Eyelid masses: a 10-year survey from a tertiary eye hospital in Tehran

The purpose of this study was to evaluate the demographics and clinical features of eyelid masses in a tertiary eye hospital over a 10-year period. A retrospective chart review was performed for patients admitted with eyelid tumors from 2000 to 2010. Data were collected and analyzed on the demographic features, location of the tumor, types of treatment, and pathologic findings. A total number of 182 patients were evaluated of which, 82 cases were benign and 100 cases were malignant neoplasms. The most common benign tumors included melanocytic nevi [35%], papilloma [19.5%], and cysts [11%]. The most frequent malignant tumors included basal cell carcinoma [BCC] [83%], squamous cell carcinoma [8%] and sebaceous gland carcinoma [6%]. The most common site for malignancy was the lower lid followed by the upper lid. BCC recurred in 16 cases that were most frequent in the lower lid. Melanocytic nevus, papilloma and cysts are the most common benign lesions and BCC is the most common malignant lesion in the eyelids. Recurrence is a feature of BCC especially in the lower lid

Outcomes of Levator Resection at Tertiary Eye Care Center in Iran: A 10-Year Experience

PURPOSE: To assess outcomes of levator resection for the surgical correction of congenital and acquired upper lid ptosis in patients with fair to good levator function and evaluation of the relationship between demographic data and success of this operation. METHODS: In a retrospective study, medical records of patients with blepharoptosis who had undergone levator resection over a 10-year period and were followed for at least 3 months were reviewed. RESULTS: Overall, 136 patients including 60 (44.1%) male and 76 (55.9%) female subjects with a mean age of 20 +/- 13.8 years (range, 2 to 80 years) were evaluated, of whom 120 cases (88.2%) had congenital ptosis and the rest had acquired ptosis. The overall success rate after the first operation was 78.7%. The most common complication after the first operation was undercorrection in 26 cases (19.1%), which was more prevalent among young patients (p = 0.06). Lid fissure and margin reflex distance (MRD1) also increased after levator resection (p < 0.001). Age, sex, type of ptosis, amblyopia, levator function, MRD1, lid fissure and spherical equivalent were not predictive of surgical outcomes of levator resection. CONCLUSIONS: Levator resection has a high rate of success and few complications in the surgical treatment of congenital and acquired upper lid ptosis with fair to good levator function. Reoperation can be effective in most cases in which levator resection has been performed.

Recurrent orbital cavernous hemangioma due to overlooked multiple tumors

To report late recurrence of orbital cavernous hemangioma in a patient ten years after complete resection of the primary tumor. A 32-year-old woman with a history of progressive visual loss and proptosis underwent lateral orbitotomy for resection of a large cavernous hemangioma. Ten years later, proptosis recurred and the patient developed progressive ocular deviation. Imaging studies were in favor of a recurrent cavernous hemangioma and the tumor was excised via the previous incision site. Reassessment of previous orbital images suggested the presence of two separate tumors, only one of which had been excised at the time of initial surgery. Recurrent orbital cavernous hemangioma may follow incomplete excision of multiple orbital lesions with gradual growth of unidentified residual tumors. Accordingly, when an encapsulated cavernous hemangioma is removed, exploration is recommended to rule out multiple lesions.

Clinical features and outcomes of treatment for fourth nerve palsy

To evaluate the clinical features, etiology and outcomes of treatment for superior oblique [SO] palsy over a 10-year period at Labbafinejad Medical Center. A complete ophthalmologic examination with particular attention to forced duction test [FDT] and tendon laxity was performed in all patients preoperatively. The palsy was divided into congenital and acquired types. Overall, 73 patients including 45 male [61.6%] and 28 female [38.4%] subjects with mean age of 19.7 +/- 11.7 [range, 1.5-62] years, were operated from 1997 to 2007. SO palsy was congenital in 56 [76%] and acquired in 17 [24%] cases. The most common chief complaint was ocular deviation [52.1%]. FDT was positive in only 7 [9.7%] cases. Other clinical findings included amblyopia [19.2%] head tilt [13.7%], chin down position [4.1%], facial asymmetry [6.8%] and tendon laxity [2.7%]. Mean preoperative vertical deviation was 16.1 prism diopters [PD] which was decreased to 1.9 PD postoperatively. Mean exotropia and esotropia were 15 and 13.9 PD respectively before the operation and both decreased to 1.5 PD of horizontal deviation postoperatively. The most common type of SO palsy based on Knapp's classification was type 3 [42.5%]. The most common operated muscle was the inferior oblique [83.6%] and the most common type of operation was inferior oblique myectomy [83.6%]. The success rate for initial surgery was 84% and was increased to 96% with a second intervention. The most common form of SO palsy requiring surgical intervention was congenital which occurred most frequently in young males. Most cases of SO palsy can be successfully treated with a single surgical procedure

