Effects of the Dibenzofuran, Usnic Acid, on Inhibition of Ocular Biofilm Formation Due to Coagulase-Negative Staphylococci.

BACKGROUND Coagulase-negative staphylococci (CoNS) are gram-positive, aerobic, commensal bacteria found on the skin and mucus membranes, including the conjunctiva. Usnic acid (UA) is a dibenzofuran derivative isolated from lichens. This study aimed to investigate the effects of usnic acid on inhibition of ocular biofilm formation due to CoNS. MATERIAL AND METHODS Nine Staphylococcus epidermidis isolates, 5 Staphylococcus hominis isolates, 2 Staphylococcus saprophyticus isolates, and 1 Staphylococcus capitis and Staphylococcus lentus isolates were taken as test bacteria. They were inoculated into brain heart infusion broth and incubated for 24 hours at 35°C and activated. Antibiotic susceptibility was investigated by Kirby-Bauer disc diffusion method. Biofilm production was determined using the microtiter plate method and optical densitometry was measured at 570 nm using an automated microplate reader. Anti-biofilm activity of UA was determined by microtitration method and biofilm removal percentage was calculated. RESULTS All tested bacteria were found as high biofilm-producer strains; they were generally resistant to methicillin, but susceptible to vancomycin. UA inhibited the biofilm formation of S. epidermidis isolates, ranging from 5.7% to 81.5%. It inhibited the biofilm formation of S. saprophyticus and S. lentus by 73.3% and 74.3%, respectively. There was no effect of UA on mature biofilms of S. epidermidis 17.7H, S. epidermidis 15.41, S. hominis 9.3, S. hominis 17.2H, S. saprophyticus, and S. lentus. CONCLUSIONS It was determined that UA exerted anti-biofilm activity on some CoNS isolated from the ocular surface. Anti-biofilm activity was found to be higher even in strains that did not show antibacterial activity.

Ophthalmic Emergencies and Effects of Different Quarantine Models During the COVID-19 Pandemic.

BACKGROUND The aim of this study was to evaluate the epidemiological features of the patients admitted to our emergency department (ED) during the COVID-19 pandemic in March, April, and May 2020, compare them with the patients in March, April, and May 2019, and to investigate the effect of various quarantine models. MATERIAL AND METHODS The records of 1206 eligible patients were reviewed. Age groups were divided according to their quarantine status. We recorded the reasons for patient presentation to the ED, the average number of patients in age groups according to quarantine days, and the problems reported by patients who presented to the ED according to quarantine days. RESULTS We enrolled 3016 of 3123 patients. The mean age was 36.4±17.3 years in 2019 and 37.8±16.4 years during the pandemic period (P=0.031). While 73.1% of the ED presentations were due to ocular trauma in 2019, it decreased to 70.7% in 2020. The proportion of those who presented to the ED during the weekend was 30.6% in 2019, but decreased to 23.9% in 2020 (<0.001). While 84.8% of trauma patients were ages 19-64 years in 2019, this rate increased to 88.9% during the pandemic (P=0.067). Non-trauma emergencies were more common than trauma emergencies in both periods in those over the age of 65 years. During the pandemic period, admissions to the ED were decreased in the quarantined age groups (P=0.001). CONCLUSIONS The changes in the number and characteristic of admissions for ophthalmic emergencies during the pandemic period may help planning allocation of healthcare personnel and resources in outpatient and emergency clinics.

Evaluation of Iridocorneal Angle, Choroidal Thickness, and Retinal Nerve Fiber Layer Thickness in Children With a History of Retinopathy of Prematurity.

