A glued technique of external dacryocystorhinostomy

Purpose: Fibrin glue was used for anastomosis of lacrimal sac and nasal mucosal flaps and was compared with the conventional suture technique in external dacryocystorhinostomy. Methods: A prospective interventional randomized control study in which 50 consecutive patients of primary acquired nasolacrimal duct obstruction (PANDO) were equally allocated into two groups. The case group underwent glued technique of external dacryocystorhinostomy (Ext DCR) in which fibrin glue was used for the apposition of the anterior lacrimal sac and nasal mucosal flaps. In the control group, conventional technique of Ext DCR was used to suture the flaps. Functional success was assessed by improvement in epiphora and fluorescein dye disappearance test (FDDT), whereas anatomical success was assessed by lacrimal irrigation and endoscopic view of the osteotomy site. Results: The anatomical success in both the groups was 92%, whereas the functional success was 92% in the case group and 88% in the control group. The difference in the success rates between the two groups was statistically non?significant. Conclusion: Glued technique of Ext DCR is a simple and easy alternative to suturing of the flaps. Though the final outcome was comparable in both the groups, glue can be especially useful in uncooperative cases, in cases of excessive bleeding, or in situations where the flaps are very thin or have become friable

Bilateral congenital infantile hemangioma of upper eyelids.

A newborn female baby presented to us with horizontally oval swelling involving posterior lamella of both upper eyelids and is limited by lid margin. The swelling was bright red, nontender, firm in consistency, nonreducible, blanches on pressure, and fixed to underlying structures with no rise in temperature. The size of the swelling was 2.8 cm × 1.1 cm × 1 cm in the right upper eyelid and 2.8 cm × 1.3 cm × 1 cm in the left upper eyelid. There was total occlusion of the visual axis [Fig. 1]. Magnetic resonance imaging of both orbit shows diffusely bulky and heterogeneous altered signal intensity lesions involving the posterior lamella of upper eyelid on both sides [Fig. 2]. The patient was prescribed oral propranolol 2 mg/kg in two divided doses under the supervision of a pediatrician and responded well to the treatment within a week of the initiation of the treatment [Fig. 3] and reduce further in size within 12 weeks of the treatment with the clearing of the visual axis [Fig. 4]. Discussion Infantile hemangioma, a benign tumor of vascular endothelial cells, is the most common type of childhood tumor.[1] Infantile hemangiomas are more common in premature or low‑birth‑weight infants.[2] It usually presents at birth or is evident by 6–8 months of age. The lesion typically manifests within the first few weeks of life, grows rapidly in the 1st year during the proliferative phase then invariably and slowly regresses over the following 4–5 years during the involutional phase.[3] For the management, the long‑term use of topical 0.5% timolol maleate solution is safe and effective in treating superficial infantile hemangiomas.[4] As compared to corticosteroids, oral propranolol also represents an effective therapy for periorbital infantile hemangioma.[5]