PubMed Health⌕ Search

Biomedical subjects

Dinesh Selva

Publications and source records attributed to Dinesh Selva.

At least 19 recordsLinked to original sources
PubMed2026

Orbital involvement in sickle cell disease: A systematic review.

Orbital involvement in sickle cell disease (SCD) is rare but potentially vision-threatening and is often misdiagnosed due to overlap with infectious orbital disease. We conducted a systematic review of case reports and series describing orbital complications in patients with confirmed SCD, following PRISMA and MOOSE guidelines. Across 53 studies, 76 cases were identified. Patients were predominantly male (77.6%), with an average age of 13.2 years. Orbital disease was the initial SCD manifestation in 6.6%. Presentations included periorbital edema in all, proptosis in 64.1%, restricted ocular motility in 56.5%, reduced visual acuity in 28.1%, and bilateral involvement in 38.2%. Laboratory findings commonly included leukocytosis (73%) and raised inflammatory markers (86.7%). Radiologically, orbital subperiosteal hematoma were observed in 70%, combined orbital bone infarction and hematoma in 38.2%, and orbital bone infarction alone in 19.7%. Magnetic resonance imaging is critical for accurate diagnosis. Intracranial hemorrhage was present in 9.2%. Less frequent manifestations included orbital apex syndrome, lacrimal gland disease, and nonspecific soft tissue swelling. Management was primarily conservative (82.9%), and surgery was reserved for vision-threatening or intracranial complications. Complete recovery was achieved in 93.1% of cases. While severe vision-threatening complications are uncommon, early recognition remains critical to optimising outcomes in sickle cell orbitopathy.

Humans↗
PubMed2003

Discoid lupus erythematosus presenting as madarosis.

PURPOSE: Discoid lupus erythematosus (DLE) is an autoimmune disorder that usually affects the sun-exposed skin. Periocular involvement occurs uncommonly and may progress from eyelid erythema to scarring and madarosis. METHODS: Observational case report. RESULT: A case of DLE that presented with madarosis alone in the absence of preceding skin erythema and scarring. CONCLUSION: Our case demonstrates that DLE may present with madarosis alone in the absence of a history of preceding erythema and scarring. Discoid lupus erythematosus should therefore be considered as a differential diagnosis in chronic blepharitis that persists despite usual medical management and eyelid hygiene. Biopsy should be considered in the presence of clinical features such as erythematous scale on the face and alopecia and sent for direct immunofluorescence staining.

Diagnosis, Differential↗
PubMed2003

Punctal-canalicular stenosis associated with mitomycin-C for corneal epithelial dysplasia.

PURPOSE: To report a case of punctal-canalicular stenosis after topical mitomycin C use for corneal dysplasia. To the authors' knowledge, this association has not previously been described. DESIGN: Observational case report. METHOD: A 62-year-old woman was noted to have a right inferotemporal corneal dysplastic lesion. She received a topical course of mitomycin-C 0.04% four times a day, which subsequently invoked a toxoallergic reaction. One month later, the patient developed right-sided epiphora. RESULTS: Probing demonstrated complete stenosis of the right lower canaliculus, 5 mm from the punctum. CONCLUSION: Mitomycin-C use may lead to lacrimal apparatus fibrosis and symptomatic epiphora when inciting a toxoallergic reaction.

Administration, Topical↗
PubMed2003

Mapped serial excision for periocular lentigo maligna and lentigo maligna melanoma.

