Tratamento cirúrgico da ptose palpebral moderada e grave: análise de resultados / Surgical treatment of moderate and severe ptosis: analysis of results

Introdução: A ptose palpebral é uma afecção comum na prática clínica na qual uma perfeita avaliação torna-se mandatória. Definimos ptose quando a margem palpebral encontra-se abaixo de 2 mm da junção córneo escleral e pode ser classificada em leve, moderada e grave. Existem inúmeras técnicas de reparo e a escolha dependerá da classificação da função do músculo levantador. Métodos: Foram analisados de forma prospectiva, no período de março de 2013 a maio de 2015, quatorze (n = 14) pacientes submetidos ao tratamento cirúrgico de ptose palpebral moderada e grave (n = 21). Inúmeros fatores foram estudados, tais como grau de ptose e função do músculo elevador da pálpebra, tipo de técnica de reparo, complicações imediatas e tardias, etc. Resultados: Quatorze pacientes foram opera-dos, totalizando 21 pálpebras, sendo que, 85% foram de etiologia adquirida e 15% congênita. Com relação ao grau de ptose, 64,3% (n = 9) foram moderadas e 35,7% (n = 5) graves. No que tange à função do músculo levantador, encontramos função boa 28,5% (n = 4), moderada 28,5% (n = 4) e pobre 43% (n = 6). Em relação às com-plicações, 2 casos de hiperemia conjutival e um caso de edema. Obtivemos um alto índice de satisfação com 85,7% (n = 12), com baixas taxas de complicações. Conclusão: A ptose palpebral é uma enfermidade comum na prática clínica e exige por parte do cirurgião um perfeito conhecimento anatômico da delicada estrutura palpebral e também de sua fisiopatologia. Uma perfeita avaliação desse paciente torna-se mandatória para o emprego do tratamento mais adequado.

Introduction: Eyelid ptosis is a common condition in clinical practice for which a complete evaluation is mandatory. Ptosis is defined when the eyelid margin is 2 mm below the corneoscleral junction and can be classified as mild, moderate, and severe. There are numerous repair techniques, and the choice will depend on the classification of the function of the levator muscle. Methods: We evaluated prospectively, from March 2013 to May 2015, 14 patients who underwent surgical treatment of moderate and severe ptosis (n = 21). Several factors were studied, such as degree of ptosis and function of the eyelid levator muscle, type of repair technique, and immediate and late complications. Results: Fourteen patients (21 eyelids) underwent operation. The etiology was acquired in 85% of the cases and congenital in 15%. With respect to the degree of ptosis, 64.3% (n = 9) of the cases were moderate and 35.7% (n = 5) were severe. With respect to the muscle function of the levator, good, moderate, and poor functions were observed in 28.5% (n = 4), 28.5% (n = 4), and 43% (n = 6) of the cases, respectively. With regard to complications, 2 cases of conjunctival hyperemia and one case of edema were observed. We obtained a high satisfaction rate of 85.7% (n = 12), with low complication rates. Conclusion: Eyelid ptosis is a common presentation in clinical practice and requires on the part of the surgeon a detailed anatomical knowledge of the delicate structure of the eyelid and its pathophysiology. A complete evaluation of these patients is mandatory for the employment of the most appropriate treatment.

Ultrasonido intraquirúrgico como medio de estimulación del colágeno aplicado a la blefaroplastia del párpado inferior / Intrasurgical ultrasound as a means collagen stimulation applied to lower eyelid blepharoplasty

El colágeno1 es una proteína que desempeña un papel crítico en la arquitectura de la piel. La cualidad que transmite es la fuerza y resistencia. La esencia de este trabajo es demostrar que con la estimulación del colágeno de la piel del párpado inferior se logra restablecer la piel necesaria para que tenga un aspecto agradable, sin necesidad de recurrir a la exéresis. Al conseguir el calentamiento del colágeno, la piel recobra propiedades como elasticidad, retracción y retención, cualidades propias de una piel joven. La idea que se quiere transmitir es que se puede mejorar la piel sin correr el riesgo6,7 de una asimetría o una desmesura que termine con ectropión o retracciones cicatrizales luego de extracción de piel. Este es un procedimiento rápido que no entorpece el normal desempeño quirúrgico, extremadamente seguro ya que se recurre a una estimulación proteica sin sacar piel y perdura el resultado en el tiempo o sea que es efi caz

Collagen1 is a protein plays a critical role in skin architecture. The quality that comes through is the strength and endurance. The essence of this paper is to demonstrate that collagen stimulation of the lower eyelid skin, manages to restore the skin necessary to have a nice look without resorting to excerecis. By getting the heating of collagen and recovers elasticity properties, shrinkage and retention qualities of youthful skin. The idea to be conveyed, is that you can improve the skin without running the risk6,7 of an asymmetry or disproportion to end scarring ectropion or retraction after removal of skin. This is a quick procedure that does not hinder the normal surgical performance, extremely safe because it uses a non-protein stimulation by removing skin and the result lasts over time or whether it is eff ective.

