Slit lamp polarized dermoscopy: a cost-effective tool to assess eyelid lesions.

PURPOSE: Dermoscopy is a complementary examination of skin lesions, which allows the observation of anatomical features invisible to the naked eye. Its use increases the diagnostic accuracy of skin tumors. The development of polarized dermoscopy allowed the observation of deeper skin structures, without the need of skin contact. The purpose of this study was to present a low-cost prototype through the adaptation of polarized lenses on a slit lamp in order to assess anatomical aspects invisible to conventional biomicroscopy in eyelid lesions. METHODS: Twenty two eyelid lesions were documented using a prototype, compound of two polarizing filters, orthogonal to each other, adapted to a slit lamp with an integrated digital camera. Images of the eyelid lesions were also obtained with non-polarized biomicroscopy and with a portable dermatoscope, and were compared regarding anatomical aspects. RESULTS: Anatomical structures imperceptible to conventional ophthalmic examination were evidenced using the polarized lenses, demonstrating that this tool can be useful to the ophthalmologist when assessing eyelid lesions. We have obtained high-quality images of the lesions. The slit lamp provided higher magnification, better focus control and easier assessment of eyelid lesions than the portable dermatoscope. CONCLUSION: Ophthalmologists already use the slit lamp in their practice. The adaptation of polarized lenses to this device is a cost-effective, fast and non-invasive method that permits to improve the diagnostic accuracy of eyelid lesions, evidencing anatomical structures imperceptible to conventional ophthalmic examination.

Orbitopalpebral and ocular sarcoidosis: what does the ophthalmologist need to know.

Sarcoidosis is a chronic multisystemic disease of unknown aetiology, characterised by non-caseating granulomas. Ocular involvement rate ranges from 30% to 60% among individuals with sarcoidosis, and can vary widely, making the diagnosis a challenge to the ophthalmologist. Cutaneous manifestations occur in about 22% of sarcoidosis cases, but eyelid involvement is rare. Eyelid swelling and nodules are the most frequent forms of eyelid involvement, but other findings have been reported. The joint analysis of clinical history, ancillary exams and compatible biopsy is needed for the diagnosis, as well as the exclusion of other possible conditions. This review aims to describe the different forms of presentations, the clinical reasoning and treatment options for ocular, eyelid and orbital sarcoidosis.

"Split-Face" Evaluation of Collagen Changes Induced by Periorbital Fractional CO2 Laser Resurfacing.

BACKGROUND: Periorbital fractional CO2 laser resurfacing has been employed for facial rejuvenation purposes. However, to the best of our knowledge, no study has objectively assessed periorbital neoformation and remodeling of local cutaneous collagen, in a split-face model, from skin samples obtained during upper blepharoplasty. OBJECTIVES: The authors sought to objectively evaluate neoformation and remodeling of local cutaneous collagen after periorbital skin fractional CO2 laser resurfacing. METHODS: Sixteen female patients presenting with dermatochalasis and periorbital rhytids were evaluated in a prospective and comparative study. All patients underwent unilateral periorbital fractional CO2 laser resurfacing 30 days before upper blepharoplasty. Quantification of types I and III collagen from laser-treated and untreated eyelid skin samples obtained during upper blepharoplasty was assessed with histochemical analysis (Picrosirius Red staining). Laser resurfacing treatment was applied to the untreated side immediately after the upper blepharoplasty. Two blinded, independent physicians evaluated clinical improvement in pretreatment and 1- and 6-month posttreatment digital images. RESULTS: Histochemical analysis showed significantly higher intensity in collagen types I (treated: 158.7 ± 5.3, untreated: 139.2 ± 5.0; P < 0.0001) and III (treated: 105.1 ± 7.7, untreated: 104.1 ± 7.1; P < 0.0001) in the fractional CO2 laser treatment samples; a greater difference was detected in collagen type I. A significant improvement in periorbital rhytidosis was observed 1 month after laser resurfacing (23%); a greater improvement in the periorbital region was observed 6 months after laser resurfacing and upper blepharoplasty (43.67%). CONCLUSIONS: Periorbital fractional CO2 laser resurfacing was an effective method to improve palpebral skin, with histochemical evidence of increase in collagen types I and III.

