Efficacy and Safety of Letibotulinum Toxin A for the Treatment of Essential Blepharospasm

PURPOSE: To evaluate the efficacy and safety of BOTULAX® in subjects with essential blepharospasm.METHODS: In this study, a total of 250 subjects with essential blepharospasm were enrolled at 15 investigational sites and a total of 220 subjects completed the study. The efficacy and safety were evaluated at weeks 4 and 16 after treatment compared with baseline. In total, 240 subjects were enrolled, treated with the investigational product, and evaluable for the primary efficacy assessment at week 4 after treatment; these subjects were included in the intention-to-treat (ITT) population. With the ITT set as the main efficacy set, efficacy assessment included Jankovic rating scale (JRS), functional disability score, investigator evaluation of global response and quality of life. Safety assessment including the incidence of adverse events was also performed.RESULTS: In terms of the primary efficacy endpoint (i.e., change in JRS total score at week 4 after treatment from baseline [ITT set]), mean change indicated a statistically significant reduction (p < 0.0001) and demonstrated the non-inferiority of the test drug to similar drugs. In terms of the secondary efficacy endpoints, mean change in JRS total score at week 16 after treatment and mean change in functional disability score at weeks 4 and 16 after treatment both exhibited a statistically significant reduction compared with baseline (p < 0.0001 for all). Among the 249 subjects treated with the investigational product in this study, 44 (17.67%) experienced 76 treatment emergent adverse events but no serious adverse events were observed.CONCLUSIONS: Based on the study results, BOTULAX® is considered to be an effective and safe treatment for essential blepharospasm.

Clinical Features of Benign Essential Blepharospasm in Korean Patients

PURPOSE: To analyze the clinical features of benign essential blepharospasm in Korean patients. METHODS: Patients diagnosed with benign essential blepharospasm in Kim's Eye Hospital from November 2014 to December 2016 were evaluated using a clinical examination and questionnaire. The questionnaire reviewed personal medical history, demographic factors, risk factors for blepharospasm development, and relieving and aggravating factors. RESULTS: Of the 101 patients enrolled, 78 (77.2%) were women. The mean age was 64.9 years old. Hypertension was the most common medical disorder (42.6%), followed by diabetes mellitus. The majority of the patients were non-smokers (83.2%) and drank less than a cup of a caffeinated beverage a day (30.7%). Fifty-seven percent of patients reported no stressful events immediately prior to symptom development. Fatigue and stress were aggravating factors in more than 55% of patients; rest was the most common relieving factor (35.6%). CONCLUSIONS: Here, we report the clinical features of benign essential blepharospasm in Korean patients for the first time. The results were consistent with previous reports showing that the majority of benign essential blepharospasm patients are women and non-smokers. In contrast to previous reports though, fatigue and stress were aggravating factors, and the most common relieving factor was rest. No stressful events had immediately preceded the development of blepharospasm in 57.4% of patients. This report may aid in treating and counseling patients with benign essential blepharospasm.

Comparison of the Efficacies of 0.94 mm and Double Silicone Tubes for Treatment of Canalicular Obstruction

PURPOSE: To compare the clinical effects of the single wide-diameter bicanalicular silicone tube and the double bicanalicular silicone tube in endonasal dacryocystorhinostomy (DCR) with canalicular trephinization for canalicular obstruction. METHODS: We retrospectively reviewed the records of 121 patients with monocanalicular or common canalicular obstruction who had undergone endonasal DCR with random bicanalicular insertion of either double silicone tubes (insertion of two tubes into each canaliculus) or a single wide-diameter (0.94 mm) silicone tube. The tubes were removed at around 3 months after surgery. RESULTS: This study included 79 eyes of 61 patients in the double-tube intubation group and 68 eyes of 60 patients in the single wide-diameter tube intubation group. Anatomical success, evaluated by syringing, was achieved in 72 of the 79 eyes (91.1%) in the double-tube intubation group and 60 of the 68 eyes (88.2%) in the single wide-diameter tube intubation group. Functional success was achieved in 65 of the 79 eyes (82.3%) in the double-tube intubation group and 61 of the 68 (89.7%) eyes in the single wide-diameter tube intubation group. There were no significant differences in the success rates of surgery between the two groups. One patient in the double-tube intubation group underwent conjunctivodacryocystorhinostomy (CDCR) and two in the wide-diameter tube intubation group underwent CDCR or reintubation to treat recurrence. CONCLUSIONS: Intubation using a single wide-diameter tube during endonasal DCR is as effective as double-tube intubation for the treatment of canalicular obstruction, with a lower rate of complications such as inflammation or patient discomfort.