PURPOSE: Retinopathy of prematurity (ROP) is proliferative retinopathy affecting premature infants associated with abnormal maturation of the retinal vasculature. We sought to evaluate iridocorneal angle, choroidal thickness, and retinal nerve fiber layer thickness (RNFLT) of the children that have a history of ROP using spectral-domain optical coherence tomography. PATIENTS AND METHODS: Fifty eyes of 28 children with a history of ROP and 46 eyes of 23 healthy school-aged children were included in this study. RNFLT, choroidal thickness, and iridocorneal angle parameters [trabecular iris angle, angle opening distance (AOD500), and trabecular iris space area (TISA500) 500 µm from the scleral spur] were evaluated using spectral-domain optical coherence tomography. Student t test was used to compare the mean of the parameters. Correlations between the variables were investigated based on the Pearson or Spearman correlation coefficient. RESULTS: Subfoveal (ROP: 253.98±42.5; control: 286.2±71.9; P=0.045), 500 µm (ROP: 242.04±41.8; control: 276.7±45.3; P=0.003), 1000 µm (ROP: 237±39.7; control: 270.15±55.93; P=0.007), and 1500 µm (ROP: 224.16±37.5; control: 259.75±55.2; P=0.003) temporal choroidal thicknesses were significantly thinner in ROP history children. None of the RNFLT parameters and ganglion cell complex thickness were different between groups. Iridocorneal angle parameters were significantly lower in children with ROP history. (trabecular iris angle: ROP=31.35±3.9 degrees, control=35.4±4.5 degrees, P<0.001; TISA500: ROP=0.167±0.05 mm, control=0.21±0.05 mm, P=0.003; AOD500: ROP=480.96±160.4 µm, control=542.95±161.2 µm, P=0.035). CONCLUSIONS: ROP is associated with differences in the iridocorneal angle. Possible iridocorneal angle pathology should be a consideration in children with a history of ROP.

Spectral domain optical coherence tomography findings in Turkish sickle-cell disease and beta thalassemia major patients.

PURPOSE: To assess probable structural changes using spectral domain optical coherence tomography (SD-OCT) on sickle-cell disease (SCD) and beta thalassemia major (B-TM) patients, without any retinal abnormalities. METHODS: This cross-sectional study included 32 B-TM, 34 SCD patients, and 44 healthy controls. One of the eyes of all participants was evaluated for SD-OCT and choroidal thickness, retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), ganglion cell complex (GCC). RESULTS: Age, gender, and intraocular pressure (IOP) were not statistically different between the three groups. Hemoglobin (Hgb), hematocrite (Htc), and ferritin levels were not statistically different between the SCD and B-TM groups. Choroidal thickness at the subfoveal region was statistically higher in the control group (353.79 ± 71.93) than in the B-TM (317.41 ± 53.44) and SCD (283.21 ± 63.27) groups. In addition, it was statistically higher in the B-TM group than the SCD group (P = 0.05). CMT did not differ among the three groups, average RNFL was only significantly thinner in SCD than in controls, and GCC thickness was significantly thinner in SCD than in controls and B-TM. CONCLUSION: In both diseases, we can show early structural changes even if proliferative or non-proliferative retinopathy or other ocular manifestations were not developed yet.

Palpebral Tarsal Solitary Neurofibroma

Solitary neurofibroma is a rare, benign tumor of the peripheral nerve sheath, and is often associated with neurofibromatosis type 1. Herein, a case of palpebral tarsal solitary neurofibroma in a patient without neurofibromatosis is presented, with a review of the literature. A 68-year-old man presented with a subcutaneous mass in the right upper eyelid of 6 months' duration. Eversion of the eyelid revealed a round, reddish mass on the lateral part of the tarsal plate which measured 12x8 mm in size. The lesion was excised with its tarsal base, diagnosed histologically, and did not recur during a follow-up of 34 months. Isolated, solitary neurofibroma of the eyelid has been reported in a total of 7 cases, including the case presented herein. The tumors arose from the eyelid margin in 4 cases, from the tarsal plate in 2 cases, and from the supratarsal conjunctiva in 1 case. The tumor did not recur after surgical excision in 5 cases for which follow-up data were available.

Evaluation of dry eye disease in newly diagnosed anxiety and depression patients using anterior segment optical coherence tomography.

