Freedman Eyelid Abnormalities
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Endogenous Brucella Endophthalmitis: a Case Report
Saudi Journal of Ophthalmology (2017) xxx, xxx–xxx Case Report Endogenous Brucella endophthalmitis: A case report ⇑ Merih Oray a, ; Zafer Cebeci a; Nur Kir a; Banu Turgut Ozturk b; Lutfiye Oksuz c; Ilknur Tugal-Tutkun a Abstract Brucellosis may be associated with a wide range of ophthalmic manifestations including endophthalmitis, which is a sight- threatening condition that needs to be rapidly recognized and treated to avoid permanent visual loss. A 26-year-old female with a 6-month history of vision loss in the left eye was treated with high dose systemic corticosteroids and azathioprine with an initial misdiagnosis elsewhere. A dense vitreous haze with opacities at the posterior hyaloid and a wide area of retinochoroiditis led to the diagnosis of endogenous endophthalmitis at presentation to us. The vitreous sample and blood cultures demonstrated growth of Brucella melitensis. She received 6 months of systemic antibiotherapy, which resulted in resolution of inflammation; however, visual acuity remained poor due to irreversible damage. Infectious etiology, including brucellosis in endemic countries, has to be considered in the differential diagnosis before administering immunomodulatory therapy in patients with panuveitis of unknown origin. Keywords: Endogenous endophthalmitis, Ocular brucellosis, Panuveitis Ó 2017 The Authors. Production and hosting by Elsevier B.V. on behalf of Saudi Ophthalmological Society, King Saud University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). http://dx.doi.org/10.1016/j.sjopt.2017.03.002 Introduction We herein present an unusual case of endogenous endophthalmitis due to B. melitensis. Brucellosis (Malta fever) is a zoonotic systemic disease caused by Brucella melitensis or Brucella abortus. -
Differentiate Red Eye Disorders
Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular -
Eyelid and Orbital Infections
27 Eyelid and Orbital Infections Ayub Hakim Department of Ophthalmology, Western Galilee - Nahariya Medical Center, Nahariya, Israel 1. Introduction The major infections of the ocular adnexal and orbital tissues are preseptal cellulitis and orbital cellulitis. They occur more frequently in children than in adults. In Schramm's series of 303 cases of orbital cellulitis, 68% of the patients were younger than 9 years old and only 17% were older than 15 years old. Orbital cellulitis is less common, but more serious than preseptal. Both conditions happen more commonly in the winter months when the incidence of paranasal sinus infections is increased. There are specific causes for each of these types of cellulitis, and each may be associated with serious complications, including vision loss, intracranial infection and death. Studies of orbital cellulitis and its complication report mortality in 1- 2% and vision loss in 3-11%. In contrast, mortality and vision loss are extremely rare in preseptal cellulitis. 1.1 Definitions Preseptal and orbital cellulites are the most common causes of acute orbital inflammation. Preseptal cellulitis is an infection of the soft tissue of the eyelids and periocular region that is localized anterior to the orbital septum outside the bony orbit. Orbital cellulitis ( 3.5 per 100,00 ) is an infection of the soft tissues of the orbit that is localized posterior to the orbital septum and involves the fat and muscles contained within the bony orbit. Both types are normally distinguished clinically by anatomic location. 1.2 Pathophysiology The soft tissues of the eyelids, adnexa and orbit are sterile. Infection usually originates from adjacent non-sterile sites but may also expand hematogenously from distant infected sites when septicemia occurs. -
Blepharoplasty, Ptosis and Canthoplasty
