Comparative Evaluation of Matrix Metalloproteinase-9 Immunoassay and Tear Osmolarity Measurement for Diagnosing Severity of Dry Eye Disease

Purpose@#To evaluate and compare the clinical efficacy of matrix metalloproteinase-9 (MMP-9) immunoassay and tear osmolarity measurement in diagnosing dry eye severity. @*Methods@#Dry eye disease (DED) patients underwent diagnostic tests including MMP-9 assay, tear osmolarity measurement, fluorescein tear breakup time, ocular surface staining, anesthetized Schirmer test, Ocular Surface Disease Index questionnaire, and slit-lamp examination. The dry eye parameters were compared according to positive MMP-9 status and increased tear osmolarity. The correlation between dry eye profiles and MMP-9 positivity and high tear osmolarity was also analyzed. @*Results@#Those who tested positive in MMP-9 immunoassay had significantly higher corneal fluorescein staining score and worse DED severity than those who tested negative. The intensity of MMP-9 positivity showed positive correlation with the corneal staining score and DED severity. However, DED patients with high tear osmolarity above 308 mOsm/L did not show significantly different dry eye signs and symptoms compared to those with lower tear osmolarity values. Tear osmolarity was associated with ocular surface staining score in severe DED patients. @*Conclusions@#MMP-9 positivity was associated with ocular surface staining and worse dry eye severity. Therefore, it may be used as a useful indicator of disease severity in conjunction to other diagnostic tests.

Analysis in Results of Microbiologic Exam Related to Donor Corneas

Purpose@#This study analyzed the microorganisms identified in donor corneas and their clinical significance. @*Methods@#The medical records of 94 patients (114 eyes) who underwent keratoplasty and microbiological tests of the donor corneas from October 2008 to December 2020 at our hospital were reviewed retrospectively. During keratoplasty, we conducted microbiological tests of the corneoscleral rim of the donor cornea and preserving solution Optisol™-GS (Bausch & Lomb, Rochester, NY, USA), and examined the antibiotic susceptibility of bacterial isolates from the cultures. @*Results@#Some isolates of domestic donor corneas revealed bacteria, but none of the imported corneas did. Gram-negative bacilli were detected from the corneoscleral rim in three eyes (2.6%): two cases of Acinetobacter baumannii/haemolyticus and one case of Pseudomonas aeruginosa. In one case (0.9%), Acinetobacter baumannii/haemolyticus was identified from preserving solution, with no bacteria found in the corneoscleral rim. Antibiotic susceptibility tests showed multi-drug resistance, except to colistin. In all cases where bacteria were detected, there was no keratitis or endophthalmitis after corneal transplantation. @*Conclusions@#Although rare, bacteria can be identified from donor corneas or the preserving solution used in corneal transplantation. Therefore, caution is needed in all processes dealing with donor corneas. Empirical antibiotics that have sufficient antimicrobial activity to suppress multi-drug resistant bacteria should be selected in corneal transplantation.

Efficacy, Retention, and Complications of Two Types of Silicone Punctal Plugs in Dry Eye Patients

Purpose@#We analyzed the clinical efficacy, retention rates, and complications after inserting two types of silicone plugs in dry eye patients. @*Methods@#The medical records of 73 patients (133 eyes) whose lacrimal puncta were occluded with the SuperEagle Punctum Plug™ (EagleVision, Denville, NJ, USA) or the Parasol Punctum Plug™ (Beaver-Visitec International, Inc. Waltham, MA, USA) were analyzed. Conventional indices for dry eye disease and tear meniscus height (TMH) using optical coherence tomography were used to determine the clinical efficacy. The overall retention rates and complications were investigated and those of each plug were compared between the two groups during the first 6 months after insertion. @*Results@#The average age was 52.52 ± 13.66 years (13-82 years). Group A included 79 eyes and group B included 54 eyes. TMH tended to increase after 6 months regardless of plug loss or removal due to complications. Schirmer Ⅰ test value differences before and 6 months after plug insertion were positively correlated with the TMH differences in study subjects (p = 0.007). Plug loss was the most frequent complication in both groups. The retention rate of the Parasol plug was higher than the SuperEagle plug (44.4% and 24.1% respectively) (p = 0.012) and the retention rate of medium-sized plugs was higher than small-sized plugs (p = 0.027). Also, the plug retention rate decreased with age at 6 months (p = 0.032). @*Conclusions@#Punctal occlusion with a silicone punctal plug was effective, regardless of the plug type or complication. The retention rate of the Parasol plug was higher than the SuperEagle plug.

