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Introduction: Leprosy is one of the dreaded communicable disease due to its profound morbidity. In earlier days in Nepal, a different settlement was designated for leprosy patient and their families. Khokana of Lalitpur district of Nepal is one of them. The study was conducted to determine ocular morbidity among leprosy patients who had completed multi drug therapy. Methods: It was descriptive, quantitative and cross sectional study conducted at Khokana Leprosy Centre in Lalitpur district of Nepal. Leprosy patients who had completed multi drug therapy and consenting for the study were enrolled. Convenience sampling was done and the sample size was 70. After detail ophthalmic evaluation, socio-demographic profile of the participants and their ocular morbidities were documented and analysed.Results: Major findings were superciliary madarosis (78.57%), ciliary madarosis (61.4%), different grades of cataract (67.10% right eye and 60% left eye), pseudophakia (30% right eye and 37.10% left eye), tylosis (44.3%), corneal hypoesthesia (10% unilaterally and 15.7% bilaterally) and dry eye (10%). Entropion was present in 2.9% both unilaterally and bilaterally. Ectropion was present in 5.7% unilaterally and 10% bilaterally. Trichiasis was present in 1.4% unilaterally and 2.9% bilaterally. Similarly, eyelid nodule was present in 7.1% unilaterally and 1.4% bilaterally. Incomplete closure of the lids was present in 8.6% unilaterally and 2.9% bilaterally. Exposure keratitis was present in 7.1% unilaterally and 1.4% bilaterally, corneal opacity in 2.9% unilaterally and 1.4% bilaterally and corneal perforation in 2.9% unilaterally. Chronic iridocyclitis was present in 2.9% cases. Retinal pearls were seen in 2.86% of cases. According to WHO criteria of blindness, 2.9% patients were blind in the present study. 14 persons were unilaterally blind and among them, two had severe visual impairment in the other eye, eight had other eye moderate visual impairment and four had other eye mild visual impairment.Conclusions: Lid abnormalities, corneal abnormalities and cataract were the commonly encountered ocular morbidities among treated leprosy patients.

Over a 2-year period, swellings of all 4 eyelid margins developed in a 32-year-old woman and was accompanied by complete loss of eyelashes. An inflammatory dermatologic condition was considered the most likely cause. A full-thickness right lower eyelid biopsy revealed a multinodular lymphoid tumor at the eyelid margin which immunophenotypically and genetically was diagnosed as an extranodal marginal zone lymphoma. The mode of presentation of the disease was considered to be most unusual, as was its B cell lineage, since the majority of primary cutaneous lymphomas are of T-cell origin. Systemic workup demonstrated bilateral involvement of the external auditory canals.

Linear scleroderma en coup de sabre with ophthalmic findings has been previously described in the literature on numerous occasions. A 57-year-old woman presented with focal trichiasis secondary to tarsal thinning, adjacent to a linear brow and forehead deformity consistent with linear scleroderma en coup de sabre. Cases of linear scleroderma en coup de sabre involving the eyelids have been reported, most often with madarosis, ptosis, or skin atrophy; however, to the authors' knowledge, this is the first reported case of linear scleroderma associated with trichiasis and involvement of the deeper eyelid tissues, particularly the tarsus.

Resumen La enfermedad de Hansen (EH) es una infección secundaria a Mycobacterium leprae, de curso crónico y que afecta preferentemente la piel y los nervios periféricos. Es una condición emergente en Chile debido a la migración humana. Presentamos un caso que afectó a un trabajador inmigrante desde Haití, que presentó antes de su arribo múltiples lesiones cutáneas en placas, con hipoestesia y madarosis unilateral. El diagnóstico de la forma multibacilar se estableció por los hallazgos clínicos, la presencia de bacilos ácido-alcohol resistentes en una muestra cutánea y la detección de células inflamatorias alrededor de los terminales nerviosos y granulomas en una biopsia de piel, desde donde se amplificaron segmentos específicos de los genes rpoB y hsp65 de M. leprae. El paciente fue tratado con el esquema combinado estándar de la OMS para la forma multibacilar durante un año, con regresión parcial de las lesiones. Durante el seguimiento se detectó por RPC una disminución del número de copias del gen rpoB de M. leprae en muestras nasofaríngeas hasta el sexto mes. El registro de enfermedades de notificación obligatoria demuestra un incremento reciente de casos de EH en Chile, todos relacionados con población migrante. La enfermedad de Hansen es una nueva condición clínica y los clínicos deben estar atentos a esta posibilidad diagnóstica. Las pruebas moleculares pueden ayudar en el diagnóstico y seguimiento.

