Naresh Joshi - Academia.edu (original) (raw)
Papers by Naresh Joshi
Oculofacial, Orbital, and Lacrimal Surgery, 2019
Eyelid reconstruction, following tumor excision or trauma, has the primary purpose of regaining t... more Eyelid reconstruction, following tumor excision or trauma, has the primary purpose of regaining the protective globe function afforded by the eyelids. Inadequate eyelid position or function may result in corneal exposure and potential vision compromise. Secondary reconstructive goals include restoration of lacrimal function, comfort, and aesthetics.
Aims: To identify ocular trauma and the sentiments towards the implementation of protective eyewe... more Aims: To identify ocular trauma and the sentiments towards the implementation of protective eyewear in female English lacrosse. Methods: Two anonymous retrospective questionnaires were devised, one for women’s lacrosse coaches and players respectively. Surveys were undertaken either anonymously online or in person during national secondary school and university tournaments. Results: Surveys were collected from 648 players and 85 coaches. 157 players reported sustaining an eye injury, 13 of those had long-term adverse consequences on their vision. 46% of coaches and 24% of players, reported ocular injuries involving doctor based care, including specialist units. The majority of coaches (64%) and players (52%) would recommend the implementation of protective eyewear, into English lacrosse. Conclusion: Data collected from this study suggests that ocular injuries, including serious visual loss, occur during lacrosse. The mandatory adoption of ocular protection should be considered in En...
Eye, 2021
Canthal rounding can occur following trauma or surgery to the medial or lateral canthus, causing ... more Canthal rounding can occur following trauma or surgery to the medial or lateral canthus, causing possible aesthetic or functional deficits to patients. Several surgical techniques to repair canthal rounding have been described previously. We report a new technique for canthoplasty repair of canthal rounding with the use of illustrative cases. This is a retrospective case series describing the technique using illustrative cases from across three sites (London [UK], Adelaide [Australia], Sydney [Australia]). Twelve patients with post-surgical canthal rounding were included. Information collected for our illustrative cases include patient demographics, diagnosis, complications, outcomes and further treatment. There were no peri- or post-operative complications. All except one patient reported good surgical outcomes after one procedure. In one patient there was rounding recurrence. Our patients reported excellent outcomes post-operatively without any significant scarring.
Ophthalmic Plastic and Reconstructive Surgery, 2018
Mean marginal reflex distance (MRD1) comparing ELR and MMCR surgery preoperatively, early, and la... more Mean marginal reflex distance (MRD1) comparing ELR and MMCR surgery preoperatively, early, and late postoperatively. MMCR MRD1 significantly different at each time point, ELR significantly different at early and late postoperative time points relative to baseline, early and late not significantly different. *p < 0.05. ELR, external levator resection; MMCR, Mueller's muscle conjunctival resection.
European Journal of Ophthalmology, 2019
Background: An increasing number of people are undergoing non-surgical aesthetic procedures, espe... more Background: An increasing number of people are undergoing non-surgical aesthetic procedures, especially injections of botulinum toxin and dermal fillers. While toxin injections have lower rates of complications, profound and serious consequences can arise with the use of dermal fillers. Case: A 29-year-old woman presented to the eye casualty department with sudden visual loss, ptosis and ophthalmoplegia after having had non-surgical rhinoplasty in a beauty salon in West London. The filler was administered by a healthcare professional not registered with the General Medical Council (GMC) or similar governing body. Discussion: Despite prompt measures on arrival at our service, the symptoms of visual loss, ptosis and ophthalmoplegia persisted. Attempts from the patient and medical services to report the incident (to trading standards and the police) were to no avail. Conclusion: This case highlights the poor treatment response to filler-related ophthalmic complications. It is also evid...
Journal of the Intensive Care Society, 2013
Sedated and ventilated critically ill patients often have inadequate eyelid closure and are susce... more Sedated and ventilated critically ill patients often have inadequate eyelid closure and are susceptible to developing exposure keratopathy and microbial keratitis. Preventative measures reduce the risk of complications and visual loss. A telephone survey of all intensive care units in England was performed to elucidate the measures being used and their prevalence. Of 267 units, 217 participated (81%). Of these, 130 (60%) had an eye care protocol and 143 (66%) of all participating units formally assessed eyelid closure. The presence of an eye care protocol did not improve the likelihood of a unit assessing eyelid closure, a key component of the detection of patients at risk of ophthalmic complications; 66% of units with eye care protocols assessed eyelid closure formally, compared to eyelid closure assessment occurring in 65% of units that did not employ an eye care protocol. Most units used at least two protective methods per unit, the most popular being Geliperm application and Lac...