Efficacy, Retention, and Complications of Two Types of Silicone Punctal Plugs in Dry Eye Patients

Purpose@#We analyzed the clinical efficacy, retention rates, and complications after inserting two types of silicone plugs in dry eye patients. @*Methods@#The medical records of 73 patients (133 eyes) whose lacrimal puncta were occluded with the SuperEagle Punctum Plug™ (EagleVision, Denville, NJ, USA) or the Parasol Punctum Plug™ (Beaver-Visitec International, Inc. Waltham, MA, USA) were analyzed. Conventional indices for dry eye disease and tear meniscus height (TMH) using optical coherence tomography were used to determine the clinical efficacy. The overall retention rates and complications were investigated and those of each plug were compared between the two groups during the first 6 months after insertion. @*Results@#The average age was 52.52 ± 13.66 years (13-82 years). Group A included 79 eyes and group B included 54 eyes. TMH tended to increase after 6 months regardless of plug loss or removal due to complications. Schirmer Ⅰ test value differences before and 6 months after plug insertion were positively correlated with the TMH differences in study subjects (p = 0.007). Plug loss was the most frequent complication in both groups. The retention rate of the Parasol plug was higher than the SuperEagle plug (44.4% and 24.1% respectively) (p = 0.012) and the retention rate of medium-sized plugs was higher than small-sized plugs (p = 0.027). Also, the plug retention rate decreased with age at 6 months (p = 0.032). @*Conclusions@#Punctal occlusion with a silicone punctal plug was effective, regardless of the plug type or complication. The retention rate of the Parasol plug was higher than the SuperEagle plug.

Patients at High Risk for Failure of Penetrating Keratoplasty

Purpose@#We report the clinical characteristics and the primary underlying diseases of patients at high risk for failure of penetrating keratoplasty (PKP) in Korea. @*Methods@#Patients at high risk of PKP failure among those who visited the ophthalmological clinics of tertiary care hospitals in Korea from April 2019 to April 2020 and who were indicated for PKP were retrospectively enrolled. We epidemiologically investigated 119 eyes of 104 patients via medical chart review. @*Results@#Herpes simplex virus (HSV) keratitis was the most common primary underlying disease (26.1%). The most common primary cause of poor bilateral visual acuity was Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) (41.7%) followed by chemical burns (19.4%). Of the 119 eyes, 40.3% had a history of previous PKP and 20.2% had undergone three or more PKP. The average number of prior PKPs was 1.02 ± 1.46. Corneal neovascularization and corneal opacity were reported in 82.4 and 92.4% of cases, respectively. As the severity of these conditions increased, the eye distributions became larger. Of all patients, 47.9 and 31.9%, respectively, received the highest corneal neovascularization and corneal opacity scores. @*Conclusions@#Our study of patients at high risk of PKP failure improves our understanding of the relevant clinical characteristics and primary underlying diseases. Such patients require careful observation and aggressive treatment. Possible alternatives to PKP should be considered if PKP consistently fails. This study will aid clinicians in deciding whether to proceed to surgery if a poor postoperative prognosis is predictable.

Episcleral Capillary Hemangioma

Purpose@#To report a case of episcleral capillary hemangioma.Case summary: A 17-year-old woman with a left conjunctival mass since the age of 4 years visited our clinic with lesion growth that began 4 months prior. At the initial visit, the patient presented with a subconjunctival hemangiomatous mass of 3.5 × 4.5 mm in size and firmly adhered to the underlying sclera, with a feeding vessel on the temporal side of the left eye. Excisional biopsy of the mass and amniotic membrane transplantation were performed. The biopsy showed many enlarged, congested blood vessels involving subconjunctival and episcleral tissue, consistent with capillary hemangioma, as confirmed by immunohistochemical staining. There was no evidence of other hemangiomatous lesions in the eye or other areas of the body. To date, the patient has been without hemangioma recurrence for 1 year. @*Conclusions@#We noted a solitary episcleral capillary hemangioma and successfully treated the lesion.

