Involutional entropion and ectropion of the lower eyelid: prevalence and associated risk factors in the elderly population.

PURPOSE: To determine the prevalence of involutional entropion and ectropion of the lower eyelid in the elderly population; to examine how these disorders are related to gender, age, skin color, and axial ocular globe projection; and to define the incidence of associated ocular surface and pathologic eyelid findings. METHODS: An ophthalmic survey was conducted in 24,565 elderly people. All participants underwent ophthalmic examination by general ophthalmologists to identify entropion and ectropion. Information about associated ocular surface and pathologic eyelid findings were collected from all patients with involutional eyelid malposition. Patients with involutional entropion and ectropion underwent measurements of the axial ocular globe projection. The Pearson chi-square test and the Mann-Whitney U test were performed. RESULTS: The prevalence of involutional entropion was 2.1%; 1.9% in men and 2.4% in women. The prevalence of involutional ectropion was 2.9%; 5.1% in men and 1.5% in women. Dry eye syndrome, lower retractor laxity, and superficial punctate keratopathy were seen significantly more often in patients with involutional entropion than in those with involutional ectropion (p < 0.001). Chronic conjunctivitis was significantly more common in patients with involutional ectropion than in those with involutional entropion (p < 0.001). The axial ocular globe projection was significantly smaller in patients with involutional entropion than in those with involutional ectropion (p < 0.001). CONCLUSIONS: The prevalence of involutional entropion and ectropion in the elderly population is 2.1% and 2.9%, respectively. The axial ocular globe position plays a pathogenic role in involutional lower eyelid malposition.

Involutional ectropion and entropion: clinicopathologic correlation between horizontal eyelid laxity and eyelid extracellular matrix.

PURPOSE: To investigate the clinicopathologic correlation between horizontal eyelid laxity and extracellular matrix components, such as collagen and elastic fibers, in involutional ectropion and entropion. Another goal was to compare the differences between involutional ectropion and entropion in regard to extracellular matrix content using computer-assisted morphometry. METHODS: This clinicopathologic study included 20 consecutive patients with involutional ectropion (group 1) and 20 consecutive patients with involutional entropion (group 2). The pinch test was performed to measure horizontal eyelid laxity in both groups. Full-thickness eyelid biopsy specimens were examined by light microscopy and computer-assisted morphometry. The Mann-Whitney U test, the Pearson chi-square test, the Pearson correlation coefficient calculation, and a linear regression analysis were performed. RESULTS: All sections of specimens from patients in groups 1 and 2 revealed abnormal collagen and elastic fibers. The Pearson correlation coefficient revealed a significant negative correlation between horizontal eyelid laxity and extracellular matrix content in the eyelid skin, the pretarsal orbicularis oculi muscle, the perimeibomian tarsal stroma, and the intermeibomian tarsal stroma. Linear regression demonstrated that horizontal eyelid laxity is dependent upon extracellular matrix components in all eyelid regions. Collagen fiber content was significantly increased in specimens from patients in group 1 compared with specimens from patients in group 2. CONCLUSIONS: The present findings suggest that a reduction of collagen and elastic fibers may contribute to the development of excessive horizontal eyelid laxity in patients with involutional ectropion and entropion of the lower eyelid.

Upper blepharoplasty with or without resection of the orbicularis oculi muscle: a randomized double-blind left-right study.

PURPOSE: To compare the aesthetic outcomes of the upper blepharoplasty with or without resection of the preseptal orbicularis oculi muscle. METHODS: An interventional randomized double-blind left-right study was conducted in 15 consecutive patients with dermatochalasis of the upper eyelid. One side was randomly chosen for resection of the preseptal orbicularis oculi muscle (group 1). The orbicularis oculi muscle of the contralateral side was preserved (group 2). All patients scored differences between both sides on the seventh day, the thirtieth day, and the ninetieth day after the surgery regarding the following symptoms: edema, hematoma, itching, and pain. Three masked ophthalmic plastic specialists analyzed the aesthetic outcomes by the visual analogical scale. RESULTS: The scoring of symptoms was significantly higher in group 1 than in group 2 on the seventh postoperative day. On the thirtieth and ninetieth days, there were no significant differences between groups 1 and 2. The analysis by 3 masked observers showed that the aesthetic result was worse in group 1 than in group 2 on the seventh postoperative day. There were no significant differences between groups 1 and 2 on the thirtieth and ninetieth days. CONCLUSIONS: Upper blepharoplasty causes more postoperative symptoms and presents worse initial aesthetic outcome when the preseptal orbicularis oculi muscle is excised. However, the final aesthetic outcome is the same when the preseptal orbicularis oculi muscle is excised or preserved.

