the right is 9.35±1.55 mm and to the left is 9.41±1.56 mm. The average width of the palpebral fissure on the right is 27.05±1.71 mm and on the left is 27.18±1.68 mm. It was found that there was some difference in the measured parameters, however, this difference was not statistically significant.

RESUMEN: El músculo orbicular de los ojos se encuentra en la cara, delante de la órbita y debajo de la piel. Los párpados limitan la fisura palpebral, la abertura natural, sujeta a variaciones geográficas, raciales y de edad. Los párpados y la fisura palpebral juegan un papel importante en la estética de las personas, pero también en el diagnóstico de ciertos procesos patológicos locales y sistémicos. El objetivo del estudio fue realizar un análisis morfométrico de la fisura palpebral en una población joven sin enfermedades o condiciones patológicas. El estudio se realizó en 90 sujetos (45 hombres y 45 mujeres) de 19,28 ± 0,69 años. Los sujetos fueron fotografiados con una cámara Nikon D3400, y los parámetros morfométricos se midieron con el software ImageJ 1.48v. El análisis estadístico de los datos se realizó en Windows Excel. Se midieron la distancia entre los puntos medios de ambas pupilas, la distancia entre ambos cantos laterales, la distancia entre ambos cantos mediales, el ancho de la fisura palpebral y la altura de la fisura palpebral en tres puntos. La altura promedio de la fisura palpebral a la derecha fue 9,35 ± 1,55 mm y a la izquierda fue 9,41 ± 1,56 mm. El ancho promedio de la fisura palpebral a la derecha era 27,05 ± 1,71 mm y a la izquierda era 27,18 ± 1,68 mm. Se determinó una diferencia leve en los parámetros medidos, sin embargo, esta diferencia no fue estadísticamente significativa.

Miastenia gravis en la infancia: una serie de tres casos / Myasthenia gravis in infancy: a series of three cases

La miastenia gravis es una enfermedad neuromuscular crónica debida a deficiencia de transmisión nerviosa en la unión neuromuscular, de origen generalmente autoinmune en el adulto, que se caracteriza por grados variables de debilidad de los músculos esqueléticos del cuerpo, que aumenta durante los períodos de actividad y disminuye después de períodos de descanso. Sin embargo en la infancia cobran especial relevancia los síndromes miasténicos congénitos, que encuentran su origen en mutaciones de genes que codifican proteínas que juegan papeles clave en el mantenimiento de la transmisión neuromuscular, teniendo edad de inicio, distribución de debilidad y respuesta a tratamiento variables. Se presentan tres casos con el objetivo de describir el comportamiento clínico de la enfermedad y la utilidad de estudios complementarios ya que es de suma importancia su precoz identificación y tratamiento. Palabras claves: Miastenia gravis, test de estimulación repetitiva, ptosis palpebral, unión neuromuscular, pares craneanos

Myasthenia gravis is a chronic neuromuscular disease due to deficiency of nerve transmission in the neuromuscular junction, usually of an autoimmune origin in the adult, which is characterized by varying degrees of weakness of the skeletal muscles of the body, which increases during periods of activity and decreases after periods of rest. In childhood, however, congenital myasthenic syndromes, which find their origin in mutations of genes that encode proteins that play key roles in maintaining neuromuscular transmission, which may have a varying age of onset, distribution of weakness and response to treatment, are particularly relevant. Three cases are presented with the aim of describing the clinical presentation and course of the disease and the usefulness of complementary studies, since its early diagnosis and treatment is of paramount importance.Keywords: Myasthenia gravis, repetitive stimulation test, palpebral ptosis, neuromuscular junction, cranial pairs.

Síndrome de Horner: revision de la literatura / Horner´s Syndrome: literature review

Resumen El Síndrome de Horner (SH) es una condición provocada por un grupo heterogéneo de patologías. Estas tienen en común el daño de la vía simpática. La localización más común de la lesión es a nivel preganglionar, por trauma o cirugías en región cervical, torácica o ápex pulmonar. El diagnóstico es primordialmente clínico mediante la identificación de la triada de miosis, ptosis y anhidrosis. Se confirma con las pruebas para cocaína e hidroximetanfetamina. El tratamiento se lleva a cabo primero con agentes farmacológicos. Los que tienen disminución del campo visual por la ptosis o por razones cosméticas se llevan a tratamiento quirúrgico. En ese caso los abordajes operatorios recomendados para ptosis leve son el procedimiento de Fasanella-Servat, el avance de aponeurosis del elevador y en casos severos el cabestrillo frontal. El objetivo es hacer una revisión de los algoritmos diagnósticos y terapéuticos del SH para lograr un abordaje sistemático debido a las múltiples etiologías que posee.

