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1.
Arq Bras Oftalmol ; 87(5): e20230296, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39109703

RESUMEN

PURPOSE: To compare inferomedial wall orbital decompression to balanced medial plus lateral wall orbital decompression in patients with Graves' orbitopathy in the inactive phase with regard to exophthalmos reduction and the effects on quality of life. METHODS: Forty-two patients with inactive Graves' orbitopathy were randomly divided into two groups and submitted to one of two orbital decompression techniques: inferomedial wall orbital decompression or medial plus lateral wall orbital decompression. Preoperative and postoperative assessments included Hertel's exophthalmometry and a validated Graves' orbitopathy quality of life questionnaire. The results of the two groups were compared. RESULTS: Compared to preoperative measurement, exophthalmos reduction was statistically significant in both groups (p<0.001) but more so in patients undergoing medial plus lateral wall orbital decompression (p=0.010). Neither orbital decompression techniques increased the visual functioning subscale score on the Graves' orbitopathy quality of life questionnaire (inferomedial wall orbital decompression p=0.362 and medial plus lateral wall orbital decompression p=0.727), but a statistically significant difference was observed in the score of the appearance subscale in patients submitted to medial plus lateral wall orbital decompression (p=0.006). CONCLUSIONS: Inferomedial wall orbital decompression is a good alternative for patients who do not require large exophthalmos reduction. However, medial plus lateral wall orbital decompression offers greater exophthalmos reduction and greater improvement in appearance (higher Graves' orbitopathy quality of life questionnaire scores), making it a suitable option for esthetic-functional rehabilitation.


Asunto(s)
Descompresión Quirúrgica , Exoftalmia , Oftalmopatía de Graves , Calidad de Vida , Humanos , Descompresión Quirúrgica/métodos , Oftalmopatía de Graves/cirugía , Oftalmopatía de Graves/psicología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Exoftalmia/cirugía , Resultado del Tratamiento , Encuestas y Cuestionarios , Órbita/cirugía , Periodo Posoperatorio
2.
Arq. bras. oftalmol ; Arq. bras. oftalmol;87(5): e2023, 2024. tab
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1568840

RESUMEN

ABSTRACT Purpose: To compare inferomedial wall orbital decompression to balanced medial plus lateral wall orbital decompression in patients with Graves' orbitopathy in the inactive phase with regard to exophthalmos reduction and the effects on quality of life. Methods: Forty-two patients with inactive Graves' orbitopathy were randomly divided into two groups and submitted to one of two orbital decompression techniques: inferomedial wall orbital decompression or medial plus lateral wall orbital decompression. Preoperative and postoperative assessments included Hertel's exophthalmometry and a validated Graves' orbitopathy quality of life questionnaire. The results of the two groups were compared. Results: Compared to preoperative measurement, exophthalmos reduction was statistically significant in both groups (p<0.001) but more so in patients undergoing medial plus lateral wall orbital decompression (p=0.010). Neither orbital decompression techniques increased the visual functioning subscale score on the Graves' orbitopathy quality of life questionnaire (inferomedial wall orbital decompression p=0.362 and medial plus lateral wall orbital decompression p=0.727), but a statistically significant difference was observed in the score of the appearance subscale in patients submitted to medial plus lateral wall orbital decompression (p=0.006). Conclusions: Inferomedial wall orbital decompression is a good alternative for patients who do not require large exophthalmos reduction. However, medial plus lateral wall orbital decompression offers greater exophthalmos reduction and greater improvement in appearance (higher Graves' orbitopathy quality of life questionnaire scores), making it a suitable option for esthetic-functional rehabilitation.

3.
Rev. bras. oftalmol ; 81: e0032, 2022. graf
Artículo en Inglés | LILACS | ID: biblio-1376780

RESUMEN

ABSTRACT In the literature, there is a confusing classification among congenital floppy eyelid, eyelid eversion and ectropion. They are described as eyelid malposition with laxity and out-turning of the eyelids in newborns, usually associated with conjunctival prolapse and chemosis. Although the underlying pathophysiology of these rare conditions is obscure, they share anatomic characteristics. Thus, instead of a plethora of denominations, a spectrum approach should join these entities. In this paper, the authors present a case series of four patients that illustrates distinctive presentations of this condition and advocate that it should be considered as variants of a spectrum of congenital ectropion. Mild cases, when promptly treated, can benefit from clinical treatment. On the other hand, severe and delayed cases will need surgical correction as in the case of acquired ectropion.


