RESUMO
PURPOSE: To develop a simple, subjective, and reliable grading scale for isotretinoin-induced meibography changes. METHODS: After analyzing meibography images obtained from systemic isotretinoin users, a grading scale was proposed and named "meibography health score." The score ranged from 1 to 3, with decreasing gland reflectivity and identifiable margins. A total of 11 medical professionals were asked to grade 10 meibography images obtained from isotretinoin users using the proposed scale and were divided into three groups: (A) ophthalmologists with experience with meibography, (B) ophthalmologists with no experience with meibography, and (C) radiologists. The kappa statistic was determined to test interrater reliability. RESULTS: The overall kappa was approximately 0.64. The kappa scores for Groups A, B, and C were 0.78, 0.59, and 0.90, respectively. Grade 2 had the lowest kappa scores (0.62, 0.35, and 0.82 for A, B, and C, respectively) and grade 3 the highest (0.78, 0.90, and 1.0 for A, B and C, respectively). Furthermore, Group C had the highest kappa scores and Group B the lowest. CONCLUSION: The meibography health score exhibited good interrater reliability, particularly in severe cases.
Assuntos
Acne Vulgar , Fármacos Dermatológicos , Isotretinoína , Glândulas Tarsais , Variações Dependentes do Observador , Humanos , Isotretinoína/efeitos adversos , Acne Vulgar/tratamento farmacológico , Reprodutibilidade dos Testes , Glândulas Tarsais/efeitos dos fármacos , Glândulas Tarsais/diagnóstico por imagem , Glândulas Tarsais/patologia , Fármacos Dermatológicos/efeitos adversos , Índice de Gravidade de Doença , Feminino , Masculino , Doenças Palpebrais/induzido quimicamente , Doenças Palpebrais/diagnóstico por imagemRESUMO
ABSTRACT: Point-of-care ultrasound was used in a child presenting to the emergency department with progressively worsening left eyelid swelling. The early use of ultrasound was helpful in detecting a soft tissue mass that is exhibiting pressure effect on the eyeball. Point-of-care ultrasound helped expedite advanced imaging and consultation with the specialist. The patient eventually had a biopsy and was diagnosed with idiopathic orbital inflammation.
Assuntos
Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Humanos , Ultrassonografia/métodos , Edema/etiologia , Edema/diagnóstico por imagem , Masculino , Diagnóstico Diferencial , Criança , Serviço Hospitalar de Emergência , Pálpebras/diagnóstico por imagem , Biópsia/métodos , Pseudotumor Orbitário/diagnóstico por imagem , Doenças Palpebrais/diagnóstico por imagem , FemininoRESUMO
PURPOSE: To investigate ocular surface and meibomian glands in patients with treatment-naive acne vulgaris. METHODS: The Ocular Surface Disease Index (OSDI) questionnaire, invasive tear film breakup time, fluorescein staining of the ocular surface, and Schirmer II test were performed for all subjects. Total eyelid and meibomian gland secretion scores were assessed. Non-contact meibography was performed with the Sirius corneal topographic device. RESULTS: The right eyes of 35 patients with acne vulgaris and 35 healthy volunteers were included the study. While the OSDI and staining scores were significantly higher in the acne group than in the control group (p=0.01 and p=0.003, respectively), the invasive tear film breakup time and Schirmer measurements were significantly lower in the acne group (p=0.000 and p=0.003, respectively). The total eyelid and meibomian gland secretion scores were also higher in the acne group than in the control group (p=0.003 and p=0.000, respectively). On the morphological evaluation of the meibomian glands, the thickening, thinning, tortuosity, and presence of ghost areas were statistically significantly more common in the acne vulgaris group than in the control group (p=0.000, p=0.001, p=0.05, and p=0.006, respectively). The percentage of the meibomian gland loss area was significantly high in the acne vulgaris group on both upper and lower meibography. The meibomian gland loss area positively correlated with total eyelid and meibomian gland secretion scores. CONCLUSION: Acne vulgaris may have a predisposition to meibomian gland dysfunction and ocular surface damage. Early recognition of meibomian gland and ocular surface alterations seems important, especially in acne vulgaris cases for which oral isotretinoin treatment is planned.