Treatment of the tear trough deformity with hyaluronic acid.

BACKGROUND: Volume loss and muscular hyperactivity are two major components of the aging process that contribute to the formation of the folds and wrinkles. Tear trough deformity is one of the most difficult depressions to correct surgically. OBJECTIVE: The authors evaluate the results of periorbital filling with hyaluronic acid (HA) in a small series of patients. METHODS: Between June 2008 and December 2009, 25 patients were treated with HA to correct tear trough deformities. The HA was administered into the preperiosteal tissues with a serial puncture technique and approximately 0.1 mL was injected at each pass. Each patient's before and after photographs were reviewed by three surgeons; to objectively assess the outcomes, a quantitative scale was used to grade the pre- and postinjection results. The significance of subjective aesthetic evaluation of the photographs was evaluated with the Mann-Whitney U-test. Differences were regarded as significant if probabilities were less than 0.05. RESULTS: The mean (SD) volume per side needed to achieve correction was 0.54 (0.27) mL on the right and 0.61 (0.30) mL on the left. Complications included some degree of bruising, erythema, and local swelling. Most patients (88%) had cosmetic improvement according to the independent evaluation. CONCLUSIONS: All patients were very satisfied with their results. During the course of the study, the authors determined that the ideal candidates for this treatment are young, with thick skin and a definite hollow.

Orbital lymphatic vessels: immunohistochemical detection in the lacrimal gland, optic nerve, fat tissue, and extrinsic oculomotor muscles.

PURPOSE: To identify the lymphatic vessels in orbital specimens from human cadavers using light microscopy and immunohistochemical analysis. METHODS: A postmortem study included 10 orbital specimens from 10 human cadavers. The orbital specimens were obtained no later than 12 hours after death. The orbital specimens were dissected into lacrimal gland, optic nerve, fat tissue, and oculomotor muscles. The histologic criteria to qualify as a lymphatic vessel were thin-walled channels of endothelium without a well-developed basal membrane and with an erythrocyte-free, irregular lumen. The immunohistochemical criteria were irregularly shaped, thin-walled vessels with an erythrocyte-free, irregular lumen and immunopositivity for podoplanin D2-40. RESULTS: The lacrimal gland, optic nerve, fat tissue, and extraocular muscle sections were positively stained with podoplanin D2-40. CONCLUSIONS: This study demonstrated lymphatic vessels in the human orbit, more precisely, in the lacrimal gland, dura mater of the optic nerve, adipose tissue, and extrinsic oculomotor muscles via light microscopy and immunohistochemistry.

[Aberrant regeneration of the oculomotor nerve followed by intracranial aneurysm: case report]. / Regeneração aberrante do nervo oculomotor secundária a aneurisma intracraniano: relato de caso.

To report a case of aberrant regeneration followed by acute palsy of the oculomotor nerve caused by intracranial aneurysm. A 59-year-old patient was attended in February 2006 complaining of headache with diplopia and blepharoptosis in the right eye. At the external ocular motility exam. Aduction, supraduction and infraduction defects with blepharoptosis in the right eye were observed. Regarding the internal ocular motility, mydriasis in the right eye. Acute palsy of the oculomotor nerve in the right eye was diagnosed and neurological examination was requested. At the Department of Neurosurgery, after having diagnosed aneurysm of the posterior communicating artery, the patient was submitted to an operation. In December 2006, it improvement of the aduction was observed, supraduction and infraduction defects remained and blepharoptosis improved during aduction of the right eye. In the internal ocular motility, miosis in the affected eye. The diagnosis of the aberrant regeneration of the oculomotor nerve after acute palsy was formulated based on anamnesis and ophthalmological follow-up tests.

Orbital lymphatic vessels: immunohistochemical detection in the lacrimal gland, optic nerve, fat tissue, and extrinsic oculomotor muscles / Vasos linfáticos orbitários: identificação imunohistoquímica na glândula lacrimal, no nervo óptico, no tecido adiposo e nos músculos extrínsecos oculomotores

