The Clinical Manifestations and Treatment Results of Congenital Lacrimal Fistula

PURPOSE: To evaluate the clinical manifestations and the results of treatment in congenital lacrimal fistula. METHODS: We retrospectively evaluated the symptoms, associated anomalies, and results of treatment in patients with congenital lacrimal fistula. RESULTS: The mean age of the 22 total patients was 22.5+/-24.6 years (4 months~77 years). Associated anomalies were shown in two patients - one with hearing loss and upper punctal atresia, and the other with imperforate anus and undescended testes. Symptoms were tearing in 18 eyes and subcutaneous nodule in 3 eyes. Most of the external ostium of the fistula were located at the skin inferomedial (16 eyes) or medial (5 eyes) to the medial canthus, but one case had external ostium at the medial palpebral conjunctiva. Symptom improved in all patients after fistulectomy with bicanalicular intubation in 12 eyes, fistulectomy in 1 eye, bicanalicular intubation in 1 eye, and dacryocystorhinostomy combined fistulectomy with bicanalicular intubation in 2 eyes. However, the fistula recurred in 3 cases (19%). CONCLUSIONS: Lacrimal fistula is a congenital anomaly which can cause tearing or subcutaneous nodule. Treatment appropriate to the patient is required to get favorable result.

The Clinical Effect of Endonasal Dacryocystorhinostomy in the Treatment of Acute Dacryocystitis

PURPOSE: To evaluate the clinical effect of endonasal dacryocystorhinostomy as a primary treatment of acute dacryocystitis with lacrimal sac abscess formation. METHODS: The study comprised 14 patients with acute dacryocystitis and lacrimal sac abscess formation who underwent endonasal dacryocystorhinostomy as a primary treatment. Postoperative evaluations included symptoms of acute dacryocystitis, physical examination, and lacrimal irrigation. Success was defined as the absence of epiphora and good lacrimal irrigation at the last follow-up. RESULTS Of the patients, two were male and twelve were female. The mean age was 54.7 years and mean follow-up period was 8.3 months. Resolution of symptoms and signs of acute dacryocystitis occurred in all patients. In one patient, recurrence of acute dacryocystitis occurred 6 months after surgery. At last follow-up, epiphora and failure of lacrimal irrigation had developed in two patients. CONCLUSIONS: Endonasal dacryocystorhinostomy is considered a safe and effective primary treatment of acute dacryocystitis with lacrimal sac abscess formation.

A Case of Primary Malignant Lymphoma Occurred in Orbit and Cavernous Sinus

PURPOSE: Primary malignant lymphoma is rarely occurs in orbit, and it needs systemic evaluation after confirmed diagnosis and radiotherapy or chemotherapy. We report a very rare case of malignant lymphoma occurred in orbit and cavernous sinus METHODS: A 69 year-old male patient was consulted for right blepharoptosis manifested about 2 months ago. Orbital CT revealed 3 X 2 cm sized orbital mass simultaneously involving cavernous sinus. Biopsy and histological examination were performed. RESULTS: The examination showed a diffuse large B cell-type malignant lymphoma, and the mass was markedly reduced by radiation. CONCLUSIONS: We report a rare case of malignant lymphoma simultaneously involving orbit and cavernous sinus with lirerature review. We confirmed it by biopsy and obtained satisfied result by radiation therapy.

Primary Angiofibroma Developed in the Orbit

PURPOSE: Angiofibroma usually affects the nasopharynx, but primarily developed angiofibroma in the orbit has not yet been reported in Korea. Thereby we report a case of angiofibroma in the orbit. METHODS: A-5-year-old girl, who had been followed up for intraorbital mass which was incidentally detected, was operated with superior orbitotomy approach due to progressive proptosis and dislocated eyeball. RESULTS: The patient was diagnosed angiofibroma in the orbit with light microscopy and immunochemistry. The symptom was improved and she wore the artificial eye due to corneal opacity 6 months after the operation. CONCLUSIONS: We diagnosed and managed the primary angiofibroma in the orbit of a young girl. In diagnosing the orbital tumor, the possibility of angiofibroma should be considered.

Surgery for the Congenital Lacrimal Fistula

PURPOSE: Congenital lacrimal fistula, a rare developmental disorder, was reviewed to evaluate clinical features and surgical techniques with its results. METHODS: The clinical features of 9 patients who received operation are retrospectively reviewed, including presenting symptoms, surgical techniques and their results. RESULTS: Excision of the fistula alone was performed for cosmetic blemish and excision of fistula with bicanalicular silicone tube intubation was done for symptomatic tearing. None of the 9 patients had symptomatic or cosmetic problem postoperatively. CONCLUSIONS: Fistulectomy with or without bicanalicular silicone tube intubation is a successful procedure for congenital lacrimal fistula.