Cause and Management of Patients With Failed Endonasal Dacryocystorhinostomy

OBJECTIVES: Endonasal dacryocystorhinostomy (DCR) is a well-established treatment method in patients with nasolacrimal duct obstruction. However, there are a few reports about the overall management of failed endonasal DCR. We investigated the causes and management strategies of failed endonasal DCR. METHODS: This retrospective review included 61 patients (61 eyes) who had undergone revision surgery by the same surgeon after failed endonasal DCR between January 2008 and December 2012. The appropriate revision method was determined after analysis of the etiology of failure by the fluorescein dye disappearance test, nasal endoscopy, lacrimal irrigation, and probing. The criteria for success of the revision surgery were defined by the passage of fluid without resistance upon lacrimal irrigation and normalization of the tear meniscus height. RESULTS: The mean duration between the primary endonasal DCR and revision surgery was 15.3 months. The average follow-up period after revision surgery was 12.2 months. The most common cause of endoscopic revision surgery was membranous obstruction. Endoscopic revision surgery was performed in 48 patients, while lacrimal silicone tube intubation under endoscopy was performed in 13 patients. The most common indication for lacrimal silicone tube intubation was functional epiphora. The overall success rate of the revision surgery was 89%. CONCLUSION: The most common cause of failed endonasal DCR was membranous obstruction. When patients with failed endonasal DCR presented at the clinic, it is important to identify the cause of the failure. Revision surgery could increase the final success rate of endonasal DCR.

Causes and Surgical Outcomes of Lower Eyelid Retraction

PURPOSE: To investigate the causes of lower eyelid retraction and evaluate the outcomes of various surgical procedures. METHODS: We conducted a retrospective medical record review of patients who underwent lower eyelid retraction surgery performed by a single surgeon at Kim's Eye Hospital between 2006 and 2013. We investigated the causes of lower eyelid retraction, clinical history, characteristics, treatment, and surgical outcomes. Preoperative and postoperative margin reflex distance 2 and inferior scleral show were measured for each eyelid. Success was defined as a positive eyelid elevation and a decrease in inferior scleral show. RESULTS: A total of 19 lower eyelids were treated in 14 patients with lower eyelid retraction. For cosmetic reasons, surgical correction for congenital lower eyelid retraction was performed on seven eyelids (36.8%). Ten eyelids (52.6%) exhibited secondary lower eyelid retraction after surgery. One eyelid (5.3%) was affected by facial palsy and one eyelid (5.3%) exhibited exophthalmos of an unknown origin. We adopted a selective approach based on lower eyelid retraction severity. Spacer grafting via a subconjunctival approach was the most commonly performed surgical technique (13 eyelids, 68.4%). The lateral tarsal strip procedure was used to horizontally tighten three eyelids (15.8%). At the time of the procedure, one of these eyelids (5.3%) also received an adjuvant suborbicularis oculi fat lift. Autogenous dermis fat grafting was performed on two lower eyelids (10.5%), whose retraction was caused by fat and soft tissue loss. Cosmetic outcomes were satisfactory in all cases. CONCLUSIONS: To achieve satisfactory surgical outcomes, surgeons should adopt an approach based on the severity of lower eyelid retraction. Mild lower eyelid retraction can be corrected without grafts. When retraction is severe and exceeds 2 mm, spacer grafts that push the lower eyelid margin upwards and support it from below are required.

