RESUMO
In this case report, we highlight minocycline-induced scleral hyperpigmentation, combined with ear and fingernail discoloration that developed after over 15 years of use for rosacea in a 78-year-old male with multiple medical comorbidities. Minocycline, a tetracycline antibiotic, is used to treat rosacea and acne as well as some orthopedic infections. It is typically used for extended periods of time; long-term use of minocycline is associated with hyperpigmentation of the sclera, conjunctiva, retina, teeth, skin, subcutaneous fat, oral mucosa, tympanic membrane, and gingiva. This case highlights that hyperpigmentation is more likely to occur in older patients than in younger patients. Scleral hyperpigmentation is not associated with vision loss; however, cosmetic concerns can prompt discontinuation of minocycline. Nonetheless, after cessation, the lesions persist in some patients. Monitoring for hyperpigmentation in patients using minocycline is important, as the hyperpigmentation is more likely to be permanent with long-term use.
Assuntos
Acne Vulgar , Hiperpigmentação , Rosácea , Doenças da Esclera , Masculino , Humanos , Idoso , Minociclina/efeitos adversos , Antibacterianos/efeitos adversos , Hiperpigmentação/induzido quimicamente , Hiperpigmentação/tratamento farmacológico , Hiperpigmentação/patologia , Acne Vulgar/tratamento farmacológico , Doenças da Esclera/induzido quimicamente , Doenças da Esclera/tratamento farmacológico , Rosácea/tratamento farmacológico , Transtornos da VisãoAssuntos
Antibacterianos/efeitos adversos , Hiperpigmentação/induzido quimicamente , Minociclina/efeitos adversos , Mucinose Folicular/tratamento farmacológico , Doenças da Esclera/induzido quimicamente , Neoplasias Cutâneas/tratamento farmacológico , Idoso , Antibacterianos/uso terapêutico , Humanos , Hiperpigmentação/diagnóstico , Hiperpigmentação/terapia , Masculino , Minociclina/uso terapêutico , Micose Fungoide/tratamento farmacológico , Doenças da Esclera/diagnóstico , Doenças da Esclera/terapia , Suspensão de TratamentoRESUMO
BACKGROUND: Interferon α2b (IFN α2b) is an established and well-tolerated treatment for ocular surface squamous neoplasia (OSSN). METHOD: Report of complications in two patients with OSSN and rheumatoid arthritis treated with adjuvant topical IFN α2b. RESULTS: One patient developed a scleral melt and the other one severe keratitis. After discontinuing treatment with IFN α2b both patients showed considerable improvement. CONCLUSION: Immunosuppressed patients with OSSN under topical IFN α2b should be closely monitored for early detection of complications.
Assuntos
Artrite Reumatoide/complicações , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias da Túnica Conjuntiva/tratamento farmacológico , Interferon-alfa/efeitos adversos , Interferon-alfa/uso terapêutico , Ceratite/induzido quimicamente , Doenças da Esclera/induzido quimicamente , Idoso , Carcinoma de Células Escamosas/complicações , Neoplasias da Túnica Conjuntiva/complicações , Feminino , Humanos , Interferon alfa-2 , Ceratite/patologia , Ceratite/prevenção & controle , Pessoa de Meia-Idade , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Recurvamento da Esclera , Doenças da Esclera/patologia , Doenças da Esclera/prevenção & controle , Resultado do TratamentoAssuntos
Antibacterianos/efeitos adversos , Minociclina/efeitos adversos , Doenças Retinianas/diagnóstico , Epitélio Pigmentado da Retina/patologia , Doenças da Esclera/diagnóstico , Tomografia de Coerência Óptica , Idoso , Angiofluoresceinografia , Humanos , Masculino , Doenças Retinianas/induzido quimicamente , Epitélio Pigmentado da Retina/efeitos dos fármacos , Rosácea/tratamento farmacológico , Doenças da Esclera/induzido quimicamente , Acuidade VisualAssuntos
Calcinose/induzido quimicamente , Corioide/patologia , Hipercalcemia/induzido quimicamente , Doenças da Esclera/induzido quimicamente , Doenças da Esclera/diagnóstico , Vitamina D/efeitos adversos , Adulto , Calcinose/diagnóstico , Calcinose/terapia , Corioide/efeitos dos fármacos , Diagnóstico Diferencial , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/prevenção & controle , Masculino , Doenças da Esclera/terapia , Banho de SolRESUMO
PURPOSE: To describe complications after use of mitomycin C (MMC) as a surgical adjuvant in pterygium surgery. METHODS: This is a retrospective chart review of patients presenting to a tertiary referral center over a 7-year period with a diagnosis of scleral stromalysis after previous pterygium removal. RESULTS: Sixteen eyes of 15 patients were identified with scleral stromalysis after pterygium surgery with the use of adjuvant MMC. Three eyes were excluded because of insufficient chart information or previous beta-irradiation treatment. Twelve of 13 eyes underwent surgical treatment for primary pterygium, and 1 eye was treated for recurrent pterygium. Time from initial pterygium surgery to presentation ranged from 1 month to 10 years. Dosage and routes of MMC administration included 0.02% intraoperative application to either the bare sclera or Tenon capsule with a range of 30 seconds to 3 minutes or topical administration 4 times daily for 2 weeks. In some cases, the dose and route of MMC administration were unknown. Four of 13 patients (31%) required a scleral patch graft with 1 patient (8%) requiring multiple patch grafts. CONCLUSIONS: Use of MMC in various forms and concentrations can cause devastating complications including scleral stromalysis. Scleral stromalysis may present anywhere from months to years after application. We suggest that MMC should be used with extreme caution when used as a surgical adjuvant for pterygium surgery. Patients must be urged to continue long-term follow-up after MMC use because of the potential for future anterior segment complications.
