[Eye lid hygiene in chronic allergic blepharoconjunctivitis patients before laser refractive surgery]. / Gigiena vek v podgotovke k lazernoi refraktsionnoi khirurgii.

AIM: To evaluate the effectiveness of eyelid hygiene in patients with chronic allergic blepharoconjunctivitis (ABC) as a part of their preparation for laser refractive surgery. MATERIAL AND METHODS: The study involved 32 patients (12 males and 20 females aged 25-42 years) with refractive errors, namely, compound myopic astigmatism (23 patients) and hyperopic astigmatism (9 patients) suffering from chronic ABC and secondary dry eye syndrome (DES). All the patients initially received a standard treatment for ABC and DES, that is olopatodin hydrochloride instillations - 1 mg/ml 2 times daily, preservative-free hyaluronic acid preparation - 1 mg/ml 3 times daily, and polyacrylic acid and dexpanthenol gel at night for one month. The scheme, however, appeared not effective enough. Hence, the patients were prescribed eyelid hygiene (Blepharolotion or Blepharosalfetka plus Blepharogel-1 2 times daily) to relive meibomian gland dysfunction (MGD). They also underwent a conventional ophthalmic examination, allergy tests, evaluation of ABC and DES signs and symptoms, tear film break-up time test, Schirmer's test, meibomian glands evaluation, optical coherence tomography with meniscometry, xerosis index evaluation, and lissamine green staining for lid wiper epitheliopathy. RESULTS: At the beginning of the study signs and symptoms of MGD-associated DES were predominant in all patients. Chronic ABC signs were mild. In 2-3 months, meibomian gland function and tear film break-up time improved significantly in most patients, while xerosis index decreased and lid wiper epitheliopathy resolved. Laser refractive surgery (LASIK) was performed in 81.25% of patients, all of whom were satisfied with the results. CONCLUSION: Inclusion of eyelid hygiene into preoperative management of patients with chronic ABC and DES allows to achieve optimum conditions for laser refractive surgery in most cases.

[Necrotising soft tissue infection of orbital area and hand: an unusual combination]. / Necrotiserende wekedeleninfectie van hand en oog.

BACKGROUND: Necrotising soft tissue infection (NSTI) is an infection of the subcutaneous tissues and often follows a fulminant course if not recognised in time. CASE DESCRIPTION: A 78-year-old man was brought to our emergency department in septic shock. Physical examination revealed an erythematous and painful swelling of the right eyelids and to a lesser extent of the right hand. The infection progressed at both sites, and suspicion of NSTI arose. An emergency surgical debridement was performed. Pathological examination of the excised tissue confirmed the presence of a necrotising infection of the fascia consistent with NSTI at both sites. CONCLUSION: This case history describes a, not previously described, 'double' presentation of NSTI. In a patient with misunderstood sepsis in combination with a soft tissue infection, it is important to consult a surgeon immediately. This case report emphasises the need for a multidisciplinary approach when treating patients with these clinical pictures. CONFLICT OF INTEREST AND FINANCIAL SUPPORT: NONE DECLARED.

[Blepharitis - When to Perform Surgery?]. / Blepharitis - wann greifen wir zum Skalpell?

AIM: Meibomian gland dysfunction/blepharitis is usually a harmless inflammatory process of the lid margin. However, it can be the first sign of a malignant lesion. Patients/Results: Clinical and histological findings are illustrated for 8 patients with changes in the lid margin and with the differential diagnosis of blepharitis. CONCLUSION: Tumours of the lid margin can mimic blepharitis or induce meibomian gland dysfunction. Conversely, blepharitis can present in a nodular form, which is highly indicative of a neoplasm. In these cases, surgical excision with ophthalmopathological evaluation of the tissue is mandatory, in order to reach the correct diagnosis and to treat the patient appropriately.