RESUMO Na literatura, existe uma classificação confusa entre floppy eyelid congênita, eversão palpebral e ectrópio congênito. Essas afecções são similarmente descritas como pálpebras frouxas e evertidas em recém-nascidos e geralmente associadas a prolapso de conjuntiva e quemose. Embora a fisiopatologia dessas raras afecções seja incerta, elas apresentam íntimas características anatômicas em comum. Assim, ao invés dessa nomenclatura variada, seria interessante incluí-las em um espectro de uma só doença. Neste artigo. apresenta-se uma série de quatro casos que ilustram diferentes apresentações dessa afecção e propõe-se que todas devam ser consideradas variações do espectro de ectrópio congênito. Casos leves são beneficiados quando tratados precocemente. Por outro lado, casos mais graves ou que são tratados tardiamente necessitarão de procedimento cirúrgico semelhante ao ectrópio adquirido.


Asunto(s)
Humanos , Recién Nacido , Preescolar , Ectropión/congénito , Párpados/anomalías , Ectropión/cirugía , Ectropión/terapia , Párpados/cirugía
4.
Arq. bras. oftalmol ; Arq. bras. oftalmol;84(6): 602-605, Nov.-Dec. 2021. graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1350071

RESUMEN

ABSTRACT Tearing is a very common symptom in ophthalmic practice; however, this issue is commonly overlooked. The authors describe the case of a patient with chronic unilateral epiphora that had been neglected for 8 y; lacrimal system workup was performed for this patient only because of dacryocystitis evolvement. Following the diagnosis of nasolacrimal duct blockage, dacryocystorhinostomy was indicated. Intraoperative abnormal mucosa was subjected to biopsy, and a diagnosis of squamous cell carcinoma in the lacrimal sac was established. Extended tumor excision was performed for the patient and adjuvant radiotherapy was administered, without any recurrence till the 2-year follow-up. The present report highlights the relevance of a detailed evaluation for determining the underlying causes of tearing, especially in chronic unilateral presentation. The consideration of potential malignancy in such cases could prevent delayed diagnosis of uncommon but potentially life-threatening malignancies of the lacrimal drainage system.


RESUMO O lacrimejamento é um sinal comum na prática oftalmológica, porém frequentemente negligenciado. Os autores descrevem um caso de um paciente com epífora unilateral direita com 8 anos de história que só após evoluir com dacriocistite foi submetido a semiologia de vias lacrimais. Após o diagnóstico de obstrução baixa da via lacrimal foi submetido a cirurgia de dacriocistorrinostomia, onde o saco lacrimal de aparência atípica foi biopsiado e identificado como carcinoma espinocelular. O paciente foi submetido a ressecção oncológica do tumor seguido de radioterapia adjuvante, permanecendo livre de recidiva por 2 anos. Este caso ressalta a importância de investigar causas da epífora, especialmente quando unilateral, dada sua maior associação com a obstrução de via lacrimal. Uma semiologia oportuna das vias lacrimais podem evitar atrasos no diagnóstico de obstrução secundárias a neoplasia, que apesar de incomuns, são potencialmente fatais.

5.
Arq Bras Oftalmol ; 84(6): 602-605, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34431882

RESUMEN

Tearing is a very common symptom in ophthalmic practice; however, this issue is commonly overlooked. The authors describe the case of a patient with chronic unilateral epiphora that had been neglected for 8 y; lacrimal system workup was performed for this patient only because of dacryocystitis evolvement. Following the diagnosis of nasolacrimal duct blockage, dacryocystorhinostomy was indicated. Intraoperative abnormal mucosa was subjected to biopsy, and a diagnosis of squamous cell carcinoma in the lacrimal sac was established. Extended tumor excision was performed for the patient and adjuvant radiotherapy was administered, without any recurrence till the 2-year follow-up. The present report highlights the relevance of a detailed evaluation for determining the underlying causes of tearing, especially in chronic unilateral presentation. The consideration of potential malignancy in such cases could prevent delayed diagnosis of uncommon but potentially life-threatening malignancies of the lacrimal drainage system.


Asunto(s)
Carcinoma de Células Escamosas , Dacriocistitis , Dacriocistorrinostomía , Enfermedades del Aparato Lagrimal , Obstrucción del Conducto Lagrimal , Conducto Nasolagrimal , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirugía , Humanos , Enfermedades del Aparato Lagrimal/diagnóstico por imagen , Enfermedades del Aparato Lagrimal/cirugía , Obstrucción del Conducto Lagrimal/diagnóstico , Obstrucción del Conducto Lagrimal/etiología , Conducto Nasolagrimal/diagnóstico por imagen , Conducto Nasolagrimal/cirugía
6.
Clinics (Sao Paulo) ; 76: e2592, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33852655

