Levels of Severity in Dry Eye Syndrome According to Delphi Panel Classification

PURPOSE: To investigate levels of severity in dry eye syndrome according to Delphi panel classification. METHODS: Three hundred and twenty-two eyes of 166 patients with dry eye syndrome that did not have coexisting lid margin disease or altered tear distribution and clearance were categorized into 1 of 4 levels of severity, according to the symptoms and signs in the Delphi panel classification. A symptom score was proposed depending on the frequency and impact on the quality of life. Degree of corneal staining using Lissamin green was categorized using the Oxford Scheme. In addition, measurement of the tear film break-up time (BUT) and Schirmer test were performed. RESULTS: According to the levels of severity in the Delphi panel classification, 120 eyes (37.26%) were categorized as level1, 166 eyes (51.55%) as level 2, 30 eyes (9.31%) as level 3, and 6 eyes (1.86%) as level 4. Negative correlations were observed between the levels of severity, BUT, and measurements of the Schirmer test (p<0.001). CONCLUSIONS: Of the 166 eyes with dry eye syndrome that did not have coexisting lid margin disease and altered tear distribution and clearance, 51.55% of eyes were classified as level 2, and 88.81% of eyes were classified as level 1 and level 2.

A Treatment using Amniotic Membrane Transplantation in Rupture of Terrien's Marginal Degeneration

PURPOSE: To evaluate the effectiveness of amniotic membrane transplantation (AMT) on the repair of peripheral corneal perforation occurring during cataract surgery of a case of Terrien's marginal degeneration. METHODS: A 77-year-old male patient was referred to our hospital from a private clinic because of corneal perforation during cataract surgery of the right eye. Emergency AMT was performed. RESULTS: The eyeball regained its integrity with stabilized corneal surface, reformed anterior chamber and clearance of the inflammation. CONCLUSIONS: AMT may be an effective alternative for treating corneal perforation or impending perforation.

A Case of Canine Tooth Syndrome due to Blow-out Fracture

PURPOSE: This is the first report of canine tooth syndrome associated with blow-out fracture in the Korean literature. METHODS: We examined a 13-year-old male patient complaining of intermittent ocular pain who had a past history of blow-out fracture in the left eye at the age of 6 years. He showed left hypertropia at the primary position and an inability to elevate the left eye in adduction. Orbital CT showed displacement of the superior portion of the ethmoid bone that comprises the medial aspect of the orbit wall and entrapment of the superior oblique muscle in association with the misaligning lesion. In conjunction with orbit CT findings and physical examination, we were able to make a diagnosis of Canine tooth syndrome. RESULTS: We anticipated surgical difficulty due to the surgical field having a lot of scar formation in situation 7 years after the trauma. In this case, we chose observation as our current treatment modality as this was not a case suitable for surgery.

The Change of Ocular Position According to the Amount of Recession after Superior Rectus Muscle Resection on White Rabbit

PURPOSE: To compare the effect of combined recession and resection on ocular position. METHODS: We designed a study with three groups of white rabbits. A recession was performed by differing the amount, 9 mm, 12 mm and 15 mm, according to the group, after 12 mm resection on superior rectus muscle. Before and 1 week after the operation, distance from lower margin to upper corneal limbus was measured using photographs. RESULTS: In 12 mm recession group, the distance before and after the operation was 9.44 mm and 9.19 mm respectively, showing no statistically significant change (P=0.2344). In 15 mm recession group, the ocular position showed significant depression, from 9.13 to 7.87 mm (P=0.0017), whereas in 9 mm recession group ocular position showed significant elevation from 9.11 to 10.85 mm (P=0.0078). CONCLUSIONS: The result of this study showed that when combined resection and recession on the same extraocular muscle were made in the same amount, eye alignment at primary ocular position was kept. Furthermore this procedure enables adjustable surgery to be considerable in incomitant strabismus.

Superior Oblique Palsy Combined with Horizontal Strabismus

PURPOSE: To investigate the clinical characteristics of superior oblique palsy in patients with horizontal strabismus. METHODS: Nineteen superior oblique palsy patients with vertical deviation or inferior oblique overaction who complained horizontal deviation were evaluated. Visual acuity, ocular movement test, prism cover test, Bielschowsky head tilt test, fundus photograph and examining photographs for head tilt and facial asymmetry were performed. Horizontal strabismus surgery and inferior oblique myectomy was done simultaneously , and the postoperative results was compared with preoperative condition. RESULTS: There were 15 exotropic patients (22.20PD+/-6.01SD) and 4 esotropic patients (22.00PD+/-12.08SD). Vertical deviation was found to be 6.74PD+/-3.35SD. Inferior oblique overaction (+0.5~2) was observed in 18 patients. Twelve patients had excyclotorsion. Of 18 patients with head tilting and 12 patients with facial asymmetry, seven patients (38.9%) in head tiltilng and six patients (50%) in facial asymmetry did not notice the abnormality. Horizontal strabismus surgery with inferior oblique myectomy showed good results in all cases. CONCLUSIONS: We should consider the possibility of superior oblique palsy when the patients showed small amount of vertical deviation, head tilt, facial asymmetry or monocular inferior oblique overaction combined with horizontal strabismus, and do the surgery simultaneously for horizontal strabismus and superior oblique palsy.