Efeitos da blefaroplastia na síndrome da disfunção lacrimal / Effects of blepharoplasty at the dysfunctional tear syndrome

OBJETIVO:Avaliar a presença da síndrome da disfunção lacrimal e alterações na sensibilidade corneana no pré e pós-operatório de pacientes com indicação de blefaroplastia superior. MÉTODOS: Foram avaliados 30 pacientes com indicação cirúrgica para correção de dermatocálase em pálpebra superior de ambos os olhos. Obtida história clínica e realizado exame oftalmológico geral, incluindo exames como teste de Schirmer I, coloração com Lissamina Verde, tempo de ruptura do filme lacrimal, coloração com fluoresceína e teste da sensibilidade corneana com estesiômetro de Cochet-Bonnet, além de teste subjetivo pelo questionário ODSI. Os exames foram realizados antes e após 90 dias da cirurgia. RESULTADOS: Apenas 23 pacientes completaram o seguimento, sendo o sexo feminino predominante. A idade dos pacientes variou de 63 a 87 anos. De acordo com o questionário ODSI aplicado, observou-se que houve melhora dos sintomas, mas a análise estatística mostrou um resultado não-significante. Com relação à análise dos resultados obtidos com o estesiômetro de Cochet-Bonnet, 7 pacientes apresentaram uma melhora na sensibilidade corneana, 9 pacientes diminuíram a resposta e 7 mantiveram seus valores. Os resultados do BUT lacrimal, colorações com Lissamina verde e Fluoresceína foram considerados estatisticamente não-significantes. O teste de Schirmer I demonstrou uma melhora estatisticamente significativa da produção lacrimal no pós-operatório. CONCLUSÃO: Neste trabalho observou-se que os pacientes submetidos à blefaroplastia superior apresentaram uma melhora nos sinais e sintomas relacionados à SDL, apesar de ter sido diagnosticado uma diminuição na sensibilidade corneana não estatisticamente significante.

PURPOSE: To evaluate the presence of dysfunctional tear syndrome and changes in corneal sensitivity in the preoperative andpostoperative patients undergoing upper blepharoplasty. METHODS: Thirty patients with surgical indication for correction of upper eyelid dermatochalasis in both eyes. Obtained clinical history and general ophthalmologic examination, including tests such as Schirmer's test, Lissamine Green staining, tear break-up time and fluorescein staining, corneal sensitivity was evaluated using the Cochet-Bonnet esthesiometer, and subjective test by questionnaire ODSI. The examinations were performed before and after 90 days of surgery. RESULTS: Only 23 patients completed the follow-up, with females predominant. The patients' ages ranged from 63 to 87 years. According to the questionnaire ODSI applied, we found that symptoms improved, but statistical analysis showed a nonsignificant result. Regarding the analysis of results obtained with the Cochet-Bonnet esthesiometer, 7 patients showed an improvement in corneal sensitivity, nine patients declined to answer and 7 maintained their values. The results of the tear BUT, and stained with Fluorescein and Lissamine green were considered statistically non-significant. The Schirmer's test showed a statistically significant improvement in tear production in the postoperative period. CONCLUSION: In this study we observed that patients undergoing upper blepharoplasty showed an improvement in the signs and symptoms related to SDL, despite having been diagnosed with a decrease in corneal sensitivity, not statistically significant.

[Ice pack test in the diagnosis of myasthenia gravis]. / Teste do gelo no diagnóstico de miastenia gravis.

PURPOSE: To demonstrate the sensitivity and the specificity of the ice test in the differential diagnosis of ptosis in myasthenia gravis. METHODS: Prospective trial with a control group. The patients were instructed to hold a frozen ice pack on the closed ptotic eyelid. They were divided into 2 groups, with group I consisting of patients with myasthenia gravis and group II (control) consisting of patients with congenital, non-myasthenic myogenic or aponeurotic ptosis. RESULTS: All patients in group I had increased palpebral fissure for at least 3 mm after the application of ice pack. No patient in group II showed increased palpebral fissure after the ice test. CONCLUSION: Ice test proved to be specific for the detection of myasthenic ptosis.