Background Radiation for Graves’ ophthalmopathy (GO) has traditionally utilized lateral opposing fields (LOF) or three-dimensional conformal radiotherapy (3DCRT) technique. The current study was conducted to report clinical outcomes and therapeutic effects of intensity modulated radiation therapy (IMRT) in treating GO patients. Methods One hundred sixteen patients with GO were treated with IMRT as initial local therapy between July 2010 and August 2013, with a median follow-up of 62 months (range 45–81 months). Radiotherapy dose was 20 Gy in 10 fractions within two to three weeks. The immediate and long-term response to IMRT was evaluated in GO severity score and in each category of symptoms. Acute and long-term complications were recorded to assess its safety. Results Symptom severity score significantly fell from the start of treatment to 4- or 6- month post-IMRT (P

A 69-year-old man presented with a 5-year history of diffuse infiltration of skin and progressive sensory loss over his bilateral hands. His face had a few papular-nodular lesions over forehead and cheeks, attenuated skin folds, with loss of eyelashes and eyebrows (figure 1). Peripheral nerve examination showed thickened bilateral ulnar and posterior tibial nerves. Slit skin smear examination and histopathology of a nodule showed features consistent with multibacillary …

Objetivo: Relatar o caso de um paciente portador de neurofibromatose e que evoluiu com Hanseníase Virchorwiana. Detalhamento do caso: Paciente do sexo masculino, 42 anos de idade, portador de neurofibromatose tipo 1, apresentou placas eritemato – edematosas maiores que 3 cm em tronco e membros superiores associado a edema de mãos e pés, espessamento do nervo ulnar direito, nódulos de Lisch na íris, madarose e infiltração de septo nasal por bacilos. Índice baciloscópio geral 2,75 para bacilos fragmentados e íntegros, confirmando o diagnóstico de Hanseníase Virchowiana e reação Hansênica tipo 1. Considerações Finais: A coexistência de hanseníase com neurofibromatose é um achado raro e pode representar um dilema diagnóstico, tendo em vista a semelhança clínica entre as duas doenças. E, ambas ligadas a reação hansênica tipo I, formam um conjunto de distúrbios que afetam as células de Schwann. Nesse âmbito, ainda são necessárias realizações de mais pesquisas para uma melhor avaliação entre a associação de neurofibromatose e hanseníase.

Purpose: To report a case of cicatricial ectropion and madarosis with the use of anti-epidermal growth factor receptor medication panitumumab. Observations: An 82-year-old man with metastatic colorectal cancer presented with cicatricial ectropion and madarosis after starting panitumumab, an anti-epidermal growth factor receptor medication used to treat metastatic colorectal cancer. His findings resolved several weeks after discontinuation of panitumumab and treatment with lubrication and antibiotic/steroid ointment. Conclusion: This case demonstrates the importance to consider potential medication side effects when treating periocular conditions in patients taking anti-epidermal growth factor receptor (anti-EGFR) agents.

Objectives: To describe the spectrum of clinical and histopathological features of a case series of basal cell carcinoma (BCC) with spontaneous regression and to discuss this phenomenon. Method: Four cases of BCC with complete/substantial regression were retrospectively identified. Patients’ records were analyzed for demographic data, clinical appearance, and the postoperative course. Formalin-fixed, paraffin-embedded specimens were routinely processed and stained with hematoxylin and eosin and periodic acid Schiff. Results: Complete (n = 1) or partial (n = 3) regression of BCC was observed in 4 patients. Two lesions at the medial canthus were histologically diagnosed as nodular BCC with significant regression. One lesion at the lower eyelid exhibited a complete regression which did not require surgical intervention. The other lesion at the lower eyelid presenting with ulceration and madarosis was excised. Scar tissue without evidence for a neoplasm was present histologically. Subsequently, the patient developed a recurrence with a histologically proven micronodular BCC. Conclusions: BCC can show spontaneous substantial or complete regression. Histological tumor absence in lesions which are clinically suspicious for a neoplasm can be a hint for a regressive BCC. Recurrences may develop from remaining tumor islands warranting periodical clinical visits in cases of clinically as well as histologically suspected regressive BCC.

Dasatinib, a second generation multi-target tyrosine kinase inhibitor (TKI) is active against many imatinib-resistant BCR-ABL mutant forms, Src, and c-Kit tyrosine kinases. While skin hypopigmentation is a well recognized adverse effect of first generation TKIs; it has rarely been reported with dasatinib. We report a rare case of diffuse cutaneous hypopigmentation and bilateral supercilliary madarosis induced by dasatinib. A 51 year-old Indian male with no co-morbidities and with history of chronic myelogenous leukaemia with complex variant of Philadelphia translocation and E 225 V mutation in P loop domain of bcr-abl transcript who was initiated on imatinib followed by dasatinib as a part of treatment. After 5 months of treatment with dasatinib, he developed supercilliary madarosis bilaterally. Cutaneous side effects may adversely affect patient’s quality of life and, therefore, require prompt attention to prevent long-term complications or suboptimal outcomes due to poor compliance.