ENVOLVE VISION BENEFITS, INC. INCLUDING ALL ASSOCIATED SUBSIDIARIES CLINICAL POLICY AND PROCEDURE DEPARTMENT: Utilization DOCUMENT NAME: Blepharoplasty, Ptosis Management and Canthoplasty PAGE: 1 of 8 REFERENCE NUMBER: OC.UM.CP.0007 EFFECTIVE DATE: 01/01/2017 REPLACES DOCUMENT: 118-UM-R6 RETIRED: REVIEWED: 10/25/2017 SPECIALIST REVIEW: Yes REVISED: 11/7/2016 PRODUCT TYPE: COMMITTEE APPROVAL: 01/09/2018 IMPORTANT REMINDER: This Clinical Policy has been developed by appropriately experienced and licensed health care professionals based on a thorough review and consideration of generally accepted standards of medical practice, peer-reviewed medical literature, government agency/program approval status, and other indicia of medical necessity. The purpose of this Clinical Policy is to provide a guide to medical necessity. Benefit determinations should be based in all cases on the applicable contract provisions governing plan benefits (“Benefit Plan Contract”) and applicable state and federal requirements including Local Coverage Determinations (LCDs), as well as applicable plan-level administrative policies and procedures. To the extent there are any conflicts between this Clinical Policy and the Benefit Plan Contract provisions, the Benefit Plan Contract provisions will control. Clinical policies are intended to be reflective of current scientific research and clinical thinking. This Clinical Policy is not intended to dictate to providers how to practice medicine, nor does it constitute a contract or guarantee regarding results. Providers are expected to exercise professional medical judgment in providing the most appropriate care, and are solely responsible for the medical advice and treatment of members. SUBJECT: Medical necessity determination of eyelid procedures for treatment of dermatochalasis and ptosis. -
T20 FUNCTIONAL UPPER EYELID BLEPHAROPLASTY Policy Author
Policy T20 Blepharoplasty THRESHOLD POLICY – T20 FUNCTIONAL UPPER EYELID BLEPHAROPLASTY Policy author: West Suffolk CCG and Ipswich and East Suffolk CCG, with support from Public Health Suffolk. Policy start date: January 2008 Subsequent reviews July 2012 September 2014 February 2017 Next review date: February 2020 1. Policy Summary 1.1 Blepharoplasty is considered a low priority treatment and will only be funded by Ipswich and East Suffolk CCG & West Suffolk CCG when the following criteria are met. It will not be funded for cosmetic reasons. 1.2 This policy doesn’t apply to anyone <19 years of age. 2. Eligibility Criteria 2.1 Upper eyelid blepharoplasty is considered medically necessary for the following indications: a) To repair defects predisposing to corneal or conjunctival irritation such as entropion or pseudotrichiasis. OR b) To treat periorbital sequelae of thyroid disease, nerve palsy, blepharochalasis, floppy eyelid syndrome and chronic inflammatory skin conditions. OR c) To relieve symptoms of blepharospasm or significant dermatitis on the upper eyelid caused by redundant tissue. OR d) Following skin grafting for eyelid reconstruction. OR e) At the same time as ptosis correction for the upper eyelid if the surplus skin is felt to be excess on lifting the ptotic eyelid 2.2 For all other individuals, the following criteria apply: a) Documented patient complaints of interference with vision or visual field related activities such as difficulty reading or driving due to upper eye lid skin drooping, looking through the eyelids or seeing the upper eye lid skin AND b) There is redundant skin overhanging the upper eye lid margin and resting on the eyelashes when gazing straight ahead AND S:\Clinical Quality\00 Chief Nursing Office\Clinical Oversight Group\POLICIES\T\Policies\T20 blepharoplasty\T20 Blepharoplasty E.docx 1 Policy T20 Blepharoplasty c) Supporting evidence from visual field testing that eyelids impinge on visual fields reducing field to 120° horizontally and/or 40° or less vertically. -
Policy 96018: Blepharoplasty, Blepharoptosis Repair, and Brow
