[Normal eyelid crease landmarks in an Iranian population]

To measure the upper eyelid crease landmarks in an Iranian population sample. We studied 208 Iranian subjects aged 30 to 50 years. Upper eyelid crease height was measured in lateral, medial and central positions using Calipers. Levator function [LF] was also evaluated after exclusion of frontalis muscle function. Mean age was 39.1 +/- 5.9 years and female to male ratio was 2.25. Overall mean LF was 15.70 +/- 1.77 mm [15.56 +/- 1.69 mm in female and 16.02 +/- 1.88 mm in male subjects]. Overall mean lid margin medial crease distance [LMMC] was 3.84 +/- 1 mm [3.71 +/- 0.94 mm in female and 4.15 +/- 1.06 mm in male subjects]; mean lid margin central crease distance [LMCC] was 7.57 +/- 1.54 mm [7.47 +/- 1.49 mm in female and 7.80 +/- 1.63 mm in male subjects] and mean lid margin lateral crease distance [LMLC] was 3.89 +/- 1.02 mm [3.82 +/- 1.03 mm in female and 4.04 +/- 1.01 mm in male subjects]. There was no significant difference between men and women regarding LF, LMCC, LMLC and double crease however, LMMC was significantly greater in male subjects. Defining a normal range for upper eye lid crease dimensions in various races and different genders is helpful for cosmetic eyelid surgery

[ effectiveness of pencil pushup training and office-based vision therapy for treatment of convergence insufficiency]

To compare the effectiveness of pencil pushup training [PPT] versus office-based vision therapy in patients with convergence insufficiency. Sixty students of Zahedan Medical University with convergence insufficiency were randomly selected. After determining refractive error [by retinoscopy using cyclopentolate 1%, if needed], near point of convergence [by millimeter ruler], near heterophoria [by alternate prism cover test] and positive relative convergence [by prism bar]; subjects were divided into two groups to receive PPT [3 times daily for 10 min], or office prism training [2 times each week for 30 min]. Subjects were re-examined 4 and 8 weeks after initiation of treatment. Independent samples t-test showed that near point of convergence, phoria and positive relative convergence were not statistically different between the two groups before treatment. After 4 and 8 weeks of treatment only positive relative convergence was different between the two groups. Repeated measurement ANOVA showed considerable difference between the two groups in general but the Bonferroni test showed that the observed difference was related only to positive relative convergence. PPT and office-based vision therapy are comparable for treatment of convergence insufficiency

[Long-term complications of enucleated or severely traumatized eyes in war veterans]

To evaluate anophthalmic socket complications and the incidence of sympathetic ophthalmia among individuals who had undergone primary enucleation or severe ocular trauma during the war between Iran and Iraq. All monocular veterans of the mentioned war in Khorasan province, Iran were recalled during a 7-month period. Preliminary data including age at the time of injury, occupation, previous operations and ocular symptoms were evaluated and all participants underwent a complete ophthalmologic examination particularly regarding the anophthalmic socket, orbital implant and prosthesis condition. Overall, 135 male individuals participated in this study. Mean age was 42 +/- 7 years and 86% were 30-50 years. Patients had undergone complete enucleation in 39 [28.9%], partial enucleation in 21 [15.6%] and evisceration in 6 [4.4%] cases. In 34 cases [25.2%] pthisis bulbi had occurred after trauma and the type of surgery was not identifiable in the remaining 35 cases [25.9%]. The most common symptom in injured eyes was mucoid or mucopurulent discharge [71%]. Common complications in 101 subjects with previous operations were superior sulcus deformity [72.3%] and socket contracture [44.5%]. Socket motility was satisfactory only in 18%. All signs of the anophthalmic syndrome are more severe and more prevalent among enucleated cases secondary to war injuries. Due to the rarity of sympathetic ophthalmia, we suggest enucleation and orbital implantation in an elective setting

Recurrence of lacrimal gland pleomorphic Adenoma [Two case report with review of literature]

In cases with lacrimal gland mixed tumor preoperative delicate clinical and radiological diagnosis lead to proper surgical approach. Incomplete resection of lacrimal gland mixed tumor may be complicated by severe tumor recurrence with the risk of malignant transformation. In this case report, we present 39 years old man with history of transcranial excision of lacrimal gland tumor. Six months before admission progressive proptosis and infer medial displacement of right globe [approximately 3 cm] has been developed. Soft tissue hypertrophy of eyelids and corneal leukoma developed due to the chronic progressive course of proptosis with chronic corneal exposure. The other case also was a 38-year-old man with significant proptosis and history of two time lacrimal gland tumor excision, one from trans cranial approach. The surgical procedure was performed in both cases through anterolateral orbitotomy without bone removal and the whole lesions were removed with pseudo capsule. The vision of the first patient improved from hand motion preoperatively to one meter finger count after surgery, and there was no recurrence in both cases 6 months postoperatively. In general, regarding risk of malignant degeneration and recurrence after incomplete excision or incisional biopsy of lacrimal gland mixed tumor, it is strongly recommended to perform complete excision with psudocapsule in the first surgery

[Correlation of delayed mustard gas ocular complications with severity of skin, respiratory, hematoogic, and immunologic complications]

To determine any possible correlation between delayed ocular complications with late-onset complications of mustard gas poisoning in other systems including skin, respiratory tract, and immunohematologic system. The study was conducted on 40 chemical war victims in Khorasan province, Iran. Ophthalmologic and dermatologic examinations and spirometry were performed for all patients. The severity of ocular, cutaneous, and respiratory complications were classified into four grades from mild to severe. Blood cell counts, flow-cytometric analyses, serum immunoglobulins and complement measurements were performed for all patients and for 35 healthy male controls. Hematological and immunological parameters were compared between the patients and the controls, using Mann-Whitney test. The correlation between these parameters and the severity of ocular complications in patients were determined, using Spearman's rank correlation test. Forty male patients [aged 43.8 +/- 9.8 years] with confirmed mustard gas poisoning 16 to 20 years after exposure were studied. Main ocular complications were found as vascular tortuosity [15%], limbal ischemia [12.5%], corneal opacity [10%], corneal vascularization [7.5%], and corneal epithelial defect [5%]. The values for WBC, RBC, HCT, IgM, and C3, as well as for the percentage of monocytes and CD3[+] lymphocytes were significantly higher [p<0.042] and the percentage of CD16+56[+] cells was significantly lower in patients than controls [P=0.006]. No significant correlation was found between the immunological parameters and the severity of ocular complications. The comparison of clinical complications in the skin, eyes, and respiratory system revealed a significant positive correlation between the respiratory and ocular complications [r=0.322, P=0.043]. Although sulfur mustard is known to cause long lasting systemic toxicity such as hematological and immunological complications, its adverse effects on the skin, eyes and the respiratory immunohematological complications