1/71. Acute dacryocystitis as a presenting sign of pediatric leukemia.PURPOSE: To report acute dacryocystitis with preseptal cellulitis as the presenting sign of leukemia in a child. methods: Case report and literature review. RESULTS: During the initial evaluation of a 17-month-old child with epiphora, left lower eyelid swelling, and a tender left medial canthal mass, a complete blood cell count demonstrated pancytopenia. bone marrow biopsy disclosed replacement of normal cellular architecture with a dense infiltrate of leukocyte blast forms. dna analysis disclosed a translocation between chromosome 10 and 11, consistent with the diagnosis of nonlymphocytic leukemia. Although the adjacent lower eyelid cellulitis responded to intravenous antibiotics, lacrimal sac distention decreased only after chemotherapy was initiated. CONCLUSIONS: dacryocystitis with preseptal cellulitis can be a presenting sign of leukemia. This blood malignancy should be considered in patients whose leukocyte counts do not correlate with their clinical presentation.- - - - - - - - - - ranking = 1keywords = count (Clic here for more details about this article) |
2/71. Presumed periorbital lupus vulgaris with ocular extension.OBJECTIVE: To report an unusual case of lupus vulgaris that spread to the left anterior ocular surface. DESIGN: Case report. PARTICIPANT: An 18-year-old woman presented with an 8-month history of an infiltrative skin lesion affecting the left lower eyelid and cheek area, left globe, right lacrimal sac area, together with a cystic lesion in the foot area. TESTING/INTERVENTION: The authors describe the clinical findings, radiologic study, and histopathologic study of the conjunctiva, skin, liver, and ankle lesion. The patient was treated with antituberculous medications for 3 months. MAIN OUTCOME MEASURES: Healing of the skin, conjunctival, and bone lesions. RESULTS: The lesion of the face healed, leaving scar tissue. The left eye showed symblepharon with loss of its anterior surface features. The right eye showed no symblepharon, the bones of the foot healed with no deformity, and the liver function test results normalized after 3 months of antituberculous medications. CONCLUSION: lupus vulgaris can be associated with multiple system involvement. Its clinical presentation and behavior depend on the patient's immunity and duration of the disease. early diagnosis and appropriate management may cure the disease with no life-threatening sequelae.- - - - - - - - - - ranking = 0.079590262718372keywords = spread, unit (Clic here for more details about this article) |
3/71. Preseptal cellulitis secondary to proteus species: a case report and review.BACKGROUND: Preseptal cellulitis is a serious ocular condition that--if left untreated--has the potential to cross the septal barrier, spread to the posterior orbit, and may result in fatal complications. Because it is difficult to determine the pathogen responsible for any cellulitis without aspirating a culture sample, treatment is usually instituted by an assumption of the most common causative organisms, staphylococcus or streptococcus. CASE REPORT: A 42-year-old black woman manifested signs and symptoms consistent with right preseptal cellulitis. Throughout treatment, visual acuity remained 20/20 for both eyes, extraocular muscles were unrestricted without pain, and anterior globe structures were clear. The patient was started on a regimen of 250-mg oral dicloxacillin four times a day. When no response was seen at 36 hours, the patient was changed to 500-mg oral ciprofloxacin every 12 hours. She responded to the 500-mg ciprofloxacin and recovered with no sequelae. An abscess, which had formed during the cellulitis, self expressed and this material was cultured. The cultures identified the responsible organism as proteus species, an unexpected pathogen in a well-groomed patient. CONCLUSION: This case demonstrates the need to consider alternate pathogens when treating preseptal cellulitis, change medications accordingly, and consider alternate treatments as needed.- - - - - - - - - - ranking = 0.076196461208258keywords = spread (Clic here for more details about this article) |
4/71. Extensive lower eyelid pigment spread after blepharopigmentation.PURPOSE: To report on a complication of blepharopigmentation. methods: Case report. RESULTS: An 81-year-old woman underwent cosmetic tattooing of all four eyelids. The pigment immediately spread from the right lower eyelid lash line to the nasojugal fold. The dispersion was so extensive in surface area that nonsurgical techniques for ameliorating the dispersion would not be effective. The unintentionally tattooed skin was excised and reconstructed with a lateral canthal suspension and full thickness skin grafts. Pathologic examination of the excised tissue revealed pigmentation of all layers of the skin and the surface of the orbicularis muscle. CONCLUSION: This case illustrates that extensive pigment spread following blepharopigmentation may require extensive reconstruction to correct the problem.- - - - - - - - - - ranking = 0.45717876724955keywords = spread (Clic here for more details about this article) |
