Invasive transitional cell carcinoma of the lacrimal sac arising in an inverted papilloma.
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Adult↗
Biomedical subjects
A M Lessner
Publications and source records attributed to A M Lessner.
Fixation duress in the pathogenesis of upper eyelid retraction in thyroid orbitopathy. A prospective study.
BACKGROUND: Upper eyelid retraction in thyroid eye disease may be caused by proptosis, levator and Müller's muscle infiltration with fibrosis or individual fiber enlargement, excessive sympathetic innervation, abnormal adhesions between levator palpebrae muscle and surrounding tissues, or fixation duress. Fixation duress refers to upper eyelid retraction while fixating with an eye with inferior rectus muscle restriction due to excessive simultaneous firing of the ipsilateral superior rectus and levator palpebrae muscles. METHODS: The authors prospectively examined six patients with strabismus and thyroid eye disease associated with inferior rectus restriction and upper eyelid retraction in whom the eyelid retraction was suspected clinically to be a result of fixation duress. All six patients underwent recession of both inferior recti ranging from 3 to 6.5 mm (mean, 4.5 mm) to improve the ocular motility and alignment, reduce the diplopia, and mitigate the upper eyelid retraction. RESULTS: Reduction of upper eyelid retraction measured as the preoperative versus postoperative difference in corneal light reflex-upper eyelid margin measurements was achieved in all patients postoperatively, ranging from 1.5 to 5.5 mm (mean, 3.2 mm). Only one patient showed significant residual retraction to warrant consideration of upper eyelid surgery. CONCLUSION: Fixation duress plays a significant role in upper eyelid retraction of thyroid eye disease in a subset of patients with restriction of the inferior rectus muscle. In this selected group of patients, the upper eyelid retraction may be reduced or eliminated upon proper recession of the tight inferior rectus muscle(s).
Diplopia↗
The transconjunctival approach to the orbital floor and orbital fat. A prospective study.
The transconjunctival approach to the inferior orbit and orbital fat offers the potential advantage of avoidance of scar creation in the lower eyelid skin and anterior lamellae. Complications of this approach, including conjunctival fornix shortening and eyelid margin malposition, have been occasionally reported. We prospectively observed 25 patients undergoing transconjunctival blepharoplasty and orbital floor surgery. Fornix depth, eyelid margin position, and the presence or absence of eyelid retraction were measured preoperatively and at each postoperative visit. No significant permanent change in these parameters was observed. Temporary entropion was observed in two patients; this resolved with conservative treatment. On self-limited suture granuloma was observed. In a subgroup of six patients, the conjunctival incision was closed on one side and left unclosed on the other. No adverse healing was noted on the unclosed side. We conclude that the transconjunctival approach is associated with a low incidence of complications, and that it does not significantly alter the fornix depth or eyelid margin position. A skin incision is avoided. The inferior orbital septum is not violated, greatly reducing the risk of development of lower eyelid retraction.
Adipose Tissue↗
Acquired contralateral oculomotor synkinesis.
A patient with a traumatic right third nerve paresis had a contralateral oculomotor synkinesis develop that involved the left upper eyelid. With infraduction in adduction of the nonparetic left globe, the left upper eyelid was elevated. Elevation of the right upper eyelid was present in adduction of the paretic eye but absent in downgaze. To our knowledge this is the first description of the pseudo-Graefe phenomenon developing contralateral to the regenerating paretic third nerve.
Adolescent↗
Vibrio alginolyticus conjunctivitis. First reported case.
A gravely ill patient had Vibrio alginolyticus conjunctivitis develop, possibly from contact with seashell fragments. It is believed to be the first reported instance of ocular infection by this organism. Marine Vibrio organisms must be considered as potential sources of ocular infection in patients with direct or indirect exposure to salt water habitats, or in patients who are immunocompromised.
Aged↗
Diagnosis and treatment of pelvic lymphoceles in the renal transplant recipient.
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Adult↗