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 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Forty patients with hypertelorism seen in the past 16 years were reviewed retrospectively. Combined intra- and extracranial surgical approach was used for 37 severe and moderate cases and subcranial approach (U-osteotomy) for 3 moderate cases. Gratifying results were obtained in patients with different types of hypertelorism by a multidisciplinary team. Complications were also reviewed. Of the 37 cases of intra- and extracranial corrections, 1 died, 4 had cerebrospinal fluid leakage and 4 had keratitis. No seizure, cerebral edema, meningitis, blindness, and ptosis occurred in this series. The average age was 13 years and two months. Operating time averaged 6 hours and 50 minutes. Hypertelorism was mostly attributable to craniofacial cleft, craniosynostosis, frontoethmoidal meningoencephalocele, frontonasal fibrous dysplasia, and trauma. Satisfactory esthetic appearance was achieved in most of the cases.
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PMID:Surgical correction of hypertelorism. Report of 40 cases. 840 75

The authors reviewed 44 tarsoconjunctival grafts performed from 1983 to 1993 to determine the nature and severity of complications related to these grafts. Follow-up ranged from 3 weeks to 10 years, with a mean of 23 months. The complications were categorized as none, minor, or major. A complication was deemed major if it required a second surgical procedure for treatment. Eleven percent (5/44) of patients had major complications, including marked upper lid retraction after upper lid reconstruction (1), wound dehiscence (2), cicatricial ectropion (1), and excessive lower lid laxity (1). Seventy-three percent (32/44) of patients had minor complications. Minor complications included trichiasis (5), notching of the donor and/or recipient lid margin (9), mild lid retraction (3), contour deformity (2), granuloma (2), prolonged edema or erythema (4), symblepharon (1), mild ectropion (2), punctate keratitis (1), minimal ptosis (1), and epiphora (1). Sixteen percent (7/44) had no complications. Despite the frequent minor complications and the occasional major complications, the use of free tarsoconjunctival grafts remains a valuable procedure in the surgeon's armamentarium for reconstruction of major eyelid defects. Knowledge and early recognition of the possible complications may result in better patient care.
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PMID:Complications of tarsoconjunctival grafts. 865 58

Two patients, men aged 82 and 53 years, with weakness of the facial muscles after surgery in the posterior fossa had keratitis caused by the inability to blink and to close the eye. Botulinum toxin type A was injected into the levator palpebrae superioris muscle under electromyographic control. A selective, reversible paralysis of this muscle was induced without weakness of the anatomically related rectus superior muscle. This botulinum toxin-induced protective ptosis appeared to be effective and safe in the treatment and prevention of keratitis in patients with a temporary weakness of the facial muscles.
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PMID:[Cornea protection in ptosis induced by botulinum injection]. 868 96

We describe 2 cases of the rare entity of bilateral infiltration of the eyelids by metastatic breast carcinoma. In 1 case, this was the first manifestation of the tumor. Both women had ptosis and lagophthalmos with secondary exposure keratitis.
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PMID:Bilateral lagophthalmos. An unusual presentation of metastatic breast carcinoma. 879 Jan 6