Assuntos
Acne Vulgar , Síndromes do Olho Seco , Doenças Palpebrais , Disfunção da Glândula Tarsal , Humanos , Glândulas Tarsais/diagnóstico por imagem , Lágrimas , Acne Vulgar/diagnóstico por imagem , Acne Vulgar/tratamento farmacológico , Doenças Palpebrais/diagnóstico por imagemRESUMO
Meibography is becoming an integral part of dry eye diagnosis. Being objective and repeatable this imaging technique is used to guide treatment decisions and determine the disease status. Especially desirable is the possibility of automatic (or semi-automatic) analysis of a meibomian image for quantification of a particular gland's feature. Recent reports suggest that in addition to the measure of gland atrophy (quantified by the well-established "drop-out area" parameter), the gland's morphological changes may carry equally clinically useful information. Here we demonstrate the novel image analysis method providing detailed information on local deformation of meibomian gland pattern. The developed approach extracts from every Meibomian image a set of six morphometric color-coded maps, each visualizing spatial behavior of different morphometric parameter. A more detailed analysis of those maps was used to perform automatic classification of Meibomian glands images. The method for isolating individual morphometric components from the original meibomian image can be helpful in the diagnostic process. It may help clinicians to see in which part of the eyelid the disturbance is taking place and also to quantify it with a numerical value providing essential insight into Meibomian gland dysfunction pathophysiology.
Assuntos
Síndromes do Olho Seco , Doenças Palpebrais , Síndromes do Olho Seco/diagnóstico por imagem , Doenças Palpebrais/diagnóstico por imagem , Análise de Fourier , Humanos , Glândulas Tarsais/diagnóstico por imagem , LágrimasRESUMO
PURPOSE: Develop a deep learning-based automated method to segment meibomian glands (MG) and eyelids, quantitatively analyze the MG area and MG ratio, estimate the meiboscore, and remove specular reflections from infrared images. METHODS: A total of 1600 meibography images were captured in a clinical setting. 1000 images were precisely annotated with multiple revisions by investigators and graded 6 times by meibomian gland dysfunction (MGD) experts. Two deep learning (DL) models were trained separately to segment areas of the MG and eyelid. Those segmentation were used to estimate MG ratio and meiboscores using a classification-based DL model. A generative adversarial network was implemented to remove specular reflections from original images. RESULTS: The mean ratio of MG calculated by investigator annotation and DL segmentation was consistent 26.23% vs 25.12% in the upper eyelids and 32.34% vs. 32.29% in the lower eyelids, respectively. Our DL model achieved 73.01% accuracy for meiboscore classification on validation set and 59.17% accuracy when tested on images from independent center, compared to 53.44% validation accuracy by MGD experts. The DL-based approach successfully removes reflection from the original MG images without affecting meiboscore grading. CONCLUSIONS: DL with infrared meibography provides a fully automated, fast quantitative evaluation of MG morphology (MG Segmentation, MG area, MG ratio, and meiboscore) which are sufficiently accurate for diagnosing dry eye disease. Also, the DL removes specular reflection from images to be used by ophthalmologists for distraction-free assessment.
Assuntos
Aprendizado Profundo , Síndromes do Olho Seco , Doenças Palpebrais , Disfunção da Glândula Tarsal , Oftalmologistas , Humanos , Glândulas Tarsais/diagnóstico por imagem , Síndromes do Olho Seco/diagnóstico por imagem , Lágrimas , Doenças Palpebrais/diagnóstico por imagemRESUMO
Abstract Background: Previous studies has shown that dry eye test abnormalities, meibomian gland dysfunction (MGD), may occur in psoriasis. Objectives: The authors aimed to evaluate the dry eye disease (DED), MGD, in psoriasis patients with meibography which is a current, objective, noninvasive method for patients with meibomian gland diseases, to investigate the relationship between disease severity and ocular involvement. Methods: This study included 50 participants with psoriasis and 50 healthy individuals. All subjects were examined by the same dermatologist and referred for ophthalmological examination including meibomian gland obstruction, lid margin alterations assessment, ocular surface disease index assessment, tear film break-up time test, Schirmer test, corneal conjunctival fluorescein staining assessment. Additionally, upper and lower lids were evaluated for meibomian gland loss with meibography. Results: MGD (28%), meibomian gland loss (MGL) (29.5%), upper meiboscore (0.61 ± 0.81), lower meiboscore (0.46 ± 0.61), DED (22%) were significantly higher in the psoriasis group compared with the control group (p = 0.008, p < 0.001, p = 0.027, p = 0.041, p = 0.044, respectively). There was a significant relationship between MGD and psoriasis area severity index (PASI) (p = 0.015, Odds Ratio = 1.211). There was a significant positive relationship between MGL with PASI (p < 0.001, r = 608) and psoriasis duration (p < 0.001, r = 0.547). Study limitations: Smaller study group and inability to detect quality changes of meibum with meibography were limitations of the study. Conclusions: Psoriasis may affect the meibomian gland morphology, may cause structural changes in meibomian glands, and as a result of these may cause MGD and DED. Therefore, ophthalmologists and dermatologists should be aware of this situation and co-evaluate the patients in this respect.