Preoperative Computed Tomography Findings for Patients with Nasolacrimal Duct Obstruction or Stenosis

PURPOSE: To identify and analyze the role of preoperative computed tomography (CT) in patients with tearing symptoms with nasolacrimal duct obstruction (NLDO). METHODS: We retrospectively reviewed the medical records and CT results on 218 patients who complained of tearing symptoms with NLDO between January 2014 and December 2014. All patients were recruited from Kim's Eye Hospital's outpatient clinic and assessed by clinical history, examination, and CT to evaluate periocular pathology and nasolacrimal drainage system. Patients with abnormal findings assessed by preoperative CT were further reviewed. RESULTS: CT was performed on 218 patients (average age, 58.2 ± 11.9 years). Of these, 196 (89.9%) had endonasal dacryocystorhinostomy, 14 (6.4%) declined surgery, and 8 (3.7%) were inoperable due to abnormal CT findings. Soft tissue opacity was the most common finding which 243 cases (85.9%) of 283 obstructed nasolacrimal duct and 89 cases (81.7%) of 109 non-obstructed nasolacrimal duct showed it. Thirty-nine (17.8%) of 218 patients showed either maxillary sinusitis or ethmoidal sinusitis and 32 (14.7%) of 218 patients presented with periocular inflammation. Other abnormal CT findings included septal deviations, previous fractures, masses, and structural abnormalities of nasal cavity. CONCLUSIONS: Preoperative CT imaging is useful in the assessment of both nasolacrimal drainage and nearby anatomical structures. This information will be helpful in planning surgical interventions and management of NLDO.

Predictors of Silicone Tube Intubation Success in Patients with Lacrimal Drainage System Stenosis

PURPOSE: To evaluate prognostic factors affecting silicone tube intubation outcomes in Asian patients with lacrimal drainage system stenosis. METHODS: A retrospective review was conducted on the medical records of 822 patients (1,118 eyes) who had undergone silicone tube intubation to treat lacrimal drainage system stenosis between January 2011 and December 2012. Patients were divided into two groups: a success group and a failure group. Success was defined as the disappearance of epiphora symptoms, normalization of tear meniscus height, and the easy passage of fluid without resistance on the postoperative syringing test. Patient and ocular parameters were compared between the success and failure groups. RESULTS: A total of 994 eyes of 727 patients were included in analyses. Patients had a mean follow-up period of 34.11 ± 18.70 weeks. Silicone tube intubation was successful in 67.2% of participants. Significant differences between the success and failure groups were found for age (p < 0.001), history of ipsilateral facial palsy (p = 0.028), follow-up period (p < 0.001), and degree of passage on the preoperative syringing test (p = 0.001). Only age (p < 0.001) and degree of passage on the preoperative syringing test (p = 0.002) remained significantly associated with silicone tube intubation success in multivariate analysis. CONCLUSIONS: Age was negatively associated with silicone tube intubation success in patients with lacrimal drainage system stenosis. The success rate was higher in patients who showed easy passage of fluid without resistance on the preoperative syringing test. These factors should be considered by surgeons planning silicone tube intubation in patients with lacrimal drainage system stenosis.

Surgical Outcomes of Canalicular Trephination Combined with Endoscopic Dacryocystorhinostomy in Patients with Distal or Common Canalicular Obstruction