RESUMEN

OBJECTIVES: To compare the surgical outcomes of inferomedial wall orbital decompression (IM-OD) and balanced medial plus lateral wall orbital decompression (ML-OD) in patients with inactive Graves' orbitopathy (GO) with regard to exophthalmos reduction and ocular motility abnormalities. METHODS: Forty-two patients with inactive GO eligible for OD were randomly assigned to either the IM-OD or ML-OD groups. Pre and postoperative evaluations included Hertel exophthalmometry, sensory, and motor extraocular motility assessment, standardized photographs in the nine gaze positions, and computed tomography (CT) of the orbits. ClinicalTrials.gov: NCT03278964. RESULTS: Exophthalmometry reduction was statistically significant in both groups (p<0.001), but was greater in the ML-OD group (p=0.010). New-onset esotropia occurred in 11.1% and 23.5% of patients who underwent IM-OD and ML-OD, respectively, with no statistically significant difference in the frequency of pre and postoperative strabismus in either group. The mean increase in preoperative esotropia was 24±6.9 and 12±8.8 prism diopters in patients who underwent IM-OD and ML-OD, respectively. In the IM-OD group, abduction and elevation worsened at the first (p<0.05) and third (p<0.05) postoperative visits but were restored at 6 months. The versions did not change postoperatively with ML-OD. The preoperative CT-measured medial rectus muscle area predicted new-onset strabismus (p=0.023). Significant postoperative medial rectus muscle enlargement occurred in both groups (p<0.001). Restriction in elevation and abduction was significantly associated with enlarged inferior (p=0.007) and medial rectus muscle areas (p=0.002). CONCLUSIONS: IM-OD is as safe as ML-OD with regard to new-onset strabismus, and represents a good alternative for patients who do not require significant exophthalmos reduction. ML-OD offers greater exophthalmos reduction and smoother postoperative recovery. Patients with preoperative enlarged medial rectus muscle on CT are at risk for new-onset esotropia, and preoperative esotropia is likely to increase after OD.


Asunto(s)
Oftalmopatía de Graves , Descompresión Quirúrgica , Oftalmopatía de Graves/diagnóstico por imagen , Oftalmopatía de Graves/cirugía , Humanos , Órbita/diagnóstico por imagen , Órbita/cirugía , Estudios Prospectivos , Estudios Retrospectivos
7.
Clinics ; Clinics;76: e2592, 2021. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1286079

RESUMEN

OBJECTIVES: To compare the surgical outcomes of inferomedial wall orbital decompression (IM-OD) and balanced medial plus lateral wall orbital decompression (ML-OD) in patients with inactive Graves' orbitopathy (GO) with regard to exophthalmos reduction and ocular motility abnormalities. METHODS: Forty-two patients with inactive GO eligible for OD were randomly assigned to either the IM-OD or ML-OD groups. Pre and postoperative evaluations included Hertel exophthalmometry, sensory, and motor extraocular motility assessment, standardized photographs in the nine gaze positions, and computed tomography (CT) of the orbits. ClinicalTrials.gov: NCT03278964. RESULTS: Exophthalmometry reduction was statistically significant in both groups (p<0.001), but was greater in the ML-OD group (p=0.010). New-onset esotropia occurred in 11.1% and 23.5% of patients who underwent IM-OD and ML-OD, respectively, with no statistically significant difference in the frequency of pre and postoperative strabismus in either group. The mean increase in preoperative esotropia was 24±6.9 and 12±8.8 prism diopters in patients who underwent IM-OD and ML-OD, respectively. In the IM-OD group, abduction and elevation worsened at the first (p<0.05) and third (p<0.05) postoperative visits but were restored at 6 months. The versions did not change postoperatively with ML-OD. The preoperative CT-measured medial rectus muscle area predicted new-onset strabismus (p=0.023). Significant postoperative medial rectus muscle enlargement occurred in both groups (p<0.001). Restriction in elevation and abduction was significantly associated with enlarged inferior (p=0.007) and medial rectus muscle areas (p=0.002). CONCLUSIONS: IM-OD is as safe as ML-OD with regard to new-onset strabismus, and represents a good alternative for patients who do not require significant exophthalmos reduction. ML-OD offers greater exophthalmos reduction and smoother postoperative recovery. Patients with preoperative enlarged medial rectus muscle on CT are at risk for new-onset esotropia, and preoperative esotropia is likely to increase after OD.


Asunto(s)
Humanos , Oftalmopatía de Graves/cirugía , Oftalmopatía de Graves/diagnóstico por imagen , Órbita/cirugía , Órbita/diagnóstico por imagen , Estudios Prospectivos , Estudios Retrospectivos , Descompresión Quirúrgica
8.
Arq Bras Oftalmol ; 81(3): 239-241, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29924201

RESUMEN

Necrotizing fasciitis is a severe infection of the subcutaneous tissue characterized by necrosis of the superficial fascia and overlying skin and is usually associated with previous trauma and comorbidities. Periorbital necrotizing fasciitis is rare and commonly causes visual loss and soft tissue defects. A better prognosis relies critically on early diagnosis, prompt medical treatment, and timely surgical intervention. We describe a rare case of periorbital necrotizing fasciitis in the absence of an inciting event. A 55-year-old female patient presented with acute painful swelling and redness of the right upper eyelid that spread to both eyelids bilaterally within 24 h. We swiftly started the patient on intravenous antibiotic therapy, and we surgically debrided the necrotic tissue the following day. We performed two further procedures to improve eyelid closure and appearance. Despite the severe presentation, timely antibiotic therapy and proper surgical interventions led to a successful outcome in this case.


