scholarly journals Floppy eyelid, an under-diagnosed syndrome: a review of demographics, pathogenesis, and treatment

2021 ◽  
Vol 13 ◽  
pp. 251584142110592
Author(s):  
Alessandra De Gregorio ◽  
Alberto Cerini ◽  
Andrea Scala ◽  
Alessandro Lambiase ◽  
Emilio Pedrotti ◽  
...  
Keyword(s):  
Early Recognition ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Lower Eyelid ◽  
Systemic Diseases ◽  
Upper Eyelid ◽  
Dry Eyes ◽  
Obstructive Sleep ◽  
The Right

Floppy eyelid syndrome (FES) is a frequent eyelid disorder characterized by eyelid laxity that determines a spontaneous eyelid eversion during sleep associated with chronic papillary conjunctivitis and systemic diseases. FES is an under-diagnosed syndrome for the inaccuracy of definition and the lack of diagnostic criteria. Eyelid laxity can result from a number of involutional, local, and systemic diseases. Thus, it is pivotal to use the right terminology. When the increased distractibility of the upper or lower eyelid is an isolated condition, it is defined as ‘lax eyelid condition’ (LAC). When laxity is associated with ocular surface disorder such as papillary conjunctivitis and dry eyes, it can be referred to as ‘lax eyelid syndrome’ (LES). However, FES is characterized by the finding of a very loose upper eyelid which everts very easily and papillary tarsal conjunctivitis affecting a specific population of patients, typically male, of middle age and overweight. Obesity in middle-aged male is also recognized as the strongest risk factor in obstructive sleep apnea-hypopnea syndrome, (OSAHS). FES has been reported as the most frequent ocular disorder associated with OSAHS. Patients with FES often complain of non-pathognomonic ocular signs and symptoms such as pain, foreign body sensation, redness, photophobia, and lacrimation. Due to these clinical features, FES is often misdiagnosed while an early recognition might be important to avoid its chronic, distressing course and the associated morbidities. This review provides an updated overview on FES by describing the epidemiology, proposed pathogenesis, clinical manifestations, related ocular, and systemic diseases, and treatment options.

scholarly journals Synchronous Surgical Treatment of Lower Eyelid Involutional Entropion and Ptosis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
D. Vasakos ◽  
E. Nakos ◽  
C. Sioulis
Keyword(s):  
Treatment Options ◽  
The Elderly ◽  
Lower Eyelid ◽  
Postoperative Recovery ◽  
Multiple Time ◽  
Upper Eyelid ◽  
Alternative Treatment Strategy ◽  
Involutional Entropion ◽  
Lateral Tarsal Strip ◽  
Upper Eyelid Ptosis

Background. Involutional entropion and upper eyelid ptosis are common eyelid diseases in the elderly population. They represent a frequent cause of discomfort and often result in significant visual and functional impairment. The surgical management of these disorders includes various treatment options and techniques and is usually carried out in multiple time sessions. Case Report. We report the case of a 72 year old female patient, suffering from right eye involutional lower eyelid entropion and ptosis, who was treated synchronously for both conditions, by applying the lateral tarsal strip procedure and the levator resection technique. Conclusion. The synchronous treatment of involutional entropion and ptosis is an alternative treatment strategy, which could potentially improve surgical outcome, while reducing postoperative recovery time and treatment costs.

Irritable Bowel Syndrome with Diarrhea

2018 ◽  
Author(s):  
Judy Nee ◽  
Jacqueline L. Wolf
Keyword(s):  
Irritable Bowel Syndrome ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Dietary Advice ◽  
Emerging Therapies ◽  
Irritable Bowel

Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal condition characterized by abdominal pain and alteration in bowel habits without an organic cause. One of the subcategories of this disorder is IBS with diarrhea (IBS-D). Clinically, patients who present with more than 3 months of abdominal pain or discomfort associated with an increase in stool frequency and/or loose stool form are defined as having IBS-D. This review addresses IBS-D, detailing the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, clinical manifestations and physical examination findings, differential diagnosis, treatment, emerging therapies, complications, and prognosis. Figures show potential mechanisms and pathophysiology of IBS, IBS-D suspected by clinical assessment and Rome III criteria, pharmacologic and nonpharmacologic treatment options, potential mechanisms of action of probiotics, and potential treatment modalities. Tables list the Rome criteria for IBS, alarm signs and symptoms suggestive of alternative diagnoses, IBS criteria, differential diagnosis of IBS-D, dietary advice options for IBS-D, and alternative and emerging therapies in IBS-D. This review contains 5 figures, 6 tables and 42 references KEYWORDS: IBS-D, eluxadoline, rifaximin, probiotics, bloating, antidepressants, bile acid malabsorption, microscopic colitis, celiac