Teste do gelo no diagnóstico de miastenia gravis / Ice pack test in the diagnosis of myasthenia gravis

OBJETIVO: Demonstrar a sensibilidade e especificidade do teste do gelo no diagnóstico diferencial de ptose palpebral por miastenia gravis. MÉTODOS: Estudo prospectivo tipo ensaio clínico com grupo controle. Foi realizado o teste do gelo em pacientes portadores de ptose palpebral. Os pacientes foram divididos em 2 grupos, sendo o grupo I constituído por pacientes com miastenia gravis e o grupo II (controle) formado por pacientes portadores de ptose congênita, miogênica não-miastênica ou aponeurótica. RESULTADOS: Todos os pacientes do grupo I tiveram aumento da fenda palpebral de, no mínimo, 3 mm após a aplicação do gelo. Nenhum paciente do grupo II apresentou incremento da fenda palpebral após o teste. CONCLUSÃO: O teste do gelo mostrou-se específico para detecção de ptose palpebral de causa miastênica.

PURPOSE: To demonstrate the sensitivity and the specificity of the ice test in the differential diagnosis of ptosis in myasthenia gravis. METHODS: Prospective trial with a control group. The patients were instructed to hold a frozen ice pack on the closed ptotic eyelid. They were divided into 2 groups, with group I consisting of patients with myasthenia gravis and group II (control) consisting of patients with congenital, non-myasthenic myogenic or aponeurotic ptosis. RESULTS: All patients in group I had increased palpebral fissure for at least 3 mm after the application of ice pack. No patient in group II showed increased palpebral fissure after the ice test. CONCLUSION: Ice test proved to be specific for the detection of myasthenic ptosis.

Valores da exoftalmometria média na população adulta da região do Grande ABC, São Paulo/Brasil / Normal exophthalmometric values in adult population of ABC Region, Sao Paulo/Brazil

OBJETIVO: Estabelecer padrões de normalidade dos valores da exoftalmometria de ambos os olhos e da distância entre os rebordos orbitários laterais (base) em adultos jovens da população do Grande ABC São Paulo/Brasil. MÉTODOS: Realizou-se a exoftalmometria com o exoftalmômetro de Hertel, em 129 pacientes do sexo feminino e 75 do sexo masculino, na faixa etária de 25 a 55 anos. Os pacientes foram separados em três grupos raciais (brancos, negros e pardos). RESULTADOS: A variação da exoftalmometria encontrada na população em estudo foi de 10 a 23mm, média de 15,57 ±2,43mm. No sexo feminino a média foi de 15,42 ±2,40mm e no masculino, 15,83 ±2,47mm. Não se encontrou uma relação estatisticamente significativa entre os sexos feminino e masculino (p=0,25). Na raça branca a média foi de 15,57 ±2,46mm, na negra foi de 16,20 ±2,70mm e na parda foi de 15,02 ±2,01mm. A diferença foi estatisticamente significativa (p=0,008) entre as raças negra e parda. A medida da base variou de 104 a 125mm (média de 113,91 ±4,37mm). A diferença entre homens e mulheres foi estatisticamente significativa (p<0,001). Na raça branca a média da base encontrada foi de 112,18 ±4,02mm, na negra foi de 115,37 ±4,71mm e na parda, 115,18 ±3,66mm. A diferença da média da base foi estatisticamente significativa (p<0,001) entre as raças branca e negra e branca e parda. Nenhum paciente apresentou assimetria entre os dois olhos maior que 2mm. CONCLUSÃO: O padrão de normalidade da exoftalmometria encontrado para a população em estudo foi de 10 a 23mm e a base variou de 104 a 125mm.

PURPOSE: To determine the normal exophthalmometry of both eyes and of the distance between lateral orbital rims (the base measurement) in young adults from ABC Region, São Paulo/Brazil. METHODS: Exophthalmometry, by Hertel's exophthalmometer, was made in 129 female and 75 male subjects, age ranging from 25 to 55 years. The subjects were divided in three groups of races (white, black and mulatto). RESULTS: The values of exophthalmometry ranged from 10 to 23mm, mean 15,57 ±2,43mm. In female the mean was 15,42 ±2,40mm and in male, 15,83 ±2,47mm. There is no statistically significant difference between female or male (p=0,25). In whites subjects the mean was 15,57 ±2,46mm, in black was 16,20 ±2,70mm and in mulatto was 15,02 ±2,01mm. There was a statistically significant difference between blaks and mulattos (p=0,008). The base measurement ranged from 104 to 125mm (mean 113,91 ±4,37mm). There was a statistically significant difference between males and females (p<0,001). In whites the base was 112,18 ±4,02mm, in blacks 115,37 ±4,71mm and in mulattos, 115,18 ±3,66mm. There was a statistically significant difference for the base measurement between white subjects and black ones, and between white subjects and mulattos (p<0,001). No individual had more than 2mm of assimetry between eyes. CONCLUSION: The normal exophthalmometric value in the studied population was 10 to 23mm and the base measurement ranged from 104 to 125mm.