Orbit (Amsterdam, Netherlands), Jan 5, 2017
A retrospective audit was conducted of four patients with upper eyelid gold weights (inserted >... more A retrospective audit was conducted of four patients with upper eyelid gold weights (inserted >5 years ago) as treatment for facial nerve palsy-related lagophthalmos. Each patient was presently examined for lagophthalmos ("opened" or "closed") at three different patient inclinations (lying flat at 0º, lying back at 45º, and sitting upright at 90º). In all four cases at 0º inclination, the upper eyelid remained "open" with significant lagophthalmos, and therefore the ocular surface was vulnerable. At other inclinations, 45º and 90º, the eyes were substantially "closed" and the ocular surface was protected. We discuss the mechanism by which this occurs. We suggest that patients fitted with upper eyelid gold weight implant who do not show adequate closure during postoperative clinical examination or signs of corneal show should try sleeping in a slightly upright position to aid ocular surface protection.
Aesthetic Surgery Journal, 2017
Journal of Cutaneous and Aesthetic Surgery, 2016
Blepharoplasty is amongst the more frequently performed aesthetic procedures with surgery perform... more Blepharoplasty is amongst the more frequently performed aesthetic procedures with surgery performed by physicians and surgeons across a variety of sub-specialities. This paper, aimed at a dermatology audience, describes patient selection, eyelid anatomy, clinical examination and surgical steps to achieve successful upper and lower lid blepharoplasty outcomes. Recommendations for minimising complications are made and photographs used to illustrate important clinical and surgical features.
Contact Lens and Anterior Eye, 2015
Approaches and techniques, 2015
Ophthalmic plastic and reconstructive surgery
Facial Plastic Surgery, 2010
The Asian eyelid differs anatomically from the Occidental (i.e., Western) eyelid; furthermore, th... more The Asian eyelid differs anatomically from the Occidental (i.e., Western) eyelid; furthermore, the aesthetic pursuit of the Oriental patient may differ from that of patients with Occidental eyelids. We describe our surgical algorithm for the creation of an eyelid fold (double eyelid operation) in the Asian upper eyelid. Many variations in achieving this goal exist; we hope that our surgical strategy provides a simple approach to achieving a consistent and long-lasting result.
Facial Plastic Surgery, 2013
Blepharoplasty of the upper eyelids is one of the most commonly performed procedures in aesthetic... more Blepharoplasty of the upper eyelids is one of the most commonly performed procedures in aesthetic plastic surgery. In this article, we describe our approach to the patient with aging of the periorbita. At all times, the approach is tailored to the individual&amp;amp;amp;#39;s needs, trying to achieve a natural result that will not in any way affect the function of the eyelid. Our current approach and techniques for upper eyelid blepharoplasty and brow lifting are described.
Trends in Anaesthesia and Critical Care, 2011
... Review. Ocular care and complications in the critically ill. KY Ronald Kam a , b , Correspond... more ... Review. Ocular care and complications in the critically ill. KY Ronald Kam a , b , Corresponding Author Contact Information , E-mail The Corresponding Author ,Michelle Hayes b , Naresh Joshi c. a, Western Eye Hospital, 171 ...
Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneous disorder that freque... more Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneous disorder that frequently involves the ocular surface. This study aims to investigate the natural history and resolution of acute ocular involvement in patients with TEN admitted to the intensive care unit (ICU). Case notes of patients admitted to ICU with TEN at a tertiary referral centre in a 9-year period were retrospectively reviewed. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; characteristics, severity of ocular involvement, SCORTEN systemic severity score and treatment were correlated with resolution of ocular involvement and time to resolution. Nine out of 10 (90%) patients had ocular involvement with 4 graded as mild, 2 as moderate and 3 as severe. All had bilateral ocular disease. The median length of hospital stay was 28 days and the median time to resolution of ocular involvement was 19 days. Four out of 9 (44%) patients still had active ocular disease at the time of discharge. Only older age (p=0.032) and a milder grade of ocular disease (p=0.001) were significantly associated with resolution of ocular disease. In a multivariable Cox-regression model, only a milder grade of ocular disease remained independently associated with time to resolution of ocular disease (p=0.006). Grading of acute ocular disease severity does not reflect systemic disease severity and is significantly associated with resolution and time to resolution of ocular involvement in TEN. The high rate of ocular involvement in patients with TEN and relatively large proportion of patients with active disease on discharge reiterates the need for constant ophthalmological monitoring of these patients.
British Journal of Hospital Medicine, 2007
A previously healthy 61-year-old Caucasian woman was referred with a recurrent right upper eyelid... more A previously healthy 61-year-old Caucasian woman was referred with a recurrent right upper eyelid lesion. She had first presented to her local ophthalmic service with a 6-month history of an eyelid lump which was initially diagnosed as a presumed chalazion and treated by incision and curettage. On examination visual acuities were 6/6 in either eye and anterior and posterior segment examination was unremarkable. Eversion of the right upper lid revealed a 4 mm lesion arising from the marginal palpebral conjunctiva around the lateral third of the eyelid (Figure 1) and a shave biopsy was performed. This revealed enlarged and atypical keratinocytes with numerous mitoses, consistent with Bowen disease. The patient had no ophthalmic history, was a controlled hypertensive (atenolol 25 mg), and had no risk factors for immunosuppression and no history of lid trauma, other skin cancers or excess sun exposure. The lesion was surgically excised using the Mohs method, frozen section histology confirming clear margins w...
Facial Plastic Surgery, 2013
The aims of this article are twofold: (1) to provide the facial plastic surgeon with a comprehens... more The aims of this article are twofold: (1) to provide the facial plastic surgeon with a comprehensive and up-to-date overview of periocular anatomy including the brow, midface, and temporal region and (2) to highlight important anatomical relationships that must be appreciated in order to achieve the best possible functional and aesthetic surgical outcomes.
Facial Plastic Surgery, 2013
Oculofacial, Orbital, and Lacrimal Surgery, 2019
Eyelid reconstruction, following tumor excision or trauma, has the primary purpose of regaining t... more Eyelid reconstruction, following tumor excision or trauma, has the primary purpose of regaining the protective globe function afforded by the eyelids. Inadequate eyelid position or function may result in corneal exposure and potential vision compromise. Secondary reconstructive goals include restoration of lacrimal function, comfort, and aesthetics.
Aims: To identify ocular trauma and the sentiments towards the implementation of protective eyewe... more Aims: To identify ocular trauma and the sentiments towards the implementation of protective eyewear in female English lacrosse. Methods: Two anonymous retrospective questionnaires were devised, one for women’s lacrosse coaches and players respectively. Surveys were undertaken either anonymously online or in person during national secondary school and university tournaments. Results: Surveys were collected from 648 players and 85 coaches. 157 players reported sustaining an eye injury, 13 of those had long-term adverse consequences on their vision. 46% of coaches and 24% of players, reported ocular injuries involving doctor based care, including specialist units. The majority of coaches (64%) and players (52%) would recommend the implementation of protective eyewear, into English lacrosse. Conclusion: Data collected from this study suggests that ocular injuries, including serious visual loss, occur during lacrosse. The mandatory adoption of ocular protection should be considered in En...
Eye, 2021
Canthal rounding can occur following trauma or surgery to the medial or lateral canthus, causing ... more Canthal rounding can occur following trauma or surgery to the medial or lateral canthus, causing possible aesthetic or functional deficits to patients. Several surgical techniques to repair canthal rounding have been described previously. We report a new technique for canthoplasty repair of canthal rounding with the use of illustrative cases. This is a retrospective case series describing the technique using illustrative cases from across three sites (London [UK], Adelaide [Australia], Sydney [Australia]). Twelve patients with post-surgical canthal rounding were included. Information collected for our illustrative cases include patient demographics, diagnosis, complications, outcomes and further treatment. There were no peri- or post-operative complications. All except one patient reported good surgical outcomes after one procedure. In one patient there was rounding recurrence. Our patients reported excellent outcomes post-operatively without any significant scarring.
