[Pyogenic granuloma of the lacrimal sac]

To report a case of free floating pyogenic granuloma within the lacrimal sac. A 13 month old infant with unresolving dacryocystitis and history of two times failed probing and once failed turbinate fracture was scheduled for dacryocystorhinostomy [DCR]. A free floating red mass was removed from the sac. Histopathologic examination confirmed a diagnosis of pyogenic granuloma. Eight months after the operation the patient was asymptomatic. When probing of the lacrimal duct fails to improve its obstruction, in addition to nasal lesions, lacrimal sac masses including pyogenic granuloma must be considered

[Effect of sodium ascorbate gel on class V composite resin restoration microleakage]

Composite restoration microleakage has been reported following bleaching treatment. The purpose of this study was to assess the in-vitro effect of sodium ascorbate gel on microleakage of class V restorations on bleached teeth. Forty-eight premolar teeth were randomly divided into 4 equal groups. Class V cavities were prepared on the buccal surfaces of group 1 teeth [negative control] and they were restored. In groups 2-4, bleaching was applied by using 9.5% hydrogen peroxide gel. In group 2 [positive control] and group 3, [delayed bonding] teeth were restored immediately and one week later, respectively. In group 4, 10% sodium ascorbate gel was applied, rinsed and restored. After thermocycling, samples were immersed in fushin and then, sectioned. Leakage was assessed and penetration of dye was scored. Data were analyzed using Kruskal-Wallis and Dunn's tests. There were significant differences in terms of microleakage between group 2 and other groups [P<0.05]. Groups 1, 3 and 4 exhibited similar leakage patterns, and all groups demonstrated less leakage values than group 2. Regarding marginal microleakage, there were significant differences between enamel and dentinal margins. Applying sodium ascorbate gel or 7-day delay following bleaching technique may improve the marginal integrity of composite class V restorations

[ case of traumatic carotid cavernous fistula]

To describe a complicated case of traumatic carotid-cavernous fistula [CCF] and our management strategy. A 13-year-old patient was referred one month following a car accident and facial trauma with severe proptosis, chemosis and limitation of ocular movement. Presence of murmur and an enlarged superior ophthalmic vein on orbital imaging suggested an arteriovenous fistula. The patient underwent transarterial fistula ballooning which resulted in alleviation of the fistula and improvement of signs and symptoms. Orbital signs and symptoms following trauma may indicate an arteriovenous fistula

Visual function following treatment of optic neuritis

Optic neuritis is a common cause of visual loss in young adults and often the first manifestation of multiple sclerosis. Recent studies have shown that treatment with intravenous methylprednisolone results in more rapid recovery of vision, but without any long term difference in visual acuity. This study was carried out to evaluate clinical characteristics of patients with optic neuritis and visual outcome after intravenous methylprednisolone treatment. In a case series study, 40 cases with optic neuritis were evaluated. Before and after treatment with methylprednisolone according to optic neuritis treatment trial, visual acuity, contrast sensitivity, color vision, streopsis and visual field were analyzed. 67.5% of the patients were females. The most common age group was between 20 and 40 [60%]. Blind spot enlargement and other visual field defects were also returned to relatively normal value after the treatment. Central scotoma was the most common field defect [70%] and mild Dutan defect was the most common color vision [60%] defect in this study. Visual acuity, contrast sensitivity, color vision, streopsis and visual field were significantly reduced in optic neuritis, relatively returning to the normal level after treatment. It seems that the assessment of other visual functions, besides visual acuity, is important in a patient with optic neuritis, because patients usually remain aware of visual deficits other than decreased visual acuity

[Outcomes of treatment for sixth nerve palsy]