To report the newest ophthalmic manifestations of a mother-daughter pair diagnosed with toe syndactyly, telecanthus, anogenital and renal malformations (STAR) syndrome, a rare X-linked developmental disorder.The medical and ophthalmic records were reviewed for a mother-daughter pair diagnosed with FAM58A confirmed STAR syndrome on chromosome Xq28.The mother at birth had left foot syndactyly, telecanthus, anal stenosis, and clitoromegaly and was told at 19 she had a hypoplastic left kidney. The daughter, born at 38 weeks after a complication of oligohydramnios, had a more severe presentation, demonstrating toe syndactyly, telecanthus, anal stenosis, clitoromegaly, bilateral renal hypoplasia, ureteral reflux, urogenital sinus, and congenital heart disease amongst others. The pair shared similar ophthalmic findings, though those of the daughter were more pronounced. They included bilateral, medial upper eyelid prominences with madarosis, mild peripapillary atrophy, and soft macular drusen with the daughter also displaying optic nerve hypoplasia and peripheral anterior synechia in the iridocorneal angle.These ophthalmic findings are the first reported to our knowledge in association with STAR syndrome. The literature frequently demonstrates that patients with developmental anomalies often have ocular manifestations, warranting a full ophthalmic examination when the diagnosis of STAR syndrome has been made or is being considered.

An 80-year-old female presented with a mass in the left upper eyelid margin that had developed during chemotherapy for acute myeloid leukemia. The mass was elastic, hard, and pinkish, with a relatively smooth surface but without madarosis. The histopathological findings corresponded to a myeloid sarcoma. No blast cells were shown in the peripheral blood at the time of biopsy, and she subsequently underwent an azacitidine injection regimen. The size of the eyelid tumor decreased 3 months after the biopsy, when the course of azacitidine injections was completed. However, acute myeloid leukemia recurred, and the patient died 5 months after her first examination.

Introduction Alopecia areata and frontal fibrosing alopecia are common causes of eyebrow loss (madarosis). Objective Assessment of trichoscopic markers of eyebrow loss in alopecia areata and frontal fibrosing alopecia. Materials and methods The analysis included 50 patients with scalp alopecia areata with madarosis, 50 patients with scalp frontal fibrosing alopecia with madarosis and 50 healthy controls. In every case, trichoscopy of the eyebrow area was performed. Results Empty follicular and eccrine duct openings were observed in all patients and presented predominantly as yellow dots. Exclamation mark hairs were only detected in patients with alopecia areata (30%). Tapered hairs, broken hair, black dots and Pohl-Pinkus constrictions were observed in 14%, 36%, 26% and 4% of patients with alopecia areata, respectively, 4%, 16%, 2% and 0% of patients with frontal fibrosing alopecia, respectively, and they were not present in healthy controls. Dystrophic hairs and whitish areas were observed only in patients with frontal fibrosing alopecia (28% and 32%, respectively). Eyebrow regrowth in distinct directions was present in 32% of patients with frontal fibrosing alopecia, 8% of patients with alopecia areata and 4% of healthy controls. Diffuse erythema was detected in 60% of patients with alopecia areata and frontal fibrosing alopecia and 56% of healthy controls. Vellus hairs and upright regrowing hairs were observed in patients with alopecia areata (62% and 58%, respectively), frontal fibrosing alopecia (60% and 84%, respectively) and healthy controls (100% and 100%, respectively). Conclusion Trichoscopy of the eyebrow area is useful in diagnosing patients with isolated eyebrow loss. The most characteristic trichoscopic features of eyebrow loss in alopecia areata include exclamation mark hairs, tapered hairs, broken hairs and black dots. Frontal fibrosing alopecia of the eyebrows is characterized by the presence of dystrophic hairs, white areas and eyebrow regrowth in distinct directions.

The eyebrows frame the upper margin of the orbit and are an essential feature of the facial landscape. Eyebrow hypotrichosis, also known as madarosis, is characterized by a lack of growth or loss of eyebrow hair. Eyebrow loss can have cosmetic, functional, and social consequences. Eyebrow hypotrichosis can be idiopathic or related to an underlying condition. Bimatoprost 0.03% solution is a prostamide F2α analog indicated for the treatment of glaucoma and ocular hypertension that has also demonstrated efficacy for hair growth; indeed, it is currently approved by the Food and Drug Administration for the treatment of eyelash hypotrichosis. A 60-year-old woman with eyebrow hypotrichosis is described who achieved excellent and sustained growth of her eyebrows with continual daily application of bimatoprost 0.03% solution. We discuss the therapeutic mechanisms of bimatoprost 0.03% solution in hair growth, review other potential modalities for treating eyebrow hypotrichosis, and summarize the findings of investigators who have utilized bimatoprost in the treatment of eyebrow hypotrichosis.