Asunto(s)
Fascitis Necrotizante/cirugía , Desbridamiento , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/patología , Femenino , Humanos , Persona de Mediana Edad , Procedimientos de Cirugía Plástica , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
9.
Arq. bras. oftalmol ; Arq. bras. oftalmol;81(3): 239-241, May-June 2018. graf
Artículo en Inglés | LILACS | ID: biblio-950457

RESUMEN

ABSTRACT Necrotizing fasciitis is a severe infection of the subcutaneous tissue characterized by necrosis of the superficial fascia and overlying skin and is usually associated with previous trauma and comorbidities. Periorbital necrotizing fasciitis is rare and commonly causes visual loss and soft tissue defects. A better prognosis relies critically on early diagnosis, prompt medical treatment, and timely surgical intervention. We describe a rare case of periorbital necrotizing fasciitis in the absence of an inciting event. A 55-year-old female patient presented with acute painful swelling and redness of the right upper eyelid that spread to both eyelids bilaterally within 24 h. We swiftly started the patient on intravenous antibiotic therapy, and we surgically debrided the necrotic tissue the following day. We performed two further procedures to improve eyelid closure and appearance. Despite the severe presentation, timely antibiotic therapy and proper surgical interventions led to a successful outcome in this case.


RESUMO Fasciite necrosante é uma infecção grave do tecido subcutâneo, caracterizada pela necrose da fáscia superficial e da pele sobrejacente. Traumas prévios e cormobidades geralmente estão associados à fasciite necrosante. Fasciite necrosante periorbital é rara. Perda visual e defeitos em tecidos moles são as morbidades mais comuns. Diagnóstico precoce, tratamento clínico rápido e intervenção cirúrgica oportuna levam a um melhor prognóstico. Reportamos um caso incomum de fasciite necrosante periorbital bilateral sem eventos desencadeantes. Uma paciente de 50 anos apresentou edema e eritema na pálpebra superior direita, que progrediu em 24 horas para ambas pálpebras bilateralmente. Ela era previamente hígida. A paciente foi submetida a debridamento cirúrgico do tecido necrótico, no mesmo dia. A paciente foi submetida a outras duas cirurgias, o que melhorou o fechamento palpebral e a aparência. Apesar da gravidade da doença, antibioticoterapia e cirurgias oportunas foram cruciais para o desfecho bem sucedido deste caso.


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Fascitis Necrotizante/cirugía , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/patología , Procedimientos de Cirugía Plástica , Desbridamiento
10.
Einstein (Säo Paulo) ; 14(4): 553-556, Oct.-Dec. 2016. graf
Artículo en Inglés | LILACS | ID: biblio-840263

RESUMEN

ABSTRACT The diagnosis of Graves’ orbitopathy is usually straightforward. However, orbital diseases that mimick some clinical signs of Graves’ orbitopathy may cause diagnostic confusion, particularly when associated to some form of thyroid dysfunction. This report describes the rare occurrence of localized inferior rectus muscle amyloidosis in a patient with autoimmune hypothyroidism, who was misdiagnosed as Graves’ orbitopathy. A 48-year-old man complained of painless progressive proptosis on the left side and intermittent vertical diplopia for 6 months. The diagnosis of Graves’ orbitopathy was entertained after magnetic resonance imaging revealing a markedly enlarged, tendon-sparing inferior rectus enlargement on the left side, and an autoimmune hypothyroidism was disclosed on systemic medical workup. After no clinical improvement with treatment, the patient was referred to an ophthalmologist and further investigation was performed. The presence of calcification in the inferior rectus muscle on computed tomography, associated with the clinical findings led to a diagnostic biopsy, which revealed amyloid deposition. This report emphasizes that a careful evaluation of atypical forms of Graves’ orbitopathy may be crucial and should include, yet with rare occurrence, amyloidosis in its differential diagnosis.


