Purpose: To report a biopsy-proven case of granulomatosis with polyangiitis (GPA) who visited for red eye and discomfort. We detected papillary thyroid cancer by a whole-body scan.Case summary: A 56-year-old female presented to our clinic with hyperemia and discomfort in the right eye for the past 1 month. The visual acuity was 0.9 in the right eye. Congestion and chemosis of the right conjunctiva were observed by slit-lamp microscopy. There was a firm, erythematous, tender mass near the right nasolacrimal duct. Impairment of adduction and infraduction and proptosis were observed. Radiologically, a 3.6 × 2.6 × 1.2 cm right orbital mass was seen in the intraorbital extraconal space, invading the right nasolacrimal duct and nasal cavity. Pathologic and supplementary investigations showed granulomatous, c-anti-neutrophil cytoplasmic antibodies (ANCA)-positive inflammation in the mass. The patient was diagnosed with GPA. Whole-body computed tomography and positron emission tomography-computed tomography revealed multiple lesions in the right orbit, nasal cavity, mediastinum, retropubic area, and left thyroid gland. Thyroid ultrasonography and biopsy led to a diagnosis of papillary carcinoma with lymph node metastasis. Topical and systemic steroids and rituximab injection were administered, and total thyroidectomy with bilateral central lymph node dissection was performed. This led to improvements in proptosis and limitation of extraocular movement. Conclusions GPA is a rare disease that may initially present with ocular symptoms. It can be associated with malignancies even in the absence of immunosuppression. Patients with ocular problems suspected of having GPA should undergo autoimmune antibody testing, including ANCA and tissue biopsy.

PURPOSE: To compare the efficacy of 3 different eye ointment instillations with eyelid taping and eyelid taping alone to prevent eye complications during surgery under general anesthesia. METHODS: A total of 296 eyes of 148 patients who underwent general anesthesia for at least 60 minutes were randomly assigned to 1 of the following 4 groups: group A, eyelid taping alone; group B, eyelid taping with solcoseryl ointment; group C, eyelid taping with carbomer ointment; group D, eyelid taping with lanolin ointment. Schirmer test, tear film break-up time (TF-BUT), conjunctival hyperemia scale (CHS), National Eye Institute corneal staining scale (NSS), and ocular surface disease index (OSDI) were prospectively evaluated before and after general anesthesia. RESULTS: TF-BUT was significantly increased in the group B compared with the preoperative value (p = 0.035). CHS was significantly decreased in all 3 ointment groups (p < 0.05) after general anesthesia and the degree was significantly higher in groups B and C (p < 0.001). No corneal abrasion developed after general anesthesia. However, corneal erosion developed in 20 eyes of previously healthy subjects; 8 eyes (12.5%) in group A, 0 eye (0%) in group B, 2 eyes (2.5%) in group C, and 10 eyes (13.9%) in group D. The occurrence rates of new lesions were significantly lower in groups B and C (p = 0.035). CONCLUSIONS: Both eyelid taping alone and eyelid taping with eye ointment are effective protection methods against corneal abrasion during operation under general anesthesia. Eye ointment instillation together with eyelid taping shows not only improvement of subjective symptoms but also improvement of objective ocular surface parameters proving to be an effective ocular protection during general anesthesia.
Actihaemyl ; Anesthesia, General* ; Eyelids ; Humans ; Hyperemia ; Lanolin ; National Eye Institute (U.S.) ; Prospective Studies ; Tears

PURPOSE: To compare the efficacy of 3 different eye ointment instillations with eyelid taping and eyelid taping alone to prevent eye complications during surgery under general anesthesia. METHODS: A total of 296 eyes of 148 patients who underwent general anesthesia for at least 60 minutes were randomly assigned to 1 of the following 4 groups: group A, eyelid taping alone; group B, eyelid taping with solcoseryl ointment; group C, eyelid taping with carbomer ointment; group D, eyelid taping with lanolin ointment. Schirmer test, tear film break-up time (TF-BUT), conjunctival hyperemia scale (CHS), National Eye Institute corneal staining scale (NSS), and ocular surface disease index (OSDI) were prospectively evaluated before and after general anesthesia. RESULTS: TF-BUT was significantly increased in the group B compared with the preoperative value (p = 0.035). CHS was significantly decreased in all 3 ointment groups (p < 0.05) after general anesthesia and the degree was significantly higher in groups B and C (p < 0.001). No corneal abrasion developed after general anesthesia. However, corneal erosion developed in 20 eyes of previously healthy subjects; 8 eyes (12.5%) in group A, 0 eye (0%) in group B, 2 eyes (2.5%) in group C, and 10 eyes (13.9%) in group D. The occurrence rates of new lesions were significantly lower in groups B and C (p = 0.035). CONCLUSIONS: Both eyelid taping alone and eyelid taping with eye ointment are effective protection methods against corneal abrasion during operation under general anesthesia. Eye ointment instillation together with eyelid taping shows not only improvement of subjective symptoms but also improvement of objective ocular surface parameters proving to be an effective ocular protection during general anesthesia.
Actihaemyl ; Anesthesia, General* ; Eyelids ; Humans ; Hyperemia ; Lanolin ; National Eye Institute (U.S.) ; Prospective Studies ; Tears

Objective: : Patients with mild ischemic stroke experience various sequela and residual symptoms, such as anxious behavior and deficits in movement. Few approaches have been proved to be effective and safe therapeutic approaches for patients with mild ischemic stroke by acute stroke. Sildenafil (SIL), a phosphodiesterase-5 inhibitor (PDE5i), is a known remedy for neurodegenerative disorders and vascular dementia through its angiogenesis and neurogenesis effects. In this study, we investigated the efficacy of PDE5i in the emotional and behavioral abnormalities in rats with mild ischemic stroke. Methods: : We divided the rats into four groups as follows (n=20, respectively) : group 1, naïve; group 2, middle cerebral artery occlusion (MCAo30); group 3, MCAo30+SIL-pre; and group 4, MCAo30+SIL-post. In the case of drug administration groups, single dose of PDE5i (sildenafil citrate, 20 mg/kg) was given at 30-minute before and after reperfusion of MCAo in rats. After surgery, we investigated and confirmed the therapeutic effect of sildenafil on histology, immunofluorescence, behavioral assays and neural oscillations. Results: : Sildenafil alleviated a neuronal loss and reduced the infarction volume. And results of behavior task and immunofluorescence shown possibility that anti-inflammation process and improve motor deficits sildenafil treatment after mild ischemic stroke. Furthermore, sildenafil treatment attenuated the alteration of theta-frequency rhythm in the CA1 region of the hippocampus, a known neural oscillatory marker for anxiety disorder in rodents, induced by mild ischemic stroke. Conclusion : PDE5i as effective therapeutic agents for anxiety and movement disorders and provide robust preclinical evidence to support the development and use of PDE5i for the treatment of mild ischemic stroke residual disorders.