Extralesional triamcinolone acetonide injection in the treatment of small chalazion

Purpose: To evaluate the effect of extralesional triamcinolone acetonide (TA) injection in the treatment of small chalazion (diameter ? 5 mm). Methods: Prospective interventional clinal study that included patients diagnosed as chalazion of small size not responding to conservative management for at least 2 weeks. All patients were treated with extralesional TA injection (4 mg). Successful resolution of a chalazion was defined as a decrease in size to 1 mm or smaller. Results: Thirty?eight patients were included in the study. The resolution was achieved in 33 (87%) patients. Nineteen (50%) patients had complete resolution after the first injection, and 13 (34.2%) patients had complete resolution after the second injection. Chalazion near the lower punctum needed more times of injections than those elsewhere (P = 0.02). Conclusions: Extralesional TA injection is effective in the treatment of both primary and recurred small chalazia. It is a simple and cost?saving procedure and can be considered an alternative first?line treatment for small chalazion.

The role of the rhinostomy ostium size on functional success in dacryocystorhinostomy / O papel do tamanho do óstio da rinostomia no sucesso funcional em dacriocistorrinostomia

Abstract Introduction Endonasal and external dacryocystorhinostomy procedures have both been used for the treatment of post-saccular obstruction of the lacrimal system. Functional success of these surgeries depends on several factors. Objective To evaluate the status of the rhinostomy ostium with endonasal and external approaches in dacryocystorhinostomy operations and to determine the effect of ostium size on postoperative functional success. Methods The charts of the patients operated in our hospital between May 2017 and January 2019 were analyzed retrospectively (ethical approval number: 2018-12.04). The patients that were operated in the ophthalmology and otolaryngology departments were included in the study. Endoscopic rhinostomy ostium measurements, punctum lavage findings and complications were recorded at 8 weeks postoperative at the earliest. Results When the 64 patient charts were reviewed (76 operations), the mean ostium width was 1.85 ± 1.11 mm in the endonasal approach group and 3.60 ± 2.24 mm in the external approach group. The mean ostium areas in endonasal and external group were 14.61 ± 16.66 mm2 and 56.05 ± 60.41 mm2, respectively. The ostium was anatomically patent and punctum lavages were negative in 11 patients (6 patients in the endonasal approach group and 5 patients in the external approach group) and these cases were considered as functional failures. The rhinostomy ostium was significantly wider in the external approach group, but this was considered ineffective on functional outcomes. Conclusion Lacrimal duct stenosis can be successfully treated with endonasal and external methods. Tear drainage may be insufficient even in the presence of a patent ostium. Therefore, functional success should also be considered when evaluating the overall success of dacryocystorhinostomy. An anatomically patent ostium is definitely required, while it is believed that ostium size does not affect functional surgical success.

Resumo Introdução Dacriocistorrinostomia endonasal e externa têm sido usados para o tratamento de obstrução pós‐sacular do sistema lacrimal. O sucesso funcional dessas cirurgias depende de vários fatores. Objetivo Avaliar o status do óstio da rinostomia nas abordagens endonasal e externa em dacriocistorrinostomias e a importância do tamanho do óstio no sucesso funcional pós‐operatório. Método Os prontuários de pacientes operados em nosso hospital entre maio de 2017 e janeiro de 2019 foram analisados retrospectivamente (número de aprovação ética: 2018-12,04). Foram incluídos no estudo os pacientes operados nos setores de oftalmologia e otorrinolaringologia. Medidas do óstio da rinostomia endoscópica, achados à irrigação do ponto lacrimal e complicações foram registrados a partir da 8ª semana de pós‐operatório. Resultados Foram avaliados prontuários de 64 pacientes (76 operações); a largura média do óstio era de 1,85 ± 1,11 mm no grupo endonasal e de 3,60 ± 2,24 mm no grupo externa. As áreas médias do óstio no grupo endonasal e externa foram 14,61 ± 16,66 mm2 e 56,05 ± 60,41 mm2, respectivamente. O óstio estava anatomicamente pérvio e as irrigações do ponto lacrimal foram negativas em 11 pacientes (6 pacientes no grupo endonasal e 5 pacientes no grupo externa) e esses casos foram considerados como falhas funcionais. O óstio da rinostomia foi significativamente maior no grupo externo, mas sem relação com a eficácia nos resultados funcionais. Conclusão A estenose do ducto lacrimal pode ser tratada com sucesso com métodos endonasais e externos. A drenagem lacrimal pode ser insuficiente mesmo na presença de óstio pérvio. Portanto, o sucesso funcional também deve ser considerado ao avaliar o sucesso do procedimento. Embora um óstio anatomicamente patente seja necessário, o tamanho do óstio não afeta o sucesso cirúrgico funcional.