ABSTRACT Purpose: To identify the lymphatic vessels in orbital specimens from human cadavers using light microscopy and immunohistochemical analysis. Methods: A postmortem study included 10 orbital specimens from 10 human cadavers. The orbital specimens were obtained no later than 12 hours after death. The orbital specimens were dissected into lacrimal gland, optic nerve, fat tissue, and oculomotor muscles. The histologic criteria to qualify as a lymphatic vessel were thin-walled channels of endothelium without a well-developed basal membrane and with an erythrocyte-free, irregular lumen. The immunohistochemical criteria were irregularly shaped, thin-walled vessels with an erythrocyte-free, irregular lumen and immunopositivity for podoplanin D2-40. Results: The lacrimal gland, optic nerve, fat tissue, and extraocular muscle sections were positively stained with podoplanin D2-40. Conclusions: This study demonstrated lymphatic vessels in the human orbit, more precisely, in the lacrimal gland, dura mater of the optic nerve, adipose tissue, and extrinsic oculomotor muscles via light microscopy and immunohistochemistry.(AU)

RESUMO Objetivos: Identificar vasos linfáticos em espécimes orbitários de cadáveres humanos através de microscopia óptica e análise imunohistoquímica. Métodos: Um estudo postmortem incluiu dez espécimes orbitários provenientes de dez cadáveres humanos. Todos os espécimes orbitários foram obtidos até 12 horas após a morte com uma técnica cirúrgica de exenteração orbitária e dissecados em glândula lacrimal, nervo óptico, gordura órbitária e músculos extraoculares. Para classificar como um vaso linfático, os critérios histológicos incluíram vasos endoteliais de parede única sem membrana basal bem desenvolvida, irregulares e lúmen sem hemácias, e os critérios imunohistoquímicos incluíram vasos endoteliais de parede única, com formato irregular e lúmen sem hemácias e reagentes a podoplanina D2-40. Resultados: As lâminas histológicas de glândula lacrimal, nervo óptico, tecido adiposo e músculos extraoculares reagiram positivamente a podoplanina D2-40. Conclusão: Este estudo demonstrou vasos linfáticos na órbita humana, mais exatamente, na glândula lacrimal, no nervo óptico, na gordura orbitária e nos músculos extrínsecos extraoculares via microscopia óptica e imunohistoquímica.(AU)

Eyelid aging: pathophysiology and clinical management.

Life expectancy is increasing in most countries. With increasing age, many individuals may develop involutional ophthalmic diseases, such as eyelid aging. Dermatochalasis, ptosis, ectropion, and entropion are common disorders in middle-aged and older adults. This review outlines the pathophysiology and clinical management of these involutional eyelid disorders. Recently, a decrease in elastic fibers with ultrastructural abnormalities and an overexpression of elastin-degrading enzymes have been demonstrated in involutional ectropion and entropion. This may be the consequence of local ischemia, inflammation, and/or chronic mechanical stress. Eyelid aging with progressive loss of tone and laxity may affect the ocular surface and adnexal tissues, resulting in different clinical symptoms and signs. Surgical management depends on the appropriate correction of the underlying anatomical defect.

Primary ductal adenocarcinoma of the lacrimal gland: case report.

A 78-year-old male patient presented with double vision, painless palpable mass under the right superolateral orbital rim, downward displacement and restricted adduction of the right eye. His visual acuity was 20/50 OD and 20/20 OS. Hertel exophthalmometry was 21 mm OD and 17 mm OS. Computed tomographic scans showed an infiltrative orbital mass with ill-defined, irregular margins, involving the lacrimal gland and the lateral rectus muscle. The patient underwent an anterior transcutaneous transseptal orbitotomy with incisional biopsy and surgical debulking. Histopathologic evaluation revealed primary ductal adenocarcinoma of the lacrimal gland. Following the metastatic work up, he underwent an eyelid-sparing orbital exenteration. Microscopically, the tumor elements were characterized by large polygonal cells with vesicular nuclei, prominent nucleoli and amphophilic cytoplasm. The tumor components comprised duct-type structures with papillary and cribriform patterns, surrounded by prominent basement membrane. The tumor cells were positive for cytokeratin-7, matrix metalloproteinase (MMP)-2, MMP-9, MMP-13 and proto-oncogene Her-2/neu, but negative for cytokeratin-5, cytokeratin-20, p63, prostate-specific antigen, S-100 protein and thyroid transcription factor. These histopathologic findings were compatible with poorly differentiated ductal adenocarcinoma of the lacrimal gland, T3N0M0. Twenty-four months after orbital exenteration, the patient was diagnosed with ipsilateral parotid gland and cervical lymph node metastases and died of disease.

[Treatment of tear trough deformity with hyaluronic acid gel filler]. / Tratamento dos sulcos palpebromalar e nasojugal com ácido hialurônico.