Metastatic eyelid disease associated with primary breast carcinoma: case report.

Metastasis confined to eyelids are rare, representing less than 1% of malignant eyelid lesions. More than 50% of all eyelid metastasis are reported to have the breast as the most common primary origin. Two cases of metastatic eyelid disease associated with primary breast carcinoma are described. These lesions were the first sign of metastatic systemic disease. Case 1: An 80-year old woman with no significant ophthalmological history complaining of a discrete painless lesion in the left upper eyelid. She had been diagnosed 10 years before as infiltrated ductal carcinoma of right mammary gland with no reference of metastatic disease. Case 2: A 77-year old woman who attends our ophthalmology service came complaining of a four-month history of a painless swelling and erythema of right lower eyelid. The past medical history was significant for infiltrated ductal carcinoma on right mammary gland 2 years before the ocular manifestation. Breast carcinoma is notorious for its presentation diversity. Metastatic disease should be considered as differential diagnosis of eyelid lesions. Although rare, these lesions can be an initial sign of systemic malignancy.

Metastatic eyelid disease associated with primary breast carcinoma: case report / Doença metastática palpebral associada a carcinoma primário de mama: relato de caso

Metastasis confined to eyelids are rare, representing less than 1 percent of malignant eyelid lesions. More than 50 percent of all eyelid metastasis are reported to have the breast as the most common primary origin. Two cases of metastatic eyelid disease associated with primary breast carcinoma are described. These lesions were the first sign of metastatic systemic disease. Case 1: An 80-year old woman with no significant ophthalmological history complaining of a discrete painless lesion in the left upper eyelid. She had been diagnosed 10 years before as infiltrated ductal carcinoma of right mammary gland with no reference of metastatic disease. Case 2: A 77-year old woman who attends our ophthalmology service came complaining of a four-month history of a painless swelling and erythema of right lower eyelid. The past medical history was significant for infiltrated ductal carcinoma on right mammary gland 2 years before the ocular manifestation. Breast carcinoma is notorious for its presentation diversity. Metastatic disease should be considered as differential diagnosis of eyelid lesions. Although rare, these lesions can be an initial sign of systemic malignancy.

Metástase confinada às pálpebras é rara, representando menos de 1 por cento das lesões malignas palpebrais. Mais de 50 por cento das metástases palpebrais são relatadas como tendo a mama como sítio primário. Relatamos dois casos de doença metastática palpebral associada a carcinoma primário de mama. Estas lesões foram o primeiro sinal de doença metastática sistêmica. Caso 1: Paciente do sexo feminino, 80 anos de idade sem antecedentes oftalmológicos apresentando discreta lesão nodular indolor na pálpebra superior do olho esquerdo. O carcinoma ductal de mama foi diagnosticado há 10 anos sem doença metastática. Caso 2: Paciente do sexo feminino, 77 anos de idade, com queixa de edema indolor e hiperemia na pálpebra inferior do olho direito há quatro meses. Apresentava antecedente pessoal de carcinoma ductal infiltrativo de mama diagnosticado há dois anos, sem doença metastática. O carcinoma de mama é notório por sua diversidade na apresentação clínica. A doença metastática deve ser considerada no diagnóstico diferencial das lesões palpebrais. Embora raras estas lesões podem ser o primeiro sinal da doença sistêmica.

[Tarsal switch levator for mitochondrial myogenic ptosis]. / Transposição da rima palpebral em ptose miogênica mitocondrial.

PURPOSE: To report the use of tarsal switch levator resection procedures that lift the palpebral fissure to visual axis without causing corneal complications in patients with mitochondrial myogenic ptosis. METHODS: Prospective study. The technique consists of an upper eyelid tarsectomy, with transfer of the autologous tarsoconjunctival graft to the posterior lamella of the lower eyelid. The surgeries were performed under local anesthesia. In case of diplopia, the surgery was performed in one eye. RESULTS: Tarsal switch procedure was performed in 9 eyes of 6 patients with mitochondrial myopathy. There were 5 women; the average age was 59.8 years and the follow-up ranged from 30 to 60 months. The palpebral fissure was moved cephalad in all patients, unmasking their visual axis in primary position and improving their head position. There was no patient with exposure symptoms after surgery. CONCLUSION: The tarsal switch procedure is useful in managing the eyelid malpositions in patients with poor eye protective mechanisms because it elevates both the upper and the lower eyelids, decreasing or eliminating the risk of lagophthalmos with corneal complications.