Abstract Horner Syndrome is a condition caused by a heterogeneous group of pathologies. These have in common the damage of the sympathetic pathway. The most common location of the lesion is at the preganglional level, due to trauma or surgeries in the cervical, thoracic or pulmonary apex region. The diagnosis is primarily clinical by identifying the triad of myosis, ptosis and anhidrosis. It is confirmed with the cocaine and hydroxymethamphetamine tests. Treatment is first carried out with pharmacological agents. Those with diminished visual field due to ptosis or cosmetic reasons are undergoing surgical treatment. In this case, the recommended operative approaches for mild ptosis are the Fasanella-Servat procedure, the elevator aponeurosis advance and, in severe cases, the frontalis sling. The objective is to review the diagnostic and therapeutic algorithms of SH in order to achieve a systematic approach due to the multiple aetiologies it possesses.

Ophthalmic contributions to assessing eyes of two neotropical canids: Cerdocyon thous and Chrysocyon brachyurus.

OBJECTIVE: To describe selected ophthalmic tests and anatomical features of eyes of crab-eating foxes (Cerdocyon thous) and maned wolves (Chrysocyon brachyurus). ANIMALS STUDIED: Six crab-eating foxes (12 eyes), eight maned wolves (16 eyes). PROCEDURES: Intramuscular and/or inhalatory anesthesia, ophthalmic evaluation with portable slit-lamp biomicroscope, Schirmer tear test (STT), intraocular pressure measurement with rebound and applanation (crab-eating fox only) tonometers, measurement of palpebral fissure length (PFL), gonioscopy, and fundoscopy. Data were analyzed with ANOVA and Tukey's tests. RESULTS: Both species presented upper and lower eyelids, both with eyelashes and Meibomian glands openings. A third eyelid was also present. In partial miosis, pigmented projections were observed along the edge of the pupil. The draining angle was open, with thin pectinate ligaments. The retina was holangiotic. For crab-eating foxes, mean ± standard deviation values were as follows: STT: 4.33 ± 2.96 mm/min; PFL: 17.45 ± 1.55 mm; rebound tonometry: 10.70 ± 3.43 mm Hg (TonoVet® calibration D),5.66 ± 3.44 mm Hg (TonoVet® calibration P), 17.00 ± 4.64 mm Hg (TonoVet® Plus calibration dog); and applanation tonometry: 11.70 ± 5.70 mm Hg(TonoPen® XL). For maned wolves, the mean ± standard deviation values were as follows: STT: 9.31 ± 7.40 mm/min; PFL: 22.79 ± 1.63 mm; rebound tonometry: 11.00 ± 2.77 mm Hg (TonoVet® calibration D), 6.78 ± 2.58 mm Hg (TonoVet® calibration P), and 18.29 ± 3.47 mm Hg(TonoVet® Plus calibration dog). CONCLUSIONS: This study contributes with knowledge that can help the clinical assessment regarding eyes of crab-eating foxes and maned wolves. The data herein presented for rebound tonometry are new for both species.

Reference values for selected ophthalmic diagnostic tests in two species of microchiroptera bats (Artibeus lituratus and Anoura caudifer).

OBJECTIVE: To establish reference values for ophthalmic tests in two bat species. BATS: Fourteen bats including seven great fruit-eating bats (Artibeus lituratus) and seven tailed tailless bats (Anoura caudifer). PROCEDURES: Normal values for following ophthalmic tests were investigated as follows: (a) aqueous tear production using the standardized endodontic paper point tear test (EPPTT), (b) rebound tonometry, and (c) horizontal palpebral fissure length. RESULTS: Aqueous tear production was 2.53 ± 1.65 mm/min for A lituratus and 1.89 ± 0.62 for A caudifer. Intraocular pressure measured in the upright position was 11.0 ± 3.28 mm Hg for A lituratus and 7.28 ± 2.70 for A caudifer. Horizontal palpebral fissure length was 5.04 ± 0.45 mm for A lituratus and 3.92 ± 0.51 for A caudifer. CONCLUSIONS: The data obtained in the present study may serve as a reference for ophthalmic parameters and help practitioners in the diagnosis and management of eye diseases in bats, as well for future investigations about microchiroptera bats.