Policy: 96018 Initial Effective Date: 11/22/1996 SUBJECT: Blepharoplasty, Blepharoptosis Repair, and Annual Review Date: 11/16/2020 Brow Ptosis Repair Last Revised Date: 11/16/2020 Prior approval is required for some or all procedure codes listed in this Corporate Medical Policy. Definition: The term blepharoplasty refers to a collection of surgical procedures that involve removal of redundant eyelid tissue (skin, muscle, and fat). Although the primary indication for blepharoplasty is to improve the eyelid appearance, redundant lax eyelid tissue (dermatochalasis) can obstruct the superior visual field and interfere with activities of daily living in some individuals. In these cases, blepharoplasty may be considered in order to produce functional improvement in vision. The pathophysiology of dermatochalasis has not been well described, but much of the process appears to involve skin changes associated with the aging process. Less commonly, systemic disorders such as Ehlers-Danlos syndrome may predispose patients to develop dermatochalasis at a younger age. Clinical manifestations are mainly cosmetic, but in severe cases eyelid tissue may obstruct the superior visual field. The most common symptoms include difficulty reading and loss of peripheral vision when driving. Blepharoplasty may help to improve function for patients with clinically significant dermatochalasis. Blepharochalasis is sometimes confused with dermatochalasis. Though similar in nomenclature, these two disorders are quite different in presentation and etiology. Blepharochalasis is a rare condition characterized by intermittent, recurrent eyelid edema, resulting in relaxation of the eyelid tissue and resultant atrophy. The lower eyelids are less commonly involved. Blepharochalasis typically presents in adolescence or young adulthood, with intermittent attacks that occur less commonly as the person ages. -
Epstein Barr Virus Dacryoadenitis Resulting in Keratoconjunctivitis Sicca in a Child
Epstein Barr Virus Dacryoadenitis Resulting in Keratoconjunctivitis Sicca in a Child C. Stephen Foster, M.D. We evaluated a 10 year-old male with bilateral severe dry eye who was profoundly disabled by pain and photophobia despite aggressive conventional lubricant and tear conservation therapy. Serologic studies were initially unrevealing and misleading. A lacrimal gland biopsy, orbital portion, left side, was performed, and tissue was processed for light and immunohistochemical studies, which enabled us to establish the diagnosis. The boy, six months prior to evaluation, had been swimming in a river in Arkansas with friends, and all developed "conjunctivitis" after this outing, but only the patient's ocular symptoms persisted, with bilateral lid swelling, conjunctival injection, and ocular discomfort. Viral conjunctivitis was diagnosed and treated with topical tobramycin and dexamethasone four times daily for two weeks without effect. Increasingly severe superficial punctate keratopathy developed, and Pred Forte every two hours and Decadron ointment at bedtime along with Ciloxan drops every four hours and lubricants were prescribed. Three weeks of this therapy was also not effective in reducing the signs and symptoms. Schirmer values were zero bilaterally, cornea sensitivity was normal bilaterally, and all cultures were negative. Serologic studies disclosed elevated alkaline phosphatase and aspartate aminotransferase, and serum angiotensin converting enzyme determination was elevated and gallium scanning disclosed abnormal uptake of gallium citrate in the parotid and lacrimal glands. All other studies were within normal limits, and HLA typing was not diagnostically helpful. The diagnosis of sarcoidosis was made, and the patient was treated with systemic Prednisone, 100 mg PO QD, without noticeable effect on the ocular signs and symptoms. -
Eyelid Conjunctival Tumors
EYELID &CONJUNCTIVAL TUMORS PHOTOGRAPHIC ATLAS Dr. Olivier Galatoire Dr. Christine Levy-Gabriel Dr. Mathieu Zmuda EYELID & CONJUNCTIVAL TUMORS 4 EYELID & CONJUNCTIVAL TUMORS Dear readers, All rights of translation, adaptation, or reproduction by any means are reserved in all countries. The reproduction or representation, in whole or in part and by any means, of any of the pages published in the present book without the prior written consent of the publisher, is prohibited and illegal and would constitute an infringement. Only reproductions strictly reserved for the private use of the copier and not intended for