PURPOSE: This study investigated the surgical outcomes of canalicular trephination combined with endoscopic dacryocystorhinostomy (DCR) in patients with a distal or common canalicular obstruction. It also identified the factors affecting surgical success rates associated with this technique. METHODS: We retrospectively reviewed the medical records of 57 patients (59 eyes) in whom a canalicular obstruction was encountered during endoscopic DCR. All patients were treated with endoscopic DCR, followed by canalicular trephination and silicone tube placement. The surgical outcome was categorized as a functional success according to the patient's subjective assessment of symptoms, including epiphora, and as an anatomical success according to a postoperative nasolacrimal duct irrigation test. Surgical success rates were compared based on age, sex, location of the obstruction, number of silicone tubes, and experience of the surgeon. RESULTS: Functional success was achieved in 55 of 59 eyes (93%) at one month, 50 eyes (84%) at three months, and 46 eyes (78%) at six months. Anatomical success was achieved in 58 of 59 eyes (98%) at one month, 52 eyes (88%) at three months, and 50 eyes (84%) at six months. There was a statistically significant difference in surgical outcome according to the experience of the surgeon. The anatomical success rate at the six-month follow-up exam was 95.4% in the >5 years of experience group, and 53.3% in the <5 years of experience group (p = 0.008, Pearson chi-square test). CONCLUSIONS: The success rate of canalicular trephination combined with endoscopic DCR in patients with a distal or common canalicular obstruction decreased gradually during the six-month follow-up period. In particular, patients undergoing procedures with experienced surgeons tended to show excellent surgical outcomes at the six-month follow-up exam.

Double Fold Affected by Levator Function in Simultaneous Double Eyelid Blepharoplasty with Blepharoptosis Surgery

PURPOSE: To evaluate height and symmetry of double folds following simultaneous levator palpebral muscle resection and double eyelid blepharoplasty for correction of blepharoptosis. METHODS: We retrospectively studied 400 eyes of 286 patients who underwent simultaneous surgeries for double eyelid construction and correction of blepharoptosis from January 2006 to December 2011. All the patients were divided into three groups based on levator palpebrae muscle function: group A consisted of 82 eyes whose Levator Function Test (LFT) was 5 cm or less, group B consisted of 115 eyes whose LFT was between 5 and 10 cm, group C consisted of 203 eyes whose LFT was over 10 cm. For each group, we evaluated the preoperative marginal reflex distance 1 (MRD1), surgical methods, the postoperative height and symmetry of the double folds, and additional operations for correcting blepharoptosis. RESULTS: Blepharoptosis surgery was performed in all groups by simultaneous levator resection and double eyelid blepharoplasty in all groups. Postoperative asymmetric double fold was the most common outcome observed in the poor levator function group A. Blepharoptosis under-correction was the most common cause of asymmetric double fold and its occurrence was statistically different between the three groups. The other causes were skin redundancy, brow elevation, double fold loosening, and blepharoptosis over-correction. CONCLUSIONS: The height of a double eyelid can be changed postoperatively by changing levator palpebrae muscle function. In cases of poor levator function, the levator palpebrae muscle is positioned slightly lower than the normal double fold. This condition may result in further relapse or recurrence in the poor levator function group. Also, levator function should be considered among the diverse factors that determine the height of the double fold.

Comparison Results of Silicone Tube Intubation According to Syringing and Dacryocystography

PURPOSE: To compare the surgical success rate of silicone tube intubation according to the preoperative lacrimal syringing test and dacryocystography (DCG) in adult patients with epiphora. METHODS: Medical records of 142 patients who underwent silicone tube intubation were retrospectively reviewed. The surgical results were divided into 3 groups based on postoperative symptoms and the syringing test results: Good, Fair, and Fail. Good and Fair were classified into the surgical success groups. We compared the surgical success rate according to the preoperative syringing test and stenosis site observed on dacryocystography. RESULTS: The success rates of silicone tube intubation were 88.4% and 87.4% in eyes with preoperative syringing results of totally-passed and partially-passed syringing tests, respectively, revealing no statistically significant differences (p = 0.838, chi-square test). However, in eyes with the preoperative syringing results of partially-passed syringing tests, the success rates were 66.7% in patients with canalicular stenosis, 83.3% in patients with nasolacrimal duct stenosis, and 94.5% in those with diffuse stenosis (p = 0.018, chi-square test). CONCLUSIONS: No significant differences were found in the success rates of silicone tube intubation according to preoperative syringing test results. However, when considered together with DCG findings, the lowest success rate was found in eyes with the partially-passed syringing test and simultaneously showed canalicular stenosis on DCG. The syringing test results considered with DCG findings may help predict the success rates of silicone tube intubation.

