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3.
Indian J Ophthalmol ; 69(5): 1161-1166, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33913851

RESUMO

Purpose: The aim of this work was to study the clinical presentation, management and outcomes of orbital and adnexal amyloidosis. Methods: This retrospective analysis included all the patients diagnosed with orbital and adnexal amyloidosis between January 1990 and December 2019. Positive staining with Congo Red and apple-green birefringence on polarized light microscopy established the diagnosis. Data analyzed included demographic profile, varied presentations, management, and outcome. Results: Thirty-three eyes of 26 patients were included. The male:female ratio was 1:1. The mean age of the study population was 42.6 ± 16 years. The median duration of symptoms was two years. Unilateral involvement was seen in 19 eyes (right = 11, left = 8). The most common presenting feature was acquired ptosis. Eyelid was the most commonly affected site followed by orbit and conjunctiva. Two patients had systemic involvement in the form of multiple myeloma and lymphoplasmacytic lymphoma. Complete excision was done in seven (26.9%) cases while 19 (73.1%) cases underwent debulking. Three patients underwent ptosis surgery. The median duration of follow-up was 1.5 years. Three cases had recurrence and underwent repeat surgery. Conclusion: Orbit and adnexa is a rare site for amyloidosis. It is usually localized; however it can occur as a part of systemic amyloidosis. Eyelid is the most common site of involvement and patients usually present as eyelid mass or ptosis. Complete excision is difficult and most of the patients usually undergo debulking surgery. All patients should undergo screening for systemic amyloidosis.


Assuntos
Amiloidose , Blefaroptose , Doenças da Túnica Conjuntiva , Doenças Orbitárias , Adulto , Amiloidose/diagnóstico , Amiloidose/epidemiologia , Amiloidose/terapia , Blefaroptose/diagnóstico , Blefaroptose/epidemiologia , Blefaroptose/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/epidemiologia , Doenças Orbitárias/terapia , Estudos Retrospectivos
4.
BMJ Case Rep ; 14(3)2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731400

RESUMO

A 73-year-old white man presents with left-sided ptosis and diplopia in the absence of ophthalmoplegia, with left hemibody paresthesia. He reports intermittent dysphagia and dizziness for 1 month and diarrhoea for 2 months. Serum and electrodiagnostic studies confirmed the diagnosis of myasthenia gravis. This case highlights the non-classic presentation of myasthenia gravis in the absence of ophthalmoplegia with a unique unexplained hemisensory deficit.


Assuntos
Blefaroptose , Transtornos de Deglutição , Miastenia Gravis , Oftalmoplegia , Idoso , Blefaroptose/etiologia , Transtornos de Deglutição/etiologia , Diplopia/etiologia , Humanos , Masculino , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico
5.
Am J Case Rep ; 22: e927556, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33431787

RESUMO

BACKGROUND Fibrosing mediastinitis is a rarely seen, progressive disease. It results from an excessive fibrotic reaction in the mediastinum. We describe a presentation of fibrosing mediastinitis that, to our knowledge, has never been seen before. CASE REPORT A 30-year-old female Colombian flight attendant presented with a right eyelid droop. Examination revealed partial right-sided ptosis and miosis but no anhidrosis. An ill-defined firm swelling was palpable at the root of the neck. Chest radiography revealed a widened mediastinum, and computerized tomography (CT) showed a right paratracheal mass without calcification extending to the thoracic inlet, encasing multiple blood vessels. All basic blood tests, magnetic resonance imaging of the head, and ultrasound Doppler of the neck vessels were normal. History and work up for infections including fungal diseases, granulomatous diseases, vasculitis, and autoimmune diseases were negative. Positron emission tomography (PET) showed significant FDG uptake in the mediastinum. Mediastinal biopsy was histologically consistent with fibrosing mediastinitis. All relevant immunohistochemistry and microbiological studies were negative. Subsequently, the patient developed signs of superior vena cava compression; this was managed by balloon angioplasty, which resulted in improvement of symptoms. However, over time, her symptoms worsened progressively, resulting in a left-sided ptosis and radiological progression of the mass on CT. She received treatment with rituximab and concomitant steroids, which yielded excellent results: the treatment led to both resolution of her symptoms and regression of the mass and its metabolic activity on PET scan. CONCLUSIONS Fibrosing mediastinitis can present with an incomplete Horner's syndrome. Treatment with rituximab and steroids shows promising results in select cases of metabolically active idiopathic fibrosing mediastinitis.