Assuntos
Humanos , Psoríase/complicações , Síndromes do Olho Seco/diagnóstico , Doenças Palpebrais/diagnóstico por imagem , Lágrimas , Glândulas Tarsais/diagnóstico por imagemRESUMO
BACKGROUND: Previous studies has shown that dry eye test abnormalities, meibomian gland dysfunction (MGD), may occur in psoriasis. OBJECTIVES: The authors aimed to evaluate the dry eye disease (DED), MGD, in psoriasis patients with meibography which is a current, objective, noninvasive method for patients with meibomian gland diseases, to investigate the relationship between disease severity and ocular involvement. METHODS: This study included 50 participants with psoriasis and 50 healthy individuals. All subjects were examined by the same dermatologist and referred for ophthalmological examination including meibomian gland obstruction, lid margin alterations assessment, ocular surface disease index assessment, tear film break-up time test, Schirmer test, corneal conjunctival fluorescein staining assessment. Additionally, upper and lower lids were evaluated for meibomian gland loss with meibography. RESULTS: MGD (28%), meibomian gland loss (MGL) (29.5%), upper meiboscore (0.61⯱â¯0.81), lower meiboscore (0.46⯱â¯0.61), DED (22%) were significantly higher in the psoriasis group compared with the control group (pâ¯=â¯0.008, pâ¯<â¯0.001, pâ¯=â¯0.027, pâ¯=â¯0.041, pâ¯=â¯0.044, respectively). There was a significant relationship between MGD and psoriasis area severity index (PASI) (pâ¯=â¯0.015, Odds Ratioâ¯=â¯1.211). There was a significant positive relationship between MGL with PASI (pâ¯<â¯0.001, râ¯=â¯608) and psoriasis duration (pâ¯<â¯0.001, râ¯=â¯0.547). STUDY LIMITATIONS: Smaller study group and inability to detect quality changes of meibum with meibography were limitations of the study. CONCLUSIONS: Psoriasis may affect the meibomian gland morphology, may cause structural changes in meibomian glands, and as a result of these may cause MGD and DED. Therefore, ophthalmologists and dermatologists should be aware of this situation and co-evaluate the patients in this respect.
Assuntos
Síndromes do Olho Seco , Doenças Palpebrais , Psoríase , Síndromes do Olho Seco/diagnóstico , Doenças Palpebrais/diagnóstico por imagem , Humanos , Glândulas Tarsais/diagnóstico por imagem , Psoríase/complicações , LágrimasRESUMO
PURPOSE: To report the clinical features, ultrasound biomicroscopic features, and management outcome in patients presenting with thyroid eye disease (TED) and lower eyelid entropion. METHODS: Retrospective interventional case review of patients with TED presenting with lower eyelid entropion over a 12-year period. RESULTS: Five patients (eight eyes) of a total of 1211 presented with lower eyelid entropion as one of the presenting signs of TED (0.41%). The average age was 28.8 years (18-39 years), and three patients were males. Three had systemic hyperthyroidism, and two were euthyroid. Four (80%) had bilateral TED, three had inactive disease, and two were active. The average Hertel exophthalmometry reading was 24.6 mm. All patients had upper lid retraction. Four (80%) had concomitant lower eyelid retraction. Entropion was medial in five and complete in three eyes. Symptomatic corneal epitheliopathy was noted in four eyes. UBM was performed in four eyes which showed a thickened middle lamella. In four eyes (three patients), the entropion was managed conservatively as the patient was not contemplating surgery for proptosis. In the remaining four eyes (two patients) orbital decompression was performed and the lower eyelid retractor release corrected the symptomatic entropion. The average follow-up was 11.6 months (range 1-30). CONCLUSION: Lower eyelid entropion is a rare presenting sign in TED. The mechanism is multifactorial and could be caused by the thickened and fibrosed lower lid retractors, as demonstrated by UBM. Young age and globe projection may play a role. Decompression approaches that involve lower lid retractor release correct the entropion.
