Cases reported "Conjunctival Diseases"

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1/12. Treatment of hyperfiltering blebs with Nd:YAG laser-induced subconjunctival bleeding.

    PURPOSE: To assess the feasibility of a new technique to manage hyperfiltering blebs after penetrating glaucoma surgery. methods: neodymium:yttrium-aluminum-garnet (Nd:YAG) laser bursts were used to induce bleeding in conjunctival and episcleral vessels in the bleb area to achieve local delivery of autologous blood. RESULTS: In the three cases reported here in which this technique was used, the treatment was successful and safe, leading to resolution of hypotony and reduction of the bleb with no complications. CONCLUSION: Subconjunctival bleeding can be achieved using Nd:YAG laser, and can represent a valuable alternative to autologous blood injection in cases of hyperfiltration after glaucoma surgery.
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2/12. Conjunctival edema and alopecia of the external third of the eyebrows in a patient with meige syndrome.

    PURPOSE: To describe a patient with meige syndrome in whom we observed the coexistence of hereditary lymphedema of the lower legs, conjunctival edema and alopecia of the lateral third of the eyebrows. methods: Case report. RESULTS: Histological examination of the conjunctival and skin specimens showed dermal edema and a slight reduction in the number of severely ectatic lymphatics in the reticular dermis. The vessel were identified as lymphatics on the basis of immunohistochemical evidence of discontinuity and/or absence of basement membrane. CONCLUSIONS: Clinical and histological findings suggest that the etiopathogenesis of the edema in meige syndrome is related to a structural ectatic defect of lymphatics. This anomaly seems to involve both skin and other sites, such as conjunctival mucosa.
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3/12. Posttraumatic carotid-cavernous sinus fistula.

    BACKGROUND AND OBJECTIVES: Posttraumatic carotid-cavernous sinus fistula is a rare complication of maxillofacial trauma and is seldom discussed in the literature. Motor vehicle accidents, falls, and other crush injuries contribute to the incidence of basilar skull fractures and the formation of fistulae. When injuries occur in the vessel wall, the carotid artery has the potential to fill the low-pressure cavernous sinus. The symptoms include chemosis, proptosis, pulsating exophthalmos, diplopia, ophthalmoplegia, orbital pain, audible bruits, and blindness. methods AND MATERIALS: The conventional treatments include carotid ligation and embolization. These techniques have often proved to be ineffective. A new method--the occlusive balloon technique--has been developed and is described in this article. A clinical case is used to illustrate the procedure. RESULTS AND/OR CONCLUSIONS: Utilization of balloon catheters provides a minimally invasive technique to treat patients, without significant morbidity or mortality. The procedure is found to be successful and predictable.
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4/12. Subconjunctival hemorrhage: the first presenting clinical feature of idiopathic thrombocytopenic purpura.

    BACKGROUND: Subconjunctival hemorrhage as the first presenting clinical feature of idiopathic thrombocytopenic purpura, to the best of our knowledge, has not been reported earlier. CASE: A 60-year-old woman presented with an isolated finding of subconjunctival hemorrhage. She later developed hemorrhage from retinal vessels and had a single episode of hematuria. OBSERVATIONS: Her blood cell count showed an extremely low platelet count. Her medical history and clinical examination for any other systemic or ophthalmic pathology were negative. Even after treating the patient with blood and platelet transfusion and maintaining her on high doses of systemic steroids, she did not respond well. CONCLUSION: The appearance of spontaneous subconjunctival hemorrhage in a patient should be thoroughly investigated as it can be an initial sign of a grave systemic disorder.
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5/12. Polychromatic corneal and conjunctival crystals secondary to clofazimine therapy in a leper.