BACKGROUND: We aimed to evaluate dry eye diseases (DED) in patients with newly diagnosed depression and anxiety patients. METHODS: Forty newly diagnosed depression, 35 anxiety patients, and 37 controls without any history of taking psychiatric drugs (or before the beginning of psychiatric medication) and topical ophthalmic drop use, were included in the study. All depression and anxiety diagnoses were performed by an experienced psychiatrist. Beck depression and anxiety tests were used to measure disease severity. Tear film break up time (TBUT), Schirmer's test, Oxford scores and ocular surface disease index (OSDI) were admiinistered to participants. Anterior segment optical coherence tomography was used to measure tear meniscus heights (TMH), tear meniscus depths (TMD) and tear meniscus areas (TMA). RESULTS: In anxiety and depression groups, Schirmer's test (mm) (7.24 ± 6.02, 6.58 ± 4.9 and 18.79 ± 4.9 respectively, p < 0.05) and TBUT (s) (5.62 ± 3.1, 5.6 ± 3.5 and 13.37 ± 1.7 respectively, p < 0.05) were significantly lower than control group. In addition, OSDI and Oxford scores were significantly higher than controls. OSDI scores were 28.01 ± 19, 30.43 ± 18.49, 14.38 ± 8.14 respectively (p = 0.002) and Oxford scores were 1.9 ± 0.7, 2.1 ± 0.6 and 0.7 ± 0.4 respectively (p = 0.001). TMD, TMH and TMA values were significantly lower in anxiety and depression groups compared with control groups. Correlations between disease inventory scores and dry eye tests were detected. CONCLUSIONS: This study showed a relation between DED and newly diagnosed anxiety and depression patients with no history of psychiatric drug use. The presence of correlation between dry eye tests and disease inventory scores strengthens this association. This is an important knowledge that need to be evaluated in these patients before starting psychiatric medication.

The newborn conjunctival flora at the post delivery 24 hours.

PURPOSE: The aim of this study was to investigate the aerobic conjunctival flora of neonates and the effects of delivery type on conjunctival flora development in neonates who were born with normal spontaneous vaginal delivery (SVD) or elective caesarean section (C/S) and who were not given prophylactic antibiotic eye drops after birth. METHODS: This cross-sectional study included 95 healthy newborns. One day after the delivery, conjunctival samples were taken from newborns who were born with normal SVD or elective C/S, and not given prophylactic antibiotic eye drops after birth. Newborns with conjunctival hyperemia and discharge were excluded from study. Samples were plated in blood agar, EMB, and chocolate agar. These cultures were incubated at 37 °C for 24-48 h. Antibiotic sensitivity was evaluated using Kirby-Bauer disc diffusion method. RESULTS: Staphylococcus aureus (S.aureus) growth was observed in 7 (70%) and coagulase negative staphylococcus (CNS) growth in 2 (20%) out of 10 eyes with bacterial growth in 9 culture positive newborns born with C/S. Two S.aureus strains were resistant to methicillin. On the other hand, CNS growth was observed in the conjunctival cultures of 17 out of 19 eyes with bacterial growth in 16 culture positive newborns born with SVD. In 2 eyes with CNS growth, there was also S.aureus growth. The positive cultures for S.aureus were significantly higher in the conjunctival cultures of neonates born with C/S compared to neonates born with SVD, where CNS growth was significantly lower (P = 0.002). All isolates were susceptible to vancomycin, teicoplanin, and gatifloxacin. Two isolates were resistant to methicillin. CONCLUSIONS: In deliveries with C/S, the newborn does not contact the vagina. This may result in changes of bacterial characteristic of the flora. Culture positivity for S.aureus was higher in C/S compared to SVD, which may be important in case neonatal conjunctivitis develops.

Biofilm forming capacity and antibiotic susceptibility of Staphylococcus spp. with the icaA/icaD/bap genotype isolated from ocular surface of patients with diabetes.