Complicaciones de la Blefaritis. Presentación de caso / Complications of Blepharitis. Case presentation

Introducción: la Blefaritis se define como inflamación bilateral crónica de los bordes palpebrales. Produce alteraciones de bordes palpebrales, glándulas de Meibomio, córnea, conjuntiva y película lagrimal, dando lugar a complicaciones. Tiene especial importancia debido a su elevada incidencia y al daño que produce sobre la superficie ocular. Objetivo: evidenciar manifestaciones clínicas y complicaciones oftalmológicas en paciente con Blefaritis mixta. Presentación del caso: paciente masculino de 82 años, raza negra con antecedentes patológicos personales de salud, acude por aumento de volumen del párpado inferior de ojo izquierdo desde hace 2 años acompañado de secreción y lagrimeo, sin tratamiento previo. El examen oftalmológico evidencia párpado inferior invertido, pestañas que contactan con la conjuntiva. Bordes palpebrales inflamados, con costras y telangiectasias, dilatación de los orificios de las glándulas de Meibomio. Lesiones tumorales en número de 3 que varían entre 2 y 4 mm, duras e indoloras en tarso inferior. Inyección conjuntival moderada y secreción espumosa. Prueba de Shirmer I 9 mm y tiempo de ruptura de película lagrimal 5 segundos. Se diagnosticó Blefaritis mixta complicada con múltiples chalazión, entropión y queratoconjuntivitis seca. Se indicó, previo consentimiento del paciente, tratamiento con tetraciclina, prednisolona, lágrimas artificiales y tratamiento quirúrgico de múltiples chalazión, y se logró la desaparición del entropión. Se realizó el diagnóstico diferencial con carcinoma de glándulas sebáceas, penfigoide cicatrizal y síndrome de Stevens-Johnson. Conclusiones: la Blefaritis es causa importante de morbilidad ocular debido a los cambios que ocasiona sobre la anatomía de los párpados y película lagrimal con el consecuente daño a la superficie ocular(AU)

Introduction: the Blepharitis is defined like a chronic inflammation of the eyelids borders. It produces alterations of eyelids borders, Meibomio glands, and cornea, conjunctive and lachrymal film, giving place to complications. It has special importance due to their high incidence. Objective: evidencing clinical manifestations and ophthalmologic complications in patient with mixed Blepharitis. Case Presentation: a male patient of 82 years, black race with antecedents of health consults because an increase of volume of the lower left lid of eye for 2 years accompanied by secretion and shed tears, without previously treatment. The ophthalmologic exam evidences reversed lower lid, lashes that contact with the conjunctive. We observed a palpable border with a blush eyelid and scabs, telangiectasias, dilation of the holes of Meibomio glands, tumor injuries in number of 3 with a size between 2 and 4 mm, hard and painless lower plate, moderate conjunctival injection, and scarce foamy secretion. The Schirmers test I 9 mm and plate break down up to 5 seconds. It was diagnosed complicated mixed Blepharitis with multiple chalazion, entropion and dry keratoconjunctivitis. Previous informed consent treatment was indicated withtetracycline, prednisolone, artificial tears and surgical treatment of multiple chalazion, being achieved the disappearance of the entropion. It was carried out the differential diagnosis with carcinoma of sebaceous glands, cicatricial pemphigus and Stevens-Johnson´s syndrome. Conclusions: the Blepharitis is an important cause of ocular morbidity due to the changes produced on the anatomy of the lids and lachrymal film with the consequent damage to the ocular surface(AU)

Management of inflammatory corneal melt leading to central perforation in children: a retrospective study and review of literature.

PURPOSE: To assess the outcome of early therapeutic penetrating keratoplasty (PKP) for corneal melt leading to perforation in children. METHODS: Case notes of all the consecutive patients presenting with acute corneal perforation that underwent urgent therapeutic PKP between 2000 and 2010 to the practice of one of the authors, both NHS at Great Ormond Street Hospital for Children and private, were retrospectively reviewed. Onset of perforation, underlying cause, medical and surgical treatment, pre- and post-operative visual acuity, graft clarity, length of follow-up, and post-operative complications were recorded. RESULTS: Four eyes of four consecutive patients (mean age of 9.5 years and median 8.5 years, range 4-17 years) were treated for acquired acute onset corneal perforations. There were three females and one male. Etiologies included herpes simplex keratitis secondary to immune recovery disease post bone marrow transplantation, acanthamoeba keratitis, recessive dystrophic epidermolysis bullosa, and blepharokeratoconjunctivitis with acne rosacea. Pre-operative visual acuity ranged from hand movements to 6/150. All the patients had severe anterior chamber inflammation. All eyes improved in visual acuity ranging from 6/9 to 6/18 with clear grafts at last follow-up. There was no recurrence of melt or perforation. Mean follow-up was 67 months (median 44 months). CONCLUSION: PKP during the acute phase together with aggressive medical therapy and close follow-up may achieve good visual outcomes in children with corneal melt with perforation and should be considered. Waiting may sometimes allow the marked inflammatory response seen in children to cause irreversible structural and/or functional damage.

