Effectiveness of Combined Surgery Simultaneously Correcting 3 Main Causes of Involutional Entropion

PURPOSE: To evaluate the long-term effectiveness of inferior retractor tightening combined with lateral tarsal strip surgery and anterior lamellar resection for simultaneously correcting the 3 main causes of involutional entropion. METHODS: In this retrospective study we reviewed 80 patients diagnosed with involutional entropion between April 2004 and February 2014 at the Korea University Guro Hospital and Cheonan Chungmu Hospital. The patients were evaluated for the 3 major causes of involutional entropion and were confirmed to have all components. Lateral canthal tendon laxity test and anterior lamellar redundancy test were performed to grade the involutional entropion patients. The patients received inferior retractor tightening, lateral tarsal strip operation and anterior lamellar resection procedure simultaneously. RESULTS: Eighty involutional entropion patients were included in the present study. The patients consisted of 35 males and 45 females with an average age of 71.1 ± 9.3 years. In the lateral canthal tendon laxity test, 52 (61.2%) eyes were grade II, 33 (38.8%) eyes were grade III. In the anterior lamellar redundancy test, 17 (20%) eyes were grade I, 57 (67.1%) eyes were grade II and; 11 (12.9%) eyes were grade III. Among the 80 patients, 85 eyelids received combined surgery, 84 had successful outcomes and 1 case recurred at 5 months following the primary surgery with an average follow up of 26.5 ± 4.6 months. Lateral canthal deformity was observed in 2 eyelids which were corrected successfully. CONCLUSIONS: Simultaneous correction of the 3 main causes of involutional entropion through inferior retractor tightening, lateral tarsal strip surgery and anterior lamellar resection procedure is effective in correcting involutional entropion and safe in avoiding overcorrection.

Therapeutic Effect of Squeezing the Punctum and Lacrimal Canaliculus in Canaliculitis Patients

PURPOSE: To report the therapeutic effect of squeezing the punctum and lacrimal canaliculus using Q-tips in canaliculitis patients. METHODS: From March 2004 to February 2014, 42 eyes of 42 patients diagnosed with canaliculitis at our clinic were retrospectively analyzed. To remove the discharge and concretions, the punctum and lacrimal canaliculus were squeezed using Q-tips without invasive procedures. RESULTS: The mean patient age was 56.39 years and mean follow-up period was 10.6 months. No statistical significance was observed in terms of rate of disease occurrence and mean age between males and females. Among the eyes analyzed, 30 (71.4%) were cured with only 1 squeezing procedure, 12 eyes (28.6%) required more than 2 procedures; 1 eye (2.3%) recurred and the period until recurrence was 3.8 months. CONCLUSIONS: Most studies support surgical management as the definitive therapy for canaliculitis to remove concretions that serve as a reservoir for bacteria. The gold standard treatments are curettage or canaliculotomy; however, these are not safe procedures and may result in epiphora in post-procedure patients due to the risk of lacrimal pump dysfunctioning or scarring of the canalicular system following invasive procedure. Squeezing punctum and lacrimal canaliculus only using Q-tips is effective in removing the canalicular concretions and without causing complications in the canalicular system.

Clinical Study on Acute Conjunctivitis after Endoscopic Dacryocystorhinostomy with Silicone Tube Intubation

PURPOSE: To investigate the incidence and clinical course of acute conjunctivitis after endoscopic dacryocystorhinostomy (DCR) with silicone tube intubation. METHODS: A retrospective study was conducted on 547 eyes in 517 patients who had undergone endoscopic DCR with silicone tube intubation between 2005 and 2009. The onset, incidence and symptoms of acute conjunctivitis, the effect of silicone tube intubation on acute conjunctivitis, and the effect of acute conjunctivitis on the success rate of DCR were investigated. RESULTS: The incidence of acute conjunctivitis was 3.8%. The mean age of 21 patients with acute conjunctivitis was 52.6 +/- 14.3 years and the mean follow-up period of those was 18.0 +/- 6.4 months after surgery. All the cases of acute conjunctivitis were resolved with topical antibiotic treatment after silicone tube removal. The success rates between patients with and without conjunctivitis were not significantly different (80.95% and 88.97%, respectively; p = 0.282). However, 4 patients with surgical failure had a longer time from onset of acute conjunctivitis to the removal of the silicone tube than 17 patients with surgical success (0.22 months and 1.13 months, respectively; p = 0.047). A higher rate (76.2%) of conjunctivitis developed in patients with granuloma around the surgical ostium. CONCLUSIONS: A correlation may exist between acute conjunctivitis and granuloma in patients with DCR with silicone tube intubation. Acute conjunctivitis did not appear to influence the surgical results, although a delayed timing of silicone tube removal in patients with conjunctivitis could decrease the success rate.

A Case of Congenital Absence of the Superior Oblique Muscle Treated With Anterior and Nasal Transposition of the Inferior Oblique Muscle

PURPOSE: To report a patient with absence of the superior oblique (SO) muscle of the left eye, who showed improvement after anterior and nasal transposition of the inferior oblique muscle for left hyperdeviation and right head tilt. CASE SUMMARY: A two-year-old boy presented with hypertropia of the left eye and right head tilt. Alternate prism-cover test in the primary position demonstrated 18 prism diopters (PD) of left hypertropia, which increased to 35 PD in the left head tilt position. A version test demonstrated overaction of the left inferior oblique muscle and underaction of the left superior oblique muscle. As an orbit CT scan showed absence of the SO muscle, the patient was diagnosed with congenital absence of SO and left anterior and nasal transposition of the inferior oblique muscle was performed. Three weeks after surgery, the patient presented with orthotropia at distant and near. The version test revealed normal oblique muscles. There was no vertical deviation shown on the Bielschowsky head tilt test. The abnormal head posturing was no longer observed. CONCLUSIONS: The authorsreport a patient manifesting abnormal head posture and hypertropia, diagnosed with absence of SO muscle, which was successfully corrected using anterior and nasal transposition of the inferior oblique muscle.