Background: Blepharitis is a very common condition encountered in ophthalmology outpatient care department. Dermatological diseases like seborrheic keratopathy and rosacea have been frequently discussed as being associated with blepharitis. However Discoid lupus erythematosis [DLE], an autoimmune condition has only rarely been reported to involve the eyelids mimicking blepharitis. DLE affecting the eyelids can produce significant morbidity with lid deformities, trichiasis and symblepharon if left untreated.Objective: To report three consecutive cases of DLE with eyelid lesions mimicking blepharitis. They presented to the department of ophthalmology at our institute from April 2014 to March 2016. The first case presented with involvement of lower eyelid in one eye. She was having multiple skin lesions which on biopsy confirmed the diagnosis of DLE. The second case was a diagnosed case of DLE who received treatment 4 years back and came with relapse of the disease affecting the eyelid. The third case was a recently biopsy confirmed case of DLE with multiple skin lesions along with bilateral eyelid involvement. Two of them had madarosis and one case had destruction of the outer lid margin at presentation. All three cases responded well to treatment with Hydrxychloroquin.Conclusion: The discoid lesions of DLE affecting the eyelids can mimic the appearance of chronic blepharitis. Ophthalmologists should be aware that DLE is a possibility while dealing with an atypical case of chronic blepharitis. Early diagnosis and treatment can prevent deformities of eyelid.

BACKGROUND : Dermatologic disorders usually have manifestations which involve the eyelids, conjunctiva, and cornea. The ocular complications may often be the most devastating outcome for survivors of the acute reaction. The key to success to minimize possibility of visual impairment is the prevention of complications. OBJECTIVES: This study highlights the ocular manifestations of various mucocutaneous disorders. MATERIALS AND METHOD S: A prospective study was conducted in the Department of Ophthalmology in a medical college hospital, over a period of 1 year, on patients presenting with mucocutaneous syndromes who were referred from the Departments of Dermatology and Medicine. Patients with co - morbid diseases like diabetes and hypertension wherein ocular involvement is likely were excluded from the study. RESULTS: In this study, 103 patients with mucocutaneous disorders were examined, of which 65 (63.1%) had ocular involvement. Majority of the patients belonged to the 21 - 30 years age group; with a male preponderance. The most common mucocutaneous syndrome in this study was herpes (37%), followed by leprosy (27%). Ocular involvement was seen in 69% patients with herpes and 79% patients with leprosy. In this study, periorbital vesicles was the most common ocular manifestation in herpes (20%), followed by blepharitis, conjunctivitis, corneal epithelial defect and keratitis; however, in leprosy, madarosis (16%) was the commonest ocular lesion. Economic blindness (visual acuity

Background: Leprosy or Hansen’s disease is a chronic mildly contagious granulomatous disease of tropical and subtropical regions caused by the rod shaped bacillus, Mycobacterium leprae. It affects the skin, peripheral nerves in the hands and feet, mucous membrane of nose, throat and eyes. When left untreated, it is capable of producing various deformities and disfigurements. Aim: To study the ocular involvement in patients with Leprosy under the parameters of age group, sex type and duration of leprosy. To study the different ocular manifestations and identify the potentially sight threatening lesions and provide early management. Methods: This was a prospective study which included 50 cases diagnosed with Hansen’s disease. Detailed history and thorough clinical examination was done. Potentially sight threatening lesions were managed conservatively or surgically. Results: Out of 50 cases of Leprosy, 58% had ocular involvement and majority were in the age group 21-40years. Ocular involvement was predominantly seen in Lepromatous type with 35% having ocular lesions. The most common ocular manifestation observed was superciliary madarosis (48%). Potentially sight threatening lesions accounted for 72.4% of which lagophthalmos was common. No cases of blindness seen. Conclusion: Visual impairment is preventable in Leprosy if detected early. The risk of ocular complications increases with the duration of the disease, despite being treated with systemic anti-leprosy drugs.

Purpose To establish the natural history of ophthalmic characteristics in Progeria patients and to determine incidence of ocular manifestations. Design Retrospective case series of patients with Progeria who were seen between 2007 and 2016. Methods Setting: Tertiary-care academic center. Patient Population: Fourteen patients (28 eyes) with Hutchinson-Gilford Progeria syndrome were included for statistical analysis from a total of 84 patients who have been enrolled in clinical trials for Progeria at Boston Children's Hospital. Clinical treatment trial patients who were not seen at the Department of Ophthalmology at our hospital, but for whom we had detailed clinical ophthalmologic records, were also included. This essentially represents an estimated 20% of the world's known patients with Progeria. Interventions or Observation Procedures: Complete ophthalmic examination. Main Outcome Measures: Visual acuity, stereoacuity, refraction, clinical findings of slit-lamp and dilated fundus examinations. Results Ophthalmic manifestations noted were hyperopia and signs of ocular surface disease owing to nocturnal lagophthalmos and exposure keratopathy. Additional ophthalmic manifestations included reduced brow hair, madarosis, and reduced accommodation. Most patients had relatively good acuity; however, advanced ophthalmic disease was associated with reduced acuity. Conclusions Children with Progeria are at risk for serious ophthalmic complications owing to ocular surface disease. Children with Progeria should have an ophthalmic evaluation at the time of diagnosis and at least yearly after that. Aggressive ocular surface lubrication is recommended, including the use of tape tarsorrhaphy at night.