Malposiciones palpebrales y su influencia en la topografía corneal previa y posterior a su corrección quirúrgica / Palpebral malpositions and their influence on corneal topography before and after surgical correction

Introducción: las malposiciones palpebrales (ptosis, dermatochalasis superior y ectropión) son de los principales motivos de consulta en el área de cirugía plástica ocular. Aún no hay información concluyente en la literatura sobre los cambios corneales topográficos que se generan con las malposiciones palpebrales y si hay cambios en la topografía corneal posterior a la corrección quirúrgica de estas. Objetivo: determinar los cambios corneales topográficos de los pacientes con malposiciones palpebrales sometidos a corrección quirúrgica. Diseño del estudio: estudio observacional prospectivo longitudinal. Método: pacientes seleccionados por conveniencia a quienes se les realizó corrección quirúrgica de afecciones palpebrales (ptosis, ectropión y dermatochalasis superior) en el Hospital Militar Central de Bogotá entre abril y septiembre de 2019. Se describieron los datos de la topografía corneal previa a la corrección y al mes y tres meses después de esta y la agudeza visual mejor corregida preoperatoria y en la última evaluación postoperatoria realizada. Resultados: se realizó corrección quirúrgica de malposiciones palpebrales a 106 ojos de 54 pacientes. El cilindro medio tuvo un cambio de 0,13 D y el desplazamiento de su eje de 1, 49º. El cambio global en la queratometría media fue de 0,01 D y el grosor corneal central disminuyó 1,5 mcs. En cuanto la agudeza visual mejor corregida hubo un aumento de 0,0415 por escala LogMAR. Conclusión: la cirugía de las malposiciones palpebrales genera cambios topográficos corneales, donde la corrección de ptosis es la que más cambios ocasiona, con persistencia de los cambios a los 3 meses postoperatorio.

Background: palpebral malpositions (ptosis, upper dermatochalasis and ectropion) are the main reasons for consultation in the area of eye plastic surgery. There is still no conclusive information in the literature on the topographic corneal changes that are generated with palpebral malpositions and if there are changes in the corneal topography after surgical correction. Objective: to determine the topographic corneal changes of patients with palpebral malpositions submitted to surgical correction. Study design: longitudinal prospective observational study. Method: patients selected for convenience who underwent surgical correction of palpebral conditions (ptosis, ectropion and upper dermatochalasis) at the Central Militar Hospital of Bogotá between April and September 2019. Corneal topography data prior to correction were described and one month and three months after this and the visual acuity better corrected preoperatively and in the last postoperative evaluation performed. Results: surgical correction of palpebral malpositions was performed in 106 eyes of 54 patients. The middle cylinder had a change of 0,13 D and the displacement of the cylinder axis of 1,49 °. The average global change in mean keratometry was 0,01 D and the central corneal thickness decreased 1,5 mcs. With the best corrected visual acuity there was an increase of 0,0415 per LogMAR scale. Conclusion: palpebral malpositions surgery generates corneal topographic changes, where the correction of ptosis is the one that causes the most changes, with persistence of the changes at 3 months postoperatively.

Trauma palpebral severo / Severe palpebral trauma

RESUMEN La ubicación anatómica de los párpados los predispone a ser dañados frecuentemente por causas traumáticas. Se informa la evolución de un paciente masculino, de 22 años de edad, remitido a la Consulta de Urgencia del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" por presentar trauma palpebral grave en su ojo izquierdo producido por un alambre. Al examen oftalmológico se constató colgajo extenso del párpado superior, que colgaba fijado de la porción temporal. Se comprobó herida horizontal de la aponeurosis del elevador del párpado superior, de bordes anfractuosos, que se extendía a todo el párpado, así como sección del canalículo superior. Se confirmó el diagnóstico de herida avulsiva grave, con afectación del borde libre palpebral y sección del canalículo superior. Se decidió la conducta quirúrgica: reconstrucción palpebral, que incluyó aponeurosis del músculo elevador del párpado superior, canalículo superior con sonda bicanalicular y borde libre palpebral. Durante el seguimiento se constataron buenos resultados estéticos y funcionales. El conocimiento de la anatomía palpebral y una reconstrucción minuciosa de los tejidos palpebrales permiten resultados posquirúrgicos excelentes en un trauma palpebral grave(AU)

ABSTRACT The anatomical location of the eyelids predisposes them to be frequently damaged by traumatic causes. The evolution of a patient aged 22 years is reported, who was referred at Ramón Pando Ferrer Cuban Institute of Ophthalmology for presenting severe eyelid trauma in his left eye caused by a wire. The ophthalmological examination showed a large flap of the upper eyelid, which hung fixed from the temporal portion. Horizontal wound of the aponeurosis of the upper eyelid elevator, with an abnormal fracture, which extended to the entire eyelid, as well as section of the upper canaliculus, was found. The diagnosis of severe avulsive wound was confirmed, with involvement of the palpebral free edge and section of the upper canaliculus. Surgical behavior was decided: eyelid reconstruction, which included aponeurosis of the upper eyelid lift muscle, upper canaliculus with bicanalicular probe and palpebral free edge. During the follow-up, good aesthetic and functional results were observed. The knowledge of the eyelid anatomy and a thorough reconstruction of the eyelid tissues allow excellent post-surgical results in severe eyelid trauma(AU)