Ophthalmic Plastic and Reconstructive Surgery, 2018
Mean marginal reflex distance (MRD1) comparing ELR and MMCR surgery preoperatively, early, and la... more Mean marginal reflex distance (MRD1) comparing ELR and MMCR surgery preoperatively, early, and late postoperatively. MMCR MRD1 significantly different at each time point, ELR significantly different at early and late postoperative time points relative to baseline, early and late not significantly different. *p < 0.05. ELR, external levator resection; MMCR, Mueller's muscle conjunctival resection.
European Journal of Ophthalmology, 2019
Background: An increasing number of people are undergoing non-surgical aesthetic procedures, espe... more Background: An increasing number of people are undergoing non-surgical aesthetic procedures, especially injections of botulinum toxin and dermal fillers. While toxin injections have lower rates of complications, profound and serious consequences can arise with the use of dermal fillers. Case: A 29-year-old woman presented to the eye casualty department with sudden visual loss, ptosis and ophthalmoplegia after having had non-surgical rhinoplasty in a beauty salon in West London. The filler was administered by a healthcare professional not registered with the General Medical Council (GMC) or similar governing body. Discussion: Despite prompt measures on arrival at our service, the symptoms of visual loss, ptosis and ophthalmoplegia persisted. Attempts from the patient and medical services to report the incident (to trading standards and the police) were to no avail. Conclusion: This case highlights the poor treatment response to filler-related ophthalmic complications. It is also evid...
Journal of the Intensive Care Society, 2013
Sedated and ventilated critically ill patients often have inadequate eyelid closure and are susce... more Sedated and ventilated critically ill patients often have inadequate eyelid closure and are susceptible to developing exposure keratopathy and microbial keratitis. Preventative measures reduce the risk of complications and visual loss. A telephone survey of all intensive care units in England was performed to elucidate the measures being used and their prevalence. Of 267 units, 217 participated (81%). Of these, 130 (60%) had an eye care protocol and 143 (66%) of all participating units formally assessed eyelid closure. The presence of an eye care protocol did not improve the likelihood of a unit assessing eyelid closure, a key component of the detection of patients at risk of ophthalmic complications; 66% of units with eye care protocols assessed eyelid closure formally, compared to eyelid closure assessment occurring in 65% of units that did not employ an eye care protocol. Most units used at least two protective methods per unit, the most popular being Geliperm application and Lac...
Orbit (Amsterdam, Netherlands), Jan 5, 2017
A retrospective audit was conducted of four patients with upper eyelid gold weights (inserted >... more A retrospective audit was conducted of four patients with upper eyelid gold weights (inserted >5 years ago) as treatment for facial nerve palsy-related lagophthalmos. Each patient was presently examined for lagophthalmos ("opened" or "closed") at three different patient inclinations (lying flat at 0º, lying back at 45º, and sitting upright at 90º). In all four cases at 0º inclination, the upper eyelid remained "open" with significant lagophthalmos, and therefore the ocular surface was vulnerable. At other inclinations, 45º and 90º, the eyes were substantially "closed" and the ocular surface was protected. We discuss the mechanism by which this occurs. We suggest that patients fitted with upper eyelid gold weight implant who do not show adequate closure during postoperative clinical examination or signs of corneal show should try sleeping in a slightly upright position to aid ocular surface protection.
Aesthetic Surgery Journal, 2017
Journal of Cutaneous and Aesthetic Surgery, 2016
Blepharoplasty is amongst the more frequently performed aesthetic procedures with surgery perform... more Blepharoplasty is amongst the more frequently performed aesthetic procedures with surgery performed by physicians and surgeons across a variety of sub-specialities. This paper, aimed at a dermatology audience, describes patient selection, eyelid anatomy, clinical examination and surgical steps to achieve successful upper and lower lid blepharoplasty outcomes. Recommendations for minimising complications are made and photographs used to illustrate important clinical and surgical features.
