[Endonasal dacryocystorhinostomy (DCR) with protected drill]. / Forage osseux protégé lors des dacryocystorhinostomies (DCR) par voie endo-nasale.

PURPOSE: To analyze the interest of protected drills to perform endoscopic endonasal DCR. MATERIAL AND METHODS: [corrected] Fifty patients suffering from chronic epiphora were operated successively. None of those patients had had prior nasal surgery. The same surgeons (BF and ER) did the surgical procedure for all the cases. The technical steps were: endoscopic visualization of the middle meatus and evaluation of the anatomic variations of the nose; identification of the lacrymal bag with a 1 mm light in the canaliculus; unciformectomy; the maxillary bone was drilled with a 3.2 mm bit (straightshot Xomed), protected and irrigated; the lacrymal bag was opened by cissors and the flap was pushed in the ethmoid and coagulated. RESULTS: The suction-irrigation system was efficient to clean the surgical site, with a good endoscopic control. The protected bit didn't damage the 4-mm optics and the septal wall mucosa, even in narrow noses. The staightshot bit (Xomed) was tough enough to drill the maxillary bone in only 68 % of the surgical cases. In 28 % the drilling was unsatisfactory and in 4 % it was inefficient. The functional results at 6 month were good in 85 %. There was no difference between normal and narrow noses. CONCLUSION: The concept of protected bits perfectly matches the endoscopic endonasal DCR. The visual comfort and security of the surgical procedure are increased. Short term results are equivalent to external DCR, but are rather inefficient and expensive.

[Orbital wooden foreign body]. / Corps étranger végétal intra-orbitaire.

A 76-year-old-female patient fell in her garden, inducing a right orbital wound in which no foreign body was primarily found. As pain and diplopia followed the orbital trauma, a CT-scan was performed, disclosing a linear external foreign body in the right orbit. An anterior orbitotomy was performed to remove an 18-mm-long wooden foreign body. Histopathology of the tissue surrounding the foreign body showed an inflammatory fibrous tissue with small granulomas around telluric particles. Improvement after the operation was dramatic with complete disappearance of diplopia the day following surgery. Antibiotics were prescribed and tetanus prophylaxis was performed.

[Corneal graft rejection and corticoid iontophoresis: 3 case reports]. / Rejet de greffe et iontophorèse de corticoïdes: à propos de 3 cas.

This is the first report of three cases of severe acute corneal graft rejection, treated by transscleral methylprednisolone (Solumédrol) iontophoresis. The efficacy of the treatment was evaluated by corneal transparency, visual acuity and corneal inflammation parameters. The patient was treated with Solumédrol iontophoresis once a day for 3 days with a topical corticotherapy reduced to three drops of dexamethasone per day. Iontophoresis was performed, under topical anesthesia, and lasted 3 minutes with a 1.5-mA current. The subjective and objective tolerance of iontophoresis was good. No side-effect was observed. Corneal transparency and visual acuity improved rapidly after the second iontophoresis procedure. These observations show that Solumédrol iontophoresis might be an alternative to pulse therapy in the treatment of corneal graft rejection. Further comparative studies are necessary to confirm these preliminary observations.

[Iridocorneal endothelial syndrome. Series of 7 cases]. / Le syndrome irido-cornéo-endothélial. A propos d'une série de 7 cas.

The ICE syndrome includes 3 variants of the same disease, previously believed to be independent entities. All 3 share clinical and histopathological features such as endothelial abnormalities, iris damage, and progressive closure of the iridocorneal angle. Seven cases of ICE syndrome are reported, affecting 6 women and 1 man, with a mean age of 40 years. Corectopia was found in 5 eyes, a uveal ectropion in 2 cases, and other iris changes in 3 cases. The endothelial changes of the cornea were confirmed by a speculum microscopy in 5 cases. There were 5 cases of Chandler syndrome, 1 of Cogan-Reese syndrome, and 1 case of iris essential atrophy in our series. Ocular hypertony was observed in 3 cases, 2 of which needed to be operated. In one patient, a corneal edema was observed.