Assessment of self-esteem and psychological aspects in patients undergoing upper blepharoplasty / Avaliação da autoestima e aspectos psicológicos em pacientes submetidos à blefaroplastia superior

Abstract Objective: To evaluate the self-esteem and quality-of-life outcomes in patients undergoing upper blepharoplasty. Methods: A cross-sectional study was performed at Federal University of São Paulo. The self-esteem and quality-of-life of 29 patients undergoing upper blepharoplasty were compared with 20 age-matched volunteers from the general population. During preoperative assessment, the patients and volunteers underwent complete ophthalmological examinations and answered two questionnaires: the Rosenberg self-esteem scale (RSES) and the World Health Organization quality of life assessment (WHOQOL-BREF). The RSES is a ten-item questionnaire developed to measure self-esteem that are answered using a four-point scale. The scores range from 0 to 30, and lower scores indicate higher self-esteem. The WHOQOL-BREF is composed of 26 questions divided into four domains. Mean values greater than 5 are considered indicative of very good quality-of-life. Data from the RSES and quality-of-life scores were compared between the two groups using an unpaired t- test. Results: The mean self-esteem scores for the patients and volunteers were 10.31 ± 0.71 and 6.9 ± 0.99, respectively (p < 0.001). The mean response scores for the WHOQOL-BREF questionnaire for the patients and volunteers were 3.67 ± 0.08 and 3.76 ± 0.08, respectively (p = 0.449). For the psychological subscale of the WHOQOL-BREF questionnaire, the results for the patients and volunteers were 3.52 ± 0.09 and 3.78 ± 0.08, respectively (p = 0.041). Conclusions: Subjects who underwent upper blepharoplasty exhibited worse self-esteem based on the RSES. Regarding quality-of-life, as assessed using the WHOQOL-BREF questionnaire, significant differences between the groups were evident in the psychological aspects subscale. Our study confirms the importance of subjecting patients to psychological evaluation prior to upper blepharoplasty.

Resumo Objetivo: Avaliar os resultados de autoestima e qualidade de vida em pacientes submetidos à blefaroplastia superior. Métodos: Um estudo transversal foi realizado na Universidade Federal de São Paulo. A autoestima e a qualidade de vida de 29 pacientes submetidos à blefaroplastia superior foram comparadas com 20 voluntários pareados para idade. Durante a avaliação pré-operatória, os pacientes e voluntários foram submetidos a exames oftalmológicos completos e responderam a dois questionários: a escala de autoestima de Rosenberg (RSES) e a avaliação da qualidade de vida da Organização Mundial de Saúde (WHOQOL-BREF). O RSES é um questionário de dez itens desenvolvido para medir a autoestima que são respondidos usando uma escala de quatro pontos. Os escores variam de 0 a 30, e os escores mais baixos indicam maior autoestima. O WHOQOL-BREF é composto por 26 questões divididas em quatro domínios. Os valores médios acima de 5 são considerados indicativos de uma boa qualidade de vida. Os dados da RSES e os escores de qualidade de vida foram comparados entre os dois grupos usando um teste de t-teste não pareado. Resultados: Os escores médios de autoestima para pacientes e voluntários foram de 10,31 ± 0,71 e 6,9 ± 0,99, respectivamente (p <0,001). Os escores de resposta média para o questionário WHOQOL-BREF para pacientes e voluntários foram de 3,67 ± 0,08 e 3,76 ± 0,08, respectivamente (p = 0,449). Para a subescala psicológica do questionário WHOQOL-BREF, os resultados para pacientes e voluntários foram 3,52 ± 0,09 e 3,78 ± 0,08, respectivamente (p = 0,041). Conclusões: Aqueles submetidos à blefaroplastia superior apresentaram menor autoestima com base na RSES. Quanto à qualidade de vida, avaliada utilizando o questionário WHOQOL-BREF, diferenças significativas entre os grupos foram evidentes na subescala de aspectos psicológicos. Nosso estudo confirma a importância de submeter os pacientes à avaliação psicológica antes da blefaroplastia superior.

