RESUMO
PURPOSE: To report three cases of eyelid involvement by sarcoidosis. In one of them, it mimicked a malignant lesion. METHODS: Retrospective case reports. RESULTS: A 73-year-old man presented with destruction of the left lower eyelid for 2 years. He had granulomatous uveitis in the left eye. Chest CT scan showed parenchymal abnormalities that could correspond to sarcoidosis. Skin biopsy revealed noncaseating granuloma. Oral and topical corticosteroids resulted in improvement of the condition. A 72-year-old female patient presented with cutaneous infiltration of the left upper eyelid for 1 month. Biopsy was consistent with sarcoidosis. Endobronchial biopsies showed interstitial fibrosis. Oral prednisone improved the condition. A 65-year-old female patient presented with edema of the right upper eyelid for 2 months. Full-thickness biopsy showed granuloma without necrosis. There was an improvement with oral steroid. CONCLUSION: Although eyelid involvement in sarcoidosis is uncommon, different forms of presentation, including destructive lesions, can be observed.
Assuntos
Sarcoidose , Idoso , Pálpebras/patologia , Feminino , Granuloma/diagnóstico , Granuloma/tratamento farmacológico , Humanos , Masculino , Prednisona/uso terapêutico , Estudos Retrospectivos , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológicoRESUMO
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.
Assuntos
Endoftalmite , Oftalmopatias , Oftalmologistas , Sarcoidose , Endoftalmite/complicações , Oftalmopatias/etiologia , Pálpebras/patologia , Granuloma/patologia , Humanos , Sarcoidose/complicações , Sarcoidose/diagnósticoRESUMO
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute and potentially fatal inflammatory vesiculobullous reactions that affect the skin and mucous membranes, and which are most often triggered by particular medications and infections. In Brazil, the drugs most frequently associated with TEN and SJS include cold medicine such as dipyrone and NSAIDs, followed by carbamazepine, phenobarbital, penicillin, and allopurinol. Genetic variations have been found to increase the risk of SJS/TEN in response to triggering factors such as medications. The most closely associated genes found in Brazilian cold-medicine-related SJS/TEN patients with severe ocular complications are HLA-A*66:01 in those of mixed African and European ancestry and HLA-B*44:03 and HLA-C*12:03 in those of solely European ancestry. Our classification system for grading ocular surface complication severity in SJS/TEN patients revealed the most severe complications to be limbal stem cell deficiency and dry eye. Changes to the conjunctival flora have also been observed in SJS/TEN patients. Our group identified bacterial colonization in 95% of the eyes (55.5% of which were gram-positive cocci, 25.5% of which were gram-negative bacilli, and 19% of which were gram-positive bacilli). Several new treatment options in the acute and chronic ocular management of the SJS/TEN patients have been described. This article highlights some Brazilian institutions' contributions to ocular surface care in both the acute phase (including the use of amniotic membrane transplantation) and the chronic phase (such as eyelid margin and fornix reconstruction, minor salivary gland transplantation, amniotic membrane and limbal transplantation, scleral contact lenses, anti-angiogenic eyedrops for corneal neovascularization, ex-vivo cultivated limbal epithelium transplantation, conjunctival-limbal autografting, oral mucosa transplantation, and keratoprosthesis).
RESUMO
OBJECTIVE: To evaluate minor salivary glands and labial mucous membrane graft in patients with severe symblepharon and dry eye secondary to Stevens-Johnson syndrome (SJS). METHODS: A prospective, non-comparative, interventional case series of 19 patients with severe symblepharon and dry eye secondary to SJS who underwent labial mucous membrane and minor salivary glands transplantation. A complete ophthalmic examination including the Schirmer I test was performed prior to and following surgery. All patients had a preoperative Schirmer I test value of zero. RESULTS: Nineteen patients with severe symblepharon and dry eye secondary to SJS were included in the study. There was a statistically significant improvement in the best spectacle-corrected visual acuity in eight patients (t test; p=0.0070). Values obtained in the Schirmer I test improved significantly in 14 eyes (73.7%) 6 months following surgery (χ(2) test; p=0.0094). A statistically significant increase in tear production (Schirmer I test) was found in eyes that received more than 10 glands per graft compared with eyes that received fewer glands (χ(2) test; p=0.0096). Corneal transparency improved significantly in 11 (72.2%) eyes and corneal neovascularisation improved significantly in five eyes (29.4%) (McNemar test; p=0.001 and p=0.0005). The symptoms questionnaire revealed improvement in foreign body sensation in 53.6% of the patients, in photophobia in 50.2% and in pain in 54.8% (Kruskal-Wallis test; p=0.0167). CONCLUSION: Labial mucous membrane and minor salivary glands transplantation were found to constitute a good option for the treatment of severe symblepharon and dry eye secondary to SJS. This may be considered as a step prior to limbal stem cell and corneal transplantation in these patients.
