Fernando Procianoy

Steatocystoma simplex of the eyelid.

A 68-year-old woman presented with a nodular pretarsal tumor on her right upper eyelid that had slowly grown over 6 months. Excisional biopsy was performed through an eyelid crease approach, and histopathology evidenced the lesion to be steatocystoma simplex. Steatocystoma simplex is an uncommon benign cutaneous lesion thought to be a circumscribed malformation arising from the pilosebaceous duct junction, rarely reported to occur in the periorbital region.

Cicatricial ectropion correction in a patient with pyoderma gangrenosum: case report

A 19 year old female with pyoderma gangrenosum was referred to the oculoplastic clinic for evaluation of severe cicatricial ectropion of the right lower eyelid. Examination evidenced important scarring of lower eyelid and malar region with secondary ectropion. A full-thickness skin graft associated with a lateral tarsal strip procedure and scar tissue release was performed. The patients corticosteroid dose was raised for the procedure, and after surgery there was no healing problem or ulcer formation in the eyelid or in the graft donor site. As pyoderma gangrenosum is associated with a pathergy phenomenon in up to 25% of the cases, the onset of new lesions is a relevant concern when performing surgery in these patients. In this case, the surgery was safely performed under corticosteroid immunosuppression.

Characterization of Normal Mediolateral Angular Direction of Lower Eyelid Eyelashes in Different Age Groups.

Purpose:To characterize the normal eyelash mediolateral angular direction of the lower eyelid in different age groups. Methods:Sixty patients were divided into 3 groups: G1 - 6 to 12 years; G2 - 20 to 35; and G3 - 60 to 85. Digital photographs were obtained and eyelids were divided in lateral, central, and medial portions. Eyelash mediolateral angular direction relative to a baseline was measured and data were compared between portions and groups. Results:The mean eyelash mediolateral angular direction in the medial portion were: G1: 133.79° ± 17.56° SD; G2: 137.74° ± 10.5° SD; and G3: 116.05° ± 26.71° SD. The mean difference in angle between G1 and G3 was 17.74° (p = 0.015) and between G2 and G3 was 21.69° (p = 0.000). The mean eyelash mediolateral angular direction in central portion were: G1: 64.36° ± 12.58° SD; G2: 77.07° ± 12.17° SD; and G3: 84.9° ± 18.48° SD. The mean difference between Group 1 and 2 was 12.71° (p = 0.001) and between Group 1 and 3 was 20.54° (p = 0.000). The mean eyelash mediolateral angular direction in the lateral portion were: Group 1: 40.57° ± 6.78° SD; Group 2: 37.21° ± 5.69° SD; and Group 3: 38.48° ± 8.35° SD. Conclusion:This study identified that lashes in the lateral portion of lower eyelid tend to maintain the same angular position throughout life. On the central and medial portions it tends to approach a 90° angle with age. The authors believe that this modification throughout life may be related to factors, such as involutional horizontal eyelid laxity and orbicular muscle modifications.

Uso de levodopa em pacientes com ambliopia

Ambliopia O definida como uma diminuicao da acuidadevisual unilateral (o mais frequente) ou bilateral, decorrente dedeprivacao visual e ou de interacao binocular anormal. Naotem causa orgânica detectAEvel ao exame fisico do olho,ocorrendo no periodo de imaturidade do sistema visual. Ereversivel quando tratada em tempo e de modo apropriado.Diagnostica-se ambliopia quando a diferenca de visao entreos olhos O de duas ou mais linhas ou quando a visao O 20/30 oupior na escala de Snellen.Estrabismo e anisometropia sao as causas mais frequentesde ambliopia, ocorrendo em 2 a 5% da populacao

Resultados do tratamento da ambliopia com levodopa combinada à oclusão

PURPOSE: To evaluate visual acuity improvement with levodopa/benzerazide associated with partial occlusion and followed by total occlusion therapy in patients with amblyopia considered irreversible. METHODS: A 9-week experimental open study was performed involving 37 patients, between 7 and 40 years old, with strabismic and/or anisometropic amblyopia. All patients were treated with levodopa (0.70 mg/kg/day) and 25% benzerazide associated with 4-hour/day occlusion of the dominant eye for 5 weeks. In the last 4 weeks, only the total occlusion (24 h) of the dominant eye was performed. Visual acuity was measured by the Early Treatment Diabetic Retinopathy (ETDR) table with the logarithmic minimum angle of resolution (logMAR) scale before the beginning of the treatment and after 1, 3, 5 and 9 weeks of treatment. Adhesions to occlusion therapy and to drug intake were checked through a written questionnaire and capsule counting. Adverse effects were evaluated by clinical examination and questionnaire. RESULTS: After 9 weeks of treatment visual acuity improved from 0.58 ± 0.16 to 0.23 ± 0.16 logMAR (4 lines of improvement in the ETDR table). CONCLUSION: Levodopa dose of 0.70 mg/kg/day is well tolerated and, when associated with occlusion therapy, significantly improves visual acuity in patients with amblyopia considered irreversible.

Effect of Low-Concentration, Nonmydriatic Selective Alpha-Adrenergic Agonist Eyedrops on Upper Eyelid Position

BACKGROUND Ptosis after botulinum toxin injection is a disturbing complication. Decongestant and antiglaucoma eyedrops are frequently prescribed for temporary improvement of eyelid ptosis. Although frequently cited on informal communications, the effect of these drugs on eyelid position has never been compared in a formal study. OBJECTIVE To measure the effect of low-concentration, nonmydriatic selective alpha agonist eyedrops on upper eyelid position. METHODS AND MATERIALS This nonrandomized clinical trial enrolled 20 healthy subjects aged 18 to 50 years. The upper margin–reflex distance (MRD1) was measured before, 30, 60, and 120 minutes after administration of 1 drop of brimonidine 0.2%, phenylephrine 0.12%, or naphazoline 0.05% to the left eye. RESULTS There was no statistically significant difference in mean MRD1 between the brimonidine and phenylephrine groups when comparing baseline to all other study time points. After administration of naphazoline 0.05%, MRD1 had a mean increase of 0.56 ± 0.11 mm (p < 0.001) after 30 minutes, 0.47 ± 0.12 mm (p = 0.001) after 60 minutes, and 0.26 ± 0.09 mm (p = 0.028) after 120 minutes when compared with baseline. CONCLUSION Brimonidine 0.2% and phenylephrine 0.12% have no effect on eyelid aperture, but naphazoline 0.05% eyedrops could be useful for temporary relief of upper eyelid ptosis in selected patients.