Assuntos
Entrópio , Exoftalmia , Doenças Palpebrais , Oftalmopatia de Graves , Adulto , Entrópio/etiologia , Entrópio/cirurgia , Exoftalmia/cirurgia , Doenças Palpebrais/complicações , Doenças Palpebrais/diagnóstico por imagem , Doenças Palpebrais/cirurgia , Pálpebras/diagnóstico por imagem , Pálpebras/cirurgia , Feminino , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/diagnóstico por imagem , Oftalmopatia de Graves/cirurgia , Humanos , Masculino , Estudos RetrospectivosRESUMO
PURPOSE: The aim of study was to evaluate the effects of oral isotretinoin on meibomian gland (MG) morphology detected with non-contact meibography and to investigate its relation with clinical dry eye tests. METHODS: Forty-five acne patients treated with isotretinoin underwent a full ophthalmological examination at baseline and in the fourth month as follows: ocular surface disease index (OSDI) questionnaire, assessments of tear film break-up time (TFBUT), corneal fluorescein staining, Schirmer test, meibum expression, and lid margin abnormalities. Non-contact meibography imaging and noninvasive tear break up time (NI-BUT) assessments were also performed. The changes in MGs were scored (meibography score) as grade 0, no change; grade 1, mild; grade 2, moderate; and grade 3, marked. RESULTS: There was a statistically significant change in OSDI, corneal fluorescein staining, lid margin abnormality, and meibum expression score during the treatment compared to baseline values (p < .001, p = .02, p < .001, and p < .001, respectively). All meibography scores showed a positive correlation with the lid margin abnormality and meibum expression score but did not correlate with the TFBUT, NI-BUT, Schirmer test, or the corneal fluorescein staining score. CONCLUSION: The morphologic analysis using non-contact meibography is a useful method for assessing isotretinoin-related changes in MGs.
Assuntos
Síndromes do Olho Seco , Doenças Palpebrais , Síndromes do Olho Seco/induzido quimicamente , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/tratamento farmacológico , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/diagnóstico por imagem , Humanos , Isotretinoína/efeitos adversos , Glândulas Tarsais/metabolismo , Lágrimas/metabolismoRESUMO
SIGNIFICANCE: The diagnosis of dry eye disease and meibomian gland dysfunction (MGD) is challenging. Measuring meibomian gland visibility may provide an additional objective method to diagnose MGD. PURPOSE: This study aimed to evaluate the ability of new metrics to better diagnose MGD, based on measuring meibomian gland visibility. METHODS: One hundred twelve healthy volunteers (age, 48.3 ± 27.5 years) were enrolled in this study. Ocular surface parameters were measured using the Oculus Keratograph 5M (Oculus GmbH, Wetzlar). Subjects were classified according to the presence or absence of MGD. New metrics based on the visibility of the meibomian glands were calculated and later compared between groups. The diagnostic ability of ocular surface parameters and gland visibility metrics was studied through receiver operating characteristic curves. Logistic regression was used to obtain the combined receiver operating characteristic curve of the metrics with the best diagnostic ability. RESULTS: Statistically significant differences were found between groups for all ocular surface parameters and new gland visibility metrics, except for the first noninvasive keratograph breakup time and gland expressibility. New gland visibility metrics showed higher sensitivity and specificity than did current single metrics when their diagnostic ability was assessed without any combination. The diagnostic capability increased when gland visibility metrics were incorporated into the logistic regression analysis together with gland dropout percentage, tear meniscus height, dry eye symptoms, and lid margin abnormality score (P < .001). The combination of median pixel intensity of meibography gray values and the aforementioned ocular surface metrics achieved the highest area under the curve (0.99), along with excellent sensitivity (1.00) and specificity (0.93). CONCLUSIONS: New meibomian gland visibility metrics are more powerful to diagnose MGD than current single metrics and can serve as a complementary tool for supporting the diagnosis of MGD.
