A case of primary cutaneous anaplastic large cell lymphoma on eyelid.

Primary cutaneous anaplastic large cell lymphoma is a kind of cluster of differentiation 30+ primary cutaneous lymphoproliferative disorders with a relatively good prognosis in the absence of high-stage disease. Primary cutaneous anaplastic large cell lymphoma shows a higher frequency in males and commonly affects the head and neck. Palpebral involvement is very rare. We present a 42-year-old lady patient with primary cutaneous anaplastic large cell lymphoma involving the eyelid which was initially misdiagnosed as stye. The patient underwent a total excision of the lesion and showed complete regression of the lesion after surgery without any other treatment. There was no evidence of local or systemic disease during follow-up after nine months.

Temporalis Muscle Transfer for the Treatment of Lagophthalmos in Patients With Leprosy: Refinement in Surgical Techniques to Prevent Postoperative Ptosis.

Facial paralysis resulting from leprosy has a serious impact on the entire face especially in the areas innervated by the facial nerves. In particular, lagophthalmos in patients with leprosy causes exposure keratitis, corneal, and conjunctival dryness, which can progress to blindness and disfigurement. Recently, we conducted 4 different temporalis muscle transfer (TMT) methods over the last 4 years to reduce ptosis. The methods used included Brown-McDowell, McCord-Codner, modified Gillies-Anderson, and modified Gillies. Seventy-five TMT operations in 60 patients were performed between 2011 and 2014. The mean age was 70.1. Fifteen patients had bilateral TMT procedures. As a result, ptosis appeared in 14(18.7%) of 75 TMT procedures for 4 years. To prevent or correct this complication, the following 4 technical refinements have simplified the surgery and yield better surgical outcomes. First, an increase in the length of the temporalis muscle flap to approximately 8 cm with a parallel course to the lateral canthus will reduce oblique pull. Second, the width of the fascia sling in the upper eyelid is narrowed (3-4 mm) to reduce weight on the eyelid. Third, the fascia sling in the upper lid should not be located along the full length of the upper lid but terminate 3.5 cm medial to lateral canthal tendon and in other words, should not be tied at the medial canthal tendon to reduce tension and weight. Lastly, the fascia sling in the eyelid should be located shallow (probably in subdermal layer) and as near as possible to the lid margin to prevent any functional disturbance in levator aponeurosis.

Efficacy of temporalis muscle transfer for correction of lagophthalmos in leprosy.

OBJECTIVES: Temporalis Muscle Transfer (TMT) is a surgical technique used to correct lagophthalmos in leprosy patients. We have evaluated the degree of success of TMT in achieving full lid closure, which is important in preventing damage to the cornea. SUBJECTS AND METHODS: A retrospective study was carried out on 69 patients who had TMT done, at one centre, on 101 eyes during the period of 1998-2009. Lid gaps on direct gaze and with both gentle and forced closure, as well as voluntary muscle testing of eye lid closure, were assessed using standard measuring techniques by a qualified physiotherapist. Associated problems due to lagophthalmos were recorded both pre- and post- operatively. Data were abstracted on to a special proforma and subjected to statistical analysis using SPSS. RESULTS: On completion of post-operative physiotherapy, 85% of the eyes could achieve full lid closure with no measurable gap. The mean (SD) lid gap on forced closure was 48 (2.8) mm pre-operatively and 0.2 (0.5) mm at the end of the in-patient stay. The mean (SD) lid gap on gentle closure was 7.9 (2.6) mm preoperatively and 2.4 (1.8) mm post-operatively. The mean (SD) vertical inter-palpebral distance, during straight gaze, was reduced from 12.6 (1.6) pre-operatively to 9.8 (1.2) postoperatively. Exposure keratitis cleared in 16 of 27 eyes (60%) and Epiphora cleared or improved in 31 eyes. CONCLUSIONS: It is concluded that the TMT is a successful option (cosmetically and functionally) for correction of lagophthalmos.

Gold weight implants in the management of lagophthalmos in leprosy patients.

