Nilson Lopes da Fonseca Junior

Metastatic eyelid disease associated with primary breast carcinoma: case report

Metastasis confined to eyelids are rare, representing less than 1% of malignant eyelid lesions. More than 50% of all eyelid metastasis are reported to have the breast as the most common primary origin. Two cases of metastatic eyelid disease associated with primary breast carcinoma are described. These lesions were the first sign of metastatic systemic disease. Case 1: An 80-year old woman with no significant ophthalmological history complaining of a discrete painless lesion in the left upper eyelid. She had been diagnosed 10 years before as infiltrated ductal carcinoma of right mammary gland with no reference of metastatic disease. Case 2: A 77-year old woman who attends our ophthalmology service came complaining of a four-month history of a painless swelling and erythema of right lower eyelid. The past medical history was significant for infiltrated ductal carcinoma on right mammary gland 2 years before the ocular manifestation. Breast carcinoma is notorious for its presentation diversity. Metastatic disease should be considered as differential diagnosis of eyelid lesions. Although rare, these lesions can be an initial sign of systemic malignancy.

Eficácia terapêutica do interferon alfa em criança com hemangioma gigante craniofacial: relato de caso

O hemangioma e o tumor benigno mais frequente da infância. O hemangioma capilar geralmente apresenta-se como uma mancha ou tumoracao violacea bem delimitada. O diagnostico destas lesoes e clinico. O hemangioma gigante e rara e extensa variacao do hemangioma capilar, que geralmente ocorre em recem-nascidos e lactentes. Varias sao as modalidades terapeuticas, como a injecao intralesional de corticoide, laserterapia, injecao intralesional de solucoes esclerosantes, corticoterapia sistemica, cirurgia, radioterapia e embolizacao. Novas modalidades terapeuticas tem sido desenvolvidas, com o objetivo de se obter melhores resultados e possibilitar o tratamento de lesoes de dificil acesso cirurgico e refratarias as modalidades terapeuticas utilizadas rotineiramente. Os melhores resultados tem sido obtidos com o interferon alfa. Este e um caso de uma paciente com tres meses de idade, que apresentava desde o nascimento, tumoracao arroxeada e amolecida em palpebra superior do olho direito, lesoes cutâneas planas e arroxeadas em regiao temporal e parietal direita. Realizada tomografia computadorizada de crânio evidenciando processo expansivo orbitario vascularizado com extensao para fossa media, seio cavernoso e fossa posterior. O tratamento inicial foi a corticoterapia oral durante quarenta dias, com reducao progressiva por quatro semanas. Com o quadro praticamente inalterado, foi iniciado o tratamento com interferon alfa, na dose de 3.000.000 U/m2, subcutâneo, tres vezes por semana. Apos 9 meses de tratamento, observa-se apenas uma pequena lesao orbitaria residual. Neste caso, o interferon alfa apresentou-se como boa opcao no tratamento do hemangioma gigante craniofacial.

Comparação entre duas soluções modificadas de lidocaína para uso em anestesia local na blefaroplastia

PURPOSE To compare pain on injection of two modified anesthetic lidocaine solutions for use in upper blepharoplasty: 2% lidocaine with 1:100,000 epinephrine, and 2% lidocaine with 1:100,000 epinephrine buffered 9:1 with 8.4% sodium bicarbonate. METHODS In this prospective, double-masked study, 25 consecutive patients undergoing upper blepharoplasty were submitted to the anesthesic procedure. Each eyelid received one of two modified lidocaine solutions. Heart rate, systemic arterial pressure and oxygen saturation level were obtained before, during and after injection of two different anesthetic solutions. Patients used a 4-point scale to rate the perceived pain on injection. RESULTS All parameters were statistically analyzed and there was a significant difference in heart rate and oxygen saturation level. CONCLUSION Pain on injection of eyelid anesthesia does not differ significantly with either buffered or unmodified lidocaine solutions.

A importância da enoftalmia senil no desenvolvimento do entrópio involucional

PURPOSE: To observe the role of senile enophthalmos in involutional entropion. METHODS: Prospective clinical study comparing a population of 30 white patients above 65 years with involutional entropion (Group I) of an age- and race-matched control group (Group II). All age and exophthalmometric values were analyzed by a statistical study. RESULTS: The average age was 77.7 years in Group I and 75.7 years in Group II. Eyes with involutional entropion are no more likely to have enophthalmos (15.22 mm) than is the involved contralateral eye (15.11 mm) or normal eyes of an age- and race-matched control group (15.13 mm). CONCLUSION: There is no correlation between involutional entropion and senile enophthalmos.