Assuntos
Alquilantes/efeitos adversos , Mitomicina/efeitos adversos , Pterígio/cirurgia , Esclera/efeitos dos fármacos , Doenças da Esclera/induzido quimicamente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alquilantes/administração & dosagem , Quimioterapia Adjuvante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Procedimentos Cirúrgicos Oftalmológicos , Pterígio/tratamento farmacológico , Recidiva , Estudos RetrospectivosRESUMO
A 52-year-old man presented with a progressive grey-black pigmentation of facial skin, sclera and teeth. The cause was long-term ingestion of minocycline, as confirmed by history and skin biopsy. Minocycline-induced hyperpigmentation can be divided into four main patterns based on clinical appearance, distribution, light- and electron microscopic characteristics. Some patterns can manifest within weeks of initiating therapy. One must be alert to the early signs and warn the patient about the often cosmetically disturbing and persistent minocycline-induced hyperpigmentation.
Assuntos
Toxidermias/prevenção & controle , Dermatoses Faciais/induzido quimicamente , Hiperpigmentação/induzido quimicamente , Hiperpigmentação/prevenção & controle , Minociclina/efeitos adversos , Doenças da Esclera/induzido quimicamente , Descoloração de Dente/induzido quimicamente , Antibacterianos/efeitos adversos , Diagnóstico Diferencial , Toxidermias/diagnóstico , Toxidermias/etiologia , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/prevenção & controle , Humanos , Hiperpigmentação/diagnóstico , Masculino , Pessoa de Meia-Idade , Doenças da Esclera/prevenção & controle , Descoloração de Dente/diagnóstico , Descoloração de Dente/prevenção & controleRESUMO
PURPOSE: To establish an animal model of autologous oral mucosa grafting for limbal stem cell deficiency. METHODS: The study was carried from August to October 2012. Fourteen SD rats were randomly and evenly allocated to study group A and control group B. Limbal stem cell deficiency was established by alkali burn in the right eye of each rat in both groups. Rats in group A received autologous oral mucosa strip transplantation following the chemical burn. Rats in group B did not receive surgery after the chemical burn. Topical antibiotics and dexamethasone were used in all rats. Corneal clarity, corneal fluorescein staining, oral mucosal graft survival, and complications at postoperative days 1, 3, 7, 14 were observed. RESULTS: The oral mucosa strip graft was detached in one rat in group A. Reepithelialization was observed starting from the graft position and was completed within 14 days in the remaining 6 eyes in group A. However, persistent corneal epithelium defect was observed in all eyes in group B, among which corneal melting and perforation was observed in 2 eyes and corneal opacification with neovascularization was observed in the remaining 5 eyes. CONCLUSION: Autologous oral mucosa strip grafting for limbal stem cell deficiency can be achieved by a rat model following chemical burn. The fate of the transplanted oral mucosal epithelial cells warrants further study.
