Clinical Efficacy of Lacrimal Endoscopy in Patients with Epiphora

PURPOSE: To evaluate the clinical efficacy of lacrimal endoscopy in patients with nasolacrimal duct obstruction (NLDO) and to compare the dacryocystography (DCG) and lacrimal endoscopic findings between patients with epiphora. METHODS: We conducted a retrospective chart review of 31 eyes of 23 patients who underwent an irrigation test, DCG, and lacrimal endoscopy from December 2014 to February 2016. We compared the clinical characteristics, and dacryocystographic findings, and lacrimal endoscopic findings of the patients, and analyzed whether or not these findings agree. RESULTS: Thirty-one eyes showed complete obstruction (13 eyes, 41.9%), partial obstruction (7 eyes, 22.6%), or patency (11 eyes, 35.5%) on irrigation test. Thirteen eyes with complete obstruction on irrigation test presented with complete obstruction (11 eyes, 84.6%) or secondary dilation (2 eyes, 15.4%) of the lacrimal sac at DCG. In terms of the level of obstruction, there was no difference between the two examinations. However, twelve eyes with complete obstruction at DCG; showed narrowing (4 eyes, 33%), granulation tissue (3 eye, 25%), mucus occlusion (2 eyes, 17%), stones (1 eye, 8%), or mucosal edema (2 eyes, 17%) on lacrimal endoscopy. Nineteen eyes with partial obstruction at DCG showed narrowing (6 eyes, 32%), mucus (5 eye, 26%), granulation tissue (4 eyes, 21%), or stones (4 eyes, 21%) on lacrimal endoscopy. CONCLUSIONS: Lacrimal endoscopy allowed real-time observation inside the lacrimal passage that cannot be detected using DCG. Both methods provide comprehensive investigations of the nasolacrimal passage system, and these methods are complementary to understand the pathophysiology of nasolacrimal duct obstruction as well as planning treatment. Lacrimal endoscopy is very useful in investigating the lacrimal drainage passage in patients with NLDO, and this method is comparable to DCG.

Effect of Mixed Injection of Botulinum Neurotoxin, Triamcinolone and 5-Fluorouracil in Graves' Upper Eyelid Retraction

PURPOSE: The aim of this study is to evaluate the effects and complications of mixed injections of botulinum neurotoxin A (BoNT-A), triamcinolone acetonide, 5-fluorouracil (5-FU) in patients with Graves upper eyelid retraction. METHODS: Twenty-four eyes of 17 patients with a mean age of 43.9 years showed symptoms of Grave's upper eyelid retraction (GUER). They received mixed injections of BoNT-A 4 IU/0.1 mL, triamcinolone acetonide 4 mg/0.1 mL and 5-FU 5 mg/0.1 mL via subconjunctival injection. The response to treatment and the presence of adverse effects were followed up for 9.0 ± 6.0 months and evaluated retrospectively. RESULTS: Margin reflex distance 1 decreased significantly from 5.6 ± 1.2 mm to 4.7 ± 1.1 mm at 1 month after injection. Tarsal platform show increased significantly from 1.4 ± 1.3 mm to 1.8 ± 1.3 mm, and tear break up time increased significantly from 5.2 ± 3.1 seconds to 10.3 ± 7.8 seconds. When success was defined as the correction amount of GUER being larger than 1 mm, the success rate was 66.7%. Kaplan-Meier survival analysis showed that GUER correction effects last longer in patients with a duration of disease longer than 6 months. There were no severe adverse effects such as diplopia, blepharoptosis and intraocular pressure elevation. CONCLUSIONS: Mixed injections of BoNT-A, triamcinolone acetonide and 5-FU, which compensate the side effects of solitary injection and enhances the anti-fibrotic effect, improves the eyelid position and tear film stability in the patients with GUER. It is an effective and safe method for treating GUER with long maintenance with less adverse effects.

Measurement of Angle Lambda Using Pentacam in Normal and Exotropic Children

PURPOSE: We measured angle lambda in normal and exotropic patients using Pentacam HR (Oculus, Wetzler, Germany). The relationship between angle lambda and refractive error was analyzed in the present study. METHODS: From December, 2013 to August, 2014, 135 eyes of 135 individuals under 16 years of age were enrolled in this study. Pentacam measures a distance between the center of the pupil and the corneal reflex point. The distance was converted to the angle lambda using the second law of cosines. All statistical analyses were performed using SPSS for Windows, version 21.0 (SPSS Inc, Chicago, IL, USA). The differences among the groups when measuring angle lambda were calculated using independent t-test, Mann-Whitney test and analysis of variance (ANOVA). Pearson's correlation test was used to analyze the correlation among the variables. RESULTS: The mean age was 7.60 +/- 3.68 years. Mean angle lambda values of the normal and exotropia groups were 4.41 +/- 2.23degrees and 4.92 +/- 2.58degrees, respectively. To evaluate the association of angle lambda and refraction measures, individuals were further classified according to the degree of myopia and hyperopia. The angle lambda values in the 3 groups according to refraction status (myopic, emmetropic and hyperopic) were 3.95 +/- 2.16degrees, 4.84 +/- 2.62degrees and 5.30 +/- 2.35degrees, respectively. A positive correlation was observed between angle lambda and spherical equivalent (correlation coefficient = 0.341, p < 0.001). A significant negative correlation was observed between angle lambda and age (correlation coefficient = -0.181, p = 0.036). There was a negative correlation between axial length and angle lambda (correlation coefficient = -0.469, p = 0.003). CONCLUSIONS: The results in this study were in agreement with the results from previous studies. Measuring the distance between the centers of the pupil and the point of corneal reflection using Pentacam is recommended as a quick, objective, quantitative and reproducible method to measure the angle lambda in children.

Changes in Lower Eyelid Positions after Individualized Lower Blepharoplasty

PURPOSE: Various forms and degrees of morphological changes in the lower eyelid are presented in this study. A comprehensive, individualized clinical approach based on sound anatomical principles and lower lid stability is needed. We evaluated morphological outcomes of lower blepharoplasty by measuring lower eyelid position. METHODS: One hundred sixty-eight eyes underwent lower blepharoplasty between August 2009 and August 2014. The mean patient age was 62.1 +/- 13 years and mean follow-up period was 6.0 +/- 10.2 months. Lower eyelid position of 84 consecutive primary lower blepharoplasty patients (52 females and 32 males) was analyzed using digital images and measured with standardized data points using the Image J Program. RESULTS: Of the 168 individualized lower eyelid blepharoplasties analyzed, margin reflex distance 2 (MRD2) decreased from 5.4 +/- 1.1 mm to 4.9 +/- 0.8 mm (p = 0.005) and marginal nose distance (MND) increased from 59.2 +/- 18.3 mm to 61.9 +/- 17.6 mm (p < 0.001). Complications after lower blepharoplasty were not observed. CONCLUSIONS: The position of the lower eyelid improved after individualized lower blepharoplasty that addressed all the anatomical lower eyelid findings was performed.