Blepharoplasty
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Post-operative care Post-operatively the patient is prescribed a topical antibiotic ointment to the eyes three times a day for 2 weeks and Lacri-Lube® ointment 2 hourly to the eyes for 48 hours and at bedtime. The Lacri-Lube® ointment is then changed to a preservative-free topical lubricant gel to be used 2 hourly during the day and Lacri-Lube® is continued at bedtime until any post-operative chemosis has resolved. Post-operative steroid drops are unnecessary. The patient is instructed to sleep with the head of the bed elevated for 2 weeks and to avoid lifting any heavy weights for 2 weeks. Clean cool packs are gently applied to the eyelid intermittently for 48 hours. The patient should be reviewed in clinic within 5 days when the Prolene sutures are removed, and again within 4–6 weeks. The conjunctival sutures should drop out spontaneously within 2 weeks. Massage to the lower eyelid/cheek junction for 3 minutes three times per day can be commenced using Lacri-Lube® ointment as soon as the Prolene sutures have been removed. This is continued for 2–3 weeks.
Nasal, bronchial, conjunctival, and food challenge techniques and epicutaneous immunotherapy of food allergy
Richard F. Lockey, Dennis K. Ledford in Allergens and Allergen Immunotherapy, 2020
The traditional development of the CAC model proposed that clinical assessment of a positive challenge be measured using signs and symptoms of ocular itching, redness, tearing, lid swelling, and chemosis [63]. Total ocular symptom score (TOSS) measures these four symptoms on a four-point scale from 0 to 3 (0 = no symptoms, 1 = mild, 2 = moderate, 3 = severe symptoms warranting treatment). However, not every participant may experience all symptoms when challenged. Ocular itching and redness are frequently used as primary responses in order to determine a positive allergic response. Itching and redness peak at approximately 3 and 15 minutes postchallenge, respectively [64,70]. Tearing and chemosis may also be objectively assessed. Chemosis can be examined by using a slit lamp, a tool that uses a bright light emitted through a long narrow opening, to determine if the conjunctivae are raised or ballooned. A score of five or greater using TOSS is considered a positive reaction following ocular challenge [61]. Alternatively, studies have used the validated five-stage Gronemeyer grading scale to measure the allergic response during a CAC [71,72]. For this method, stage 0 is an absence of a reaction, whereas stages 1 through 4 indicate progressively more severe signs and symptoms. Stage 1 indicates itching, ocular redness, and foreign-body sensation. Stage 2 adds tearing and vasodilation of conjunctiva bulbi to stage 1 signs and symptoms [71,72]. Next, stage 3 includes blepharospasm, erythema, and vasodilation of conjunctiva tarsi on top of stage 2 observations. Finally, stage 4 adds chemosis and lid swelling to stage 3 findings [71,72]. CAC that results in stage 2 or greater is considered a positive reaction.
Clinical Neuroanatomy
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
The eye is often injected with chemosis. Lid lag is especially noticeable on downward gaze. There may be diplopia simply due to globe displacement, but actual paralysis of the superior and lateral rectus muscles is a specific feature. In spite of its metabolic basis, the condition is usually unilateral. Vision may be threatened and acute high-dose steroids may be of value in treatment. A CT or MRI scan will usually show marked swelling of the extraocular muscles.
Transient vision loss after optic nerve sheath fenestration
Published in Orbit, 2020
Bayan Al Othman, Jared Raabe, Amina Malik, Helen Li, Ashwini Kini, Andrew G. Lee
In our case of post-ONSF-related visual loss, the patient had acute inflammatory orbital signs including proptosis, chemosis, pain with eye movement, and significant periorbital edema along with extensive orbital enhancement and inflammation on the post-contrast MRI of the orbit. Table 1 summarizes the previous cases of transient vision loss after optic nerve sheath fenestration (ONSF) reported by Brodsky and Rettele, Flynn et al., and Knight et al.5–7 Two out of three cases were treated with IV steroids followed by an oral steroid taper. The third report did not discuss treatment, but all three patients were reported to have experienced eventual significant recovery. In these cases, post-operative ophthalmoscopy revealed disc edema in two-thirds cases.5,7 In one case it showed occlusion of cilioretinal and long posterior ciliary arteries, as well as increased retinal arterial caliber and venous pulsations.7 Post-operative MRI was only mentioned in one case and showed no signs of orbital or nerve sheath hemorrhage.5 Clinical evidence of inflammation (conjunctival chemosis and eyelid edema) was described in one case.7
COVID-19-related Conjunctivitis Review: Clinical Features and Management
Published in Ocular Immunology and Inflammation, 2023
William Binotti, Pedram Hamrah
Early studies with systemic COVID-19 infection have reported ocular involvement, to which follicular conjunctivitis was the main manifestation in infected patients.5–15,22,23 The characteristics of the conjunctivitis are similar to the other viral forms, namely epiphora, conjunctival hyperemia, conjunctival and eyelid chemosis, tarsal follicular reaction, and preauricular and submandibular lymphadenopathy (Figure 1).21 The most common ocular signs and symptoms were conjunctival chemosis, ocular redness, ocular pain, discharge, and conjunctival follicular reaction.7,10 The literature shows a wide incidence range of conjunctivitis (0.8–31.6%) in these patients.5,6,22,23 The wide range is mainly explained by the heterogeneity of the studies. While some studies relied on questionnaires from infected patients after being discharged from the hospital, other studies reported ocular findings on hospitalized or critically ill COVID-19 patients without slit-lamp examination. In contrast, the eye is often overlooked in these patients that are often under acute life-threatening situations, where ocular manifestations might be under-reported or underestimated.
Neuro-Ophthalmic Sarcoidosis
Published in Neuro-Ophthalmology, 2020
Giovanni Campagna, Claudia M. Prospero Ponce, Aroucha Vickers, Bennett Yau-Bun Hong, Francesco Pellegrini, Daniele Cirone, Francesco Romano, Piernicola Machin, Andrew G. Lee
A 50-year-old Caucasian woman developed left upper eyelid ptosis of one-month duration with increasing retrobulbar fullness, worsening proptosis and tearing OS. Her past ocular history included left high myopia and left presumed strabismic amblyopia OS (best corrected visual acuity 20/200 OS). She was otherwise healthy and took no medications. Extraocular motility exam of the left eye revealed normal adduction but all other ductions were impaired OS. The right eye moved normally. There was a 3 mm ptosis of the left upper eyelid (Figure 2a) and 3 mm of newly acquired left proptosis. There was a left RAPD and generalised left visual field depression. Slit lamp examination disclosed mild conjunctival chemosis OS. The fundus examination revealed chorioretinal striae nasal to the optic disc in the setting of a myopic fundus. The right eye was entirely normal on examination. MRI of the brain and orbits with contrast revealed marked thickening of extraocular muscles (EOM) and tendons with a lesser involvement of the lateral rectus muscle on the left side (Figure 2b). The lateral wall of the cavernous sinus was involved. Medial rectus muscle biopsy showed histologic findings of non-caseating granuloma consistent with orbital sarcoidosis (Figure 2c–d).
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