Infrabrow Skin Excision Associated With Upper Blepharoplasty to Address Significant Dermatochalasis With Lateral Hooding in Select Asian Patients.

PURPOSE: In Asian patients, lateral hooding in the aging upper eyelid is prominent and frequently seen. Removal of the redundant skin of this region during classic blepharoplasty tends to produce a resultant prolonged scar. Furthermore, as the height of the eyelid skin excision increases, suturing of the thick upper skin to the thin pretarsal skin can result in upper lid fullness. This study documents the combination of infrabrow skin excision and upper blepharoplasty to address lateral hooding in select patients of Asian ancestry. METHODS: This study is a retrospective chart review of patients who underwent infrabrow skin excision associated with upper blepharoplasty. The inclusion criteria were moderate and severe upper eyelid dermatochalasis in patients with high eyebrows and lateral hooding; residual lateral hooding following previous blepharoplasty. RESULTS: Thirty-two eyelids of 16 female patients of Japanese ancestry underwent infrabrow skin excision associated with upper blepharoplasty. The mean age of patients was 68.87 ± 7.88 years (57-82 years). Mean follow up was 37.25 ± 18.96 months (9-72 months). Patients were evaluated at 1, 3, 6, and 9 months at least. The Strasser system for evaluation of surgical results was applied at 3 months. All patients had scores indicating good results and were satisfied with the cosmetic outcome and improvement of visual field after surgery. No complications related to wound dehiscence, lagophthalmos, hypertrophic scars, or sensory changes were observed. CONCLUSION: The combination of infrabrow skin excision and upper blepharoplasty was effective to address moderate and severe dermatochalasis with lateral hooding in select patients of Japanese ancestry.

Melhorando os resultados da blefaroplastia superior: zetaplastia para correção de queda do supercílio lateral / Improving the results of upper eyelid blepharoplasty: zetaplasty to correct lateral eyebrow sliding

INTRODUÇÃO: Um problema estético frequentemente observado no processo de envelhecimento facial é a queda dos supercílios, principalmente na sua porção lateral. MÉTODOS: A fim de obter resultados estéticos satisfatórios e cicatriz menos extensa, apresentamos uma técnica menos invasiva para elevação do supercílio lateral. Esta técnica é indicada para casos selecionados de pacientes com dermatocálaze associada à queda da porção lateral do supercílio. RESULTADOS: A técnica mostrou-se de fácil execução, proporcionando resultados estéticos gratificantes, similares aos da técnica descrita por Castañares, com a vantagem de resultar em cicatrizes limitadas à região lateral do supercílio. CONCLUSÕES. A zetaplastia com transposição de retalhos cutâneos no terço lateral dos supercílios mostrou-se uma boa opção para a elevação desta área. Além de ser pouco invasiva, esta técnica apresenta como vantagens cicatriz pouco evidente, menor custo e proporciona um efeito estético natural nesta importante região da face.

INTRODUCTION: A frequent aesthetic problem that occurs in the aging process is the drooping of the eyebrows, more common and evident in the mid lateral aspect. METHODS: In order to obtain a satisfactory cosmetic result associated with minimal scar extension, we present a less invasive technique, indicated for select patients who present with dermatochalasis and lateral eyebrow sliding. RESULTS: This technique showed to be an easy procedure to execute and resulted in satisfactory aesthetic outcomes, similar to the technique described by Castañares, with the advantage of scar limited to the lateral region. CONCLUSIONS: As another option for the surgical elevation of the eyebrow lateral third segment, an easy Z-type skin flap transposition is a cost-effective procedure that can offer less evident scars with a natural aesthetic effect in this exposed area of the face.

Cicatricial ectropion secondary to psoriatic arthritis.

