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Abscesso/microbiologia , Doenças Palpebrais/patologia , Transtornos Psicóticos/psicologia , Ferimentos e Lesões/complicações , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Adulto , Antibacterianos/uso terapêutico , Cisto Epidérmico/patologia , Doenças Palpebrais/etiologia , Doenças Palpebrais/microbiologia , Humanos , Masculino , Órbita/diagnóstico por imagem , Ruptura/complicações , Tomógrafos Computadorizados , Resultado do Tratamento , Ferimentos e Lesões/microbiologiaRESUMO
INTRODUCTION: Necrotising fasciitis (NF) is a severe infection of deep subcutaneous soft tissues with high morbidity and mortality. Periocular necrotising fasciitis (PONF) is a very rare condition with many unanswered questions about the presentation and management. We present a retrospective case series of patients with PONF from three centres in Australia and two in the UK to investigate the clinical and microbiological characteristics and outcomes and report on patients treated with antibiotics alone. RESULTS: Twenty-nine patients (20 men; 69%) with PONF were identified and followed up for between 2â months and 10â years (median 57, mean 52.6â months) between 1990 and 2013. Conditions associated with chronic immunocompromise were present in 16/29 (55%). Twenty-one (75%) recalled minor periocular trauma or an infected lesion, two having been assaulted by the same assailant. Systemic shock occurred in 6/29 (21%) patients and 1 died. Group A, ß-haemolytic Streptococcus was the most common bacterium identified (25/29, 86%). Intravenous antibiotics were used in all patients, and up to five tissue debridements were required to control the disease in 23/29 (74%); reconstructive surgery was required in 12/29 (41%) patients. One patient died from the disease and visual loss occurred in four eyes of four patients (14%). CONCLUSIONS: PONF has a better prognosis than disease elsewhere in the body, but is still associated with significant risk of visual loss and a small risk of death. Intravenous antibiotic treatment with cautious observation may be reasonable in selected patients with a low threshold for debridement.
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Antibacterianos/uso terapêutico , Desbridamento/métodos , Fasciite Necrosante/terapia , Doenças Orbitárias/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fasciite Necrosante/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/diagnóstico , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
PURPOSE: To study the hypothesis that in normal patients, changes in eyelid elasticity may occur asymmetrically and in relation to the side on which the individual sleeps. DESIGN: Prospective, consecutive, single-center study within a large, tertiary-referral ophthalmology department within a university hospital. METHODS: This prospective study was carried out consecutively on 262 normal patients. The 3 inclusion criteria were 1) age≥55 years, 2) absence of facial nerve palsy, and 3) absence of eyelid trauma or surgery. Immediately before the ocular plastic surgeon assessed the patient, each patient was questioned in a separate consulting room by the attending orthoptist as to his or her customary side of sleeping. After detailed explanation, the "history-masked" ocular plastic surgeon then assessed the patient's upper eyelid laxity, the main outcome measurement. This was performed by asking the seated patient to look down and then gently grasping the upper eyelids close to the eyelid margin, just medial to the lateral commissure. The ocular plastic surgeon, with thumbs pronated, simultaneously distracted both upper eyelids superiorly, laterally, and anteriorly. The measured separation of the upper eyelid from the globe conjunctiva was obtained using calipers. Eyelid laxity grading was designated as grade 1: 0 to 1.9 mm; grade 2: 2.0 to 3.9 mm; grade 3: 4 to 9 mm; and grade 4: floppy. RESULTS: Two hundred sixty-two patients (58% females) who consecutively satisfied the selection criteria were evaluated, of which 70.22% (183/262) patients had significantly greater laxity of the upper eyelid that corresponded to the side on which they customarily slept. An unpaired t test used to compare the eyelid laxity between the sleeping side and nonsleeping side was statistically significant (p<0.001). CONCLUSION: Normal patients demonstrate a correlation between the side on which they historically or customarily sleep and the laxity of their ipsilateral upper eyelid.
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Pálpebras/fisiopatologia , Lateralidade Funcional/fisiologia , Hipotonia Muscular/fisiopatologia , Músculos Oculomotores/fisiopatologia , Sono/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
PURPOSE: To report 2 patients with apocrine adenocarcinoma of the eyelid and review the literature. DESIGN: Noncomparative, retrospective case series and review. PARTICIPANTS: Clinical data of 2 patients with histopathologic diagnoses of apocrine adenocarcinoma of the eyelid were obtained from medical records. The histopathology and immunohistochemistry data for the 2 cases were studied. A retrospective review was performed on all reported cases of eyelid apocrine carcinoma. MAIN OUTCOME MEASURES: Clinical features, histopathology, immunohistochemistry, and clinical course following treatment are reported. The results of a retrospective review of clinical presentations, local and systemic spread, treatment method, and prognosis from published case reports on eyelid apocrine adenocarcinoma are discussed. RESULTS: One patient had orbital invasion at presentation. This patient had radiotherapy alone and had no systemic or local recurrence at 2 years. One patient underwent a 4-mm margin wide surgical excision. This patient had no local or systemic recurrences at 1 year. A review of the literature suggests that the prognosis of adnexal apocrine tumors is indeterminate and variable. Most patients have successful outcomes following local surgical excision. Radiotherapy has been used as an adjunctive treatment for local metastatic disease. CONCLUSIONS: Apocrine adenocarcinoma is a rare adnexal tumor of the eyelid, which may present with orbital invasion.
