Brimonidine-induced unilateral ocular lichen planus: a case report / Líquen plano ocular unilateral induzido por brimonidina: relato de caso

ABSTRACT This report was written to describe a case of unilateral brimonidine-induced conjunctival lichen planus. Because the ophthalmic examination indicated chronic conjunctivitis or drug-induced pseudopemphigoid, the patient underwent thorough ophthalmic and systemic examinations, as well as conjunctival biopsy and direct immunofluorescence studies. A 71-year-old woman with unilateral left eye findings of chronic conjunctivitis was referred to our Ophthalmology Department. The patient reported that chronic conjunctivitis began shortly after she initiated use of topical brimonidine. Ophthalmic examination revealed foreshortening of the inferior fornix and symblepharon. Conjunctival biopsy revealed submucous lymphocytes and shaggy distribution of fibrinogen on direct immunofluorescence; this was suggestive of ocular lichen planus. No other systemic lesions were found that were consistent with the presentation of lichen planus. A good response was observed to topical cyclosporine treatment. To our knowledge, this may be the first report of unilateral ocular lichen planus without systemic findings. The correlation with the initiation of topical brimonidine suggests that this might be the first case of biopsy-confirmed brimonidine-induced ocular lichen planus.

RESUMO Este relato é para descrever um caso de líquen plano conjuntival unilateral induzido por brimonidina. Como o exame oftalmológico indicava conjuntivite crônica ou pseudopenfigóide induzido por medicamento, o paciente foi submetido a exames oftalmológicos e sistémicos completos, além de biópsia conjuntival e estudos de imunofluorescência direta. Uma mulher de 71 anos de idade com achados unilaterais do olho esquerdo de conjuntivite crônica foi encaminhada ao nosso departamento de Oftalmologia. A paciente relatou que a conjuntivite crônica começou logo após o início do uso da brimonidina tópica. O exame oftalmológico revelou encurtamento do fórnice inferior e do symblepharon. A biópsia conjuntival revelou linfócitos submucosos e distribuição felpuda de fibrinogênio na imunofluorescência direta; isso era sugestivo de líquen plano ocular. Não foram encontradas outras lesões sistêmicas compatíveis com a apresentação do líquen plano. Uma boa resposta foi observada no tratamento tópico com ciclosporina. Pelo nosso conhecimento, este pode ser o primeiro relato de líquen plano ocular unilateral sem achados sistêmicos. A correlação com o início da brimonidina tópica sugere que este pode ser o primeiro caso de líquen plano ocular induzido por brimonidina confirmado por biópsia.

Oculoectodermal syndrome: twentieth described case with new manifestations

Abstract Oculoectodermal syndrome is a rare disease characterized by the association of aplasia cutis congenita, epibulbar dermoids, and other abnormalities. This report describes the twentieth case of the disease. We report a 4-year-old female child who presented with the classical features of the syndrome: aplasia cutis congenita and epibulbar dermoids. Our case expands the clinical spectrum of the disease to include: diffuse hyperpigmentation (some following the Blaschko´s lines); hypopigmented skin areas on the trunk; arachnoid cyst on the right fronto-parietal border; rounded left side of the hippocampus; and dermoid cyst underlying the bulb-medullary transition. Our patient also reported infantile hemangioma on the right wrist and verrucous hemangioma on the left leg, the latter not previously described in the literature.

Disseminated cutaneous sporotrichosis associated with ocular lesion in an immunocompetent patient

Abstract: A 59-year-old female patient, previously healthy, immunocompetent, presented left bulbar conjunctiva lesions and nodular-ulcerated lesions on the arms and cervical region, besides left cervical and retroauricular lymphadenopathy. She had previous contact with domestic cats that excoriated her face. The diagnosis was conclusive of disseminated sporotrichosis through clinical and epidemiological history and cultures of skin and ocular secretions. It evolved with good response to oral antifungal therapy.

Keratoacanthoma of the conjunctiva in a young patient / Ceratoacantoma da conjuntiva em um paciente jovem

ABSTRACT Keratoacanthomas rarely occur in the conjunctiva. We report a case of a 24-year-old man with a rapidly growing conjunctival mass. The tumor was excised with a safety margin to exclude squamous cell carcinoma and was histopathologically diagnosed as a keratoacanthoma. There has been no recurrence over 2 years of follow-up. To the best of our knowledge, he is the youngest patient to be diagnosed with conjunctival keratoacanthoma who had no known risk factors such as skin disorders, trauma, surgery, or infection. In similar cases, we recommend complete early surgical excision and careful follow-up to exclude malignancy.