OBJECTIVES: To evaluate the use of gold weights as upper lid implants in the management of lagophthalmos due to facial nerve affection in leprosy patients. DESIGN: Gold implants of various weights were inserted in the upper eyelids of 12 patients with leprosy. Pre- and post-operative lid closures were recorded and patients were followed up for 1 year. RESULTS: Despite early satisfactory results with good closure, six out of 12 implants were extruded within the first year. Two more implants had to be removed due to chronic inflammatory reaction. CONCLUSION: Long term result of gold weight implants in leprosy patient is unsatisfactory and needs further evaluation.

Lid surgery in patients affected with leprosy in North-Eastern Nigeria: are their needs being met?

Corneal blindness is second only to cataract as a cause of blindness in leprosy patients. Eyelid surgery provided by trained paramedical staff can often prevent blindness in these patients. We sought to determine the extent to which paramedic personnel are meeting the eyelid surgical needs of these patients and to investigate the barriers that may be preventing them from seeking surgery. A total of eight leprosy settlements in north-eastern Nigeria were selected for this study. In these villages, 480 residents who were 30 years of age or older who had been diagnosed as having leprosy had their eyes examined for the presence of lagophthalmos, entropion/trichiasis and evidence of surgery for either of these conditions. Patients who had not been operated on for either of these conditions were questioned to determine their reasons for not seeking surgery. One hundred and sixteen (12.1 %) eyes were in need of surgery while 5.1 % of eyes had been operated upon. The surgical coverage for eyelid surgery was 30%; lagophthalmos had a better surgical coverage of 44.4% compared to entropion/trichiasis, which had 24.7% coverage. Lack of awareness about the treatment available was the most common reason given for not seeking surgery. This study shows that despite the presence of trained paramedical staff in the community, the eyelid surgical needs of these patients are not being met primarily because the level of awareness about the availability of effective treatment still remains low. In addition, the readiness of eye-care staff to visit these settlements was disappointing. Extra efforts will have to be made.

[Long-term results after the correction of the paralytic ectropion caused with leprosy in 115 eyes].

OBJECTIVE: To analyze the long-term results after the correction of the paralytic ectropion in leprosy. METHODS: Seventy-four patients with 115 paralytic ectropion eyes after leprosy were treated with the surgical procedures included medial canthoplasty, medial canthal tendon plication, lateral tarsal strip, medial canthal resection, lateral canthoplasty, and lid shortening. The results were evaluated with the follow-ups from 2 to 4 years. RESULTS: The eye-redness was reduced from 93 to 40 while the epiphora from 107 eyes (24 mild, 36 moderate and 47 severe) to 90 (40 mild, 32 moderate and 18 severe). The mean lid gap in mild eye closure was reduced from 6.8 mm to 5.3 mm and the cornea lesion was reduced from 53 to 36. The results were excellent in 18 eyes (15.7%), good in 45 eyes (39.1%), fair in 41 eyes (35.7%) and poor in 11 eyes (9.6%). However, the mean visual acuity remained same pre- and postoperatively. CONCLUSIONS: Surgical correction of ectropion is helpful for cornea protection and could improve the signs and symptoms of the eyes such as epiphora and red [abstract truncated].

Lagophthalmos surgery in leprosy: findings from a population-based survey in Korea.

Lagophthalmos continues to be a serious problem in cured leprosy patients. We conducted a population-based survey of lagophthalmos surgical coverage (LSC), barriers to lagophthalmos surgery and outcome of lagophthalmos surgery in leprosy patients in South Korea. In our survey, there were 60 patients with lagophthalmos who had needed surgery (> 5 mm gap), 34 of whom had received surgery, resulting in a lagophthalmos surgery coverage of 57%. Among the 34 patients who had received lagophthalmos surgery, 18 needed further surgery. Among those who had never had surgery, none of the demographic indicators predicted surgical uptake; the primary reason given for failure to have surgery was lack of knowledge about it. Outcome of surgery (by eye) showed that 29% of eyes still had a gap of 5 mm or more. The frequency of symptoms (tearing, blurring of vision, pain, etc.) was high. Even in settings with a good eye care infrastructure, such as Korea, uptake of surgery can still be low and results may not be satisfactory to patients. There is a need for practical guidelines for leprosy control programmes in the areas of (a) patient recognition, (b) patient education, (c) monitoring the uptake of surgery, and (d) monitoring the outcome of surgery to ensure the best possible outcome.

Reanimation of the lagophthalmos using stainless steel weight implantation; a new approach and prospective evaluation.

