Purpose: To study the effect of periocular steroid use on intraocular pressure (IOP). Methods: Charts of adult patients with atopic dermatitis or eczema treated with topical periocular steroid creams and ointments from January 1st, 2007 to October 1st, 2017 were reviewed. Patients with the following were excluded: glaucoma, ocular hypertension, known systemic/topical/injectable steroid history, and lack of documented IOP prior to or during treatment with periocular steroid ointment. Patient data were collected regarding gender, treatment regimen, as well as IOP prior to and during treatment. Steroid responders were identified. Statistical analysis was performed using linear mixed effects models adjusting for follow-up time to test the relationship between pre and posttreatment IOP change adjusting for intereye correlations. Results: Thirty-one patients were identified. Twenty-one were treated bilaterally and 10 unilaterally. Five patients were glaucoma suspects. The mean treatment period was 14.2 weeks with a range of 0.1–83.9 weeks. Patients were treated with fluorometholone (42%), loteprednol etabonate (23%), dexamethasone-neomycin-polymyxin B (13%), hydrocortisone 1% or 2.5% (3%), and tobramycin-dexamethasone (19%). In the combined sample, there was no significant IOP change even after adjusting for follow-up time (mean change: +0.44 mm Hg, p = 0.126). However, eyes with baseline IOP ≥ 14 mm Hg had a significant increase (+0.73 mm Hg/year, p = 0.032). Individual steroid responses included the following: 1 intermediate and 30 low responders, of which 19 patients had an IOP change of <1 mm Hg. One patient had a clinically significant intermediate steroid response of 7 mm Hg. Conclusions: Periocular steroid treatment causes a statistically significant rise in IOP in eyes with higher baseline IOP measurements, the risk of which increases with follow up. While this change is not always correlated with a clinically significant rise in IOP, clinicians should monitor more closely patients at greatest risk of steroid response.
Atypical mycobacterial infections as a result of cosmetic tourism come at considerable cost to patients and the health care system. When our results are taken into consideration with other risks of cosmetic tourism, the financial risks likely far outweigh the benefits.
Hidrocystomas are benign, cystic lesions of eccrine and apocrine sweat glands. The literature on hidrocystomas is sparse, consisting of a handful of case reports and limited retrospective reviews. This is the first known bi-institutional, retrospective, chart review aimed to elucidate the demographics and basic clinical presentation of hidrocystomas. Medical records of adult patients with a pathological diagnosis of hidrocystoma from September 1, 2008 to August 1, 2015 in the Oculoplastic and Reconstructive Surgery Service at the Illinois Eye and Ear Infirmary (UIC) and Department of Ophthalmology of Weill Cornell Medical College (Cornell) were reviewed. Children under the age of 18 were not included. Data collection included: gender, race, age at diagnosis, laterality, location, total number of lesions, and recurrence. Results from both institutions were compared against each other and as a whole. A total of 107 patients were diagnosed with hidrocystoma on pathology. The mean age of diagnosis was 56 years (22-85). Hidrocystomas were diagnosed in 69 (64.4%) females and 38 (35.5%) males. Lesions were most commonly found in African American (37.4%), Caucasian (30.8%), and Hispanic (16.8%) patients combined across the two institutions with different patient populations. Lesions were largely unilateral (74.8%) and found on the lower lid (38.6%), lateral canthus (31.2%), upper lid (17.7%), and medial canthus (12.6%). Recurrences were seen in 2.3% of lesions. The majority of recurrences occurred in patients who identified their race as Hispanic (2/5) and Caucasian (3/5). Recurrences were seen in 2 males and 3 females. Apocrine and ecccrine hidrocystomas may be more common in female, African American, Caucasian, and Hispanic patients, presenting most commonly in adults in their mid-fifties. Lesions tend to be unilateral with lower lid lesions being the most prevalent location and medial canthus lesions being the least prevalent location for lesion growth. Recurrences may be most common in Hispanics and Caucasians and less common in African Americans. Although a precise recurrence rate cannot be determined at this time, our data suggests that the recurrence rate is low with current excisional methods.
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