Assuntos
Blefaroptose/etiologia , Mediastinite/complicações , Mediastinite/diagnóstico , Miose/etiologia , Esclerose/complicações , Esclerose/diagnóstico , Adulto , Feminino , Humanos , Mediastinite/terapia , Esclerose/terapia
8.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(12): 1320-1325, 2020 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-33328004

RESUMO

A boy, aged 2 years and 4 months, had a sudden onset of blepharoptosis of the right eyelid, accompanied by the mouth deviated to the right side, drinking cough, nystagmus, and developmental regression. Cranial MRI showed softening lesions formed after infarction of the right dorsolateral medulla oblongata, while head CT angiography showed no imaging of the proximal part of the V4 segment of the right vertebral artery. The child was diagnosed with dorsolateral medulla oblongata syndrome and was treated with gamma globulin to regulate immune function, with mannitol to reduce neuronal edema, with low-molecular-weight heparin sodium to improve local hypercoagulation of occluded blood vessels, with hyperbaric oxygen to improve local ischemia and hypoxia and promote the recovery of brain function, and with neuromuscular electrical stimulation to promote the recovery of neuromuscular function. Before discharge, only mild right ataxia and Horner syndrome remained. This article reports the first case of infantile dorsolateral medulla oblongata syndrome and provides experience for the diagnosis and treatment of the disease.


Assuntos
Blefaroptose/etiologia , Disartria/etiologia , Síndrome Medular Lateral/diagnóstico , Bulbo/diagnóstico por imagem , Pré-Escolar , Humanos , Síndrome Medular Lateral/complicações , Imageamento por Ressonância Magnética , Masculino
10.
Rinsho Shinkeigaku ; 60(8): 527-532, 2020 Aug 07.
Artigo em Japonês | MEDLINE | ID: mdl-32641625

RESUMO

We describe herein a case with left-side ptosis induced by pure midbrain infarction in a 49-year-old woman. She also presented with diplopia and right-side cerebellar ataxia. MRI demonstrated new ischemic stroke of the left ventral paramedian midbrain. In this case, ischemia of the left oculomotor fascicles caused the left-side ptosis and diplopia, and ischemia of the left decussation of the superior cerebellar peduncle caused the right-side cerebellar ataxia. These symptoms resulted from inner superior medial mesencephalic branch infraction. This case offers an educational example that can be explained by models proposed in the past and requires knowledge of neuroanatomy and cerebrovasculature.


Assuntos
Blefaroptose/etiologia , Infarto Cerebral/complicações , Mesencéfalo/irrigação sanguínea , Feminino , Humanos , Pessoa de Meia-Idade
11.
J Postgrad Med ; 66(3): 162-164, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32675453

RESUMO

Plus-minus lid syndrome is a rare manifestation of midbrain infarct, characterized by ptosis of one eye and lid retraction in the other eye. It has also been described in ocular myasthenia gravis, orbital myositis, or after lesions of the oculomotor nerve. Our patient was a 55-year-old man with hypertension and atrial fibrillation, who presented to us with acute onset left-sided ptosis and right-sided eyelid retraction. He was apathic and had right-sided ataxia. His MRI of the brain showed acute infarct involving the paramedian midbrain. To our knowledge, severe apathy and resultant executive function disorder have not been described previously in a patient having plus-minus lid syndrome with ataxia.


Assuntos
Fibrilação Atrial/complicações , Blefaroptose/etiologia , Hipertensão/complicações , Doenças do Nervo Oculomotor/complicações , Anticoagulantes/administração & dosagem , Apatia , Ataxia , Fibrilação Atrial/tratamento farmacológico , Blefaroptose/fisiopatologia , Infarto Cerebral/complicações , Infarto Cerebral/fisiopatologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hipertensão/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Mesencéfalo/irrigação sanguínea , Pessoa de Meia-Idade , Nervo Oculomotor/fisiopatologia , Doenças do Nervo Oculomotor/fisiopatologia , Inibidores da Agregação Plaquetária/administração & dosagem , Síndrome , Resultado do Tratamento
12.
Curr Opin Ophthalmol ; 31(4): 241-246, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32487809

