Case Report of Blindness After Intranasal Ethmoidectomy

Surgical extirpation and drainage of the paranasal sinus is frequently used by the otolaryngologist in the management of allergic, infectious, and neoplastic sinus diseases. Several surgical approaches to the ethmoid and maxillary sinuses, including ethmoidectomy and Caldwell-Luc's operation, may be used. In the intranasal approach to ethmoidectomy, the lamina papyracea, the thin partition separating the periorbita from the ethmoid sinus. cannot be directly visualized during this procedure and may be perforated inadvertently. Endoscopic nasal sinus surgery has only recently been introduced into Korea. This rather novel technique, especially when used by less-experienced surgens, has major complications similar to what has been reported with the traditional intranasal sphenoethmoidectomy. Even then, major complications may occur in the hands of very experienced surgeons. The ophthalmolgist may be consulted in the management of patients with orbital complications of sinus surgery. We present one patient with ophthalmic complications of sinus surgery encountered by the authors. The purpose of this report is to present to the ophthalmologist examples of orbital complications that may arise from sinus surgery, and treatment options.

Clinical Effects of Punctal Occlusion Using Chromic Catgut

The treatment of dry eye patients is based on the management of the main causes of the disease. When the process of disease continues regardless of various conventional treatments, punctal occlusion can be employed. We used collagen implant. 1-0 and 2-0 chromic catgut in 33 eyes of dry eye patients to evalute the efficacy of punctal occlusion using chromic catgut. Symptoms(grade 0 to 3) were improved from the first week and persistently decreased in symptom grade during four weeks' follow-up period. The superficial corneal punctate erosion(grade 0 to 3) was improved after 2 weeks of the procedure in the whole 33 eyes(p<0.05). There was no superiority between collagen implant and chromic catgut. There was no improvement by score of the Schirmer test and the BUT in each group(p<0.05). We concluded that chromic catgut was easily applicable, very effective, inexpensive and showed less complication compared with collagen implant. We suggested that it could be used more widely in punctal occlusion in dry eye patients.

Incidence of Demodex Folliculorum in Chronic Blepharitis

Demodex is a common ectoparasite in human eyelash. However the occurrence rate and pathogencity are still controversial. The purpose of this study were to investigate the occurrence rate and classification of Demodex from eyelashes and its relationship with blepharitis. We selected 28 blepharitis patients and 132 patients without blepharitis(control group) who vistied St. Family's Hostital from March 1992 to July 1992. The following results were obtained. Demodex was observed in 17 out of 28 blepharitis patients(60.7%) and in 32 out of 132 control group(24.2%). This difference was stastically significant(p<0.05). In blepharitis patients. Demodex index was 19.6 and lash index was 12.2. In control group. Democlex index 7.4 and lash index 5.3.

Effect of Plasma Coagulation Factor XIII Deficiency on the Healing Following Trabeculectomy in Rabbits

Conjunctival fibroblastic proliferation with contracting scar formation has been implicated as a possible cause of glaucoma filtering surgery failure. The inhibitory effect of plasma coagulation factor XIII deficiency on the healing following trabeculectomy of the eyes in rabbits was studied. The plasma coagulation factor XIII deficiency was induced by two successive intravenous injections of anti-rabbit plasma coagulation factor XIII-goat immunoglobulin. Grossly, artificially prepared filtering bleb was well preserved on plasma coagulation factor XIII ddicient groups compared with control groups. Histologically. wound healing following trabeculectomy was delayed and the size of the scar was reduced on plasma coagulation factor XIII deficient groups compared with control groups. The above findings suggest that plasma coagulation factor XIII deficiency inhibit the healing precess following traheculectomy.

Normal Conjunctival Goblet Cell Density in Korean Measured by Impression Cytology

