Haemolacria: A Novel Approach to Lesion Localization.

PURPOSE: To report the use of punctal plugs as a new modality to assist in the localization of lesions providing symptomatic relief in patients with haemolacria during their workup. METHODS: Retrospective case series. RESULTS: One boy and one girl, ages 16 and 20, respectively, reported spontaneous bloody tearing. Workup included probing and irrigation of the nasolacrimal system, blood and coagulation profiles, blood typing, serum hormone levels, conjunctival biopsy, and imaging. All findings were normal and failed to suggest a cause in any of the cases. Punctal plugs were inserted into each patient's inferior punctum OS without complication. On initial follow-up visits, each patient reported cessation of bloody tears OS with continued bloody tears OD. Over time, both patients experienced complete cessation of haemolacria in both eyes. CONCLUSIONS: Haemolacria is a condition caused by a group of disorders that result in the production of tears that are partially composed of blood. The large majority of cases result in a specific diagnosis. Only rarely does workup result in undetermined etiology. The novel approach of utilizing punctal plugs in the management of haemolacria may not only provide symptomatic relief for lesions distal to and including the punctum, but also assists in anatomic localization in idiopathic cases.

Contrast Sensitivity Testing in Functional Ptosis and Dermatochalasis Surgery.

PURPOSE: To assess whether taped versus untaped contrast sensitivity testing reliably predicts improvement following eyelid-lifting surgery in patients with ptosis and/or dermatochalasis. METHODS: This prospective study compared pre- and postoperative near contrast sensitivity in patients presenting to 2 ophthalmic plastic surgery practices with functional dermatochalasis and/or ptosis as determined by Humphrey visual field testing. Contrast sensitivity was measured using Mars near cards, held at 40 cm under standard lighting conditions. Logarithmic contrast sensitivity scoring cards were used for analysis. Marginal reflex distance was also collected. Pairwise comparison was used to assess the preoperative and postoperative contrast sensitivity scores. This study was conducted under the approval of the institutional review board. RESULTS: Seventy-eight eyes of 41 patients with ptosis +/ dermatochalasis underwent eyelid-lifting surgery. The mean preoperative untaped contrast sensitivity was 1.30. The mean preoperative taped and postoperative log contrast sensitivities were 1.52 (11.85% increase) and 1.51 (11.44% increase), respectively. The difference between the 2 groups was not statistically significant (p = 0.864). The marginal reflex distance improved by a mean of 2.0 (p < 0.0005). CONCLUSIONS: Contrast sensitivity improves significantly following blepharoplasty and ptosis surgery. The degree of improvement in contrast sensitivity can accurately be predicted by preoperative taped/untaped testing. Contrast sensitivity testing may provide an additional screening modality for functional dermatochalasis and ptosis. In the future, contrast sensitivity may provide an additional preoperative assessment tool in patients who do not meet traditional visual field screening standards or who are unable to perform classic visual field testing.