Assuntos
Síndromes do Olho Seco , Doenças Palpebrais , Disfunção da Glândula Tarsal , Adulto , Idoso , Síndromes do Olho Seco/diagnóstico por imagem , Doenças Palpebrais/diagnóstico por imagem , Humanos , Glândulas Tarsais/diagnóstico por imagem , Pessoa de Meia-Idade , Lágrimas , Adulto JovemRESUMO
INTRODUCTION: Granulomatosis with polyangiitis (GPA) is a chronic systemic vasculitis characterized by necrotizing granulomatous vasculitis. The disease mainly affects the middle and small blood vessels and mainly occurs in the upper respiratory tract (nose and paranasal sinuses), lower respiratory tract (lungs), and kidneys. Disease occurrence in the eyelid area is relatively rare. The standard GPA treatment is combination therapy with adrenocortical hormone and immunosuppressants. Radiotherapy as a treatment option for GPA has not been widely investigated. PATIENT CONCERNS: A 29-year-old man presented with a 1.0â×â1.0âcm mass without exophthalmos and decreased vision in the left lower eyelid. Computed tomography revealed a mass-like high-density shadow below the left eye with a computed tomography value of 80-108 U. DIAGNOSIS: The laboratory investigations revealed positive cytoplasmic antineutrophil cytoplasmic antibodies (titerâ=â1:40). Biopsy of the lower left eyelid mass revealed necrosis and granulomatous reaction with a large number of inflammatory cell infiltration. After consultation with the pathology department, the diagnosis was determined as left lower eyelid GPA. INTERVENTIONS: The patient received 9MeV electron beam radiation therapy in the area of the left lower eyelid lesion. OUTCOMES: The lesion in the patient was significantly reduced and the symptom relieved obviously. No symptom recurrence or significant toxicity occurred during or after the treatment. The patient remains under routine follow-up. CONCLUSION: We present a case of a male patient with GPA located exclusively in the eyelid area, who underwent successful radiotherapy and achieved a complete response. The lesson we learned from this case study is that for GPA patients, when the standard treatment model fails to achieve good results, novel treatments such as radiotherapy should be considered according to the situation.
Assuntos
Doenças Palpebrais/diagnóstico , Granulomatose com Poliangiite/diagnóstico , Adulto , Diagnóstico Diferencial , Doenças Palpebrais/diagnóstico por imagem , Doenças Palpebrais/cirurgia , Granulomatose com Poliangiite/diagnóstico por imagem , Granulomatose com Poliangiite/radioterapia , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Neuro-ophthalmologic deficit after thalamic infarction has been of great concern to ophthalmologists because of its debilitating impacts on patients' daily living. We aimed to describe the visual and oculomotor features of thalamic infarction and to delineate clinical outcomes and prognostic factors of the oculomotor deficits from an ophthalmologic point of view. METHODS: Clinical and neuroimaging data of all participants were retrospectively reviewed. Among the 12,755 patients with first-ever ischemic stroke, who were registered in our Stroke Data Bank between January 2009 and December 2018, 342 were found to have acute thalamic infarcts on MRI, from whom we identified the patients exhibiting neuro-ophthalmologic manifestations including visual, oculomotor, pupillary, and eyelid anomalies. RESULTS: Forty (11.7%) of the 342 patients with thalamic infarction demonstrated neuro-ophthalmologic manifestations, consisting of vertical gaze palsy (n = 19), skew deviation with an invariable hypotropia of the contralesional eye (n = 18), third nerve palsy (n = 11), pseudoabducens palsy (n = 9), visual field defects (n = 7), and other anomalies such as isolated ptosis and miosis (n = 7). Paramedian infarct was the most predominant lesion of neuro-ophthalmologic significance, accounting for 84.8% (n = 28) of all patients sharing the oculomotor features. Although most of the patients with oculomotor abnormalities rapidly improved without sequelae, 6 (18.2%) patients showed permanent oculomotor deficits. Common clinical features of patients with permanent oculomotor deficits included the following: no improvement within 3 months, combined upgaze and downgaze palsy, and the involvement of the paramedian tegmentum of the rostral midbrain. CONCLUSIONS: Thalamic infarction, especially in paramedian territory, can cause a wide variety of neuro-ophthalmologic manifestations, including vertical gaze palsy, skew deviation, and third nerve palsy. Although most oculomotor abnormalities resolve spontaneously within a few months, some may persist for years when the deficits remain unimproved for more than 3 months after stroke.