[Comparison of two modified lidocaine solutions for local anesthesia in blepharoplasty]. / Comparação entre duas soluções modificadas de lidocaína para uso em anestesia local na blefaroplastia.

PURPOSE: To compare pain on injection of two modified anesthetic lidocaine solutions for use in upper blepharoplasty: 2% lidocaine with 1:100,000 epinephrine, and 2% lidocaine with 1:100,000 epinephrine buffered 9:1 with 8.4% sodium bicarbonate. METHODS: In this prospective, double-masked study, 25 consecutive patients undergoing upper blepharoplasty were submitted to the anesthesic procedure. Each eyelid received one of two modified lidocaine solutions. Heart rate, systemic arterial pressure and oxygen saturation level were obtained before, during and after injection of two different anesthetic solutions. Patients used a 4-point scale to rate the perceived pain on injection. RESULTS: All parameters were statistically analyzed and there was a significant difference in heart rate and oxygen saturation level. CONCLUSION: Pain on injection of eyelid anesthesia does not differ significantly with either buffered or unmodified lidocaine solutions.

[Frontalis suspension with polytetrafluorethylene for the treatment of blepharoptosis]. / Suspensão ao músculo frontal com politetrafluoretileno para o tratamento da blefaroptose.

PURPOSE: To evaluate the functional results and complications of the use of expanded polytetrafluoroethylene in frontalis suspension surgery for the treatment of blepharoptosis. METHODS: Frontalis suspension procedure with polytetrafluoroethylene was performed between 2003 and 2007 on 23 patients (36 eyes) with blepharoptosis. An average follow-up time was 15.8 months (range, 3 to 36). Surgical technique used was described by Fox. RESULTS: The causes of blepharoptosis found were: congenital in 20 patients (86.95%), blepharophimosis in 2 (8.69%) and traumatic in 1 (4.35%). At the first week of postoperatory 6 (26.08%) patients related palpebral asymmetry, 4 (17.39%) noticed local edema, 3 (13.04%) presented granulomas and 1 (4.35%) presented facial cellulitis on the ipsilateral frontal region. After 3 months of follow-up 3 (13.04%) patients related palpebral asymmetry and 1 (4.35%) persisted the granuloma. CONCLUSION: Polytetrafluoroethylene - Model CV3, 6.0 (Gore-tex(R), W.L. Gore & Associates Inc, Flagstaff, AZ, EUA) is an adequate material with good functional results (86.9%), relatively few complications (4.35%) and insatisfaction (13.4%) that could be an alternative for fascia lata in the surgery of frontalis suspension for the treatment of blepharoptosis.

Transposição da rima palpebral em ptose miogênica mitocondrial / Tarsal switch levator for mitochondrial myogenic ptosis

OBJETIVO: Relatar o uso da ressecção do tarso da pálpebra superior e enxerto na pálpebra inferior para a elevação da rima palpebral e liberação do eixo visual, sem causar complicações corneanas em pacientes portadores de ptose miogênica mitocondrial. MÉTODOS: Estudo prospectivo. A técnica cirúrgica consiste na tarsectomia da pálpebra superior e autoenxerto do tarso na lamela posterior da pálpebra inferior. As cirurgias foram realizadas sob anestesia local. No caso de diplopia, a cirurgia foi realizada em apenas um olho. RESULTADOS: O procedimento foi realizado em 9 olhos de 6 pacientes com miopatia mitocondrial. Cinco pacientes eram do sexo feminino, a média de idade foi de 59,8 anos e o seguimento variou de 30 a 60 meses. A rima palpebral elevou em todos os pacientes, descobrindo o eixo visual na posição primária do olhar e melhorando a posição viciosa de cabeça. Não houve complicações decorrentes da exposição do globo ocular. CONCLUSÃO: A técnica de transposição da rima palpebral é útil na correção do mau posicionamento das pálpebras em pacientes sem mecanismos de proteção porque eleva a pálpebra superior e a inferior, diminuindo ou eliminando o risco de causar lagoftalmo com complicações corneanas.