Bilateral ptosis: Lesion in the oculomotor nuclei or supranuclear lesion?

BACKGROUND: Bilateral ptosis is a very interesting clinical challenge for doctors because of the multiple possible localizations of a lesion which can lead to this neurological sign. OBJECTIVES: Through this case report, we aim to determine the difference between an apraxia of lid opening (ALO) with difficulty in initiating the act of lid elevation, in spite of adequate understanding, motor control and cranial nerve pathways, and a bilateral ptosis with a lesion in the oculomotor nucleus or blepharospasm. METHODS: The case report of a 50-year-old patient presenting bilateral ptosis and multiple ischemic lesions in the brainstem and bilateral frontal lobe lesions after the emergency removal of a large frontal tumor. RESULTS: Our patient had an ALO according to the neurological follow-up and showed the ability, after a few weeks, of initiating the act of opening her eyes with her hand. The ophthalmic evaluation confirmed that in her case the ALO was associated with a nuclear lesion of the oculomotor nerve secondary to a midbrain lesion. CONCLUSION: Our case report confirms multiple differential diagnoses in bilateral ptosis and the importance of clinical examination in spite of good neurological imaging.

[The neurological and ophthalmic symptoms in the child after the serious head injury due to the fall from the fifth storey. A case report]. / Objawy neurologiczne i oczne u dziecka po ciezkim urazie glowy na skutek wypadniecia z piatego pietra. Opis przypadku.

INTRODUCTION: The prognosis in the case of head injury may be different, Serious head injures are the leading causes of the death. In the remaining cases, the child recovers entirely, or disturbances of the cognitive and motor activities remain. The aim of the work is to show neurological and ophthalmological complications at the child after the fali down from the fifth storey. CASE REPORTS: A four-year-old girl with severe injuries of the body as result of the fall down from the fifth storey has been described. She had serious changes within head--the bruise of the brain with typical symptoms after brain trauma. The period spent in coma lasted for quite long time, therefore the return of the base life activities also stretched over months. Control computer tomography scan of the head showed multiple fractures of the skull bones and of brain tissue injury. The organ of sight complications concerned visual acuities, the large angle squint, the entire lack of the convergence reflex and post-traumatic symptoms on the fundus of eyeballs. RESULT: The long-term suitable medical care let the child to survive and then slowly recover. CONCLUSION: The intensive treatment and the rehabilitation of the child after the heavy head trauma allowed to obtain the astounding improvement of the psychomotor activities. It is very important for the children after the head trauma to conduct for the multispecialist treatment and proper long-term rehabilitation of children.

A simple new method for the construction of a ptosis crutch.

A technique by which a ptosis crutch can be fitted in minutes, using readily available and inexpensive materials and tools, is described. No specialist skills are needed and the device can be fitted to existing frames and lenses.

[Combined treatment of congenital blepharoptosis in children and adolescents]. / Kombinirovannoe lechenie vrozhdennogo blefaroptoza u detei i podrotskov.

The paper deals with a complex procedure for rehabilitation of children with congenital blepharoptosis, which includes the multilevelled impact on the concerned central and peripheral links of the neuromuscular apparatus by using magnetic laser therapy and electrostimulation.

The absent lateral canthal tendon: reconstruction using a Y graft of palmaris longus tendon.

Absence of the lateral canthal tendon, whether congenital or acquired, imposes cosmetic and functional deformities that are surgically correctable. We propose a means of reconstructing the lateral canthal tendon using a Y graft of palmaris longus tendon. The benefits of this method are discussed. We believe it offers an alternative approach for supporting the lateral canthus and lower eyelid, and is especially useful when reestablishment of the lateral canthal tendon is necessary because of local tissue destruction or congenital absence. Three patients with congenital absence of the lateral canthal tendon are presented.