Treatment of xanthelasma palpebrarum with a 1064-nm, Q-switched Nd:YAG laser.

BACKGROUND: Xanthelasma palpebrarum is the most common cutaneous xanthoma characterized by soft, yellow papules or plaques that arise on the periorbital skin. As these lesions can be cosmetically disfiguring, many patients seek medical help to remove these lesions. OBJECTIVE: To determine the effectiveness and minimum number of treatment sessions with a 1064-nm, Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of xanthelasma. METHODS: A retrospective review of patients with xanthelasma consecutively treated with Q-switched Nd:YAG laser was conducted. Forty-six patients with 103 lesions were identified from January 2012 through August 2015. Photographs taken of patients immediately before treatment and 4-8 weeks after treatment were independently evaluated by 2 dermatologists. RESULTS: After a single treatment session, 93.2% of lesions had some degree of clearance. All lesions had excellent-to-complete clearance after at least 4 treatment sessions. Patients usually required 4 treatment sessions for optimal results. LIMITATIONS: This was a retrospective study. Treatment parameters varied, follow-up periods were not uniform, and response was not assessed with a validated scale. CONCLUSION: The Q-switched Nd:YAG laser is effective and well tolerated in the treatment of xanthelasma in our study population.

Fractional CO2 laser is an effective therapeutic modality for xanthelasma palpebrarum: a randomized clinical trial.

BACKGROUND: Xanthelasma palpebrarum (XP) is a common cosmetic concern. Although there is a wide range of therapeutic modalities for XP, there is no general consensus on the optimal treatment for such condition. OBJECTIVE: Compare the efficacy and safety of super pulsed (SP) and fractional CO2 lasers in the treatment of XP. PATIENTS AND METHODS: This prospective randomized comparative clinical study included 20 adult patients with bilateral and symmetrical XP lesions. Xanthelasma palpebrarum lesions were randomly assigned to treatment by either single session of ablative SP CO2 laser or 3 to 5 sessions of ablative fractional CO2 laser with monthly intervals. All patients were assessed using digital photography and optical coherence tomography images. RESULTS: Xanthelasma palpebrarum lesions on both sides were successfully removed with significant improvement in size, color, and thickness. Although lesions treated by SP CO2 laser showed significantly better improvement regarding color and thickness of the lesions, downtime and patient satisfaction were significantly better for lesions treated with fractional CO2 laser. Scarring and recurrence were significantly higher in lesions treated by SP CO2 laser. CONCLUSION: Ablative fractional CO2 laser is an effective and safe therapeutic option for XP with significantly shorter downtime and higher patient satisfaction compared with SP CO2 laser.

Protracted hypofractionated radiotherapy for Graves' ophthalmopathy: a pilot study of clinical and radiologic response.

PURPOSE: To evaluate the clinical and radiologic response of patients with Graves' ophthalmopathy given low-dose orbital radiotherapy (RT) with a protracted fractionation. METHODS AND MATERIALS: Eighteen patients (36 orbits) received orbital RT with a total dose of 10 Gy, fractionated in 1 Gy once a week over 10 weeks. Of these, 9 patients received steroid therapy as well. Patients were evaluated clinically and radiologically at 6 months after treatment. Clinical response assessment was carried out using three criteria: by physical examination, by a modified clinical activity score, and by a verbal questionnaire considering the 10 most common signs and symptoms of the disease. Radiologic response was assessed by magnetic resonance imaging. RESULTS: Improvement in ocular pain, palpebral edema, visual acuity, and ocular motility was observed in all patients. Significant decrease in symptoms such as tearing (p < 0.001) diplopia (p = 0.008), conjunctival hyperemia (p = 0.002), and ocular grittiness (p = 0.031) also occurred. Magnetic resonance imaging showed decrease in ocular muscle thickness and in the intensity of the T2 sequence signal in the majority of patients. Treatments were well tolerated, and to date no complications from treatment have been observed. There was no statistical difference in clinical and radiologic response between patients receiving RT alone and those receiving RT plus steroid therapy. CONCLUSION: RT delivered in at a low dose and in a protracted scheme should be considered as a useful therapeutic option for patients with Graves' ophthalmopathy.

Treatment of xanthelasma palpebrarum using a pulsed dye laser: a prospective clinical trial in 38 cases.

BACKGROUND: Several studies have reported positive results of nonablative laser treatment of xanthelasma palpebrarum, but the published evidence is weak and inconclusive. OBJECTIVE: To systematically evaluate the effect of pulsed dye laser (PDL) treatment of xanthelasmas. MATERIALS AND METHODS: Twenty female Caucasian patients with 38 lesions (< or =1 mm above skin level) were enrolled. They received up to five treatment sessions with a PDL (wavelength, 585 nm; energy fluence, 7 J/cm(2); pulse duration, 0.5 ms; spot size, 10 mm; number of passes, 2) at 2- to 3-week intervals. Photographs were taken before each treatment session and 4 weeks after the last treatment. Two independent examiners categorized clearance into four groups (no clearance [<25% xanthelasma area(s) cleared], moderate [25-50%], good [51-75%], and excellent [>75%]). Patient satisfaction was assessed on a verbal rating scale. RESULTS: Approximately two-thirds of the lesions showed clearance greater than 50%, and one-quarter had clearance greater than 75%. Interrater reliability was excellent (contingency coefficient >0.7 at all visits). Treatments were well tolerated and had no major side effects. Patient satisfaction was generally high. CONCLUSION: PDL is a promising approach for treating xanthelasmas, especially when multiple sessions are performed.

Radiosurgery versus carbon dioxide laser for dermatochalasis correction in Asians.