Conjunctival goblet cells are thought to be the main source of tear mucin, and it is believed that this mucin plays an important role on increasing the tear film stability and the wettability of the ocular surface. The measurement of the conjunctival goblet cell density is useful for the differential diagnosis among the various ocular surface diseases, and for the evaluation of the efficacy of the treatment. This method can be checked simply and rapidly, but the normal conjunctival goblet cell density in Korean has not been reported. We examined the goblet cell density in the 68 eyes (57 patients) of normal subjects using an impression cytological technique on the palpebral and bulbar conjunctiva. The results were as follows: 1. Normal goblet cell density was 1316.9 +/- 491.7 cells/mm2 in the inferior palpebral conjunctiva, 57.9 +/- 67.9 cells/mm2 in the superor bulbar conjunctiva. 2. There was no significant difference in goblet cell density according to sex and age ( p>0.05, t-test). 3. The goblet cell density was increased as a rise of break-up time(BUT), but was not correlated with BUT(r=0.24, 0.05). Also there was no correlation between the goblet cell density and Schirmer test value (r=-0.10, 0.09), (r=regression coefficient). It is suggested that the above findings would aid in the diagnosis of the dry eye syndrome and allow differential diagnosis among the various ocular surface diseases.

Early Doppler Echocardiographic Determination of Left Ventricular Diastolic Filling Defect In Adult Onset Diabetes Mellitus

To determine the early diagnostic parameters of the left ventricular diastolic filling defect in the uncontrolled adult onset diabetes mellitus, 86 diabetics were evaluated from the left ventricular inflow velocity pattern using pulsed Doppler echocardiography compared with normal 21 subjects. The diabetics were divided into 3 groups according to the presence or absence of background diabetic retinopathy(RE or coexisting cardiovascular diseases(group I : 34 cases without RE, group II : 24 cases with RE, group III : 28 cases with CVD). RE was thought to be having microangiopathy, but the cases with persistant massive proteinuria were excluded in this study. The left ventricular inflow velocity patterns were recorded from the apical approach. Peak velocity of the rapid filling phase(PFVE), that in the atrial systole(PFVA), E/A ratio, acceleration time(AT), deceleration time(DT), acceleration rate(ATR) and deceleration rate(DTR) were measured in the left ventricular inflow patterns. The results were ; 1) PFVE, AT and ATR in group I(56.26+/-12.21mm/sec, 70.91+/-14.98msec, 858.5+/-247mm/sec2), group II(51.91+/-14.35mm/sec, 64.84+/-14.98msec, 855.7+/-248.5mm/sec2) and group III(50.07+/-12.45mm/sec, 67.59+/-17.46msec, 817.5+/-266.8mm/sec2) were not significantly changed(p>0.05) compared to the controls(50.24+/-8.24mm/sec, 66.19+/-10.98msec, 784.5+/-221mm/sec2). 2) PFVA and DT in group I(51.21+/-14.86mm/sec, 156.2+/-23.42msec) and group II(64.26+/-13.93mm/sec, 64.84+/-14.13msec) were significantly increased(p0.05). 3) E/A ratio was significantly decreased in group II(0.82+/-0.21) and III(0.75+/-0.23) compared to the controls(1.19+/-0.25, p0.05) was noted. 4) DTR was also decreased in group II(311.9+/-95mm/sec2, p<0.05) and group III(297.7+/-125.8mm/sec2, p<0.05) compared to the controls(370.2+/-88mm/sec2) and group I(379.8+/-126mm/sec2). In conclusion, left ventricular diastolic filling defect in adult onset diabetics could be determined by using a various parameters of the pulsed Doppler echocardiography, which were closely related with diabetic retinopathy(RE). And DT and PFVA could be used as good parameters for early determination of the left ventricular diastolic filling defect in diabetics even without microangiopathy.

A Case of Goldenhar's Syndrome

The authors experienced a case of oculo-auricular dysplasia(Goldenhar's syndrome). Goldenhar's syndrome is a rare congenital disorder, which is characterized by epibulbar dennoid, preauricular appendage and pretragal blind fistula. The patient was 4-year-old boy who had epibulbar dermoid, preauricular appendage, small facial bone, small mandible and hypoplastic maxillary sinuses. In addition to above mention, we reviewed the several literatures about this syndrome.

A Case of Molluscum Contagiosum on the Lower Eyelid

Molluscum Contagiosum is a self-limited or contagious caused by a virus of the Pox virus group. It has ocular importance to examine the eyelids for Molliscum in case of conjunctivitis unresponsive to routine therapy. We had an experience of a case of Molluscum Contagiosum on the left lower eyelid. On the corresponding site of this Molluscum at the bulbar conjunctiva, the limbus, and the cornea, no follicles, epithelial keratitis nor erosions were seen. This patient was managed by simple excision of the lesion under local infiltration anesthesia. Now, we report our experience with this patient along with the review of other papers in this report.