Assuntos
Infarto Cerebral/diagnóstico por imagem , Doenças Palpebrais/diagnóstico por imagem , Doenças do Nervo Oculomotor/diagnóstico por imagem , Distúrbios Pupilares/diagnóstico por imagem , Doenças Talâmicas/diagnóstico por imagem , Transtornos da Visão/diagnóstico , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/diagnóstico por imagem , Estudos Retrospectivos , Adulto JovemAssuntos
Edema/etiologia , Exoftalmia/etiologia , Doenças Palpebrais/etiologia , Hemorragia/etiologia , Anormalidades Linfáticas/complicações , Doenças Orbitárias/complicações , Malformações Vasculares/complicações , Pré-Escolar , Edema/diagnóstico por imagem , Exoftalmia/diagnóstico por imagem , Doenças Palpebrais/diagnóstico por imagem , Feminino , Hemorragia/diagnóstico por imagem , Humanos , Anormalidades Linfáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Doenças Orbitárias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Malformações Vasculares/diagnóstico por imagemAssuntos
Abscesso/microbiologia , Edema/microbiologia , Doenças Palpebrais/microbiologia , Tumor de Pott/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus constellatus/isolamento & purificação , Abscesso/diagnóstico por imagem , Abscesso/terapia , Edema/diagnóstico por imagem , Edema/terapia , Doenças Palpebrais/diagnóstico por imagem , Doenças Palpebrais/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Tumor de Pott/diagnóstico por imagem , Tumor de Pott/terapia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/terapia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
ABSTRACT Purpose: Inferior eyelid laxity is classically evaluated using "snap-back" and "distraction" tests. This study aimed to assess the reproducibility of the technique used to indirectly quantify the horizontal tension in the lower eyelids using digital image processing. Methods: This longitudinal study was conducted to assess the reproducibility of a new technique that quantifies the horizontal tension in the lower eyelid. The study was conducted at the Hospital das Clínicas of Porto Alegre. The protocol was established by two trained ophthalmologist examiners, allowing intra- and interobserver agreement analyses. Image acquisition was done in two stages: the first image was captured with the eyelid in primary gaze position and the second with the eyelid in traction position. All images and measurements were processed using Image J 1.33m software from the National Institute of Health. The Bland-Altman method, intraclass correlation coefficients, concordance correlation coefficients, and technical measurement error were used to evaluate reproducibility. Results: The study participants comprised healthy individuals with no ophthalmologic pathologies. The measurements obtained in the neutral position showed a slightly higher agreement than those obtained in the traction position. The mean difference between the measurements performed in the traction position was 0.028 ± 0.7 mm and 0.014 ± 0.9 mm in the intra- and interobserver analyses, respectively. The Bland-Altman method demonstrated adequate confidence limits for both measurements. Correlation coefficients for measurements varied between 0.87 [95% confidence interval (CI) 0.68-0.95] and 0.91 (95% CI 0.77-0.97) in the neutral position and between 0.72 (95% CI 0.37-0.89) and 0.76 (95% CI 0.4-0.91) in the traction position. Conclusion: A high intra- and interobserver concordance was observed in the studied method to quantify lower eyelid tension. The proposed method is simple and easily reproducible, and to the best our knowledge, this is the first method that quantifies lower eyelid horizontal tension on the basis of digital image processing. This modified distraction test might be useful in studies quantifying lower eyelid horizontal tension.