RESUMO O diagnóstico de orbitopatia de Graves usualmente é fácil de ser estabelecido. No entanto, doenças da órbita que simulam alguns sinais clínicos da orbitopatia de Graves podem levar à confusão diagnóstica, particularmente quando associada à alguma forma de disfunção tireoidiana. Relatamos a ocorrência rara de amiloidose localizada no músculo reto inferior em paciente com hipotireoidismo autoimune, que recebeu inicialmente o diagnóstico errôneo de orbitopatia de Graves. Paciente masculino, 48 anos, com queixa de proptose progressiva e indolor do lado esquerdo e diplopia vertical intermitente há 6 meses. O diagnóstico de orbitopatia de Graves foi considerado após a realização de ressonância magnética, que revelou aumento importante do músculo reto inferior esquerdo, sem acometimento do tendão, e uma propedêutica sistêmica detectou hipotireoidismo autoimune. Como não houve melhora com o tratamento clínico, o paciente foi encaminhado a um oftalmologista, que realizou nova investigação. A presença de calcificação no músculo reto inferior na tomografia computadorizada, associada aos achados clínicos, levou a uma biópsia da lesão, que demonstrou a deposição de material amiloide. Este relato enfatiza como uma avaliação minuciosa das formas atípicas de orbitopatia de Graves é essencial e deve incluir a ocorrência, embora rara, de amiloidose no diagnóstico diferencial da orbitopatia de Graves.


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Oftalmopatía de Graves/diagnóstico , Amiloidosis/diagnóstico , Músculos Oculomotores , Biopsia , Tiroiditis Autoinmune/diagnóstico , Tomografía Computarizada por Rayos X , Oftalmopatía de Graves/patología , Oftalmopatía de Graves/diagnóstico por imagen , Enfermedad de Hashimoto/diagnóstico , Enfermedades de los Párpados/diagnóstico por imagen , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas , Amiloidosis/patología , Amiloidosis/diagnóstico por imagen , Músculos Oculomotores/patología , Músculos Oculomotores/diagnóstico por imagen
11.
Indian J Ophthalmol ; 64(7): 538-40, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24088630

RESUMEN

Kimura's disease (KD) is a rare chronic inflammatory disease of unclear etiology, characterized by subcutaneous nodules, mainly in the head and neck region, frequently associated with regional lymphadenopathy. Orbital involvement is infrequent and when it occurs, usually affects the eyelid or the lacrimal gland. We report a case of a 44-year-old man that presented with bilateral slowly progressive proptosis that was initially misdiagnosed as Graves' Ophthalmopathy. 15 months of worsening proptosis and the development of facial and temporal swelling led to further investigation. Computed tomography and magnetic resonance imaging showed enlargement of all recti muscles and diffuse orbital infiltration. An orbital biopsy was performed and was consistent with the diagnosis of KD. Long term oral corticosteroid showed marked improvement of proptosis and facial swelling. This case serves to emphasize that KD should be included in the differential diagnosis of inflammatory diseases of the orbit, even when characterized by predominant involvement of the extraocular muscles.


Asunto(s)
Hiperplasia Angiolinfoide con Eosinofilia/complicaciones , Errores Diagnósticos , Exoftalmia/diagnóstico , Adulto , Hiperplasia Angiolinfoide con Eosinofilia/diagnóstico , Biopsia , Diagnóstico Diferencial , Exoftalmia/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Músculos Oculomotores , Tomografía Computarizada por Rayos X
12.
Einstein (Sao Paulo) ; 14(4): 553-556, 2016.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-28076605

RESUMEN

The diagnosis of Graves' orbitopathy is usually straightforward. However, orbital diseases that mimick some clinical signs of Graves' orbitopathy may cause diagnostic confusion, particularly when associated to some form of thyroid dysfunction. This report describes the rare occurrence of localized inferior rectus muscle amyloidosis in a patient with autoimmune hypothyroidism, who was misdiagnosed as Graves' orbitopathy. A 48-year-old man complained of painless progressive proptosis on the left side and intermittent vertical diplopia for 6 months. The diagnosis of Graves' orbitopathy was entertained after magnetic resonance imaging revealing a markedly enlarged, tendon-sparing inferior rectus enlargement on the left side, and an autoimmune hypothyroidism was disclosed on systemic medical workup. After no clinical improvement with treatment, the patient was referred to an ophthalmologist and further investigation was performed. The presence of calcification in the inferior rectus muscle on computed tomography, associated with the clinical findings led to a diagnostic biopsy, which revealed amyloid deposition. This report emphasizes that a careful evaluation of atypical forms of Graves' orbitopathy may be crucial and should include, yet with rare occurrence, amyloidosis in its differential diagnosis. RESUMO O diagnóstico de orbitopatia de Graves usualmente é fácil de ser estabelecido. No entanto, doenças da órbita que simulam alguns sinais clínicos da orbitopatia de Graves podem levar à confusão diagnóstica, particularmente quando associada à alguma forma de disfunção tireoidiana. Relatamos a ocorrência rara de amiloidose localizada no músculo reto inferior em paciente com hipotireoidismo autoimune, que recebeu inicialmente o diagnóstico errôneo de orbitopatia de Graves. Paciente masculino, 48 anos, com queixa de proptose progressiva e indolor do lado esquerdo e diplopia vertical intermitente há 6 meses. O diagnóstico de orbitopatia de Graves foi considerado após a realização de ressonância magnética, que revelou aumento importante do músculo reto inferior esquerdo, sem acometimento do tendão, e uma propedêutica sistêmica detectou hipotireoidismo autoimune. Como não houve melhora com o tratamento clínico, o paciente foi encaminhado a um oftalmologista, que realizou nova investigação. A presença de calcificação no músculo reto inferior na tomografia computadorizada, associada aos achados clínicos, levou a uma biópsia da lesão, que demonstrou a deposição de material amiloide. Este relato enfatiza como uma avaliação minuciosa das formas atípicas de orbitopatia de Graves é essencial e deve incluir a ocorrência, embora rara, de amiloidose no diagnóstico diferencial da orbitopatia de Graves.