Outcomes of Isolated Medial Orbital Wall Fracture Reconstructions

PURPOSE: To evaluate surgical results after the reconstruction of isolated medial orbital wall fractures. METHODS: We performed a retrospective chart review of patients with isolated medial orbital wall fractures who underwent reconstruction using the transcaruncular approach from March 2012 to October 2013. Computed tomography (CT) was performed before and after surgery. Postoperative follow-ups were conducted at 1 week, 1 month, and 3 months. Diplopia, ocular motility, postoperative complication, and exophthalmometry were recorded at each follow-up visit. Preoperative and postoperative enophthalmos was quantified using Hertel exophthalmometry and a quantitative method for the area of the circular sector under the chord (CA)/orbital area (OA) ratio at the CT scan. Patients were divided into either the incomplete or complete reduction groups based on the degree of reduction observed on postoperative CT. RESULTS: We evaluated 55 patients (42 males, 13 females) with an average age of 36 years. Five of 55 patients with preoperative enophthalmos of more than 2 mm obtained good symmetry after surgery. Diplopia at primary gaze was resolved in 9 of 9 patients and 2 patients had residual diplopia on lateral gaze. The difference of exophthalmometry and CA-to OA ratio between before and after reconstruction was not significantly changed in either the incomplete or complete groups. CONCLUSIONS: Enophthalmos and diplopia were well corrected in all subjects. If reduction was successfully performed in the anterior portion of medial orbital wall fracture, clinically significant enophthalmos might be preventable even if complete reduction was not obtained.

Causes and Treatments of Entropion and Ectropion in Adults

PURPOSE: To evaluate the causes and treatments of entropion and ectropion in adults. METHODS: A retrospective review was performed of 397 patients (490 eyes) with entropion and 109 patients (138 eyes) with ectropion who underwent corrective surgery at Kim's Eye Hospital from January 2009 to December 2012. RESULTS: The surgical correction of entropion was 3.5 times greater than that of ectropion. The causes of entropion were classified as senile (98.4%), cicatricial (1.4%) and spastic (0.2%). The causes of ectropion were classified as cicatricial (60.1%), paralytic (23.2%) and senile (16.7%). CONCLUSIONS: The main causes of entropion and ectropion were senile and cicatricial, respectively. Specifically, senile entropion was more common than senile ectropion, which is considered to be related to the lid anatomy of Asian patients.

Clinical Characteristics of Pediatric Orbital Pseudotumors

PURPOSE: To describe the clinical manifestations, radiologic findings, and treatment outcomes of pediatric pseudotumors. METHODS: A retrospective chart review of patients diagnosed with pediatric pseudotumor (age under 20 years old) from August 2008 to February 2012 was performed. RESULTS: Thirteen patients (16 eyes) were included in this study. The mean age of the subjects was 14.2 years (5-20 years). Swollen eyelid (56.3%), ptosis (43.8%), conjunctival injection (18.8%), localized mass (18.8%), limitation of ocular movement (12.5%), proptosis (6.3%), and decreased visual acuity (6.3%) were found initially. Dacryoadenitis (62.5%), myositis (18.8%), anterior orbital inflammation (18.8%), and diffuse type (6.3%) were observed on orbital computed tomography (CT). Among the 13 patients (16 eyes), 8 patients (10 eyes) were administered oral systemic corticosteroids, 2 patients (2 eyes) received IV systemic corticosteroid, 1 patient (1 eye) received systemic corticosteroids combined with NSAID, and 2 patients (3 eyes) were prescribed NSAIDs only. Symptoms improved 4.1 days after initiation of treatment. CT scans revealed that one patient experienced diffuse-type disease recurrence twice. CONCLUSIONS: Orbital pseudotumors, which are rare in younger people, are likely to respond very well to corticosteroid treatment, and the recurrence of orbital inflammation is rare.

