One-Stage Reconstruction Technique for Large Congenital Eyelid Coloboma

Hashish, A; Awara, Amr M

doi:10.3109/01676830.2011.582979

Cited by 12 publications

(12 citation statements)

References 7 publications

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“…Once the patient is alert, EK often resolves spontaneously; however, it may also lead to corneal scarring and vision loss, especially if sufficiently advanced [16,36,38]. Consequently, any evidence of EK, especially an opacity or haziness of the cornea, should prompt consultation…”

Section: Symblepharonmentioning

confidence: 99%

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Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Bird¹,

Dingley²,

Stawicki³

et al. 2018

Vignettes in Patient Safety - Volume 2

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Exposure keratopathy (EK) is a frequently overlooked complication seen in nearly 60% of sedated or intubated intensive care unit (ICU) patients. Signs and symptoms of EK often start as mild subjective complaints of eye pain and irritation, but can progress to vision loss in the most severe cases. For many critically ill patients, the presence of sedation effectively precludes their ability to communicate clinical complaints typically associated with EK. This, combined with the potentially severe sequelae, makes EK a potentially preventable complication and a patient safety issue. Clinical management of EK can be challenging for both providers and patients due to the nature of treatment with eye drops and ointments as well as the burden and expense of associated procedural interventions. Risk factors for EK have been extensively described in the literature, and wider dissemination of this knowledge should facilitate education of physicians and nurses regarding EK prevention. The most common risk factors include lagophthalmos, chemosis, Bell's palsy, and congenital deformities. Additionally, critically ill patients are less likely to be promptly diagnosed due to the focus of staff on life-threatening problems over ocular prophylaxis. However, the potential severity of complications associated with EK mandates that prevention remains a crucial component of the care of at-risk patients. The reader will explore the broad category of adverse medical occurrences included under the umbrella term, "errors of omission" (EOO): an error category that is most likely to culminate in EK. The most critical preventive measure is education of health care providers, although this may not be enough by itself. To this end, universal precautions against EK in combination with education may be used to help combat the relatively high incidence of this easily preventable ocular pathology.

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Section: Symblepharonmentioning

confidence: 99%

“…with an ophthalmologist [38,39]. Such expert evaluation is critical to confirming the diagnosis of EK and the initiation of appropriate therapy, as exemplified in this chapter's clinical vignettes.…”

Section: Band Keratopathymentioning

confidence: 99%

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Bird¹,

Dingley²,

Stawicki³

et al. 2018

Vignettes in Patient Safety - Volume 2

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“…Until now, there are only sporadic case reports on clinical presentation 3,4 and several studies on the surgical management of congenital eyelid coloboma, including Tessier number 10 clefts. 2,[5][6][7][8][9] However, despite its potentially devastating nature and the increasing indications for ocular reconstructive surgery, there is currently no standardized method for evaluating the spectrum of ocular manifestations and the severity of ocular involvement in this congenital disease.…”

Section: Introductionmentioning

confidence: 99%

Manifestation and grading of ocular involvement in patients with Tessier number 10 clefts

Shao

et al. 2017

Eye

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PurposeThe objective of this study is to evaluate and grade the extent and severity of ocular involvement in Tessier number 10 cleft.Patients and methodsA retrospective, noncomparative, interventional case series was conducted between January 2006 and December 2015. Clinical data were reviewed from 59 patients (85 eyes) with Tessier number 10 clefts. Detailed medical history and ophthalmic examination of patients with a confirmed diagnosis of Tessier number 10 cleft were recorded on an itemized data collection form. Ocular manifestations were categorized as upper eyelid defect, symblepharon with cutaneous pterygium (skin growing onto the globe), corneal complications, and lower eyelid ectropion; components were evaluated and graded on a scale from 0 to 3, according to their severity.ResultsMore than half of the cases (43 eyes, 53.8%) had severe upper eyelid defect, and severe symblepharon with cutaneous pterygium were observed in 38 eyes (47.5%). Nearly half of the cases (40 eyes, 50.0%) have severe corneal complications, and lower eyelid ectropion was found in 34 eyes (42.5%). The severity of symblepharon, corneal complications, and lower eyelid ectropion were significantly correlated with the upper eyelid defect; the correlation coefficient (r) ranged from 0.844 to 0.629 (P<0.0001).ConclusionThis study presents the ocular manifestation of Tessier number 10 clefts with large-series cases, and establishes an effective grading system to evaluate Tessier number 10 clefts, which is useful for the diagnosis, treatment, and prediction of outcomes in patients with a Tessier number 10 cleft.

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“…3 However, especially in larger defects, as in this case, surgery should be performed promptly to lessen or prevent exposure keratopathy. Historically, sliding tarsoconjunctival/ myocutaneous flaps, 4 skin grafts, 5 or large lateral myocutaneous flaps 3 have been used with varying success.…”

Section: Diagnosis and Discussionmentioning

confidence: 99%

“…External canthotomy and cantholysis and semicircular or rotational flaps are often used for defects involving up to 50% of the lid margin, whereas the Cutler-Beard technique is generally reserved for defects of larger size. 3 Because two-stage techniques and prolonged occlusion of the pupil at this age can cause significant amblyopia, one-stage techniques, such as sliding tarsoconjunctival/myocutaneous flaps, 4 skin grafts, 5 or large lateral myocutaneous flaps 3 have been employed for large defects. However, these procedures carry significant risks for wound morbidity, prolonged healing time, and visible scarring.…”

Section: Differential Diagnosismentioning

confidence: 99%