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Doenças da Túnica Conjuntiva/cirurgia , Síndromes do Olho Seco/cirurgia , Doenças Palpebrais/cirurgia , Mucosa Bucal/transplante , Glândulas Salivares Menores/transplante , Síndrome de Stevens-Johnson/complicações , Adulto , Doenças da Túnica Conjuntiva/etiologia , Doenças da Túnica Conjuntiva/fisiopatologia , Córnea/fisiopatologia , Síndromes do Olho Seco/etiologia , Síndromes do Olho Seco/fisiopatologia , Doenças Palpebrais/etiologia , Doenças Palpebrais/fisiopatologia , Feminino , Humanos , Freio Labial , Masculino , Estudos Prospectivos , Inquéritos e Questionários , Técnicas de Sutura , Lágrimas/fisiologia , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
Sebaceous carcinoma of the eyelid is a very rare slow-growing tumor and is considered an aggressive eyelid neoplasm. It can reach mortality rate of about 6 percent. Diagnosis is often delayed because of its ability to masquerade as other periocular lesions, both clinically and histologically. We present three cases of sebaceous carcinoma, with different surgical outcomes, showing the importance of early diagnosis.
Carcinoma sebáceo é um tumor raro de crescimento lento considerado uma das mais agressivas neoplasias palpebrais. Pode alcançar taxa de mortalidade de aproximadamente 6 por cento. O diagnóstico tardio é comum devido a sua habilidade de se confundir com outras lesões perioculares tanto clinicamente quanto histologicamente. Relatamos três casos de carcinoma sebáceo da pálpebra com diferentes resultados cirúrgicos, enfatizando a importância do diagnóstico precoce.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma Sebáceo , Neoplasias Palpebrais , Neoplasias das Glândulas Sebáceas , Adenocarcinoma Sebáceo/diagnóstico , Adenocarcinoma Sebáceo/cirurgia , Diagnóstico Diferencial , Neoplasias Palpebrais/diagnóstico , Neoplasias Palpebrais/cirurgia , Pálpebras/cirurgia , Neoplasias das Glândulas Sebáceas/diagnóstico , Neoplasias das Glândulas Sebáceas/cirurgia , Resultado do TratamentoRESUMO
Sebaceous carcinoma of the eyelid is a very rare slow-growing tumor and is considered an aggressive eyelid neoplasm. It can reach mortality rate of about 6%. Diagnosis is often delayed because of its ability to masquerade as other periocular lesions, both clinically and histologically. We present three cases of sebaceous carcinoma, with different surgical outcomes, showing the importance of early diagnosis.
Assuntos
Adenocarcinoma Sebáceo , Neoplasias Palpebrais , Neoplasias das Glândulas Sebáceas , Adenocarcinoma Sebáceo/diagnóstico , Adenocarcinoma Sebáceo/cirurgia , Idoso , Diagnóstico Diferencial , Neoplasias Palpebrais/diagnóstico , Neoplasias Palpebrais/cirurgia , Pálpebras/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias das Glândulas Sebáceas/diagnóstico , Neoplasias das Glândulas Sebáceas/cirurgia , Resultado do TratamentoRESUMO
Prolapsed orbital fat has rarely been described and is often confused with other conjunctival tumours, such as dermolipoma. We describe the clinical features and treatment of 15 patients with prolapsed orbital fat. We report here our experience in 15 consecutive patients who presented to the Vision Institute of Federal University of São Paulo, Brazil, between July 2004 and December 2007. Age, sex, presenting complaint, physical findings, associated local and systemic diseases, type of treatment, and complications were recorded. Ten patients were men, and ages ranged from 44-86 (mean 68). Eleven patients presented with unilateral disease. Thirteen had superotemporal prolapse, and two atypical superonasal prolapse. Two gave a history of trauma. All patients had the prolapsed fat excised for cosmetic reasons. There were no complications. Orbital fat prolapse is usually superotemporal, mainly in men, and is easily differentiated from other lesions, such as prolapsed lacrimal gland. Excision is always indicated, usually for cosmetic reasons.
Assuntos
Tecido Adiposo/patologia , Doenças Orbitárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Tecido Adiposo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos de Coortes , Doenças da Túnica Conjuntiva/patologia , Doenças da Túnica Conjuntiva/cirurgia , Estética , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/patologia , Prolapso , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: To describe the results of a conservative and reversible technique for the treatment of progressive myopathic blepharoptosis in cases when surgery is not indicated, using octyl-2-cyanoacrylate liquid bandage. METHODS: Ten consecutive patients with progressive myopathic blepharoptosis were studied. Octyl-2-cyanoacrylate liquid bandage was applied to the upper eyelid to create a deeper eyelid crease. Margin reflex distance, photographs, and visual fields were obtained prior to and after treatment. RESULTS: All patients described a better appearance after application of the product, and none had an allergic response. All cases had an increase in the margin reflex distance and improvement in visual fields. CONCLUSION: Octyl-2-cyanoacrylate liquid bandage is an alternative method that is simple, safe, and effective in the management of severe blepharoptosis. Moreover, it can be used in patients without systemic conditions or those who are unwilling to undergo a surgical procedure.