Improvement of chronic epiphora symptoms after surgery in patients with different preoperative schirmer-test values.

BACKGROUND: To compare improvement of epiphora symptoms after surgery between patients who had different preoperative basal Schirmer test values. DESIGN: Retrospective comparative case-series study. PARTICIPANTS: Twenty-two consecutive patients (one eye/patient) undergoing surgery for chronic epiphora symptoms resistant to ≥ 6 months of medical treatments (who incidentally had a preoperative basal [oxybuprocain-HCL 0.4 %] Schirmer-test and a postoperative one-year follow-up) were ranked according to their preoperative basal Schirmer test values and divided into two groups of equal size: group I, patients with lower (0 to 6 mm) and group II, patients with higher (7 to 25 mm) Schirmer test values. INTERVENTION: Combination of Piffaretti's endocanlicular endoscopic lacrimal drainage (22 patients), lacrimal intubation (8 patients), lacrimal punctoplasty (22 patients), lateral canthoplasty (18 patients), and/or conjunctivochalasis (8 patients) surgical procedures. OUTCOME: Subjective self-perceptions of improvement of their epiphora symptoms was made by the patients one-year after surgery. RESULTS: While between groups I and II mean (± SD) preoperative basal Schirmer test values significantly differed (4 ± 3 mm/ 5 min vs. 10 ± 6 mm/ 5 min, p ≤ 0.001, Mann-Whitney rank sum test), the mean postoperative improvement of epiphora symptoms did not (82 ± 30 % vs. 76 ± 34 %, p = 0.92) and no significant (rho = -0.11, p = 0.62, Spearman rank correlation coefficient) correlation between Schirmer test values and symptoms improvement was found. In both groups > 70 % of patients reported ≥ 70 % (satisfactory) postoperative improvement. CONCLUSIONS: In the present study, patients who had different preoperative basal Schirmer test values reported having very similar epiphora symptoms improvement one-year after surgery.

Feasibility of not having a postoperative control at day-1 after outpatient oculoplastic surgical procedures.

BACKGROUND: After outpatient oculoplastic surgical procedures, to report the feasibility of a policy of planning the first post-operative control not at one day after surgery but at the time of suture removal or lacrimal drainage system irrigation. PATIENTS AND METHODS: A retrospective case-series chart review analysis in a tertiary referral center of hundred and five consecutive outpatients was performed. Surgical procedures: eyelid (75/105), transpunctal endoscopic lacrimal drainage (11/105), both eyelid and transpunctal endoscopic lacrimal drainage (15/105), orbita soft tissue (4/105). MAIN OUTCOME: number of patients who had a first post-operative control for a different purpose than the one planned by the policy and whether it led to additional interventions. RESULTS: Out of 105 patients, 95 had their first control 12 +/- 4 days (mean +/- SD) after surgery according to the established policy. In 10 patients the first control occurred earlier (3 +/- 1 days) without leading to additional medico-surgical interventions. CONCLUSION: After outpatient oculoplastic surgical procedures, it is possible, with apparently no major consequences, to plan the first post-operative control not on the first day after surgery but later at time of suture removal or lacrimal drainage system irrigation.

Eyelid sebaceous gland carcinoma in a young Caucasian man.

BACKGROUND: Eyelid sebaceous gland carcinoma is rarely observed in young Caucasian men. HISTORY AND SIGNS: A 28-year-old man was referred for a recurring chalazion of the eyelid that had been operated four times in the past two years. The chalazion-like lesion of the external third of the upper left eyelid was associated with a cystic lesion. Cytology of the fluid in the cyst and histology of the lesion were compatible with a sebaceous cell carcinoma. Magnetic resonance imaging revealed that the cystic lesion associated with the eyelid tumour was extending into the orbit. THERAPY AND OUTCOME: According to current clinical practice and experience, to increase the chance of survival of the patient, an orbital exenteration was conducted to remove the sebaceous cell carcinoma in total. CONCLUSIONS: Although rare, one should be aware that an eyelid sebaceous cell carcinoma can occur in a young Caucasian man and this diagnosis should be evoked in case of a recurrent chalazion.