Obstructive sleep apnoea and schizophrenia: a primer for psychiatrists

2011 ◽  
Vol 23 (5) ◽  
pp. 201-209 ◽  
Author(s):  
Abdulkader Alam ◽  
Kadiamada Nanaiah Roy Chengappa
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Daytime Sleepiness ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Sleep Apnoea ◽  
Diagnosis And Treatment ◽  
Adverse Health Outcomes ◽  
Ovid Medline ◽  
Obstructive Sleep ◽  
Osa Treatment

Alam A, Chengappa KNR. Obstructive sleep apnoea and schizophrenia: a primer for psychiatristsObjective:The main objective of this review is to improve psychiatric clinician awareness of obstructive sleep apnoea (OSA) and its potential consequences in patients with schizophrenia. This article will also discuss the diagnosis and treatment options for OSA while considering the significant role psychiatrists can play in facilitating the diagnosis and treatment of OSA.Data sources:Ovid, Medline and PsychInfo databases were searched for articles between 1960 and 2010. Search terms used wereSleep apnoeaorapnoeaandschizophreniaorpsychosis. The number of articles retrieved was 38. Articles were carefully reviewed for any data pertinent to OSA in patients with schizophrenia.Conclusions:OSA is a common disorder that is frequently unrecognised. As a chronic breathing condition, OSA is associated with adverse health outcomes and high mortality. OSA may co-occur with schizophrenia or evolve over time, especially with weight gain. The diagnosis should be considered whenever a patient presents with risk factors or clinical manifestations that are highly suggestive of OSA. Those who report snoring, daytime sleepiness and are obese or have a large neck circumference should be considered for an OSA diagnosis. Appropriate diagnosis and treatment of OSA can reduce daytime sleepiness, improve cardiovascular and other medical conditions, as well as reduce mortality. Psychiatrists can play very important role in suspecting OSA in their patients and making the initial referral. Furthermore, behavioural management, especially promoting weight loss and smoking cessation, are effective components of OSA treatment that psychiatrists are positioned to facilitate with their patients.

scholarly journals Optimization of Diagnosis and Surgical Treatment of Involutional Entropion of the Lower Eyelid

2021 ◽  
pp. 892-897
Author(s):  
. Anshu ◽  
Pradeep G. Sune
Keyword(s):  
Scientific Literature ◽  
Signs And Symptoms ◽  
Corneal Neovascularization ◽  
Lower Eyelid ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Data Bases ◽  
Upper Eyelid ◽  
Involutional Entropion ◽  
Corneal Thinning

Background: Rolling inwards of the lid margin is called entropion, and is produced by a disparity in length and tone between the anterior skin muscle, and posterior tarso-conjunctival laminae of the eyelid. Involutional, cicatricial, spastic, or congenital are some of the classifications involutional entropion there is general instability of the lid structures with age .A weakness of the posterior retractors of the lid occurs, together with a laxity of the medial and lateral canthal ligaments,  accompanied by a loss of posterior support ,as atrophy of the orbital fat leads to enophthalmos. The current treatment modalities for this condition are surgical in nature, although non-surgical temporary medical treatment are also used. It's a commonest types of eyelid asymmetry. Corneal and conjunctival damage may lead to abrasions, scarring, corneal thinning, or corneal neovascularization due to this misalignment. Unilateral or bilateral entropion is possible. Involutional entropion of lower eyelids are common, but cicatricial upper eyelids are common.  Entropion of lower eyelid is a much more prevalent than entropion of the upper eyelid. Objective: The purpose is to review the scientific literature on diagnosis and surgical management of involutional entropion of the lower eyelid. Methodology: The data were collected from the various electronic data bases like google scholar, PubMed and various books. Conclusion: After reviewing the articles, we come to the conclusion that the signs and symptoms of involutional entropion are easily manageable by given treatment.

Obstructive sleep apnoea

2021 ◽  
pp. 335-344
Author(s):  
Terry Robinson ◽  
Jane Scullion
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Nursing Care ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Diagnostic Procedures ◽  
Sleep Apnoea ◽  
Differential Diagnoses ◽  
Treatment Prevalence ◽  
Obstructive Sleep ◽  
Psychosocial History

This chapter covers the causes, signs, and symptoms of obstructive sleep apnoea (OSA). It explains the process of diagnosis, from a history, medications, family, and psychosocial history, occupation, and diagnostic procedures. Differential diagnoses that should be excluded are listed. The prevalence of OSA is estimated to be around 4% of the population. It is quite a common disorder, although this figure may be an underestimate as many people may not seek treatment. Prevalence figures also vary according to the chosen threshold for defining a significant sleep abnormality and symptoms. Treatment options are also outlined, and the specific aspects of nursing care are listed.