Contact Lens and Anterior Eye, 2015
Approaches and techniques, 2015
Ophthalmic plastic and reconstructive surgery
Facial Plastic Surgery, 2010
The Asian eyelid differs anatomically from the Occidental (i.e., Western) eyelid; furthermore, th... more The Asian eyelid differs anatomically from the Occidental (i.e., Western) eyelid; furthermore, the aesthetic pursuit of the Oriental patient may differ from that of patients with Occidental eyelids. We describe our surgical algorithm for the creation of an eyelid fold (double eyelid operation) in the Asian upper eyelid. Many variations in achieving this goal exist; we hope that our surgical strategy provides a simple approach to achieving a consistent and long-lasting result.
Facial Plastic Surgery, 2013
Blepharoplasty of the upper eyelids is one of the most commonly performed procedures in aesthetic... more Blepharoplasty of the upper eyelids is one of the most commonly performed procedures in aesthetic plastic surgery. In this article, we describe our approach to the patient with aging of the periorbita. At all times, the approach is tailored to the individual&amp;amp;amp;#39;s needs, trying to achieve a natural result that will not in any way affect the function of the eyelid. Our current approach and techniques for upper eyelid blepharoplasty and brow lifting are described.
Trends in Anaesthesia and Critical Care, 2011
... Review. Ocular care and complications in the critically ill. KY Ronald Kam a , b , Correspond... more ... Review. Ocular care and complications in the critically ill. KY Ronald Kam a , b , Corresponding Author Contact Information , E-mail The Corresponding Author ,Michelle Hayes b , Naresh Joshi c. a, Western Eye Hospital, 171 ...
Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneous disorder that freque... more Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneous disorder that frequently involves the ocular surface. This study aims to investigate the natural history and resolution of acute ocular involvement in patients with TEN admitted to the intensive care unit (ICU). Case notes of patients admitted to ICU with TEN at a tertiary referral centre in a 9-year period were retrospectively reviewed. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; characteristics, severity of ocular involvement, SCORTEN systemic severity score and treatment were correlated with resolution of ocular involvement and time to resolution. Nine out of 10 (90%) patients had ocular involvement with 4 graded as mild, 2 as moderate and 3 as severe. All had bilateral ocular disease. The median length of hospital stay was 28 days and the median time to resolution of ocular involvement was 19 days. Four out of 9 (44%) patients still had active ocular disease at the time of discharge. Only older age (p=0.032) and a milder grade of ocular disease (p=0.001) were significantly associated with resolution of ocular disease. In a multivariable Cox-regression model, only a milder grade of ocular disease remained independently associated with time to resolution of ocular disease (p=0.006). Grading of acute ocular disease severity does not reflect systemic disease severity and is significantly associated with resolution and time to resolution of ocular involvement in TEN. The high rate of ocular involvement in patients with TEN and relatively large proportion of patients with active disease on discharge reiterates the need for constant ophthalmological monitoring of these patients.
British Journal of Hospital Medicine, 2007
A previously healthy 61-year-old Caucasian woman was referred with a recurrent right upper eyelid... more A previously healthy 61-year-old Caucasian woman was referred with a recurrent right upper eyelid lesion. She had first presented to her local ophthalmic service with a 6-month history of an eyelid lump which was initially diagnosed as a presumed chalazion and treated by incision and curettage. On examination visual acuities were 6/6 in either eye and anterior and posterior segment examination was unremarkable. Eversion of the right upper lid revealed a 4 mm lesion arising from the marginal palpebral conjunctiva around the lateral third of the eyelid (Figure 1) and a shave biopsy was performed. This revealed enlarged and atypical keratinocytes with numerous mitoses, consistent with Bowen disease. The patient had no ophthalmic history, was a controlled hypertensive (atenolol 25 mg), and had no risk factors for immunosuppression and no history of lid trauma, other skin cancers or excess sun exposure. The lesion was surgically excised using the Mohs method, frozen section histology confirming clear margins w...
Facial Plastic Surgery, 2013
The aims of this article are twofold: (1) to provide the facial plastic surgeon with a comprehens... more The aims of this article are twofold: (1) to provide the facial plastic surgeon with a comprehensive and up-to-date overview of periocular anatomy including the brow, midface, and temporal region and (2) to highlight important anatomical relationships that must be appreciated in order to achieve the best possible functional and aesthetic surgical outcomes.
Facial Plastic Surgery, 2013