Botulinum toxin has become the initial treatment of choice for the management of essential blepharospasm, hemifacial spasm and other craniocervical dystonias. Numerous studies have confirmed a 90% to 95% response rate. Although a number of common side effects have been reported, the occurrence and incidence of rare local complications remains poorly understood. More importantly, the acute and chronic distant effects of botulinum toxin have not been clearly elucidated. A better understanding of such effects is essential if clinicians are to appropriately advise patients on the use of this therapeutic modality. This article is based on the Duke University experience in the management of over 500 patients with craniocervical spasm disorders, combined with a review of the published literature. These disorders include essential blepharospasm, oromandibular dystonia, hemifacial spasm, and torticollis. The incidence of side effects following more than 6000 treatments with botulinum toxin is presented. Pertinent research relating to the causes of these complications is also reviewed. The most common complications of treatment with botulinum toxin are related to acute local effects resulting from chemodenervation. The most important clinical effect in this group is weakening of the levator muscle resulting in ptosis, and the corneal consequences of lagophthalmos. The latter includes exposure keratitis, dry eyes, blurred vision, and hypersecretion epiphora. Less common local effects include facial numbness, diplopia, and ectropion. Some distant effects are being observed with increasing frequency. These include pruritus, dysphagia, nausea, and a flu-like syndrome. Most significant, however, are the rare reports of generalized weakness and the documentation of EMG abnormalities distant to the site of toxin injection. This has been seen with injections for both blepharospasm and torticollis. Until further studies on the long-term distant complications of botulinum toxin are available, it is recommended that patients receive as few life-time doses of toxin as possible, consistent with adequate management of their spasms. The practice of reinjecting patients routinely every three months, or at the first return of mild spasms should be discouraged.
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PMID:Botulinum-A toxin in the treatment of craniocervical muscle spasms: short- and long-term, local and systemic effects. 882 30

Ten consecutive cases of severe unilateral congenital ptosis were surgically corrected before 1 year of age (range 3-11 months) in an attempt to achieve early functional and cosmetic improvement. In all cases, a frontalis suspension using Mersilene mesh was performed. With a mean follow-up of 40.3 months (range 33-54 months), all patients achieved normal or near normal eyelid position and all had their chin-up head posture resolved. One patient developed a mild exposure keratitis that was treated successfully with topical antibiotics and lubricants. Our findings suggest that the Mersilene mesh sling has good potential for ptosis management in infants who are too young for fascial harvesting. However, a larger series with a longer follow-up period is required before the eventual safety and efficacy of the Mersilene mesh sling can be properly ascertained.
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PMID:Early correction of severe unilateral infant ptosis with the Mersilene mesh sling. 953 36

Manifestations of herpes zoster ophthalmicus (HZO) infection are well known in HIV-seropositive White patients in developed countries, but this association has not been previously noted in African AIDS patients. This paper analyzes 8 cases (3 men and 5 women) 24-40 years of age who were treated at the Eye Department of the University of Nigeria Teaching Hospital, Enugu, for HZO in 1994-97. Of the 6 patients who consented to HIV screening, 4 were HIV-seropositive. One of the HIV-infected patients had been treated for pulmonary tuberculosis a year prior to the present illness, but the remaining 7 were in apparent good health. The patients presented with skin eruptions in the area of distribution of the trigeminal nerve on the affected side of the face and head. Visual acuity was impaired in all 8 cases. The most common ocular findings were lid edema, ptosis, conjunctival infection, corneal anesthesia, keratitis, uveal inflammation, and abnormal pupillary reaction. The severity of presentation was similar in HIV-positive and HIV-negative patients and all improved during follow-up; however, clinical improvement was less rapid or pronounced among the HIV-positive patients. These findings suggest that HZO infection in young Africans should be regarded as a possible indicator of HIV infection.
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PMID:Herpes zoster ophthalmicus and HIV infection in Nigeria. 970 97

The ophthalmic, neurologic, and neuro-ophthalmic literature over the past year have included a wide variety of interesting case reports, patient series, and reviews involving eye movement abnormalities. This review highlights some of the more important articles and how they contribute to our understanding, diagnosis, and treatment of these disorders. A few topics will receive particular emphasis. In patients with sixth nerve palsies, botulinum toxin injection of the ipsilateral medial rectus muscle has been advocated. Recent results suggest that this treatment has no beneficial effect in acute sixth nerve palsies, but it may have a role in chronic cases. Two groups of authors, each supplying retrobulbar botulinum toxin injection for patients with acquired nystagmus and debilitating oscillopsia, obtained mixed results. One group of patients was moderately satisfied, whereas in the other group, no patients elected to repeat the treatment because of side effects such as ptosis, diplopia, or discomfort from keratitis. Finally, skew deviation is becoming a more recognized cause of vertical double vision from a central or peripheral basis. Articles published recently showed that cyclodeviation may be seen in skew deviation, and that binocular cyclotorsion distinguishes this motility abnormality from a fourth nerve palsy, which exhibits monocular excyclotorsion.
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PMID:Eye movement disorders. 1016 Apr 15