PURPOSE: To report the use of tarsal switch levator resection procedures that lift the palpebral fissure to visual axis without causing corneal complications in patients with mitochondrial myogenic ptosis. METHODS: Prospective study. The technique consists of an upper eyelid tarsectomy, with transfer of the autologous tarsoconjunctival graft to the posterior lamella of the lower eyelid. The surgeries were performed under local anesthesia. In case of diplopia, the surgery was performed in one eye. RESULTS: Tarsal switch procedure was performed in 9 eyes of 6 patients with mitochondrial myopathy. There were 5 women; the average age was 59.8 years and the follow-up ranged from 30 to 60 months. The palpebral fissure was moved cephalad in all patients, unmasking their visual axis in primary position and improving their head position. There was no patient with exposure symptoms after surgery. CONCLUSION: The tarsal switch procedure is useful in managing the eyelid malpositions in patients with poor eye protective mechanisms because it elevates both the upper and the lower eyelids, decreasing or eliminating the risk of lagophthalmos with corneal complications.

Comparação entre duas soluções modificadas de lidocaína para uso em anestesia local na blefaroplastia / Comparison of two modified lidocaine solutions for local anesthesia in blepharoplasty

OBJETIVO: Comparar a dor causada pela injeção de solução de lidocaína 2% e epinefrina 1:100.000 com a injeção de solução de lidocaína 2% e epinefrina 1:100.000 tamponada com bicarbonato sódico 8,4% na proporção de 9:1 durante a realização de anestesia local em pacientes a serem submetidos a blefaroplastia superior bilateral. MÉTODOS: Estudo prospectivo duplo-cego, onde 25 pacientes foram submetidos a blefaroplastia superior, sob anestesia local. Cada pálpebra recebia uma das duas soluções anestésicas modificadas definidas por sorteio realizado por um dos pesquisadores que não participava do procedimento cirúrgico. Foram observadas as alterações na frequência cardíaca, pressão arterial sistêmica e saturação de oxigênio, comparadas aos índices de base do próprio paciente, obtidas previamente no início do procedimento. Ao término das aplicações, solicitava-se ao paciente uma nota (de 0 a 4) referente a dor. RESULTADOS: Apenas dois parâmetros (frequência cardíaca e saturação de O2) apresentaram diferença estatisticamente significativa durante a aplicação das duas soluções. CONCLUSÃO: Não houve diferença estatisticamente significativa entre a sensação de dor causada pela injeção de solução de lidocaína 2% e epinefrina 1:100.000 com a aplicação da mesma solução tamponada com bicarbonato sódico 8,4% na proporção de 9:1, em pacientes submetidos a blefaroplastia superior bilateral.

PURPOSE: To compare pain on injection of two modified anesthetic lidocaine solutions for use in upper blepharoplasty: 2% lidocaine with 1:100,000 epinephrine, and 2% lidocaine with 1:100,000 epinephrine buffered 9:1 with 8.4% sodium bicarbonate. METHODS: In this prospective, double-masked study, 25 consecutive patients undergoing upper blepharoplasty were submitted to the anesthesic procedure. Each eyelid received one of two modified lidocaine solutions. Heart rate, systemic arterial pressure and oxygen saturation level were obtained before, during and after injection of two different anesthetic solutions. Patients used a 4-point scale to rate the perceived pain on injection. RESULTS: All parameters were statistically analyzed and there was a significant difference in heart rate and oxygen saturation level. CONCLUSION: Pain on injection of eyelid anesthesia does not differ significantly with either buffered or unmodified lidocaine solutions.

Suspensão ao músculo frontal com politetrafluoretileno para o tratamento da blefaroptose / Frontalis suspension with polytetrafluorethylene for the treatment of blepharoptosis