Facomatosis tipo Cesioflammea: Reporte de caso de neonato con Manchas Mongólicas y Vino oporto. Una presentación simple de una condición dermatológica compleja.

2020 ◽  
pp. 14-18
Author(s):  
Vonetta A Vallejo Lewis ◽  
Militza Torres Herrera ◽  
Ian Alberto Gonzalez Grajales,
Keyword(s):  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Congenital Glaucoma ◽  
Pigmented Lesion ◽  
Different Types ◽  
The Face ◽  
Systemic Manifestations ◽  
The Right ◽  
Renal Vascular ◽  
Rule Out

La facomatosis pigmentovascular es un conjunto de signos y síntomas caracterizado por la coexistencia de malformaciones vasculares capilares con una lesión pigmentaria cutánea congénita (nevo epidérmico, nevo spilus o melanosis dérmica) asociada o no, a manifestaciones sistémicas. Existen varios grupos de facomatosis pigmentovasculares según el tipo de nevo asociado a la lesión capilar vascular. Puede existir solo la afectación cutánea o tener manifestaciones sistémicas, entre ellas, traumatológicas, neurológicas, oftalmológicas, inmunológicas, renales, vasculares, linfáticas, entre otras.Exponemos el caso de un neonato masculino, quien presenta manchas vino oporto facial bilateral, cuello y tórax anterior y posterior, junto a melanocitosis dérmicas en espalda y ambos miembros inferiores, asociado a glaucoma congénito del ojo derecho. Debido a las manifestaciones clínicas cutáneas y sistémicas, se diagnostica facomatosis pigmentovascular, realizándose evaluación multidisciplinaria por radiología, dermatología, oftalmología, genética y neurología, para descartar afectación extracutánea.Los estudios complementarios son de vital importancia para detectar alteraciones extracutáneas, como se presentaron en el paciente. Abstract Phakomatosis pigmentovascularis is set of signs and symptoms characterized by the association of a vascular nevus with a congenital pigmented lesion (epidermal nevus, nevus spilus, and dermal melanocytosis) associated or not to systemic malformations. There are different types of phakomatosis pigmentovascularis according to the pigmentary nevus associated with the vascular malformation. There may be only the cutaneous condition or have systemic manifestations such as, trauma, neurological, ophthalmological, inmunological, renal, vascular, lymphatic, among others disorders.We present the case of a male newborn who had a port wine stain located bilaterally on the face, anterior and posterior thorax and neck, together with dermal melanocitosis in the back and lower extremities, associated with congenital glaucoma of the right eye. Due the clinical manifestations, the diagnosis of phakomatosis pigmentovascularis was made and multidisciplinary evaluation is requested by radiology, dermatology, ophthalmology, genetics and neurology to rule out extracutaneous involvement.Complementary studies are essential to detect extracutaneous alterations as presented in the patient.  

scholarly journals Nail Biting as a Cause of Appendicitis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Michael Pagacz ◽  
Philip Bao ◽  
Juan Carlos Alvarez Moreno ◽  
Lydia Howard
Keyword(s):  
Abdominal Pain ◽  
Foreign Body ◽  
Acute Appendicitis ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Primary Treatment ◽  
Lower Quadrant ◽  
Nail Biting ◽  
Periappendiceal Abscess ◽  
The Right

Ingestion of a foreign body is commonly encountered in clinical practice, but most cause no complications, passing spontaneously through the gastrointestinal tract. However, they can cause obstructive signs and symptoms, and surgical intervention for extraction of the foreign body may be required after identifying its location. We present here the case of a 49-year-old woman who presented to our emergency room with abdominal pain localizing to the right lower quadrant. Evaluation was most consistent with acute appendicitis, and she underwent uncomplicated appendectomy. A keratin nail with Actinomyces was identified in her appendix. Foreign bodies in the appendix can cause simple appendicitis, perforation, periappendiceal abscess, and peritonitis. Regardless of etiology, an appendectomy often ends up the primary treatment, but unusual and rare causes are worth noting if only for the clinician to be aware of when evaluating the next patient with abdominal pain and considering treatment options or future prevention. Our case is an example of a rare scenario in which an Actinomyces-contaminated human nail lodged in the appendix of a woman eventually resulting in acute appendicitis.