BACKGROUND: Volume loss and muscular hyperactivity are two major components of the aging process that contribute to the formation of the folds and wrinkles. Tear trough deformity is one of the most difficult depressions to correct surgically. PURPOSE: The aim of this study was to evaluate the results of ten patients submitted to periorbital filling with hyaluronic acid gel filler. METHODS: Between June and August, 2008, 10 patients have had their tears troughs treated with hyaluronic acid gel filler. The filler was introduced by a serial puncture technique and approximately 0.1 ml was injected at each pass. The filler was placed in the pre-periosteal tissue. Patients photographs before and after the procedure were reviewed to assess the outcomes. RESULTS: The mean volume per side needed to achieve correction was on the right side 0.61 ml (SD=0.25) and on the left side 0.65 ml (SD=0.26). The most common complications were bruising, erythema, local swelling, and pain at the injection site. The effect of treatment lasted up to 12 months. CONCLUSIONS: This pilot study showed that the treatment of tear trough deformity with hyaluronic acid gel filler was feasible, predictable and effective. All patients were very satisfied with their results.

[Chronic suppurative canaliculitis - clinical and therapeutic aspects: report of 3 cases]. / Canaliculite crônica supurativa - aspectos clínicos e terapêuticos: relato de 3 casos.

Lacrimal canaliculitis is a rare disease caused mainly by Actinomyces israelii. It should be regarded as a differential diagnosis of recurrent chronic conjunctivitis. The purpose of this study was to report 3 cases of chronic suppurative canaliculitis and different treatment options. The first patient presented with an upper left canaliculitis and was treated with a canaliculotomy. Nevertheless, he had an ipsilateral lower canaliculitis after 6 months and underwent intracanalicular injections of fortified cefazolin with complete remission. The second patient presented with a lower left canaliculitis and underwent a canaliculotomy. The third patient had a lower left canaliculitis and underwent intracanalicular injections of fortified cefazolin. Both achieved complete remission. The present article demonstrated that intracanalicular irrigation of fortified cefazolin may be a helpful treatment of chronic suppurative canaliculitis with mild symptoms and signs. The most important benefit of this approach is to avoid injury to the lacrimal canaliculus.

Eyelid aging: pathophysiology and clinical management / Envelhecimento palpebral: fisiopatologia e considerações clínicas

ABSTRACTLife expectancy is increasing in most countries. With increasing age, many individuals may develop involutional ophthalmic diseases, such as eyelid aging. Dermatochalasis, ptosis, ectropion, and entropion are common disorders in middle-aged and older adults. This review outlines the pathophysiology and clinical management of these involutional eyelid disorders. Recently, a decrease in elastic fibers with ultrastructural abnormalities and an overexpression of elastin-degrading enzymes have been demonstrated in involutional ectropion and entropion. This may be the consequence of local ischemia, inflammation, and/or chronic mechanical stress. Eyelid aging with progressive loss of tone and laxity may affect the ocular surface and adnexal tissues, resulting in different clinical symptoms and signs. Surgical management depends on the appropriate correction of the underlying anatomical defect.

RESUMOA expectativa de vida está aumentando na maioria dos países. Com o envelhecimento, muitos indivíduos desenvolverão doenças oculares crônicas e involucionais, tais como o envelhecimento palpebral. Dermatocálase, ptose, ectrópio e entrópio são doenças frequentes em adultos e idosos. Esta revisão destaca a fisiopatologia e a clínica de doenças palpebrais involucionais. Recentemente, uma diminuição de fibras elásticas com anormalidades ultraestruturais e um aumento de enzimas degradantes de elastina foram demonstrados em ectrópio e entrópio involucionais. Isto pode ser consequência de isquemia local, inflamação e/ou estresse mecânico crônico. O envelhecimento palpebral com perda progressiva de tônus e flacidez pode afetar a superfície ocular e os anexos oculares, resultando em sinais e sintomas clínicos diferentes. O tratamento cirúrgico depende da correção apropriada do defeito anatômico subjacente.

Ten-year follow-up of a case series of primary epithelial neoplasms of the lacrimal gland: clinical features, surgical treatment and histopathological findings.

