Ana Estela Sant'Anna

Avaliação do olho seco no pré e pós-operatório da blefaroplastia

PURPOSES To evaluate the importance of objective examinations together with ocular history and orbital and periorbital anatomy, to identifying patients at risk of developing a post-blepharoplasty dry eye complication. METHODS A prospective study was performed on 29 patients with dermatochalasis that were studied before and three months after blepharoplasty. Changes in ocular symptoms, physical examination and in objective tests, like Schirmers test, tear film break-up time and rose bengal coloration were evaluated. RESULTS No statistical significant alteration in results of objective tests, except Schirmer II test, between pre and postoperative period were found. In relation to eyelid anatomy, alterations in palpebral fissure and in excursion of the upper eyelid, that were statistically significant were found after surgery. CONCLUSIONS It may be stated that palpebral fissure alterations occur frequently in patients submitted to esthetic blepharoplasty. It is also possible to conclude, that in this study, the objective tests for dry eye evaluation, did not demonstrate significant postoperative alterations, except for Schirmer II test.

Eyelid swelling as the only manifestation of ocular sarcoidosis.

Purpose: To describe a case of eyelid sarcoidosis without systemic manifestations with a three-year follow-up. Methods: A 73-year-old woman presented complaining of a one-year history of swelling and hyperemia in the right upper eyelid. To confirm the diagnosis, we performed an incisional biopsy of the eyelid. Results: Histopathological examination showed a non-caseating granulomatous process suggestive of sarcoidosis. After three years, the patient was asymptomatic and physical and laboratory examination showed no signs of systemic sarcoidosis. Conclusion: The histopathological exam was fundamental for the diagnosis.

Sebaceous carcinoma of the eyelid - different diagnostic times, different outcomes: case reports

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.

Prolapsed orbital fat: 15 consecutive cases

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.

Absence of Bacterial or Fungal Growth in Vials of Reconstituted Botulinum Toxin Type A After Storage

BACKGROUND Botulinum toxin type A (BTX-A; Botox) is supplied as individual freeze-dried preparations that should be administered within 24 hours after reconstitution. To avoid wasting this expensive drug, some physicians have resorted to storing vials of reconstituted BTX-A beyond the recommended duration. However, there is insufficient evidence to indicate that the sterility of previously reconstituted BTX-A is maintained during storage. OBJECTIVES The authors sought to determine whether bacterial and/or fungal proliferation occurred in vials of reconstituted BTX-A and subsequent storage of the remaining solution under refrigeration for 4 weeks. METHODS A portion of the contents of 88 consecutive 100-U vials of BTX-A was administered aseptically to 108 patients for essential blepharospasm, hemifacial spasm, or facial rejuvenation. The vials were then stored for 4 weeks in a refrigerator, after which the contents were transferred to various media (blood agar, chocolate agar, Sabouraud agar, brain-heart infusion medium, and thioglycolate broth) and assessed for bacterial and/or fungal growth by standard methods. RESULTS None of the BTX-A vials contained detectable bacterial or fungal contamination after 4 weeks of storage. CONCLUSIONS Storing vials of reconstituted BTX-A for 4 weeks after administration to patients was not associated with detectable growth of bacteria or fungi.

Evaluation of dry eye in the preoperative and postoperative period of blepharoplasty

PURPOSES: To evaluate the importance of objective examinations in conjunction with ocular history and orbital and periorbital anatomy, to identify patients at risk of developing a post-blepharoplasty dry eye complication. METHODS: A prospective study was peformed on 29 patients with dermatochalasis who were studied before and three months after blepharoplasty. Changes in ocular symptoms, physical examination and in objective tests, like Schirmers test, tear film break-up time and rose Bengal coloration were evaluated. RESULTS: No statistically significant alteration in results of objective tests, except Schirmer II test, was found between the pre- and postoperative period. Regarding eyelid anatomy, alterations in palpebral fissure and excursion of the upper eyelid were observed that were statistically significant postoperatively. CONCLUSIONS: It is possible to state that the palpebral fissure alterations happen frequently in patients submitted to esthetic blepharoplasty. It was also possible to conclude, by this study, that the objective tests for dry eye evaluation, did not show significant alterations postoperatively, except for Schirmer II test.

Efeito do uso de lente escleral cosmética na sensibilidade tátil corneal em phthisis bulbi

PURPOSE: To compare corneal sensitivity between normal eyes and those whith phthisis bulbi and also to analyze the alterations of corneal sensitivity in phthisis bulbi induced by wearing ocular prosthesis. METHODS: Prospective study of 23 patients with unilateral phthisis bulbi. Bilateral cornea sensitivity was evaluated using the Cochet-Bonnet esthesiometer before and after 3 months of wearing ocular prosthesis. RESULTS: In all patients, corneal sensitivity of the eye with phthisis bulbi was lower than that of the normal eye (control). In 96% there was decrease of corneal sensitivity after adaptation of ocular prosthesis. CONCLUSION: After wearing ocular prosthesis, there is a reduction in corneal sensitivity in phthisis bulbi. The pathophysiology seems to be the same as that found in contact lens wearers.

Média das medidas palpebrais em descendentes de orientais

Purpose: To determine average anatomical measurements in oriental offspring (both parents Japanese) aiming to help oculoplastic surgeons to deal with these patients. Methods: The palpebral crease height, eyebrow height and visible pretarsal skin were measured in 56 oriental offs-pring, totalizing 112 lids. 16 (28.5%) patients were male and 40 (71.5%) female. The mean age was 25.2 years. There were no statistically significant differences between right and left lids of both genders. Results: The average measure of the eyebrow height was 13.6 mm (2.5 SD) in males and 14.5mm (2.2 SD) in females. (T= 1.7) (P= 0.083), not statistically significant. The average of visible pretarsal skin in males was 1.2 (1.2 SD) and 1.7 (1.6 SD) in female. (T= 1.84) (P= 0.070), not statistically significant. The average palpebral crease height was 3.9 mm (2.5 SD) in males and 4.9 mm (2.9 SD) in females. (T= 1.95) (P= 0.060), not statistically significant. Conclusions: Due to equivalence of means between both lids and between both genders, the average measure- ments may be used as good anatomical marks in surgical procedures in Oriental lids.