INTRODUCTION: Bacterial biofilm is an exopolysaccharide matrix that is produced by bacteria while they adhere on abiotic or biotic surfaces. The bacteria living in this matrix are more resistant to antibiotics than planctonic bacteria. The biofilm formation property of the bacteria is determined by genes; and this is related to virulence of the microorganism. In ophthalmology, biofilms form especially on abiotic surfaces such as silicon tubes, contact lenses, intraocular lenses etc. AIM: Our aim was to investigate genotypic and phenotypic structures of biofilms that are produced by Staphylococcus spp., which was obtained from the eyes of diabetic patients and determine the effect on antibiotic susceptibility. METHODS: The study group was comprised with 83 isolates from diabetic patients and 21 isolates from non-diabetic patients. Presumptive isolates were detected and confirmed by a microbial identification system VITEK II. Automated EcoRI Ribotyping was performed. Biofilm production was detected by Congo Red Agar Plate and Microtiter Plate Assay. Disc diffusion method was used for determination of antibiotic susceptibility of isolates. RESULTS: Out of the 83 isolates from diabetic patients, 25 were weakly (30%), 20 were moderately (24%), and 25 were strongly (30%) biofilm positive. Seven isolates of S. aureus, 11 isolates of S.epidermidis, 2 isolates of S. warneri, 3 isolates of S.hominis, and 2 isolates of S.lugdunensis were identified as strong biofilm producers. Out of the 83 Staphylococcus isolates, 37 were cefuroxime, 18 ciprofloxacin, 11 vancomycin, 12 gatifloxacin, and 18 moxifloxacin resistant. In total, 37 strains were resistant to three or more antibiotics. There was a statistically significant relation between biofilm formation and multidrug resistance (against three or more antibiotics, p<0.001). In nondiabetic patients, 15(71%) isolates were non adherent or weakly adherent, and 2(10%) were strongly adherent biofilm positive. CONCLUSION: In conclusion, bacterial conjunctival flora of patients with diabetes is likely to produce biofilm. Biofilm formation is associated with multidrug rsistance in patients with diabetes.

A Clinical Scoring System for Diagnosis of Ocular Demodicosis.

BACKGROUND Demodex may cause chronic and refractory blepharitis with associated ocular surface problems, and its diagnosis and treatment can be quite challenging. In this study, our aim was to assess the efficacy of tea tree oil in Demodex treatment on caucasian patients in an industrialized region of Turkey, and to develop a systematic scoring system for extremely accurate diagnosis in the absence of advanced facilities. MATERIAL AND METHODS Charts of 412 patients with blepharitis were reviewed. A group of 39 out of 412 cases were identified as chronic and treatment-refractory, and therefore were enrolled in this study. Eyelashes from each of the lower and upper eyelids of both eyes were evaluated at ×40 and ×100 magnification using light microscopy. Treatment was started with 4% tea tree oil eyelid gel and 10% eyelash shampoo. Symptoms and findings were scored according to the most common complaints. RESULTS The mean age of the patients was 54.1±15.4 years. Seventeen (43.5%) patients were male and 22 (56.5%) patients were female. In 30 out of the 39 patients (76.9%) D. folliculorum was detected. Symptoms disappeared in 25 patients. The mean score of patients who were Demodex-negative was 2.7±1.0, and the mean score of patients who were Demodex-positive was 3.8±1.6 (p=0.047). Ninety-four percent of those with a score of 4 and over were found to be Demodex-positive (p=0.025). CONCLUSIONS Treatment with tea tree oil can be successful. If there is no facility to identify Demodex under light microscopy, we recommend starting treatment for patients who have scores of 4 and over using the scoring chart developed in this study.

Prevalence and associated factors of external punctal stenosis among elderly patients in Turkey.

PURPOSE: To estimate the prevalence of external punctal stenosis (EPS) in the elderly population and investigate associated factors. METHODS: A total of 278 patients ≥65 years of age were evaluated for evidence of EPS from January to July 2016. Associated systemic, ocular, demographic, and lifestyle factors were investigated. Multiple logistic regression analyses were applied to evaluate the factors related to having EPS. P values <0.05 were considered statistically significant. RESULTS: The prevalence of EPS in this study population was 63.3%, with a mean age of 70.67 ± 7.85 (65-92 years). The ocular factor that was most commonly related to EPS was chronic blepharitis (48.9%). EPS was also associated with taking glaucoma medications (95% CI, 0.08-0.96, p=0.043), smoking history (95% CI, 0.13-0.84, p=0.021), ectropion (95% CI, 0.004-0.26, p=0.001), complaints of tearing (95% CI, 1.11-3.52, p=0.02), and outdoor occupational activity (95% CI, 3.42-9.97, p<0.05). CONCLUSIONS: EPS is more common in elderly patients than in the general population. Outdoor occupational activity, taking antiglaucomatous medications, ectropion, and smoking are significantly associated with EPS. In addition, surgical treatment decisions should be made after complete evaluation and interviewing the patients.