Sarcoma granulocítico em órbita: relato de caso

Orbital granulocytic sarcoma is a localized tumor consisting of malignant cells of myeloid origin. This tumor may present in association with acute myelogenous leukemia. Granulocytic sarcoma may be found in a variety of locations throughout the body including the orbit and typically affects children and young adults. There is a slight male predominance in these cases. This is an uncommon case report of a 33-year-old Latin-American woman who was admitted to the Hospital for rapidly progressive orbital proptosis. There was no systemic manifestation of leukemia. The occurrence of orbital granulocytic sarcoma before the development of systemic leukemia in children and young adults is not uncommon and these cases frequently develop hematological evidence within 2 months after initial orbital disease. In this case report, there was no systemic manifestation of leukemia in the last 30 months, even in the presence of orbital tumors. Granulocytic sarcoma is most frequently confused with malignant lymphoma, rhabdomyosarcoma and neuroblastoma. The differential diagnosis of these cases can be challenging, particularly when there is no evidence of systemic leukemia, when imaging features are not sufficiently specific to distinguish granulocytic neoplasms from other tumors. To establish the diagnosis often a biopsy is required. The treatment in such cases (orbital granulocytic sarcoma) is not standardized. Orbital granulocytic sarcoma may be suspected in cases of orbital tumors even in the absence of systemic manifestations of leukemia at any age.

Metástase orbitária como único achado em paciente com hepatocarcinoma: relato de caso

Orbital metastasis of hepatocellular carcinoma is rare. We report an unusual orbital metastatic lesion as the only finding in a case of hepatocellular carcinoma. A 57-year-old man presented with a 6-month history of orbital painful right orbital mass, associated with proptosis. Computed tomography of the orbits showed an orbital soft tissue mass leading to bone erosion and intracranial invasion. Computed tomography of the abdomen showed a focal perfusion abnormality in the left lobe of the liver. Incisional biopsy was performed and the histopathologic examination of the specimen confirmed the diagnosis. The patient died 15 months after the initial presentation. COMENTS: This is a rare case of orbital metastasis of hepatocellular carcinoma. There was no another metastatic lesion and the patient reported only ophthalmological symptoms.

Efeitos da blefaroplastia na síndrome da disfunção lacrimal

OBJETIVO:Avaliar a presenca da sindrome da disfuncao lacrimal e alteracoes na sensibilidade corneana no pre e pos-operatorio de pacientes com indicacao de blefaroplastia superior. METODOS: Foram avaliados 30 pacientes com indicacao cirurgica para correcao de dermatocalase em palpebra superior de ambos os olhos. Obtida historia clinica e realizado exame oftalmologico geral, incluindo exames como teste de Schirmer I, coloracao com Lissamina Verde, tempo de ruptura do filme lacrimal, coloracao com fluoresceina e teste da sensibilidade corneana com estesiometro de Cochet-Bonnet, alem de teste subjetivo pelo questionario ODSI. Os exames foram realizados antes e apos 90 dias da cirurgia. RESULTADOS: Apenas 23 pacientes completaram o seguimento, sendo o sexo feminino predominante. A idade dos pacientes variou de 63 a 87 anos. De acordo com o questionario ODSI aplicado, observou-se que houve melhora dos sintomas, mas a analise estatistica mostrou um resultado nao-significante. Com relacao a analise dos resultados obtidos com o estesiometro de Cochet-Bonnet, 7 pacientes apresentaram uma melhora na sensibilidade corneana, 9 pacientes diminuiram a resposta e 7 mantiveram seus valores. Os resultados do BUT lacrimal, coloracoes com Lissamina verde e Fluoresceina foram considerados estatisticamente nao-significantes. O teste de Schirmer I demonstrou uma melhora estatisticamente significativa da producao lacrimal no pos-operatorio. CONCLUSAO: Neste trabalho observou-se que os pacientes submetidos a blefaroplastia superior apresentaram uma melhora nos sinais e sintomas relacionados a SDL, apesar de ter sido diagnosticado uma diminuicao na sensibilidade corneana nao estatisticamente significante.