Outcomes of surgical and non-surgical treatment for sixth nerve palsy

To report the outcomes of surgical and non-surgical treatment in sixth nerve paresis and palsy. This retrospective study was performed on hospital records of 33 consecutive patients [37 eyes] with sixth nerve dysfunction who were referred to Labbafinejad Medical Center from September 1996 to September 2006, and underwent surgical procedures or botulinum toxin injection. Patients were divided into three groups: group A had muscle surgery without transposition, group B underwent transposition procedures and group C received Botulinum toxin injection. Overall, 33 patients including 19 male and 14 female subjects with mean age of 20.4 +/- 17.2 years [range, 6 months to 66 years] were studied. Eye deviation improved from 50.3 +/- 16.8 to 6.0 +/- 9.8 prism diopters [PD] after the first operation and to 2.5 +/- 5.0 PD after the second operation in group A, from 56.9 +/- 24.3 to 5.5 +/- 16.0 PD after the first procedure and to almost zero following the second in group B, and from 44.3 +/- 10.5 to 15.0 +/- 20.0 PD 6 months following botulinum toxin injection in group C. Head posture and limitation of motility also improved significantly in all three groups. The overall rate of reoperations was 21%. Various procedures are effective for treatment of sixth nerve dysfunction; all improve ocular deviation, head turn and abduction deficit. The rate of reoperation is not high when treatment is appropriately selected according to clinical condition

Late probing for congenital nasolacrimal duct obstruction

To report the results of late nasolacrimal duct probing in patients with congenital nasolacrimal duct obstruction [NLDO]. This retrospective study was performed on a consecutive series of patients with congenital NLDO who underwent late [after 15 months of age] nasolacrimal duct probing for the first time. Over a period of five years, 158 patients including 75 [47.4%] male and 83 [52.6%] female subjects with mean age of 3 +/- 4.2 years [range, 15 months to 37 years] underwent initial probing for NLDO. Nasolacrimal duct probing was performed unilaterally in 78% and bilaterally in 22% of the patients. Success rate was 75% overall, 72% in unilateral cases and 83% in bilateral instances. Success rate was not correlated with age at intervention. Nasolacrimal duct probing seems to be reasonably successful for treatment of congenital NLDO in patients older than 15 months who are seen for the first time. Silicone intubation or dacryocystorhinostomy should be reserved for refractory cases

Effect of horizontal rectus surgery on clinical and paraclinical indices in congenital nystagmus

To determine the effect of horizontal rectus muscle surgery on visual acuity, head posture and electronystagmographic indices in patients with congenital nystagmus. This prospective comparative case series was conducted on 58 patients with congenital nystagmus over a period of three years. Patients were divided into three groups: the first group [29 cases] had head posture less than 20D, binocular visual acuity [BOVA] less than 20/30 and tropia less than 30D and underwent large recession of all four horizontal rectus muscles; the second group [23 cases] had head posture less than 20D, BOVA < 20/30 and tropia more than 30D who underwent large recession of two horizontal rectus muscles; and the third group [6 cases] had head posture more than 20D with any BOVA or tropia who underwent Kestenbaum-Anderson surgery. Mean age of the patients was 18.7 +/- 9.1 years and mean follow-up period was 17.5 +/- 7.4 months. Visual acuity improved in all three study groups and was statistically significant in the 2-rectus group [P < 0.001]. The speed and amplitude of nystagmus waves decreased in all groups which was statistically significant in the 4-rectus group [P values, 0.02 and 0.04, respectively]. A small myopic shift was seen in the 2-rectus and 4-rectus groups and a small hyperopic shift was found in the Kestenbaum-Anderson group. Statistically significant improvement was achieved in eye deviation in the 2-rectus group and in head posture in the Kestenbaum-Anderson group [P < 0.001]. Horizontal recti surgery in congenital nystagmus can improve visual acuity, ocular deviation and abnormal head posture, which is particularly marked with 2-rectus recession. Electronystagmographic indices improve especially with 4-rectus recession