Puntoplastia en dos cortes modificada en estenosis de puntos y canalículos lagrimales inferiores / Modified two-snip punctoplasty for stenosis of inferior lacrimal points and canaliculi

RESUMEN Objetivo: Determinar los resultados alcanzados con la utilización de la puntoplastia en dos cortes modificada en el manejo de los pacientes con estenosis de los puntos y canalículos lagrimales inferiores. Métodos: Se realizó un estudio descriptivo y retrospectivo de una serie de casos, en el Hospital Universitario Clínico Quirúrgico "Comandante Manuel Fajardo", desde enero del año 2016 a diciembre de 2018. La muestra quedó conformada por 22 pacientes (38 ojos), sometidos a la técnica quirúrgica, y fue caracterizada de acuerdo con la edad, el sexo, el color de la piel, la bilateralidad, la localización anatómica de la obstrucción, los antecedentes patológicos personales, las complicaciones y la evaluación funcional final. Resultados: De un total de 22 pacientes, 17 estuvieron entre las edades de 60 y 79 años, el 72,7 por ciento del sexo femenino y el 86,4 por ciento con piel de color blanco. La blefaritis fue el principal antecedente oftalmológico encontrado (18,2 por ciento), la obstrucción fue bilateral en el 72,7 por ciento de los casos, y fundamentalmente a nivel del punto lagrimal (16 casos). El 86,8 por ciento no mostró complicaciones posoperatorias; 3 casos presentaron extrusión del tutor de silicona, los cuales estuvieron en relación con el fallo en el resultado final. En el 92,1 por ciento se constató el éxito de la cirugía. Conclusiones: La estenosis de la vía lagrimal se produce principalmente en mujeres, de raza blanca, mayores de 60 años y sin antecedentes patológicos referidos. La afectación es más frecuente a nivel del punto lagrimal. Con la técnica quirúrgica se logra un resultado excelente y con complicaciones mínimas(AU)

ABSTRACT Objective: Determine the results achieved by modified two-snip punctoplasty in the management of patients with stenosis of inferior lacrimal points and canaliculi. Methods: A retrospective descriptive study was conducted of a case series at Comandante Manuel Fajardo Clinical Surgical University Hospital from January 2016 to December 2018. The sample was 22 patients (38 eyes) undergoing the surgical technique. The variables studied were age, sex, skin color, bilaterality, anatomical location of the obstruction, personal pathological antecedents, complications and final functional evaluation. Results: Of the total 22 patients, 17 were in the 60-79 years age group, 72.7 percent were female and 86.4 percent were white. Blepharitis was the main ophthalmological antecedent (18.2 percent). Obstruction was bilateral in 72.7 percent of the cases, fundamentally at the lacrimal punctum (16 cases). 86.8 percent did not have any postoperative complication, whereas 3 presented extrusion of the silicone tutor. These were related to failure in the final result. Surgery was successful in 92.1 percent of the cases. Conclusions: Lacrimal duct stenosis prevails in white skin women aged over 60 years without reported pathological antecedents. The disorder is more common at the lacrimal punctum. The surgical technique used achieves excellent results with minimum complications(AU)

A Lacrimal Punctal Keratinizing Cyst of the Lower Lid

PURPOSE: We report an unusual case of a keratinizing cyst on the lacrimal punctum. CASE SUMMARY: A 49-year-old female presented with an outpouching punctal mass at the left lower lid that occurred a week prior to her visit. Histopathological examination revealed a cyst filled with keratin arranged in lamina and surrounding the bacterial colony. The epithelial wall was composed of multilaminar, keratinizing squamous epithelium without goblet cells. The features were consistent with a keratinizing cyst. There was no recurrence at 4 months after the excision, and the punctum was patent. CONCLUSIONS: Keratinizing cyst should be considered as a differential diagnosis of the cystic mass of the punctum. Because it has an excellent prognosis after surgical resection, complete resection should be performed if a keratinizing cyst is suspected.

An Unusual Case of Double Lacrimal Puncta

PURPOSE: Congenital double puncta are usually unilateral, and the accessory punctum exists on the medial side in a slit configuration that is distinct from the shape of the normal punctum. We report a case of an unusual case of double lacrimal puncta which the lateral, rather than the medial, punctum was judged to be the accessory punctum. CASE SUMMARY: A 39-year-old male patient with no underlying disease and no ophthalmologic history visited our clinic with right eye epiphora of 2 weeks duration. On slit lamp examination, double puncta were observed in the right lower eyelid and the remaining puncta were normal. On lacrimal syringing test and dacryocystography were performed and revealed incomplete obstruction with partial narrowing of the nasolacrimal duct. Silicone tube intubation was performed through the right lower medial punctum and symptoms improved postoperatively. CONCLUSIONS: The present case is an unusual case of double lacrimal puncta which has not been reported in Korea. Unlike the previous literature, the lateral, rather than the medial, punctum was judged to be the accessory punctum. Because accessory punctm can be present on the lateral side, it is necessary to distinguish between the accessory punctm and the main punctum through the accurate dacryocystography and lacrimal syringing test for the treatment of the patient.