To report the outcomes of surgical and non-surgical treatment for sixth nerve palsy and paresis in our center. Hospital records of 33 patients [35 eyes] with sixth nerve dysfunction who were referred to Labbafinejad Medical Center from September 1996 to September 2006 and underwent surgical procedures or botulinum toxin injection were reviewed. Patients were divided into three groups: Group A had muscle surgery without transposition; group B had transposition procedures and group C had botulinum toxin injection. The deviation improved from 50.3 +/- 16.8 to 6 +/- 9.8 prism diopter [PD] after the first operation and to 2.5 +/- 5 PD after the second operation in group A; from 56.9 +/- 24.3 to 5.5 +/- 16 PD after the first operation and to almost zero following the second operation in group B; and from 44.3 +/- 10.5 to 15 +/- 20 PD 6 months following botulinum toxin injection. Head posture and limitations of motility also improved significantly in all three groups. The overall reoperation rate was 18.2%. Various procedures are effective for sixth nerve dysfunction; all improve ocular deviation, head turn and abductive capacity of the eye. The rate of reoperation is not high if treatment is selected appropriately according to the patient's condition

[Isolated eyelid involvement as a rare presentation of orbital pseudotumor]

To report a case of isolated eyelid pseudotumor. A 40-year-old man presented with swelling and erythema of the right upper eyelid of 4 months duration. Multiple topical and systemic antibiotics had been administrated without any response. Incisional biopsy and evaluation of the lesion disclosed a diagnosis of eyelid pseudotumor. Oral prednisolone was initiated and then tapered slowly on the basis of clinical response. After six months, the eyelid lesion disappeared totally. Isolated eyelid involvement is a rare presentation of inflammatory pseudotumor of the orbit and should be considered in the differential diagnosis of eyelid lesions

[Orbital echinococcosis with two different features; hydatid and alveolar cysts]

To present two patients with hydatid and alveolar cysts of the orbit and to present their clinical, imaging, pathologic and therapeutic features. Two young children from rural areas were referred for progressive proptosis. Imaging showed intraorbital cysts. They were operated on with a clinical suspicion of hydatid and alveolar cysts. Pathologic evaluation confirmed the diagnoses in both instances. Clinical findings and imaging before the operation help the diagnosis of orbital echinococcosis. Knowing the nature of these lesions can prevent surgical complications. Alveolar cysts are much more invasive than hydatid cysts and their treatment is more difficult

[Outcomes of levator resection at labbafinejad medical center during 1995-2005]

To describe the etiology, outcomes and complications of levator resection procedure for correction of congenital and acquired blepharoptosis. In a retrospective nonrandomized study, medical records of 136 patients with blepharoptosis who underwent levator resection at Labbafinejad Medical Center from 1995 to 2005 were evaluated. Of 136 patients undergoing levator resection [including 44.1% men and 55.9% women with mean age of 20 +/- 13.8 [range 2-80] years], 120 cases had congenital ptosis [88.2%] while others had acquired ptosis. Success rate was 83.1% which was more frequent in acquired ptosis than congenital ptosis [93.8% vs. 81.7%, P=0.30]. Second and third surgeries for residual ptosis were performed in 19.1% and 2.2% of patients, respectively. The most common complication was under-correction [13.9%]. Levator resection an effective method for correction of upper eyelid ptosis with low complication rates and seems to be more effective in acquired ptosis

[Intelligene quotient in patients with congenital strabismus]

To evaluate intelligene quotient [IQ] in patients with congenital strabismus scheduled for surgery at Labbafinejad Medical Center. All patients with congenital strabismus scheduled for surgery were enrolled consequtively over a one year period in a cross sectional study and were evaluated for verbal, performance and total IQ, and compared with normal population whose mean IQ is 100 +/- 15. During the study period, 109 patients with a mean age of 18.4 +/- 10.5 years [range: 4-63 years] were included. Educational status in most patients [%80] was less than high-school diploma. Most patients [%79.8] lived in urban areas, 46 patients [%42.2] had some degrees of unilateral or bilateral amblyopia. Mean verbal IQ was 87.2 +/- 19.6 [range 45-127], performance IQ was 81 +/- 15.5 [range 44-111] and total IQ was 83.5 +/- 18.3 [range 40-120].Total IQ was lower in comparison with normal population [P<0.01] and was significantly higher in urban residents as compared to rural residents [85.1 +/- 19.5 versus 77.3 +/- 10.8, P=0.016]. Patients with non educated parents and with coexisting amblyopia had lower IQ levels. Total IQ was higher in myopes than emmetropes and both had better IQ levels than hyperopes. IQ was betters with vertical deviations and was higher in ETs than XTs, however, these comparisons were not statistically significant [All Ps> 0.05]. Patients with congenital strabisumus assessed in this study had lower mean IQ than normal. The reason may be genetic background or acquired causes secondary to strabismus

