1/17. Gas-permeable scleral contact lens therapy in ocular surface disease.PURPOSE: To describe the therapeutic benefits of nonfenestrated gas-permeable scleral contact lenses in the management of patients with ocular surface disease.methods: The charts of 49 consecutive patients (76 eyes) with ocular surface disease whose management included the use of gas-permeable scleral contact lenses were reviewed. We also developed a questionnaire to assess the impact of lens wear on subjective aspects of activities of daily living. RESULTS: The mean age of the 49 patients was 44.6 years (range, 3 to 87 years); 31 patients were female and 18 were male. The most common indication for fitting of the lenses was stevens-johnson syndrome (54 [71%] of the 76 eyes). Other indications included ocular cicatricial pemphigoid, exposure keratitis, toxic epidermal necrolysis, postherpetic keratitis, congenital deficiency of meibomian glands, superior limbal keratoconjunctivitis, Sjogren syndrome, and inflammatory corneal degeneration. The mean follow-up was 33.6 months (range, 2 to 144 months). Improvement in best-corrected visual acuity (defined as a gain of 2 or more Snellen lines) was observed in 40 (53%) of the eyes. In eight (53%) of the 15 eyes with active corneal epithelial defects at the time of lens fitting, the defects healed, whereas in the remaining seven eyes the corneal epithelial defects remained unchanged. Forty-five (92%) of the 49 patients reported improvement in their quality of life as a result of reduction of photophobia and discomfort. The mean wearing time of the gas-permeable scleral contact lenses was 13.7 hours per day (range, 4 to 18 hours). Many patients had preparatory surgical procedures before lens fitting (for example, punctal occlusion or mucous membrane grafting), and some had visual rehabilitation surgical procedures (for example, keratoplasty and/or cataract surgery) after lens fitting.CONCLUSIONS: Gas-permeable scleral contact lens wear provides an additional effective strategy in the surface management and visual rehabilitation of patients with severe ocular surface disease.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/17. Positive polymerase chain reaction and histology with borderline serology in Parinaud's oculoglandular syndrome.PURPOSE: To report a case of Parinaud's oculoglandular syndrome (POS) in which, despite a borderline serology, polymerase chain reaction (PCR) testing for a conjunctival biopsy was positive for bartonella henselae, a source of cat-scratch disease. A Steiner silver stain demonstrated the organism. methods: Case Report. RESULTS: A 65-year-old man was seen for a foreign body in his left eye (OS) associated with chemosis and a preauricular node. CONCLUSION: B. henselae is a known cause of POS. This gram-negative pleomorphic rod has been more frequently discovered in connection with this syndrome due to improved diagnostic testing such as indirect immunofluorescence antibody and PCR testing. Frequently, serology is positive if the organism is present. This report describes a patient with clinical findings of POS who, despite borderline serology, had pleomorphic rods on Steiner silver stain and positive PCR testing compatible with Bartonella henselae.- - - - - - - - - - ranking = 5keywords = gland (Clic here for more details about this article) |
3/17. Presumed minor salivary gland secretion in a patient with a history of oral mucous membrane graft.PURPOSE: To describe presumed minor salivary gland secretion in a patient with a history of oral mucous membrane graft in conjunctival plastic surgery. DESIGN: Interventional case report. methods: A 74-year-old woman who had had an oral mucous membrane graft in the left eye complained of mucous discharge. Slit-lamp examination revealed a yellowish-red mass lesion in the superior bulbar conjunctiva. RESULTS: The lesion was excised. Histopathologic examination of the excised tissue revealed lobules and a duct of minor salivary glands. After removal of the mass, mucous discharge decreased. CONCLUSION: Minor salivary glands within a mucous membrane graft may cause mucous discharge in the eye.- - - - - - - - - - ranking = 7keywords = gland (Clic here for more details about this article) |
4/17. Oculoglandular syndrome. cat-scratch disease without the cat scratch.Oculoglandular syndrome and swelling of the parotid gland are unusual manifestations of cat-scratch disease. Although exposure to cats is considered an important part of the patient history, an actual cat scratch is not required to establish the diagnosis. Oral fluoroquinolones show promise in the treatment of the infection.- - - - - - - - - - ranking = 6keywords = gland (Clic here for more details about this article) |
5/17. Correlation of corneal complications with eyelid cicatricial pathologies in patients with stevens-johnson syndrome and toxic epidermal necrolysis syndrome.PURPOSE: To look at the correlation between many factors (time of hospitalization, floppy eyelid syndrome, trichiasis, open lacrimal puncta, symblepharon, and aqueous tear deficiency) and corneal complications in stevens-johnson syndrome (SJS). DESIGN: Observational cases series. patients: Clinical data were retrospectively reviewed from 38 patients (32.7 /-20.1 years old) with SJS (n = 11) and with toxic epidermal necrolysis (TENS) (n = 27) from January 2002 to August 2004. One case report with SJS was included to verify the presence of tarsal/lid margin ulceration at the acute stage. methods: The medical history was retrieved regarding presumed causative medications used within 15 days and the duration of hospitalization. Data of the latest photographic documentation and eye examination were compared and correlated in a masked fashion. MAIN OUTCOME MEASURES: Floppy eyelid, trichiasis, lid margin keratinization, meibomian gland orifice metaplasia, symblepharon, tarsal scar, and corneal complications. RESULTS: Acute SJS/TENS was characterized by tarsal conjunctival ulceration. Keratinization of the eyelid margin with variable degrees of meibomian gland dysfunction was observed in all cases. Floppy eyelid, trichiasis, partially or totally opened lacrimal punctum, symblepharon, and aqueous tear deficiency were not significantly correlated with corneal complications. In contrast, there was a strong correlation between the severity of eyelid margin and tarsal pathology and the extent of corneal complications (Spearman r, 0.54; P = 0.0005). A multivariable regression analysis also showed that the extent of eyelid and tarsal pathology had a significant effect on corneal complications (coefficient, 0.84; P = 0.006). CONCLUSIONS: patients with acute SJS/TENS are characterized by severe inflammation and ulceration of the tarsal conjunctiva and lid margins. If left unattended, lid margin keratinization and tarsal scar, together with lipid tear deficiency, contribute to corneal complications because of blink-related microtrauma. Attempts to suppress inflammation and scarring by amniotic membrane transplantation at the acute stage and to prevent microtrauma at the chronic stage are vital to avoid sight-threatening complications.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