Conjunctival Fibroma after Excision of a Recurrent Pterygium

Purpose@#To report a case of conjunctival fibroma after excision of a recurrent pterygium.Case summary: A 44-year-old male was referred with pterygium recurrence. The patient had undergone pterygium surgery on his left eye 7 years prior. Examination of the conjunctiva revealed fibrovascular proliferative tissue that had grown onto the cornea at the medial limbus in his left eye. The patient underwent pterygium excision, amniotic membrane transplantation, and intraoperative 0.02% mitomycin C soaking. Pterygium was confirmed histologically. Two years after surgery, a 5 × 3 mm semi-translucent, white conjunctival mass at the medial limbus was found in the left eye. The best-corrected visual acuity was 1.0 in both eyes and the intraocular pressure was within normal limits. Suspecting recurrent pterygium, the patient underwent excision of the conjunctival mass, conjunctival autograft, and 0.02% mitomycin C soaking during surgery. Under histologic examination, paucicellular substantia propria with abundant collagen and scattered fibroblasts was observed; the mass was diagnosed as conjunctival fibroma. No sign of recurrence was evident 2 years postoperatively. @*Conclusions@#Although conjunctival mass after pterygium excision is likely to be recurrent pterygium in most cases, there is the rare possibility of conjunctival fibroma; thus, histologic examination should be performed for differential diagnosis.

Age-related Clinical Analysis of Bacterial Keratitis in Daejeon and Chungcheong Provinces: a Multicenter Study

Purpose@#The purpose of this study was to investigate the age-related clinical features, risk factors, and prognoses of bacterial keratitis in Daejeon and Chungcheong provinces and the patterns and trends of fluoroquinolone antibiotic susceptibility. @*Methods@#Medical records of 433 patients (433 eyes) who visited one of the five university hospitals in Daejeon and Chungcheong provinces and were diagnosed as culture-positive bacterial keratitis between January 2000 to December 2018 were reviewed retrospectively. The patients were divided into younger and older groups based on an age of 60 years. Predisposing factors, prognostic factors, treatment method, causative organisms, and susceptibility to fluoroquinolone were analyzed. @*Results@#Two hundred seventy three males (63.0%) and 160 females (37.0%) were included. The most common risk factors in the younger group were contact lens wear (27.5%) and trauma and foreign body (27.0%). The most common risk factors in the older group were trauma and foreign body (30.5%). Staphylococcus species was the most common causative Gram-positive bacteria, regardless of age, and Pseudomonas species was the most common among Gram-negative bacteria. The older group tended to have more severe keratitis required more surgical treatment and had a worse visual outcome than the younger group (p 0.05). @*Conclusions@#Bacterial keratitis in Daejeon and Chungcheong provinces indicated more severe clinical aspects and worse prognoses in older patients showing similar results from previous studies. Caution regarding trauma and foreign bodies and managing previous ocular disease is necessary for all age groups. Education regarding adequate contact lens care and hygiene is required for younger (<60 years) patients.

Conjunctival Fibroma after Excision of a Recurrent Pterygium

Purpose@#To report a case of conjunctival fibroma after excision of a recurrent pterygium.Case summary: A 44-year-old male was referred with pterygium recurrence. The patient had undergone pterygium surgery on his left eye 7 years prior. Examination of the conjunctiva revealed fibrovascular proliferative tissue that had grown onto the cornea at the medial limbus in his left eye. The patient underwent pterygium excision, amniotic membrane transplantation, and intraoperative 0.02% mitomycin C soaking. Pterygium was confirmed histologically. Two years after surgery, a 5 × 3 mm semi-translucent, white conjunctival mass at the medial limbus was found in the left eye. The best-corrected visual acuity was 1.0 in both eyes and the intraocular pressure was within normal limits. Suspecting recurrent pterygium, the patient underwent excision of the conjunctival mass, conjunctival autograft, and 0.02% mitomycin C soaking during surgery. Under histologic examination, paucicellular substantia propria with abundant collagen and scattered fibroblasts was observed; the mass was diagnosed as conjunctival fibroma. No sign of recurrence was evident 2 years postoperatively. @*Conclusions@#Although conjunctival mass after pterygium excision is likely to be recurrent pterygium in most cases, there is the rare possibility of conjunctival fibroma; thus, histologic examination should be performed for differential diagnosis.