RESUMO

PURPOSE OF REVIEW: Refractive surgery is one of the most popular elective procedures performed in the world. Given that dry eye is a common complaint following keratorefractive surgery, evaluation, and treatment of periocular conditions that further predispose the patient to dry eye symptoms is an important part of the presurgical assessment. Periocular conditions and surgeries can also affect the ocular surface and keratometry, and should be addressed. For example, ptosis, orbital fat herniation, ectropion, and eyelid masses have been shown to induce corneal topography changes and astigmatism. The oculoplastic considerations for refractive surgery include both the contribution of eyelid position on dry eye, ocular surface damage, refractive error, and outcomes, as well as the timing of oculoplastic surgery in relation to the refractive surgery. In this review, the recently published literature on eyelid and orbital surgery in relation to keratorefractive surgery is reviewed to elucidate the relationship of periocular factors with refractive surgery outcomes and complications. To improve keratorefractive surgery outcomes, a literature review is presented, discussing evaluation, management, and timing of management of oculoplastics conditions. RECENT FINDINGS: Dry eye syndrome is a well known complication of keratorefractive procedures. This is exacerbated with concurrent eyelid or orbital disorders, such as ectropion, lagophthalmos, and thyroid eye disease. In addition to impacting dry eye and ocular surface damage, eyelid surgeries can also affect corneal topography and refraction. Studies have found that patients with ptosis have topographic corneal aberrations from the eyelid exerting pressure on the cornea, while ptosis repair and blepharoplasty patients may undergo an astigmatic change postoperatively. Finally, the corneal flap created in laser-assisted in situ keratomileusis may be at risk for displacement or damage postoperatively with this risk changing, depending on method of flap creation, and time elapsed since keratorefractive surgery. SUMMARY: Eyelid and orbital conditions that predispose to dry eye syndrome and refractive changes should be evaluated and optimized prior to keratorefractive surgery. Patients electing to have oculoplastic surgery, like ptosis repair, should be fully healed prior to any refractive surgery to allow both refractive changes and eyelid positions to stabilize prior to the refractive surgery.


Assuntos
Blefaroptose/fisiopatologia , Síndromes do Olho Seco/fisiopatologia , Doenças Orbitárias/fisiopatologia , Erros de Refração/fisiopatologia , Procedimentos Cirúrgicos Refrativos , Astigmatismo/cirurgia , Blefaroptose/etiologia , Síndromes do Olho Seco/etiologia , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ , Ceratoplastia Penetrante , Doenças Orbitárias/etiologia , Período Pós-Operatório , Refração Ocular/fisiologia
13.
Rev. clín. med. fam ; 13(2): 149-152, jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-199837

RESUMO

Presentamos un caso clínico de eritema multiforme. Se trata de una dermatosis aguda con lesiones muco-cutáneas polimorfas que suelen ser bilaterales y simétricas. Su curso suele ser benigno y autolimitado. Por esta razón el tratamiento es sintomático y responden a diversas causas. En raras ocasiones, la evolución tórpida hace de este proceso una enfermedad grave que requiere medidas de soporte extraordinarias como en el síndrome de Stevens-Johnson, por lo que un médico de familia ha de conocerlo y saber tratarlo


We present a clinical case of erythema multiforme. This is an acute dermatosis with polymorphous mucocutaneous lesions which are usually bilateral and symmetric. This usually has a benign and self-limited course. For this reason, treatment is symptomatic and resulting from different causes. Rarely, a torpid evolution makes this condition a serious disease that requires extraordinary support measures like in Stevens-Johnson syndrome. Therefore, family doctors should know it and know how to treat it


Assuntos
Humanos , Masculino , Idoso , Eritema Multiforme/diagnóstico , Síndrome de Stevens-Johnson/diagnóstico , Malassezia/isolamento & purificação , Diagnóstico Diferencial , Prurido/etiologia , Blefaroptose/etiologia , Conjuntivite/etiologia
14.
Pediatr. aten. prim ; 22(86): 165-168, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198531

RESUMO

El sarcoma granulocítico es una manifestación extramedular de la leucemia mieloide aguda (LMA) poco frecuente. Es más común en la población pediátrica y puede presentarse en cualquier momento en el curso de la enfermedad. En ocasiones, puede preceder a la aparición clínica de leucemia mieloide aguda. Se presenta el caso de un niño de tres años con infiltración orbitaria bilateral que precipitó el diagnóstico de LMA


