Evaluation of Tear Film Lipid Layer Thickness Measurements Obtained Using an Ocular Surface Interferometer in Nasolacrimal Duct Obstruction Patients

PURPOSE: To compare the tear film lipid layer thickness (LLT) between patients with incomplete nasolacrimal duct obstruction (NLDO) and normal controls and to analyze the changes in tear film LLT and blinking pattern after silicone tube intubation in NLDO patients. METHODS: We reviewed the medical records of 68 eyes in 52 incomplete NLDO patients who underwent silicone tube intubation from January 2017 to July 2017. The LLT, blinking pattern, and Meibomian gland image were measured with the LipiView II ocular surface interferometer. The Meibomian gland drop-out ratio was measured using the polygon selection tool in the Image J program. Tear meniscus height, which is the other lacrimal indicator, was assessed with spectral-domain optical coherence tomography. RESULTS: Tear meniscus height was significantly decreased after silicone tube intubation (p < 0.01). Preoperative minimum, maximum, and average LLT values were 62.4 ± 24.0, 86.7 ± 17.9, and 71.7 ± 23.3 nm, respectively. Significant changes in the minimum, maximum, and average LLT (74.8 ± 23.6, 98.8 ± 11.0, and 91.6 ± 16.1 nm, respectively) were observed after silicone tube intubation (p < 0.001, p = 0.001, and p < 0.001). The partial blinking/total blinking ratio in 20 seconds and the Meibomian gland drop-out ratio showed no significant change after silicone tube intubation. CONCLUSIONS: Overall, the LLT was increased after silicone tube intubation. Silicone tube intubation may be helpful in maintaining LLT with a normalized of amount of tears.

Changes in Tear Meniscus Height Following Lower Blepharoplasty as Measured by Optical Coherence Tomography

PURPOSE: The lower eyelid serves important roles in tear distribution and drainage. The purpose of this study was to measure the tear meniscus height (TMH) with anterior segment optical coherence tomography after lower blepharoplasty. METHODS: A total of 52 eyes from 26 patients treated between July 2012 and June 2015 were included in the study. A transcutaneous or transconjunctival approach was performed, depending on whether (1) the supportive lower lid orbicularis oculi muscle was tightened, (2) the middle lamella was elongated, (3) minimal fat was removed or transpositioned, and (4) lateral canthal support was established. Marginal reflex distance 2 and marginal nose distance were analyzed with Image J software. TMH was measured with anterior segment optical coherence tomography. A paired t-test and Wilcoxon signed-rank test were used for statistical comparisons. RESULTS: Marginal reflex distance 2 decreased and marginal nose distance increased with both surgical techniques. TMH decreased from 337.3 ± 117.9 to 289.3 ± 69.1 µm (p = 0.024) in patients who had transcutaneous lower blepharoplasty, but increased from 186.5 ± 35.5 to 274.8 ± 58.3 µm (p = 0.000) in patients who had transconjunctival lower blepharoplasty. Medial and lateral TMHs decreased significantly from 228.8 ± 80.7 to 152.7 ± 42.1 µm (p = 0.008) in patients with transcutaneous lower blepharoplasty. TMH was significantly restored after lower blepharoplasty with either approach. CONCLUSIONS: Enhancing the lower eyelid position combined with orbicularis muscle tightening and lateral canthal support can normalize the TMH following lower eyelid blepharoplasty.

Clinical Efficacy of Lacrimal Endoscopy Assisted Silicone Tube Intubation in Patients with Nasolacrimal Duct Obstruction

PURPOSE: We evaluated the clinical efficacy of lacrimal endoscopy-assisted silicone tube intubation in patients with a nasolacrimal duct obstruction. METHODS: We conducted a retrospective chart review of 86 eyes of 67 patients who underwent lacrimal endoscopy (RUIDO fiberscope; Fibertechco, Tokyo, Japan)-assisted silicone tube intubation from December 2014 to March 2017. We compared clinical characteristics, irrigation test results, and dacryocystographic and lacrimal endoscopic findings, and analyzed factors related to surgical success. RESULTS: In total, 86 eyes of 67 patients underwent lacrimal endoscopy-assisted silicone tube intubation. The success rate was 87.2%. There was a significantly lower preoperative tear meniscus height (420.5 ± 198.1 µm vs. 639.0 ± 224.3 µm, p < 0.001). In the surgically successful group, narrowing was frequently observed (29.0% vs. 0%, p = 0.030). Dacryolith findings were associated with surgical failure (10% vs. 29%, p = 0.043). CONCLUSIONS: Lacrimal endoscopy-assisted silicone tube intubation is considered an effective and successful operative procedure and enables the observation of real-time findings inside the lacrimal drainage passage for the treatment of pathological lesions. Narrowing observed during lacrimal endoscopy indicated successful treatment as opposed to dacryolith findings, which were associated with a failed outcome.

Clinical Outcomes of Browlift Using Various Methods

PURPOSE: The present study investigated the outcomes of browlift using various surgical methods including direct browplasty, endoscopic browlift and transblepharoplasty browlift. METHODS: Twenty-eight brow ptosis cases in 19 patients were treated in the present study. The mean patient age was 67.9 +/- 9.7 years, and the mean observation period was 9.0 +/- 3.8 months. Nine cases were treated with direct browplasty, eight cases with endoscopic browlift and 11 cases with transblepharoplasty browlift. Photographs of patients were taken before surgery and two months, six months and on the final follow-up after surgery. The brow-to-pupil distance (BPD), brow-to-medial canthus distance (BMCD), and brow-to-lateral canthus distance (BLCD) were analyzed by the Image J Program. RESULTS: BPD increased 1.88 +/- 0.99 mm, BMCD increased 1.06 +/- 1.21 mm and BLCD increased 1.36 +/- 1.17 mm in all patients six months after surgery. Regarding the change in BPD, direct browplasty increased 1.79 +/- 1.29 mm, endoscopic browlift increased 1.94 +/- 0.80 mm and transblepharoplasty browlift increased 1.90 +/- 0.94 mm without significant difference among the groups on the final follow-up. In terms of brow shape, direct browplasty effectively elevated the lateral brow and endoscopic browlift effectively elevated the medial brow compared to other procedures. No significant complications were observed in any patient. CONCLUSIONS: Browlift techniques such as direct browplasty, endoscopic browlift and transblepharoplasty browlift are safe and effective surgical methods to correct brow height and shape in patients with brow ptosis without any significant complications.

Cognitive Function Evaluation by Mini-Mental State Examination-Korea in Essential Blepharospasm

PURPOSE: The present study evaluated cognitive functions of Korean patients with essential blepharospasm by the Mini Mental State Examination - Korea (MMSE-K). METHODS: Atotal of 33 patients diagnosedwith essential blepharospasm were evaluated. Using the K-MMSEcognitive functions such as orientation, registration and recall, attention and calculation, language, comprehension, and decision were evaluated. RESULTS: All patients were alert and orientedwith an average K-MMSEscore of 25.2 +/- 4.0 points. The normal group scores were above 24 points in 25 patients (75%), suspected dementia scores were from 20 to 23 points in 5 patients (15%), and definite dementia scores were from 15 to 19 points in 3 patients (9%). Neurologic and brain imaging evaluation was performed in the 8 patients with suspected dementia or definite dementia. Among these patients, 2 were diagnosed with Parkinson's disease, 2 were shown to have a specific brain lesion on magnetic resonance imaging, and 1 was diagnosed with a stroke and treated with antiplatelet therapy. CONCLUSIONS: The K-MMSE can be a helpful tool for the early detection of cognitive dysfunction in outpatients with essential blepharospasm.