PURPOSE: To report the early cure rate for periocular lentigo maligna (LM) and LM melanoma (LMM), using modified Mohs surgery with vertically cut paraffin-embedded sections (mapped serial excision [MSE]). A secondary aim was to identify differences in the clinical features and outcomes between periocular LM and LMM and those found elsewhere on the head and neck. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: One hundred thirty-five patients undergoing 141 MSE procedures. METHODS: A prospective series of 141 MSE procedures for LM and LMM over a 10-year period (1993-2002) in a single-center Mohs surgical unit. MAIN OUTCOME MEASURES: Recurrence, site, size of LM or LMM, invasiveness, prior recurrence, clear margin of excision, size of final defect, and number of levels required for complete excision. RESULTS: One hundred forty-one MSE procedures, of which 23% (32/141) were for LMM and 19% (27/141) were for periocular lesions. Location or prior recurrence were not predictive of invasive disease; however, the size distribution of the initial lesion (P = 0.0354) and the final defect after MSE (P = 0.0183) were larger in LMM. Thirty-one percent of LM and 14% of LMM less than 1 mm thick required larger than 5-mm and 1-cm margins, respectively, for complete excision. Mean follow-up of 32 months (range, 1-100 months) revealed 4 recurrences (3%), of which two were periocular (P = 0.188). CONCLUSIONS: Our review is the largest prospective series of MSE for LM and LMM and suggests that it is the treatment of choice in these forms of melanoma. Mapped serial excision offers a high early cure rate in conjunction with tissue conservation, which is of particular relevance in the periocular region. There were no significant differences between periocular LM and LMM and those found elsewhere in the head and neck region. It also appears that the current recommendations of 5-mm margins for in situ melanoma (LM) and 1-cm margins for melanoma less than 1 mm thick are insufficient for complete excision of LM or LMM, emphasizing the importance of margin-controlled excision of these lesions.

Adult↗
PubMed2003

Trichilemmal carcinoma of the upper eyelid.

INTRODUCTION: Trichilemmal carcinoma (TLC) is a rare adnexal tumour related to the external hair sheath. We describe the first case of TLC on the upper eyelid to be treated with Mohs micrographic surgery. CASE REPORT: A 65-year-old man presented with a 2-month history of a firm 4 mm left upper eyelid nodule. An incisional biopsy revealed an infiltrative, lobulated tumour composed of large, polygonal, clear cells. A diagnosis of trichilemmal carcinoma was made and the patient underwent Mohs micrographic surgery. At follow-up 2 years later, there was no evidence of recurrence. CONCLUSION: The pathogenesis of TLC remains unclear, with actinic damage, longterm low dose irradiation and transformation from benign trichilemmoma having been postulated. Trichilemmal carcinomas must be differentiated from other malignant clear cell tumours of the eyelid and the correct diagnosis made promptly as TLC takes an indolent clinical course, in which metastasis is a rare event, despite the tumour's cytologically malignant appearance. We recommend Mohs micrographic surgery as a treatment modality for this tumour, due to its potential for locally aggressive growth and local recurrence.

Aged↗
PubMed2003

Recurrent morphoeic basal cell carcinoma at the lateral canthus with orbitocranial invasion.

We present a case of recurrent, nodulocystic and morphoeic basal cell carcinoma (BCC) at the lateral canthus, with clinically silent orbital and intracranial invasion which was treated with radiotherapy. Orbital invasion is a rare complication of periocular BCC and occurs primarily in high-risk canthal lesions. Preoperative ophthalmological review and imaging should be considered in these cases.

Aged↗
PubMed2003

Pathogenesis of orbital cholesterol granuloma.

Two cases are presented of orbital cholesterol granuloma associated with gradual proptosis arising in men aged 35 and 41 years. Computed tomography demonstrated osteo-lytic masses in the frontal bone at the lacrimal fossa. Curettage revealed a characteristic histology of foreign body reactions surrounding cholesterol clefts. In both cases abnormal bone, more consistent with fibrous dysplasia than reactive change, was found at the periphery. The finding of abnormal bone associated with orbital cholesterol granulomas suggests that a pre-existing bone anomaly may be present in a subset of these cases.

Adult↗
PubMed2003

Craniopharyngioma: a review of long-term visual outcome.