Comparison of Biofilm Formation Capacities of Two Clinical Isolates of Staphylococcus Epidermidis with and without icaA and icaD Genes on Intraocular Lenses.

OBJECTIVES: To compare biofilm formations of two Staphylococcus epidermidis (S. epidermidis) isolates with known biofilm formation capacities on four different intraocular lenses (IOL) that have not been studied before. MATERIALS AND METHODS: Two isolates obtained from ocular surfaces and identified in previous studies and stored at -86 °C in 15% glycerol in the microbiology laboratory of the Anadolu University Department of Biology were purified and used in the study. The isolates were S. epidermidis KA 15.8 (ICA+), a known biofilm producer isolate positive for icaA, icaD and bap genes, and S. epidermidis KA 14.5 (ICA-), known as a non-biofilm producer isolate negative for icaA, icaD and bap genes. The biofilm formation capacities of the 2 isolates on 4 different IOLs were compared. Two of the IOLs were acrylic (UD613 [IOL A], Turkey; SA60AT [IOL B], USA), and the other two were polymethyl methacrylate (PMMA) (B60130C [IOL C], India; B55125C [IOL D], India). Bacterial enumeration and optical density measurements were done from biofilms that formed on the IOLs. Biofilms were imaged using scanning electron microscopy. RESULTS: Mean bacterial counts on the IOLs were 7.1±0.4 log10 CFU/mL with the ICA+ isolate, and 6.7±0.8 log10 CFU/mL with the ICA- isolate; there were no statistically significant differences. Biofilm formation was lower with acrylic lenses than PMMA lenses with both isolates (p=0.009 and p=0.013). The highest biofilm production was obtained on IOL C (PMMA) (p<0.001) and the lowest was obtained on IOL A (hydrophilic acrylic) (p<0.001). CONCLUSION: Bacterial counts after biofilm formation were lower on acrylic lenses, especially hydrophilic acrylic with hydrophobic properties. Further animal and in vivo studies are required to support the findings of this study.

Demographic Characteristics and Clinical Outcome of Work-related Open Globe Injuries in the Most Industrialised Region of Turkey.

OBJECTIVES: To evaluate demographic characteristics and clinical outcomes of work-related open globe injuries in the most industrialized region of Turkey. MATERIALS AND METHODS: The demographic and medical records of patients with work-related open globe injuries who presented to the ophthalmology or emergency departments with an official occupational accident report were retrospectively reviewed. Visual acuity categories were defined according to the World Health Organization. The injury types and zones of the open globes were classified according to Birmingham Eye Trauma Terminology System. RESULTS: Among 479 patients with work-related eye injuries in 5 years, there were 102 eyes of 101 patients with open globe injuries (21%). The mean age of the patients was 34.5±8.9 years with a mean follow-up of 12.5±12.6 months. The injuries peaked in June in the hour between 12:00 and 13:00. Eighty-six percent presented to emergency services within 12 hours after the injury. Twenty-two percent of the patients had been wearing protective eyewear at the time of injury. The open globe injuries were penetrating in 51%, intraocular foreign body in 40%, rupture in 7% and perforation in 2% of the eyes. The most frequent finding was traumatic cataract. Final visual acuity of 33.3% of patients was below 3/60. Seventy-eight percent of patients that had visual acuity worse than 6/18 at presentation had visual acuity of 6/18 or better at final visit. Sixty-three percent of eyes which had injuries involving all 3 zones resulted in phthisis bulbi, enucleation or evisceration. CONCLUSION: Work-related open globe injuries may have severe consequences such as visual impairment and blindness among the young male working population in industrialized areas. Nearly half of the occupational open globe injuries resulted in visual impairment and blindness.

Comparison of Retinal Nerve Fiber Layer Thickness in Terms of Birth Weight in Prematurely Born Children.