Concordancia entre el diagnóstico clínico y el anatomopatológico de los tumores malignos del párpado / Concordance between clinical and anatomopathological diagnosis of palpebral malignancies

RESUMEN Objetivo: Evaluar la concordancia entre el diagnóstico clínico inicial y el histopatológico de tumores palpebrales malignos. Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo de pacientes portadores de diferentes tumores palpebrales, atendidos en el Servicio de Cirugía Plástica Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el periodo comprendido de enero a diciembre del año 2016, en el que se describieron las características clínicas y anatomopatológicas, y la concordancia entre ambos diagnósticos. Resultados: Predominó el grupo de 60-79 años de edad (46,1 por ciento), el sexo femenino (51,7 por ciento) y el color de piel blanco (92,6 por ciento) . Las lesiones se presentaron fundamentalmente en el párpado inferior (77,0 por ciento) y las telangectasias constituyeron el signo de malignidad más consistente (56,8 por ciento), con predominio del carcinoma basocelular, seguido del carcinoma espinocelular (81,4 por ciento y 15,2 por ciento, respectivamente). La concordancia entre el diagnóstico clínico y el histopatológico fue de 69,2 por ciento para el carcinoma basocelular; 9,7 por ciento para el espinocelular y 30 por ciento para el sebáceo (índice de Kappa de 0,338; 0,262 y 0,357, respectivamente). Conclusiones: Existe la mayor concordancia entre diagnóstico clínico e histopatológico en el carcinoma basocelular; no así en el resto de los tumores estudiados(AU)

ABSTRACT Objective: To assess the concordance between the initial and histopathological clinical diagnosis of malignant palpebral tumors. Methods: An observational, descriptive and retrospective study of patients with different eyelid tumors was performed. The patients were treated in the Ocular Plastic Surgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology, in the period from January to December of 2016, during which the clinical and pathological characteristics were described, together with the concordance between both diagnoses. Results: The age group of 60-79 years predominated (46.1 percent), as it was with the female sex (51.7 percent) and the white skin color (92.6 percent). The lesions occurred mainly in the lower eyelid (77.0 percent) and telangiectasia constituted the most consistent sign of malignancy (56.8 percent), with a predominance of basal cell carcinoma, followed by spinocellular carcinoma (81.4 percent and 15, 2 percent, respectively). The concordance between the clinical and histopathological diagnosis was 69.2 percent for basal cell carcinoma; 9.7 percent for the spinocellular carcinoma; and 30 percent for the sebaceous carcinoma (Kappa index of 0.388, 0.262 and 0.357, respectively). Conclusions: There is the greatest concordance between the clinical and histopathological diagnosis in basal cell carcinoma, but not in the rest of the tumors studied(AU)

Síndrome de párpado laxo / The lax eyelid syndrome

RESUMEN El síndrome de párpado laxo es un cuadro que con frecuencia pasa inadvertido. Los síntomas que lo caracterizan son generalmente muy inespecíficos, por lo que a menudo los pacientes son diagnosticados erróneamente con conjuntivitis infecciosa crónica, blefaritis o síndrome del ojo seco, lo que puede llevar a un retraso o falta de tratamiento durante meses o incluso años. Se presenta el caso de una paciente de 54 años, atendida en el Servicio de Cirugía Plástica Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", quien refirió sensación de arenilla, ardor y secreciones. Durante el interrogatorio se constató la presencia de trastornos del sueño y eversión del párpado superior al dormir. Se le diagnosticó un síndrome de párpado laxo y se decidió realizar tratamiento quirúrgico, con el uso de la técnica de acortamiento horizontal del párpado. Al mes de la cirugía se observó la desaparición de toda la sintomatología y un resultado estético muy favorable. Aunque el síndrome del párpado laxo no es potencialmente mortal, puede conducir a condiciones serias que amenazan la visión y ser un indicador de condiciones sistémicas fatales(AU)

ABSTRACT The lax eyelid syndrome is a condition that often goes unnoticed. The symptoms that characterize it are generally very nonspecific, so patients are often misdiagnosed with chronic infectious conjunctivitis, blepharitis, or dry eye syndrome, which can lead to a delay or lack of treatment for months or even years. The case of a 54-year-old patient is presented. The patient was treated at the Ocular Plastic Surgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology and reported gritty sensation, burning and secretions. During the interrogation, the presence of sleep disorders and dislocation of the upper eyelid during sleep was found. The patient was diagnosed with lax eyelid syndrome and it was decided to perform surgical treatment, using the horizontal lid shortening technique. One month after the surgery, the disappearance of all the symptoms and a very favorable aesthetic result were observed. Although lax eyelid syndrome is not life-threatening, it can lead to serious conditions that threaten vision and can be an indicator of fatal systemic conditions(AU)