Publications by authors named "Patricia Ann L Lee"

13 Publications

  • Page 1 of 1

Bilateral Epibulbar Dermolipomas in a Patient With Goldenhar Syndrome.

J Craniofac Surg 2021 Mar-Apr 01;32(2):e217-e218

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.

Abstract: A 19-year-old woman consulted for bilateral superotemporal conjunctival lesions that had been present since birth. Physical examination also revealed hemifacial microsomia and bilateral auricular appendages. Medical history included heart, hearing, and neurologic problems. Excision biopsy of these lesions showed nodular proliferations of adipose tissue, which corresponded to the diagnosis of dermolipomas in the setting of Goldenhar syndrome. Complete examination for other first and second branchial arch anomalies is warranted in patients presenting with such lesions.
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http://dx.doi.org/10.1097/SCS.0000000000006919DOI Listing
March 2021

Tear film break-up patterns in thyroid eye disease.

Sci Rep 2021 Mar 5;11(1):5288. Epub 2021 Mar 5.

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.

Evaluation of tear film break-up pattern (TFBUP) is the main diagnostic method for tear film-oriented therapy (TFOT) of dry eye. This prospective, observational study examined TFBUPs in 154 eyes/sides from 78 patients with thyroid eye disease (TED) who met the diagnostic criteria for dry eye in Japan. TFBUPs were classified as area, line, spot, dimple, and random breaks. Results for the status of TED and dry eye were compared between the TFBUPs. Consequently, line, spot, dimple, and random breaks were observed in 80 (51.9%), 29 (18.8%), 10 (6.5%), and 35 eyes (22.7%) while no eyes showed area breaks. The random break group had the highest incidence of lid lag/Graefe sign and superior limbic keratoconjunctivitis (SLK) (P < 0.050). Although the incidence of each TFBUP is almost equal in patients with simple dry eye without TED, line breaks were more frequently observed in TED. In addition, while random breaks in simple dry eye are usually only associated with minor ocular surface damages, those in TED were associated with a higher incidence of concomitant SLK. These results will be helpful for understanding the etiology of dry eye in TED and for TFOT in TED.
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http://dx.doi.org/10.1038/s41598-021-84661-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935998PMC
March 2021

Relationship Between Eyelid Pressure and Lacrimal Status in Mild Facial Nerve Palsy.

Cureus 2021 Jan 20;13(1):e12830. Epub 2021 Jan 20.

Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, JPN.

Purpose: Facial nerve palsy is frequently associated with both epiphora and dry eye, and orbicularis oculi muscle weakness or paralysis is the main cause of these symptoms. Eyelid pressure is a quantitatively measurable parameter for evaluating the tone and function of the orbicularis oculi muscle. The aim of this study was to examine the relationship between eyelid pressure and lacrimal status in patients with mild facial nerve palsy.

Methods: This prospective, interventional study included 10 patients with unilateral facial nerve palsy. The severity of facial nerve palsy was determined using the CADS scale (cornea, static asymmetry, dynamic function, and synkinesis). Eyelid pressure was measured using a blepharo-tensiometer. Lacrimal status was quantified through tear meniscus height (TMH), clinical assessment of meibomian gland dysfunction (MGD) (eyelid margin abnormalities, Marx line, meibum expression, and loss of meibomian glands), corneal fluorescein staining, tear break-up time, and Schirmer test I results.

Results: All 10 patients suffered from mild facial nerve palsy without eyelid ectropion or entropion, or gustatory epiphora. Lower eyelid pressure during forceful eye closure was significantly decreased in affected eyes (P = 0.007), but upper eyelid pressure during forceful eye closure and static upper and lower eyelid pressure were not significantly different between the affected and unaffected sides (P > 0.050). The TMH, MGD, and dry eye measurements showed no significant difference between the affected and unaffected eyes (P > 0.050).