5/71. Total upper eyelid reconstruction with mucosalized tarsal graft and overlying bipedicle flap.Total or near-total upper eyelid reconstruction with a mucosalized tarsal graft and overlying bipedicled myocutaneous flap was performed on 12 patients. This technique offers several advantages over other reconstructive methods: (1) the opportunity for immediate visual rehabilitation through a single-staged procedure without obscuration of the visual axis, (2) preservation of eyelid blinking and closure by relocation of functional orbicularis muscle, (3) excellent eyelid contour, and (4) use of tissue physiologically similar to that removed. The technique and clinical results are presented herein.- - - - - - - - - - ranking = 0.0033938015101142keywords = unit (Clic here for more details about this article) |
6/71. Linear IgA disease.PURPOSE: A case of linear IgA disease is reported to alert ophthalmologists and physicians to this unusual cause of chronic cicatrizing conjunctivitis. methods: Clinical records of a patient suffering from linear IgA disease were reviewed. RESULTS: A 65-year-old woman with a complicated medical history experienced rapidly progressive chronic cicatrizing conjunctivitis leading to corneal perforation. Undiagnosed gingivitis and palatal ulceration had been present for 5 years prior to the onset of ocular symptoms and vitamin C deficiency had followed the consequent dietary restrictions. A diagnosis of linear IgA disease was made on conjunctival biopsy, which demonstrated linear deposits of IgA along the epithelial basement membrane. The perforation was managed successfully with a conjunctival pediculate flap. Control of the inflammation was achieved with systemic prednisolone and cyclophosphamide but at the expense of serious systemic side-effects. CONCLUSIONS: Linear IgA disease causes progressive conjunctival cicatrization in many affected individuals.Although dapsone generally controls the inflammation, heavier systemic immunosuppression was required in this case. Involvement of skin or other mucosal surfaces may become symptomatic before the conjunctivitis, and physicians must be educated to refer patients for ophthalmological review on diagnosis. Conversely, ophthalmologists encountering ocular linear IgA disease should be aware of the possibility of other mucosal involvement requiring physician intervention.- - - - - - - - - - ranking = 0.5keywords = count (Clic here for more details about this article) |
7/71. pemphigus of the eyelids.We report the case of a 56-year-old woman who presented with a 2-month history of widespread oral erosion and a 3-day history of small papules on the lower eyelids. No other skin involvement was found. Histopathological examination revealed suprabasal cleft and acantholysis in the lower epidermis of the papule on the lower eyelid and in the lower mucous membrane of the oral mucosa. Intercellular deposits of IgG and C3 were seen in the whole epidermis of the specimen from the papule on the right lower eyelid by direct immunofluorescence study. These deposits were also observed in the biopsy specimen from erosion on the left buccal membrane. Indirect immunofluorescence study using normal human skin as a substrate showed intercellular antibodies directed to the cell surface of the whole epidermis with a titer of 1:40. The titers of antibodies to desmoglein 3 and 1 were 118 and 25.9, respectively, by enzyme-linked immunosorbent assay. The patient was treated with an oral administration of prednisolone (0.75 mg/kg/day) for 9 days, which improved the skin eruptions and oral erosion. The dose of prednisolone was gradually tapered and it took 10 weeks to cease this treatment. These findings suggest that this patient is an unusual case of pemphigus vulgaris (mucosal dominant type) diagnosed from the clinical and histopathological findings, with positive antibodies to desmoglein 3 and 1.- - - - - - - - - - ranking = 0.076196461208258keywords = spread (Clic here for more details about this article) |