OBJETIVO: Relatar a experiência com o uso do fio de politetrafluoretileno nas cirurgias de suspensão ao músculo frontal para correção de blefaroptose. MÉTODOS: Foram estudados todos os casos de blefaroptose grave submetidos à cirurgia pela técnica de suspensão ao músculo frontal como fio de politetrafluoretileno, no período de fevereiro de 2003 a abril de 2007. Foram realizadas 36 cirurgias em 23 pacientes, a média de seguimento foi de 15,8 meses (variando de 3 a 36 meses). A técnica cirúrgica utilizada foi a descrita por Fox. RESULTADOS: Entre as causas de blefaroptose foram encontradas: congênita em 20 (86,95 por cento) pacientes, blefarofimose em 2 (8,69 por cento) pacientes e traumática em 1 (4,35 por cento) paciente. Na primeira semana de pós-operatório, 6 (26,08 por cento) pacientes referiram assimetria palpebral, 4 (17,39 por cento) notaram edema local, 3 (13,04 por cento) pacientes apresentaram granuloma no local do fio e 1 (4,35 por cento) paciente apresentou celulite facial na região frontal unilateral. Após 3 meses de seguimento, 3 (13,04 por cento) pacientes referiram assimetria palpebral, e em 1 (4,35 por cento) paciente persistia o granuloma. CONCLUSÃO: O politetrafluoretileno - Modelo CV3, 6.0 (Gore-Tex®; W.L. Gore & Associates Inc, Flagstaff, AZ, EUA) é um material adequado com bons resultados funcionais (86,9 por cento), baixos índices de complicação (4,35 por cento) e insatisfação (13,4 por cento), podendo ser uma alternativa em relação à fáscia lata, na cirurgia de suspensão ao frontal para tratamento de ptose palpebral grave.

PURPOSE: To evaluate the functional results and complications of the use of expanded polytetrafluoroethylene in frontalis suspension surgery for the treatment of blepharoptosis. METHODS: Frontalis suspension procedure with polytetrafluoroethylene was performed between 2003 and 2007 on 23 patients (36 eyes) with blepharoptosis. An average follow-up time was 15.8 months (range, 3 to 36). Surgical technique used was described by Fox. RESULTS: The causes of blepharoptosis found were: congenital in 20 patients (86.95 percent), blepharophimosis in 2 (8.69 percent) and traumatic in 1 (4.35 percent). At the first week of postoperatory 6 (26.08 percent) patients related palpebral asymmetry, 4 (17.39 percent) noticed local edema, 3 (13.04 percent) presented granulomas and 1 (4.35 percent) presented facial cellulitis on the ipsilateral frontal region. After 3 months of follow-up 3 (13.04 percent) patients related palpebral asymmetry and 1 (4.35 percent) persisted the granuloma. CONCLUSION: Polytetrafluoroethylene - Model CV3, 6.0 (Gore-tex®, W.L. Gore & Associates Inc, Flagstaff, AZ, EUA) is an adequate material with good functional results (86.9 percent), relatively few complications (4.35 percent) and insatisfaction (13.4 percent) that could be an alternative for fascia lata in the surgery of frontalis suspension for the treatment of blepharoptosis.

Artificial eye amplitudes and characteristics in enucleated socket with porous polyethylene spherical and quad-motility implant.

PURPOSE: To compare artificial eye amplitudes in enucleated socket with porous polyethylene either spherical or quad-motility implant and study the characteristics of artificial eyes fit with the two orbital implants. METHODS: A total of 21 patients were prospectively studied who underwent enucleation because of an intraocular melanoma and the randomization defined a porous polyethylene either spherical or quad-motility orbital implant. Measurements of the amplitude of the artificial eye were obtained with prism and digital photos. The software Scion Image analyzed the digital photos (www.scioncorp.com) and the quantitative data were allocated to groups. The measurements (height, length, thickness) and weight of the 21 artificial eyes were analyzed. Student's t-test was performed to determine the significance of difference between groups (p<0.05). RESULTS: There was no statistically significant difference of the artificial eye amplitude analyzed by means of prisms between both orbital implants (p>0.05 for all directions). On analyzing the digital photos, the artificial eye with spherical implant showed higher artificial eye amplitude downward (p=0.009) among patients older than 55 years old, rightward (p=0.036) and downward (p=0.008) among the 9 patients with enucleated right eye. Height and length were similar in the 21 artificial eyes but those artificial eyes fit with quad-motility orbital implants were statistically significant thicker (p<0.001) and heavier (p=0.001). CONCLUSIONS: The similar amplitude of movement of artificial eyes was observed with both spherical and quad-motility orbital implants. Artificial eyes fit with quad-motility orbital implant are significantly thicker and heavier than those fit with spherical orbital implant.

