A Study of Result and Reproducibility of the Fluorescein Clearance test(FCT) Between Normal and Blepharospasm Patient

On the proposed fluorescein clearance test by Pflugfelder and Tseng, measurements of volume and concentration of instilled fluorescein, being changed by tear secretion, pumping action, during confined time, are able to discern tear turnover rate(tear clearance). We performed TBUT, Schirmer test and modified FCT to the 60 eyes of healthy person, to the 36 eyes of essential blepharospasm patient, and to the 32 eyes of hemifacial spasm patients. We modified the FCT to economize time. Under the topical anesthesia with 0.5% propacaine, test was performed after instilling a 20 microliter of Flucaine(0.25% fluorescein sodium, and 0.5% propacaine) into the conjunctival sac and standard Schirmer strip was then placed for another 10 minutes. The length of the portion was measured and the concentration of tint fluorescein was graded into 5 degrees(photodocumented classification under the cobalt blue light)(FCT 1). Waiting 10 minutes, a standard Schirmer strip was placed into with nasal stimulation and length and concentration was also measured(FCT 2). The agreement of classification was determined with Kappa values for evaluation for reproducibility and and reliability of FCT. The intra-observer agreement(examination repeated twice) was k=0.84 and the inter-observer agreement(two obsevers' examination) was k=0.77, which revealed a consistent result. Patients with blepharospasm was indicated decreased basal secretion compared with normal control(p<0.001) and also showed delayed tear clearance whith represented significant increased concentration(p<0.001). We concluded that FCT was revealed high reproducibility by intra-observer and inter-observer agreement and test may be useful diagnostic method to evaluate delayed tear clearance.

Delayed Tear Clearance Induced by Botulinum Toxin Injection in Essential Blepharospasm and Hemifacial Spasm

Assuming that botulinum toxin injection can release the involuntary contraction as well as reduce the tear drainage function, mediated by paralysis of orbicularis oculi muscles, then give rise to effect on tear clearance, Authors have examined 18 blepharospasm and 32 hemifacial spasm patients to evaluate the pre- and post- botulinum toxin injectional values of BUT, Schirmer test, and fluolescein clearance test 1, 2, which evaluate possibilities of delayed tear clearanee induced by botulinum toxin injection. Following treatment with botulinum toxin, results of BUT were increased significantly (p<0.0001), values of Schirmer test tended to increase without statistical significance. In fluorescein clearance test 1, length and concentration values were increased significantly(p<0.05), but in fluorescein clearance test 2, only length measurements were increased significantly(p<0.05). And also in blepharospasm cases of BUT values less than 4 second, both Schirmer test and fluorescein clearance test results were increased with statistical significance(p<0.05). We concluded that delayed tear clearance induced by botulinum toxin injection could be effective treatment for facial dystonias, especially combined cases with dry eye.

Histopathologic Findings of Rabbit Cilia after Application of Radio Frequency Wave

As a modality of effective treatment for trichiasis, authors performed experimental study of the radio frequency application(Mehl's method) to the cilia of four rabbit eyes with the different application times(10, 30, 60, 180 seconds). For the control, electrolysis to the cilia of the two eyes, and two eyes without any application were observed histopathologically. Regardless of the radio frequency application time, the radio frequency applied eyelids did not reveal any gross changes, and the selective degenerative changes(pyknotic, vacuolar, and karyorrhaxis) were observed microscopically in the hair regeneration part(internal root sheath of hair, hair matrix, and papillae of hair). In the electrolysed eyelids, gross scar and severe necrotic changes were appeared in microscopic findings. As a result of our observation, it is indicated that the application of radio frequency as a treatment for trichiasis, in compare with the electrolysis, revealed less destructive to the adjacent tissue, with more selective changes on the portion for hair regeneration.