Age-related Clinical Analysis of Bacterial Keratitis in Daejeon and Chungcheong Provinces: a Multicenter Study

Purpose@#The purpose of this study was to investigate the age-related clinical features, risk factors, and prognoses of bacterial keratitis in Daejeon and Chungcheong provinces and the patterns and trends of fluoroquinolone antibiotic susceptibility. @*Methods@#Medical records of 433 patients (433 eyes) who visited one of the five university hospitals in Daejeon and Chungcheong provinces and were diagnosed as culture-positive bacterial keratitis between January 2000 to December 2018 were reviewed retrospectively. The patients were divided into younger and older groups based on an age of 60 years. Predisposing factors, prognostic factors, treatment method, causative organisms, and susceptibility to fluoroquinolone were analyzed. @*Results@#Two hundred seventy three males (63.0%) and 160 females (37.0%) were included. The most common risk factors in the younger group were contact lens wear (27.5%) and trauma and foreign body (27.0%). The most common risk factors in the older group were trauma and foreign body (30.5%). Staphylococcus species was the most common causative Gram-positive bacteria, regardless of age, and Pseudomonas species was the most common among Gram-negative bacteria. The older group tended to have more severe keratitis required more surgical treatment and had a worse visual outcome than the younger group (p 0.05). @*Conclusions@#Bacterial keratitis in Daejeon and Chungcheong provinces indicated more severe clinical aspects and worse prognoses in older patients showing similar results from previous studies. Caution regarding trauma and foreign bodies and managing previous ocular disease is necessary for all age groups. Education regarding adequate contact lens care and hygiene is required for younger (<60 years) patients.

Clinical Significance of Computerized Videokeratoscopic Indices for Dry Eye

PURPOSE: We evaluated the usefulness of the Tomey TMS-4N™ computerized videokeratoscopy (Tomey, Nagoya, Japan) for dry eye by analyzing the correlation between the regularity indices of TMS-4N™ and conventional dry eye parameters or dry eye severity. METHODS: In this retrospective study, the medical records of 193 dry eye patients (386 eyes) were analyzed. The regularity indices of TMS-4N™ such as the surface asymmetry index (SAI), surface regularity index (SRI), potential visual acuity (PVA), and irregular astigmatism index (IAI) were compared with conventional dry eye parameters (corrected visual acuity [CVA], ocular surface disease index [OSDI] score, tear film break-up time [TBUT], corneal staining score [CFS], and Schirmer's I test). We also analyzed correlations between the regularity indices of TMS-4N™ and dry eye severity according to the Korean Corneal Disease Study Group. RESULTS: The regularity indices of TMS-4N™ such as SAI, SRI, PVA, and IAI increased according to the severity of dry eye. The regularity indices correlated significantly and positively with the CVA and CFS, but were significantly and negatively correlated with the TBUT. The OSDI score did not correlate with the regularity indices. CONCLUSIONS: The regularity indices of TMS-4N™ provide an objective method for follow-up as well as a means to measure the severity of dry eye disease.

Evaluation of Anterior Stromal Puncture Using Nd:YAG Laser for Refractory Recurrent Corneal Erosion

PURPOSE: To evaluate the clinical results of anterior stromal puncture (ASP) using neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for refractory recurrent corneal erosion (RCE). METHODS: Ten eyes of eight patients with RCE showing poor response to conservative therapy who were treated with Nd:YAG laser ASP and followed up for at least 4 months were studied. The cause and duration of erosions, times, and total energy of the laser were recorded. The preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure, complications, and recurrence were reviewed. RESULTS: The mean follow-up time was 9.6 months. The laser energy setting was 0.2 or 0.3 mJ per shot. The average total laser energy was 6.2 mJ. Two of 10 eyes received another Nd:YAG laser treatment. All 10 eyes were successfully treated and had no recurrence after the operation during follow-up. Postoperative BCVAs were equal to or better than the preoperative BCVAs. No significant complications except faint corneal haze were observed. CONCLUSIONS: Nd:YAG laser ASP is an effective and safe procedure to treat refractory RCE in short-term follow-up.

The Relationship between the Nuclear Density Using Scheimpflug Imaging with Phacoemulsification Parameters

PURPOSE: To evaluate the correlation between nuclear density measured using the Pentacam(R) (Oculus Optikgerate GmbH, Wetzlar, Germany) Scheimpflug imaging system and phacoemulsification parameters. METHODS: The nuclear density was measured using maximal nuclear density with ImageJ, Pentacam(R) nucleus staging (PNS), average value and maximal value in lens densitometry. Intraoperatively, effective phaco time (EPT) and balanced salt solution (BSS) used were noted and compared with the nuclear density calculation methods. As an index of corneal endothelial cells, the changes in cell density (CD) were compared with the nuclear density. RESULTS: Regarding EPT, maximal nuclear density with ImageJ (r = 0.379, p < 0.01) and PNS (r = 0.367, p < 0.01) were correlated positively, but the other methods were not correlated. Concerning BSS used, maximal nuclear density with ImageJ (r = 0.279, p = 0.03) and PNS (r = 0.286, p = 0.04) were positively correlated, but the other methods were not correlated. The specular microscopy showed that as the nuclear density increased, the postoperative CD tended to decrease, but without statistical significance. CONCLUSIONS: Preoperative nuclear density measurements using maximal nuclear density with ImageJ or PNS were correlated with phacoemulsification parameters.