Assuntos
Queimaduras Químicas/cirurgia , Modelos Animais de Doenças , Células Epiteliais/transplante , Queimaduras Oculares/cirurgia , Limbo da Córnea/cirurgia , Mucosa Bucal/transplante , Transplante de Células-Tronco/métodos , Álcalis , Animais , Queimaduras Químicas/patologia , Córnea , Doenças da Córnea/induzido quimicamente , Doenças da Córnea/patologia , Doenças da Córnea/cirurgia , Úlcera da Córnea/induzido quimicamente , Úlcera da Córnea/patologia , Úlcera da Córnea/cirurgia , Queimaduras Oculares/induzido quimicamente , Queimaduras Oculares/patologia , Fluoresceína , Sobrevivência de Enxerto , Limbo da Córnea/citologia , Limbo da Córnea/lesões , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Reepitelização , Doenças da Esclera/induzido quimicamente , Doenças da Esclera/patologia , Doenças da Esclera/cirurgia , Transplante Autólogo , TransplantesRESUMO
A 40-year-old woman presented with ocular discomfort in both eyes that had persisted for several months. Six months ago, she had undergone a bilateral nasal and temporal conjunctivectomy using a bare scleral technique followed by a postoperative application of 0.02% mitomycin C (MMC) to treat her chronic hyperemic conjunctiva for cosmesis. Slit-lamp examination revealed that the patient had bilateral nasal and temporal scleral thinning, and a calcified plaque on her nasal conjunctiva. There was no episcleral tissue present around the wound area, and it was difficult to detect any normal conjunctival tissue in the adjacent area for covering the lesion. We believe that performing an aggressive conjunctival excision procedure followed with MMC application for cosmetic enhancement may be disastrous in certain cases.
Assuntos
Doenças da Túnica Conjuntiva/tratamento farmacológico , Doenças da Túnica Conjuntiva/cirurgia , Mitomicina/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Doenças da Esclera/induzido quimicamente , Adulto , Antibióticos Antineoplásicos/efeitos adversos , Doenças da Túnica Conjuntiva/patologia , Feminino , Humanos , Complicações Pós-Operatórias/patologia , Doenças da Esclera/patologiaRESUMO
Introducción: Aproximadamente un tercio de las cegueras infantiles son debidas a los traumatismos, siendo la principal causa de déficit visual y ceguera monocular en ninos. caso clínico: Se reporta el caso de un preescolar masculino de 2 años de edad quien presentó úlcera escleral en ojo izquierdo secundaria a quemadura química por pila de reloj cuyo motivo de consulta fue contacto con detergente, con cicatrización dificultosa debido a cuerpo extraño mineral retenido en fondo de saco conjuntival inferior durante aproximadamente un mes, contando desde el ingreso al área pediátrica. conclusión: Se reporta un caso inusual de úlcera escleral. Hasta el momento no se han reportado otros casos de úlcera escleral secundaria a quemadura química por pila de reloj y por objetos retenidos en fondo de saco conjuntival inferior, resaltando el manejo diagnóstico y la demora en la extracción del cuerpo extraño, representando una emergencia oftalmológica.
Introduction: Approximately one-third of childhood blindness is due to trauma, representing the leading cause of visual impairment and monocular blindness in children. case report: The patient is a 2 year old preschool boy, who presented scleral ulcer in his left eye secondary to chemical burn caused by watch battery. The reason for seeking medical care was difficult healing caused by a mineral foreign body retained in the lower conjunctival sac after the patient came in contact with detergent one month before the pediatric consultation. Discussion: An unusual case of scleral ulcer was reported. So far, no other similar cases have been reported. The diagnosis process and the delay for the removal of the foreign body are emphasized in this serious ophthalmologic emergency.
Assuntos
Humanos , Masculino , Pré-Escolar , Corpos Estranhos no Olho/complicações , Doenças da Esclera/induzido quimicamente , Queimaduras Oculares/induzido quimicamente , Queimaduras Oculares/terapia , Queimaduras Químicas , Túnica Conjuntiva , Traumatismos Oculares/induzido quimicamente , Baterias Alcalinas/efeitos adversosRESUMO
BACKGROUND: Formaldehyde is extensively used for preservation of cadavers in departments of anatomy. However, it is a noxious chemical which may cause serious health problems. OBJECTIVE: To assess the effect of exposure of medical students to formaldehyde at the Department of Anatomy, Niger Delta University, Nigeria. METHODS: In a questionnaire-based study, 93 second-year medical students were surveyed at the Department of Human Anatomy, Niger Delta University, Nigeria. The average duration of exposure for each student in the dissection hall was 6 hr/wk. Participants with history of cough, respiratory or skin diseases were excluded from the study. RESULTS: Out of 93 questionnaires distributed, 75 were completed and returned (response rate: 81%). Of 75 students, 58 (77%) were strongly affected by unpleasant smell of formaldehyde. It was followed by "runny or congested nose" and "redness of the eyes." "Skin-related diseases" was identified as the least ranked effect of formaldehyde. CONCLUSION: Due to the numerous health challenges that formaldehyde causes to students in the gross anatomy dissection laboratories, it cannot be considered as a suitable chemical for embalmment of cadaver for dissection.
Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Anatomia/educação , Fixadores/efeitos adversos , Formaldeído/efeitos adversos , Odorantes , Dermatite de Contato/etiologia , Dissecação , Educação de Graduação em Medicina , Humanos , Laboratórios , Obstrução Nasal/induzido quimicamente , Nigéria , Doenças da Esclera/induzido quimicamente , Inquéritos e Questionários , Síncope/induzido quimicamenteRESUMO
The authors report a case of scleral dellen occurrence after fibrin glue use in strabismus surgery. The complication was well managed and it may alert surgeons preferring fibrin glue for conjunctival closure to the possibility of scleral dellen occurrence.
Assuntos
Exotropia/cirurgia , Adesivo Tecidual de Fibrina/efeitos adversos , Doenças da Esclera/induzido quimicamente , Adesivos Teciduais/efeitos adversos , Adulto , Túnica Conjuntiva/lesões , Feminino , Humanos , Ferimentos e Lesões/tratamento farmacológicoAssuntos
Córnea/efeitos dos fármacos , Doenças da Córnea/induzido quimicamente , Glucocorticoides/efeitos adversos , Esclera/efeitos dos fármacos , Doenças da Esclera/induzido quimicamente , Córnea/patologia , Doenças da Córnea/patologia , Glucocorticoides/administração & dosagem , Humanos , Esclera/patologia , Doenças da Esclera/patologiaRESUMO
Was this a case of Addison's disease, hemochromatosis, or melanoma? Or did one of the patient's medications have something to do with it?
Assuntos
Antibacterianos/efeitos adversos , Face , Hiperpigmentação/induzido quimicamente , Minociclina/efeitos adversos , Doenças da Esclera/induzido quimicamente , Doença de Addison/diagnóstico , Idoso , Comorbidade , Diagnóstico Diferencial , Feminino , Humanos , Hiperpigmentação/classificação , Hiperpigmentação/epidemiologia , Rosácea/tratamento farmacológicoRESUMO
PURPOSE: To evaluate whether intravitreal fluocinolone acetonide (FA) implantation (Retisert) leads to scleral thinning. METHODS: Scleral thickness was measured at the pars plana region (4 quadrants) with anterior segment OCT (Visante) in FA implanted eyes (18) with noninfectious posterior uveitis in comparison to eyes with prior vitrectomy (8), and normal eyes without prior surgery (30). RESULTS: Mean scleral thickness in normal (nonsurgical) eyes was 0.99/0.93/0.88/0.86, and 0.92 mm in the inferonasal/inferotemporal/superotemporal/superonasal quadrants, and overall, respectively. Sclera was thinner in each quadrant of the FA implanted eyes compared to the fellow or nonsurgical eyes, although none reached statistical significance, as the differences were small. However, a few FA implanted eyes demonstrated more dramatic scleral thinning than others. CONCLUSIONS: FA implant appears to lead to statistically nonsignificant scleral thinning overall with few exceptions. Clinicians should be aware of potential scleral thinning in select cases, important for reimplantation and long-term follow-up.
Assuntos
Implantes de Medicamento/efeitos adversos , Fluocinolona Acetonida/efeitos adversos , Glucocorticoides/efeitos adversos , Esclera/patologia , Doenças da Esclera/patologia , Uveíte Posterior/tratamento farmacológico , Adulto , Feminino , Fluocinolona Acetonida/administração & dosagem , Glucocorticoides/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Esclera/efeitos dos fármacos , Doenças da Esclera/induzido quimicamente , Doenças da Esclera/diagnóstico , Resultado do Tratamento , Acuidade Visual , VitrectomiaRESUMO
We report a case of hepatotoxicity induced by methimazole treatment in a patient affected by hyperthyroidism. A 54-year-old man, presented to our observation for palpitations, excessive sweating, weakness, heat intolerance and weight loss. On physical examination, his blood pressure was 140/90 mmHg and heart beat was 100/min regular. He had mild tremors and left exophthalmos. Laboratory test revealed a significant increase in serum thyroid hormone levels with a decrease in thyroid stimulating hormone levels. A diagnosis of hyperthyroidism was made and he began treatment with methimazole (30 mg/day). Fourteen days later, he returned for the development of scleral icterus, followed by dark urine, and abdominal pain in the right upper quadrant. Laboratory examinations and liver biopsy performed a diagnosis of cholestatic hepatitis, secondary to methimazole usage. Methimazole was promptly withdrawn and cholestyramine, ursodeoxycholic acid, and chlorpheniramine were given. After five days, abdominal pain resolved and laboratory parameters returned to normal. Naranjo probability scale indicated a probable relationship between hepatotoxicity and methimazole therapy. In conclusion physicians should be aware the risk of hepatotoxicity related with methimazole.