Conclusions: Mild facial nerve palsy is associated with decreased lower eyelid pressure during forceful eye closure. However, no other differences in upper eyelid pressure during forceful eye closure, static eyelid pressure, TMH, MGD, or dry eye disease symptoms were noted. These results imply that eyelid pressure slightly decreases due to mild facial nerve palsy, but this change may be clinically negligible.
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http://dx.doi.org/10.7759/cureus.12830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899130PMC
January 2021

Amyloidosis in the Palpebral Conjunctiva Mimicking Lymphoproliferative Lesion.

Case Rep Ophthalmol 2021 Jan-Apr;12(1):73-76. Epub 2021 Jan 14.

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Japan.

A 47-year-old Japanese woman presented with a 1-year history of foreign body sensation in the right eye. Upon examination, a linear soft tissue lesion in the lower conjunctival fornix was noted. The mass resembled a conjunctival lymphoproliferative lesion but was pinkish-yellow rather than salmon pink in color. Histopathology of the biopsy specimens revealed amyloidosis. Systemic workup showed no other lesions. The conjunctival lesion did not recur at 3 months postoperatively. Since conjunctival amyloidosis mimics conjunctival lymphoproliferative lesions, it is important to keep conjunctival amyloidosis as a differential diagnosis in the diagnosis of a pinkish conjunctival lesion.
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http://dx.doi.org/10.1159/000510392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879327PMC
January 2021

Modified Loop Myopexy (Yokoyama's Procedure) for High Myopic Strabismus Fixus.

Case Rep Ophthalmol 2021 Jan-Apr;12(1):68-72. Epub 2021 Jan 14.

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Japan.

In the classic loop myopexy (Yokoyama) procedure, muscle belly union in the deep orbit is technically difficult, particularly in patients with deep-set eyes and narrow palpebral fissures. Our modified procedure includes a lateral canthotomy and cantholysis and upper conjunctival fornix incisions to facilitate this step.
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http://dx.doi.org/10.1159/000510818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879241PMC
January 2021

Muscle Spindles in the Levator Palpebrae Superioris Muscle of Human Adults.

J Craniofac Surg 2020 Nov 10. Epub 2020 Nov 10.

Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital.

In this experimental anatomic study, the authors examined the number and distribution of muscle spindles in the levator palpebrae superioris (LPS) muscle of human adults. This study included 11 orbits from 11 cadavers (mean age at death, 81.9 years). The LPS muscles were harvested and equally divided into 5 sections using transverse incisions. Muscle spindles were counted in each section. Consequently, muscle spindles were identified in 4 (36.4%) of the 11 orbits studied. One to 4 muscle spindles were identified in each of these 4 orbits. All muscle spindles were found in the most proximal section (the muscle origin), and no muscle spindles were identified in the other sections. The results indicate that the LPS muscle is associated with a smaller number of muscle spindles as compared with the rest of the extraocular muscles. Since higher muscle spindle numbers are associated with finer motor movements, eyelid opening does not seem to require much precision, compared to ocular movement.
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http://dx.doi.org/10.1097/SCS.0000000000007135DOI Listing
November 2020

Amyloidosis in the Bulbar Conjunctiva Following Transconjunctival Ptosis Surgery.

J Craniofac Surg 2020 Oct 6. Epub 2020 Oct 6.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.

A 52-year-old woman presented with persistent eye irritation following her third transconjunctival ptosis surgery. Examination revealed a yellow-pink nodular lesion in the bulbar conjunctiva. Excision biopsy and histopathology showed granulation tissue. However, the tumor recurred 1 month postoperatively. Repeat biopsy and histopathology revealed amyloid deposits. Systemic work-up showed no other lesion. A retained suture found in the upper fornix was also removed. No tumor recurrence has since been noted over the 7-month follow-up period. This report aims to highlight a case of bulbar conjunctival amyloidosis that developed as a complication following multiple transconjunctival eyelid surgeries.
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http://dx.doi.org/10.1097/SCS.0000000000007159DOI Listing
October 2020

Dacryoendoscopic examination for location of internal orifice of congenital lacrimal fistula: A case series.

