PubMed Health⌕ Search

Biomedical subjects

B R Frueh

Publications and source records attributed to B R Frueh.

At least 19 recordsLinked to original sources
PubMed1992

Effects of eyelid protractor excision for the treatment of benign essential blepharospasm.

Data were analyzed from 37 patients with essential blepharospasm who had undergone upper eyelid protractor excision with brow suspension, and who had a median follow-up of 40 months (range, 12 to 83.5 months) after surgery. Of the 37 patients, 15 (40.5%) had sufficient relief of their spasms at their last follow-up; 22 patients (59.5%) had functionally significant recurrent or residual spasms after upper eyelid surgery. Of these 22 patients, 12 (55%) had recurrences more than six months after surgery, and four patients (18%) had recurrences more than one year after surgery. Patients with Meige syndrome were no more likely to experience recurrent spasms after upper eyelid surgery than patients who lacked a lower facial spasm component. Recurrence of symptoms was primarily the result of lower eyelid spasms in 11 patients (50%), upper eyelid spasms in one patient (5%), and all eyelids in six patients (27%). The location of recurrent spasms could not be ascertained in four patients (18%), with whom we had only telephone contact. Seven of 12 patients (58%) undergoing secondary procedures had relief from their spasms at the end of this study. Excluding those patients who chose to decline further surgery, 22 of 27 patients (81.5%) received satisfactory relief of symptoms after upper eyelid and, if needed, lower eyelid and repeat upper eyelid protractor excision. These long-term results are comparable to those reported previously for differential section of the facial nerve. Because the side effects of eyelid protractor excision are generally more acceptable, we recommend that when surgery is determined to be necessary for essential blepharospasm, upper eyelid protractor excision is the preferred surgical approach.

Aged↗
PubMed1992

Through curettage in the treatment of chronic canaliculitis.

While various techniques have been proposed for the treatment of canaliculitis, there have been no published series that evaluate the efficacy of simple curettage in the treatment of persistent or recurrent canaliculitis. We report the effectiveness of thorough, simple curettage (without canaliculotomy) in 11 patients with chronic canaliculitis. All patients had a history of canaliculitis-related symptoms for a minimum of 6 months and clinically detectable canalicular concretions before initial treatment. Thorough, simple curettage (without canaliculotomy) resolved the chronic canaliculitis in all of the patients. Ten of the 11 patients were cured with a maximum of two sessions of curettage. One patient required three treatments of curettage and silicone intubation for common canalicular narrowing to render her free of symptoms. No surgical complications occurred in any of the patients. Our report confirms the effectiveness and low morbidity of thorough curettage in the treatment of persistent or recurrent cases of canaliculitis.

Adult↗
PubMed1992

Why the NOSPECS classification of Graves' eye disease should be abandoned, with suggestions for the characterization of this disease.

The NOSPECS classification of Graves' eye disease is inadequate for a number of reasons: (a) poor characterization of the condition with no indication of disease activity, marked underrepresentation of eyelid position, and overrepresentation of corneal problems, (b) it represents neither a continuous nor stepladder progression of disease as the numbered classification would suggest, (c) parts of it are subjective, and (d) the gradings of classes 3, 5, and 6 are poor. Graves' eye disease should be characterized rather than classified, using objective clinical assessments of optic nerve function, proptosis, ocular motility, and eyelid position. It is recommended that a multicenter clinical trial be done to determine the significance of different values and changes in values for each assessment. Disease activity is to be defined by the clinical trial in terms of changes of the four assessments as a function of time. This should produce a simple characterization that would create an image of the patient's eye problems for a knowledgeable physician and be sufficient to guide decisions on whether currently accepted surgical therapies are advisable. Data from the clinical trial would enable the characterization to predict the likelihood of success of various immunosuppressive therapies.

Graves Disease↗
PubMed1991

Long-term efficacy of orbital decompression for compressive optic neuropathy of Graves' eye disease.