The effect of perforated punctal plugs in the management of acquired punctal stenosis.

OBJECTIVE: The objectives of this study were to report the success rates for perforated punctual plug (PPP) in the management of acquired punctual stenosis and to evaluate the factors influencing success rates. DESIGN: This was a retrospective, cross-sectional, comparative study. PARTICIPANTS: There were 20 patients. METHODS: Twenty eyes of 20 patients who underwent PPP implantation for the management of acquired punctual stenosis and punctual obstruction were retrospectively evaluated regarding sex and age of the patients and the duration and severity of epiphora, associated blepharitis, and the success of treatment. In all patients, punctum dilation was performed carefully to prevent damage to the ampulla before the insertion of plugs. Perforated punctual plugs were removed 2 months after insertion. RESULTS: There were 7 cases of punctal stenosis, 9 cases of membranous obstruction, 2 punctal burns, 1 papilloma, and 1 nevus involving the punctum causing epiphora. The mean age of patients was 41.4 (SD, 3.9) years. The mean interval between the onset of epiphora and PPP implantation was 32.1 (SD, 10.7) months. Associated chronic blepharitis was detected in 13 eyes. Success was achieved in 17 eyes (85%). Patients whose procedures failed were older (67.7 vs 36.8, P = 0.019) and more likely to have blepharitis (100: 23.5%, P = 0.031). Spontaneous plug loss was noted in 4 eyes between the 1- and 2-month follow-up examination. No patients had residual epiphora. CONCLUSIONS: Perforated punctual plug implantation for the treatment of acquired punctual stenosis and obstruction is very effective. However, careful punctum dilation should be performed, and the patient age and comorbidities should be considered before treatment.

[Nodular fasciitis of the eyelid and anterior orbit in children: case report and review of the literature]. / Noduläre Fasziitis im Kindesalter im Bereich des Lids und der vorderen Orbita: Kasuistik und Literaturübersicht.

An 8-year-old boy presented with a 6-week history of a rapidly progressive erythematous swelling of the right upper eyelid. Ultrasonography and magnetic resonance imaging revealed a subcutaneous nodular mass of the right upper eyelid medially with extension into the anterior orbit. The clinical differential diagnosis included rhabdomyosarcoma. A transcutaneous excisional biopsy was performed, and histopathologic examination confirmed the diagnosis of nodular fasciitis. Five years after surgery, there is no evidence of local recurrence, and the result is aesthetically satisfactory.

[Chronic blepharitis. Pathogenesis, clinical features, and therapy]. / Chronische Blepharitis. Pathogenese, klinischer Verlauf und therapeutische Ansätze.

Chronic blepharitis is one of the most common diseases of the eyelids, but surprisingly, it is not often recognized. Frequently, a skin disease such as seborrheic dermatitis, atopic dermatitis, or acne rosacea is the underlying cause of chronic blepharitis. Bacterial pathological lipase, cholesterylesterase production, and bacterial lipopolysaccharides are pathogenetically relevant. Only rarely do genuine bacterial infections play a role. Collarettes occur at the base of the eye lashes, and the Meibomian glands show either abundant fluid secretion or inspissated secretion with obstruction of the orifices. Chronic blepharitis can include sequelae including dry eye and corneal and lid contour changes. The basic treatment comprises attendance of the underlying dermatological disease and lid hygiene. In addition, preservative-free tear film substitutes, antibiotics, immunomodulatory agents, or even surgical intervention may become necessary.

Intracapsular lens removal in a Przewalski's wild horse (Equus caballus przewalskii).

A 11.5-yr-old female Przewalski's wild horse (Equus caballus przewalskii) presented for unilateral blepharitis and drainage from the left eye. The left cornea was not ulcerated, and intraocular evaluation was hampered by severe corneal edema. The left eye appeared to respond positively to treatment with anti-inflammatories and a topical mydriatic agent. During the ensuing 2 yr, there were minor episodes of epiphora from the left eye. The discharge then increased, and a luxated lens was noted during an examination by a veterinary ophthalmologist as part of the preshipment examination. Initially, the lens was located in the anterior compartment but was in the vitreal compartment at the time of surgery, complicating the intracapsular extraction. After successful removal of the lens, the horse was transferred to a new institution without incident, where it appears to have adapted well to its probable loss of vision in the left eye. No further episodes of uveitis, corneal edema, or epiphora have been reported, and the horse has successfully foaled at the new institution.