Objective: We describe the case of a patient with metastatic breast cancer who presented with eyelid margin thickening and madarosis more suggestive of sebaceous cell carcinoma than metastatic disease. Histopathology confirmed metastatic breast adenocarcinoma. Case Report: A 59-year-old woman with a known history of metastatic breast carcinoma actively enrolled in a clinical trial presented with a thickened right upper eyelid margin with madarosis and without ulceration. Although the possibility of metastasis was considered, a biopsy was performed to ensure the patient did not have a primary eyelid malignancy such as sebaceous cell carcinoma given her immunocompromised state. Histopathology revealed metastatic breast adenocarcinoma. Conclusions: To the authors’ best knowledge, metastatic breast carcinoma presenting as eyelid margin thickening without ulceration has not previously been reported. Eyelid metastasis is rare, and this patient’s clinical presentation was found to be unusual as well. It is important to establish metastatic disease even in a small focus such as the eyelid, as it may alter disease management.

We report a 62-year-old farmer who consulted with multiple chronic wounds over his limbs and chest. Physical examination revealed multiple ulceration, madarosis and infiltration of ear lobes. Slit skin smear showed numerous acid-fast bacilli consistent with a diagnosis of lepromatous leprosy associated with Lucio’s phenomenon. Administration of thalidomide together with MDT resulted in a huge improvement.

Lucio's phenomenon (LPh) is considered a necrotizing panvasculitis and a variant of leprosy Type 2 reaction, clinically characterised by necrotic-haemorrhagic lesions on the extremities and trunk. LPh is observed in diffuse lepromatous leprosy (DLL or Lucio-Latapi leprosy). This is a distinct form of lepromatous leprosy (LL) reported mainly in Mexico. Anti-phospholipid antibody syndrome (APS) has been rarely described in LPh. We report a case of Lucio-Latapi leprosy with LPh observed in a patient from the province of El Oro in Ecuador, who presented clinical manifestations of long standing DLL (non-nodular infiltration of the skin, collapse of the nasal pyramid, madarosis, atrophy of the earlobes), of LPh (necrotic-haemorrhagic macules with irregular shapes) and of APS (necrosis of the right big and second toe). Histopathology showed perineural and periadnexal foamy macrophages with numerous bacilli (diagnostic of LL) in the subcutis, a mild lobular panniculitis with a large subcutaneous vessel infiltrated by macrophages in the wall (typical of LPh) and vessels of the superficial and mid dermis occluded by thrombi but without signs of vasculitis (typical of occlusive vasculopathy as in APS). Our observations suggest that some cases of LPh may be associated with APS. Anti-cardiolipin antibodies (aCL) and lupus anticoagulant (LA) should be tested in patients with LPh because this may have therapeutic implications.

A 58-year-old otherwise healthy man, who lived his entire life in a rural place of Colombia working as a farmer, presented with a 5-year history of diffuse skin infiltration, multiple nodular lesions that coalesced into plaques, especially on the forehead, ears, cheeks and arms (figure 1A,B), associated with incomplete anaesthesia of the face, 6 kg weight loss, asthenia, adynamia, subjective fever, osteoarticular pain and progressive right fallen foot. Physical examination was notable for an afebrile and stable condition, with xerodermia, hypohidrosis, partial madarosis of the lower eyelashes, …

Leprosy, or Hansen disease, is a chronic infectious disease caused by Mycobacterium leprae which is associated with inflammation that may damage the skin and the peripheral nerves. Leprosy remains an important public health problem in Southeast Asia, America, and Africa. It has been speculated that, as with TB, HIV infection may exacerbate leprosy lesions and/or lead to increased susceptibility to leprosy. We report the case of leprosy and HIV co-infection and reveals its clinical manifestation. A 34-year-old female came to outpatient clinic complaining of rednessplaque on her face of 2-months duration. It was also accompanied with thick sensation but without itchy or burning sensation. We found thick erythematous plaque with sharp margin and hypoesthesia on her face and body. There were no madarosis, saddle nose, lagophthalmos, nor sign of neuritis. The slit-skin smear revealed BI 1+ globi and MI 2%. From laboratory examination we found CBC was within normal limit, IgM anti PGL-1 titer was 1265 u/mL and IgG anti PGL-1 was 834 u/mL Both histological examination on her ear lobe and extremity revealed that was similar to the lesion of leprosy. The detection of HIV antibody was positive with CD4 count on 325 cells/μL. We treat her with MDT for MB leprosy along with ART (Tenofovir, Lamivudine, and Efavirenz). After 6-months follow-up we observed no progression of the lesions though the slit-skin smear after completing 6 months of therapy become negative. M. leprae does not seem to accelerate the decline of immune function when associated with HIV infection. HIV infection does not seem to affect the clinical classification and progression of leprosy. Treatment of the HIV-leprosy co-infected patient consists of the combination of ARTs and anti-leprosy agents. So that, the treatment of leprosy and HIV co-infection does not differ from that of a seronegative leprosy patient.