PURPOSE: To assess the clinical presentation and long-term visual outcome in a series of patients with craniopharyn-gioma. METHODS: Retrospective case review. RESULTS: Thirty-six patients were reviewed, comprising 19 female patients and 17 male patients. The age range was 2-77 years with a bimodal distribution of 17 children (mean age 10 years) and 19 adults (mean age 47 years). Blurred vision was the most common visual complaint (23 cases, 64%) and headache the most frequent systemic complaint (19 cases, 53%). The average duration of systemic symptoms was 45 weeks compared to 10 weeks for visual symptoms. Deficits in visual acuity occurred in 13 patients (36%) and showed no significant change from initial presentation to final review. Sixteen patients (44%) had bitemporal hemianopia on presentation and pleomorphism (change from one type of visual field defect to another) occurred in 11 patients. Recurrence of tumour occurred in 15 patients (42%) and was more likely in children (59%) than adults (26%). The mean time period to recurrence was 7 years. The average follow-up period for all cases was 10 years. CONCLUSION: Patients with craniopharyngioma generally present late, and the visual symptoms are often preceded by a long history of systemic symptoms. Children are more likely to present with systemic symptoms than adults. Visual field pleomorphism is a feature of craniopharyngioma and occurred in one-third of the patients. Local recurrence is common. Although magnetic resonance imaging is the recommended means of follow up, regular neuro-ophthalmic review is useful in the early detection of anterior visual pathway compression by recurrent tumour.

Adolescent↗
PubMed2003

Self-inflicted blindness and Brown-Séquard syndrome.

A 30-year-old paranoid schizophrenic man suffered a psychotic episode while flying on an airplane, locked himself in the bathroom, detached the temples of his sunglasses, and stabbed them deeply into both medial orbits. He then secured one temple into the door hinge and rammed the back of his neck repeatedly against it. The injuries caused no light perception from optic nerve trauma and a Brown-Séquard hemitransection of the spinal cord.

Adult↗
PubMed2003

Bilateral dynamic proptosis due to frontoethmoidal sinus mucocele.

A 34-year-old man presented with bilateral inferior and lateral globe displacement and spontaneous, dynamic proptosis in both eyes, pulsatile in nature. Computed tomography and magnetic resonance imaging scans confirmed bilateral frontoethmoidal mucoceles with erosion of the orbital roof, and intracranial extension. Following a transcutaneous mini-trephine of the left orbital mucocele, the dynamic proptosis disappeared, and both proptosis and restriction of eye movements in the left eye improved. This is the first reported case of frontoethmoidal sinus mucocele causing bilateral spontaneous dynamic proptosis.

Adult↗
PubMed2003

Frontoethmoidal osteoma: a stereotactic-assisted sino-orbital approach.

A 28-year-old woman had an extensive osteoma arising in the frontoethmoidal sinuses and involving the orbital roof. The tumor was successfully removed by means of a combined sinus endoscopic and orbital approach, with the assistance of stereotactic localization. The patient had postoperative ptosis, diplopia, and supraorbital nerve anesthesia, which all resolved over a 3-month period. A stereotactic-assisted, sino-orbital approach to selected frontoethmoidal osteomas may provide a viable alternative to an orbitocranial approach.

Adult↗
PubMed2003

Orbitofrontal cholesterol granuloma: percutaneous endoscopic-assisted curettage.

This paper describes the use of endoscopic visualization in curettage of orbital cholesterol granuloma (OCG). Two males aged 54 and 50 years presented with orbitofrontal cholesterol granulomas arising in the superolateral frontal bone and abutting the dura. The granulomas were approached via a superior eyelid crease incision and a 70 degree rigid endoscope was used to visualize curettage of the granuloma from the inner surface of the frontal bone and the dura. Both patients made an uncomplicated recovery and there was no recurrence at eight months and two years follow up. Percutaneous endoscopic curettage is an alternative to blind curettage, lateral orbitotomy or frontal craniotomy for OCG.

Bone Diseases↗