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Case 277

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Female, 93yo, sought eye care due to tearing and severe discomfort in the eyes, which worsen upon exposure to light. Comorbidities: controlled arterial hypertension and non-insulin dependent type 2 diabetes. History of stroke 10 years ago, with sequelae of paralysis of lower limbs. She performed manual work for a lifetime on a farm.

Based on clinical history and image provided, what is the probable diagnosis?

a) Blepharospasm

25%

b) Exotropia

25%

c) Blepharitis

25%

d) Ectropium

25%
   

Image analysis

Image 1: Face photography, highlighting eye region (authorized by the patient), showing eversion of lower eyelids of both eyes (yellow circles). 

 

Image 2: Detail of the photograph of face, showing the left eye with ectropion. The margin of the lower eyelid is in eversion of 180º (red arrow), exposing the tarsal conjunctiva (blue arrow) and causing lacrimation (green arrow). The lower tear point is also exposed, with consequent keratinization.

Highlights

- Ectropion is the eversion of the palpebral margin, being classified as congenital, involutional, paralytic, cicatricial or mechanical;

- Its prevalence is approximately 2.9% in Brazilian elderly;

- The involutional (senile) type is the most common and results from tissue relaxation due to aging;

- Scarring cases are usually caused by frequent sun exposure of light-skinned individuals;

- Possible consequences: chronic keratoconjunctivitis, constant tearing and even keratinization of tarsal conjunctiva;

- Treatment is essentially surgical;

- Surgery can prevent keratitis and corneal ulcers and allows comfort and esthetic benefit.

References

- HoldsJB, Fernandes JBVD. Órbita, Pálpebras e Vias Lacrimais. 7 ed. São Paulo: Santos Editora, 2013.

- KANSKI, JJ. Oftalmologia Clínica. 5 ed. Rio de Janeiro: Elsevier, 2004.

- Ing E, MPH, FRCSC. (2016, Apr 15). Ectropion differential diagnoses. Medscape. Available at: <http://emedicine.medscape.com/article/1212398-overview#a6>. Acess: 21/07/17.

- Pereira FJ, Trindade SP, Cruz AAV. Ectrópio congênito: relato de três casos e revisão de literatura. Arq. Bras. Oftalmol., São Paulo, v. 70, n.1, p.149-52, Jan./Feb. 2007. Available ate: http://www.scielo.br/pdf/abo/v70n1/28.pdf. Acess: 21/07/17.

- SILVA, CP etal. Prevalência do ectrópio palpebral e características dos portadores na população da região Centro-Oeste do Estado de São Paulo. Arq. Bras. Oftalmol., São Paulo, v. 72, n.1, p.39-42, Fev. 2009. Available at:  <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492009000100008&lng=en&nrm=iso>. Acess: 21/07/17.

Authors

Carla Maria Fraga Faraco, doctorgraduated from Faculty of Medicine of UFMG.

E-mail: cmffaraco[at]gmail.com

 

Luísa Bernardino Valério, academic of the 6th year of Faculty of Medicine of UFMG.

E-mail: luisabernardino[at]gmail.com 

Supervisor

Dra Mariana Andrade Fontenelle, ophthalmologist specialist in ocular plastic surgery.

E-mail: marianafontenelle[at]hotmail.com

Reviewers

Thiago Heringer, Rafael Valério, Juliana Albano, Marina Leão, Giovanna Vieira and Professor Viviane Parisotto. 

Translated by

Juliana Albano de Guimarães, academic of the 6th year of Faculty of Medicine of UFMG.

E-mail: julianaalbanog[at]gmail.com

Test question

(Medical Residence - HPEV) Newborn with tearing, photophobia and blepharospasm in both eyes suggests:

a) Bacterial keratitis

25%

b) Blunt trauma

25%

c) Intracranial hypertension

25%

d) Congenital glaucoma

25%

e) Obstruction of lacrimal pathways

25%
   

Commentics

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