[Causes and outcomes of treatment for superior oblique palsy during a decade at labbafinejad medical center]

Superior oblique palsy is a common cause of paralytic strabismus. This disorder causes diplopia, head posture and facial asymmetry. This retrospective study reviews patient with superior oblique [SO] palsy operated at Labbafinejad Medical Center from 1997 to 2007. In this descriptive study, records of patients with SO palsy scheduled for surgery were reviewed. Forced duction test [FDT] and tendon laxity was checked in each patient. Patients were divided into congenital and acquired subgroups. During the study period, 83 patients were referred for surgery. Of these 73 patients with complete records [45 males, 28 females] were enrolled into our study, with age ranging from 1.5 to 62 [mean 19.7 +/- 11.7] years. SO palsy was congenital in 56 patients [76%] and acquired in 17 patients [24%]. Most patients [47.9%] had left side and 13.7% had both eyes involvement. The most common chief complaint was ocular deviation [52.1%]. The following abnormalities were noted: positive FDT 7 patients [9.7%], tendon laxity 2 patients [2.7%], amblyopia 14 patients [19.2%], facial asymmetry 5 patients [6.8%], head tilt 10 patients [13.7%], and chin down position 3 patients [4.1%]. Mean preoperative vertical deviation was 16.2 +/- 8.3 which was reduced to 1.9 +/- 4 prism diopters after surgical intervention [P<0.05]. Mean exotropia and esotropia were 15 +/- 9.5 and 13.9 +/- 11.5 prism diopters before operation, respectively and both were reduced to mean horizontal deviation of 1.5 +/- 4.8 prism diopters after operation [P<0.05]. The most common Knapp classification of disease was type 3 [42.5%]. The most common muscle operated was the inferior oblique [83.6%] and the most common type of operation was the inferior oblique myectomy. The most common form of superior oblique palsy leading to operation is the congenital form which occurs most commonly in young men. The most popular surgical intervention at this center was inferior oblique myectomy

[Recurrent cavernous hemangioma of the orbit secondary to tumor remnants]

To report the clinical, radiological, pathological and therapeutic features of a case of recurrent cavernous hemangioma. A 32 year old lady with progressive decrease of vision in her right eye associated with blepharoptosis was diagnosed to have orbital cavernous hemangioma which was excised. 10 years later she presented with recurrent proptosis and progressive eye deviation. Imaging showed the same pathology in the same orbit and repeat excision confirmed a cavernous hemangioma. Evaluation of old CT scans showed that the recurrent lesion was a twin tumor and we had only excised one of them in the first operation. Recurrent cavernous hemangioma may be the result of a small residual tumor which grows gradually and becomes clinically evident after some years. When the mass is large or seems multilobulated, after excision of the main mass a thorough search to find small residual masses seems mandatory

[Adie's tonic pupil following chicken pox]

To report a case of Adie's tonic pupil following chicken pox. A 7-year-old girl with history of chicken pox manifesting one week ago presented with loss of near and far vision in her right eye. The right pupil was larger than the left in room light and abnormal iris configuration was seen with pen light illumination. After instillation of diluted pilocarpine [0.1%] in both eyes, miosis occurred only in the right pupil and a diagnosis of tonic pupil was established. The patient was treated with bifocal glasses which resulted in relief of the visual symptoms. We recommend pupil and refractive evaluation in children with chicken pox. Bifocal glasses can help reduce symptoms of tonic pupil until recovery of the disease