RESUMO Ceratoacantoma raramente ocorre na conjuntiva. Nós relatamos o caso de um homem de 24 anos de idade, com uma massa conjuntival de rápido crescimento. O tumor foi retirado com uma margem de segurança para excluir carcinoma de células escamosas. Ele foi diagnosticado histopatologicamente como sendo ceratoacantoma. Não houve recidiva em dois anos de seguimento. Ele é o paciente mais jovem com ceratoacantoma conjuntival que não tinham fatores de risco conhecidos como doenças de pele a ser descrito. Em casos semelhantes, recomendamos excisão cirúrgica precoce completo e um acompanhamento cuidadoso para excluir malignidade.

Clinical study of histologically proven conjunctival cysts

This is a clinco-histopathological study of different varieties of conjunctival cysts where modification of surgical technique was done as per requirement for intact removal of cysts to minimise recurrence rate. Retrospective study of 40 cases of conjunctival cysts. A thorough ocular examination and basic haematological work up was done for all patients. B-scan USG and MRI was done wherever required to see the posterior extent. All patients underwent surgical excision of cyst followed by histo-pathological examination. The various types of conjunctival cysts found in our study were primary inclusion cyst 12 [30%], secondary inclusion cyst 6 [15%], pterygium with cysts 15 [37.5%], parasitic cyst 4 [10%], lymphatic cyst 2 [5%], and orbital cyst with rudimentary eye 1 [2.5%]. The common symptoms noted were progressive increase in size of cyst [39.45%], cosmetic disfigurement [26.23%], foreign body sensations [27.86%], proptosis [1.6%], ocular motility restrictions [3.2%] and decreased visual acuity [1.6%]. The patients were followed till one year after surgical excision for any recurrence and complications and no recurrence was seen. Careful and intact removal of conjunctival cyst is important to prevent recurrence. Minor modifications in surgical technique according to the size, site and nature of cyst help in intact removal and prevent recurrence

Amiloidosis conjuntival: reporte de tres casos / Conjunctival amyloidosis: three case report

La amiloidosis conjuntival es una condición infrecuente en la práctica clínica, que se caracteriza por el depósito de material amiloide de la conjuntiva. Se estima que es la causa del 0,002 por ciento de las lesiones conjuntivales. Dada la baja incidencia de esta patología, existen pocos reportes en la literatura. En este trabajo se presentan los casos clínicos de tres pacientes con amiloidosis conjuntival que fueron atendidos en nuestro centro y se propone una aproximación diagnóstica para evaluar la existencia de amiloidosis sistémica.

Conjunctival amyloidosis is a rare condition characterized by the localized deposition of amyloid material in the conjunctiva. It's supossed to be the cause of 0.002 percent of conjunctival lesions. Given the low incidence of this disease, there are few reports in the literature. In this manuscript we present the cases of three patients with primary conjunctival amyloidosis who were attended at our institution. We also propose a diagnostic algorithm to rule out systemic amyloidosis in patients in whom the finding is conjunctival amyloidosis.

Conjunctival inclusion cysts following small incision cataract surgery.

The occurrence of acquired conjunctival inclusion cysts following various ophthalmic surgeries such as strabismus surgery, scleral buckling, pars plana vitrectomy, ptosis surgery and phacoemulsification has been reported. We report two cases of conjunctival inclusion cysts following manual Small Incision Cataract Surgery (SICS) in two male patients aged 65 and 67 years. The cysts originated from the scleral tunnel used for manual SICS. Both were treated by excision and confirmed histopathologically. No recurrence was noted at three months follow-up. To our knowledge, conjunctival inclusion cysts following SICS have not been reported previously. Careful reflection of conjunctiva during tunnel construction and posterior chamber intraocular lens implantation may prevent their occurrence.

