RESUMO
A 46-year-old Asian female patient with thyroid eye disease reported ocular irritation, eyelid swelling, diplopia, and pain with eye movement. The patient was diagnosed with active thyroid eye disease and secondary thyroid eye disease-acquired epiblepharon, which was causing bilateral punctate epithelial erosion. Treatment was started with newly U.S. Food and Drug Administration approved teprotumumab, an insulin-like growth factor-1 receptor inhibitor. Four infusion treatments later, the patient's epiblepharon was alleviated with minimal side effects. In this report, the authors present a case of thyroid eye disease-acquired epiblepharon resolving with teprotumumab treatment.
Assuntos
Anticorpos Monoclonais Humanizados , Oftalmopatia de Graves , Pálpebras , Feminino , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/tratamento farmacológico , Humanos , Pessoa de Meia-IdadeAssuntos
Envelhecimento , Blefaroptose/diagnóstico , Blefaroplastia , Blefaroptose/etiologia , Blefaroptose/fisiopatologia , Blefaroptose/cirurgia , Síndrome de Horner/complicações , Síndrome de Horner/fisiopatologia , Humanos , Distrofia Muscular Oculofaríngea/complicações , Distrofia Muscular Oculofaríngea/fisiopatologia , Miastenia Gravis/complicações , Miastenia Gravis/fisiopatologia , Distrofia Miotônica/complicações , Distrofia Miotônica/fisiopatologia , Músculos Oculomotores/fisiopatologia , Doenças do Nervo Oculomotor/complicações , Doenças do Nervo Oculomotor/fisiopatologia , Oftalmoplegia Externa Progressiva Crônica/complicações , Oftalmoplegia Externa Progressiva Crônica/fisiopatologia , Médicos de Atenção Primária , Leitura , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologia , Campos VisuaisRESUMO
Preseptal cellulitis and postseptal (orbital) cellulitis represent a spectrum of orbital infections which a primary care provider and ophthalmologist may see during practice. Most often these conditions occur through spread from the sinuses, though there are a variety of other inciting factors. These conditions can both present with erythema and edema, but a complete and thorough exam can help a practitioner differentiate the two. Patients should be treated with targeting the most common pathogens and followed very closely by their providers. This article will discuss the anatomy, pathogenesis, risk factors, diagnosis, management and prognosis of preseptal and orbital cellulitis.
Assuntos
Abscesso/terapia , Antibacterianos/uso terapêutico , Desbridamento , Drenagem , Celulite Orbitária/terapia , Infecções Estafilocócicas/terapia , Infecções Estreptocócicas/terapia , Abscesso/diagnóstico , Aspergilose/diagnóstico , Aspergilose/imunologia , Aspergilose/terapia , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/terapia , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/terapia , Humanos , Hospedeiro Imunocomprometido/imunologia , Mucormicose/diagnóstico , Mucormicose/imunologia , Mucormicose/terapia , Celulite Orbitária/diagnóstico , Periósteo , Médicos de Atenção Primária , Atenção Primária à Saúde , Índice de Gravidade de Doença , Infecções Estafilocócicas/diagnóstico , Infecções Estreptocócicas/diagnóstico , Tomografia Computadorizada por Raios XAssuntos
Blefaroplastia , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/terapia , Técnicas Cosméticas , Preenchedores Dérmicos/uso terapêutico , Dermatite Alérgica de Contato/diagnóstico , Dermatite Perioral/diagnóstico , Diagnóstico Diferencial , Humanos , Aparelho Lacrimal , Linfedema/diagnóstico , Prolapso , Rosácea/diagnóstico , Doenças da Glândula Tireoide/diagnóstico , Testes de Campo Visual , Campos VisuaisRESUMO
Patients with infection or inflammation of the eyelid will often first present to their primary care physicians with symptoms such as redness, swelling, tearing, itchiness, or a foreign body sensation. There are a variety of conditions that affect the eyelid which can cause such symptoms, and the exam and history can help a provider differentiate some of the more common conditions. This article will provide a comprehensive review of the background, diagnosis and management of dry eye disease, chalazion, hordeolum (stye), and preseptal cellulitis.
