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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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