Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Pterygium/Pingueculum
Document related concepts
Transcript
Cataract and Premium IOLs Blepharoplasty Lid Surgery Botox and Facial Fillers Laser Refractive Surgery Pterygium Dry Eyes Diabetic Glaucoma Clinical Studies Irritation, burning, tearing Foreign body sensation Redness Decreased vision Double vision in advanced cases May be asymptomatic Yellow-white flat or slightly raised conjunctival lesion Usually in the interpalpebral fissure, nasal to the limbus Not involving the cornea Wing-shaped fold of fibrovascular tissue Elevated at the interpalpebral fissure of the conjunctiva Nasal > temporal to the limbus Can be bilateral, usually asymmetric Extending onto the cornea – loss of corneal transparency and irregular astigmatism May be vascularized and injected May be associated with superficial punctate keratitis or dellen (thinning of the cornea due to uneven tear pooling and drying) Stocker’s line (iron line) may be seen on the leading edge of the pterygium on the cornea Conjunctival intraepithelial neoplasia (CIN) ◦ Unilateral jelly-like, velvety, leukoplakic (white) mass ◦ Often elevated, vascularized, and not wing-shaped Dermoid ◦ Congenital white lesion ◦ Usually inferotemporal limbus ◦ Occasionally associated with deformity of the ear, preauricular skin tags, and/or vertebral skeletal defects (Goldenhar’s syndrome) Pannus ◦ Blood vessels growing on to the cornea, often associated with contact lens wear, trachoma, phlyectenular keratitis, atopic disease, blepharitis, ocular rosacea, herpes keratitis, or others Elastoid degeneration of collagen and the subepithelial fibrovascular tissue UV sun, dust, wind… repeated exposure Chronic irritation – contact lenses, welding Higher prevalence with proximity to the equator Conservative therapy, unless ◦ Reduce vision due to induced astigmatism or encroachment onto the visual axis ◦ Cosmetic ◦ Marked discomfort and irritation, unrelieved by conservative treatment ◦ Restricted ocular motility ◦ Progressive growth toward visual axis Protect eye from sun – wear sunglasses Mild - topical lubricants Moderate - topical antihistamine/vasoconstrictor Mod. to severe - topical corticosteroid Recurrence rate is very high 10% - 90% No single approach is universally successful Recurrence rate is reduced with grafting approach Temporal Recurrent Pterygium – 5 years Excise pterygium – head and body Clean conjunctiva to bare sclera Avoid damage of underlying rectus muscle Polish with diamond burr Mitomycin C application – antifibroblast Harvest autograft – limbus to limbus Tisseel fibrin glue Topical antibiotic and steroid Watch IOP http://www.youtube.com/watch?v=A7m61oVD ytc Abnormal eversion or turning out of the lid margin away from the globe. Usually involves lower lids Usually has a horizontal lid laxity Co-morbidity: associated with corneal/conjunctival exposure Red and irritated eye with tearing. Pain, gritty feeling, crusting of lids Constantly wiping their eyes, exacerbating the lid laxity. History of chronic eye drop use, especially in glaucoma pts. History of facial or eye trauma/cancer/surgery. Facial skin pathology Congenital ◦ Rare ◦ May be associated with other orbital abnormalities Blepharophimosis Microphthalmos Buphthalmos Down syndrome Acquired ◦ ◦ ◦ ◦ Involutional – most common Paralytic Cicatricial Mechanical Most common Horizontal lid laxity – age related CN VII palsy – Bell palsy, herpes zoster, tumor of parotid gland Scarring of anterior lamella ◦ ◦ ◦ ◦ ◦ Facial burns Trauma Chronic dermatitis Chronic use of eye drops - glaucoma Excessive lower lid blepharoplasty Lid tumors Lubrication Wipe only superiorly and nasally to avoid conjunctival irritation Antibiotic ointment, especially at night Lateral tarsal strip procedure – for horizontal lid laxity/involutional ectropion Medial conjunctival spindle procedure – for mild medial ectropion with punctum ectropion Anterior lamella graft may be necessary in cicatricial ectropion Conjunctival and corneal exposure – keratinization and perforation Retrobulbar hemorrhage, hematoma, infection, wound dehiscence, poor positioning of tarsal strip, and rounded lateral canthus Inversion of eyelid margin Usually lower lid Lashes rubbing against ocular surface Red and irritated eye Foreign body sensation Blurred vision Congenital Acute spastic Involutional Cicatricial Rare Pediatric epiblepharon – no symptoms Result of ocular irritants – infection, inflammatory, trauma Horizontal lower lid laxity of medial and /or lateral canthal tendons Snap test Tight squeeze test Scarring of palpebral conjunctiva – trauma, chemical burns, Stevens-Johnson syndrome, ocular cicatricial pemphigoid, infections, or topical medication Snap test is difficult Epiblepharon – pretarsal orbicularis muscle and skin override the lid margin and push the eyelashes inward. ◦ Asymptomatic ◦ Common in Asians ◦ Spontaneously resolves as face matures Trichiasis Distichiasis Lubrication Lid hygiene Antibiotic/steroid Taping of lower lid Quickert sutures ◦ Temporary fix ◦ Good for spastic entropion Tarsal wedge resection ◦ Successful ◦ In-office procedure Horizontal or vertical lid shortening Retrobulbar hemorrhage Wound dehiscence Infection Corneal injury Recurrence Consecutive ectropion