Ichthyosiform dermatoses are a group of hereditary disorders characterized by dryness and roughness of the skin with excessive accumulation of epidermal scales. Four main types of Ichthyosis are Ichthyosis vulgaris, x-linked recessive, lamellar ichthyosis and epidermolytic hyperkeratosis. Lamellar ichthyosis is the rarest form with an incidence of 1 in 3, 00,000. It has autosomal recessive inheritance. Ocular manifestations include exposure keratitis secondary to ectropion, unilateral megalocornea, and enlarged corneal nerve, and blepharitis, absence of the meibomian gland, trichiasis, madarosis and absence of lacrimal puncta. Ectropion of both upper and lower lids have been documented. We are reporting a rare case of lamellar ichthyosis with bilateral upper eyelid ectropion in a child.

This study reports a unique case of a Marjolin ulcer in a patient who presented with periocular sebaceous cell carcinoma 16 years after a lye chemical burn. A 68-year-old woman presented with a long history of irregular and tender right upper and lower eyelid margins, periocular erythema, madarosis, trichiasis, ptosis, and chemosis, occurring many years after chemical burn to the area. After eyelid biopsy established the diagnosis of sebaceous cell carcinoma, subsequent map biopsies of the conjunctival surface revealed extensive sebaceous cell carcinoma with pagetoid spread, necessitating anterior exenteration for definitive treatment. This report describes the first case in which a sebaceous cell carcinoma has arisen in the area of a chemical burn. Sebaceous cell carcinomas should be included in the spectrum of Marjolin ulcers, and ophthalmologists should be aware of this entity when evaluating patients with a history of a burn to the eyelids.

Allogeneic hematopoietic stem cell transplantation (HSCT) has evolved over the past two decades to become the standard of care for hematologic and lymphoid malignancies. Major ocular complications after allogeneic HSCT have been increasing in number and severity. Graft-versus-host disease (GVHD) remains a major cause of ocular morbidity after allogeneic HSCT. The main objective of this review is to elucidate the ocular complications in patients developing GVHD following HSCT.Ocular complications secondary to GVHD are common and include dry eye syndrome, acquisition of ocular allergy from donors with allergic disorders. Eyelid changes may occur in GVHD leading to scleroderma-like changes. Patients may develop poliosis, madarosis, vitiligo, lagophthalmos, and entropion. The cornea may show filamentary keratitis, superficial punctate keratitis, corneal ulcers, and peripheral corneal melting which may lead to perforation in severe cases. Scleritis may also occur which can be anterior or posterior. Keratoconjunctivis sicca appears to be the most common presentation of GVHD. The lacrimal glands may be involved with mononuclear cell infiltration of both the major and accessory lacrimal glands and decrease in tear production.Severe dry eye syndrome in patients with GVHD may develop conjunctival scarring, keratinization, and cicatrization of the conjunctiva.Therapy of GVHD includes systemic immunosuppression and local therapy. Surgical treatment in refractory cases includes surgical intervention to improve the manifestation of GVHD of the eye. This may include tarsorrhapy, prose lenses, punctal occlusions and corneal transplantation.

Purpose This case report presents the use of bimatoprost 0.03% to help regrow eyelashes on a patient suffering from trichotillomania. Trichotillomania is characterized by repetitive compulsive hair pulling that leads to noticeable hair loss. Trichotillomania sufferers are affected by this condition in many ways including shame, embarrassment, guilt, and lower self-esteem. Although a formal therapy regimen does not exist, current treatment approaches include behavioral therapy and pharmacotherapy. In cases where a patient pulls the eyelashes, topical bimatoprost (Latisse) may be used to treat madarosis of the eyelashes by increasing growth, including length, thickness, and darkness. Case report A 55-year-old white female presented to the clinic with an interest in using bimatoprost ophthalmic solution (Latisse; Allergan). The patient reported a history of eyelash pulling since age 12 and began treatment to control the impulses with amitriptyline 1 week before her appointment. Follow-up appointments showed increased lash growth bilaterally over a 4-month period as a result of Latisse usage. Conclusions Those who pull their eyelashes may benefit from using bimatoprost 0.03%. The management of trichotillomania involving the eyelashes presents an opportunity for eye care professionals to collaborate with mental health providers for the betterment of shared patients. By expediting the patient's lash growth, Latisse can improve patients' self-image, reinforce compliance, and play an important adjunctive role in any therapy regimen.

Erythema nodosum leprosum (ENL) is a type 2 reaction, which is a humoral response to Mycobacterium Leprae infection. The fig. 1 and 2 depict the presentation of a 30-year-old with arthritis of large joints and dactylitis. Since 2 years, he had progressive nodular ulcerative lesions over trunks, thighs and upper-extremities (Fig. 3, 4, 5 and 6), and madarosis and nodular lesions on both the ear lobes (Fig. 7 and 8). Further evaluation of skin biopsy and histopathological examination confirmed the diagnosis of lepromatous leprosy with type 2 reaction.