Asunto(s)
Amiloidosis/diagnóstico , Oftalmopatía de Graves/diagnóstico , Músculos Oculomotores , Amiloidosis/diagnóstico por imagen , Amiloidosis/patología , Biopsia , Enfermedades de los Párpados/diagnóstico por imagen , Oftalmopatía de Graves/diagnóstico por imagen , Oftalmopatía de Graves/patología , Enfermedad de Hashimoto/diagnóstico , Humanos , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas , Masculino , Persona de Mediana Edad , Músculos Oculomotores/diagnóstico por imagen , Músculos Oculomotores/patología , Tiroiditis Autoinmune/diagnóstico , Tomografía Computarizada por Rayos X
13.
Arq Bras Oftalmol ; 74(5): 374-6, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-22184002

RESUMEN

Primary localized amyloidosis is rare in the orbit. We report the case of a 63-year-old woman that presented with bilateral proptosis and ophthalmoplegia. A computed tomography scan revealed an infiltrative amorphous and markedly calcified mass in both orbits while a magnetic resonance scan showed a heterogeneous hypointense signal on T2-weighted images. A biopsy was performed through an anterior orbitotomy. Microscopy revealed extracellular amorphous and eosinophilic hyaline material which stained pink with Congo red and displayed green birefringence on polarized microscopy, leading to a diagnosis of amyloidosis. The results of the systemic workup were completely normal. A two-year follow-up period without any treatment disclosed no worsening of the condition. While calcification of nonvascular orbital lesions has often been regarded as suggestive of malignant disease, our case is a reminder that it can also be a characteristic presenting sign of orbital amyloidosis.


Asunto(s)
Amiloidosis/diagnóstico , Calcinosis/diagnóstico , Enfermedades Orbitales/diagnóstico , Amiloidosis/complicaciones , Calcinosis/etiología , Diagnóstico Diferencial , Femenino , Humanos , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas , Imagen por Resonancia Magnética , Persona de Mediana Edad , Enfermedades Orbitales/etiología , Tomografía Computarizada por Rayos X
14.
Arq. bras. oftalmol ; Arq. bras. oftalmol;74(5): 374-376, set.-out. 2011. ilus
Artículo en Inglés | LILACS | ID: lil-608414

RESUMEN

Primary localized amyloidosis is rare in the orbit. We report the case of a 63-year-old woman that presented with bilateral proptosis and ophthalmoplegia. A computed tomography scan revealed an infiltrative amorphous and markedly calcified mass in both orbits while a magnetic resonance scan showed a heterogeneous hypointense signal on T2-weighted images. A biopsy was performed through an anterior orbitotomy. Microscopy revealed extracellular amorphous and eosinophilic hyaline material which stained pink with Congo red and displayed green birefringence on polarized microscopy, leading to a diagnosis of amyloidosis. The results of the systemic workup were completely normal. A two-year follow-up period without any treatment disclosed no worsening of the condition. While calcification of nonvascular orbital lesions has often been regarded as suggestive of malignant disease, our case is a reminder that it can also be a characteristic presenting sign of orbital amyloidosis.


Amiloidose primária e localizada na órbita é rara. Relatamos o caso de paciente do sexo feminino, 63 anos que se apresentou com proptose bilateral e oftalmoplegia. A tomografia computadorizada mostrou uma massa infiltrativa amorfa e calcificada em ambas as órbitas enquanto que a imagem por ressonância magnética mostrou imagem heterogênea hipointensa ponderada em T2. Uma biópsia foi realizada por orbitotomia anterior. A microscopia revelou um material extracelular amorfo, hialino e eosinofílico que corou com vermelho Congo e mostrou cor verde birrefringente à microscopia com luz polarizada, levando ao diagnóstico de amiloidose. O resultado da investigação sistêmica foi inteiramente negativo. Um período de seguimento de dois anos sem qualquer tratamento não evidenciou piora da condição. Enquanto que a presença de calcificação de lesão não vascular da órbita frequentemente é considerada sugestiva de doençamaligna, o nosso caso serve para lembrar que pode também ser um sinal característico de amiloidose orbitária.


Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Amiloidosis/diagnóstico , Calcinosis/diagnóstico , Enfermedades Orbitales/diagnóstico , Amiloidosis/complicaciones , Calcinosis/etiología , Diagnóstico Diferencial , Imagen por Resonancia Magnética , Enfermedades Orbitales/etiología , Tomografía Computarizada por Rayos X
15.
Arq Bras Oftalmol ; 70(3): 537-9, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17768567

RESUMEN

Presentation of one case of extraocular muscle enlargement caused by cysticercosis, its clinical, diagnostic and treatment aspects, and review of the literature on this theme. A female 38-year-old patient with extraocular muscle enlargement and a small cystic lesion at the superior rectus muscle insertion was treated with oral prednisone for almost one year, with a non-specific inflammation of right orbit diagnosis. There were important ocular motility restriction and pain. Computerized tomography disclosed a superior rectus muscle thickening with a small cystic and apparently empty lesion at the muscle's insertion. Excisional biopsy and histopathological study confirmed the clinical suspicion of cysticercosis. There was partial resolution of the restricted motility. Extraocular muscle cysticercosis is the most common site of this disease when involving the orbit. Oral albendazole and prednisone are efficient, but a long history of disease can lead to important residual ocular motility restriction.


Asunto(s)
Cisticercosis/diagnóstico , Infecciones Parasitarias del Ojo/diagnóstico , Enfermedades Orbitales/diagnóstico , Adulto , Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Cisticercosis/tratamiento farmacológico , Diagnóstico Diferencial , Infecciones Parasitarias del Ojo/tratamiento farmacológico , Femenino , Humanos , Inflamación/diagnóstico , Trastornos de la Motilidad Ocular/parasitología , Músculos Oculomotores/parasitología , Prednisona/uso terapéutico , Tomografía Computarizada por Rayos X
16.
Arq. bras. oftalmol ; Arq. bras. oftalmol;70(3): 537-539, maio-jun. 2007. ilus
Artículo en Inglés | LILACS | ID: lil-459847

RESUMEN

Presentation of one case of extraocular muscle enlargement caused by cysticercosis, its clinical, diagnostic and treatment aspects, and review of the literature on this theme. A female 38-year-old patient with extraocular muscle enlargement and a small cystic lesion at the superior rectus muscle insertion was treated with oral prednisone for almost one year, with a non-specific inflammation of right orbit diagnosis. There were important ocular motility restriction and pain. Computerized tomography disclosed a superior rectus muscle thickening with a small cystic and apparently empty lesion at the muscle's insertion. Excisional biopsy and histopathological study confirmed the clinical suspicion of cysticercosis. There was partial resolution of the restricted motility. Extraocular muscle cysticercosis is the most common site of this disease when involving the orbit. Oral albendazole and prednisone are efficient, but a long history of disease can lead to important residual ocular motility restriction.


Apresentação de um caso de aumento de músculo extra-ocular causado por cisticercose, seus aspectos diagnósticos, clínicos, tratamento e revisão da literatura sobre o tema. Paciente de 38 anos do sexo feminino com aumento de músculo reto superior e pequena lesão cística foi tratada por um ano com prednisona oral com o diagnóstico de inflamação inespecífica da órbita. Havia importante restrição da motilidade ocular e dor. Tomografia computadorizada demonstrou espessamento do reto superior e pequena lesão cística, aparentemente sem conteúdo, na inserção do músculo. Biópsia excisional e estudo histopatológico confirmaram a suspeita de cisticercose. Houve melhora parcial da restrição de motilidade. A cisticercose de músculo extra-ocular é a mais frequente forma orbitária da doença. Tratamento clínico com albendazol e prednisona é eficiente, mas um atraso no diagnóstico pode levar a importante restrição residual na motilidade ocular.


Asunto(s)
Adulto , Femenino , Humanos , Cisticercosis/diagnóstico , Infecciones Parasitarias del Ojo/diagnóstico , Enfermedades Orbitales/diagnóstico , Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Cisticercosis/tratamiento farmacológico , Diagnóstico Diferencial , Infecciones Parasitarias del Ojo/tratamiento farmacológico , Inflamación/diagnóstico , Trastornos de la Motilidad Ocular/parasitología , Músculos Oculomotores/parasitología , Prednisona/uso terapéutico , Tomografía Computarizada por Rayos X
17.
Arq Bras Oftalmol ; 69(3): 435-8, 2006.
Artículo en Portugués | MEDLINE | ID: mdl-16936974

RESUMEN

Proptosis and diplopia due to enlargement of extraocular muscles represent important presenting signs of many orbital disorders. Although dysthyroid ophthalmopathy is the most common cause of enlargement of extraocular muscles, the differential diagnosis is extensive. We report a patient with a 3-month history of diplopia and unilateral proptosis and a markedly enlarged inferior rectus muscle on imaging studies. A biopsy of the lesion followed by systemic evaluation established the diagnosis of metastatic renal cell carcinoma. There are few cases of metastatic tumors to the extraocular muscles reported in the literature and thus our objective is to report a new case, review the literature and reiterate the inclusion of this disorder in the differential diagnosis of enlargement of the extraocular muscles.