Treatment of Syringomyelia with Consideration on its Pathophysiology

The authors present a case of syringomyelia with postlaminectmy kyphosis. Twenty six year-old male, who received a operation 11 years ago for intradural cervical schwannoma. The patient visited our hospital for the evaluation of the quadripresis of recent onset. Preoperative magnetic resonance(MR) images revealed syringomyelia from C2 to T2. With phase contrast Cine MR image, cerebrospinal fluid dynamics were evaluated preoperatively and after surgical correction of kyphosis. The authors present the pathophysiology of syringomyelia and the selection of surgical procedure on basis of cerebrospinal fluid dynamics of syringomyelia.

Treatment of Syringomyelia with Consideration on its Pathophysiology

The authors present a case of syringomyelia with postlaminectmy kyphosis. Twenty six year-old male, who received a operation 11 years ago for intradural cervical schwannoma. The patient visited our hospital for the evaluation of the quadripresis of recent onset. Preoperative magnetic resonance(MR) images revealed syringomyelia from C2 to T2. With phase contrast Cine MR image, cerebrospinal fluid dynamics were evaluated preoperatively and after surgical correction of kyphosis. The authors present the pathophysiology of syringomyelia and the selection of surgical procedure on basis of cerebrospinal fluid dynamics of syringomyelia.

Anatomical Study of Lacrimal Passage using Computed Tomography

OBJECTIVE: We could measure diameters of lacrimal sac and surrounding bone thickness of normal Korean with accurate data by using orbital CT. METHODS: We measured the lacrimal sac, surrounding bone thickness, and frequency of Haller cell with thin-section computed tomography examinations in 115 normal Korean orbits with no signs of pathology related to the lacrimal drainage system for 1999 to 2001. RESULTS: The mean length of lacrimal sac was 10.45+/-1.96 mm, A-P width was 5.96+/-1.26 mm, L-R width was 3.72+/-0.92 mm. The surrounding bone thickness of upper portion of lacrimal sac was 6.46+/-1.40 mm, middle portion was 3.24+/-1.11 mm, lower portion was 0.78+/-0.23 mm. The frequency of Haller cell was 13.9%. The diameters of lacrimal sac and surrounding bone thickness were larger in males than females, and increasing tendency with aging. CONCLUSION: In this study, Korean lacrimal sac size was slightly smaller than the caucasian and Korean male's surrounding bone thickness was thicker than female. These data will be very helpful in making appropriate osteotomy by using the drill during dacryocystorhinostomy and avoiding unnecessary manipulation.

Surgical Correction of Congenital Epiblepharon: Lower Eyelid Crease Reforming Technique

Epiblepharon is a commonly encountered congenital anomaly in Asian infants and children. It causes symptoms of ocular irritation and inferior punctate corneal epithelial erosion. Surgical correction may be needed if ocular irritation symptom and corneal pathology persist with age. A series of 185 lower eyelid epiblepharon in 98 Korean children underwent lower eyelid crease reforming technique. Surgical treatment included excision of redundant skin and pretarsal orbicularis muscle with lid everting suture by anastomosis of the subcutaneous tissue and inferior tarsal border including capsulopalpebral fascia. With a minimum follow-up of 12 months, a total of 37 [20%]eyelids developed recurrence of cilia touch, and then 9 [4.8%]eye-lids needed further surgery.

Morphological Evaluation of Upper Eyelid in Korean

Facial appearance is influenced by the anatomic relationship of the eyebrow and eyelid. The morphology and normal anatomical value of upper eyelids are variable depending on race, sex and age, and have not been standardized yet in Korea. The authors statistically analysed normal anatomical variation of the upper eyelid morphology of 200 eyes of Koreans who had no surgery or trauma in the upper eyelid. One hundred men and one hundred women were included in this study. Physical examination of upper eyelid morphology included upper eyelid height, presence of upper eyelid crease and its level, height and width of palpebral fissure, height of tarsal plate, intercanthal distance, levator function, and presence of epicanthal fold with type. Average age was 21.09 in men and 23.03 in women, average heights of upper eyelid 15.04 mm and 16.05 mm, average heights of palpebral fissure 8.12 mm and 9.08 mm, average width of palpebral fissure 26.55 mm and 28.02 mm, average heights of tarsal plate 7.62 mm and 8.07 mm, and average intercanthal distances 36.82 mm and 35.90 mm. Increased values were noted in women compared to men, in upper eyelid height, height and width of palpebral fissure, and height of tarsal plate, especially levator fuction.But we couldn't find the statistical variation. Upper eyelid crease was noted in 29% in men, 54%in women.29 eyes in men and 24 eyes in women had epicanthal fold with epicanthus tarsalis being most prevalent morphologically. In our study, there was no meaningful difference of upper eyelid morphology depend on sex and we found that the favorate upper eyelid crease shape was the parallel crease type with narrow height in Koreans. These results may be beneficial in making a basic plan for the upper eyelid surgery such as blepharoplasty.