Preoperative Ocular Aberrations Measured by Zywave(R) II Aberrometer in Individuals Screened for Refractive Surgery

PURPOSE: To report the distribution of ocular higher-order aberrations in candidates for refractive surgery measured by Zywave(R) II aberrometer. METHODS: The present study included 232 eyes of 116 subjects. Ocular aberration data were obtained by measurements per eye using Zywave(R) II aberrometer. The mean Zywave spherical equivalent (SE) and higher order aberrations (HOAs) calculated in the central 6-mm zone and expressed as root mean square (RMS) values were analyzed. Correlation analysis was performed to assess the association between ocular HOAs and gender, age, SE refractive error, or central corneal thickness (CCT) and investigate the aberration symmetry between right and left eyes. RESULTS: The average SE was-4.67 +/- 1.83 diopters (D). The mean RMS values of total HOA, 3rd, 4th or 5th summated HOAs, coma, trefoil and spherical aberration (SA) were 0.421 +/- 0.201 microm, 0.346 +/-0.206 microm, 0.202 +/- 0.105 microm, 0.087 +/- 0.048 microm, 0.241 +/- 0.172 microm, 0.225 +/- 0.154 microm and 0.136 +/- 0.102 microm, respectively. There was no significant differences of the mean total HOA, summated HOAs, coma, trefoil and SA between genders, age and refractive errors, but the 3rd order trefoil was strongly related with myopia (r = -0.900, p = 0.008). There was symmetry of ocular aberrations between both eyes and the ocular aberrations were not correlated with CCT. CONCLUSIONS: Herein, we report the normative distribution of ocular aberrations in the myopic Korean population measured by Zywave(R) II aberrometer. The 3rd order trefoil and myopia were correlated and mirror symmetry was observed between right and left eyes.

Clinical Features and Results of Steroid Therapy for Orbital Inflammatory Pseudotumor

PURPOSE: To evaluate the clinical features and treatment outcomes of steroid therapy for orbital inflammatory pseudotumor. METHODS: Sixty-four patients diagnosed with orbital inflammatory pseudotumor were reviewed retrospectively. Patients with a follow-up period of less than 6 months were excluded from the study. The pseudotumor was classified into myositic, lacrimal, anterior, diffuse, or apical type according to orbital computed tomography findings. All patients were initially treated with systemic corticosteroids and evaluated for response to the treatment. Treatment outcome was considered a "success" if the patient had complete relief of symptoms with no recurrence, and a "failure" if the patient had no or only partial relief of symptoms or showed relapse. Factors affecting the treatment outcome were analyzed. RESULTS: The most frequent lesion subtype was myositis. Periorbital edema was the most common symptom and was evident in 53.1% of the patients. Thirty-eight patients (59.4%) showed treatment success. Age, sex, bilaterality, and mean follow-up length did not correlate with the treatment outcome. A short interval from symptom onset to treatment time and apical subtype were significantly associated with good steroid response (p < 0.05). CONCLUSIONS: In orbital inflammatory pseudotumor, myositis was the most common subtype. A short interval from symptom onset to treatment time and apical subtype were associated with good steroid response.

Clinical Results of Phototherapeutic Keratectomy for Refractory Recurrent Corneal Erosion

PURPOSE: The present study evaluated the clinical results of phototherapeutic keratectomy (PTK) for refractory recurrent corneal erosion (RCE). METHODS: A total of 12 eyes from 11 RCE patients who had been initially treated with conservative therapy but suffered from recurrence, were treated using PTK with 193 nm excimer laser. The preoperative and postoperative best corrected visual acuity (BCVA), spherical equivalent, average keratometric value, re-epithelialization time, corneal haze, complications and recurrence were investigated. RESULTS: PTK was combined with photorefractive keratectomy in 1 eye. The mean follow-up time was 11.42 months. All 12 eyes were successfully treated and had no recurrence during the follow-up except 1 eye where the symptoms recurred 9 months postoperatively. Postoperative BCVAs were all better than the preoperative BCVAs. Mild myopic change (average -0.20 diopter) and increased average keratometric values (average 0.27 diopter) were noted in 11 eyes which were treated using PTK alone. The average re-epithelialization time was 5.63 days. No specific complication except mild corneal haze was found. CONCLUSIONS: PTK is a safe and effective treatment for refractory RCE in short-term follow-up.

