Minor salivary glands and labial mucous membrane graft in the treatment of severe symblepharon and dry eye in patients with Stevens-Johnson syndrome.

OBJECTIVE: To evaluate minor salivary glands and labial mucous membrane graft in patients with severe symblepharon and dry eye secondary to Stevens-Johnson syndrome (SJS). METHODS: A prospective, non-comparative, interventional case series of 19 patients with severe symblepharon and dry eye secondary to SJS who underwent labial mucous membrane and minor salivary glands transplantation. A complete ophthalmic examination including the Schirmer I test was performed prior to and following surgery. All patients had a preoperative Schirmer I test value of zero. RESULTS: Nineteen patients with severe symblepharon and dry eye secondary to SJS were included in the study. There was a statistically significant improvement in the best spectacle-corrected visual acuity in eight patients (t test; p=0.0070). Values obtained in the Schirmer I test improved significantly in 14 eyes (73.7%) 6 months following surgery (χ(2) test; p=0.0094). A statistically significant increase in tear production (Schirmer I test) was found in eyes that received more than 10 glands per graft compared with eyes that received fewer glands (χ(2) test; p=0.0096). Corneal transparency improved significantly in 11 (72.2%) eyes and corneal neovascularisation improved significantly in five eyes (29.4%) (McNemar test; p=0.001 and p=0.0005). The symptoms questionnaire revealed improvement in foreign body sensation in 53.6% of the patients, in photophobia in 50.2% and in pain in 54.8% (Kruskal-Wallis test; p=0.0167). CONCLUSION: Labial mucous membrane and minor salivary glands transplantation were found to constitute a good option for the treatment of severe symblepharon and dry eye secondary to SJS. This may be considered as a step prior to limbal stem cell and corneal transplantation in these patients.

Eyelid swelling as the only manifestation of ocular sarcoidosis.

PURPOSE: To describe a case of eyelid sarcoidosis without systemic manifestations with a three-year follow-up. METHODS: A 73-year-old woman presented complaining of a one-year history of swelling and hyperemia in the right upper eyelid. To confirm the diagnosis, we performed an incisional biopsy of the eyelid. RESULTS: Histopathological examination showed a non-caseating granulomatous process suggestive of sarcoidosis. After three years, the patient was asymptomatic and physical and laboratory examination showed no signs of systemic sarcoidosis. CONCLUSION: The histopathological exam was fundamental for the diagnosis.

Efeito do uso de lente escleral cosmética na sensibilidade tátil corneal em phthisis bulbi / Effect of ocular prosthesis on cornea sensitivity in phthisis bulbi

OBJETIVOS: Comparar a sensibilidade tátil corneal entre olhos normais e aqueles com phthisis bulbi e avaliar as alterações provocadas na sensibilidade tátil corneal pelo uso de lente escleral cosmética em phthisis bulbi. MÉTODOS: Estudo prospectivo de 23 pacientes com phthisis bulbi unilateral. Foram realizadas medidas da sensibilidade tátil corneal em ambos os olhos utilizando-se o estesiômetro de Cochet-Bonnet antes e após 3 meses do uso da lente escleral cosmética. RESULTADOS: Em todos os pacientes, a medida da sensibilidade tátil corneal no olho com phthisis bulbi foi menor do que no contralateral (controle). Em 96 por cento houve diminuição da sensibilidade tátil corneal após a adaptação da lente escleral cosmética. CONCLUSAO: Após a adaptação da lente escleral cosmética, ocorre diminuição da sensibilidade tátil corneal nos olhos. A fisiopatologia é semelhante à encontrada nos usuários de lentes de contato.

Ptose palpebral: estudo de 390 casos / Blepharoptosis: study of 390 cases

Foram examinados 390 pacientes com queixa de queda da pálpebra superior no setor de Plástica Ocular da Universidade de Säo Paulo - Escola Paulista de Medicina, no período de janeiro 1985 a fevereiro 1995. Encontrou-se 68,9 por cento de ptose congênita, 22,8 por cento de ptose adquirida e 8,2 por cento de pseudoptose. Com relaçäo ao sexo, 54,8 por cento eram do sexo masculino e 45,1 por cento do sexo feminino. O estudo dos pacientes com ptose congênita mostrou: ambliopia em 5,9 por cento; fenômeno de Marcus Gunn em 5,3 por cento e síndrome de blefarofimose em 6,3 por cento. Alteraçäo na motilidade ocular extrínseca estava presente em 30 por cento dos casos de ptose congênita e 29 por ceneto de ptose adquirida. A alteraçäo palpebral mais comum foi o epicanto inverso. Os autores analisam as alteraçöes oculares e palpebrais associadas ao quadro de ptose palpebral