[Conjunctival pyogenic granuloma in a patient with chalazions]. / Granulome pyogénique de la conjonctive palpébrale chez un patient porteur d'un chalazion. A propos d'une observation anatomo-clinique.

A 28-year-old male patient had a chalazion on his left eyelid. Increased discomfort led to the discovery of a conjunctival mass under the inner part of his upper eyelid. On clinical examination, a small reddish mass on the palpebral conjunctiva of the upper left eyelid was only visible on the underside of the lid; the mass was diffusely reddish. Additionally, a chalazion was present in the middle of the lower left eyelid. As this condition was a source of discomfort to the patient, the mass was surgically resected. The histological study found a typical pyogenic granuloma, a possible complication in the course of a chalazion.

[Wolfram syndrome. Three case reports]. / Syndrome de Wolfram. A propos de 3 cas.

Wolfram syndrome is a rare disorder defined by the occurrence of diabete mellitus, diabete insipidus, optic atrophy and deafness; DIDMOAD is a commonly accepted acronym. We report 3 further cases: two girls and one boy. Their age ranged from 12 to 17 years. The diagnosis was based on the presence of juvenile diabete mellitus, bilateral optic atrophy, urologic signs, with urinary tract dilation; and deafness in two cases. The ophthalmic signs of Wolfram syndrome are progressive decrease in visual acuity, constriction of the peripheral visual field with or without central scotoma, color vision disturbances and bilateral optic disc atrophy. Diabetic retinopathy is a rare complication. The other clinical features are discussed so as to differentiate between Wolfram syndrome and other optic atrophies associated with diabete mellitus. We discuss of the pathogenic hypothesis including the mitochondrial dysfunction.

[Visual prognosis factors in congenital cataract]. / Les facteurs de pronostic visuel dans la cataracte congénitale.

PURPOSE: Study of different factors which can change the visual prognosis in congenital cataract. METHODS: One hundred seventy eyes of 100 children with congenital cataract are operated by extracapsular cataract extraction with limbic incision. Posterior rhexis and anterior vitrectomy were associated in children under 2 years. Implantation was used in 42%, contact lens in 8%. Other cases were corrected by glasses. The prognostic factors studied were: uni- or bilaterality, partial or complete aspect of cataract, age of apparition and management, and association with other malformations. RESULTS: Only 9 eyes out of 30 with unilateral congenital cataracts had visual acuity > or = 2/10; 44.4% of bilateral cataracts had visual acuity > or = 2/10; The best visual acuity was noted in progressive and partial cataract without associated malformations.

[Tuberculous uveitis]. / Uvéite tuberculeuse.

Ocular tuberculosis is relatively rare; however, the most common ocular lesion during ocular tuberculosis is uveitis. The recrudescence of this disease is probably caused by human immunodeficiency virus or long-term corticotherapy. The authors report a of chronic unilateral tuberculosis-related uveitis complicated by panophthalmia with subconjunctival abcesess and scleral fistula. A histopathological study revealed a granulomatous inflammation with caseous material. An extensive work-up revealed no extraocular lesion. A systemic bactericidal treatement associated with topical steroids decreased the local inflammation with phthisis bulbi, and with no spread of the infection. The authors discuss the etiopathogenic, clinical, and therapeutic aspects of tuberculosis-related uveitis.

[Orbital lymphangioma. A case report]. / Lymphangiome orbitaire. A propos d'un cas.

The diffuse form of orbital lymphangioma is well known for its difficult surgical treatment. A diffuse orbital lymphangioma was diagnosed in a 6-year-old girl, revealed by unilateral recurrent proptosis. The imaging procedure discovered a mass presumed to be vascular in nature. The initial incompleted surgical removal was followed by 3 recurrences motivating 3 reoperations. Finally, the tumor was removed incompletely, with an acceptable reduction of the proptosis. The pathologic analyses indicated lymphangioma. Some vascular orbital tumors such as lymphangioma, may be very difficult to manage because of local spreading and frequent recurrence.

