Demographic profile and clinical characteristics of patients presenting with acute ocular burns

Purpose: To study and compare the demographic and clinical profile of acute ocular burns (AOB) in children and adults. Methods: This retrospective case series included 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to two tertiary eye care centers within one month of sustaining AOB. Data regarding demographics, causative agents, severity of injury, visual acuity (VA), and treatment were collected and analyzed. Results: Males were more commonly affected particularly among adults (81% versus 64%, P < 0.00001). Among children, 79% sustained domestic injuries, whereas 59% of adults had work?place injuries (P < 0.0001). Most cases were due to alkali (38%) and acids (22%). Edible lime (chuna, 32%), superglue (14%), and firecrackers (12%) in children, and chuna (7%), insecticides, lye, superglue (6% each), toilet cleaner (4%) and battery acid (3%) in adults, were the main causative agents. The percentage of cases with Dua grade IV?VI was greater in children (16% versus 9%; P = 0.0001). Amniotic membrane grafting and/or tarsorrhaphy were needed in 36% and 14% of affected eyes in children and adults, respectively (P < 0.00001). The median presenting VA was logMAR 0.5 in children and logMAR 0.3 in adults (P = 0.0001), which improved significantly with treatment in both groups (P < 0.0001), but the final VA in eyes with Dua grade IV?VI burns was poorer in children (logMAR 1.3 versus logMAR 0.8, P = 0.04). Conclusion: The findings clearly delineate the at?risk groups, causative agents, clinical severity, and treatment outcomes of AOB. Increased awareness and data?driven targeted preventive strategies are needed to reduce the avoidable ocular morbidity in AOB

Lagophthalmos: An etiological lookout to frame the decision for management

Purpose: To describe the etiology, clinical profile, duration of lagophthalmos cases and thereby, framing a decision for the management based on the severity of Exposure keratitis (EK), Facial palsy (FP) with each etiology and to describe the outcome of the management options. Methods: The method was a prospective review of 120 lagophthalmos cases treated at a single tertiary center from January 2018 to January 2019. The main outcome measures were analysing the association between age, etiology, duration and management of lagophthalmos. Results: Of the 120 patients studied, paralytic etiology was noted in 86 and eyelid etiology in 34 patients. The percentage of various lagophthalmos etiology documented were Bell’s palsy (35.83%), lagophthalmos in ICU patients (15%), traumatic facial palsy(FP) (10.80%), stroke associated FP (6.67%), infection associated FP (6.67%), iatrogenic FP, cicatricial lagophthalmos (5%), lagophthalmos post eyelid surgeries (5%), neoplastic FP(3.33%), congenital FP (1.67%), proptosis induced lagophthalmos (1.67%), floppy eyelid syndrome induced lagophthalmos (0.83%) and lid coloboma associated lagophthalmos (0.83%). A statistically significant correlation was noted between exposure keratitis and age, with an increased prevalence age advances. The management showed significant variation with individual etiology, with some etiologies unquestionably requiring surgical management. Surgical management is crucial as the duration of lagophthalmos increases more than 6 weeks, EK involving pupillary axis and poor FP recovery. Conclusion: This study concludes that the conservative management was sufficient in all cases when the duration is less than 1 week, Exposure keratitis not involving the pupillary axis (EK< Grade II) and FP with good functional recovery ( FP < Grade III). The predominant causes being Bell’s palsy, lagophthalmos in ICU patients and vascular FP. Whereas, cases with poor functional recovery of facial palsy(FP) and permanent eyelid deformation require definitive surgical management like Traumatic FP & cicatricial lagophthalmos

Posterior lamellar tarsorrhaphy in the early treatment of severe eyelid trauma/burns / 世界急诊医学杂志（英文）

@#In patients with lagophthalmos due to eyelid trauma, it is imperative to ensure adequate closure of the eye to protect the ocular surface. Sometimes it is difficult to surgically close eyelids by conventional methods of tarsorrhaphy, such as intermarginal suture tarsorrhaphy, Week’s tarsorrhaphy, and tongue-in-groove tarsorrhaphy. We need intact eyelid tissues to perform these procedures and might not be possible in patients with severe lagophthalmos due to lost/damaged eyelid tissues either due to deficient length of tissues or increased tension at the wound site, which can result in surgical failure.