A 47 year-old male, with no history of pathological notables who present since 3 years chronic and severe itching eyelids pushing the patient to remove her eyelashes. Examination of the eyelids objectified a madarosis with irritation of eyelids (A). Dermoscopic examination revealed the presence of nits attached to the eyelashes (B). There was any lesions on the examination of other body areas. Based on the observation of nits at the base of the eyelashes (C) a diagnosis of phthiriasis palpebrarum was mad. Patient was treated with oral ivermectin associated to hygiene measure. Phthiriasis palpebrarum (lice infestation of eyelids), caused by the Phthirus pubis, is an unusual cause of blepharitis and conjunctivitis and may easily be overlooked because of the failure of physicians to recognize P. pubis. Dermoscopy can aid in the detection of nits and in monitoring treatment response by determining whether nits contain viable or dead nymphs or are empty (D).Pan African Medical Journal 2016; 23

Yektas, Cigdem/0000-0002-5951-7253; Tufan, ALI EVREN/0000-0001-5207-6240 WOS: 000405329400026 PubMed: 28475521 …

Loss of hair-bearing tissue in the head and neck area can result from surgery, trauma, burns, tumors, and infection, as well as a diversity of inflammatory conditions, and the resulting defect can present a challenging problem for the reconstructive surgeon. Hair transplantation can be used as a reconstructive method alone or in conjunction with other techniques. The current method of using follicular unit grafts has led to natural restorations for a variety of areas including not only the scalp but also eyebrows, eyelashes, and beard areas. Camouflage provided by hair grafts can provide restoration not obtainable with other methods.

Purpose To describe 4 patients with histopathologically confirmed tarsal conjunctival nevi and to review the literature regarding nevi in this location. Methods Clinicopathologic series of 4 cases diagnosed at the New York Eye and Ear Infirmary between January 1990 and April 2009. PubMed was searched for reported cases of tarsal conjunctival nevi. Results Four patients (mean age 44 years, median 50 years, range 5-70 years) with tarsal conjunctival nevi were identified (3.4% of all histopathologically diagnosed conjunctival nevi). These lesions presented in adulthood (3 cases) and were associated with elevation/nodularity (3 cases), gray-brown coloration (3 cases), physician-documented growth (1 case), madarosis (1 case), and intrinsic vessels (1 case). Histopathology revealed combined nevi centered in the posterior lamella of the eyelid, predominantly in peri-Meibomian gland distribution. Review of the literature identified 10 previously reported cases of tarsal nevi with detailed clinicopathologic correlation in 3 of these patients. Conclusions Tarsal conjunctival nevi are rare. Adult presentation; subjective and objective evidence of growth; and associated inflammation, vascularity, and eyelid margin changes may make clinical distinction of tarsal nevi from melanoma challenging. Biopsy, therefore, is prudent as histopathology alone allows documentation of the benign nature of these lesions.

Background The aim of this study was to evaluate ocular changes in patients with xeroderma pigmentosum (XP) and Cockayne syndrome (CS). Both diseases belong to the progeroid syndromes caused by single gene mutations with premature aging. Both syndromes are very rare autosomal recessive diseases caused by a gene defect leading to deficient DNA repair. Patients 12 patients (4 female, 8 male) with XP between 3 and 67 years old and a 39-year-old female patient with CS were examined. The examination included visual acuity testing, slit lamp biomicroscopy, funduscopy and performance of a Schirmer test. Results Changes of the lids in the XP group included blepharitis in 7 patients, distichiasis in 2, and madarosis in 3 patients. 8 patients had multiple lentigines solares of the lids. One patient showed scars of the lower lids after excision of a squamous cell carcinoma and a basal cell carcinoma. Conjunctival lesions comprised a tumour of unknown origin of the conjunctiva in 1 patient, teleangiectasia of the conjunctiva in 5 patients, pterygia in 4, and pinguecula in 1 patient. Two patients had an intraepithelial melanosis of the conjunctiva, and one showed conjunctival nevi. Two patients had corneal scars and corneal vascularisation, another a significant conjunctivalisation of the cornea. A Schirmer test was feasible only in 3 patients. Tear production was markedly reduced in all these patients. Break-up time was shortened significantly in 6 patients examined. The patient with the CS showed atrophy of the pupillary rim and a subcapsular cataract. Funduscopically there were pigment epithelial changes. Conclusions Patients with XP often exhibit ocular changes. Beside the light-dependent degenerative and inflammatory manifestations at the lids, the conjunctiva and the cornea patients with XP also develop malignancies early in life. The majority of patients suffer from dry eye symptoms.