    A 67-year-old man had a diagnosis of dapsone-resistant lepromatous leprosy. He received clofazimine (Lamprene) at a dosage of 100 mg twice daily. After 3 years of therapy, results of slit-lamp examination disclosed myriad polychromatic crystals diffusely involving the cornea and perilimbal conjunctiva of both eyes. Thick sections (1 micron) from a conjunctival biopsy showed numerous rectangular-to-rhomboidal crystals within stromal fibroblasts and macrophages. By electron microscopy, these cells contained elongated, membrane-bound, cleft-like spaces that corresponded to the sites where crystals had been present previously. Additionally, complex lipid inclusions were observed in mesenchymal cells as well as in endothelial cells and pericytes of blood vessels. The ocular side effects of clofazimine therapy are reviewed. clofazimine-induced keratopathy should be included in the differential diagnosis of patients with polychromatic crystalline deposits in the corneas. To the best of the authors' knowledge, this complication of clofazimine therapy has not been described previously.
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6/12. Conjunctival hemorrhagic lymphangiectasis.

    Conjunctival hemorrhagic lymphangiectasis is a benign condition resulting from an abnormal communication between conjunctival lymphatics and conjunctival blood vessels. In this paper, two cases of conjunctival hemorrhagic lymphangiectasis are presented and the possible mechanisms giving rise to this entity are discussed. To aid in clinical differential diagnosis, a short discussion of conjunctival lymphangioma is also presented.
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7/12. Case of sarcoidosis with uncommon tumorous mass formation in bulbar conjunctiva.

    A case of sarcoidosis with ocular involvement, including uncommon tumorous mass formation on the bulbar conjunctiva, was reported. The patient was a 62-year-old woman who had been suffering from chronic bronchiolitis for several years. The conjuctival masses, yellowish brown in color with localized injection and follicles, were found in both eyes. In addition to the conjunctival masses, the common manifestations of sarcoidosis were observed in the eyes, showing nodules on the iris and trabeculum, discrete fluffy "snowball" opacities in the vitreous, and perivascular nodules on the retinal vessels. Microscopically, the biopsy specimen obtained from he conjunctival masses was composed of epithelioid tubercles with Langhans type and foreign body type giant cells. Ziehl-Neelsen stain revealed no tuberculous bacilli. Transbronchial lung biopsy also revealed epithelioid tubercles. Both ocular and pulmonary lesions were observed to respond well to treatment with corticosteroid hormone. We emphasized that patients with interstitial pneumonitis or pulmonary fibrosis should be examined ophthalmologically, and recommended conjunctival biopsy in patients with suspected sarcoidosis.
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8/12. disseminated intravascular coagulation in infancy and in the neonate. Ocular findings.

    We report two cases of neonatal disseminated intravascular coagulation (DIC). One case is associated with placenta previa and respiratory distress, and the other shows hemorrhage with Gram-negative sepsis. In both cases, results of autopsy show microscopic confirmation of DIC in several body tissues. One pair of eyes demonstrates intraocular hemorrhages and intravascular fibrin in the choriocapillaris (a typical manifestation) and intravascular fibrin in the ciliary body vessels of one eye. In addition, the other pair of eyes shows involvement of iris vessels, a unique finding, as is intraretinal intravascular fibrin in one eye of the same patient.
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9/12. microscopic polyangiitis with ocular involvement.

    microscopic polyangiitis is an exclusively small-vessel (arterioles, capillaries, or venules) vasculitis that primarily involves the kidney and often involves the lungs, skin, or nervous system. Characteristic features include focal segmental glomerulonephritis, nongranulomatous necrotizing vasculitis, and serum positive for perinuclear-staining antineutrophil cytoplasmic antibodies (P-ANCA). We report a case of microscopic polyangiitis with previously unreported eyelid and conjunctival manifestations that responded well to immunosuppressive therapy.
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10/12. Conjunctival injection, episcleral vessel dilation, and subconjunctival hemorrhage in patients with new tsutsugamushi disease.

    Tsutsugamushi disease is found in two types: classical and new. There have been very few reports describing the ocular findings in patients with the new form. We have described four patients with this type, selected according to their clinical and laboratory findings, including immunofluorescent titers and polymerase chain reaction results. Eyes were examined by standard ophthalmic procedures. Patient 1 had bilateral conjunctival injection and subconjunctival hemorrhage; patients 2-4 had conjunctival injection and episcleral vessel dilation bilaterally. We believe that conjunctival injection is found in most eyes of patients with new tsutsugamushi disease.
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