Transposição da rima palpebral em ptose miogênica mitocondrial

OBJETIVO: Relatar o uso da resseccao do tarso da palpebra superior e enxerto na palpebra inferior para a elevacao da rima palpebral e liberacao do eixo visual, sem causar complicacoes corneanas em pacientes portadores de ptose miogenica mitocondrial. METODOS: Estudo prospectivo. A tecnica cirurgica consiste na tarsectomia da palpebra superior e autoenxerto do tarso na lamela posterior da palpebra inferior. As cirurgias foram realizadas sob anestesia local. No caso de diplopia, a cirurgia foi realizada em apenas um olho. RESULTADOS: O procedimento foi realizado em 9 olhos de 6 pacientes com miopatia mitocondrial. Cinco pacientes eram do sexo feminino, a media de idade foi de 59,8 anos e o seguimento variou de 30 a 60 meses. A rima palpebral elevou em todos os pacientes, descobrindo o eixo visual na posicao primaria do olhar e melhorando a posicao viciosa de cabeca. Nao houve complicacoes decorrentes da exposicao do globo ocular. CONCLUSAO: A tecnica de transposicao da rima palpebral e util na correcao do mau posicionamento das palpebras em pacientes sem mecanismos de protecao porque eleva a palpebra superior e a inferior, diminuindo ou eliminando o risco de causar lagoftalmo com complicacoes corneanas.PURPOSE To report the use of tarsal switch levator resection procedures that lift the palpebral fissure to visual axis without causing corneal complications in patients with mitochondrial myogenic ptosis. METHODS Prospective study. The technique consists of an upper eyelid tarsectomy, with transfer of the autologous tarsoconjunctival graft to the posterior lamella of the lower eyelid. The surgeries were performed under local anesthesia. In case of diplopia, the surgery was performed in one eye. RESULTS Tarsal switch procedure was performed in 9 eyes of 6 patients with mitochondrial myopathy. There were 5 women; the average age was 59.8 years and the follow-up ranged from 30 to 60 months. The palpebral fissure was moved cephalad in all patients, unmasking their visual axis in primary position and improving their head position. There was no patient with exposure symptoms after surgery. CONCLUSION The tarsal switch procedure is useful in managing the eyelid malpositions in patients with poor eye protective mechanisms because it elevates both the upper and the lower eyelids, decreasing or eliminating the risk of lagophthalmos with corneal complications.

Eficácia do resfriamento da pele no alívio da dor desencadeada pela injeção de toxina botulínica tipo A nas distonias faciais

PURPOSE: To evaluate the efficacy of skin cooling with ice on pain relief in periocular injection with botulinum toxin type A in patients with facial dystonias. METHODS: In this prospective study, 13 patients received botulinum toxin type A injection in glabela (procerus m.) and periocular region (orbicular m.) for facial dystonias treatment. Before the injections, one side of the glabela was submitted to a 5-minute cooling period, while the opposite side had Epitezan® cream applied, as a placebo. The application was done at the cooled side first. After the application on each side the patients were instructed to rate the pain associated with the injection on a scale from 0 to 10, with 0 indicating no pain and 10 the worst pain. RESULTS: The average pain score on the side where cold was applied was 3,92 ± 3,28, while on the control side the average pain score was 2,92 ± 2,18 (p < 0,0166). CONCLUSION: In this study, skin cooling with ice cubes was efficient in pain relief in periocular botulinum toxin injections in patients with facial dystonias.

Teste do gelo no diagnóstico de miastenia gravis

PURPOSE: To demonstrate the sensitivity and the specificity of the ice test in the differential diagnosis of ptosis in myasthenia gravis. METHODS: Prospective trial with a control group. The patients were instructed to hold a frozen ice pack on the closed ptotic eyelid. They were divided into 2 groups, with group I consisting of patients with myasthenia gravis and group II (control) consisting of patients with congenital, non-myasthenic myogenic or aponeurotic ptosis. RESULTS: All patients in group I had increased palpebral fissure for at least 3 mm after the application of ice pack. No patient in group II showed increased palpebral fissure after the ice test. CONCLUSION: Ice test proved to be specific for the detection of myasthenic ptosis.