Follow-up methods and the apparent success of entropion surgery.

PURPOSE: To determine if follow-up methods affect the apparent success rate of the surgical repair of involutional entropion. METHODS: A review of articles published in English between 1939 and 1997, and a review of a series of 112 patients who underwent entropion repair with a combination of a tarsal strip procedure, a partial pretarsal orbiculectomy, and creation of an eyelid crease. RESULTS: Only ten of 104 published reports contained information on the method by which follow-up data were attained. The apparent success rate of surgery in the case series declined in proportion to the effort made to detect unsuccessful cases. Long-term follow-up office examinations revealed cases of residual postoperative entropion that had not been detected by spontaneous patient complaints or by telephone interviews. CONCLUSION: Future reports on the results of entropion repair should include long-term follow-up that includes physical examination with testing to provoke latent entropion.

Tarsoconjunctival flap supplementation: an approach to the reconstruction of large lower eyelid defects.

In the presence of a full-thickness lower eyelid defect too large for reconstruction with a tarsoconjunctival flap alone, the posterior lamella is often reconstructed with a free graft of nasal septal cartilage and mucosa, ear cartilage, or hard palate mucosa. In this series, an alternative approach was taken: a tarsoconjunctival flap of maximum horizontal dimension was created to reconstruct the majority of the posterior lamella defect. A second reconstruction technique, such as a periosteal flap or a Tenzel semicircular flap, was then used to supplement the tarsoconjunctival flap and reconstruct the remainder of the posterior lamella defect. Tarsoconjunctival flap supplementation yielded favorable results in eight patients and is advocated for the reconstruction of large posterior lamella defects too large for reconstruction with a tarsoconjunctival flap alone.

Evaluation of lacrimal obstruction secondary to facial fractures using computed tomography or computed tomographic dacryocystography.

Facial fractures that result in lacrimal drainage obstruction may add complexities to lacrimal surgery. The role of preoperative assessment of lacrimal obstruction after facial fractures using computed tomography (CT) or CT dacryocystography was assessed in this study. Consecutive patients (n = 13) with symptomatic lacrimal obstruction after facial fractures underwent radiologic evaluation prior to lacrimal surgery. The first three patients underwent CT alone. The subsequent 10 patients underwent CT dacryocystography, in which radio-opaque dye was instilled into the lacrimal sac prior to CT. Radiographic findings pertinent to surgical management were present in 11 of the 13 patients and included alterations in bony anatomy, plates or wires adjacent to the lacrimal sac, nasal septal deviation, sinusitis, anterior ethmoid air cells, and anteriorly located middle turbinates. CT or CT dacryocystography prior to lacrimal surgery in patients with previous facial fractures may facilitate preoperative planning and intraoperative execution. It is recommended that the cost of these studies be minimized by adherence to streamlined protocols widely used in sinus CT.

Anophthalmic socket pain.

We examined and treated four patients with anophthalmic socket pain. Conditions responsible for this problem in this series included scleritis after evisceration, amputation neuroma, pain from a skull-base meningioma, and chemical dependency with drug-seeking behavior. The pain associated with the scleritis after evisceration responded to removal of the scleral remnant. The pain associated with the amputation neuroma responded to removal of the orbital implant and its pseudocapsule in which the amputation neuroma was embedded. The pain associated with the meningioma was intractable. The pain associated with the chemical dependency remained a persistent problem. A careful history and physical examination are critical in the evaluation of anophthalmic socket pain. Computed tomography or magnetic resonance imaging may be helpful in some cases.

Failure of collagen plugs to predict epiphora after permanent punctal occlusion.

In two patients with keratoconjunctivitis sicca, epiphora did not occur after temporary canalicular occlusion with collagen implants, but did occur after subsequent permanent punctal occlusion. This suggests that collagen implants may not always produce total occlusion. Patients should be warned of this possibility.

Conventional frozen sections in periocular basal-cell carcinoma: a review of 236 cases.

Two hundred thirty-six periocular basal-cell carcinomas were resected under conventional frozen-section control. Only two tumors recurred, yielding a success rate of 99.2%. The mean follow up was 56 months. Eighty-one of the 236 patients were followed for at least 5 years; the 5-year cure rate was 97.5%. To our knowledge, this is the largest reported series of periocular basal-cell carcinoma resected under conventional frozen-section control; also, we believe the follow-up data are superior to those of previous series. The high success rates with conventional frozen-section techniques in this and other series are comparable to those reported for the Mohs micrographic techniques.

Lacrimal obstruction after medial maxillectomy.

Medial maxillectomy can result in lacrimal obstruction and the need for subsequent dacryocystorhinostomy. Computed tomographic dacryocystography is a technique in which radiopaque dye is instilled in the lacrimal sac and computed tomography is subsequently performed. Computed tomographic dacryocystography facilitated the management of a patient with lacrimal obstruction after medial maxillectomy by helping to exclude recurrent tumor and sinusitis, and by providing a surgical "roadmap" in the presence of altered anatomy.

Evaluation of dacryocystorhinostomy failure with computed tomography and computed tomographic dacryocystography.

Five patients with dacryocystorhinostomy failures were examined with computed tomography or computed tomographic dacryocystography. In computed tomographic dacryocystography, radiopaque dye was instilled into the lacrimal sac before computed tomography to show its shape, location, and relation to surrounding structures. Problems with the bony ostium were detected in all five patients. Recurrent nasal polyposis, a retained metallic clip, and an unresected ethmoid air cell were also identified. Computed tomography and computed tomographic dacryocystography provided important information that facilitated reoperation after dacryocystorhinostomy failure.

Adrenal suppression and growth retardation after injection of periocular capillary hemangioma with corticosteroids.

Adrenal suppression and/or growth retardation were noted in two patients after injection of periocular capillary hemangiomas with corticosteroids. Parents should be warned of these two potential complications of intralesional corticosteroid therapy. Baseline and posttreatment adrenal function should be monitored. If iatrogenic adrenal suppression occurs, supplemental systemic corticosteroids may be necessary in situations involving systemic stress such as infection or surgery.