Clinical Features Associated With Outcomes of Canalicular Laceration Repair

PURPOSE: To evaluate clinical characteristics and outcome of repair of canalicular laceration with Crawford stent. METHODS: All 40 patients who underwent canalicular laceration repair from 2004 to 2007 in the hospital were retrospectively reviewed. Demographics, cause of canalicular injury, surgical management with Crawford stent, and its outcome were analyzed RESULTS: Most cases were male with step wound (34 cases 85%). Average age of fourty patients was 41.7 years old. Outcome had varied depending on the time of surgery, the location of laceration, the suture method, the wound condition, and the duration for stent. Maintaining silicone tube more than three months, and surgical approach within forty-eight hours resulted in statistically significant results. CONCLUSIONS: The outcome of canalicular laceration was better when surgical approach was done within forty-eight hours and silicone tube was maintained more than three months.

A Case of an Asymptomatic Intralenticular Foreign Body

The purpose of this article is to report a case of an asymptomatic intralenticular metallic foreign body that was retained for 6 months. A 66-year-old male visited our ophthalmology department because of decreased visual acuity in his left eye 6 months after he suffered ocular trauma while mowing. He had not been treated because he did not experience any discomfort. His corrected visual acuity was 0.4. Central corneal opacity, an intralenticular metallic foreign body, and an intact posterior capsule were observed on slit lamp examination. Phacoemulsification with posterior chamber lens implantation and simultaneous removal of the intralenticular foreign body was performed. Seventeen days after the operation, his corrected visual acuity was 1.0, the intraocular lens was well-seated, and there was no intraocular inflammation. In this case report, a patient was found to have an intralenticular metallic foreign body retained for 6 months. During this time he did not experience any ocular dysfunction due to the foreign body. Mowing accidents are common in Korea. Despite the absence of symptoms, patients reporting a history of lawn mowing should be thoroughly examined.

Factors Associated with a Poor Visual Result in Acute Endophthalmitis After Cataract Surgery

PURPOSE: To determine the factors related to the clinical outcome of acute endophthalmitis after cataract surgery. METHODS: Authors performed a retrospective study of 65 eyes of 65 patients who had been treated for endophthalmitis from 2001 to 2006 at our hospital. We analyzed the relationship between final visual outcomes and prognostic factors. RESULTS: Final visual acuities were 0.5 or better in 49.2% of all eyes. Of 57 eyes, 29 eyes (50.8%) were culture positive. Staphylococcus epidermidis and Streptococcus pneumoniae were the most common organisms isolated. Cases with baseline acuity of counting fingers or better, cases with culture-negative or gram-positive infection, and cases not requiring vitrectomy had better prognoses. CONCLUSIONS: Baseline visual acuity, type of cultured organism, and method of treatment are significantly related to visual prognosis.

A Case of Reconstruction of Punctal, Vertical Canaliculus, and Ampulla Laceration

PURPOSE: To report a case with a rare form of laceration through the upper punctum, vertical canaliculus, ampulla, and upper eyelid. A modified method of repair involving the use of a bicanalicular silicone stent in the canalicular systems was used successfully. METHODS: A 7-year-old child with laceration through the upper punctum, vertical canaliculus, ampulla, and upper eyelid visited our hospital and was treated with the repair methods. A Crawford Probe(R) (FCI Ophthalmics, Marshfield Hills, MA, U.S.A.) was intubated. No direct suture was done to the canaliculus. Two 8-0 Vicryl sutures were passed through the orbicularis around the ampulla in circular fashion and tied. The authors evaluated the effectiveness and stability of the silicone stent. RESULTS: On the 13th day after surgery, all the lid sutures were removed. One and two months after surgery, the patient had no tearing. Three and a half months after operation, the patient visited our clinic because of prolapse of the silicone stent to the ocular side. Irrigation through the lacrimal passage was normal and the stent was removed. Two months after removal, the patient was free from symptom with a patent canaliculus.