Silicone Tube Intubation in Acquired Nasolacrimal Duct Obstruction

45 eyes of 37 adult patients with nasolacrimal duct[NLD]obstruction were treated with silicone tube intubation. Silicone tube was removed between 1 and 12 months[mean 3.96 months]after surgery. After variable follow-up periods of 3 to 23 months[mean 6.82 months], 57.8%showed no epiphora, 28.9% showed intermittent epiphora and 13.3%showed ersistent epiphora. Complications were minimal and did not affect the outcome. We recommend that silicone intubation can be an alternative to dacryocystorhinostomy in selected adult patients. It is safe and less traumatic procedure with relatively high success rate in partial NLD obstruction and total obstruction with recent onset.

Morphological Evaluation of Upper Eyelid in Korean Children

A prospective study was designed to evaluate upper eyelid morphology of 83 eyes of 83 children beneath the age of fifteen who had visited our hospital between May 1996 and April 1997. Forth three boys and forth girls were included in this study. Physical examination of upper eyelid morphology included upper eyelid height, presence of upper eyelid crease and its level, height and width of palpebral fissure, intercanthal distance, levator function, and presence of epicanthal fold with type. There were no gender-related statistical differences in this study. Average heights of upper eyelid was 11.87mm in boys and 11.68mm in girls, average heights of palpebral fissure 7.67mm and 8.23mm, average width of palpebral fissure 23.62mm and 23.77mm, average intercanthal distances 31.93mm and 31.75mm. To match the age, study group were devided into two as Group 1: 1-6 years old and Group 2: 7-15 years old. Average width of palpebral fissure was 22.31mm in group 1 and 26.39mm in group 2. Increased values were noticed in group 2 compared to group 1, upper eyelid height, height of palpebral fissure, intercanthal distance, especially width of palpebral fissure. Fifty-one eyes(61.4%) have epicanthal fold with epicanthus tarsalis being most prevalent morphologically. Thirty upper lid creases were detected there was meaningful differencd of upper eyelid morphology by age, and not by gender.

Canaliculoplasty Using Mini-Monoka or Bicanalicular Stent for Repair of Canalicular Laceration

A retrospective study was designed to evaluate the clinical characteristics of canalicular injury including causes and associated ocular traumas, time of operation, and appropriate operating methods and materials. The authors retrospectively reviewed the charts of 60 patients who underwent repair of lacerated canaliculi from June 1992 to September 1997 at Chonnam University Hospital. Most injuries occurred at second and third decades(30, 50%). The most common cause was fist blow(19, 31.7%). Among a total of 44 patients who could be followed for more than 6 months, 30 of 32 eyes(93.8%) who were repaired with Mini-Monoka and 11 of 12 eyes(91.7%) with bicanalicular stent met with successful results. There were 8 prolapses of tube, 2 granuloma formations, 2 wound infections, one punctal slit, and one canalicular stenosis as the postoperative complication. All of them ware treated successfully. Canaliculoplasty was not successful in cases that operation was performed 48 hours after trauma and the tube was prolapsed within 3 months. No significant associations were found between presence of postoperative epiphora and sex, causes of injury, location of injury and type of canalicular stent. Canaliculoplasty with either Mini-Monoka or bicanalicular stent had successful postoperative outcomes without any significant complications.

Clinical Evaluation of the Traumatic Optic Neuropathy

Traumatic optic neuropathy is one of true ophthalmic emergencies and there is no proven form of treatment for traumatic optic neuropathy. 82 cases of traumatic optic neuropathy were investigated to evaluate the effectiveness of high dose corticosteroid for the visual improvement. Age, sex, initial visual acuity, final visual acuity, interval to treatment, the type of trauma and the affected region were studied retrospectively.250 mg of Methylprednisolone was administered intravenously every 6 hours for 3 days, and then followed by tapering using oral prednisone The vision was improved in 36 of 82 cases[43.9%]. It was difficult to interpret the relation-ships between the affected region and visual improvement, the interval for each treatment and final visual acuity. However, the vision was improved in 45 of 50 cases who had an initial visual acuity of above light perception, but in the two of 32 cases with no light perception. If indicated, fifteen cases were treated with a combination of high dose corticosteroid and optic nerve decompression. In initial treatment of traumatic optic neuropathy, high dose corticosteroid was effecive. Whether or not initial visual acuity was better than light perception was a key risk factor in the outcome.

