José Byron Vicente Dias Fernandes

Dacryocystectomy: indications and results

BACKGROUND After the advent of dacryocystorhinostomy (DCR), dacryocystectomy (DCT) was regarded as mutilant surgery and reserved for lacrimal sac tumors. PURPOSE To present current indications for dacryocystectomy. METHODS Eighteen eyes from 11 patients subjected to DCT were reviewed retrospectively. Nine patients had chronic dacryocystitis confirmed by dacryocystography and two patients had lacrimal sac tumors. RESULTS The indications for DCT were: three patients with systemic medical problems, three patients with dry eye, two cases of lacrimal sac tumors, two cases of traumatic dacryocystitis and one case of cutaneous leishmaniasis. Dacryocystitis was resolved in 17 of 18 eyes; the two cases of tumor evolved without epiphora. One patient (traumatic dacryocystitis) had recurrence of dacryocystitis. CONCLUSIONS DCT is mainly performed when a lacrimal sac tumor is suspected but, since it avoids the intra- and postoperative complications related to dacryocystorhinostomy, it can be indicated in cases of dacryocystitis with significant lacrimal discharge and an enlarged or altered lacrimal sac.

Ophthalmomyiasis as a cause of canalicular lesion

OBJECTIVE Myiasis is the invasion of human tissues by Diptera larvae. Ocular involvement is uncommon. Trauma is the major cause of lacrimal apparatus lesions. However, it is rarely associated with parasitic infestation. The objective of this paper is to report a case of canalicular laceration caused by Dermatobia hominis larva. DESCRIPTION An eight-year-old girl presented preseptal cellulitis that was refractive to antibiotics. A Dermatobia hominis larva was observed inside the lacrimal sac. Surgical extraction was performed and laceration of the lacrimal drainage system was noted. COMMENTS Parasitic infection of the lacrimal apparatus is rare. Surgical extraction is the treatment of choice in such cases. Despite being uncommon, ophthalmomyiasis should be considered as a possible diagnosis when cellulitis is not responsive to antibiotics, especially in endemic areas. This is the first description of lacrimal drainage system injury by Dermatobia hominis larva.

Tratamento de fitiríase palpebral com ivermectina

The authors report a case of a 16-year-old patient with phthi-riasis palpebrarum treated with oral ivermectin. Although already used for a number of other parasitic diseases it is also effective against human lice. One outstanding advan-tage of that drug could be its easy medical regimen.

Ivermectina no tratamento de miíase orbitária: relato de caso

OBJECTIVE: We report a case of myiasis in a patient with basocellular carcinoma of the orbit, treated with ivermectine prior to surgery. METHODS: We report a case and emphasize the efficacy of ivermectine in the treatment of myiasis, as alternative therapy. RESULTS: After oral administration of a single dose of ivermectine we saw a complete resolution of the myiasis in a 48-hour period. CONCLUSION: Ivermectine can be used successfully in the treatment of orbital myiasis, turning the mechanical removal of larvae an unnecessary procedure.

Enxerto de mucosa do palato duro: complicações na área doadora - Relato de casos

The graft of hard palate mucosa is a satisfactory substitute for posterior eyelid lamella (tarsus and conjunctiva) in eyelid reconstruction. The advantages of hard palate over other graft materials are: its mucosal surface, minimal contraction during healing, and easiness of harvesting. We present two palatal donor site complications and we discuss the probable pathophysiology of these complications.

Comparative analysis between sclera treated with glycerin and sclera treated with gamma irradiation, alkali and glycerin in the reconstruction of anophthalmic socket: experimental study in rabbits