Assuntos
Antitireóideos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Colestase Intra-Hepática/induzido quimicamente , Hipertireoidismo/tratamento farmacológico , Metimazol/efeitos adversos , Dor Abdominal/induzido quimicamente , Biópsia , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Colestase Intra-Hepática/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Esclera/induzido quimicamenteRESUMO
A case of early-onset sclerolimbal ectasia following low-dose topical mitomycin C application during uveitic glaucoma surgery is reported. Intraoperative and postoperative clinical courses were consistent with sclerolimbal ectasia. Adjunctive utilization of intraoperative low-dose 0.02% mitomycin C for the management of chronic uveitic glaucoma patients who are under concomitant systemic immunosuppressive regimen may enhance the risk of subacute postoperative sclerolimbal ectasia. Mitomycin C concentrations < 0.02%, decreased scleral exposure time, and a strict informed consent policy are strongly recommended in this subset of uveitic patients.
Assuntos
Alquilantes/efeitos adversos , Doenças da Córnea/induzido quimicamente , Glaucoma de Ângulo Aberto/terapia , Mitomicina/efeitos adversos , Doenças da Esclera/induzido quimicamente , Trabeculectomia , Uveíte Anterior/terapia , Adolescente , Alquilantes/administração & dosagem , Terapia Combinada , Dilatação Patológica/induzido quimicamente , Glaucoma de Ângulo Aberto/tratamento farmacológico , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Pressão Intraocular , Masculino , Mitomicina/administração & dosagem , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/cirurgiaRESUMO
PURPOSE: To report on severe limbus cell insufficiency after trabeculectomy with subconjunctival injection of mitomycin C. DESIGN: Interventional small case-series. METHODS: Seven consecutive Caucasian patients (seven eyes) underwent penetrating trabeculectomy that included subconjunctival injection of 0.1 to 0.2 ml of mitomycin C (0.2 mg/ml) at the 12 o'clock position. RESULTS: All patients with a follow-up time of >1.5 years (n = 3 eyes; 43%) experienced marked ocular surface problems that included corneal thinning (n = 1) and scleral melting (n = 2). Four patients (57%) with a follow-up time of <14 months did not show complications that were attributable to the subconjunctival application of mitomycin. CONCLUSIONS: Because limbal stem cell deficiency may be a late complication of subconjunctival mitomycin C injection, subconjunctival injection of mitomycin C may be avoided in routine antiglaucomatous filtering surgery.
Assuntos
Antibióticos Antineoplásicos/efeitos adversos , Doenças da Córnea/induzido quimicamente , Limbo da Córnea/efeitos dos fármacos , Mitomicina/efeitos adversos , Células-Tronco/efeitos dos fármacos , Trabeculectomia , Túnica Conjuntiva , Humanos , Injeções , Limbo da Córnea/patologia , Doenças da Esclera/induzido quimicamente , Células-Tronco/patologiaRESUMO
PURPOSE: To describe four patients with an enlarging orbital mass from a swollen MIRAgel scleral buckle that simulated an orbital neoplasm. METHODS: In a retrospective, single-center case series at the Ocular Oncology Service at Wills Eye Hospital of Thomas Jefferson University, 4 eyes of 4 patients were referred for evaluation and treatment of a suspected orbital tumor. RESULTS: The initial presenting features were orbital mass (case 1), strabismus (case 2), and conjunctival mass with orbital extension (cases 3 and 4). Each patient vaguely recalled previous uncomplicated retinal detachment surgery 12 to 20 years earlier. Confirmation of the buckling implant material was made with the retina surgeon in 3 cases. A nontender, forniceal conjunctival mass, deep to the Tenon fascia and appearing as a translucent firm elevation was seen in all 4 cases. Axial CT (case 1) revealed a circumscribed anterior temporal orbital mass, believed to be a large inclusion cyst, 4 times thicker than the nasal scleral buckle. Ocular ultrasonography depicted an echolucent mass in the episcleral region (cases 3 and 4) that was 2 times thicker than the nasal scleral buckle (case 3). Excision was attempted in case 1, but only piecemeal removal was achieved, leading to extensive postoperative inflammation and decreased vision. The other 3 cases were followed conservatively without excision because they were each recognized to be a swollen MIRAgel implant and not an orbital tumor. CONCLUSIONS: MIRAgel scleral buckle material can greatly enlarge over a period of 10 years and simulate an orbital tumor or orbital cyst. Patients often do not recall details of the retinal surgery. Caution is advised regarding excision of this material because it is friable and can lead to extensive postoperative inflammation.