In a retrospective evaluation of the long-term effect of transantral-ethmoidal decompression for compressive optic neuropathy, the authors evaluated visual acuity, visual fields, color vision, and motility in 30 patients (52 orbits) for a median follow-up period of 2.5 years (range, 0.6 to 6.5 years). Patients with preoperative visual acuity of 20/40 or better uniformly remained in this category and demonstrated an earlier stabilization of vision than those with poorer preoperative visual acuity. Of the ten patients whose preoperative visual acuity was 20/50 to 20/100, 80% attained acuity of 20/40 or better. In patients whose visual acuity was 20/200 or less (n = 7), 57% attained an acuity of 20/40 or better. The most common visual field defect was generalized constriction, which was noted in 43 of the 52 eyes (83%). After decompression, the preoperative visual field defect had improved or completely resolved in all but one case. Dyschromatopsia, noted in 20 eyes preoperatively, cleared in 17 (85%) postoperatively. Although the study showed that surgical decompression is beneficial, some patients may require additional modalities of treatment.

Adult↗
PubMed1990

Facial nerve injury and hemifacial spasm.

We studied evidence of facial nerve damage in patients with hemifacial spasm. Three types of evidence of nerve damage were analyzed: objectively measured weakness in eyelid protractor strength, clinically evident weakness of muscles innervated by the seventh nerve, and clinically evident aberrant seventh nerve regeneration. Of the 60 patients in the study, 54 (90%) had at least one of these features of seventh nerve damage. Objectively measured eyelid protractor weakness was noted in 27 of 58 patients (47%) who were tested. Clinically apparent weakness of at least one of four facial muscle groups was noted in 42 of 60 patients (70%). Aberrant seventh nerve regeneration was documented in 25 of 60 patients (42%). These findings indicate that facial nerve damage is common in patients with hemifacial spasm.

Adult↗
PubMed1989

A comparison of two methods of punctal occlusion.

We performed punctal occlusion by thermal cautery on 23 patients (45 sides, 90 puncta). One punctum on the right side was randomly assigned to deep cauterization of the punctum and vertical canaliculus, and the other punctum assigned to cauterization of the punctum only. The two treatments were assigned to the opposite puncta on the left side. One month after cauterization, the puncta that received deep cauterization were significantly more likely to have remained closed than those that received superficial cauterization (P less than .01). Survival analysis over a period of follow-up that exceeded one year after surgery, using time to examination because of a reopened punctum as the endpoint, indicated a long-term advantageous effect of deep over superficial cauterization.

Electrocoagulation↗
PubMed1989

Efficacy of the primary dye test.

A primary dye test was performed on the right lacrimal system of 25 normal subjects by three physicians of differing levels of experience in performing the test. The frequency of positive primary dye tests for each of the three examiners was higher than previously reported. The most experienced examiner had the highest percentage (100%) of positive primary dye tests, and the least experienced examiner had the lowest percentage (80%) of positive tests. However, variation between the most experienced examiner and the other two was due, at least in part, to a difference in fluorescein instillation. Therefore, the effect of experience could not be ascertained. The most experienced examiner used four moistened fluorescein strips medially and each used a 10-minute interval after dye instillation before looking for evidence of dye passage through the nasolacrimal duct. Twenty-one (84%) of the subjects had a positive primary dye test on initial blowing of the nose. This indicates that even inexperienced examiners can expect to detect a high percentage of functioning lacrimal drainage system with the method of the experienced examiner.

Adult↗
PubMed1989

Transantral orbital decompression for compressive optic neuropathy due to sphenoid ridge meningioma.

We present a case of unilateral exophthalmos and compressive optic neuropathy due to sphenoid ridge meningioma. The patient underwent transantral orbital decompression with removal of the orbital floor and medial wall that resulted in rapid, dramatic normalization of both visual acuity and visual field in the involved eye. Due to the slow-growing, noninfiltrative nature of meningiomas, we propose this procedure as an alternative, initial, palliative treatment for selected cases of compressive optic neuropathy due to meningioma compressing the posterior orbit. This procedure can provide restoration of visual function with less risk to the patient than neurosurgical resection.