8/71. Rhabdomyomatous mesenchymal hamartoma of the eyelid: report of a case and literature review.PURPOSE: To report a rare case of rhabdomyomatous mesenchymal hamartoma and to compare its features with those cases previously reported. DESIGN: Interventional case report and literature review. INTERVENTION: Complete ophthalmologic and systemic examinations followed by excisional biopsy and histopathologic examination. MAIN OUTCOME MEASURES: Clinical examination features and histopathologic findings. RESULTS: A 6-month-old Latino male presented with a congenital, elevated, smooth, flesh-colored right lower eyelid lesion. An ipsilateral right limbal dermoid and an upper eyelid coloboma were also present. Excisional biopsy of the eyelid lesion revealed randomly oriented mature striated muscle tissue with associated adipose tissue, blood vessels, pilosebaceous units, and peripheral nerves, findings consistent with rhabdomyomatous mesenchymal hamartoma. Of the 24 reported cases (including the current case), eight had associated congenital anomalies. CONCLUSIONS: Although rhabdomyomatous mesenchymal hamartomas are rare and benign, they may be associated with other congenital anomalies and anomaly syndromes. As a result, we recommend systemic evaluation of patients diagnosed with this entity.- - - - - - - - - - ranking = 0.0033938015101142keywords = unit (Clic here for more details about this article) |
9/71. An outbreak of trematode-induced granulomas of the conjunctiva.PURPOSE: To describe the epidemiologic, clinical, and histopathologic features of trematode granulomas of the conjunctiva, eyelid, and anterior chamber in pediatric patients. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Forty-one children from a southern Indian village with conjunctival granulomas. methods: The village of Sellananthal was selected for a field visit after analysis of earlier hospital-based allergic conjunctival granuloma cases. Children with ocular diseases were examined, and histories of exposure to assumed risk factors and clinical findings were evaluated. Selected patients were brought to the base hospital for excisional biopsy. Serial sections obtained from the excised nodules were examined for the presence of a parasite. MAIN OUTCOME MEASURES: Histopathologic examination of excised conjunctival lesions or response of lesions to local medical therapy. RESULTS: In this year-long prospective study, 41 children (16 years or younger; 38 boys and 3 girls) with clinical features of allergic conjunctival granulomas were examined. Thirty-four patients were from a single village located in the southern Indian state of Tamil Nadu; the remaining 7 were from various parts of the same state. All children swam in their village's freshwater pond. Twenty patients with nodules less than 5 mm in diameter received medical treatment; 13 with larger nodules underwent surgical excision of the lesions. Nine of these 13 cases revealed a zonal granulomatous inflammation admixed with eosinophilic leukocytes; 4 of these 9 displayed fragments of the tegument and internal structures of a trematode and Splendore-Hoeppli phenomenon. The remaining 4 of the 13 cases revealed nongranulomatous inflammation made up of lymphocytes, histiocytes, and eosinophils. Eight patients refused surgical treatment. CONCLUSIONS: In southern india, one cause of allergic conjunctival granulomas in children seems to be trematode infection. The clustering of cases in a single village and exposure to a village freshwater pond indicate the need for an epidemiologic investigation and study of the parasite's life cycle. Sporadic cases from other parts of the state with similar histories of exposure to their local pond or river water suggest a widespread distribution of the etiologic agent.- - - - - - - - - - ranking = 0.076196461208258keywords = spread (Clic here for more details about this article) |
10/71. Multiple bilateral eyelid molluscum contagiosum lesions associated with TNFalpha-antibody and methotrexate therapy.PURPOSE: To demonstrate a patient developing multiple bilateral eyelid molluscum contagiosum lesions after initiation of TNFalpha-antibody therapy for rheumatoid arthritis. DESIGN: Single interventional case report. methods: Clinical, histopathologic, and immunologic-serological findings are presented. RESULTS: A 67-year-old patient with a 5-year history of rheumatoid arthritis had been treated with prednisone and methotrexate for the last 5 years. After initiation of additional TNFalpha-antibody treatment, complaints from rheumatoid arthritis subsided, but multiple bilateral molluscum contagiosum lesions of upper and lower eyelids occurred despite normal or only slightly reduced CD(4) (420-178/ microl) and CD(8) counts (143-58/microl). Histopathologic evaluation of the excised warts confirmed the clinical diagnosis. Under continued therapy, the warts have been recurring for 12 months. CONCLUSION: TNFalpha-antibody treatment for rheumatoid arthritis may compromise the host response to molluscum contagiosum, especially if methotrexate is given additionally. patients should be informed about this potential complication.- - - - - - - - - - ranking = 0.5keywords = count (Clic here for more details about this article) |
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