[Melkersson-Rosenthal syndrome: anatomo-clinical and evolutive concepts]. / Syndrome de Melkersson-Rosenthal. Concepts anatomo-cliniques et évolutifs.

PURPOSE: To inform ophthalmologists about the Melkersson-Rosenthal Syndrome. A new clinical classification is suggested. METHODS: Commented observation and review of the litterature. RESULTS: The presented case is characterized by an exclusive involvement of orbital sphere, due to inflammation of palpebral and orbital fat. CONCLUSION: Melkersson-Rosenthal Syndrome can be divided into type 1 characterized by perioral lesions and type 2 characterized by periocular lesions, with preferential involvement of fat and evolution towards fibrosis.

Idiopathic sclerosing inflammation of the upper eyelid.

Idiopathic sclerosing inflammation has commonly been found in the diffuse orbital tissues. We report the inflammation of the right upper eyelid in a 65-year-old man. Computed tomography and magnetic resonance imaging showed a diffuse mass localized only in the right upper eyelid. Histologic study of the excised specimen revealed dense collagenous tissue with sparse infiltration of mixed inflammatory cells. Immunohistochemical study showed that the inflammatory cells were largely composed of T cells (UCHL-1), histiocytes (PG-M1) and scattered plasma cells (immunoglobulins). No L26-positive B cells were found. We believe that idiopathic sclerosing inflammation of the upper eyelid, as demonstrated in our patient, may be rare.

Blepharoplasty.

Cosmetic blepharoplasty is performed in various subspecialties, therefore articles appear in the ophthalmic, plastic surgical, otolaryngologic, and dermatologic literature. We review the past year's articles regarding evaluation, technique, adjunctive procedures, and complications. As the various techniques of upper-eyelid and lower-eyelid blepharoplasty have taken their place in the armamentarium of the aesthetic surgeon, attention has turned toward adjunctive procedures to enhance the surgical result.

Blefaroplastia cosmética: técnica quirúrgica / Cosmetic blepharoplasty: surgical technique

En este trabajo se considera fundamentalmente la técnica quirúrgica de la blefaroplastia. Se sigue paso a paso el procedimiento en párpados superiores e inferiores. Se hace referencia previamente a la importancia del examen del paciente y a su indicación con fines estéticos pero también funcionales. Luego, se mencionan brevemente las complicaciones

Necrotising fasciitis of the orbit.

A rare case of necrotising fasciitis affecting the face is described which, following prompt treatment and reconstruction, resulted in a successful outcome.

Blefaroplastia cosmética: técnica quirúrgica / Cosmetic blepharoplasty: surgical technique

En este trabajo se considera fundamentalmente la técnica quirúrgica de la blefaroplastia. Se sigue paso a paso el procedimiento en párpados superiores e inferiores. Se hace referencia previamente a la importancia del examen del paciente y a su indicación con fines estéticos pero también funcionales. Luego, se mencionan brevemente las complicaciones (AU)

Dermis-fat graft for orbital reconstruction after subtotal exenteration.

A surgical technique for reconstruction after subtotal orbital exenteration uses an autogenous dermis-fat graft. A musculocutaneous flap is advanced over the graft to provide the anterior vascular supply for the free dermis-fat graft. The periorbita and remaining orbital tissue provide the vascular supply posteriorly. This technique eliminates extensive skin grafting and delayed spontaneous healing. Wound healing is rapid and surgical morbidity is minimized. We have used this procedure in three patients with sebaceous gland adenocarcinoma, two patients with severe posttraumatic contracted sockets, and as a palliative procedure in one patient with a fungating choroidal melanoma and widespread metastasis.

Streptococcal gangrene of the eyelids. Case reports.

Following a brief review of the literature, three patients with fulminating periocular infections resulting in necrosis of the eyelids are reported on. The case histories demonstrate certain common features, different aetiological factors and diverse end results. The pathogenesis, microbiology and treatment are discussed.