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Biomedical subjects

J A Burns

Publications and source records attributed to J A Burns.

9 recordsLinked to original sources

Benign eyelid lesions.

BACKGROUND: Benign eyelid lesions include a diverse group of tumors, infections, and degenerative lesions that require specialized care for identification and treatment. OBJECTIVE: Diagnosis of benign eyelid lesions based on their clinical characteristics with pathological confirmation by biopsy where indicated. METHODS: Clinical evaluation, biopsy, and treatment with medication, surgery, and laser surgery are utilized. RESULTS: Improvement or complete resolution of these eyelid lesions is possible. CONCLUSION: Special care is necessary to avoid ocular complications that could compromise vision, comfort, and cosmesis.

Eyelid Neoplasms

Management of epiphora in the presence of congenital punctal and canalicular atresia.

We treated ten eyes in six pediatric patients with epiphora and punctal and canalicular atresia in one or both lids. Attempted probing and irrigation had failed to improve the epiphora. Nine out of ten of the lacrimal systems had additional anomalies, such as cutaneous lacrimal fistulas (anlage ducts), small sacs, and nasolacrimal duct stenosis or obstruction. A surgical plan is described for the exploration and reconstruction of these markedly abnormal nasolacrimal drainage systems, including a new method of performing bicanalicular intubation. Four of the five eyes with at least part of one canaliculus present have had resolution of epiphora.

Child

Volume augmentation of the anophthalmic orbit with cross-linked collagen (Zyplast).

Injectable glutaraldehyde cross-linked collagen (Zyplast) has been used to augment the soft-tissue volume of the anophthalmic sockets of five patients. Follow-up of more than 1 year has demonstrated that this material can be used safely with long-lasting results. Enophthalmos and pseudoptosis were treated by injecting Zyplast transconjunctivally into the muscle cone. Superior sulcus deepening was treated by injecting Zyplast transcutaneously into the superior extraconal fat posterior to the orbital septum ("preaponeurotic fat pad"). In some cases the size of the ocular prosthesis required can be decreased. Surgical volume augmentation of the socket and superior sulcus was averted in all five patients.

Collagen

The effect of blepharoptosis on the field of vision.

Upper eyelid position, pupillary diameter, and visual field impairment were measured in 26 eyes with adult-onset blepharoptosis. The magnitude of superior visual field impairment was inversely proportional to the distance between the upper lid margin and the pupillary aperture. The distance between the upper lid and the central corneal reflex was the most useful measurement for predicting visual field impairment. Superior visual field impairment was present when the distance between the upper lid and the central corneal reflex was less than 2.5 mm. Visual field impairment inferiorly, temporally, and nasally occurred when the central corneal reflex was obscured and less than 1.5 mm of the vertical diameter of the pupil was visible. Observation of the relationship between the upper eyelid and the pupillary aperture provides useful information for the performance of accurate diagnostic perimetry, as well as for the management of blepharoptosis.

Adult

Long-term dislocation of a hard contact lens.

A 48-year-old female was fitted with hard contact lenses and lost the right lens the next day. She was asymptomatic for 62 months but then presented with a painful mass in the right superonasal orbital quadrant. Surgical exploration was non-diagnostic. Five months later the contact lens was found in the right upper fornix. This case emphasizes the importance of a thorough ocular examination, including double eversion of the lids and sweeping the fornices of patients with unidentified periocular masses or pain.

Conjunctiva

Modified Kinosian dacryocystorhinostomy: a review of 122 cases.

A consecutive series of 122 dacryocystorhinostomies is reviewed, and a surgical technique which preserves the anterior lacrimal crest and eliminates the need to create mucosal flaps is described. The success rate of this simplified technique is 89%. The success rate rises to 94% following secondary revisions. This is comparable to more complicated procedures. Canalicular and common punctal stenosis are not found to be contraindications to dacryocystorhinostomy for obstruction of the nasolacrimal duct but do lower the success rate. Eighty-one percent of patients with concomitant canalicular disease and nasolacrimal duct obstruction were cured by dacryocystorhinostomy with silicone intubation. A success rate of 98% was achieved in patients without preoperative canalicular disease.

Aged

Demystifying ethical decision making.

Ethical dilemmas frequently occur in the practice of orthopaedic nursing. Nurses, however, are often unsure about how to resolve these dilemmas. The language of ethics remains elusive. Yet, because nurses have a central role in patient care, they need to become more comfortable making ethical decisions related to their practice. This article briefly describes the dialectical process of ethical decision making and demonstrates this process by using a case presentation. Readers are encouraged to put themselves into the role of the bedside nurse in the case, determine what they believe to be the right action, and provide a well-grounded rationale for that decision.

Adult