Weight implants have been used for over 30 years in surgical rehabilitation following lagophthalmos. However, there has been a renewed interest among ophthalmologists in recent years. The weight implant technique combined with lateral canthus resuspension was performed on 22 eyes in Thai patients. It is a reliable method for correcting lagophthalmos and ectropion. In previous studies almost pure gold was used in 99.99% of eyelid implants. However, we wanted to use other materials which are not expensive and are readily available. A stainless steel plate was selected. The majority of our surgeries were done with a stainless steel weight implant of 1.368 g. Patients were followed for 7 to 55 months, and no rejections of the implants were observed. This study achieved a > or = 90% success rate, and showed that a stainless steel plate is an alternative to gold for the weight implant technique.

Lid surgery to reduce discomfort produces an unexpected improvement in visual acuity--a case presentation.

A significant cause of blindness in leprosy is corneal scarring secondary to corneal anaesthesia and lagophthalmos (Brand & ffytche 1985). Such patients may continue to experience considerable ocular discomfort, particularly when there is associated ectropion of the lower lid, with inflammation of the exposed tarsal conjunctiva (Courtright & Johnson 1991). Where visual outcome is no longer the primary consideration, one may hesitate to subject patients to surgery, particularly in relatively unsophisticated field conditions, attempting instead to relieve the patient's discomfort by conservative treatment such as frequent topical ocular lubricants, use of protective spectacles or eye shades etc. A case is presented here in which minor surgery aimed solely at relieving ocular discomfort resulted in an unexpected improvement in visual acuity. This suggests that there are instances where a more aggressive approach to treatment of even severely damaged eyes could prove more rewarding than anticipated.

[External canthopexy using the Edgerton-Montandon procedure in lagophthalmos of leprosy patients. Technique and indications. Apropos of 30 cases]. / La canthopexie externe selon le procédé d'Edgerton-Montandon dans les lagophtalmies des malades de la lèpre. Technique et indications. A propos de trente cas.

This paper deals with the results observed in 21 ancient leprosy patients suffering from lagophthalmos (13 of whom suffered from bilateral lagophthalmos) and treated by the Edgerton-Montandon surgical procedure which associates lateral canthopexy and tarsorraphy. Eighteen of the 21 treated patients were reviewed at one month after the procedure and, overall, results could be evaluated for 30 eyes. Improvement was noted in all of the 30 eyes and, globally, the residual palpebral fissure (during voluntary closing of the eyes by the patient) decreased from 6.7 mm before the procedure to 1.8 after the procedure. The following recommendations may be proposed. For young patients with intact corneal sensation, the Gillies procedure remains the procedure of choice to correct lagophthalmos. For older patients with corneal anesthesia, at high risk of blindness, the Edgerton-Montandon procedure should be recommended.

Resultados da correçäo cirúrgica do lagoftalmo (técnica de Gillies) em doentes de hanseníase / Results of surgical correction of lagophthalmos (Gillies technique) in leprosy patients

Foram analisados os resultados de 51 cirurgias de transferência do músculo temporal (Técnica de Gillies), realizadas em 34 pacientes com lagoftalmo. O principal objetivo foi avaliar a extensao e o tempo para recuperaçao da oclusao palpebral voluntária e o efeito estático da técnica sobre a pálpebra inferior, nos casos com ectrópio parcial e epífora. Em 34 (66.67 por cento) olhos houve recuperaçao completa e duradoura da oclusao palpebral voluntária. As medianas dos tempos para obtençao de fendapalpebral zero, ao morder, foram de 8 dias (l - 120) nos casos do grupo excelente e de 14 dias (l - 120) nos casos do grupo bom. A correçao do ectrópio parcial e epífora foi constatada em 15 (83,33 por cento) olhos. A recuperaçao da oclusao palpebral voluntária e a reposiçao da pálpebra inferior, observada na maioria dos casos, confirmam a efetividade da técnica de Gillies para correçao do lagoftalmo.

Facial palsy--a leprosy surgeon's viewpoint.

Facial palsy is cosmetically unacceptable, whether affecting eyes or mouth. It endangers the vision. Both upper and lower facial paralysis can be surgically dealt with, using the temporal muscle and fascia. This produces satisfactory results in a relatively short period of time.