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Adenocarcinoma/patologia , Glândulas Apócrinas/patologia , Neoplasias Palpebrais/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Adenocarcinoma/terapia , Idoso de 80 Anos ou mais , Neoplasias Palpebrais/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias das Glândulas Sudoríparas/terapiaAssuntos
Cegueira Noturna/etiologia , Transtornos da Visão/etiologia , Campos Visuais , Deficiência de Vitamina A/diagnóstico , Comportamento Alimentar , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Cegueira Noturna/terapia , Equipe de Assistência ao Paciente , Deficiência de Vitamina A/terapia , Xeroftalmia/etiologia , Xeroftalmia/terapiaRESUMO
We describe a technique of irrigating and thereby rapidly and effectively clearing the cornea of relatively large amounts of surface contaminants that reduce surgical visibility and may contribute to endophthalmitis. This technique is referred to as "macrowash." If the technique is required, it is usually at the commencement of cataract surgery, immediately after placement of the surgical drape. The technique not only saves time, but also reduces the volume of irrigating solution required by the "microwash" technique, which is traditionally carried out by the scrub nurse/surgical assistant using a Rycroft cannula attached to a 15 mL container of irrigating solution.
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Extração de Catarata , Córnea/fisiologia , Irrigação Terapêutica/métodos , Acetatos/administração & dosagem , Cateterismo , Combinação de Medicamentos , Humanos , Minerais/administração & dosagem , Cloreto de Sódio/administração & dosagemRESUMO
Eye involvement in inherited epidermolysis bullosa (EB) can occur as a spectrum of symptoms and signs. This article describes these signs and symptoms. It also offers options for treatment.
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Ambliopia/etiologia , Doenças da Córnea/etiologia , Epidermólise Bolhosa/complicações , Ambliopia/patologia , Ambliopia/terapia , Doenças da Córnea/patologia , Doenças da Córnea/terapia , Epidermólise Bolhosa/patologia , Epidermólise Bolhosa/terapia , HumanosAssuntos
Endoftalmite/microbiologia , Infecções Oculares Bacterianas/microbiologia , Facoemulsificação/efeitos adversos , Complicações Pós-Operatórias , Antibacterianos/uso terapêutico , Cefuroxima/uso terapêutico , Córnea/cirurgia , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Humanos , Implante de Lente Intraocular , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/isolamento & purificação , Técnicas de Sutura , CicatrizaçãoAssuntos
Segmento Anterior do Olho/irrigação sanguínea , Calázio/tratamento farmacológico , Corioide/irrigação sanguínea , Isquemia/induzido quimicamente , Oclusão da Veia Retiniana/induzido quimicamente , Esteroides/administração & dosagem , Esteroides/efeitos adversos , Humanos , Injeções Intralesionais , Doenças Vasculares/induzido quimicamenteAssuntos
Competência Clínica/estatística & dados numéricos , Internato e Residência , Oftalmologia/educação , Facoemulsificação/educação , Educação de Pós-Graduação em Medicina , Georgia , Hospitais de Veteranos , Humanos , Complicações Intraoperatórias , Facoemulsificação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Acuidade VisualAssuntos
Calázio/terapia , Glucocorticoides/administração & dosagem , Temperatura Alta/uso terapêutico , Procedimentos Cirúrgicos Oftalmológicos , Triancinolona Acetonida/administração & dosagem , Curetagem , Glucocorticoides/uso terapêutico , Humanos , Injeções , Ensaios Clínicos Controlados Aleatórios como Assunto , Triancinolona Acetonida/uso terapêuticoAssuntos
Entrópio/etiologia , Pálpebras/patologia , Paralisia Facial/complicações , Pré-Escolar , Doenças da Córnea/etiologia , Doenças da Córnea/cirurgia , Entrópio/cirurgia , Pálpebras/cirurgia , Paralisia Facial/cirurgia , Humanos , Lactente , Doenças do Aparelho Lacrimal/etiologia , Doenças do Aparelho Lacrimal/cirurgia , Músculos Oculomotores/patologia , Músculos Oculomotores/cirurgiaAssuntos
Glaucoma de Ângulo Aberto/epidemiologia , Oftalmopatia de Graves/epidemiologia , Pressão Intraocular , Glaucoma de Ângulo Aberto/diagnóstico , Oftalmopatia de Graves/diagnóstico , Humanos , Irã (Geográfico)/epidemiologia , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/epidemiologia , PrevalênciaRESUMO
A 69-year-old man was referred with epiphora and soft-tissue swelling in the left nasolacrimal sac region. Ipsilateral Jones 1 and 2 tests were negative. On attempting sac "wash out" via the left lower canaliculus, there was fluid reflux from the left upper canaliculus. CT revealed bony erosion of the lacrimal and frontal process of the maxillary bone by nasal polyposis. T2-weighted axial MRI demonstrated severe bilateral intranasal polyposis with those on the left pushing the lacrimal sac laterally and simulating a mucocele. Transnasal polypectomy re-established physiologic tear drainage and relieved the swelling in the region of the lacrimal fossa. This case emphasises the importance of routine nasal endoscopy as part of the assessment of the lacrimal system.