[Evaluation of refractive state in patients with unilateral congenital nasolacrimal duct obstruction]

To evaluate refractive state in patients with unilateral congenital nasolacrimal duct obstruction. In this descriptive prospective study, patients with unilateral congenital nasolacrimal duct obstruction scheduled for surgery were enrolled over a period of two years [2007-2009]. Cycloplegic refractive error in both eyes was measured under anesthesia before surgery [probing, silicon intubation or dacryocystorhinostomy]. When more than one procedure was required, only the first refraction was considered for analysis. Anisometropia greater than 0.5 diopter was defined as clinically significant. Ninety-four patients with mean age of 25.4 +/- 20.4 months [range: 6 month to 10 years] entered the study. In older ages the prevalence of clinical signs secondary to nasolacrimal obstruction such as discharge and epiphora increased, however, this was not statistically significant [r=0.115 and P=0.270]. Spherical equivalent refractive error in 78 [83%], 8 [8.5%] and 8 [8.5%] affected eyes was hyperopic, myopic and emmetropic, respectively. Corresponding figures in unaffected eyes were 67 [71.3%], 22 [23.4%] and 5 [5.3%], respectively. The prevalence of anisometropia greater than 0.5 D was 25% and that of less than 0.5 D was 43%. Anisometripia was not present in 32% of patients. Each month increase in patient's age was associated with 0.007 D higher difference in spherical refractive error between two eyes [P=0.019]. For cylindrical refractive error, this change was negative and non-significant [P=0.291] and for spherical equivalent it was positive but non-significant [P=0.137]. In older ages, more surgeries were needed [r=0.297, P=0.004]. Anisometropia increase with age and more time is necessary to relieve the obstruction during surgery. Anisometropia specially anisohyperopia in older subjects becomes more common and also difficult to treat. Early refraction and intervention help to prevent amblyopia and may reverse the anisometropia

[Late presentation of retinoblastoma: a case report]

To introduce a case of neglected advanced retinoblastoma. A 6 year old girl presented with a large orbital mass enlarging over her cheek on the right side. She underwent exenteration and histopathologic evaluation. A diagnosis of retinoblastoma was made with free margins. This case presents a rare form of retinoblastoma with extensive local progression but no metastasis or CNS involvement. Although most of the retinoblastoma cases are diagnosed before the age of 3 years, there are neglected cases who present at advanced stages

[Outcomes of amniotic membrane grafting in surgery for severe upper lid cicatricial entropion]

To evaluate the efficacy of amniotic membrane [AM] grafting in surgery for severe upper lid cicatricial entropion. This randomized clinical trial was performed on both upper eyelids of 22 patients with severe cicatricial entropion. On one side the anterior and posterior lamellae were split and the anterior lamella was recessed. On the other side, the same procedure was done but bare tarsus was covered with AM. Patients were evaluated one day, one and two weeks, and one and three months after surgery. The mean follow-up period was 9.89 +/- 6.17 [range 4-21] months. Overall, 22 patients [13 women and 9 men] aged 55 to 84 years [mean age, 71.54 +/- 8.58] entered the study. The cause of cicatricial entropion was old trachoma in 18 [81.8%] and idiopathic in 4 [18.2%] subjects. In second week, eyelids with AM stained less with fluorescein than the control group [P= 0.016]. At the end of the first month, all lids were epithelialized. There was no significant difference between the two groups in the number of lids with recurrent trichiasis but the number of lashes in contact with the globe in the AM group was significantly lower than the controls [P= 0.042]. There was no significant difference in tarsal shrinkage and normalization of bare tarsus between the study groups. Subgraft hemorrhage occurred in 3 cases in the first week which completely resolved by one month. AM is a useful tissue which can enhance reepithelialization of bare tarsus and may be considered as an adjunct in lid split entropion surgery

[Correlation of otolaryngological disorders and congenital nasolacrimal duct obstruction]

To determine the frequency of otolaryngological disorders in patients with congenital nasolacrimal duct obstruction [CNLDO] as compared to controls. In this case-control study, 80 children with CNLDO [cases] and 80 children without CNLDO [controls] were examined for ophthalmological and otolaryngological dosirders. Data analysis was performed using Pearson Chi-square and Fisher exact tests for frequency values and t-test for mean values. Mean age was 22.7 +/- 14.3 [range 5-72] months in the case group and 23.4 +/- 13.7 [range 9-72] months in controls [P=0.76]. CNLDO was bilateral in 7 [8.75%], left-sided in 23 [28.75%] and right-sided in 50 [62.5%] cases .There were no significant differences between cases and controls in nasal, oral and external ear examinations, however otitis media with effusion [OME] was found in 26.3% of cases vs 10% in controls [P=0.01]. Odds ratio for OME in the CNLDO group was 3.2 [95% confidence interval, 1.32-7.75]. Tympanometry was type A in 71.3%, type B in 22.5%, type C in 5% and unrecordable in 1.3% of cases compared to type A in 88.8% and type B in 11.2% of controls [P=0.01]. The incidence of asymptomatic OME in patients with CNLDO is higher than controls therefore, children with CNLDO may need screening for OME for timely diagnosis and treatment