Bone Neoplasms↗
PubMed1988

The effect of omitting botulinum toxin from the lower eyelid in blepharospasm treatment.

We randomly selected 26 patients with essential blepharospasm to receive either botulinum toxin or saline injection in their lower eyelids to evaluate the necessity of lower eyelid injection to relieve blepharospasm. As diplopia may occur from botulinum toxin injections for blepharospasm, most commonly from injection of the lower eyelid, and surgical relief of blepharospasm is often achieved by excision of only the upper eyelid protractors, omission of toxin from the lower eyelid seemed both desirable and possible. All patients received botulinum toxin in the upper eyelids, above the eyebrows, across the glabella, and near the lateral canthus. Thirteen of 15 patients who received saline in their lower eyelids had relief of spasm, with the same spasm-free interval as those who received toxin. We recommend avoiding injection of toxin in the medial two thirds of the lower eyelid in order to diminish the likelihood of diplopia from inferior oblique muscle paresis.

Blepharitis↗
PubMed1988

A pharmacologic study of the sympathetic eyelid tarsal muscles.

The contractile state of the sympathetically innervated superior and inferior tarsal muscles, also known as Mueller's muscles, was defined in 10 young adults by stimulating and then paralyzing these muscles pharmacologically in a randomized, double-masked study, using one eye for drug and the other for control. The drugs used topically were phenylephrine hydrochloride 2.5 and 10% for muscle stimulation, and guanethidine 5% and thymoxamine hydrochloride 0.5% for muscle inhibition. A model is described for accurately examining and recording changes in the vertical palpebral fissure simultaneously bilaterally using magnified images from two high-resolution, high-sensitivity video cameras. The superior tarsal muscle averaged 50% of its total possible contraction when it was in its tonic state, and the inferior tarsal muscle averaged 67%. The drug instillations defined the mean maximum total excursion of the superior tarsal muscle as 3.0 mm, with 1.5 mm of upward displacement and 1.5 mm of downward displacement from its tonic position. The inferior tarsal muscle had a mean maximum total excursion of 0.3 mm, with 0.1 mm downward displacement and 0.2 mm upward displacement from its tonic position.

Adult↗
PubMed1986

Treatment of facial spasm with botulinum toxin. An interim report.

Forty-eight patients were given serial injections of botulinum toxin in their eyelids for treatment of eyelid spasm during a two-year interval. Ninety-four percent obtained relief of spasm from botulinum toxin injection. The duration of the spasm-free interval as well as the incidence of ptosis and of diplopia was dose dependent. The marked increase in the incidence of these side effects with only a small increase in the duration of the spasm-free interval, when a dose of 25 units per lid was used, leads the authors to conclude that this dose is too high and should not be used. Since diplopia was most commonly caused by paresis of the inferior oblique muscle, and since blepharospasm usually can be controlled by excising the upper lid protractors, further studies are required to determine whether lower lid injection is necessary and, if it is found to be so, whether injecting only the lateral portion of the lid would be adequate.

Blepharospasm↗
PubMed1986

Lid protractor force generation in Graves' eye disease.

The posterior vector of the lid protractor force was measured in 29 patients with Graves' eye disease (GED) and 70 normal subjects. Patients with GED had significantly lower mean lid protractor force generation than normal subjects, although GED patients with compressive optic neuropathy did not show this difference. There was a negative correlation between the posterior force vectors and the exophthalmometer reading in GED patients only. It is conjectured that these two factors are linked by orbital and lid inflammation. The inflammation that increases orbital bulk, and thus increases the exophthalmometer reading, may well cause atrophy in the orbicularis oculi muscles, decreasing its force generation.

Exophthalmos↗