collective use, and short analyses and quotations justified by the illustrative or scientific nature of the work in which they are incorporated, are authorized (Law of March 11, 1957 art. 40 and 41 and Criminal Code art. 425). EYELID & CONJUNCTIVAL TUMORS EYELID & CONJUNCTIVAL TUMORS 5 6 EYELID & CONJUNCTIVAL TUMORS Foreword Dr. Serge Morax I am honored to introduce this Photographic Atlas of palpebral and conjunctival tumors,which is the culmination of the close collaboration between Drs. Olivier Galatoire and Mathieu Zmuda of the A. de Rothschild Ophthalmological Foundation and Dr. Christine Levy-Gabriel of the Curie Institute. The subject is now of unquestionable importance and evidently of great interest to Ophthalmologists, whether they are orbital- palpebral specialists or not. Indeed, errors or delays in the diagnosis of tumor pathologies are relatively common and the consequences can be serious in the case of malignant tumors, especially carcinomas. Swift diagnosis and anatomopathological confirmation will lead to a treatment, discussed in multidisciplinary team meetings, ranging from surgery to radiotherapy. -
Involutional Type of Entropion in a Child with Cutis Laxa
1432 Br J Ophthalmol 2000;84:1432–1438 Br J Ophthalmol: first published as 10.1136/bjo.84.12.1432 on 1 December 2000. Downloaded from LETTERS TO THE EDITOR Involutional type of entropion in a child with cutis laxa EDITOR,—The diVuse elastic tissue disease called cutis laxa (CL) is a serious, even lethal systemic illness, involving not only the skin but connective tissues throughout the body.1 The skin hangs in loose folds, producing the appearance of premature ageing. Internal manifestations such as emphysema, ectasia of the aorta, and multiple hernias are usually present. We report a child with cutis laxa, who presented with an unusual ophthalmic mani- festation of the disease. CASE REPORT Our patient, who is nowa4yearoldboyand Figure 2 Eyelid tissue stained for elastic fibres showing marked granular degeneration of the elastic the third child to a normal first degree cousin fibres. Aldehyde-fuscin, ×400. couple, was noted to have redundant skin and a hoarse cry at the age of 3 months. Skin biopsy Surgical correction was carried out using a arrangements; hence the term “generalised was consistent with cutis laxa (elastin stain lateral tarsal strip in addition to two full elastolysis”. showed focal thickening of the elastic fibres thickness lid sutures. A small piece of resected Goltz and coworkers suggested an imbalance with tapered ends). His 7 month old sister was eyelid tissue was sent for pathological examina- between the circulating pancreatic elastase and also diagnosed as having cutis laxa at 3 months tion. its inhibitor (pancreatic elastase inhibiting sub- of age. Her ophthalmic examination revealed Staining for elastic tissue revealed marked stance, EIS), with a diminution of the latter in no abnormalities. -
Congenital Ocular Anomalies in Newborns: a Practical Atlas
www.jpnim.com Open Access eISSN: 2281-0692 Journal of Pediatric and Neonatal Individualized Medicine 2020;9(2):e090207 doi: 10.7363/090207 Received: 2019 Jul 19; revised: 2019 Jul 23; accepted: 2019 Jul 24; published online: 2020 Sept 04 Mini Atlas Congenital ocular anomalies in newborns: a practical atlas Federico Mecarini1, Vassilios Fanos1,2, Giangiorgio Crisponi1 1Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria Cagliari, University of Cagliari, Cagliari, Italy 2Department of Surgery, University of Cagliari, Cagliari, Italy Abstract All newborns should be examined for ocular structural abnormalities, an essential part of the newborn assessment. Early detection of congenital ocular disorders is important to begin appropriate medical or surgical therapy and to prevent visual problems and blindness, which could deeply affect a child’s life. The present review aims to describe the main congenital ocular anomalies in newborns and provide images in order to help the physician in current clinical practice. Keywords Congenital ocular anomalies, newborn, anophthalmia, microphthalmia, aniridia, iris coloboma, glaucoma, blepharoptosis, epibulbar dermoids, eyelid haemangioma, hypertelorism, hypotelorism, ankyloblepharon filiforme adnatum, dacryocystitis, dacryostenosis, blepharophimosis, chemosis, blue sclera, corneal opacity. Corresponding author Federico Mecarini, MD, Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria Cagliari, University of Cagliari, Cagliari, Italy; tel.: (+39) 3298343193; e-mail: [email protected]. -