Assuntos
Celulite (Flegmão)/fisiopatologia , Calázio/fisiopatologia , Síndromes do Olho Seco/fisiopatologia , Terçol/fisiopatologia , Administração Oral , Administração Tópica , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/terapia , Calázio/diagnóstico , Calázio/terapia , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/terapia , Terçol/diagnóstico , Terçol/terapia , Temperatura Alta/uso terapêutico , Humanos , Disfunção da Glândula Tarsal/diagnóstico , Disfunção da Glândula Tarsal/fisiopatologia , Disfunção da Glândula Tarsal/terapia , Plug Lacrimal , Sinusite/complicações , Xeroftalmia/diagnóstico , Xeroftalmia/fisiopatologia , Xeroftalmia/terapiaRESUMO
Patients who experience trauma to the eyelid or the orbit may present to their primary care providers or directly to the emergency room for evaluation of their injuries. These patients will often be in pain and may have bleeding around the eye, which can make evaluation of these patients difficult. Many traumatic injuries to the eye require quick and immediate intervention. In this article, we will review the background, anatomy, exam and management of some of the most common eye traumas including eyelid lacerations, orbital hemorrhages, intraorbital foreign bodies, and orbital fractures.
Assuntos
Pálpebras/lesões , Traumatismos Faciais/terapia , Corpos Estranhos/terapia , Lacerações/terapia , Procedimentos Cirúrgicos Oftalmológicos , Fraturas Orbitárias/terapia , Procedimentos de Cirurgia Plástica , Hemorragia Retrobulbar/terapia , Descompressão Cirúrgica , Traumatismos Faciais/diagnóstico , Corpos Estranhos/diagnóstico , Hemorragia/diagnóstico , Hemorragia/terapia , Humanos , Lacerações/diagnóstico , Órbita , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/terapia , Fraturas Orbitárias/diagnóstico , Médicos de Atenção Primária , Atenção Primária à Saúde , Hemorragia Retrobulbar/diagnóstico , Técnicas de Sutura , Tétano/prevenção & controle , Toxoide Tetânico/uso terapêutico , Irrigação Terapêutica , Tomografia Computadorizada por Raios XAssuntos
Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Tratamento Conservador , Dacriocistorinostomia , Obstrução dos Ductos Lacrimais/diagnóstico , Obstrução dos Ductos Lacrimais/terapia , Dacriocistite/complicações , Dacriocistite/diagnóstico , Dacriocistite/terapia , Fibrose , Humanos , Inflamação/fisiopatologia , Doenças do Aparelho Lacrimal/diagnóstico , Doenças do Aparelho Lacrimal/fisiopatologia , Doenças do Aparelho Lacrimal/terapia , Obstrução dos Ductos Lacrimais/etiologia , Obstrução dos Ductos Lacrimais/fisiopatologia , Ducto Nasolacrimal/anatomia & histologia , Ducto Nasolacrimal/fisiologiaAssuntos
Blefarospasmo/fisiopatologia , Doenças do Nervo Facial/fisiopatologia , Espasmo Hemifacial/fisiopatologia , Mioquimia/fisiopatologia , Músculos Oculomotores/fisiopatologia , Sincinesia/fisiopatologia , Inibidores da Liberação da Acetilcolina/uso terapêutico , Benzodiazepinas/uso terapêutico , Blefarospasmo/complicações , Blefarospasmo/diagnóstico , Blefarospasmo/terapia , Toxinas Botulínicas Tipo A/uso terapêutico , Síndromes do Olho Seco/etiologia , Síndromes do Olho Seco/terapia , Doenças do Nervo Facial/diagnóstico , Doenças do Nervo Facial/terapia , Espasmo Hemifacial/complicações , Espasmo Hemifacial/diagnóstico , Espasmo Hemifacial/terapia , Humanos , Lubrificantes Oftálmicos/uso terapêutico , Cirurgia de Descompressão Microvascular , Mioquimia/complicações , Mioquimia/diagnóstico , Mioquimia/terapia , Músculos Oculomotores/cirurgia , Sincinesia/complicações , Sincinesia/diagnóstico , Sincinesia/terapiaAssuntos
Envelhecimento , Lesões da Córnea/prevenção & controle , Ectrópio/terapia , Entrópio/terapia , Lubrificantes Oftálmicos/uso terapêutico , Fita Cirúrgica , Inibidores da Liberação da Acetilcolina/uso terapêutico , Toxinas Botulínicas/uso terapêutico , Cicatriz/complicações , Ectrópio/etiologia , Ectrópio/fisiopatologia , Entrópio/etiologia , Entrópio/fisiopatologia , Pestanas , Doenças do Nervo Facial/complicações , Doenças do Nervo Facial/terapia , Remoção de Cabelo , Humanos , Músculos Oculomotores , Espasmo/complicações , Espasmo/terapiaRESUMO
The periocular region sees high rates of cancer compared to the rest of the body and can be affected by several unique tumors. Treatment typically involves surgical excision, although adjunctive therapies and prognosis vary depending on the diagnosis. Basal cell carcinoma (BCC) is the most common malignancy affecting this region and should be excised promptly. This is followed by squamous cell carcinoma, which is often mistaken for BCC but is treated similarly. Melanoma is less common but more deadly, with relatively high rates of metastasis and death. Rare tumors that may be found in this region include sebaceous carcinoma, Merkel cell carcinoma, and microcystic adnexal carcinoma. While uncommon, these tumors are associated with poor outcomes and frequent recurrence. Recognition of periocular skin cancer is an important skill for primary care physicians, as prompt diagnosis and treatment can be sight or life-saving.
Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/terapia , Neoplasias Palpebrais/terapia , Melanoma/terapia , Cirurgia de Mohs , Neoplasias Cutâneas/terapia , Adenocarcinoma Sebáceo/diagnóstico , Adenocarcinoma Sebáceo/terapia , Antineoplásicos Imunológicos/uso terapêutico , Doença de Bowen/diagnóstico , Doença de Bowen/terapia , Carcinoma Basocelular/diagnóstico , Carcinoma de Célula de Merkel/diagnóstico , Carcinoma de Célula de Merkel/terapia , Carcinoma de Células Escamosas/diagnóstico , Procedimentos Cirúrgicos Dermatológicos , Neoplasias Palpebrais/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Ceratose Actínica/diagnóstico , Ceratose Actínica/terapia , Melanoma/diagnóstico , Neoplasias de Anexos e de Apêndices Cutâneos/diagnóstico , Neoplasias de Anexos e de Apêndices Cutâneos/terapia , Neoplasias das Glândulas Sebáceas/diagnóstico , Neoplasias das Glândulas Sebáceas/terapia , Neoplasias Cutâneas/diagnósticoRESUMO
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
RESUMO
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare, low-grade adnexal neoplasm with predilection for the periorbital skin of older women. Histologically and immunophenotypically, EMPSGC is analogous to another neoplasm with neuroendocrine differentiation, solid papillary carcinoma of the breast. Both lesions are spatially associated with neuroendocrine mucinous adenocarcinomas of the skin and breast, respectively. EMPSGC is ostensibly a precursor of neuroendocrine-type mucinous sweat gland adenocarcinoma (MSC), a lesion of uncertain prognosis. Non-neuroendocrine MSC has been deemed locally aggressive with metastatic potential, and previous works speculated that EMPSGC-associated (neuroendocrine-type) MSC had similar recurrence and metastatic potential with implications for patient follow-up. Only 96 cases of EMPSGC have been reported (12 cases in the largest case series). Herein, we present 63 cases diagnosed as "EMPSGC" in comparison with aggregated results from known published EMPSGC cases. We aim to clarify the clinicopathologic features and prognostic significance of the neuroendocrine differentiation of EMPSGC and its associated adenocarcinoma and to determine the nosological relevance of EMPSGC association in the spectrum of MSC histopathogenesis. Results established an overall female predominance (66.7%) and average presenting age of 64 years. EMPSGC lesions were associated with adjacent MSC in 33.3% of cases. The recurrence rate for neuroendocrine-type MSC was ~21%, less than the reported 30% for non-neuroendocrine MSC. There were no cases of metastasis. EMPSGC and neuroendocrine-type MSC are distinct entities with more indolent behavior than previously reported, supporting a favorable prognosis for patients.