[Uveal effusion in its pseudotumoral form. A case report]. / Effusion uvéale dans sa forme pseudotumorale. A propos d'une observation.

Uveal effusion exhibits various clinical presentations, some of which may lead to erroneous diagnosis and mimic a choroidal tumor. A 73-year-old female patient displayed a choroidal lesion with a tumoral appearance spontaneously affecting her right eye. Ultrasonography did not establish the diagnosis, leaving doubt for a tumor. In addition to the tumor - like lesion, a moderate inflammation was found in her right eye. The clinical course was favorable and one month after the initial examination, no fundus abnormalities were observed. The delay imposed by the MRI examination contributed to the lack of any active treatment. Apart from cases occurring postoperatively, the diagnosis of uveal effusion may sometimes be difficult to establish. In order to avoid enucleation and even if ultrasonography is helpful in reaching the correct diagnosis, it seems appropriate to wait and regularly follow up the patients when the diagnosis is not certain. The clinical course might be helpful to establish the diagnosis. Our case suggests that in pseudotumoral forms of uveal effusion, we should repeat clinical examination and ultrasonography in order to manage these patients appropriately.

[Basal cell carcinoma associated with a squamous cell papilloma at the inner part of the eyelid]. / Carcinome basocellulaire associé à un papillome de l'angle interne de la paupière.

There are numerous variants of cutaneous tumors involving the eyelids. Tumors of a different nature may at times be observed simultaneously in the same area of the eyelid. A clinicopathologic case of a 36-year-old male patient with 2 different cutaneous tumors at the nasal part of the left eyelid is reported. One was a nodular tumor on the inner canthus with a pearly appearance; the other had a papillomatous pattern. After surgical removal, the histopathological study of the tumors disclosed a typical basal cell carcinoma and a squamous cell papilloma. Both tumors can be commonly observed on the eyelids and surgical excision cured the patient.

[Inflammatory pseudotumor of the caruncle]. / Pseudotumeur inflammatoire de la caroncule.

A 6-year-old girl exhibited a recent caruncular tumor which was increasing in size. It was removed after a CT scan had showed a both medial and superficial mass. Fortunately, histological tests only found inflammatory cells attesting that the mass was due to an inflammation of this area. Inflammation is one of the different processes that may increase the size of the caruncle, but sometimes, only histopathology can provide conclusive evidence.

[Molluscum contagiosum of the eyelid]. / Molluscum contagiosum de la paupière inférieure.

A 6-year-old girl had a single molluscum contagiosum of the lower eyelid. Clinically, the tumor had grown slowly since it had been discovered 8 months before the child was seen at our consultation. It appeared as a nodular lesion on the middle part of the eyelid. Its surface was irregular and its color was the same as the epidermis. It was surgically excised, using the shaving biopsy technique. Its histopathological study showed a papillomatous lesion with the typical features of a molluscum contagiosum. The patient was lost to follow-up soon after the surgery.

[Chalazion mimicking an eyelid tumor]. / Forme pseudotumorale d'un chalazion.

A 3-year-old girl had a tumor growing for a month on the superior right eyelid, attached on the free margin of the eyelid and partially necrotic. A surgical excision was performed under general anesthesia. The histopathological study found an inflammatory lesion with epithelioid and giant cells, evidence of a granuloma, suggesting the diagnosis of chalazion. This case shows the various clinical presentations of this common and benign disease of the eyelid.

[Pleomorphic adenoma mimicking dacryoadenitis]. / Adénome pléomorphe simulant une dacryoadénite.

A 56-year-old female patient displayed an increased volume of her left lacrimal gland with pain and inflammation. On CT scan, a hyperdense lacrimal mass was found in the left lacrimal fossa. Observation was the first course, for no steroid therapy could be applied because of evolving digestive ulcers. After 9 months of observation, the gland was surgically removed en bloc through a wide anterolateral approach. Pathological analysis of the gland showed a pleomorphic adenoma. This case illustrates the advantage of a wide surgical approach in treating lacrimal gland tumors, in order to avoid or limit the risk of recurrence.

