Surgical Outcome of Levator Recession for Correction of Upper Eyelid Retraction

PURPOSE: To assess the efficacy of levator recession under local anesthesia to treat upper eyelid retraction. METHODS: Records of 12 patients (12 lids) were reviewed retrospectively. Postoperative cosmetic results were assessed as good, fair, or poor based on the upper lid height and symmetry. Preoperative and postoperative marginal reflex distance (MRD1, mm), upper eyelid asymmetry, lid lag, lagophthalmos, and ocular exposure symptoms were compared. The reoperation rate was also evaluated. RESULTS: Causes accounting for upper lid retraction were Graves ophthalmopathy (9 lids, 75.0%), orbital pseudotumor (2 lids, 16.7%), and hypercorrection from previous ptosis operation (1 lid, 8.3%). At a mean +/- standard deviation of 27.7 +/- 24.0 months follow-up (range, 5-60 months), 11 patients (91.7%) showed significantly better cosmetic results. MRD1 decreased an average of 3.1 +/- 1.3 mm from 6.3 +/- 1.5 mm preoperatively to 3.2 +/- 0.9 mm postoperatively (p < 0.001). Upper lid asymmetry, lagophthalmos, and lid lag were also reduced significantly (p < 0.001). Overcorrection occurred in 3 lids (25%) and required levator advancement. Eleven patients (91.7%) experienced complete resolution of dry eye symptoms following levator recession. CONCLUSIONS: Levator recession showed good cosmetic results up to 2 years after surgery for upper eyelid retraction.

Clinical Effects of Punctal Occlusion Using Chromic Catgut

The treatment of dry eye patients is based on the management of the main causes of the disease. When the process of disease continues regardless of various conventional treatments, punctal occlusion can be employed. We used collagen implant. 1-0 and 2-0 chromic catgut in 33 eyes of dry eye patients to evalute the efficacy of punctal occlusion using chromic catgut. Symptoms(grade 0 to 3) were improved from the first week and persistently decreased in symptom grade during four weeks' follow-up period. The superficial corneal punctate erosion(grade 0 to 3) was improved after 2 weeks of the procedure in the whole 33 eyes(p<0.05). There was no superiority between collagen implant and chromic catgut. There was no improvement by score of the Schirmer test and the BUT in each group(p<0.05). We concluded that chromic catgut was easily applicable, very effective, inexpensive and showed less complication compared with collagen implant. We suggested that it could be used more widely in punctal occlusion in dry eye patients.

Case Report of Blindness After Intranasal Ethmoidectomy

Surgical extirpation and drainage of the paranasal sinus is frequently used by the otolaryngologist in the management of allergic, infectious, and neoplastic sinus diseases. Several surgical approaches to the ethmoid and maxillary sinuses, including ethmoidectomy and Caldwell-Luc's operation, may be used. In the intranasal approach to ethmoidectomy, the lamina papyracea, the thin partition separating the periorbita from the ethmoid sinus. cannot be directly visualized during this procedure and may be perforated inadvertently. Endoscopic nasal sinus surgery has only recently been introduced into Korea. This rather novel technique, especially when used by less-experienced surgens, has major complications similar to what has been reported with the traditional intranasal sphenoethmoidectomy. Even then, major complications may occur in the hands of very experienced surgeons. The ophthalmolgist may be consulted in the management of patients with orbital complications of sinus surgery. We present one patient with ophthalmic complications of sinus surgery encountered by the authors. The purpose of this report is to present to the ophthalmologist examples of orbital complications that may arise from sinus surgery, and treatment options.