Official Newsletter of APSOPRS 2016 Volume 2 Issue 4
Official Newsletter of APSOPRS 2016 Volume 2 Issue 4 Asia-Pacific Society of Ophthalmic Plastic and Reconstructive Surgery President Message: Hirohiko Kakizaki APSOPRS President Dear APSOPRS colleagues, Hirohiko Kakizaki (Japan) Season’s greetings during mid-summer! It has been 2 years since the new council APSOPRS Vice-Presidents started, and now at the last Hunter Yuen (Hong Kong, SAR) corner. Gangadhara Sundar (Singapore) The first thing we did was Kasturi Bhattacharjee (India) the move of the secretariat from Singapore to Japan. The most important matter was managing the members. At the time, the number of the official members were only 77, which means only Editor 77 members paid the fee to the society. The society Audrey Looi (Singapore) had 197 past (unpaid) members, though. I was very surprised at this reality as the APSOPRS is the representative society in this area and an affiliated Editorial Board society of APAO. In addition, the APSOPRS has been a reciprocal society of the ASOPRS. This matter was Ashok Grover (India) simply caused by the bothersome payment system. We before had only two methods of payment: one Kelvin Chong (Hong Kong, SAR) was the direct payment at a conference venue and Yoon-Duck, Kim (South Korea) the other was via bank transfer, the latter of which needs a complicated procedure. We therefore Lily Li Dong Mei (China) simplified the payment system using the Paypal via Raoul Henson (Philippines) web. As a result, the number of the paying members has increased to 112 by now. This is not Sunny Shen (Singapore) enough, of course, so please invite your colleagues and try to catch up with the ASOPRS and ESOPRS! In relation to this membership management, we have launched the “life membership” system. -
Carotid-Cavernous Sinus Fistulas and Venous Thrombosis
141 Carotid-Cavernous Sinus Fistulas and Venous Thrombosis Joachim F. Seeger1 Radiographic signs of cavernous sinus thrombosis were found in eight consecutive Trygve 0. Gabrielsen 1 patients with an angiographic diagnosis of carotid-cavernous sinus fistula; six were of 1 2 the dural type and the ninth case was of a shunt from a cerebral hemisphere vascular Steven L. Giannotta · Preston R. Lotz ,_ 3 malformation. Diagnostic features consisted of filling defects within the cavernous sinus and its tributaries, an abnormal shape of the cavernous sinus, an atypical pattern of venous drainage, and venous stasis. Progression of thrombosis was demonstrated in five patients who underwent follow-up angiography. Because of a high incidence of spontaneous resolution, patients with dural- cavernous sinus fistulas who show signs of venous thrombosis at angiography should be followed conservatively. Spontaneous closure of dural arteriovenous fistulas involving branches of the internal and/ or external carotid arteries and the cavernous sinus has been reported by several investigators (1-4). The cause of such closure has been speculative, although venous thrombosis recently has been suggested as a possible mechanism (3]. This report demonstrates the high incidence of progres sive thrombosis of the cavernous sinus associated with dural carotid- cavernous shunts, proposes a possible mechanism of the thrombosis, and emphasizes certain characteristic angiographic features which are clues to thrombosis in evolution, with an associated high incidence of spontaneous " cure. " Materials and Methods We reviewed the radiographic and medical records of eight consecutive patients studied at our hospital in 1977 who had an angiographic diagnosis of carotid- cavernous sinus Received September 24, 1979; accepted after fistula.