Rootman, Daniel B.; Bokman, Christine L.; Katsev, Blake; Rafaelof, Michael; Ip, Michael; Manoukian, Narek; Esfandiari, Mahtash; Webb, Noreen M.
Purpose: To determine if crowdsourced ratings of oculoplastic surgical outcomes provide reliable information compared to professional graders and oculoplastic experts.
In this prospective psychometric evaluation, a scale for the rating of postoperative eyelid swelling was constructed using randomly selected images and topic experts. This scale was presented adjacent to 205 test images, including 10% duplicates. Graders were instructed to match the test image to the reference image it most closely resembles. Three sets of graders were solicited: crowdsourced lay people from Amazon Mechanical Turk marketplace, professional graders from the Doheny Image Reading Center (DIRC), and American Society of Ophthalmic Plastic and Reconstructive Surgery surgeons. Performance was assessed by classical correlational analysis and generalizability theory.
The correlation between scores on the first rating and the second rating for the 19 repeated occurrences was 0.60 for lay observers, 0.80 for DIRC graders and 0.84 for oculoplastic experts. In terms of inter-group rating reliability for all photos, the scores provided by lay observers were correlated with DIRC graders at a level of r = 0.88 and to experts at r = 0.79. The pictures themselves accounted for the greatest amount of variation among all groups. The amount of variation in the scores due to the rater was highest in the lay group at 25%, and was 20% and 21% for DIRC graders and experts, respectively.
Crowdsourced observers are insufficiently precise to replicate the results of experts in grading postoperative eyelid swelling. DIRC graders performed similarly to experts and present a less resource-intensive option.
Schear, Matthew J.; Rodgers, Rand
Everolimus is a newer generation mammalian target of rapamycin inhibitor approved for immunosuppressive use in a number of advanced medical conditions. The authors report a unique case of persistent eyelid edema believed to be related to the immunosuppressive therapy. The therapy was being well tolerated despite the persistent eyelid edema, so the patient underwent a bilateral upper eyelid blepharoplasty. The patient responded well with resolution of her eyelid dermatochalasis and markedly decreased edema. Everolimus-induced eyelid edema should be recognized by clinicians as a potential side effect of the medication. Surgical excision of excess eyelid tissue by blepharoplasty can be a successful way to manage this side effect.
Everolimus (zortress) was initially approved as an immunosuppressive agent for renal transplantation patients.1 Approval for the treatment of subependymal giant cell astrocytomas associated with tuberous sclerosis, progressive metastatic pancreatic neuroendocrine tumors, human epidermal growth factor receptor 2 negative breast cancer in postmenopausal woman, liver transplantation patients, and well-differentiated neuroendocrine tumors of gastrointestinal or pulmonary origin has followed.2 , 3 Everolimus is a derivative of sirolimus (rapamune), and similar to sirolimus acts as an inhibitor of mammalian target of rapamycin.1 Few prior studies have reported eyelid edema from sirolomus.4–6 Many prior medications have been implicated in eyelid edema formation.4–11 To date, periocular edema has not been reported as a side effect of everolimus. We report a patient with bilateral upper eyelid edema associated with everolimus therapy requiring surgical intervention to ameliorate the significant skin redundancy and the visual field defect. This report complies with the Declaration of Helsinki and Health Insurance Portability and Accountability Act regulations.
Lilly H. Wagner, MD; Jill Rotruck, MD; Rona Z. Silkiss, MD
A 3-year-old Asian girl presented to the emergency department with high fever (>40°C) of 2 days’ duration, bilateral upper and lower eyelid edema, and dysuria. Results of urinalysis revealed pyuria, and she was prescribed oral cephalexin, 250 mg every 12 hours, for a presumed urinary tract infection. The patient returned 2 days later with persistent fever, worsening eyelid edema, and a new macular rash over her buttocks and shins. At this time, the ophthalmology service was consulted owing to concern for Stevens-Johnson syndrome precipitated by the treatment with cephalexin.
Yu, Jonathan T.S.; Peng, Liam; Ataullah, Sajid
A 54-year-old woman received multiple injections of hyaluronic acid filler to the brow region to address volume loss over a 21-month period. She then developed significant pitting edema of both upper eyelids, which persisted for 6 years. Hyaluronidase (Hyalase) was injected into the subcutaneous brows and resulted in complete resolution of the edema within 2 days. This confirms that the hyaluronic acid injected into the brows was responsible for this patient’s chronic eyelid edema. This case illustrates an unusual long-term complication of periocular hyaluronic acid filler.
Raffaele Piscopo MD, Mary Romano MD, Alessandra Di Maria MD, Riccardo Vinciguerra MD & Paolo Vinciguerra MD
Introduction: Paraneoplastic clinical signs are characterized by a large and heterogeneous variety of manifestations due to several possible underlying neoplasms. Paraneoplastic pemphigus (PNP) is a particular paraneoplastic variety that usually primarily affects the dermic and/or oral mucosa and is characterized by a high rate of mortality (90%). Therefore, it is important to recognize its possible signs early. This report describes a case of ocular paraneoplastic pemphigus (PNP) presenting with recalcitrant eyelid ulceration and hyperemic conjunctivitis caused by an undiagnosed prostate cancer.
Methods: A 77-year-old man was admitted to our department because of recalcitrant hyperemic conjunctivitis in both eyes, complicated with large ulceration of both upper eyelids in spite of topical therapy. After 3 weeks, oral mucositis and bullous dermatitis on the chest and arms developed.
Results: Complete slit lamp ocular study, conjunctival swabs, routine hematologic tests, serum neoplasm markers, indirect immunofluorescence study, immunoblotting, and oral mucose biopsy with direct immunofluorescence were performed under the hypothesis of a paraneoplastic sign. Total body computed tomography scan and ultrasound-guided needle prostate biopsy completed the diagnostic process and confirmed the diagnosis of prostate PNP. Complete remission of ocular clinical signs was achieved by treatment of the prostate malignancy with systemic immunosuppressive therapy and chemotherapy.