Ectropion is characterized by the eversion of the eyelid margin and the consequent exposure of the conjunctiva and cornea. The shortening of the anterior lamella of the lid causes cicatricial ectropion. We described a case of skin pathology causing cicatricial ectropion. The case is about a 68-year-old woman with a 2-year history of psoriatic arthritis. She complained of eyelid tearing and redness for two years. Due to the psoriasis, she presented a very dry skin, also in the periocular region, resulting in cicatricial ectropion. A skin graft was indicated to correct the eyelid malposition. Careful investigation should be performed in patients who have a skin disease that can lead to cicatricial ectropion.

Aberrações ópticas de alta ordem em pacientes com distonias faciais tratados com toxina botulínica / Ocular wavefront aberrations in patients with facial dystonia treated with botulinum toxin

OBJETIVO: Avaliar as aberrações ópticas de alta ordem em pacientes com distonias faciais tratados com toxina botulínica tipo A. MÉTODOS: Pacientes com diagnóstico clínico de espasmo hemifacial ou blefaroespasmo essencial em atividade foram submetidos ao exame biomicroscópico e à análise de frente de ondas através do aberrômetro Alcon LADARvision®, sob midríase medicamentosa. A seguir, foram tratados com injeções de toxina botulínica tipo A. Após um mês, a análise de frente de ondas foi repetida da mesma forma e pelo mesmo oftalmologista. As aberrações de alta ordem foram comparadas antes e após o tratamento. O teste T pareado foi utilizado para comparar os valores numéricos antes e após o tratamento. RESULTADOS: Foram incluídos no estudo um total de 11 pacientes, 6 com blefaroespasmo essencial (54,5 por cento) e 5 com espasmo hemifacial (45,5 por cento). Nos pacientes com espasmo hemifacial foram analisados apenas o lado acometido, totalizando 17 olhos com espasmo. A idade variou de 50 a 72 anos, com média de 65,9 ± 8,2 anos. Oito pacientes eram do sexo feminino (72,7 por cento), sendo a relação masculino/feminino de 1:2,6. A média do "root mean square" (RMS) das aberrações de alta ordem foi 0,68 antes e 0,63 após um mês do tratamento (p=0,01). A média da aberração esférica foi de 0,23 e 0,17 antes e após o tratamento respectivamente (p=0,01). Não houve diferenças estatisticamente significantes nos demais tipos de aberrações de alta ordem após o tratamento (p>0,05). CONCLUSÃO: O tratamento com toxina botulínica A pode diminuir as aberrações esféricas em pacientes com distonias faciais.

PURPOSE: To analyze the ocular wavefront aberrations in patients with facial dystonia treated with botulinum toxin A. METHODS: Patients with benign essential blepharospasm and hemifacial spasm in activity underwent slit lamp examination and bilateral wavefront analysis under pharmacologic mydriasis using Alcon LADARvision® wavefront aberrometry system. After that, all patients were treated with botulinum toxin A injections performed by the same ophthalmologist. After one month, the wavefront analysis was performed in the same way and by the same examiner. The main outcome measure was the change in ocular wavefront aberrations. Paired T-test was used to compare pre and post-injection numeric wavefront values. RESULTS: From a total of 11 patients enrolled in this study, 6 (54.5 percent) had essential blepharospasm and 5 (45.5 percent) had hemifacial spasm. The fellow eyes of patients with hemifacial spasm were not included, totalizing 17 eyes with spasm. Eight patients were female (72.7 percent) and three were male (27.3 percent), the male:female ratio was 1:2.6. The age ranged from 50 to 72 years old with a mean of 65.9 ± 8.2 years. The mean of high order root mean square (RMS) wavefront aberrations was 0.68 before and 0.63 one month after the treatment (p=0.01). Before the treatment, the mean of spherical aberration was 0.23 and decreased to 0.17 one month after the treatment (p=0.01). There was no significant difference in the other higher-order aberrations before and after the treatment (p>0.05). CONCLUSION: The treatment with botulium toxin may decrease spherical aberrations in patients with facial dystonia.

Oral azithromycin for treatment of posterior blepharitis.

