Analysis of Upper Eyelid Fat Pad Changes with Aging and Body Mass Index in Korean

PURPOSE: To evaluate differential changes in the central and nasal fat pads of the upper eyelid associated with aging and the effect of body mass index in Koreans. METHODS: Using a standardized scale, the volume grade of the central and nasal fat pads was graded from 0 to 3 (0 for depressed, 1 for flat, 2 for mildly protruded, and 3 for markedly protruded) in normal adults, consisting of 20 males and 20 females from 30 years of age to 80 years of age. The body mass index was calculated for every patient through interviews using their height and weight. Statistical evaluations correlating age and body mass index with central and nasal fat pad changes were performed. Statistical evaluations correlating age with fat pad changes except for the effect of body mass index were performed. RESULTS: Except for the effect of body mass index, the central fat pad increased (r = -0.176, p = 0.007) and nasal fat pad decreased (r = 0.252, p < 0.001) with aging, which was statistically significant. CONCLUSIONS: With aging, the central fat pad increases and nasal fat pad decreases in the upper eyelid. Clinically, this finding has implications in cosmetic and functional upper eyelid blepharoplasty. In addition, the results may be useful to determine whether to conserve or remove the fat as well as the amount of fat removal during upper blepharoplasty.

Monocanalicular and Bicanalicular Intubation with Sequential Probing for Congenital Nasolacrimal Duct Obstruction in Patients Over the Age of 24 Months

PURPOSE: The clinical effectiveness of monocanalicular or bicanalicular intubation with sequential probing was evaluated in patients over the age of 24 months with congenital nasolacrimal duct obstruction. METHODS: Patients over 24 months of age with congenital nasolacrimal duct obstruction who underwent monocanalicular intubation with sequential probing (19 patients, 20 eyes) or bicanalicular intubation with sequential probing (22 patients, 22 eyes) were studied. Success rates and complications were evaluated. Silicone tube was removed 6 months after surgery. Success was defined as no epiphora and no retention on fluorescein dye disappearance test. RESULTS: The success rate was 95.0% (19 eyes / 20 eyes) in the monocanalicular intubation group and complications included 7 cases of early tube dislodgement, which achieved successful outcome. The success rate was 82.6% (19 eyes / 22 eyes) in the bicanalicular intubation group and complications included 4 cases of punctal slitting, and 3 cases of tube extrusion. The success and complication rates were not significantly different between the 2 groups (p = 0.608, p = 1.000, respectively). CONCLUSIONS: In congenital nasolacrimal duct obstruction, the monocanalicular tube intubation group had similar success and complication rates to the bicanalicular tube intubation group. Silicone tube maintenance for 2 months in the monocanalicular group and for 3 months in the bicanalicular group was sufficient.

The Effects of Transcanalicular Diode Laser-Assisted Revision Surgery for Failed Dacryocystorhinostomy

PURPOSE: To determine the intranasal causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted revision surgery. METHODS: Twenty-four patients (29 eyes) who underwent revision surgery for a failed DCR at the Department of Ophthalmology, Ansan Hospital, Korea University between March 2009 and February 2011 were included in the present retrospective study. The intranasal causes of failed DCR, the time of symptoms such as epiphora and discharge after DCR, success rates of revision surgeries and follow-up periods were evaluated. RESULTS: Membranous obstruction was found in 25 eyes (86.2%) and was accompanied with granuloma in 10 eyes; these were the most common causes of failed DCR. The mean time for symptom development after DCR was 14.6 months, the success rate of the first revision surgery was 82.1% and good results were obtained in 5 eyes after the second revision surgery. Recurrence developed in 2 eyes, but symptoms improved after the lateral tarsal strip procedure. CONCLUSIONS: Membranous obstruction was the most common intranasal cause of failed DCR and transcanalicular diode laser-assisted revision surgery produced good results. Additionally, in patients with persistent epiphora following anatomically-patent revisional surgery, lacrimal pump failure due to lower eyelid laxity should be considered and corrected.