[Medical treatment in prevention of rebleeding in traumatic hyphema]

Traumatic hyphema is among the most common challenges in ophthalmologic emergency. Its most common complication, rebleeding, is accompanied with poor prognosis. Rebleeding could cause corneal blood staining, glaucoma, and optic atrophy. Thus, the most important goal in hyphema treatment is prevention of rebleeding. This study was aimed to evaluate epidemiology, medical treatment, and short term complications of traumatic hyphema. This was a descriptive cross-sectional study, done in the year in Khatam- al- Anbia Ophthalmologic Hospital in Mashhad. 100 patients with traumatic hyphema were evaluated by an epidemiologic questionnaire and complete eye examination in emergency room. They all were treated by topical corticosteroid and cycloplegic with or without systemic medication [prednisone or tranexamic acid] according to degree of hyphema .All patients were followed for at least 10 days. Data was analyzed, using descriptive statistics and frequency distribution tables. 81% of patients were male with male to female ratio of 4:1. The patients' mean age was 26.5 +/- 15.4 years old. 62% of patients were under 30 years of age. The patients' right and left eyes were affected in 48% and 50%, respectively; 2% had both eyes affected. No statistically significant difference was found between right and left eye involvement. The mean visual acuity at presenting time was 4/10. There was a direct correlation between presenting visual acuity and severity of hyphema [p=0.043]. No correlation was found between age, sex, and the type of trauma with severity of hyphema. The mean intraocular pressure [IOP] was 18 mmHg at presenting time. There wasn't any correlation between IOP and severity of hyphema. The mean visual acuity at the last follow up visit was 8/10. Rebleeding occurred in 10 patients out of 100 cases. The risk of rebleeding with medical treatment was 10%. Rebleeding was found to occur 4.3 days after trauma, averagely. In this study, it was seen in the cases with hyphema of the degree of 4 or more [the only risk factor for rebleeding, in this study]. Traumatic hyphema is a common cause of refer to ophthalmology emergency room. Results of this study showed that complications of traumatic hyphema, especially rebleeding, could be prevented, significantly, with medical treatment

Abnormal Cambridge low-contrast grating sensitivity results associated with diabetic retinopathy as a potential screening tool

Contrast sensitivity is proposed as a potential screening tool for the early detection of diabetic retinopathy. A cross-sectional study was performed in a tertiary referral university eye centre. A total of 80 diabetes patients were recruited and tests were performed on 154 eyes. Contrast sensitivity was checked using Cambridge low-contrast grating. Abnormal contrast sensitivity was observed in 27.1% of eyes with diabetic retinopathy, compared with 9.0% in unaffected eyes, a statistically significant difference. Cambridge low-contrast grating is a potential screening tool for early detection of diabetic retinopathy by non-ophthalmologistsp

[Benign reactive lymphoid hyperplasia of caruncle and plica: report of five cases]

To report five cases of benign reactive lymphoid hyperplasia of the caruncle and plica and describe their clinical course and pathology. Five patients with fish flesh pinkish masses in the caruncle and plica were referred to Labbafinejad Hospital from 1997 to 2006. The masses were excised. Clinical appearance and course as well as pathology and immunohistochemistry confirmed benign reactive lymphoid hyperplasia. They followed for 2-108 months. No complications were detected during the follow up period. In masses of caruncle and plica with above-mentioned appearance, benign reactive lymphoid hyperplasia must be considered in the differential diagnosis. Pathologic and immunohistochemical evaluation should be performed to rule out lymphoma. Removal of these lesions incurs no complications in short-term period

[Acute comitant esotropia following penetrating keratoplasty]

To report a case of bilateral kertatoconus who presented with acute comitant esotropia after penetrating keratoplasty in the fellow eye. A 17-year-old male with keratoconus underwent penetrating keratoplasty in his right eye. He experienced diplopia after removal of the patch from the operated eye 12 hour postoperatively due to esotropia in his left [unoperated] eye. Diplopia was controlled using prism glasses and botulinum toxin A until penetrating keratoplasty was performed in his left eye which resulted in return of fusion which remained stable after 3 years of follow up. Acute comitant esotropia may occur after loss of fusion due to patching of one eye in a vulnerable patient. In this patient fusion was preserved with non-surgical methods until it was permanently returned surgically