Lacrimal punctal and peripunctal involvement in calcinosis cutis

Calcinosis cutis is a rare metabolic disorder characterized by cutaneous and subcutaneous deposition of insoluble calcium salts. Ocular adnexal involvement is uncommon but mostly seen in males and in the upper eyelid. Solitary lesions are more common than multiple. The treatment of choice is excision biopsy. Histopathological examination provides a definitive diagnosis. Directed systemic investigations help to rule out underlying pathologies and aids further management. The present case reports the punctal and peripunctal involvement in a case of ocular adnexal calcinosis cutis.

Successful micro-resection of lacrimal punctum neoplasm using XL -radiofrequency ablation skin apparatus under a microscope / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To study the therapeutic method of XL -radiofrequency ablation skin apparatus (invented by Rehabilitation medicine, PLA General Hospital) in micro-resecting the lacrimal punctum neoplasm and to observe its clinical effects. ·METHODS:XL-radiofrequency ablation skin apparatus was performed on 7 cases (7 eye lesions) of lacrimal punctum neoplasm including 3 intradermal nevus, 1 boundary nevus, 1 mixed nevus with inflammatory granuloma,1 inflammatory granuloma,and 1 squamous papillary cell tumor by separating layer, point and flake removing methods. The clinical effect was investigated 2-6mo postoperatively and leftover was removed by twice. The postoperative follow- up durations ranged from 6 to 60mo. ·RESULTS: Totally 6 cases (6 eye lesions) were cured successfully by once but 1 case by twice. They were all without recurrence, cicatrix, palpebral margin deformity, obstruction of lacrimal punctum, stenosis of lacrimal punctum or epiphora. Micro - resecting the lacrimal punctum neoplasm using the XL-radiofrequency ablation skin apparatus had several advantages, such as high accuracy,no cicatrix,no bleeding,no epiphora,no damage to the structure of lacrimal canaliculus, short operation time, little pain during the procedure, without hospitalization, slight inflammation reaction after procedure. ·CONCLUSION: The efficacy of XL - radiofrequency ablation skin apparatus is significantly more evident and highly accurate in micro - resecting lacrimal punctum neoplasm.

Therapeutic Effect of Squeezing the Punctum and Lacrimal Canaliculus in Canaliculitis Patients

PURPOSE: To report the therapeutic effect of squeezing the punctum and lacrimal canaliculus using Q-tips in canaliculitis patients. METHODS: From March 2004 to February 2014, 42 eyes of 42 patients diagnosed with canaliculitis at our clinic were retrospectively analyzed. To remove the discharge and concretions, the punctum and lacrimal canaliculus were squeezed using Q-tips without invasive procedures. RESULTS: The mean patient age was 56.39 years and mean follow-up period was 10.6 months. No statistical significance was observed in terms of rate of disease occurrence and mean age between males and females. Among the eyes analyzed, 30 (71.4%) were cured with only 1 squeezing procedure, 12 eyes (28.6%) required more than 2 procedures; 1 eye (2.3%) recurred and the period until recurrence was 3.8 months. CONCLUSIONS: Most studies support surgical management as the definitive therapy for canaliculitis to remove concretions that serve as a reservoir for bacteria. The gold standard treatments are curettage or canaliculotomy; however, these are not safe procedures and may result in epiphora in post-procedure patients due to the risk of lacrimal pump dysfunctioning or scarring of the canalicular system following invasive procedure. Squeezing punctum and lacrimal canaliculus only using Q-tips is effective in removing the canalicular concretions and without causing complications in the canalicular system.

To study the result of the therapeutic effect of Sea buckthorn oil using grab taper lacrimal punctum / Шинэ санаа Шинэ нээлт

Studied with comparing the results of the method of zone which using the Hippophae rhamnoides and normal zone to 22 people who got narrow of lacrimal punctum. In the result of treatment the people’s lacrimal punctum was widen for 64.2% and 64.2% repeated who are zoned normal and the people’s lacrimal punctum was widen for 75% and 12.5% repeated who are zoned with oil of Hippophae rhamnoides after 14-21 days. Here after future, we need to use research the method of using the oil of hippophae hamnoidesfor eyes practice.