[A cutaneous horn of the free margin of the eyelid: an anatomical and clinical observation]. / Corne cutanée du bord libre palpébral. A propos d'une observation anatomo-clinique.

A cutaneous horn was observed close to the free margin of the inferior right eyelid in a 26-year-old-male patient. A minimal resection was primarily performed. Histopathologic study disclosed a precancerous keratosis. As the tumor had not been entirely excised, a complementary resection was performed secondarily to obtain the entire resection of the tumor.

[Conjunctival semi-lunar fold nevus of presumed late onset]. / Naevus du repli semi-lunaire de la conjonctive de découverte tardive.

Conjunctival nevi are lesions observed commonly occasionnally and can be found later in a life. Such a lesion was observed on the conjunctival semilunar fold in a 76-year-old female patient. It was oval in shape, pigmented, and was mainly visible when the affected eye was in abduction. As no accurate anterior clinical history was available, surgical resection was performed. Hitopathological study disclosed a subepithelial nevus, which was completely resected. Regular follow-up was recommended, as is usual after surgical resection of a conjunctival pigmented tumor.

[Pseudotumoral eyelid inflammation. Apropos of an anatomo-clinical case]. / Inflammation palpébrale pseudotumorale. A propos d'une observation anatomo-clinique.

A clinicopathological case of a 76-year-old male patient with a chronic inflammatory change of the inferior left eyelid is reported. The inflammation appeared as a reddish area of the inner part of the eyelid, without sharp limits, but with loss of lashes. Numerous local treatments did not to cure this condition. As some true eyelid tumors may mimic an inflammation during growth and, for example, sebaceous carcinoma may clinically present as chronic unilateral blepharitis, a surgical excisional biopsy was performed on this left eyelid. Its histopathological study showed a granulomatous inflammation, which was typical of a simple chalazion. This case clearly illustrates that the chalazion may not always appear as a limited nodular inflammation of the eyelid, but may have a more diffuse clinical presentation.

[Followup of chicken pox keratitis. Anatomic-clinical case report]. / Kératite varicelleuse séquellaire.

Chicken pox is a very common infectious disease in children. Its corneal involvement is less serious than with measles, which may lead to blindness in numerous developing countries. However, with occasional cases occur. A case of a 59-year-old male patient whose left cornea was involved during a chicken pox infection at the age of 7 is reported. More recently, the vision of the right eye was normal at 20/20 and reduced to visual perception in the affected left eye. Corneal sensitivity was maintained in the left eye, which, however exhibited a central epithelial defect. A central round opacity of the left corneal stroma was believed to be the scar resulting from a previous disciform keratitis. The left central cornea was thinned and there was neither an anterior chamber flare nor new corneal vessels. This corneal condition required a corneal allograft, performed quickly because of the potential risk of perforation. Histopathological study of the corneal button showed a central corneal thinning with an increase in epithelial thickness. The corneal stroma was disorganized, with irregular collagen bundles. No inflammatory cells could be observed, however. All the histopathological changes observed were those of a corneal scar.

[Meibomian adenocarcinoma of the free palpebral edge. Report of a case]. / Adénocarcinome meibomien du bord libre palpébral. A propos d'une observation.

A case of meibomian carcinoma of the left eyelid is reported in a 72-year-old female patient. The tumor had been present on the left eyelid for months. Clinically, the tumor appeared as a reddish mass implanted on the external part of the free margin of the left superior eyelid. An excisional biopsy disclosed meibomian carcinoma. A total resection of the left superior eyelid was followed by plastic surgery. Results after a one-month follow-up were very satisfactory. This case is emphasizes the importance of an early diagnosis which enabled us to perform a rather conservative treatment limited to the removal of the affected eyelid. The diagnosis of meibomian carcinoma is infrequent but it must be kept in mind in cases of tumor without the typical clinical characteristics of a basal cell or squamous cell carcinoma. Complete removal surgery may bring a curative effect and histopathology has a key role in the diagnosis of meibomian carcinoma.