Clinical Results of Nasopore(R) Nasal Packing on Endonasal Dacryocystorhinostomy

PURPOSE: To investigate the effects of Nasopore(R) as a nasal packing material on the surgical success rate and prevalence of postoperative complications after endonasal dacryocystorhinostomy (DCR). METHODS: The present study included a total of 558 patients (699 eyes) with primary acquired nasolacrimal duct obstruction who underwent endonasal DCR; 227 eyes were packed with Nasopore(R) and 472 eyes were packed with Merocel(R). The surgical success rate and postoperative complications such as synechiae, granulation, wound healing (osteal mucosal epithelium epithelialization), postoperative bleeding, infection, and revision rate were compared between the packing materials. RESULTS: The surgical success rate of the Nasopore(R) group (99.1%, 98.6%) showed significantly better results than the Merocel(R) group (97.2%, 95.1%) at postoperative 1 and 3 months (p = 0.04, 0.03 Pearson chi-square test), whereas there was no statistically significant difference between the 2 groups in postoperative surgical success rate at 1 week and 6 months. In comparison of postoperative complications, the Nasopore(R) group (0%) showed a lower incidence of delayed wound healing (delayed epithelialization of osteal mucosal epithelium) than the Merocel(R) group (2.3%; p = 0.013), whereas there was no difference in granulation, synechiae, postoperative bleeding, infection and revision rate (p > 0.05). CONCLUSIONS: The Nasopore(R) group showed a lower proportion of delayed wound healing and improvement of the surgical success rate at an early postoperative period after endonasal DCR compared to non-absorbable nasal packing material.

Frequency and Characteristic Findings of the Common Canaliculus in Koreans

PURPOSE: To investigate the different types of anatomical connection between the lacrimal sac and the canaliculi using digital subtraction dacryocystography (DCG) in Koreans. METHODS: The authors of the present study performed digital subtraction DCG in Korean patients who presented with epiphora from January 2010 until December 2010. The 248 patients (496 eyes) who achieved a satisfactory DCG image were classified as follows: 1) type I: visible common canaliculus (CC), 2) type II: no visible CC and the canaliculi entering the sac at the point where they meet on the sac wall (common opening), 3) type III: no visible CC and common opening, and each canaliculus entering the sac from different points. RESULTS: Out of a total of 496 eyes, CC was observed in 449 eyes (type I: 90.5%). In 41 eyes (8.3%), the CC was absent (type II), but the upper and lower canaliculi joined at the wall of the lacrimal sac. In 6 eyes (1.2%), the upper and lower canaliculi entered the sac separately (type III). Eighteen patients (7.3%) showed different types of lacrimal drainage system between the 2 eyes. CONCLUSIONS: The CC may not exist in all patients, and the type of anatomical connection between the lacrimal sac and the canaliculi may be different between the eyes in the same individuals. Although such patients comprise a minority, anatomical knowledge of the lacrimal drainage system could be helpful to assess and manage patients with lacrimal drainage disorder.

Factors Affecting the Outcome of Silicone Intubation for Congenital Nasolacrimal Duct Obstruction

PURPOSE: To determine the factors affecting the outcome of silicone intubation for congenital nasolacrimal duct obstruction. METHODS: A total of 233 eyes of 200 children that received silicone intubation were enrolled in a retrospective study. RESULTS: The overall success of silicone intubation was 193 of 233 eyes (82.8%). There was no significant difference in success rate between age groups. Tube retention time did not affect the success rates. Immediate tube dislocation as early as within 2 weeks did not lower the success rates (81.5%). Success rates were significantly lowered by persistent epiphora at the point of tube removal (p < 0.001). CONCLUSIONS: The outcome of silicone intubation is determined by symptomatic improvement, which is not affected by tube retention time. Unplanned early tube dislocation may not affect the outcome of silicone intubation unless symptoms are persistent, and sufficient tube retention time does not ensure the success if symptoms are persistent.