PURPOSE To compare two sclera decontamination methods: treatment with glycerin versus treatment with gamma irradiation, alkali and glycerin, aiming to detect the clinical and histological alterations in rabbit anophthalmic sockets reconstructed with sclera-involved polymethylmethacrylate spheres. METHODS Thirty-nine New Zealand-breed rabbits were divided into two groups: group I, whose animals were submitted to enucleation of one eye and reconstruction with a polymethylmethacrylate sphere involved in glycerin-treated sclera; group II, where there was enucleation, and reconstruction performed with a polymethylmethacrylate sphere involved in sclera treated with gamma irradiation, alkali and glycerin. The two groups were observed at four moments, at 7, 21, 42 and 84 days after surgery. Preset times elapsed, the rabbits were euthanized, sockets were exenterated, the material was processed for embedment in paraffin, cut into 5 microm sections thick and stained with hematoxylin-eosin and Massons trichrome techniques. The scleras were submitted to morphometric and semiquantitative analysis. Results were compared by Mann-Whitneys non-parametric test. RESULTS Comparative analysis of vascularization of the surgical interface pointed out a significative difference in the evaluation done 21 days after the implant (P<0.001), with group II showing greater neovascularization. Comparison of the fibrous capsule thickness displayed a significative difference at moments corresponding to 21 days (P<0.001) and 42 days (P<0.001). At both moments, group II presented a thicker fibrous capsule than group I. Likewise, there was variation in sclera thickness, being thicker in group II, at the 21-day post-implant (P=0.003) moment, and at the 42-day moment (P=0.024), as well. Along the experimental period, when groups were analyzed we could observe statistically significative diminution of vascularization in the surgical interface, in group I, as well as in group II, at the moment of 7, 21, 42 and 84 days. CONCLUSION When used as coating on the polymethylmethacrylate implant for the reconstruction of rabbit anophthalmic socket, the sclera treated with gamma irradiation, alkali and glycerin reacted similarly to the traditionally used glycerin-treated sclera. The two treatments induced a similar inflammatory response. The formation of neovessels, thickness of fibrous capsule and of sclera developed differently in the two groups. Nevertheless, they presented similar results at the end of the 84-day observation period. There was no significant difference between the two groups, with regard to sclera preservation.

Triquíase pós blefaropigmentação: relato de caso

Blepharopigmentation is a procedure used to create a permanent eyeliner to replace the daily application of cosmetic lash line enhancement. Few studies show ocular and lid complications of blepharopigmentation. The present paper describes 3 cases of trichiasis related to this procedure. The authors discuss the probable pathophysiology and comment the treatment of the cases.

Circuito elétrico auxiliar para intubação das vias lacrimais

SUMMARY Purpose: To present an auxiliary electrical circuit (CAI) forlacrimal system intubation. Method: The device is described as well as its application to40 patients with congenital and traumatic lacrimalobstruction. Results: An electrical characteristics study of CAI wasperformed and compared to other instruments reported inthe literature, showing its advantages. Its use helped theretrieval of Crawford probes in all patients. Conclusions: CAI is safe and effective. Its use allows a quicklocalization and retrieval of Crawford probe even whenperformed by trainee physicians not familiar with lacrimalanatomy. Keywords : Lacrimal system; Intubation. REFERENCIAS BIBLIOGRAFICAS1. Bison S, Soccol O. Confeccao artesanal de arame de Johnson. Arq Bras Oftal1988;61(5);599-601.2. Dibble RF, Friedel SD. A Simplified method of monocanalicular siliconeintubation. Ophthalmic Surg 1990;21:134-5.3. Franca VP, Rayes A, Deboni JA, Moura EM. Obstrucao lacrimal do recOm-nascido. In: Soares EJC, Moura EM Goncalves JO, eds. Cirurgia PlAEsticaOcular. Sao Paulo: Roca, 1997,479-92.4. Kikuta HS. Laceracies canaliculares. In: Moreira Jr., CA, Kikuta HS, FreitasD, eds. Trauma Ocular. Rio de Janeiro: Cultura MOdica, 1997, capitulo 19.5. Gavaris PT. Lacrimal duct probing light. Trans Am Acad Ophtalmol Otolaringol1976;18:118-9.6. Bargum R. Ohmmeter-guided nasolacrimal intubation. Opthalmic Surg1992;23:827-8.7. Katowitz JA, Hollsten DA. Silicone intubation of the naso lacrimal drainagesystem. In: Linberg JV, ed. Lacrimal Surgery. New York: ChurchillLivingstone, 1988, capitulo 6.8. Commission Electrotechnique Internacionale. Effets du courant passant par lecorps humain (Publication 479-1). GenŁve. 1984.