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Lagophthalmos caused by cicatricial adhesion of orbital adipose tissue to orbital roof: A case report.

ABSTRACT: To report a case of lagophthalmos caused by cicatricial adhesion of orbital adipose tissue to the orbital roof.A 23-year-old female was presented with right lagophthalmos. Five months prior to consult at our clinic, she suffered from a penetrating trauma to the frontal lobe of the brain through the right orbital roof with cerebrospinal fluid leakage. Decompressive craniectomy was performed immediately after the injury using a coronal incision, which was followed by reconstruction with an artificial bone 1 month later. On examination at our clinic, she showed right exposure keratopathy with best corrected visual acuity of 20/100 due to corneal opacity. The palpebral contracted scar was first elongated using Z-plasty technique but excursion of the upper eyelid under a finger force assistance was insufficient to eliminate lagophthalmos. However, complete eyelid closure under a finger force assistance was achieved after sharp dissection of the cicatrized adipose tissue from the orbital roof. An autogenous dermis-fat was grafted on the orbital roof and superior orbital rim to avoid adhesion of orbital adipose tissue onto the bone again.Cicatricial adhesion of an orbital adipose tissue to the orbital roof is one of the possible causes of posttraumatic lagophthalmos in patients with an orbital roof fracture. Surgeons need to be aware of this condition in planning of surgical repair when such a fracture is encountered.

SUBMITTER: Kitaguchi Y

PROVIDER: S-EPMC5862542 | biostudies-other | 2018 Mar

REPOSITORIES: biostudies-other

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Lagophthalmos caused by cicatricial adhesion of orbital adipose tissue to orbital roof: A case report.

Kitaguchi Yoshiyuki Y Mupas-Uy Jacqueline J Takahashi Yasuhiro Y Kakizaki Hirohiko H

American journal of ophthalmology case reports 20180106

<h4>Purpose</h4>To report a case of lagophthalmos caused by cicatricial adhesion of orbital adipose tissue to the orbital roof.<h4>Observations</h4>A 23-year-old female was presented with right lagophthalmos. Five months prior to consult at our clinic, she suffered from a penetrating trauma to the frontal lobe of the brain through the right orbital roof with cerebrospinal fluid leakage. Decompressive craniectomy was performed immediately after the injury using a coronal incision, which was follo ...[more]

PMID: 29577100

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Project description:BackgroundThyroid eye disease (TED) is the most frequent orbital disease in adults and is characterized by the accumulation of orbital adipose tissue (OAT). It can lead to eyelid retraction or even vision loss. Orbital decompression surgery serves as the primary treatment for inactive TED by removing the excess OAT. However, there is a lack of alternative treatments to surgery due to the unclear understanding of the pathogenesis, particularly the metabolic features. Accordingly, our study was implemented to explore the content and features of metabolites of OATs from TED patients.MethodThe OATs used in the current study were obtained from the orbital decompression surgery of seven patients with inactive TED. We also collected control OATs from eye surgical samples of five individuals with no history of autoimmune thyroid diseases, TED, or under non-inflammatory conditions. The liquid chromatography mass spectrometer was used for the measurements of the targeted metabolites. Afterwards, we performed differential metabolite assay analysis and related pathway enrichment analysis.ResultsIn our study, a total of 149 metabolite profiles were detected in all participants. There were significant differences in several metabolite profiles between the TED group and the control group, mainly including uric acid, oxidized glutathione, taurine, dGMP, oxidized glutathione 2, uracil, hexose-phosphate, 1-methylnicotinamide, D-sedoheptulose 1,7-bisphosphate, and uridine 5'-monophosphate (all p-value < 0.05). The TED-related pathways identified included purine metabolism, beta-alanine metabolism, glutathione metabolism (p-values < 0.05). Our study found overlaps and differences including uric acid and uracil, which are in accordance with metabolites found in blood of patients with TED from previous study and several newly discovered metabolite by our study such as hexose-phosphate, 1-methylnicotinamide, D-sedoheptulose 1,7-bisphosphate, compared to those tested from blood, OAT, or urine samples reported in previous studies.ConclusionThe findings of our study shed light on the metabolic features of OAT in individuals with TED. These results may help identify new treatment targets for TED, providing potential avenues for developing alternative treatments beyond ophthalmic surgery.

Dataset Information

Lagophthalmos caused by cicatricial adhesion of orbital adipose tissue to orbital roof: A case report.

Publications

Lagophthalmos caused by cicatricial adhesion of orbital adipose tissue to orbital roof: A case report.

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