RESUMO Objetivo: A frouxidão palpebral inferior é avaliada classicamente por meio de testes de "snap-back" e "distraction test". O objetivo deste estudo foi avaliar a reprodutibilidade da técnica utilizada para quantificar indiretamente a tensão horizontal nas pálpebras inferiores através do processamento digital de imagens. Métodos: Este estudo longitudinal foi realizado para avaliar a reprodutibilidade de uma nova técnica que quantifica a tensão horizontal na pálpebra inferior. O estudo foi realizado no Hospital das Clínicas de Porto Alegre. O protocolo foi estabelecido por dois examinadores oftalmologistas treinados, permitindo análises de concordância intra e interavaliador. A aquisição de imagens foi feita em duas etapas: a primeira imagem foi capturada com a pálpebra na posição primária do olhar e a segunda com pálpebra tracionada. Todas as imagens e medições foram processadas usando o software Image J 1.33m do National Institute of Health. O método de Bland-Altman, os coeficientes de correlação intraclasses, os coeficientes de correlação de concordância e o erro técnico da medida foram utilizados para avaliar a reprodutibilidade. Resultados: Os participantes do estudo foram indivíduos saudáveis e sem patologias oftalmológicas. As medidas obtidas na posição neutra mostraram concordância levemente maior do que as obtidas na posição tracionada. A diferença média entre as medidas realizadas na posição tracionada foi de 0,028 ± 0,7mm e 0,014 ± 0,9mm nas análises intra e interobservadores, respectivamente. O método de Bland-Altman demonstrou limites de confiança adequados para ambas as medidas. Os coeficientes de correlação para as medidas variaram entre 0,87 [intervalo de confiança de 95% (IC) 0,68-0,95) e 0,91 (IC 95% 0,77-0,97) na posição neutra e entre 0,72 (IC 95% 0,37-0,89) e 0,76 (IC 95% 0,46-0,91) na posição tracionada. Conclusão: Observou-se elevada concordância intra e interobservador no método estudado para quantificar a tensão palpebral inferior. O método proposto é simples e facilmente reproduzível, e, do melhor modo possível, este é o primeiro método que quantifica a tensão horizontal da pálpebra inferior com base no processamento digital de imagens. Este teste de distração modificado pode ser útil em estudos que quantifiquem a tensão horizontal da pálpebra inferior.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/normas , Interpretação de Imagem Assistida por Computador/métodos , Doenças Palpebrais/fisiopatologia , Doenças Palpebrais/diagnóstico por imagem , Valores de Referência , Software , Fotografação/métodos , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Pálpebras/fisiopatologia , Pálpebras/diagnóstico por imagemAssuntos
Fístula Carótido-Cavernosa/complicações , Doenças Palpebrais/etiologia , Hematoma/etiologia , Fístula Carótido-Cavernosa/diagnóstico por imagem , Fístula Carótido-Cavernosa/patologia , Doenças Palpebrais/diagnóstico por imagem , Doenças Palpebrais/patologia , Hematoma/diagnóstico por imagem , Hematoma/patologia , Humanos , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To examine the effectiveness of using meibomian gland (MG) dropout and distortion for dry eye disease (DED) diagnosis in a young population with long-term contact lens (CL) wear. METHODS: Seventy-three CL-wearers and 68 non-CL-wearers (20-28 years old) participated in the study. The diagnosis of DED was based on an ocular surface disease index ≥ 13, and a noninvasive breakup time < 10 seconds or positive corneal fluorescein staining. The MG dropout and distortion in each subject were quantified with non-invasive meibography. Receiver operating characteristic (ROC) curves were created to evaluate the effectiveness of using MG dropout and distortion to determine the presence of DED in CL-wearers and non-CL-wearers. RESULTS: In non-CL-wearers, the MG distortion was significantly higher in DED subjects than in normal subjects (3.83 ± 1.81 versus 1.59 ± 1.04). In CL-wearers, MG distortion was not significantly different (5.12 ± 4.11 versus 5.51 ± 3.15 in normal and DED subjects respectively). The area under the ROC curve (AUC) for MG distortion was 0.783 in the non-CL-wearers, but 0.507 in CL-wearers. In non-CL-wearers, MG dropout was significantly higher in DED subjects than in normal subjects (0.22 ± 0.08 versus 0.15 ± 0.06). In CL-wearers, MG dropout was also significantly higher in DED subjects than in normal subjects (0.29 ± 0.11 versus 0.22 ± 0.08). The AUC for MG dropout used to classify DED was 0.740 in the non-CL-wearers and 0.715 in CL-wearers. CONCLUSIONS: MG dropout was effective in distinguishing subjects with DED from normal subjects in both CL wearers and non-CL wearers. MG distortion can only distinguish DED subjects from normal ones in non-CL wearers, but not in CL wearers.