Int J Pediatr Otorhinolaryngol 2020 Dec 29;139:110408. Epub 2020 Sep 29.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan. Electronic address:

We examined the location of the internal orifice of congenital lacrimal fistula using a dacryoendoscope in 5 patients. A suture inserted from the skin orifice and passing into the lacrimal drainage system through the fistula track was identified using a dacryoendoscope. Consequently, the suture passed into the lacrimal sac in all patients. Although the internal orifice had been reported to be predominantly located in the common canaliculus, the methods previously used for identification of the internal orifice were less accurate. The results in our study suggest a higher incidence of congenital lacrimal fistulae connected with the lacrimal sac.
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http://dx.doi.org/10.1016/j.ijporl.2020.110408DOI Listing
December 2020

Bilateral Epibulbar Dermolipomas in a Patient With Goldenhar Syndrome.

J Craniofac Surg 2020 Aug 20. Epub 2020 Aug 20.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan.

A 19-year-old woman consulted for bilateral superotemporal conjunctival lesions that had been present since birth. Physical examination also revealed hemifacial microsomia and bilateral auricular appendages. Medical history included heart, hearing, and neurologic problems. Excision biopsy of these lesions showed nodular proliferations of adipose tissue, which corresponded to the diagnosis of dermolipomas in the setting of Goldenhar syndrome. Complete examination for other first and second branchial arch anomalies is warranted in patients presenting with such lesions.
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http://dx.doi.org/10.1097/SCS.0000000000006919DOI Listing
August 2020

Spontaneous orbital decompression in thyroid eye disease: new measurement methods and its influential factors.

Graefes Arch Clin Exp Ophthalmol 2020 Oct 25;258(10):2321-2329. Epub 2020 May 25.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan.

Purpose: To evaluate spontaneous decompression of the medial orbital wall and orbital floor in thyroid eye disease using new measurement methods and to analyze the influential factors.

Methods: This retrospective study included 86 patients (172 sides). Regarding evaluation of spontaneous medial orbital decompression, an anteroposterior line was drawn between the posterior lacrimal crest and the junction between the ethmoid bone and corpus ossis sphenoidalis. The bulged and/or dented areas from that line were measured. Regarding evaluation of spontaneous orbital floor decompression, the length of the perpendicular distance from a line that was drawn between the inferior orbital rim and the orbital process of palatal bone to the tip of the superior bulge of the orbital floor was measured.

Results: Multivariate linear regression analysis revealed that the maximum cross-sectional areas of the superior rectus/levator palpebrae superioris complex (P = 0.020) and medial rectus muscle (P = 0.028) were influential factors for spontaneous decompression of medial orbital wall (adjusted r = 0.090; P < 0.001), whereas the number of cycles of steroid pulse therapy (P = 0.002) and the maximum cross-sectional area of the inferior rectus muscle (P = 0.007) were the ones for that of the orbital floor (adjusted r = 0.096; P < 0.001).

Conclusion: We believe that the identification of multiple influential factors of spontaneous decompression of the medial orbital wall and orbital floor will be helpful for better understanding and planned management of thyroid eye disease patients undergoing orbital decompression surgery.
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http://dx.doi.org/10.1007/s00417-020-04762-0DOI Listing
October 2020

Re: epibulbar osseous choristoma within a dermolipoma: case report and literature review.

Orbit 2020 Oct 1;39(5):395-396. Epub 2020 Apr 1.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital , Aichi, Japan.

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http://dx.doi.org/10.1080/01676830.2020.1749287DOI Listing
October 2020

Patency of the lacrimal drainage system in patients with a peripunctal tumour.

Orbit 2020 Oct 30;39(5):394. Epub 2020 Mar 30.

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital , Nagakute, Japan.

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http://dx.doi.org/10.1080/01676830.2020.1745852DOI Listing
October 2020