Asunto(s)
Carcinoma de Células Renales/secundario , Neoplasias del Ojo/secundario , Neoplasias Renales/patología , Neoplasias de los Músculos/secundario , Músculos Oculomotores/patología , Carcinoma de Células Renales/diagnóstico , Carcinoma de Células Renales/cirugía , Diagnóstico Diferencial , Diplopía/etiología , Exoftalmia/etiología , Neoplasias del Ojo/diagnóstico , Neoplasias del Ojo/cirugía , Humanos , Neoplasias Renales/diagnóstico , Neoplasias Renales/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias de los Músculos/diagnóstico , Neoplasias de los Músculos/cirugía , Tomografía Computarizada por Rayos X
18.
Arq. bras. oftalmol ; Arq. bras. oftalmol;69(3): 435-438, maio-jun. 2006. ilus
Artículo en Portugués | LILACS | ID: lil-433814

RESUMEN

Proptose e diplopia decorrentes de alargamento de músculo extra-ocular representam importante sinal de apresentação de várias afecções da órbita. Embora a causa mais comum de alargamento de músculo extra-ocular seja a orbitopatia distiroidiana, o diagnóstico diferencial destas doenças é extenso. Relatamos neste trabalho o caso de um paciente com história de diplopia e proptose unilateral de três meses que apresentava importante espessamento isolado do músculo reto inferior direito e após investigação clínica, radiológica e biopsia incisional teve o diagnóstico de tumor metastático de células renais para o músculo reto inferior. Há poucos casos relatados de metástases para a musculatura ocular extrínseca sendo assim nosso objetivo relatar um novo caso, revisar a literatura e reforçar a inclusão deste distúrbio no diagnóstico diferencial do espessamento da musculatura extra-ocular.


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Carcinoma de Células Renales/patología , Neoplasias del Ojo/secundario , Neoplasias Renales/patología , Músculos Oculomotores/patología , Carcinoma de Células Renales/diagnóstico , Carcinoma de Células Renales/cirugía , Diagnóstico Diferencial , Diplopía , Exoftalmia , Neoplasias del Ojo/diagnóstico , Neoplasias del Ojo/cirugía , Neoplasias Renales/diagnóstico , Neoplasias Renales/cirugía , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X
19.
Arq Neuropsiquiatr ; 64(1): 139-41, 2006 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-16622572

RESUMEN

Giant pituitary adenomas are uncommonly large tumors, greater than 4 cm in size that can produces endocrine symptoms, visual loss and cranial nerve palsies. We report the rare occurrence of seesaw nystagmus as the presenting sign of giant pituitary adenoma. A 50-year-old man presented with headache associated with visual loss and seesaw nystagmus. Perimetry revealed bitemporal hemianopia and magnetic resonance imaging showed a giant pituitary adenoma. After surgery, nystagmus disappeared. Our case is relevant in understanding its pathogenesis since it documents seesaw nystagmus in a patient bitemporal hemianopia due to a large tumor but without mesencephalic compression.


Asunto(s)
Adenoma/complicaciones , Hemianopsia/etiología , Nistagmo Patológico/etiología , Neoplasias Hipofisarias/complicaciones , Adenoma/cirugía , Hemianopsia/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Nistagmo Patológico/diagnóstico , Neoplasias Hipofisarias/cirugía , Pruebas del Campo Visual
20.
Arq. neuropsiquiatr ; Arq. neuropsiquiatr;64(1): 139-141, mar. 2006. ilus
Artículo en Inglés | LILACS | ID: lil-425290

RESUMEN

Adenoma pituitário gigante é um tumor incomum, maior que 4 cm que produz sintomas endócrinos, perda visual e paralisia de nervos cranianos. Relatamos um caso de nistagmo em gangorra como sinal de apresentação de adenoma pituitário gigante. Um paciente de 50 anos, masculino, apresentava cefaléia, perda visual e nistagmo em gangorra. A perimetria revelou hemianopsia bitemporal e a imagem por ressonância magnética demonstrou um adenoma pituitário gigante. Após a cirurgia, o nistagmo desapareceu. Nosso caso é importante na compreensão da fisiopatogenia do nistagmo em gangorra, pois documenta sua ocorrência em paciente com hemianopsia bitemporal decorrente de tumor hipofisário sem compressão mesencefálica.


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Adenoma/complicaciones , Hemianopsia/etiología , Nistagmo Patológico/etiología , Neoplasias Hipofisarias/complicaciones , Adenoma/cirugía , Hemianopsia/diagnóstico , Imagen por Resonancia Magnética , Nistagmo Patológico/diagnóstico , Neoplasias Hipofisarias/cirugía , Pruebas del Campo Visual
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