Epidemiología de las lesiones conjuntivales y su correlación clínico-patológica / Epidemiology of conjunctival lesions and clinical-pathological correlation

Se realizó una revisión de los 1166 casos de lesiones conjuntivales recibidos por el Laboratorio de Patología Ocular del Hospital Clínico de la Universidad de Chile entre los años 1968-2005. En base a ella se describen los distintos diagnósticos histopatológicos según su frecuencia, distribución por sexo, edad, localización y tiempo de evolución. La edad promedio para los casos fue de 36 años con un 51,5 por ciento de hombres afectados y un tiempo de evolución promedio de 68 meses. Las lesiones más frecuentes fueron las pigmentarias (44,2 por ciento), seguidas de las epiteliales (22,7 por ciento) y los cuadros infecciosos (10,9 por ciento). La localización más frecuente para todas las lesiones fue bulbar. Se estableció, además, una correlación entre los diagnósticos clínicos e histopatológicos, la cual resultó ser positiva en un 60,9 por ciento, siendo marcadamente superior para las lesiones pigmentarias e inferior para lesiones degenerativas, cuadros infecciosos y tumores clasificados como pre-malignos o malignos.

We made a retrospective review of 1166 cases of conjuntival lesions, accepted for its study at the Laboratory of Ocular Pathology, University of Chile, from 1968 to 2005. Based on this survey, different histopathologic diagnosis were described, characterized by its frequency, gender distribution, age, location and time of evolution. The average age was 36 years, with a 51,5 percent being male, and an average time of evolution of 68 months. Most frequent lesions were pigmented (44,2 percent), followed by epithelial (22, 7 percent), and infectious diseases (10,9 percent). The most frequent location was bulbar. A clinical - pathologic correlation was established, being positive in 60,9 percent of cases. It was noticeable superior for pigmented lesions, and inferior for degenerative lesions, infectious disease and tumors classified as pre malignants or malignants.

Histopathological study of conjunctival lesions.

Lesions of conjunctiva comprise a varied spectrum of conditions. A total of 50 patients, 34 males and 16 females, with lesions in conjunctiva were subjected to study. Histopathological examination of the biopsied specimens from the lesions was done using haematoxylin and eosin (H&E) stain and other special stains when needed. The study was done to report the spectrum and frequency of different lesions of conjunctiva in a tertiary care eye hospital in India.

Método citológico e histopatológico no diagnóstico das lesões da conjuntiva: estudo comparativo / Cytologic and histologic methods in the diagnosis of conjunctival lesions: comparative study

OBJETIVOS: Avaliar a eficácia e a confiabilidade do método citológico nas lesões da conjuntiva, comparando-o com o exame histopatológico. MÉTODOS: Realizou-se estudo prospectivo em 31 lesões conjuntivais. O material para estudo foi coletado raspando-se as lesões com a ajuda da espátula de Kimura. Posteriormente, procedeu-se à exérese das mesmas que foram encaminhadas para o exame histopatológico. As lâminas do exame citológico foram coradas pela técnica de Papanicolaou. RESULTADOS: O método citológico mostrou alta especificidade (100 por cento) e sensibilidade (92,9 por cento). O valor preditivo positivo foi de 100 por cento e o valor preditivo negativo foi de 94,4 por cento. CONCLUSÕES: O simples método citológico é efetivo e seguro no diagnóstico de lesões tumorais da conjuntiva.

Conjunctival keratoacanthoma

Ceratoacantoma geralmente ocorre na pele e raramente é encontrado na conjuntiva. Relatamos um caso de uma mulher de 34 anos que apresentou uma massa conjuntival de rápido crescimento. O tumor foi retirado com margem de segurança para excluir carcinoma de células escamosas. Ao exame histopatológico, o tumor apresentou configuração crateriforme, sendo consistente com ceratoacantoma atípico. Não houve recorrência após dois anos de seguimento. Ceratoacantoma conjuntival é uma doença rara. Um diagnóstico diferencial entre carcinoma de células escamosas e ceratoacantoma pode ser difícil. Recomendamos total remoção e seguimento cuidadoso de pacientes com lesões escamosas crateriformes.

Conjunctival amyloidosis of both eyelids.

Amyloidosis of the palpebral conjunctiva is a rare condition which results in chronic ocular discomfort. We present our experience with this rare patient in whom both upper and lower palpebral conjunctivae were involved, but no systemic amyloidosis.

