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Biomedical subjects

D R Kulwin

Publications and source records attributed to D R Kulwin.

At least 19 recordsLinked to original sources
PubMed1995

Management of canalicular injury associated with eyelid burns.

PURPOSE: To develop a protocol for treatment of injuries to the puncta and canaliculi associated with eyelid burns. METHODS: We retrospectively reviewed the records of seven patients who required treatment of punctal and canalicular stenosis caused by burns to the medial eyelids. RESULTS: Seven patients were treated within 5 days of injury: one by punctal dilation and six by surgical debridement, punctoplasty or canaliculoplasty, and silicone intubation. All remained free of epiphora. CONCLUSIONS: Early evaluation and treatment of punctal and canalicular burn injuries are beneficial. If the puncta are only slightly stenotic, close observation with serial lacrimal testing and punctal dilation is recommended. If the puncta and lateral canaliculi are severely stenotic or obliterated, surgical débridement and punctoplasty or canaliculoplasty followed by placement of a silicone stent effectively prevents permanent lacrimal stenosis and epiphora.

Adult↗
PubMed1995

Acquired ptosis in the young and middle-aged adult population.

PURPOSE: The authors studied the etiology of acquired ptosis in the young to middle-aged adult population with specific attention to the role of rigid contact lens use. METHODS: The study consisted of all patients between the ages of 15 and 50 years with acquired ptosis who presented between April 1986 and May 1994. Potential factors responsible for acquired ptosis were investigated in all patients with specific attention directed to history and duration of contact lens wear. RESULTS: In the consecutive series of 91 young to middle-aged adults with acquired ptosis, we found contact lens wear to be the only identifiable cause in 47% of patients. This was the most common cause for acquired ptosis in this age group. Trauma was a distant second cause, accounting for 19% of patients. Of the contact lens-induced ptosis, 58% were unilateral and 42% were bilateral. Of the 25 patients who wore contact lenses and had unilateral ptosis on examination, manual elevation of the ptotic lid showed an unsuspected contralateral ptosis to be manifest in seven patients due to Hering's law. Ptosis was overwhelmingly associated with rigid contact lens wear, and levator aponeurosis disinsertion was found in the large majority at the time of surgical repair. CONCLUSION: This study suggests that contact lens-induced ptosis is a much more common cause of acquired ptosis in young and middle-aged adults than has been suspected previously. The ptosis is primarily due to levator aponeurotic disinsertion, presumably due to recurrent traction on the aponeurosis during rigid contact lens removal.

Adolescent↗
PubMed1994

Periorbital dirofilariasis.

A differential diagnosis of inflammatory periocular soft tissue masses includes sarcoidosis, ruptured dermoid cyst, infectious abscess, metastatic neoplastic disease, and idiopathic pseudotumor. The authors present the case of a 42-year-old woman with a periocular inflammatory mass caused by dirofilaria of a nematode classification as Dirofilaria tenuis. The extraction of the worm was curative and the patient has been symptom-free for the ensuing 12 months. This zoonotic infection, spread by mosquito vectors from animal hosts to humans, is rarely encountered in the United States as a cause of periorbital inflammation. A history of migratory swelling and residence in, or travel to, endemic areas (the southeastern United States) should suggest the possibility of Dirofilaria infection.

Adult↗
PubMed1993

Rhabdomyosarcoma manifesting as acquired nasolacrimal duct obstruction.

A 5-month-old boy with acquired epiphora developed a right inferonasal lower eyelid mass, which was shown on computed tomography to involve the inferior and medial recti muscles and the nasolacrimal duct. Orbital exploration and excision of the mass disclosed this to be an embryonal rhabdomyosarcoma. This case illustrates the importance of distinguishing acquired nasolacrimal duct obstruction in infancy from true congenital nasolacrimal duct obstruction.

Diagnosis, Differential↗
PubMed1992

Tarsotomy for the treatment of cicatricial entropion with trichiasis.

Transverse tarsotomy and lid margin rotation is a simple procedure that is effective in repositioning the entropic lid margin without requiring external incisions or grafting. We report the results of this procedure in 81 eyelids of 58 patients with cicatricial entropion and trichiasis who were followed up for a minimum of 6 months after surgery. Fifty-nine (94%) of sixty-three eyelids with mild to moderate cicatricial entropion were cured with this procedure. Patients with severe cicatricial entropion had a lower success rate with initial tarsotomy (55%), but in these patients the procedure had minimal complications and repeating the operation resulted in a higher success rate. Tarsotomy and lid margin rotation produces excellent cosmetic and functional results when used to treat patients with mild to moderate cicatricial entropion. In cases of more severe cicatricial entropion, we still recommend it as the initial procedure after which more complex modalities may be used if needed.

Adolescent↗
PubMed1992

Extended access/internal approaches for the management of facial trauma.

The two most significant recent developments in the treatment of facial trauma are the introduction of plating systems, which provide rigid internal fixation and the development of surgical approaches that allow wide exposure of the entire facial skeleton while minimizing external incisions. These approaches (referred to as extended access/internal approaches) are hemicoronal and coronal flaps, the sublabial approach to the midface, the transconjunctival approach to the orbital floor and orbital rim, and the intraoral management of mandibular fractures. These approaches work well, and have become standard techniques for managing facial trauma; however, each one has definite technical points that need to be adhered to to assure their success. Additionally, there are situations where these approaches are not appropriate and, in fact, may even be detrimental. This article outlines our approach to facial trauma using these extended access/internal approaches and discusses the important technical factors of each approach. Our experience in treating 113 patients with 119 fractures and 161 approaches over the last 2 years is presented and the role extended access/internal approaches have played is reviewed. The indications, limitations, and possible complications associated with each approach are outlined.

Facial Bones↗
PubMed1991

Lipomatous hamartoma of the orbit.

Proliferations of mature adipose tissue, while common in retroperitoneal and subcutaneous sites, rarely occur in the orbit. We describe the clinical, radiographic, and histopathologic findings of a nonencapsulated lipomatous tissue overgrowth of the right orbit in a 35-year-old man. The mass had caused proptosis since childhood and was apparently present since birth. Due to the age at onset, the histologic similarity to normal orbital fat, and the lack of encapsulation or choristomatous elements, we propose the term lipomatous hamartoma for this entity.

Adult↗
PubMed1990

Management of congenital lacrimal sac fistula.

Fourteen patients who were treated for symptomatic congenital lacrimal sac fistula were retrospectively reviewed to evaluate surgical success. Excision of the fistula alone was performed on 9 patients and excision with nasolacrimal intubation on 5 patients (to our knowledge, the latter has not been previously described in the English literature). None of the 14 patients were symptomatic postoperatively during a mean follow-up of 16 months, with a range from 3 to 39 months. We conclude that dacryocystorhinostomy is usually not necessary to successfully treat symptomatic congenital lacrimal sac fistula.

Adolescent↗
PubMed1990

Management of lower-lid retraction with hard-palate mucosa grafting.

Lower eyelid retraction is frequently managed by recession of the lower-lid retractors and interposition of a "spacer graft." We have used hard-palate mucosa as our spacer material in 25 eyelids of 18 patients. A graft twice the height of the measured amount of lid retraction was used and resulted in predictable, satisfactory results. The hard-palate mucosa was easily obtained and the donor site healed well in all patients, with minimal care.

Adult↗