Traumatic Optic Neuropathy Accompanying Orbital Grease Gun Injury

We report a case of traumatic optic neuropathy accompanying a grease gun injury to the orbit. A 48-year-old man with a grease gun injury visited our clinic with decreased visual acuity, proptosis and limited extraocular movement (EOM). Orbital CT revealed a crescent mass of fat in the medial intraconal space. The grease was exuded from a lacerated conjunctival wound. The visual evoked potential (VEP) test demonstrated a decreased response in the left eye. Proptosis and EOM were improved after surgical removal of the grease. Systemic high-dose corticosteroid therapy was administered for suspected traumatic optic neuropathy, after which VEP nearly recovered, while visual acuity was slightly improved. A second surgery for traumatic cataract did not further improve visual acuity.

Success Rates According to the Shape of Rhinostomy After Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the success rates according to the shape of rhinostomy after endonasal dacryocystorhinostomy. METHODS: We analyzed 131 patients (188 cases) who had undergone endonasal dacryocystorhinostomy with a minimum follow-up of 6 months. After surgery, all cases were classified into flat, alcove, concave, or concealed concave types according to Jane's rhinostomy classification. Patency to irrigation and improved symptoms were considered indicative of a successful outcome. RESULTS: There were 81 flat type patients (125 cases), 31 alcove type patients (42 cases), 19 concave type patients (21 cases), and no cases were classified as concealed concave type. The success rates were 75.2%, 85.7%, 81.0% respectively, and the most common cause of failure was the formation of granulation within the ostium. The success rates did not significantly vary according to the shape of rhinostomy (p=0.144). CONCLUSIONS: The success rates after endonasal dacryocystorhinostomy of flat, alcove, and concave types in turn were 75.2%, 85.7%, and 81.0%.

Pseudotumor : Distribution, Clinical Features, Treatment Outcomes

PURPOSE: To evaluate the clinical characteristics and results of outcomes in different types of orbital pseudotumor. METHODS: This study included 62 patients diagnosed with orbital pseudotumor between 2002 and 2007, who were followed-up for more than 6 months. The pseudotumor was classified into anterior, diffuse, apical, myositic, or lacrimal types according to computed tomography (CT) findings. All patients were initially treated with corticosteroids and checked for symptom improvement and response to the corticosteroids. RESULTS: Lacrimal type pseudotumor (61%, 39/62) showed the highest incidence, and lid swelling (97%, 60/62) was the most common symptom. Response rate to corticosteroid treatment was 84%, and the recurrence rate was 29%. CONCLUSIONS: The orbital pseudotumors were localized by computed tomography and classified to compare the symptoms, treatment efficacy and recurrence rates between the different types. The orbital pseudotumor is most commonly diagnosed based on clinical symptomsand radiologic features without biopsy. The orbital pseudotumor showed a good treatment response but also a high recurrence rate. Therefore, when starting treatment, it is important to consider differential diagnosis. It is recommended to carefully examine patients who have lid swelling for a few weeks with computed tomography before using corticosteroid treatment.

Results of Conjunctiva-Muller Muscle Resection in Mild Eyelid Ptosis

PURPOSE: To assess surgical outcomes after adjusting the amount of resection of the conjunctiva and the Muller muscle according to 10% phenylephrine test results. METHODS: The charts of 32 patients (32 eyes) with mild upper eyelid ptosis were reviewed retrospectively. They all had conjunctiva-Muller muscle resections. A preoperative 10% phenylephrine test was performed to determine the resection amount of the Muller muscle and conjunctiva. An 8 mm resection was performed when phenylephrine raised the ptotic lid to the same level as that of the contralateral lid. A 7 mm resection was performed when the ptotic lid was raised to a level higher than that of the contralateral lid. A 9 mm resection was performed when the ptotic lid was raised to a level not quite to the level of the contralateral lid. RESULTS: Of the 32 patients, 28 were female and 4 were male. The mean age of the patients was 30.8+/-10.2 years. Patients were followed up for an average of 40.2+/-36.8 days, postoperatively. Postoperative upper lid positions were exactly symmetrical in 26 of the 32 patients. Five patients showed undercorrection, and 1 patient showed overcorrection. CONCLUSIONS: Excellent results were obtained by resecting the conjunctiva and Muller muscle according to the phenylephrine reaction of a ptotic eyelid.