Assuntos
Lentes de Contato , Síndromes do Olho Seco/diagnóstico , Doenças Palpebrais/diagnóstico , Glândulas Tarsais/patologia , Adulto , Área Sob a Curva , Córnea/fisiologia , Doenças Palpebrais/diagnóstico por imagem , Feminino , Fluorofotometria , Humanos , Masculino , Glândulas Tarsais/diagnóstico por imagem , Concentração Osmolar , Curva ROC , Radiografia , Inquéritos e Questionários , Lágrimas/química , Lágrimas/fisiologia , Adulto JovemRESUMO
PURPOSE: Inferior eyelid laxity is classically evaluated using "snap-back" and "distraction" tests. This study aimed to assess the reproducibility of the technique used to indirectly quantify the horizontal tension in the lower eyelids using digital image processing. METHODS: This longitudinal study was conducted to assess the reproducibility of a new technique that quantifies the horizontal tension in the lower eyelid. The study was conducted at the Hospital das Clínicas of Porto Alegre. The protocol was established by two trained ophthalmologist examiners, allowing intra- and interobserver agreement analyses. Image acquisition was done in two stages: the first image was captured with the eyelid in primary gaze position and the second with the eyelid in traction position. All images and measurements were processed using Image J 1.33m software from the National Institute of Health. The Bland-Altman method, intraclass correlation coefficients, concordance correlation coefficients, and technical measurement error were used to evaluate reproducibility. RESULTS: The study participants comprised healthy individuals with no ophthalmologic pathologies. The measurements obtained in the neutral position showed a slightly higher agreement than those obtained in the traction position. The mean difference between the measurements performed in the traction position was 0.028 ± 0.7 mm and 0.014 ± 0.9 mm in the intra- and interobserver analyses, respectively. The Bland-Altman method demonstrated adequate confidence limits for both measurements. Correlation coefficients for measurements varied between 0.87 [95% confidence interval (CI) 0.68-0.95] and 0.91 (95% CI 0.77-0.97) in the neutral position and between 0.72 (95% CI 0.37-0.89) and 0.76 (95% CI 0.4-0.91) in the traction position. CONCLUSION: A high intra- and interobserver concordance was observed in the studied method to quantify lower eyelid tension. The proposed method is simple and easily reproducible, and to the best our knowledge, this is the first method that quantifies lower eyelid horizontal tension on the basis of digital image processing. This modified distraction test might be useful in studies quantifying lower eyelid horizontal tension.
Assuntos
Doenças Palpebrais/diagnóstico por imagem , Doenças Palpebrais/fisiopatologia , Interpretação de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/normas , Adulto , Pálpebras/diagnóstico por imagem , Pálpebras/fisiopatologia , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Fotografação/métodos , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , SoftwareRESUMO
Intravascular papillary endothelial hyperplasia (IPEH) is a benign vascular lesion, typically found in the skin, consisting of a papillary proliferation of endothelial cells intimately related to a thrombus; it appears to be a rare variant of an organizing process. IPEH very rarely develops in the periocular region, with fewer than 20 such cases currently reported in the English language literature. We describe one of the largest ever case series of this uncommon lesion occurring in the periocular region and discuss its clinical features, imaging characteristics, and surgical management.
Assuntos
Endotélio Vascular/patologia , Oftalmopatias/patologia , Doenças Palpebrais/patologia , Face/patologia , Testa/patologia , Idoso , Diagnóstico Diferencial , Oftalmopatias/diagnóstico por imagem , Oftalmopatias/cirurgia , Doenças Palpebrais/diagnóstico por imagem , Doenças Palpebrais/cirurgia , Face/diagnóstico por imagem , Face/cirurgia , Feminino , Testa/diagnóstico por imagem , Testa/cirurgia , Humanos , Hiperplasia/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Sebaceous cell carcinoma is well known as the "great masquerader" mimicking other benign or malignant eyelid conditions and lesions. We present a case of a middle age male presenting with a subacute left upper lid abscess who was ultimately diagnosed with malignant sebaceous cell carcinoma after incision and drainage and treatment with broad spectrum antibiotics. This case highlights the deceptive clinical and radiographic appearance of this tumor and the importance of histologic examination in atypical or refractory periorbital abscesses.