Sleep apnea syndrome is characterized by recurrent complete or partial upper airway obstructions during sleep and recognized as an important risk factor for cardiovascular and cerebrovascular diseases. Several eye diseases have been associated with sleep apnea syndrome. Due to floppy eyelids often a chronic conjunctivitis occurs. A leaking mask used for apnea treatment may also induce a conjunctivitis. The lids may show an upper lid ptosis, lower lid ectropium, blepharochalasis, or trichiasis. Corneal findings include infectious keratitis, dry eye, recurrent erosion, keratoconus, and progressive endotheliopathy. Several optic neuropathies also seem to be associated with sleep apnea syndrome.
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PMID:[Eye diseases in sleep apnea syndrome]. 1121 89

Twenty eyes from 10 Pacific sleeper sharks Somniosus pacificus, infected with the copepod Ommatokoita elongata, were collected in Prince William Sound, Alaska, and the eyes of an additional 18 S. pacificus captured in the same area were inspected for copepods. Prevalence of infection by adult female O. elongata was 97% (n = 28); mean intensity of infection was 1.89 (+/-1SD = 0.32) adult female copepods per infected shark and 1.0 (+/- 1SD = 0.0) adult female copepods per infected eye. Five of the 20 collected eyes were infected by O. elongata chalimi, and 9 of 20 eyes had 1 to several remnants of bullae embedded in the cornea. Bullae were each associated with a corneal opacity, and anchoring plugs of chalimi were associated with pinpoint lesions in the cornea or conjunctiva. All eyes exhibited marked edema and erosion of the bulbar conjunctiva, and this torus-shaped lesion corresponded to each O. elongata adult female's presumed feeding and abrasion radius. Histological examinations revealed lesions in the anterior segment of eyes to be generally similar, but graded, in severity, and in all eyes they involved the conjunctiva, cornea, filtration angle, and iris. Epithelial lesions were characterized by corneal ulceration, dysplasia, hyperplasia, and heterophilic keratitis, and by ulcerative conjunctivitis accompanied by epithelial hyperplasia with rete peg formation. Disorganization of fibers, necrosis, mineralization, minimal heterophilic influx, and perilimbic neovascularization were associated with bullae in the corneal stroma. Within the limbus there was diffuse histiocytic and lymphocytic inflammation and marked lymphofollicular hyperplasia. Heterophilic and mononuclear anterior uveitis affecting the filtration angle and anterior surface of the iris was also observed in most eyes. One eye had a partial transcorneal prolapse of a ruptured lens, with degenerative changes in the ruptured lens and severe keratitis associated with the anchoring devices of an adult copepod and several chalimi. Fourteen eyes exhibited 1 to several, randomly distributed, small, round to irregular, corneal opacities or pits that were not associated with copepods, and it is likely that these opacities represented lesions associated with adult female or larval anchoring devices from past infections. The avascular cornea represents a niche that is somewhat shielded from host immune reactions, and this, and the fact that the general body surface of sleeper sharks is covered by tall and sharp placoid scales, may partially explain the corneal attachment of O. elongata adult females. It was concluded that O. elongata infections can lead to severe vision impairment in Pacific sleeper sharks but that these infections do not significantly debilitate hosts because they probably do not need to rely on acute vision for their survival.
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PMID:Ocular lesions associated with attachment of the copepod Ommatokoita elongata (Lernaeopodidae: Siphonostomatoida) to corneas of Pacific sleeper sharks Somniosus pacificus captured off Alaska in Prince William Sound. 1209 14


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