Irritable Bowel Syndrome with Diarrhea

2018 ◽  
Author(s):  
Judy Nee ◽  
Jacqueline L. Wolf
Keyword(s):  
Irritable Bowel Syndrome ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Dietary Advice ◽  
Emerging Therapies ◽  
Irritable Bowel

Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal condition characterized by abdominal pain and alteration in bowel habits without an organic cause. One of the subcategories of this disorder is IBS with diarrhea (IBS-D). Clinically, patients who present with more than 3 months of abdominal pain or discomfort associated with an increase in stool frequency and/or loose stool form are defined as having IBS-D. This review addresses IBS-D, detailing the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, clinical manifestations and physical examination findings, differential diagnosis, treatment, emerging therapies, complications, and prognosis. Figures show potential mechanisms and pathophysiology of IBS, IBS-D suspected by clinical assessment and Rome III criteria, pharmacologic and nonpharmacologic treatment options, potential mechanisms of action of probiotics, and potential treatment modalities. Tables list the Rome criteria for IBS, alarm signs and symptoms suggestive of alternative diagnoses, IBS criteria, differential diagnosis of IBS-D, dietary advice options for IBS-D, and alternative and emerging therapies in IBS-D. This review contains 5 highly rendered figures, 6 tables, and 99 references. 

scholarly journals Post-COVID-19 Benign Paroxysmal Positional Vertigo

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Siniša Maslovara ◽  
Andro Košec
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Viral Infections ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Short Report ◽  
Common Symptom ◽  
Mild Disease ◽  
Positional Vertigo ◽  
The Right ◽  
Paroxysmal Positional Vertigo

Background. COVID-19 is a disease caused by a new strain of coronavirus (SARS-COVID-19). The WHO first learned about this new virus on December 31, 2019, following a report on a group of cases of “viral pneumonia” in Wuhan, People’s Republic of China, and declared a pandemic in March 2020. The disease was an almost complete unknown at the outset, but knowledge of its pathophysiology, clinical picture, and treatment options grew and developed rapidly. Objective. Dizziness is a very common symptom that patients report in routine clinical practice and one of the significant clinical manifestations of COVID-19. This short report investigated a possible connection between COVID-19 and benign paroxysmal positional vertigo (BPPV). Methods. We present two cases of benign paroxysmal positional vertigo (BPPV), which developed within two weeks of SARS-COVID-19 infection, manifesting with mild disease severity in early November 2020. Results. In both cases, the disease manifested by severe, short-lived attacks of vertigo, objective-circular type, with accompanying nausea and vomiting. The symptoms occurred when lying in bed and turning to the right and assuming an upright position. The diagnosis of posterior semicircular canal BPPV (PC-BPPV) was made based on a subjectively and objectively positive right-sided Dix–Hallpike test. Conclusions. The pathophysiology of post-COVID BPPV is probably similar to that of other viral infections, with some of its specificities such as inducing hypercoagulation and microthrombus formation, which can cause significant circulatory disorders possibly affecting its pathogenesis.

scholarly journals Bilateral primary eyelid meibomian gland epithelioma in a dog: a case report

2019 ◽  
Vol 70 (1) ◽  
pp. 1435
Author(s):  
A. KOMNENOU ◽  
G. CHARALAMBIDOU ◽  
S. MAKROGKIKAS ◽  
N. PAPAIOANNOU
Keyword(s):  
Lower Eyelid ◽  
Meibomian Gland ◽  
Surgical Removal ◽  
Upper Eyelid ◽  
Palpebral Conjunctiva ◽  
Lateral Canthus ◽  
Tarsal Glands ◽  
The Right ◽  
Left Eyelid ◽  
Periorbital Swelling

In this paper an extremely rare case of primary bilateral eyelid meibomian gland epithelioma in a dog is presented. Meibomian tumors arise from the meibomian (tarsal) glands on the inner aspect of the eyelid, and meibomian gland adenomas and adenocarcinomas are the most frequent neoplasia arising from those glands. A 10-year-old male dog was admitted, with ophthalmic signs of periorbital swelling of the right eye. During the last two years, the dog had a progressive engorgement of the upper eyelid of the right eye, and during the past few months, strabismus and exophthalmos were also noticed, as well as a slighter enlargement on the lower eyelid of the left eye. Upon ophthalmic examination strabismus and periorbital swelling at the lateral canthus of the right eye, accompanied by mild exophthalmos and lagophthalmos, were recorded. Also, deep ulcerative keratitis with corneal oedema and neovascularization were noticed. Intense chemosis, epiphora and a small pinkish mass arising from the palpebral conjunctiva of the left lower eyelid were also seen. Neoplasia of both eyelids was suspected, and a series of diagnostic examinations were carried out. Orbital exenteration of the right eye was performed in the first place, followed by surgical removal of the mass of the left eyelid one month later. Based on clinical and histopathological findings, meibomian gland epithelioma was diagnosed. No relapse or metastases (local or distant) were observed in re-examinations within 18 months after the surgery. This study shows that although meibomian gland epithelioma is rare, it should be considered in the differential diagnosis of cases of orbital and eyelid tumors. Even though this tumor shows low malignancy, prompt surgical intervention and extended excision is the treatment of choice, in order to preserve vision in some cases. To the authors’ knowledge, the present case is the first report of bilateral meibomian gland epithelioma in the veterinary literature.

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