6/17. Pediatric ocular acne rosacea: long-term treatment with systemic antibiotics.PURPOSE: To report our experience with four cases of pediatric ocular acne rosacea, including responses to long-term systemic treatment. DESIGN: Retrospective interventional case series. methods: The medical records of four consecutive cases diagnosed with pediatric ocular acne rosacea over a period of 36 months were reviewed. Diagnostic criteria were meibomian gland dysfunction, blepharitis, lid margin telangiectasia, punctate superficial keratopathy, and conjunctival hyperemia with or without inferior corneal vascularization. RESULTS: The patients, aged between four and 12, were all females with bilateral disease. Meibomitis, blepharitis, conjunctival hyperemia, and punctuate epitheliopathy was evident in each case. Cutaneous involvement was seen in two cases (50%), and limbal vascularization with subepithelial or stromal infiltrates was present in three cases (75%). One case showed corneal ulceration at presentation. All four children received systemic doxycycline or erythromycin for at least 12 months and showed considerable improvement within the first month of therapy. No recurrence was noted within the mean 25.5 months of follow-up. None of the girls experienced any side effects during the long treatment duration. CONCLUSIONS: Ophthalmologists should consider acne rosacea as a potential diagnosis for any child who has any combination of meibomian disease, chronic blepharitis, recurrent chalazia, and chronic symptoms of photophobia, ocular irritation, and redness that does not respond to routine medical treatment. Such patients respond very well to long-term treatment with systemic erythromycin/doxycycline.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
7/17. Anaplastic carcinoma of the lacrimal gland presenting with recurrent subconjunctival hemorrhages and displaying incipient sebaceous differentiation.Primary adenocarcinomas of the lacrimal gland rarely display sebaceous differentiation. An anaplastic lacrimal gland neoplasm manifesting this feature was excised from a 64-year-old man who initially appeared with recurrent painless subconjunctival hemorrhages. Globe displacement and tumor-induced hyperopia were later findings. Electron microscopic studies performed on the widely excised tumor documented prominent lipid vacuoles, desmosomes, scattered cytoplasmic filaments, and linear segments of basement membrane material. The patient refused radical surgery and instead opted for 6,000 rads of adjuvant radiotherapy. Eleven months postoperatively liver and bone metastases developed, but he was free of local orbital recurrence. Twenty-two months postoperatively he died from complications of his metastatic disease. This most unusual lacrimal neoplasm is discussed in terms of its initial signs and symptoms and its histopathology. When the current case is analyzed in combination with three earlier reports, there is evidence that primary lacrimal gland sebaceous carcinoma is probably among the most malignant orbital tumors due to its uniform early fatality.- - - - - - - - - - ranking = 7keywords = gland (Clic here for more details about this article) |
8/17. Cyst of ectopic (choristomatous) lacrimal gland.A rare case of cyst of an ectopic lacrimal gland in the bulbar conjunctiva is reported in a 40 year-old-man. The clinical presentation histopathology, differential diagnosis and treatment of this choristomatous lacrimal ductal cyst (Group IV according to Bullock's classification) is described.- - - - - - - - - - ranking = 5keywords = gland (Clic here for more details about this article) |
9/17. Congenital cyst of Krause's gland.cysts of Krause's glands usually occur as retention cysts in cicatricial conditions of the conjunctiva. We report a rare case of congenital cyst of Krause's gland in a 2-year-old boy.- - - - - - - - - - ranking = 6keywords = gland (Clic here for more details about this article) |
10/17. Assessment of activity of ocular sarcoidosis by gallium scanning.gallium (67Ga) citrate uptake over the orbits, parotid glands, and lungs was examined in six newly detected patients with sarcoidosis and 17 with chronic sarcoidosis. Six of 23 (26%) had uveitis, 18/23 (78%) decreased lacrimal secretion, and 13/16 (81%) epithelioid cell granulomas in conjunctival biopsies. Ten patients with other diseases served as controls. Only five patients had ocular complaints and two had enlarged parotid glands. 67Ga uptake over the orbits and parotids was measured by a quantitative computer based method. gallium uptake was significantly higher over the orbits (p less than 0.001) and parotids (p less than 0.01) in the newly detected patients and in the parotids (p less than 0.01) in the chronic group than the corresponding uptake in the controls. We suggest that in sarcoidosis an increased 67Ga uptake in the orbital and parotid areas may be a phenomenon comparable to an increased 67Ga uptake in the lungs in active alveolitis. gallium scan is a good method for revealing even symptomless ophthalmic sarcoid changes. However, in chronic sarcoidosis an equal or only slightly increased gallium uptake over the orbits compared with background activity does not exclude ocular sarcoid disease.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
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