PURPOSE: To study the potential effects of both prematurity and the sub-groups of low birth weight on thickness of RNFL. METHODS: Prospective case series of 26 preterm school-aged children with low birth weight whose retinal nerve fiber layer analyses with RTVue-100 Fourier-domain optic coherence tomography were performed in 2013 at the Department of Ophthalmology, Erzurum Region Education and Training Hospital. RESULTS: The mean retinal nerve fiber layer thicknesses were 100.6 ± 13.3 microns in extremely low birth weight, 103.9 ± 8.4 microns in very low birth weight, and 104.1 ± 10.8 microns in low birth weight groups. There was no significant difference in RNFL among the groups. CONCLUSIONS: No significant relationship was found between birth weights and retinal nerve fiber layer thickness of preterm children who were appropriate for gestational age.

Comparison of central corneal thickness estimated by an ultrasonic pachymeter and non-contact specular microscopy.

PURPOSE:: To compare central corneal thickness (CCT) measurements of healthy individuals obtained with ultrasonic pachymetry (UP) and non-contact specular microscopy (NCSM). METHOD:: In total, 148 eyes of 74 subjects with no ocular or systemic diseases were included in the study. Central corneal thickness measurements of all patients performed with UP and NCCM were compared. RESULTS:: A total of 74 subjects (38 females) were included in this study. The mean age was 45.2 ± 18.4 (range 12-85) years. The mean central corneal thickness of all 148 eyes was 546.9 ± 40 µm with UP and 510.8 ± 42 µm with NCSM. The mean central corneal thickness measured with NCSM was 35 µm thinner than that measured with UP (p<0.001). A high degree of agreement was found between the two methods (r=0.942, p<0.001). CONCLUSIONS:: Our results suggest that NCSM measures thinner corneas than UP and that the correction formula we identified should be applied when comparing between these two devices.

Relationship among Corneal Biomechanics, Anterior Segment Parameters, and Geometric Corneal Parameters.

Purpose. To investigate the relationship between corneal biomechanical parameters, anterior segment parameters, and geometric corneal parameters in a healthy Caucasian group. Methods. This retrospective study included the healthy eyes with best corrected visual acuity of at least 20/40 of 122 Caucasian subjects. The anterior segment parameters and geometric corneal parameters such as corneal volume, central corneal thickness, horizontal and vertical corneal radii, anterior and posterior steep, and flat keratometric values were measured with a Scheimpflug camera. The biomechanical properties were measured with Ocular Response Analyzer. Results. One hundred and twenty-two healthy Caucasian subjects (67 males, 55 females) with a mean age of 45.32 ± 20.23 were enrolled. Both corneal hysteresis and corneal resistance factor were positively correlated with CCT (r = 0.529, p < 0.001; r = 0.638, p < 0.001) and CV (r = 0.635, p < 0.001; r = 0.579, p < 0.001) and negatively correlated with age (r = -0.373, p < 0.001; r = -0.249, p < 0.001). Both in age-gender and multivariate models, CH and CRF had statistically significant negative association with the posterior steep K value. Conclusions. CH and CRF are negatively correlated with posterior steep and average posterior K values.

Antibiotic susceptibility, antibacterial activity and characterisation of Enterococcus faecium strains isolated from breast milk.

Enterococci, which have useful biotechnological applications, produce bacteriocins, including those that exert anti-Listerial activity. The present study aimed to determine the antibiotic susceptibility patterns and antimicrobial activity of Enterococcus faecium strains isolated from human breast milk. The strains were identified using carbohydrate fermentation tests and ribotyping. Subsequently, the antibacterial activity of the isolates was investigated, and the quantities of lactic acid and hydrogen peroxide produced, and the proteolytic activity of E. faecium, were determined. In addition, biofilm formation by E. faecium strains was assessed. E. faecium strains exhibited antimicrobial activity against food-borne and clinical bacterial isolates. Furthermore, following 24 h incubation, the tested strains exhibited resistance to a pH range of 2.0-9.5 and tolerance of bile acid, lysozyme activity and phenol. Supernatants of the E. faecium TM13, TM15, TM17 and TM18 strains were shown to be effective against Listeria monocytogenes, and were also resistant to heat. Further studies are required in order to determine whether certain strains of E. faecium may be used for the development of novel antibacterial agents.

