Eye examination for early diagnosis of disseminated tuberculosis in patients with AIDS.

Choroidal tuberculosis is present in 5-20% of patients with disseminated tuberculosis, and point-of-care dilated binocular indirect ophthalmoscopy eye examination can provide immediate diagnosis. In geographical areas of high tuberculosis prevalence and in susceptible patients (CD4 counts less than 200 cells per µL) detection of choroidal granulomas should be accepted as evidence of disseminated tuberculosis. With training and proper support, eye screening can be done by HIV/AIDS clinicians, allowing early tuberculosis treatment. In regions with a high burden of tuberculosis, we recommend that eye screening be a standard part of the initial assessment of susceptible patients, including at a minimum all patients with HIV/AIDS with CD4 less than 100 cells per µL with or without eye symptoms, and with or without suspicion of disseminated tuberculosis.

Histology of Müller's muscle observed in quiescent Graves' orbitopathy.

OBJECTIVE: Histologic examination of Müller's muscle (MM) in patients with clinically significant upper eyelid retraction secondary to Graves' orbitopathy (GO). DESIGN: Prospective, single-blinded, comparative experimental study at a single institution. PARTICIPANTS: Patients from a single San Francisco Bay Area practice (RZS). METHODS: Consecutive patients with upper eyelid retraction secondary to GO who underwent surgical correction by transcutaneous mullerectomy were recruited between January and December 2011. An equal number of control MM specimens were gathered in consecutive patients undergoing conjunctivo-MM resection for ptosis correction. A total of 10 specimens in each group was available for analysis. The proportion of fat and fibrosis, as well as inflammatory markers, was studied and graded in both the study and the control group by a masked pathologist. These data were compared between groups using the Student t-test. RESULTS: No significant difference between the 2 groups of MM specimens was detected. CONCLUSIONS: Patients with quiescent GO with clinically significant eyelid retraction exhibit normal MM histology.

Use of hyaluronic Acid gel in the management of paralytic lagophthalmos: the hyaluronic Acid gel "gold weight".

PURPOSE: To evaluate the safety and efficacy of injecting hyaluronic acid gel in the upper eyelid as a nonsurgical alternative in the treatment of paralytic lagophthalmos. METHODS: This is a retrospective study of 9 patients (10 eyelids) with paralytic lagophthalmos treated with hyaluronic acid gel in the prelevator aponeurosis region and/or pretarsal region of the paralytic upper eyelid. Pretreatment, posttreatment, and follow-up photographs were digitized, and overall outcomes assessed. Measurements of lagophthalmos were standardized and compared. Slit-lamp examination was used to evaluate the degree of exposure keratopathy. ImageJ was used for photographic analysis. RESULTS: Ten eyelids (9 patients, 7 men; mean age 69.2 years; range, 31-90 years) with paralytic lagophthalmos were treated with hyaluronic acid gel. The average amount of injected hyaluronic acid gel was 0.9 ml (range, 0.2-1.2 ml). All patients demonstrated significant improvement in lagophthalmos and exposure keratopathy. The mean improvement in lagophthalmos was 4.8 mm (range, 0.9-11.9 mm; p = 0.001). Of the 5 patients with follow-up, the mean follow-up period was 3.6 months (range, 2-5 months). Of these, 2 had no change in lagophthalmos (both maintained 0 mm at 5 months), one had a slight decrease in lagophthalmos (4.8-4.6 mm at 2 months), one had a slight increase in lagophthalmos (0.3-0.5 mm at 2 months), and one had a more significant increase in lagophthalmos (1.9-4.3 mm at 4 months). The latter patient underwent a second treatment with further reduction of lagophthalmos to 0.4 mm. Overall, there was a decrease in margin reflex distance from the upper eyelid margin to the corneal light reflex (MRD1) but it was not statistically significant. Complications were minor and included transient ecchymosis, edema, and tenderness at the injection sites. CONCLUSIONS: On the basis of these preliminary results, hyaluronic acid gel shows promise as a safe and effective nonsurgical treatment for the management of paralytic lagophthalmos. This treatment may be particularly useful in patients who are poor surgical candidates and/or as a temporizing measure in patients in whom return of facial nerve function is anticipated, given the hyaluronic acid gel's properties of slow resorption and reversibility with hyaluronidase.