Granulocytic sarcoma is an unusual extramedullary manifestation of acute myeloid leukemia (AML). It is more common in the pediatric population and it may present at any time in the course of the disease. Occasionally, it may precede the clinical onset of acute myeloid leukemia. The case of a 3-year-old male child with a bilateral orbital infiltration that precipitated the diagnosis of AML is presented


Assuntos
Humanos , Masculino , Pré-Escolar , Leucemia Mieloide Aguda/diagnóstico , Sarcoma Mieloide/diagnóstico , Neoplasias Orbitárias/diagnóstico , Blefaroptose/etiologia , Exoftalmia/etiologia , Citometria de Fluxo/métodos
16.
Plast Reconstr Surg ; 145(5): 1155-1162, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332530

RESUMO

BACKGROUND: Cosmetic treatment of the forehead using neuromodulators is challenging. To avoid adverse events, the underlying anatomy has to be understood and thoughtfully targeted. Clinical observations indicate that eyebrow ptosis can be avoided if neuromodulators are injected in the upper forehead, despite the frontalis muscle being the primary elevator. METHODS: Twenty-seven healthy volunteers (11 men and 16 women) with a mean age of 37.5 ± 13.7 years (range, 22 to 73 years) and of diverse ethnicity (14 Caucasians, four African Americans, three Asians, and six of Middle Eastern descent) were enrolled. Skin displacement vector analyses were conducted on maximal frontalis muscle contraction to calculate magnitude and direction of forehead skin movement. RESULTS: In 100 percent of investigated volunteers, a bidirectional movement of the forehead skin was observed: the skin of the lower forehead moved cranially, whereas the skin of the upper forehead moved caudally. Both movements converged at a horizontal forehead line termed the line of convergence, or C-line. The position of the C-line relative to the total height of the forehead was 60.9 ± 10.2 percent in men and 60.6 ± 9.6 percent in women (p = 0.941). Independent of sex, the C-line was located at the second horizontal forehead line when counting from superior to inferior (men, n = 2; women, n = 2). No difference across ethnicities was detected. CONCLUSIONS: The identification of the C-line may potentially guide practitioners toward more predictable outcomes for forehead neuromodulator injections. Injections above the C-line could mitigate the risk of neuromodulator-induced brow ptosis.


Assuntos
Blefaroptose/prevenção & controle , Técnicas Cosméticas/efeitos adversos , Músculos Faciais/anatomia & histologia , Fármacos Neuromusculares/efeitos adversos , Envelhecimento da Pele/efeitos dos fármacos , Adulto , Idoso , Blefaroptose/etiologia , Toxinas Botulínicas/administração & dosagem , Toxinas Botulínicas/efeitos adversos , Músculos Faciais/efeitos dos fármacos , Músculos Faciais/inervação , Feminino , Testa , Voluntários Saudáveis , Humanos , Injeções Intramusculares/efeitos adversos , Injeções Intramusculares/métodos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Adulto Jovem
17.
J Craniofac Surg ; 31(5): e481-e483, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310889

RESUMO

Delayed orbital apex syndrome (OAS) is rare during orbital blowout fracture reconstruction. A 30-year-old woman fractured the right orbital floor in a fall and undergone repairing operation 2 weeks later. After severe sneezing on postoperative day 10, she gradually arose vision loss, ophthalmoplegia, ptosis with a dilated and fixed pupil within few hours, then consulted our department and was diagnosed as OAS. Computed tomography scan showed displaced implant and retrobulbar emphysema resulting in a constellation of compression to orbital apex. Therefore, an exploratory operation was engaged to reposition the implant and reduce the emphysema concurrent with mega-dose steroids. The patient regained vision immediately and resolved all symptoms at the 6 months follow-up.


Assuntos
Blefaroptose/etiologia , Enfisema/etiologia , Oftalmoplegia/etiologia , Fraturas Orbitárias/cirurgia , Complicações Pós-Operatórias , Distúrbios Pupilares/etiologia , Transtornos da Visão/etiologia , Adulto , Feminino , Humanos , Período Pós-Operatório , Tomografia Computadorizada por Raios X
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