How Important Is the Etiology in the Treatment of Epiphora?

Purpose. There are several etiological factors that cause epiphora, and treatment differs according to the cause. We aimed to evaluate the etiology of epiphora and the treatment modalities of the affected patients. Materials and Methods. Data of patients who were referred to ophthalmology clinics for epiphora were retrospectively analyzed. All patients were evaluated for epiphora etiology, treatment modalities, and duration of complaints, after complete ophthalmologic examination. Results. This study consisted of 163 patients with a mean age of 64.61 ± 16.52 years (range 1-92 years). Lacrimal system disease (48.4% [79/163]) was the most common cause, followed by ocular surface disease (dry eye/blepharitis) (38.7% [63/163]). Among the patients included in this study, 69% (113/163) did not receive any treatment, whereas only 1.8% (3/163) were treated surgically. About 4.3% of the patients (7/163) had a complaint for more than 5 years (p = 0.012) and six of these had chronic dacryocystitis and one had ectropion. Conclusion. Epiphora not only has a negative impact on patients' comfort, but also puts them at risk for probable intraocular operations in the future. Therefore, the wide range of its etiology must be taken into consideration and adequate etiology-specific treatment options must be applied.

An Important Cause of Blindness in Children: Open Globe Injuries.

Objective. Our aim was to present and evaluate the predictive factors of visual impairment and blindness according to WHO criteria in pediatric open globe injuries. Methods. The medical records of 94 patients younger than 18 years who underwent primary repair surgery were reviewed retrospectively. The initial and final visual acuity, anterior and posterior segment findings, and zone of injury were noted. The patients were classified as blindness in one eye or visual impairment in one eye. Results. Of 412 patients who presented with open globe injury, 94 (23%) were under 18 years old. Fifty-four (16 females, 38 males) children were included. The mean age of the children was 7.1 ± 4.1 years. According to WHO criteria, 19 of 54 patients (35%) had unilateral blindness and 8 had unilateral visual impairment (15%). There was no significant relationship between final visual acuity and gender and injured eye. In visually impaired and blind patients, presence of preoperative hyphema, retinal detachment, and zone 2 and zone 3 injuries was significantly higher. Conclusion. Presence of hyphema and zone 2 and zone 3 injuries and retinal detachment may end up with visual impairment and/or blindness in children.

Isolated bitemporal hemianopsia due to traumatic chiasmal syndrome.

A 20-year-old man presented with complaints of inability to see the outer half of objects and blurred near vision while reading. His complaints began one year ago after a motor vehicle accident that caused cranio-orbital fractures. Ocular examination revealed complete bitemporal hemianopsia and slight exotropia. Central visual acuity was 20/20 in both eyes. Radiologic studies demonstrated fractures in the fronto-ethmoid and sphenoid bones and thinning of the optic chiasm. No hypothalamic-pituitary abnormality was detected. Clinical findings remained unchanged during follow-up. Although rare, blunt head trauma may cause an isolated damage to the chiasmal crossing nerve fibers, resulting in a complete, bitemporal hemianopsia associated with normal visual acuity. Traumatic chismal syndrome should be considered in the differential diagnosis of patients presenting with bitemporal hemianopsia.

Post-thyroidectomy iatrogenic Horner's syndrome with heterochromia.

PURPOSE: To present a case of iatrogenic Horner's syndrome seen together with the heterochromia in the post-thyroidectomy period. METHODS: A 23-year-old female patient was admitted to our clinic with complaints of low vision in the eye and difference in eye color that developed over the past two years. In the left eye, myosis and minimal ptosis (∼1 mm) was detected, and the color of the iris was lighter than the right eye. RESULTS: The pre-diagnosis of left iatrogenic Horner's syndrome was finalized after 0.5% topical apraclonidine test. CONCLUSION: Heterochromia can be observed in iatrogenic Horner's syndrome.