PURPOSE: To describe and analyze the features of a cases series of patients with primary epithelial neoplasms of the lacrimal gland, its surgical treatment, and histopathological findings. METHODS: Retrospective evaluation of files from patients with primary epithelial neoplasms of the lacrimal gland in the period from 1997 to 2007. All patients with primary epithelial tumors of the lacrimal gland were included in this study. Data on gender, age, clinical features, surgical treatment, histopathological findings and follow-up were collected. The slides with histological sections of the tumors were reviewed by the same pathologist. RESULTS: During the study period, there were 12 patients, 5 (41.7%) with benign tumors, all pleomorphic adenomas (benign mixed tumor) and 7 (58.3%) with malignant neoplasms, thus distributed: four cases of adenoid cystic carcinoma, two of mucoepidermoid carcinoma and one carcinoma expleomorphic adenoma. Globally, patients mean age was 54.1 years-old (ranging from 14 to 70 years-old), with mean age of 52.4 years-old (ranging from 14 to 65 years-old) for benign neoplasms, and 55.3 years-old for malignant neoplasms (ranging from 26 to 70 years-old). Clinical follow-up information, ranging from 2 to 10 years-old, was available for all patients. Three patients developed distant metastasis and died of disease. CONCLUSIONS: The most frequent primary epithelial neoplasms of the lacrimal gland were pleomorphic adenoma and adenoid cystic carcinoma during the study period. Malignant tumors were more frequent than benign tumors. The histopathological diagnosis and the disease initial stage can play a significant role in patient's survival.

Plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma: case report.

The authors present a rare case of plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma in a 42-year-old woman. The lesion was surgically removed and analyzed. Histopathological examination with immunostaining revealed it to be positive for immunoglobulin G and Kappa chains, demonstrating monoclonality. However, no abnormality was observed on serum electrophoresis, skeletal survey and bone marrow aspiration. Therefore, the tumor was diagnosed solitary plasmacytoma of bone. The patient was treated with external beam radiotherapy and has remained disease free for 5 years and 6 months until 2007, when she presented a pathological fracture due to multiple myeloma. Extensive medical work-up to rule out multiple myeloma or other malignant lymphoproliferative conditions involving orbit or ocular adnexa is needed when the diagnosis of solitary plasmacytoma of bone is suspected because treatment and prognosis are very different.

[Trachoma: epidemiologic study in students in Alagoas State--Brazil]. / Tracoma: estudo epidemiológico de escolares em Alagoas--Brasil.

PURPOSE: To define the detection rate of trachoma in scholars from Alagoas--Brazil. METHODS: The sample included 6,424 children and adolescents. Scholar's clinical evaluation was performed by medical students under the supervision of professors of the Department of Ophthalmology, according to the World Health Organization guidelines. The clinical evaluation was characterized by eyelashes, eyelids, conjunctiva and cornea examination in both eyes. The scholars were cataloged and data of name, sex, age, clinical forms diagnosis and city were recorded. Regarding the age, the students were divided into three groups: group A (<10 years old), group B (10-14 years old) and group C (>14 years old). RESULTS: The detection rate of trachoma was 4.5%. From 3,280 male scholars, 161 (4.9%) cases were confirmed; from 3,144 female scholars, 131 (4.2%) cases were considered confirmed. From the total scholars in group A, B and C; respectively 175 (5.3%), 113 (8.0%) and 4 (1.6%) were considered confirmed cases. CONCLUSION: In this region, it seems that trachoma has not been eradicated and, therefore, must remain as a differential diagnosis of chronic follicular conjunctivitis in children and adolescents from this region.

Primary ductal adenocarcinoma of the lacrimal gland: case report / Adenocarcinoma ductal primário da glândula lacrimal: relato de caso

A 78-year-old male patient presented with double vision, painless palpable mass under the right superolateral orbital rim, downward displacement and restricted adduction of the right eye. His visual acuity was 20/50 OD and 20/20 OS. Hertel exophthalmometry was 21 mm OD and 17 mm OS. Computed tomographic scans showed an infiltrative orbital mass with ill-defined, irregular margins, involving the lacrimal gland and the lateral rectus muscle. The patient underwent an anterior transcutaneous transseptal orbitotomy with incisional biopsy and surgical debulking. Histopathologic evaluation revealed primary ductal adenocarcinoma of the lacrimal gland. Following the metastatic work up, he underwent an eyelid-sparing orbital exenteration. Microscopically, the tumor elements were characterized by large polygonal cells with vesicular nuclei, prominent nucleoli and amphophilic cytoplasm. The tumor components comprised duct-type structures with papillary and cribriform patterns, surrounded by prominent basement membrane. The tumor cells were positive for cytokeratin-7, matrix metalloproteinase (MMP)-2, MMP-9, MMP-13 and proto-oncogene Her-2/neu, but negative for cytokeratin-5, cytokeratin-20, p63, prostate-specific antigen, S-100 protein and thyroid transcription factor. These histopathologic findings were compatible with poorly differentiated ductal adenocarcinoma of the lacrimal gland, T3N0M0. Twenty-four months after orbital exenteration, the patient was diagnosed with ipsilateral parotid gland and cervical lymph node metastases and died of disease.