A comparative study of tarsorrhaphy and amniotic membrane transplantation in the healing of persistent corneal epithelial defects

Purpose: To compare and study the clinical outcome of tarsorrhaphy and amniotic membrane transplant in the healing of persistent corneal epithelial defects in terms of clinical improvement and symptomatic relief. Methods: This was an interventional, prospective study in which a total of 60 patients with persistent epithelial defects (PED's), randomly divided into two groups of 30 patients each who underwent tarsorrhaphy (Group A) or amniotic membrane transplantation (Group B) with a 4-week-follow-up period, were included. The main parameters studied were the size of an epithelial defect, total healing time, pain score, and complications. Results: The study included 60 eyes of 60 patients with PED. The healing time was 9.83 � 6.51 days in Group A (median = 9.50 days, IQR = 1�days) vs. 18.33 � 13.46 days (median = 19.50 days, IQR = 1� days) in Group B. A total of ten eyes (16.7%) did not heal at the end of 4 weeks. Conclusion: There was a significant reduction in the area of epithelial defect at the end of the 1 week and 2 week follow up postoperatively, in both the treatment forms. The mean healing time in patients of Group A was less as compared to that of the patients in Group B.

Multiple Intraorbital Glass Foreign Bodies.

It is frequently difficult to identify and localize intraorbital foreign bodies despite modern-day high-resolution imaging studies. Although there can be grave complications associated with retention of organic intraorbital foreign bodies, many believe that removal of such bodies in most cases is unwarranted. A high clinical suspicion, proper choice of imaging studies, and removal by a skilled orbital surgeon probably make the risk of surgical exploration and foreign body removal less than the risk of foreign body retention. We present a case of extraconal foreign bodies (11 glass particles), which required exploration for retrieval. An initial bedside exploration led to locating two foreign bodies (glass particles of 2 × 2 cm and 1 × 1 cm size respectively). A second exploration in the ophthalmology operating theater yielded 11 foreign bodies (glass particles of various sizes) in the superior area of extraconal space.

Therapeutic Observation of Conjunctiva Valve Combined with Tarsorrhaphy and Standardized Drug Intervention Treating Refractory Kera-tohelcosis / 浙江中医药大学学报

[Objective] To discuss the cure effect of conjunctiva valve combined with tarsorrhaphy and standardized medication on refractory keratohelcosis. [Method] Choose 37 cases with 37 eyes of the disease above, divide them into control group, n=17, and observation group, n=20; the control one take conjunctiva valve combined with tarsorrhaphy and routine medicine intervention; other group, standardized drug intervention instead of routine medicine. Observe the therapeutic effect after 6m. [Result] In observation group, 18 cases were cured(90%), 2 better(10%); for other group, they were 9(52.9%) and 4(23.5%) respectively, and 4 cases had no effect(23.5%). Comparing both cure effects, the difference had statistical meaning. [Conclusion] The conjunctiva valve combined with tarsorrhaphy could markedly improve the cure effect if intervened with standardized drug.

Melting ulcer in a colt: clinical management and evolution / Úlcera fundente en un potro: manejo clínico y evolución / Úlcera colagenolítica em um potro: manejo clínico e evolução

Anamnesis: a colt showing a whitish coloration accompanied by abundant secretion on the left eye was examined. Clinical and laboratory findings: at ophthalmological examination, signs of melting ulcer were observed. Culture isolation revealed positive growing of Flavobacterium sp. and Gram-negative rods. Treatment approach: several keratectomies and tarsorrhaphies, as well as exhaustive antiproteinases, antiinflammatory, and antibiotic treatments, were conducted. Treatment focused on reducing inflammatory response, eliminating infective organisms, and promoting epithelial healing. Colt showed complete recovery of vision after 3 months. Conclusions: clinical management of melting ulcer implies exhaustive, though unexpensive, treatment.

Anamnesis: se examinó un potro que presentó una coloración blanquecina acompañada de abundante secreción en el ojo izquierdo. Hallazgos clínicos y de laboratorio: al examen oftalmológico se observaron signos de ulcera fundente. El aislamiento por cultivo mostró crecimiento de Flavobacterium sp. y cocos Gram negativos. Abordaje terapéutico: se realizaron varias queratectomías y tarsorrafias, además de un tratamiento exhaustivo con antiproteinasas, antiinflamatorios y antibióticos enfocado a reducir la respuesta inflamatoria, eliminar los microorganismos infecciosos y promover la cicatrización epitelial. 3 meses después, el potro mostró recuperación completa de la visión. Conclusiones: el manejo clínico de la úlcera fundente es demandante, pero no es un tratamiento costoso.