[Association of helicobacter pylori infection with primary open angle glaucoma]

To compare the frequency of Helicobacter pylori [H. pylori] infection in subjects with primary open angle glaucoma [POAG] vs controls. In a case-control study, 44 patients with primary open angle glaucoma and 79 patients with senile cataract [control group] were investigated for serum level of anti-H. pylori antibody using the enzyme-linked immunosorbant assay [ELISA] method. The study included 26 male and 18 female subjects with mean age of 60.8 +/- 20.6 years in the case group and 44 male and 35 female subjects with mean age of 66.0 +/- 19.8 years in the control group. Seropositivity was higher in patients with glaucoma [70.5%] compared to controls [40.5%] with an odds ratio of 3.51 [95% confidence interval, 2.89-4.11; P= 0.001]. H. pylori infection is much more prevalent in patients with primary open angle glaucoma. Further investigations are required to evaluate the possible causative role of H. pylori infection in primary open angle glaucoma

[Prevalence of amblyopia and epidemiologic study of strabismus in Mashhad]

Strabismus or eye deviation is one of the important fields in pediatric ophthalmology and is the most common cause of amblyopia. Amblyopia is one of the leading of vision loss and monocular blindness and because it develops in the early years, it affects an individual for life. The earlier amblyopia is identified, the more successfully it is manged. In this analytical descriptive study, 107 patients, who referred to department of ophthalmology, Emam Reza hospital, from 2000-2003, were selected and a questionnaire was filled for each patient according to the medical records. Data were analyzed using SPSS 10 statistical software. 42.1% of our patients were male and 52% of them was female. Mean age of the patients was 13.22 years. Distribution curve of ages has two pick in 2-3 years and 14-19 years. According to the data, 86.0% of patients referred from Central Khorasan and only 0.9% of South Khorasan. 47.7% of patients were unaducated and 60.7% of them were esotropia. Amblyopia was seemed in 20.6% of the patients. The results of this study confirm the high prevalence of amblyopia among the strabismus patients. As attendance at follow up is often poor, pediatricians should be aware of the association to encourage opportunistic assessment and ophthalmological surveillance of this population. It is advisable to screen and perform optometrical and opthalmological examination, in the age that children are predisposed for amblyopia to prevent it

Double elevator palsy: a 10-year review of operated patients

To evaluate the clinical manifestations and surgical results in patients with double elevator palsy operated at Labbafinejad Eye Center from 1993 to 2004. The study was conduct on hospital records of 20 patients with double elevator palsy. Patients were classified in three groups including primary elevator muscle palsy [9 subjects], primary supranuclear palsy with secondary inferior rectus restriction [4 subjects] and pure inferior rectus restriction [7 subjects] according to results of forced duction test [EDT], force generation test [FGT] and Bell's reflex. Patients in the first group underwent Knapp procedure, the second group underwent Knapp procedure and inferior rectus muscle recession simultaneously and the third group underwent vertical recess-resect or mere inferior rectus recess operation. Success was defined as deviation /= 25% improvement in muscle restriction after all strabismus operations. The patients included 10 male and 10 female subjects with mean age of 12.6 yr [1.5-32 yr]. Mean follow up period was 22 +/- 20 months. Mean pre- and post-operative deviations were 32 +/- 8 PD and 3.8 +/- 8 PD [P<0.0001] and mean muscle restrictions before and after operation were -3.5 +/- 0.7 and -2.3 +/- 1.2 [P<0.0001], respectively. Overall success rate was 77% for correction of deviation and 80% for improvement in muscle restriction. Appropriate surgery must be individualized in patients with double elevator palsy. FDT, and FGT and Bell's reflex evaluation are useful to determine the underlying pathology and determine the optimal surgical procedure in each case