Paciente do sexo masculino e com 78 anos de idade apresentou diplopia, massa palpável abaixo da margem orbitária direita, deslocamento inferior do bulbo ocular direito e limitação da adução do olho direito. A acuidade visual foi 20/50 OD e 20/20 OE. A exoftalmometria de Hertel foi 21 mm OD e 17 mm OE. Tomografia computadorizada mostrou uma massa orbitária, infiltrativa e com margens irregulares, envolvendo a glândula lacrimal e o músculo reto lateral. O paciente foi submetido a uma orbitotomia anterior com biópsia incisional. O exame histopatológico revelou adenocarcinoma ductal primário da glândula lacrimal. Em seguida, o paciente foi submetido a uma exenteração orbitária com preservação das pálpebras. Microscopicamente, os elementos tumorais foram caracterizados por células poligonais grandes com citoplasma anfofílico, núcleo vesicular e nucléolo proeminente. Os componentes tumorais incluíram estruturas ductais com padrões cribriforme e papilífero e cercadas por membrana basal proeminente. As células tumorais foram positivas para citoqueratina 7, metaloproteinase 2 da matriz, metaloproteinase 9 da matriz, metaloproteinase 13 da matriz e Her-2/neu, mas negativas para citoqueratina 5, citoqueratina 20, p63, antígeno prostático específico, proteína S-100 e fator de transcrição da tiroide. Estes achados histopatológicos foram compatíveis com o diagnóstico de adenocarcinoma ductal pouco diferenciado da glândula lacrimal, T3N0M0. Vinte e quatro meses após a exenteração orbitária, o paciente foi diagnosticado com metástases nos linfonodos cervicais ipsilaterais e na glândula parótida ipsilateral e faleceu.

Tratamento dos sulcos palpebromalar e nasojugal com ácido hialurônico / Treatment of tear trough deformity with hyaluronic acid gel filler

OBJETIVO: Verificar a eficácia do preenchimento dos sulcos nasojugal e palpebromalar deprimidos através da injeção de ácido hialurônico e analisar as complicações observadas. MÉTODOS: Foi realizado um estudo piloto, prospectivo, aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de São Paulo, com pacientes recrutados no Serviço de Plástica Ocular do Departamento de Oftalmologia da UNIFESP/EPM. Foram selecionados pacientes de ambos os sexos, com idade entre 25 e 60 anos, que apresentavam os sulcos nasojugal e/ou palpebromalar deprimidos, que não haviam sido submetidos à cirurgia na pálpebra inferior nem apresentavam histórico de trauma nesse local. O ácido hialurônico foi aplicado via transcutânea e depositado na região supraperiosteal em pequenos volumes. Todo paciente foi tratado pelo mesmo cirurgião (GAPV), tendo sido examinado no pós-operatório em intervalos regulares e fotografado no pré-operatório, no pós-operatório imediato, na 4ª semana, no 6º e no 12º mês após o procedimento. Ao final deste período todas as fotos foram analisadas por profissional não ligado a esta pesquisa, visando verificar a eficiência da técnica em atingir seus objetivos. RESULTADOS: Entre junho e agosto de 2008, 10 pacientes foram incluídos neste estudo piloto. Oito pacientes foram tratadas uma única vez, enquanto duas precisaram de retoque na 4ª semana após a aplicação inicial. O volume injetado foi em média de 0,61 ml (DP=0,25) no lado direito e de 0,65 ml (DP=0,26) no lado esquerdo. As complicações observadas foram equimose em 6 casos, edema local maior que 48 horas em um paciente e lesão cutânea semelhante à acne em um participante. CONCLUSÕES: O estudo piloto demonstrou que o tratamento dos sulcos nasojugal e pálpebro-malar com uso de ácido hialurônico se mostrou eficaz e previsível, com alto nível de satisfação dos pacientes e com resultado duradouro.

BACKGROUND: Volume loss and muscular hyperactivity are two major components of the aging process that contribute to the formation of the folds and wrinkles. Tear trough deformity is one of the most difficult depressions to correct surgically. PURPOSE: The aim of this study was to evaluate the results of ten patients submitted to periorbital filling with hyaluronic acid gel filler. METHODS: Between June and August, 2008, 10 patients have had their tears troughs treated with hyaluronic acid gel filler. The filler was introduced by a serial puncture technique and approximately 0.1 ml was injected at each pass. The filler was placed in the pre-periosteal tissue. Patients photographs before and after the procedure were reviewed to assess the outcomes. RESULTS: The mean volume per side needed to achieve correction was on the right side 0.61 ml (SD=0.25) and on the left side 0.65 ml (SD=0.26). The most common complications were bruising, erythema, local swelling, and pain at the injection site. The effect of treatment lasted up to 12 months. CONCLUSIONS: This pilot study showed that the treatment of tear trough deformity with hyaluronic acid gel filler was feasible, predictable and effective. All patients were very satisfied with their results.