Alteraciones conjuntivales en niños con prúrigo actínico / Conjuntival features in children with actinic prurigo

El prúrigo actínico es una dermatosis crónica que afecta zonas expuestas al sol. En este trabajo se pretende determinar las alteraciones oculares en segmento anterior y anexos, y precisar los principales cambios macroscópicos y microscópicos en las conjuntivas bulbar y tarsal de niños con prúrigo actínico. El estudio se realizó en niños de ambos sexos entre 6 y 16 años con diagnóstico de prúrigo actínico, a cada uno de ellos se les practicó una exploración oftalmológica completa y con el consentimiento de los padres o familiar responsable se realizó toma de biopsia conjuntival del ojo más afectado. Se estudiaron 22 ojos de 11 pacientes, la edad promedio fue de 10.6 años. Los hallazgos clínicos más frecuentes fueron: hiperemia conjuntival, folículos en párpado superior, secreción hialina, pannus, puntos de Trantas y queratopatía epitelial punteada respectivamente. Los hallazgos microscópicos más frecuentes fueron: melanosis, ausencia de células caliciformes, infiltrado inflamatorio linfoplasmocitario, metaplasia epidermoide con queratinización superficial, elastosis, e incontinencia pigmentaria (melanófagos). Podemos concluir que las alteraciones oculares en niños con prúrigo actínico tienen características clínicas e histopatológicas específicas mas no patognomónicas, sin embargo mediante la correlación clinicopatológica, el índice de certeza diagnóstica puede ser mayor

Cyst of accessory lacrimal gland

When a patient is presented with a subconjunctival cyst, it is not only hard to reveal its true nature clinically but also easy to rupture during excision. We experienced cases with cysts of the accessory lacrimal gland in two patients with subconjunctival cysts. They had lid swelling at initial presentation and underwent surgical excision of subconjunctival cysts located in superior portion of the upper tarsal plate. The lining of these cysts composed of ductal epithelia. Biochemical analyses for serum and cystic fluid were performed in one case, in which was found high Ig A titer in the cystic fluid. These cysts seemed to originate from the duct of Wolfring's accessory lacrimal gland, considering their anatomic locations and pathologic findings. Complete removal of the cyst is important, because recurrences have been reported in cases of incomplete removal or simple aspiration.

Conjunctival impression cytology--a study of normal conjunctiva.

Conjunctival impression cytology was used to study conjunctival ocular surface in 30 normal individuals in the age group of 20 to 60 years. The cytology was graded according to the classification of Nelson. Out of 30 subjects, 26 showed the features of Grade O (average age 28.33 years) and 4 showed grade 1 (average age 56.66 years). The method was very easy to perform, cheap and fast. The relationship of various cells to each other was maintained. This method can be used to study the conditions like trachoma, avitaminosis A and other disorders of conjunctival surface. It can be undertaken by a paramedical worker in an out patient clinic.

Papilomas conjuntivales y su relación con papillomavirus / Conjunctival papillomas and its relation with papillomavirus

Se estudian 26 papilomas conjuntivales, retrospectivamente, analizando histológicamente los mismos, con especial interés en la detección de coilocitosis y de antígenos geno-específicos de papillomavirus por inmunoperoxidasa. Seis de los papilomas mostraron coilocitosis, tres de los cuales recidivaron y un papiloma mostró presencia de antígenos virales intranucleares en un pequeño sector. Se identificó además un grupo de lesiones (10 en total), con algunos rasgos morfológicos compartidos con los papilomas, pero con indicios de cambio maligno ya sea citológico (displasia) o estructural (tendencia a la infiltración tisular). Ello se sugiere que representa el sustento morfológico de la posible transformación maligna en algunos papilomas

Citomorfologia conjuntival e meio ambiente: técnica de recolha e morfologia celular / Conjunctival cytomorphology and environment: uptake technic and cell morphology

Sendo impossível, por métodos convencionais, a obtençäo de amostras representativas para estudo citológico em doenças oculares näo exsudativas, recorrem os autores, à semelhança do que tem vindo a ser estudado em outros órgäos, à análise do líquido de lavagem ocular, nomeadamente da sua fase celular. Descreve-se e comenta-se uma metodologia "standard" para a obtençäo de líquido de lavagem ocular (LLO) em condiçöes satisfatórias para estudo morfológico em microscopia óptica. Säo demonstrados e comentados alguns aspectos obtidos em individuos normais ou com patologia ocular, discutindo-se desta forma, a validade e fiabilidade do método