PURPOSE: To evaluate the effects of oral azithromycin in patients with posterior blepharitis. METHODS: Twenty-six eyes of 13 patients with posterior blepharitis diagnosed by a qualified ophthalmologist were enrolled in this study. Patients were instructed to use oral azithromycin 500 mg per day for 3 days in 3 cycles with 7-day intervals. Subjective clinical outcomes were graded and scored 1 day before and 30 days after the end of the treatment (53 days after initiating the treatment) based on severity scores of: (1) eyelid debris; (2) eyelid telangiectasia; (3) swelling of the eyelid margin; (4) redness of the eyelid margin; and (5) ocular mucus secretion. For the assessment of global efficacy, patients were asked by the investigator to rate the subjective symptoms (eyelid itching, ocular itching, eyelid hyperemia, ocular hyperemia, ocular mucus secretion, photophobia, foreign body sensation, and dry eye sensation) on a scale of 0 (no symptoms) to 5 (severe symptoms). Break-up time, Schirmer I test, corneal fluorescein staining score, and rose bengal staining score were also performed in all patients. RESULTS: All clinical outcomes scoring showed statistically significant improvement after oral azithromycin, except for eyelid swelling. Average subjective symptom grading improved statistically after treatment with oral azithromycin, except for eyelid hyperemia, photophobia, and foreign body sensation. Average tear film break-up time values showed statistically significant improvement after the treatment with oral azithromycin. No statistically significant improvement was observed on average values of Schirmer I test, corneal fluorescein staining score, and rose bengal staining score. CONCLUSIONS: The combination of multiple clinical parameters shown in this study supports the clinical efficacy of pulsed oral azithromycin therapy for the management of posterior blepharitis.

Two-year outcome of partial lacrimal punctal occlusion in the management of dry eye related to Sjögren syndrome.

PURPOSE: To analyze the influence of thermal partial punctal occlusion on the ocular surface of dry eye related to Sjögren syndrome. MATERIAL AND METHODS: Thirty-seven eyes of 19 patients (3 male and 16 female; 49.11 ± 14.33 years old) with keratoconjunctivitis sicca were enrolled in this study. Superior and inferior partial occlusion were performed in both eyes under topical anesthesia using thermal cautery with a sterile tip to obtain lacrimal punctum smaller than 0.5 mm. Schirmer I, break-up-time, diameter of lacrimal puncta, corneal fluorescein, and rose Bengal staining scores were analyzed before and after 24 weeks and after 24 months of the procedure. All measurements were performed under controlled climate. RESULTS: The average lacrimal punctum diameter before the procedure was 0.65 ± 0.134 mm. All lacrimal puncta were successfully reduced to less than 0.5 mm after 4 weeks of the procedure. The average Schirmer I test values improved statistically after 24 weeks and maintained stable after 24 months. Average break-up-time, rose Bengal, and fluorescein staining score values improved statistically after 24 weeks and improved even more after 24 months. Average Schirmer I test, break-up-time, rose Bengal, and fluorescein staining scores showed significant improvement (p < 0.0001) after 24 months of partial thermal punctal occlusion. CONCLUSION: Our study showed that reducing the punctum diameter to 0.5 mm can improve vital staining scores, break-up-time, and Schirmer I test in dry eye related to Sjögren syndrome.

Treatment of the tear trough deformity with hyaluronic acid.

BACKGROUND: Volume loss and muscular hyperactivity are two major components of the aging process that contribute to the formation of the folds and wrinkles. Tear trough deformity is one of the most difficult depressions to correct surgically. OBJECTIVE: The authors evaluate the results of periorbital filling with hyaluronic acid (HA) in a small series of patients. METHODS: Between June 2008 and December 2009, 25 patients were treated with HA to correct tear trough deformities. The HA was administered into the preperiosteal tissues with a serial puncture technique and approximately 0.1 mL was injected at each pass. Each patient's before and after photographs were reviewed by three surgeons; to objectively assess the outcomes, a quantitative scale was used to grade the pre- and postinjection results. The significance of subjective aesthetic evaluation of the photographs was evaluated with the Mann-Whitney U-test. Differences were regarded as significant if probabilities were less than 0.05. RESULTS: The mean (SD) volume per side needed to achieve correction was 0.54 (0.27) mL on the right and 0.61 (0.30) mL on the left. Complications included some degree of bruising, erythema, and local swelling. Most patients (88%) had cosmetic improvement according to the independent evaluation. CONCLUSIONS: All patients were very satisfied with their results. During the course of the study, the authors determined that the ideal candidates for this treatment are young, with thick skin and a definite hollow.