Artificial eye amplitudes and characteristics in enucleated socket with porous polyethylene spherical and quad-motility implant

PURPOSE: To compare artificial eye amplitudes in enucleated socket with porous polyethylene either spherical or quad-motility implant and study the characteristics of artificial eyes fit with the two orbital implants. METHODS: A total of 21 patients were prospectively studied who underwent enucleation because of an intraocular melanoma and the randomization defined a porous polyethylene either spherical or quad-motility orbital implant. Measurements of the amplitude of the artificial eye were obtained with prism and digital photos. The software Scion Image analyzed the digital photos (www.scioncorp.com) and the quantitative data were allocated to groups. The measurements (height, length, thickness) and weight of the 21 artificial eyes were analyzed. Student's t-test was performed to determine the significance of difference between groups (p<0.05). RESULTS: There was no statistically significant difference of the artificial eye amplitude analyzed by means of prisms between both orbital implants (p>0.05 for all directions). On analyzing the digital photos, the artificial eye with spherical implant showed higher artificial eye amplitude downward (p=0.009) among patients older than 55 years old, rightward (p=0.036) and downward (p=0.008) among the 9 patients with enucleated right eye. Height and length were similar in the 21 artificial eyes but those artificial eyes fit with quad-motility orbital implants were statistically significant thicker (p<0.001) and heavier (p=0.001). CONCLUSIONS: The similar amplitude of movement of artificial eyes was observed with both spherical and quad-motility orbital implants. Artificial eyes fit with quad-motility orbital implant are significantly thicker and heavier than those fit with spherical orbital implant.

OBJETIVOS: Comparar a amplitude de movimento da prótese ocular em cavidade enucleada e com implante orbitário esférico e "quad-motility" e estudar as características das próteses oculares adaptadas com os dois modelos de implantes orbitários. MÉTODOS: Vinte e um pacientes foram prospectivamente estudados após a enucleação devido a melanoma intra-ocular e cuja randomização definiu o implante orbitário de polietileno poroso nos modelos esférico e "quad-motility". Medidas da amplitude da prótese ocular foram obtidas com prisma e fotografia digital. O programa Scion Image analisou as fotos digitais (www.scioncorp.com) e os resultados foram distribuídos por grupos. As medidas (altura, comprimento, espessura) e o peso das 21 próteses também foram analisados. O teste de t foi realizado para determinar a significância da diferença entre os grupos (p<0,05). RESULTADOS: Não houve diferença significante na amplitude do movimento das próteses oculares, analisada com a interposição do prisma em ambos implantes orbitários (p>0,05 em todas as posições). Ao analisar a fotografia digital, as próteses adaptadas com implante esférico apresentaram maior amplitude de movimento na infraversão (p=0,009) para pacientes acima de 55 anos, infraversão (p=0,008) e dextroversão (p=0,036) nos nove pacientes com o olho direito enucleado. Altura e comprimento foram similares nas 21 próteses oculares. Próteses oculares adaptadas com implante "quad-motility" foram significantemente mais espessas (p<0,001) e pesadas (p=0,001). CONCLUSÕES: A amplitude de movimento das próteses oculares foi similar nos implantes esférico e "quad-motility". As próteses oculares adaptadas com implante "quad-motility" são significantemente mais espessas e pesadas do que as adaptadas com implante esférico.

[The role of senile enophthalmos in involutional entropion]. / A importância da enoftalmia senil no desenvolvimento do entrópio involucional.

PURPOSE: To observe the role of senile enophthalmos in involutional entropion. METHODS: Prospective clinical study comparing a population of 30 white patients above 65 years with involutional entropion (Group I) of an age- and race-matched control group (Group II). All age and exophthalmometric values were analyzed by a statistical study. RESULTS: The average age was 77.7 years in Group I and 75.7 years in Group II. Eyes with involutional entropion are no more likely to have enophthalmos (15.22 mm) than is the involved contralateral eye (15.11 mm) or normal eyes of an age- and race-matched control group (15.13 mm). CONCLUSION: There is no correlation between involutional entropion and senile enophthalmos.

A importância da enoftalmia senil no desenvolvimento do entrópio involucional / The role of senile enophthalmos in involutional entropion

OBJETIVO: Observar a importância da enoftalmia senil no desenvolvimento do entrópio involucional. MÉTODOS: Estudo prospectivo de 30 pacientes da raça branca com idade superior a 65 anos com diagnóstico de entrópio involucional uni ou bilateral. Estes pacientes (Grupo I) e um grupo controle (Grupo II) foram submetidos a exoftalmometria com o exoftalmômetro de Hertel. Os pacientes do grupo controle não apresentavam entrópio involucional, porém os demais critérios de inclusão e exclusão foram observados. As variáveis idade e exoftalmometria foram submetidas a análise estatística. RESULTADOS: A idade média do Grupo I foi de 77,7 anos e do Grupo II, 75,7 anos. Ao analisar os 18 casos unilaterais do Grupo I foi observado que não há diferença estatisticamente significante entre os valores da exoftalmometria obtidos nos olhos com doença (15,22 mm) com os dos olhos sem a doença (15,11 mm). O mesmo ocorreu analisando a média da exoftalmometria do Grupo II (15,3 mm) em relação à dos olhos com doença. CONCLUSÃO: Não foi observada relação entre a presença de entrópio involucional e enoftalmia senil.