Puntoplastia en el tratamiento de la queratoconjuntivitis seca / Punctum surgery for the treatment of keratoconjunctivitis sicca

Evaluar clínicamente de pacientes portadores de queratoconjuntivitis seca posterior a puntoplastia con la técnica de parche del punto lagrimal. Se realizó puntoplastia con la técnica de parche del punto lagrimal a 31 pacientes (62 ojos) portadores de queratoconjuntivitis seca grado 2, que acudieron a la consulta en el a±o 2006, y se utilizó conjuntiva autóloga en 16 pacientes (32 ojos) y mucosa labial, en 15 casos (30 ojos), y se les evaluó clínicamente al mes y a los tres meses de realizada la cirugía. En 26 pacientes se observó una mejoría subjetiva y objetiva después de colocarse el parche punctal, independientemente del tejido utilizado en la confección del parche. A los tres meses de la cirugía, 2 pacientes en los que se utilizó mucosa labial y 3 en los que se colocó conjuntiva no experimentaron mejoría. Ningún paciente empeoró ni se presentaron complicaciones. Se logró una mejoría clínica cuantitativa y cualitativa en el 83,87 por ciento de los pacientes portadores de queratoconjuntivitis seca grado 2, a los cuales se le practicó puntoplastia con técnica de parche punctal, independientemente del material utilizado.

Clinical evaluation of patients with keratoconjuctivitis sicca after a punctum surgery using the lacrimal point plug technique. Punctum surgery using the lacrimal point plug technique was performed on 31 patients (62 eyes) who suffered 2nd degree keratoconjuctivitis sicca and went to the ophthal mologist's office in 2006; autologous conjunctiva and labial mucosa were used in 16 patients (32 eyes) and 15 cases (30 eyes) respectively. They were all clinically evaluated one month and three months after surgery. Subjective and objective improvement was observed in 26 patients after the placing of punctual plug, regardless of the tissue. After three months of the operation, 2 patients who carried the labial mucosa plug and 3 patients with the autologous conjunctiva did not improve their condition. No patient got worse and complications did not occur. Quantitative and qualitative improvement was observed in 83,87 percent of patients with 2nd degree keratoconjunctivitis sicca, who were performed punctum surgery with the punctual plug technique regardless of the used material.

A Case of Congenital Accessory Punctum and Canaliculus in a Dry Eye Patient

PURPOSE: We report a case of congenital accessory punctum and canaliculus in a patient with dry eye, which had not previously been reported in Korea. METHODS: A 56-year old woman presented with dry eye that was more pronounced in the left eye than in the right. An accessory punctum was found in the left medial canthus. Dacryocystogram showed that the accessory punctum had an independent canaliculus which was connected to a normal upper canaliculus. RESULTS: The symptoms were relieved after permanent punctal occlusion of the lower and accessory puncta. CONCLUSIONS: Severe dry eye can be induced by congenital accessory punctum and canaliculus.

The Clinical Evaluation on the Patients Complaining of Epiphora

The clinical analysis on the etiologies was done along with frequency of the patient's complaints of epiphora.The etiologies of the fifty-four patients screened by fluorescein dye disappearance test were classified by the causative location of the lacrimal pathway. The average of the patient's ages was 48.7 years old and average duration of symptom was 26.1 months.The causative locations were punctum[35.2%], nasolacrimal duct, lacrimal pump and nasal cavity in following order.The most common causes of each group were senile lid laxity[5.6%] for lacrimal pump, conjunctivochalasis and punctual atresia[11.1%]for lacrimal pump, idiopathic narrowing[9.3%]for canaliculus and idiopathic narrowing[16.6%]for nasolacrimal duct.Probing was the most common past history[18.5%]and the kinds of treatment were dacryocystorhinostomy, punctoplasty, lid tightening, probing, and conjunctivod acryocystorhinostomy. These data are expected to be a useful guide of rapid diagnosis and appropriate treatment for the epiphora patients without complicate processes and discomfort.

Study of lacrimal Punctal Size in Normal Adults

To investigate of lacrimal punctal size in normal korean adults, we measured diameter and area of punctum and punctal papilla according to sex and age group using slit lamp photography in 120 persons, 120 eyes. In upper eyelid, the average diameter and area of lacrimal punctum were 0.57+/-0.2mmxo.29+/-0.1mm, 0.13+/-0.07mm2 andthe average diameter and area of punctal papilla were 1.34+/-0.37mmx0.89+/-0.24mm, 0.98+/-0.53mm2. In lower eyelid, the average diameter and area of lacrimal punctum were 0.61+/-0.17mmx0.3+/-0.1mm, 0.15+/-0.08mm2 and the average diameter and area of punctal papilla were 1.46+/-0.32mmx0.99+/-0.19mm, 1.15+/-0.4mm2. In size difference between lacrimal punctum, lower punctum was larger than upper punctum, but not statistically significant. In size difference between punctal papilla, lower papilla was significantly larger than upper papilla. There is no difference in punctal and papilla size between male and female. The size distribution of punctum was related to age, but size distribution of papilla was not.