[Ocular wavefront aberrations in patients with facial dystonia treated with botulinum toxin]. / Aberrações ópticas de alta ordem em pacientes com distonias faciais tratados com toxina botulínica.

PURPOSE: To analyze the ocular wavefront aberrations in patients with facial dystonia treated with botulinum toxin A. METHODS: Patients with benign essential blepharospasm and hemifacial spasm in activity underwent slit lamp examination and bilateral wavefront analysis under pharmacologic mydriasis using Alcon LADARvision wavefront aberrometry system. After that, all patients were treated with botulinum toxin A injections performed by the same ophthalmologist. After one month, the wavefront analysis was performed in the same way and by the same examiner. The main outcome measure was the change in ocular wavefront aberrations. Paired T-test was used to compare pre and post-injection numeric wavefront values. RESULTS: From a total of 11 patients enrolled in this study, 6 (54.5%) had essential blepharospasm and 5 (45.5%) had hemifacial spasm. The fellow eyes of patients with hemifacial spasm were not included, totalizing 17 eyes with spasm. Eight patients were female (72.7%) and three were male (27.3%), the male:female ratio was 1:2.6. The age ranged from 50 to 72 years old with a mean of 65.9 ± 8.2 years. The mean of high order root mean square (RMS) wavefront aberrations was 0.68 before and 0.63 one month after the treatment (p=0.01). Before the treatment, the mean of spherical aberration was 0.23 and decreased to 0.17 one month after the treatment (p=0.01). There was no significant difference in the other higher-order aberrations before and after the treatment (p>0.05). CONCLUSION: The treatment with botulium toxin may decrease spherical aberrations in patients with facial dystonia.

Temporary management of involutional entropion with octyl-2-cyanoacrylate liquid bandage application.

PURPOSE: To evaluate the use of octyl-2-cyanoacrylate liquid bandage (Band-Aid liquid, Ethicon, Johnson & Johnson, New Jersey, USA) as a temporary treatment in patients awaiting surgical repair for involutional entropion. METHODS: Thirteen patients (15 eyelids) with involutional entropion were evaluated while they waited for surgical intervention. The lids were repositioned by the application of octyl-2-cyanoacrylate liquid bandage in the malar fold. Patients were followed-up at days 1, 7 and 15. Assessment and duration of correction were recorded. RESULTS: All the patients presented successful correction at day 1, with significant improvements in signs and symptoms. The mean duration of action of the octyl2-cyanoacrylate liquid bandage was three days. No ocular or dermatological reactions were noted. CONCLUSION: Octyl-2-cyanoacrylate liquid bandage showed to be a simple, safe and effective option to temporarily treat involutional entropion, while patients waited for surgical intervention.

Temporary management of involutional entropion with octyl-2-cyanoacrylate liquid bandage application / Tratamento temporário do entrópio involucional com octil-2-cianoacrilato

PURPOSE: To evaluate the use of octyl-2-cyanoacrylate liquid bandage (Band-Aid liquid®, Ethicon, Johnson & Johnson, New Jersey, USA) as a temporary treatment in patients awaiting surgical repair for involutional entropion. METHODS: Thirteen patients (15 eyelids) with involutional entropion were evaluated while they waited for surgical intervention. The lids were repositioned by the application of octyl-2-cyanoacrylate liquid bandage in the malar fold. Patients were followed-up at days 1, 7 and 15. Assessment and duration of correction were recorded. RESULTS: All the patients presented successful correction at day 1, with significant improvements in signs and symptoms. The mean duration of action of the octyl2-cyanoacrylate liquid bandage was three days. No ocular or dermatological reactions were noted. CONCLUSION: Octyl-2-cyanoacrylate liquid bandage showed to be a simple, safe and effective option to temporarily treat involutional entropion, while patients waited for surgical intervention.