Canaliculite crônica supurativa - aspectos clínicos e terapêuticos: relato de 3 casos / Chronic suppurative canaliculitis - clinical and therapeutic aspects: report of 3 cases

A canaliculite lacrimal é uma afecção rara, cujo principal agente etiológico é o Actinomyces israelii. Ela deve ser considerada como um diagnóstico diferencial nos casos de conjuntivite crônica recorrente. O objetivo deste estudo é relatar 3 casos de pacientes com canaliculite crônica supurativa e diferentes formas de tratamentos. O primeiro paciente apresentou uma canaliculite superior esquerda e foi tratado com uma canaliculotomia. Entretanto, o mesmo desenvolveu uma canaliculite inferior ipsilateral após 6 meses e foi submetido a um esquema de injeção intracanalicular de cefazolina fortificada com resultado satisfatório. O segundo paciente apresentou uma canaliculite inferior esquerda e foi tratado com uma canaliculotomia. O terceiro paciente teve uma canaliculite inferior esquerda e foi submetido a um esquema de injeção intracanalicular de cefazolina fortificada. Ambos obtiveram completa resolução dos sintomas e sinais. O presente estudo demonstra que a irrigação intracanalicular de cefazolina fortificada pode ser uma forma útil de tratamento de canaliculite crônica supurativa com sintomatologia mais branda. O maior benefício desta abordagem é evitar o traumatismo cirúrgico da canaliculotomia.

Lacrimal canaliculitis is a rare disease caused mainly by Actinomyces israelii. It should be regarded as a differential diagnosis of recurrent chronic conjunctivitis. The purpose of this study was to report 3 cases of chronic suppurative canaliculitis and different treatment options. The first patient presented with an upper left canaliculitis and was treated with a canaliculotomy. Nevertheless, he had an ipsilateral lower canaliculitis after 6 months and underwent intracanalicular injections of fortified cefazolin with complete remission. The second patient presented with a lower left canaliculitis and underwent a canaliculotomy. The third patient had a lower left canaliculitis and underwent intracanalicular injections of fortified cefazolin. Both achieved complete remission. The present article demonstrated that intracanalicular irrigation of fortified cefazolin may be a helpful treatment of chronic suppurative canaliculitis with mild symptoms and signs. The most important benefit of this approach is to avoid injury to the lacrimal canaliculus.

Ten-year follow-up of a case series of primary epithelial neoplasms of the lacrimal gland: clinical features, surgical treatment and histopathological findings / Dez anos de acompanhamento de uma série de casos de neoplasias epiteliais primárias da glândula lacrimal: características clínicas, tratamento cirúrgico e achados histopatológicos

PURPOSE: To describe and analyze the features of a cases series of patients with primary epithelial neoplasms of the lacrimal gland, its surgical treatment, and histopathological findings. METHODS: Retrospective evaluation of files from patients with primary epithelial neoplasms of the lacrimal gland in the period from 1997 to 2007. All patients with primary epithelial tumors of the lacrimal gland were included in this study. Data on gender, age, clinical features, surgical treatment, histopathological findings and follow-up were collected. The slides with histological sections of the tumors were reviewed by the same pathologist. RESULTS: During the study period, there were 12 patients, 5 (41.7 percent) with benign tumors, all pleomorphic adenomas (benign mixed tumor) and 7 (58.3 percent) with malignant neoplasms, thus distributed: four cases of adenoid cystic carcinoma, two of mucoepidermoid carcinoma and one carcinoma expleomorphic adenoma. Globally, patients mean age was 54.1 years-old (ranging from 14 to 70 years-old), with mean age of 52.4 years-old (ranging from 14 to 65 years-old) for benign neoplasms, and 55.3years-old for malignant neoplasms (ranging from 26 to 70 years-old). Clinical follow-up information, ranging from 2 to 10 years-old, was available for all patients. Three patients developed distant metastasis and died of disease. CONCLUSIONS: The most frequent primary epithelial neoplasms of the lacrimal gland were pleomorphic adenoma and adenoid cystic carcinoma during the study period. Malignant tumors were more frequent than benign tumors. The histopathological diagnosis and the disease initial stage can play a significant role in patient's survival.