PURPOSE: To observe the role of senile enophthalmos in involutional entropion. METHODS: Prospective clinical study comparing a population of 30 white patients above 65 years with involutional entropion (Group I) of an age- and race-matched control group (Group II). All age and exophthalmometric values were analyzed by a statistical study. RESULTS: The average age was 77.7 years in Group I and 75.7 years in Group II. Eyes with involutional entropion are no more likely to have enophthalmos (15.22 mm) than is the involved contralateral eye (15.11 mm) or normal eyes of an age- and race-matched control group (15.13 mm). CONCLUSION: There is no correlation between involutional entropion and senile enophthalmos.

[Bipedicle myocutaneous flap for cicatricial ectropion correction]. / Retalho miocutâneo bipediculado para correção do ectrópio cicatricial.

PURPOSE: To evaluate the correction of lower eyelid cicatricial ectropion due to shrinking of anterior lamela with the surgical technique of bipedicle myocutaneous flap from the upper eyelid. METHODS: Prospective study with eight eyelids of six patients. There were two patients with unilateral ectropion who had received external local radiotherapy. RESULTS: There were three male and three female patients, with mean age of 72 years. One patient presented an incomplete blinking for one month that spontaneously resolved. Three eyelids of two patients maintained a residual ectropion; one of them had received local external radiotherapy. Follow-up ranged from 19 to 23 months (mean of 20 months) and all patients improved their ocular condition. CONCLUSION: The bipedicle myocutaneous flap is effective for correction of cicatricial ectropion due to shrinking of anterior lamella.

Retalho miocutâneo bipediculado para correção do ectrópio cicatricial / Bipedicle myocutaneous flap for cicatricial ectropion correction

OBJETIVO: Avaliar a correção do ectrópio cicatricial da pálpebra inferior secundário à retração da lamela anterior utilizando-se a técnica cirúrgica do retalho miocutâneo bipediculado da pálpebra superior. MÉTODOS: Estudo prospectivo com oito pálpebras de seis pacientes. Dois pacientes apresentavam ectrópio unilateral secundário à radioterapia externa local. RESULTADOS: Três pacientes do sexo feminino e três do masculino, com idade média de 72 anos. Um paciente permaneceu com piscar incompleto por 30 dias, quando houve melhora espontânea. Três pálpebras de dois pacientes permaneceram com ectrópio residual, sendo que um deles havia recebido radioterapia externa local. O seguimento variou de 19 a 23 meses (média de 20 meses) e todos os pacientes apresentaram melhora dos sintomas. CONCLUSÃO: O retalho miocutâneo bipediculado é técnica efetiva nos casos de ectrópio cicatricial por encurtamento da lamela anterior.

[Eyelid trichoepithelioma--report of 2 cases]. / Tricoepitelioma palpebral--relato de 2 casos.

Trichoepithelioma is a benign skin tumor and is most commonly found on the face, however, there are few reports about its occurrence on the eyelids. It is not usually recognized because of its rarity, origin, biological potential, and controversial classification. The purpose of this paper is to report two cases of solitary trichoepithelioma on the eyelid, their histopathology and treatment. This lesion should be considered when a single solid nodule on the face appears, and can be differentiated from basal-cell carcinoma. Histopathologic confirmation is essential.

Tricoepitelioma palpebral: relato de 2 casos / Eyelid trichoepithelioma: report of 2 cases

O tricoepitelioma é tumor cutâneo benigno derivado dos folículos pilosos. É comum na face, porém há poucos relatos sobre a ocorrência na pálpebra. não é freqüentemente reconhecido devido à sua raridade, controvérsias na sua classificação, origem e potencial biológico. O objetivo deste artigo é apresentar 2 casos de tricoepitelioma solitário na pálpebra, o exame histopatológico e seu tratamento. Esta lesão deve ser considerada quando for encontrado um nódulo solitário na região facial e diferenciada do carcinoma basocelular. A confirmação por meio do exame histopatológico é essencial.