OBJETIVO: Avaliar o uso de octil-2-cianoacrilato (Band-Aid liquid®, Ethicon, Johnson & Johnson, New Jersey, EUA) como tratamento temporário em pacientes com entrópio involucional, enquanto aguardam cirurgia. MÉTODOS: Foram avaliados treze pacientes (15 pálpebras) com entrópio involucional enquanto aguardavam tratamento cirúrgico definitivo. As pálpebras foram reposicionadas através da aplicação de octil-2-cianoacrilato na prega malar. Os pacientes foram avaliados nos dias 1, 7 e 15. Foram descritos os resultados e duração da aplicação. RESULTADOS: Todos os pacientes apresentaram melhora satisfatória da posição palpebral no dia 1, com melhora significativa dos sinais e sintomas. A média de duração da ação do octil-2-cianoacrilato foi de três dias. Não foram observadas reações dermatológicas ou oculares. CONCLUSÃO: Octil-2-cianoacrilato mostrou-se como uma alternativa simples, segura e eficaz para o tratamento temporário do entrópio involucional, enquanto os pacientes aguardavam a realização do tratamento cirúrgico.

Presentation of glaucoma in an urban tertiary care hospital in South America: legal blindness and prevalence.

PURPOSE: To determine disease severity in glaucoma patients who presented to a tertiary care service for the first time and to determine the prevalence of different types of glaucoma. METHODS: Retrospective analysis of data of patients referred to the Glaucoma Service at the Santa Casa de Misericórdia de São Paulo, Brazil in 2007. A complete chart review from 448 patients was done; data regarding age, gender, ethnicity, family history, duration of the disease, previous treatment, best corrected visual acuity, cup-to-disc ratio, intraocular pressure, diagnosis and treatment were collected. Glaucoma was diagnosed by the presence of typical optic disk abnormalities, disregarding IOP values. RESULTS: 52.3% of patients presented visual acuity less than or equal to 20/200 and 67.7% presented cup-to-disc ratio between 0.8 and 1.0 in the worse-seeing eye; 13.4% of patients were considered legally blind. Primary open angle glaucoma was the most prevalent form of glaucoma (54.2%, 95% CI: 48.5-59.5) and chronic angle closure glaucoma was the second most frequent (11.5%, 95% CI: 8.25-15.5). CONCLUSION: A considerable rate of patients (almost 60% in the better-seeing eye and 70% in the worse-seeing eye) presented with advanced glaucoma. Strategies that create conditions for early diagnosis are deemed necessary to reduce glaucoma-related blindness in the Brazilian population.

Hospital psiquiátrico: um mal necessário? discussões acerca da reforma psiquiátrica brasileira / Psychiatric hospital: is it necessary? discussions about the brazilian psychiatric renovation

Nas últimas décadas, vários setores da sociedade têm se preocupado com o problema das instituições psiquiátricas e muitos países têm pensado novos projetos para modificar a assistência psiquiátrica. No Brasil, a Lei n° 10216 de abril de 2001, da autoria do deputado Paulo Delgado, dispõe sobre a proteção e os direitos das pessoas portadoras de transtornos mentais. Vária perguntas surgem quando se examina o processo da reforma psiquiátrica brasileira. Por meio de pesquisa bibliográfica, entrevistas e dados oficiais das condições dos hospitais e outros setores de atendimento ao doente psiquiátrico, procurou-se compreender o processo de fechamento dos hospitais psiquiátricos, ora em curso no país, diante das condições efetivas para que a reforma e, em particular, a lei de Paulo Delgado possam ser cumpridas sem que haja prejuízo ainda maior dos doentes psiquiátricos.