Assuntos
Biomarcadores Tumorais/análise , Carcinoma/patologia , Mucinas/análise , Neoplasias Císticas, Mucinosas e Serosas/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma/química , Carcinoma/epidemiologia , Carcinoma/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Císticas, Mucinosas e Serosas/química , Neoplasias Císticas, Mucinosas e Serosas/epidemiologia , Neoplasias Císticas, Mucinosas e Serosas/terapia , América do Norte , Prognóstico , Estudos Retrospectivos , Neoplasias das Glândulas Sudoríparas/química , Neoplasias das Glândulas Sudoríparas/epidemiologia , Neoplasias das Glândulas Sudoríparas/terapiaRESUMO
BACKGROUND: Nasolacrimal duct obstruction (NLDO) is a condition that results in the overflow of tears (epiphora) or infection of the nasolacrimal sac (dacryocystitis). The etiology of acquired NLDO is multifactorial and is not fully understood. Dacryocystorhinostomy (DCR) is the surgical correction of NLDO, which aims to establish a new drainage pathway between the lacrimal sac and the nose. The success of DCR is variable; the most common cause of failure is fibrosis and stenosis of the surgical ostium. Antimetabolites such as mitomycin-C (MMC) and 5-fluorouracil (5-FU) have been shown to be safe and effective in reducing fibrosis and improving clinical outcomes in other ophthalmic surgery settings (e.g. glaucoma and cornea surgery). Application of antimetabolites at the time of DCR has been studied, but the utility of these treatments remains uncertain. OBJECTIVES: Primary objective: To determine if adjuvant treatment with antimetabolites improves functional success in the setting of DCR compared to DCR alone. Secondary objectives: To determine if anatomic success of DCR is increased with the use of antimetabolites, and if the surgical ostium is larger in participants treated with antimetabolites. SEARCH METHODS: We searched the Cochrane Register for Controlled Trials (CENTRAL) (which contains the Cochrane Eye and Vision Trials Register) (2019, Issue 9), Ovid MEDLINE, Embase.com, PubMed, LILACS (Latin American and Caribbean Health Sciences Literature database), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic searches. We last searched the electronic databases on 6 September 2019. SELECTION CRITERIA: We only included randomized controlled trials. Eligible studies were those that compared the administration of antimetabolites of any dose and concentration versus placebo or another active treatment in participants with NLDO undergoing primary DCR and reoperation. We only included studies that had enrolled adults 18 years or older. We also included studies that used silicone intubation as part of the DCR procedure. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently screened the search results, assessed risk of bias, and extracted data from the included studies using an electronic data collection form. MAIN RESULTS: We included 31 studies in the review, of which 23 (1309 participants) provided data relating to our primary and secondary outcomes. Many of the 23 studies evaluated functional success, while others also assessed our secondary outcomes of anatomic success or ostium size, or both. Study characteristics Participant characteristics varied across studies, with the age of participants ranging from 30 to 70 years. Participants were predominantly women. These demographics correspond to those most frequently affected by nasolacrimal duct obstruction. Almost all of the studies utilized MMC as the antimetabolite, with only one using 5-FU. We assessed most trials as at unclear risk of bias for most domains. Conflicts of interest were not frequently reported, although the antimetabolites used are generic medications, and studies were not likely to be conducted for financial interest. Findings Twenty studies provided data on the primary outcome of functional success, of which 7 (356 participants) provided data at 6 months and 14 (909 participants) provided data beyond 6 months. At six months, the results showed no evidence of effect of antimetabolite on functional success (risk ratio (RR) 1.12, 95% confidence interval (CI) 0.98 to 1.29; low-certainty evidence). Beyond six months, the results favored the antimetabolite group (RR 1.15, 95% CI 1.07 to 1.25; moderate-certainty evidence). Fourteen studies reported data on the secondary outcome of anatomic success, of which 4 (306 participants) reported data at 6 months and 12 (831 participants) provided data beyond 6 months. Results at six months showed no evidence of effect of antimetabolite on anatomic success (RR 1.02, 95% CI 0.95 to 1.11; low-certainty evidence). Beyond six months, participants in the antimetabolite group were more likely to achieve anatomic success than those receiving DCR alone (RR 1.09, 95% CI 1.04 to 1.15; moderate-certainty evidence). At six months and beyond six months follow-up, two studies reported mean change in ostium size. We did not conduct meta-analysis for the various follow-up periods due to clinical, methodological, and statistical heterogeneity. However, point estimates from these studies at six months consistently favored participants in the antimetabolite group (low-certainty evidence). Beyond six months, while point estimates from one study favored participants in the antimetabolite group, estimates from another study showed no evidence of a difference between the two groups. The certainty of evidence at both time points was low. Adverse events Adverse events were rare. One study reported that one participant in the MMC group experienced delayed wound healing. Other studies reported no significant adverse events related to the application of antimetabolites. AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that application of antimetabolites at the time of DCR increases functional and anatomic success of DCR when patients are followed for more than six months after surgery, but no evidence of a difference at six months, low-certainty of evidence. There is low-certainty evidence that combining antimetabolite with DCR increases the size of the lacrimal ostium at six months. However, beyond six months, the evidence remain uncertain. Adverse effects of the application of antimetabolites were minimal.