Role of Dacryoscintigraphy in the Diagnosis and Treatment of Pediatric with Epiphora / 대한핵의학회잡지

PURPOSE: We conducted this study to evaluate the role of dacryoscintigraphy in the diagnosis and treatment of pediatric patients with epiphora. MATERIALS AND METHODS: In 58 patients aged from 2 months to 15 years (mean age 2.8+/-2.3 years), dacryoscintigraphy was performed using a gamma camera with 4 mm pinhole collimator. We correlated symptoms with dacryosicntigraphic findings in all patients. In 37 patients who underwent ophthalmologic procedures, we analyzed the agreements of dacryoscintigraphic findings with the operation. RESULTS: High rates of agreements between epiphora and obstruction on dacryoscintigraphy (69/72, 95.8%), and between scintigraphic obstructive findings and operation sites (44/47, 93.6%) were noted. Nine of fourty-four (20.5%) asymptomatic eyes showed obstructive findings on dacroscintigraphy. CONCLUSION: In pediatric patients with epiphora, dacryoscintigraphy is a useful tool not only in diagnosing nasolacrimal duct obstruction but also in making a decision for therapeutic procedures.

Giant Conjunctival Granuloma Developed after Drilling of the Hydroxyapatite Orbital Implant

We experienced a patient who developed protrusion of prosthesis due to giant conjunctival granuloma around screw type sleeve without dehiscence or infection of conjunctival wound 1 year after hydroxyapatite drilling. We performed excision of granuloma with mitomycin-C soaking, and then obtained an excellent cosmesis without recurrence.

The Utility of Three-dimensional CT in Orbital Diseases

PURPOSE: Orbital computed tomography was useful for evaluation of orbital truama because it can visualize most soft tissues, foreign bodies and bone details. Advancements in computer software makes three diemensional CT available with more higher quality and reasonable cost. We studied the officency, merit and limitation of orbital three dimensional CT. METHODS: We evaluated the conventional orbital CT and three dimensional orbital CT of the patients visited department of ophthalmology and emergency room to orbital trauma or other orbital diseases. RESULTS: The three dimensional orbital CT was not superior to conventional orbital CT in evaluation of orbital soft tissue disease but useful for evaluation of orbital bony details. CONCLUSION: In cases of coexamination with conventional orbital CT, the three dimensional orbital CT was useful for diagnosis and surgical planning in orbital truamatized patient.

Cyclic Esotropia Following Ocular Surgery

The cause of cyclic strabismus is not clear but is assumed to be an abnormality of the biological clock mechanism. Secondary factors, combined with surgery or trauma as well as unknown causes stimulate its occurrence and may be followed by the periodicity of strabismus. We report postoperative follow-up results of 4 cases of cyclic esotropia following surgery. Two cases (case 1 and 2), who developed cyclic esotropia after surgery for intermittent exotropia, show good postoperative alignment without periodicity. But in case 3, originally treated for intermittent exotropia after receiving treatment for consecutive esotropia, the patient reverted to original condition. In case 4, originally treated for congenital glaucoma and receiving secondary treatment for cyclic esotropia, the cyclic esotropia was recurred. After surgery for consecutive cyclic strabismus, it is necessary to follow up for a long time.

A Study on the Injury Mechanism and Types of the Ocular Trauma

The study was the clinical analysis of 509 patients with pure ocular injuries who visited to Chonnam University Hospital Emergency center from July 1, 1996 to June 30, 1997 retrospectively. Clinical data survey including sex and age distribution, causes of trauma, injury site, ocular disease, and surgical intervention was done. Most of ocular injury patients were male. 3rd and 4th decade who were socially active were nearly 50%. Direct and indirect injury from foreign body was the most common cause of ocular injuries followed by fist blow, traffic accident, falling down, and sport injury. Cornea was the most common ocular injury site (209 patients, 41.1%). The incidence of the traumatic ocular disease showed corneal erosion (117 patients, 22.9%) and then eyeball perforation, traumatic hyphema etc. by frequency of order. Eyeball perforation was the most common ocular injury which needed a emergency surgical intervention. As a results, emergency physicians have to pay attention to the cornea in case of any type of ocular injuries and eyeball perforation which caused by direct and indirect injury from foreign body.

A Case Report of Simplified Cosmetical Correction of Post-Exenterated State

Orbital exenteration has been used as a corrective method to treat lifetreatening neoplasm, life-threatening infection, and pain or deformity. After orbital exenteration, patients have been left with a severely disfiguring facial defect. Nowadays postoperative adjustment is usually better than before, with improved surgical and prosthesis manufacturing techniques. Actually Korean ophthalmologists do not have chances of adequate ocular prosthesis support compared to the other foreign countries. Authors experienced satisfying cosmetic result using a photography glasses frame for the pos-exenterated patient who had a squamous cell carcinoma of the orbit. We report this first case in Korea with review of the literatures.