OBJETIVO: Descrever e analisar as características de uma série de casos de portadores de neoplasias epiteliais primárias da glândula lacrimal, o tratamento cirúrgico, assim como os achados histopatológicos. MÉTODOS: Avaliação retrospectiva dos arquivos de pacientes com neoplasias epiteliais primárias da glândula lacrimal, no período de 1997 até 2007. Todos os pacientes com tumores epiteliais primários da glândula lacrimal foram incluídos neste estudo. Foram analisados os dados sobre sexo, idade, características clínicas, tratamento cirúrgico, achados histopatológicos e seguimento dos pacientes. As lâminas com secções histológicas dos tumores foram revisadas pelo mesmo patologista. RESULTADOS: No período do estudo, foram encontrados 12 pacientes, sendo 5 (41,7 por cento) portadores de tumores benignos, todos adenomas pleomórficos (tumor benigno misto), e 7 (58,3 por cento) com neoplasias malignas, assim distribuídos: quatro casos de carcinoma adenóide cístico, dois de carcinoma mucoepidermóide e um de carcinoma ex-adenoma pleomórfico. Analisando-se de modo global, a idade média dos portadores foi de 54,1 anos (variando de 14 a 70 anos); com média de idade de 52,4 anos (variando de 14 a 65 anos) para neoplasias benignas, e 55,3 para neoplasias malignas (variando de 26 a 70 anos). Informações do seguimento, variando de 2 a 10 anos, estavam disponíveis para todos os pacientes. Três pacientes desenvolveram metástases distantes e morreram devido à doença. CONCLUSÕES: A maioria das neoplasias epiteliais primárias da glândula lacrimal foi o adenoma pleomórfico e o carcinoma adenóide cístico no período de estudo. Os tumores malignos foram mais frequentes que os benignos. O diagnóstico histopatológico e o estadiamento inicial da doença podem desempenhar uma papel significante na sobrevida do paciente.

Tracoma: estudo epidemiológico de escolares em Alagoas - Brasil / Trachoma: epidemiologic study of scholars from Alagoas State - Brazil

OBJETIVOS: Definir a taxa de detecção de tracoma em escolares do Estado de Alagoas - Brasil. MÉTODOS: A amostra foi constituída de 6.424 crianças e adolescentes. A avaliação clínica dos escolares foi realizada por graduandos da Faculdade de Medicina sob supervisão de professores do Departamento de Oftalmologia, seguindo os critérios da Organização Mundial de Saúde. A avaliação clínica foi caracterizada por exame dos cílios, das pálpebras, da conjuntiva e da córnea de ambos os olhos. Os estudantes foram catalogados, anotando-se nome, sexo, idade, diagnóstico da forma clínica e município. Quanto à idade, os escolares foram divididos em três grupos: grupo A (<10 anos), grupo B (10-14 anos) e grupo C (>14 anos). RESULTADOS: A taxa de detecção de tracoma foi de 4,5 por cento. Dos 3.280 estudantes do sexo masculino, 161 (4,9 por cento) casos foram considerados confirmados, e dos 3.144 estudantes do sexo feminino, 131 (4,2 por cento) casos foram considerados confirmados. Do total de escolares do grupo A, B e C, respectivamente 175 (5,3 por cento), 113 (8,0 por cento) e 4 (1,6 por cento), foram considerados casos confirmados. CONCLUSÃO: Nesta região, o tracoma parece não ter sido erradicado e, portanto, deve permanecer como diagnóstico diferencial de conjuntivite folicular crônica em crianças e adolescentes advindos dela.

PURPOSE: To define the detection rate of trachoma in scholars from Alagoas - Brazil. METHODS: The sample included 6,424 children and adolescents. Scholar's clinical evaluation was performed by medical students under the supervision of professors of the Department of Ophthalmology, according to the World Health Organization guidelines. The clinical evaluation was characterized by eyelashes, eyelids, conjunctiva and cornea examination in both eyes. The scholars were cataloged and data of name, sex, age, clinical forms diagnosis and city were recorded. Regarding the age, the students were divided into three groups: group A (<10 years old), group B (10-14 years old) and group C (>14 years old). RESULTS: The detection rate of trachoma was 4.5 percent. From 3,280 male scholars, 161 (4.9 percent) cases were confirmed; from 3,144 female scholars, 131 (4.2 percent) cases were considered confirmed. From the total scholars in group A, B and C; respectively 175 (5.3 percent), 113 (8.0 percent) and 4 (1.6 percent) were considered confirmed cases. CONCLUSION: In this region, it seems that trachoma has not been eradicated and, therefore, must remain as a differential diagnosis of chronic follicular conjunctivitis in children and adolescents from this region.