Antecedentes: foi examinado um potro que apresentava uma coloração esbranquiçada acompanhada por abundante secreção no olho esquerdo. Achados clínicos e de laboratório: ao exame oftalmológico foram encontrados sinais de úlcera colagenolítica. O isolamento por cultura apresentou crescimento de Flavobacterium sp. e cocos Gram negativos. Abordagem terapêutica: foram realizadas várias ceratectomias e tarsorrafias, além da instauração de um tratamento exaustivo com antiproteinases, anti-inflamatórios e antibióticos voltado para a redução da resposta inflamatória, a remoção de micro-organismos infecciosos e a estimulação da cicatrização epitelial. 3 meses depois o potro apresentou completa recuperação da visão. Conclusões: o manejo clínico da úlcera colagenolítica é exigente, mas não é um tratamento caro.

Reevaluation of Medial tarsorrhaphy in the management of paralytic ectropion / 나학회지

Paralytic lagophthalmos and ectropion in the treatment of leprosy patients are serious complications of facial paralysis, which may lead to exposure keratitis and corneal ulceration, which can further lead to blindness. In 1995, 1997, 1999 and 2001, we reported in this journal on the surgical treatment of paralytic lagophthalmos and ectropion. In the 1st report, made in 1995, for lid closing, I (Ahn) performed various methods of traditional surgery such as temporal muscle transfer, medial and lateral canthoplasty, as well as gold implantation. In the 2nd report, made in 1997, we (Ahn and Park) presented a combination treatment of gold plate with minor changes of design and weight in the upper lid and medial canthoplasty with horizontal shortening in the lower lid. In the 3rd report, made in 1999, we described an additional graft of conchal cartilage in the lower lid. However, the lateral end of the cartilage would warp and create new partial ectropion several months later. Therefore, we shifted from cartilage to Alloderm(R), acellular dermal graft. In the 4th report, made in 2001, we reported that Alloderm(R) is a good substitute for the cartilage and is also an effective volume filler to the atrophic lower lid. The medial portion of the lower lid often presented with a recurrence of the ectropion, despite having tightened the bilateral plication of the medial and lateral canthal ligaments with an Alloderm(R) graft in the inferior border of the tarsus. In order to treat the recurring ectropion, a modified permanent tarsorrhaphy was performed. We have noted that a modified permanent tarsorrhaphy on the medial canthal area in Z-plasty successfully corrected the partial ectropion and resulted in decreased epiphora and increased esthetic satisfaction.

The Effect of Palpebral Spring in Lagophthalmos caused by Nerve Palsy

Facial palsy produces asymmetry of the face and lagophthalmos, incomplete eyelid closure. Exposure keratitis and eyeball pain can be induced by prolonged lagophthalmos, and the vision can be treatened at last. Therefore, the correc tion of lagophthalmos is important to preserve the proper visual function. Tarsorrhaphy has been the classic method of providing corneal protection in lagophthalmos caused by facial nerve palsy, but it produces a cosmetic problem and limits vision, so it should be reserved only to comatous patients. Since Morel-Fatio and Lalardrie implanted a palpebral spring in 1964 first time, several modifications have been reported to maximize the effect of spring in lagophthalmos. The authors experienced the dynamic eyelid animation with papebral spring, custom-made by authors with orthodontic wire in four patients who sufferd from exposed keratitis and eyeball pain due to lagophthalmos, which were intractable to medical therapy. Eyeball pain and keratitis were completely subsided in all patients with good lid closure. One patient was removed the palpebral spring due to recovery of facial nerve function at postoperative 6 months, other three patinets are well with implanted pa.lpebral spring.

The Comparison of the Effect of Therapeutic Lrens, Collagen Shield, and Tarsorrhaphy on Stromal Inflammation after Photorefractive Keratectomy in a Rabbit model

Reducing inflammation after photo refractive keratectomy may decrease postoperative pain and reduce corneal haze intensity. We evaluated the effect of the therapeutic lens(T-lens) and collagen shield on stromal inflammation. Adult New Zealand white rabbits were subjected to excimer laser PRK. Polymorphonuclear leukocytes(PMNs) of ablated corneal stroma were counted 10 hours after surgery with a microscope. The number of PMNs in the central cornea was lower in the T-lens group (29.77 +/- 11.6) and collagen shield group(36.77 +/- 5.9) than in the tarsorrhaphy group (75.33 +/- 14.6). Of all the groups, the eyes which were left unpatched showed the most marked infiltration of PMNs into the wound(226.83 +/- 18.2). The T-lens and collagen shield may reduce postoperative corneal haze intensity better than a pressure patch by suppression of stromal inflammation.