Docetaxel can cause skin reactions such as hypersensitivity, edema, and erythrodysesthesia syndrome as well as side effects involving the skin, including alopecia, nail onycholysis, nail pigmentation, photosensitivity, scleroderma, and paresthesia. In this case report, a patient was admitted to the hospital with widespread erythematous and edematous eruption in the head, neck, trunk, and lower and upper extremities, erythema around the eyes, and drooping of the lower eyelids that developed about 2 hours after receiving chemotherapy consisting of docetaxel. Use of the Naranjo Adverse Drug Reaction Probability Scale--a method for estimating the probability of adverse drug reactions--indicated a probable relationship between the skin reaction and docetaxel therapy in this patient. Docetaxel-associated skin reactions that are so extensive and severe as to lead to eye madarosis and ectropion are reported rarely in the literature.

Eyebrows, eyelashes, and eyelids are cosmetically and functionally important periocular landmarks that offer insights into a patient's emotional state. Several pathologies exist with respect to the eyebrows, eyelashes, and eyelids. Madarosis refers to loss of the eyebrows or eyelashes; milphosis refers specifically to eyelash loss. Excess growth of eyelash hair is termed trichomegaly. Excess skin in the upper or lower eyelids is called dermatochalasis. Pathology of these important structures can be reflective of important local and systemic disease processes.

Ocular complications associated with cutaneous lupus erythematosus (CLE) are less studied compared with those ones associated with systemic lupus erythematosus (SLE). The main ocular sites involved in patients affected by discoid lupus erythematosus (DLE) are eyelids followed by orbit and periorbit, the least being cornea. The most common complications are blepharitis usually affecting the lower lid and associated with some type of lid lesion such as plaque or erythematosus patches and madarosis. Few cases with LE profundus (LEP) and ocular complications are reported, but they are associated with orbital inflammatory syndrome and severe complications. The main treatment prescribed is hydroxychloroquine with a dose of 200 mg twice a day for 6 to 8 weeks. Corticosteroids are also used. Intervals between the correct diagnosis and the beginning of the ocular symptoms are commonly delayed. Ophthalmologist should be aware of the ocular manifestation of this autoimmune disease.

Epiphora due to canalicular stenosis is, a recently described side effect of weekly docetaxel. We prospectively evaluated the incidence of this complication and other ocular manifestations in patients treated at our medical center. Twenty-one consecutive patients (breast cancer: 14; metastatic non-small cell lung cancer: 6; metastatic nasopharyngeal carcinoma: 1) (female/male: 14/7; age range; 34–78 yr) were treated with weekly docetaxel (35 mg/m2/wk iv for 6 wk, cycles repeated every 49 d). A standard questionnaire regarding epiphora was completed before each dose of docetaxel Patients who complained of excessive tearing underwent a thorough ophthalmologic evaluation before receiving the next dose. Epiphora due to stenosis of the lacrimal puncti, and canaliculi developed in seven (33%) patients following a cumulative dose of 208–645 mg/m2 (median: 400 mg/m2). Two patients developed complete canalicular stenosis requiring surgery. Epiphora was accompanied by madarosis and ectodermalization of the palpebral and bulbar conjunctiva, complete in five patients. Treatment was discontinued due to epiphora in two (10%) patients. After a median follow-up of 11 mo, four patients still had epiphora. Epiphora due to canalicular stenosis is a frequent complication of weekly docetaxel and might be dose limiting. Irreversible damage requiring, surgical intervention may develop despite close monitoring.

Histoid leprosy, a clinical and histological variant of multibacillary leprosy, may offer a challenging diagnosis even for experts. An 83-year-old woman presented with papular, nodular and tumor-like lesions of 3 years of evolution, affecting fingers, toes, hands, thighs and knees, and wide superficial ulcers in her lower calves. Cutaneous lymphoma was suspected. A biopsy of a nodule of the knee showed a diffuse dermal infiltrate with microvacuolated histiocytes, moderate numbers of lymphocytes and plasma cells. Cutaneous lymphoma was suggested. Immunohistochemistry (IHC) showed prominent CD68-positive macrophages, as well as CD3, CD8 and CD20 positive cells. Additional sections suggested cutaneous leishmaniasis. New biopsies were sent with the clinical diagnoses of cutaneous lymphoma, Kaposi´s sarcoma or lepromatous leprosy, as the patient had madarosis. These biopsies showed atrophic epidermis, a thin Grenz zone and diffuse inflammation with fusiform cells and pale vacuolated macrophages. Ziehl-Neelsen stain showed abundant solid phagocytized bacilli with no globii formation. Abundant bacilli were demonstrated in the first biopsy. Histoid leprosy was diagnosed. The patient received the WHO multidrug therapy with excellent results. We concluded that Ziehl Neelsen staining should be used in the presence of a diffuse dermal infiltrate with fusiform and vacuolated histiocytes, which suggests a tumor, and an IHC particularly rich in CD68-positive macrophages; this will reveal abundant bacilli if the lesion is leprosy. A good clinical pathological correlation is essential to establish a proper diagnosis and management of the patient.