Significant Intraocular Sequelae in Orbital Blunt Trauma and Their Association with Blowout Fracture

PURPOSE: To investigate the frequency of significant intraocular sequelae (SIOS) in orbital blunt trauma and their association with blowout and facial bone fractures. METHODS: A retrospective survey consisting of 726 patients with orbital blunt trauma who visited Korea University Medical Center was performed. Patients were divided into three groups: blowout fracture only group (group 1), facial bone fracture group (nasal bone fracture, maxillary fracture, zygoma fracture without blowout fracture, group 2), and non-fracture group (group 3). SIOS (traumatic iridocyclitis, commotio retina, hyphema, retinal hemorrhage, eyeball rupture, vitreous hemorrhage, retinal detachment, lens dislocation, traumatic cataract) were surveyed in each group, and the association between the frequency of SIOS and the presence of blowout fracture or facial bone fracture was analyzed. RESULTS: The frequency of SIOS in the fracture groups was 83.8% in group 1 and 73.3% in group 2, which were both higher than the 67.9% in group 3, the non-fracture group (p = 0.000 by chi-square linear by linear association). Traumatic iridocyclitis and hyphema were also significantly higher in groups 1 and 2 than group 3 (p = 0.003, p = 0.008 by chi-square linear by linear association). CONCLUSIONS: SIOS was found significantly more often in the fracture group than the group without fracture, although the frequency of severe SIOS was lower in the fracture group than the non-fracture group. The results from the present study could help in the treatment and management of patients with orbital blunt trauma.

Clinical Efficacy of Blepharotomy for Upper Eyelid Retraction Associated with Thyroid Eye Disease

PURPOSE: To investigate the clinical efficacy of blepharotomy to treat upper eyelid retraction associated with thyroid eye disease. METHODS: A retrospective survey was performed with 9 eyes of 7 thyroid ophthalmopathy patients, who visited Korea University Medical Center from August 2009 to February 2011, and had undergone blepharotomy. The sex, age, change of upper eyelid retraction, postoperative complication, follow-up periods, and the surgical results were reviewed. To assess the efficacy of blepharotomy more objectively, the preoperative and postoperative pictures of patients were taken and the following lid parameters measured: marginal reflex distance 1, interpalpebral fissure height, total palpebral fissure area, upper nasal palpebral fissure area, and upper temporal palpebral fissure area. RESULTS: The mean age of patients was 37.4 years and mean follow-up period was 12.8 months. Five patients had undergone surgery unilaterally and 2 patients, bilaterally. Seven eyes of 6 patients had undergone full thickness blepharotomy and 2 eyes of 1 patient had undergone graded blepharotomy. According to the 3-month preoperative and postoperative picture analysis, all lid parameters improved significantly after blepharotomy (2.03 mm, 1.95 mm, 24.28 mm2, 12.98 mm2, and 16.21 mm2, respectively). Complications associated with blepharotomy included multiple and high folds in 2 eyes of 2 patients who had undergone full thickness blepharotomy. Re-operation was performed on only 1 eye and the result was satisfactory. CONCLUSIONS: Blepharotomy for upper eyelid retraction is a safe and highly effective surgery for upper eyelid retraction associated with symptomatic thyroid eye disease. This technique achieves excellent functional and cosmetic outcomes.

Clinical Manifestations, Management, and Ophthalmologic Complications of Orbital Roof Fractures and Zygoma Fractures

PURPOSE: To investigate the clinical manifestations, management, and ophthalmologic complications of orbital roof fractures and zygoma fractures. METHODS: A retrospective survey of 119 patients who visited Korea University Medical Center from June 2009 to June 2010 was performed. The sex, age, causes, fracture characteristics, neurologic injury, ocular injury, and combined facial bone fractures of patients who were diagnosed with orbital roof fracture and zygoma fracture were statistically analyzed. RESULTS: The mean age of patients with orbital roof fracture was 33.0 years old. The most common cause of orbital roof fracture was traffic accident (36.1%) with 6 patients receiveing surgical treatement (9.8%). Among the ophthalmologic diagnoses of the patients with orbital roof fracture, traumatic iridocyclitis was the most common (7 eyes) followed by eyeball rupture (2 eyes). The mean age of patients with zygoma fracture was 36.6 years old. The most common cause of zygoma fracture was traffic accident (32.8%), with 51 patients receiving surgical treatement (87.9%). Among the ophthalmologic diagnoses of the patients with zygoma fracture, traumatic iridocyclitis was the most common (6 eyes), followed by commotio retina (4 eyes). CONCLUSIONS: The present study regarding clinical characteristics and treatment of orbital roof fracture and zygoma fracture is helpful for ophthalmologists regarding the treatment of accompanying ophthalmologic complications.

Medial and Lateral Canthal Tendon Laxity: An Evaluation of Patients with Involutional Entropion and Epiphora

PURPOSE: The degree of laxity of the medial and lateral canthal tendon in Korean subjects with and without involutional entropion and epiphora was evaluated in the present study. METHODS: The present study included 180 normal subjects (360 eyes), 12 patients (15 eyes) with involutional entropion, and 41 patients (58 eyes) with epiphora. The degree of laxity of the medial and lateral canthal tendon, which grades the position of the inferior punctum, was measured using the lateral and medial distraction test. RESULTS: The mean degree of medial and lateral canthal tendon laxity was 1.83/1.08 in normal subjects. A statistical difference was not observed between sexes, and the mean degree of laxity tended to be higher in older patients. The mean degree of laxity was 2.78/2.18 and 2.28/1.22 in the involutional entropion group and the epiphora group, respectively. The involutional entropion group and the epiphora group underwent endoscopic endonasal dacryocystitis (D), medial spindle procedure (M), and endoscopic endonasal dacryocystitis with the medial spindle procedure and/or the tarsal strip procedure (T). The mean degree of laxity was 1.84/1.04 in group D, 3.00/1.20 in group M, 2.33/2.00 in group D + T, 3.20/1.40 in group D + M and 3.50/2.00 in group D + T + M before surgery. CONCLUSIONS: The results from the present study may aid in the selection of a basic treatment plan for Korean patients with involutional entropion or epiphora.

A Statistical Observation of Ocular Injuries and Visual Predictive Value of Ocular Trauma Score

PURPOSE: To investigate the clinical characteristics of ocular injuries for the prevention and predictability of visual prognosis and the treatment of ocular injuries using the ocular trauma score. METHODS: A retrospective survey was performed in 1341 eyes of 1257 patients, who visited Korea University Medical Center from May 2009 to December 2009. The sex, age, causes, diagnosis, primary ocular surgery, injury site, initial and final visual acuities and complications were statistically reviewed. The ocular trauma score was calculated by assigning certain numerical raw points to the following six variables: initial visual acuity, globe rupture, endophthalmitis, perforating injury, retinal detachment, and a relative afferent pupillary defect. The correlation of the ocular traumascore with the final visual acuity was investigated. RESULTS: The incidence of ocular injuries was higher in males (79.0%) than in females and was more common in people in their 40s and 20s respectively. Among the patient the diagnoses, corneal erosion was most common in males, orbital wall fracture was most common in females, and corneal erosion, orbital wall fracture, orbital contusion, and hyphema were most common overall. An ocular trauma score was less than 44 in 6 eyes (0.7%), 9 eyes (1.0%) between a score of 45 and 65, 48 eyes (5.2%) between a score of 66 and 80, 122 eyes (13.2%) between a score of 81 and 90, and 737 eyes (79.9%) between a score of 91 and 100. CONCLUSIONS: The present study determined that the ocular trauma score showed a good visual predictive value and could be used in prevention and treatment of ocular injuries.