BACKGROUND AND OBJECTIVES: Carbon dioxide (CO(2)) laser and radiosurgery are techniques commonly employed in oculoplastic surgery. However, there is no literature comparing their results in blepharoplasty. STUDY DESIGN/MATERIALS AND METHODS: Twenty Chinese patients with dermatochalasis underwent radiosurgery in one upper eyelid and CO(2) laser in the contralateral eyelid. Intraoperative time, hemorrhage, and pain control were assessed. Subjects were evaluated at postoperative 1 hour, 1 week, 1 month, and 3 months for hemorrhage and wound healing by a masked assessor. RESULTS: All patients reported minimal pain with either technique. A significantly shorter operative time was achieved with CO(2) laser, with better intraoperative hemostasis. There was no significant difference in postoperative hemorrhage and wound swelling between radiosurgery and CO(2) laser. No significant intraoperative complications were noted. CONCLUSIONS: Both radiosurgery and CO(2) laser are equally safe and effective for upper lid blepharoplasty. CO(2) laser achieves shorter operative time with superior intraoperative hemostasis.

Bilateral primary orbital non-Hodgkin's lymphoma in a patient with scleroderma: a case report.

Orbital presentation of non-Hodgkin's Lymphoma (NHL) is uncommon but occurs both as the only site of disease and as a site of recurrence. Primary orbital NHLs are usually low-grade, and mostly extranodal marginal zone/mucosa associated lymphoid tissue B-cell neoplasms. They are commonly associated with chronic inflammatory conditions. The issue of bilaterality in orbital lymphoma is not very common. The onset of malignant lymphoproliferation may precede, follow, or exist simultaneously with scleroderma. Different treatment modalities were applied in orbital NHL such as surgery, radiation therapy, chemotherapy or both. We report a 57-year-old man with scleroderma presenting with eyelid hernias who had biopsy-proven marginal zone NHL, successfully treated with radiotherapy and combined chemotherapy, and also review the literature.

Atypical lymphoid hyperplasia of the eyelids manifesting as xanthelasma-like lesions.

We describe a patient who had bilateral, yellow papules of the upper eyelids. This proved to be the clinical manifestation of an atypical lymphoid hyperplasia of the orbits. We describe this clinical presentation as a new sign of this condition. This finding serves to broaden the differential diagnosis of yellow papules on the eyelids. Atypical lymphoid hyperplasia of the orbits poses a challenging problem. Their benign or malignant nature cannot usually be determined by clinical and radiologic criteria. Most of these infiltrates result in extraocular lymphoma. We describe a patient with bilateral, yellow papules of the upper eyelids that proved to be a manifestation of an atypical lymphoid hyperplasia of the orbits.

Present status of eyelid phototherapy. Clinical efficacy and transmittance of ultraviolet and visible radiation through human eyelids.

BACKGROUND: Phototherapy for the eyelid has not previously been recognized as a safe and effective treatment of photoresponsive dermatoses of the eyelid, such as atopic dermatitis, vitiligo, psoriasis, lymphomatoid papulosis, and parapsoriasis. OBJECTIVE: The purpose of this study was to demonstrate the efficacy and safety of this treatment. METHODS: Two cases are presented to demonstrate clinical efficacy. In addition, a retrospective eye evaluation of seven patients receiving a combined total of greater than 1300 eyelid phototherapy treatments was performed. To determine whether potentially harmful UV radiation is significantly transmitted through eyelid skin, an in vitro study was conducted to measure the percentage transmittance of ultraviolet-visible radiation through five excised eyelids. RESULTS: In the two cases presented, remarkable improvement occurred without adverse side effects, suggesting that it is possible to deliver incremental UV dosages to eyelid skin to achieve clearing of skin disease. Retrospective analysis of patients' records revealed no ocular disease from the phototherapy. In vitro eyelid examination produced data that indicated negligible quantities of UV radiation were transmitted through eyelid skin compared with the visible spectrum, in which up to 77% of the radiation was transmitted through the tissue. CONCLUSION: The combined clinical experience and transmittance data suggest that eyelid phototherapy is a safe and effective treatment in selected patients.

X-ray epilation for the treatment of trichiasis.

.richiasis is a complication of many different disorders of the eyelids. Treatment is difficult and painful when conventional methods of plucking, surgical excision, electrolysis, or cryotherapy are employed. Since superficial x-ray therapy for the treatment of eyelid skin cancers causes permanent loss of the eyelashes in the irradiated field, we attempted to exploit this observation for the treatment of trichiasis. A rabbit model was used to determine the minimum permanent epilating dose. The dose was found to be approximately 4,000 rad of superficial radiation along with the following factors: 110 kV, 10 mamp, a target skin distance of 20 cm, a half-value layer of 1.0 mm of aluminum, and no filter. The dosage schedule used was 300 rad given three times per week. Two patients with severe scarring trichiasis were treated with the same factors and a total dose of 4,000 rad; excellent results were achieved. We believe that x-ray therapy is an easy, safe, and painless method for the management and cure of chronic trichiasis.

Radiation therapy in amyloidosis of the eyelid and conjunctiva: a case report.

Many questions about amyloidosis are still unanswered. Etiology and pathogenesis remain unclear. Diagnosis is difficult to prove without a biopsy. Several approaches have been tried, but no effective cure has been documented. Russian authors report the use of cobalt therapy for a patient with local laryngeal amyloidosis. This paper presents a case report of a patient with local amyloidosis of the conjunctiva. Superficial radiation therapy was used, and resulted in some shrinkage of the lesions. Surgical excision was later utilized to remove the remaining amyloid deposits.