Surgical treatment of Graves orbitopathy: a modified balanced technique.

Surgery has a definite place in the treatment of the exophthalmos in Graves orbitopathy. Thirty-two patients with Graves orbitopathy were operated on. Twenty patients received a three-wall orbital decompression. Five patients received a two-wall orbital decompression with lipectomy and seven patients underwent a two-wall orbital decompression combined with an advancement osteotomy of the supra-, lateral- and infra-orbital rim and a lipectomy. In cases with Hertel values less than 25 mm, the two-wall orbital decompression with removal of orbital fat. and in cases with Hertel values more than 25 mm, the two-wall orbital decompression with lipectomy and an advancement osteostomy of the supra-, lateral- and infraorbital rim is the treatment of choice.

Intraorbital bamboo foreign body in a chronic stage: case report.

A case of intra-orbital bamboo foreign body in a chronic stage is presented. This case seems to confirm the importance of radiological examination, including three-dimensional computed tomography to choose the optimal surgical approach to remove the foreign body.

Surgical treatment of proptosis bulbi by three-wall orbital decompression.

PURPOSE: Three-wall orbital decompression was tested using a coronal approach as a technique. PATIENTS AND METHODS: Three-wall orbital decompression by a coronal approach was performed in three patients with proptosis due to Grave's ophthalmopathy, in six patients with Grave's ophthalmopathy because their vision was threatened due to optic nerve compression, and in one patient with exorbitism due to Crouzon's syndrome for cosmetic rehabilitation. RESULTS: Proptosis reduction averaged 4.7 mm. The technique provides good access to the orbital walls, facilitating adequate proptosis reduction, and leaves no visible scar. Diplopia, present preoperatively in four patients, was improved in three patients and unchanged in one. There was no loss of visual acuity.

Grease-gun injury of the orbit: computed tomography and magnetic resonance imaging in diagnosis and treatment.

A 19-year-old male was referred because of a grease-gun injury of the left orbit, resulting in a 25 mm proptosis and marked decrease in vision. The clinical diagnosis of penetration of the retrobulbar fat space by the grease and the subsequent accurate drainage of the grease was made possible on the basis of high resolution computed tomography (CT) and magnetic resonance imaging (MRI). As a result, lateral orbitotomy could be avoided. Eight months after the injury the visual acuity was fully recovered and the proptosis reduced to 2 mm. The visual field was relatively undisturbed. The specific value of CT and MRI for the management of this unusual trauma is briefly discussed.

Analysis of human tear protein profiles using high performance liquid chromatography (HPLC).

Using high performance liquid chromatography (HPLC) the tear protein profiles were measured in controls, patients with Sjögren's disease, questionable dry eye (idiopathic dry eye), idiopathic chronic conjunctivitis and the corneal melting syndrome. Qualitative comparison of the protein profiles of patients with Sjögren's disease, corneal melting and IgA deficiency shows a marked difference in the heights of various peaks as compared to the profiles of the control group. The total protein content of tears in controls and in patients with idiopathic chronic conjunctivitis is age dependent and appears to increase until the age of 40 and to decrease afterwards. The peaks containing IgA, lactoferrin and lysozyme were measured in various eye diseases. In idiopathic chronic conjunctivitis and in the corneal melting syndrome no differences were seen in comparison with controls. In patients with idiopathic dry eye and Sjögren's disease a marked decrease in the three proteins was seen. The study presented here indicates that the HPLC analysis of tears is a promising technique which may increase our knowledge of this ocular fluid.

A retrospective study of ocular findings in patients treated with PUVA.

Photochemotherapy combined with psoralen, now widely used in the treatment of psoriasis, vitiligo, Andrews' disease and some other skin conditions, has been accepted as one of the potential factors that might contribute to the development of cataract. This view is based upon experimental animal studies. In the present study 408 patients receiving PUVA treatment in the period between 1977 and 1983 have been followed up for up to 6 years after the initiation of therapy. Repeated ophthalmological examinations were performed, particularly in order to detect any early signs of lens changes. In 20 patients development or increase of lens opacities could be observed. There is some evidence that in 3 of these 20 patients cataract formation was attributable to PUVA.

Lacrimal gland enlargement as one of the ocular manifestations of Wegener's granulomatosis.

Wegener's granulomatosis is characterized by chronic, focal, necrotizing and granulomatous vasculitis. The localized form involves mainly the upper or lower respiratory tracts, or both. In the commoner generalized form, the kidneys are also affected. Literature findings suggest that ocular manifestations are a predominating sign in about 30% of cases. Ocular findings may include conjunctivitis, keratitis and sclerouveitis, pseudotumor of the orbit or proptosis. We report on a patient who showed bilateral episcleritis, keratitis, nasolacrimal duct obstruction and enlargement of the lacrimal gland. The latter finding was confirmed by CT scan.