The use of botulinum toxin A in the treatment of functional epiphora.

AIM: The purpose of this study was to investigate the hitherto undescribed effects of botulinum toxin A injected into the lacrimal gland in patients with functional epiphora. METHODS: A prospective non-comparative interventional case series study was designed to include patients with functional epiphora who presented to the Oculoplastic unit at the Wolverhampton and Midland Counties Eye Infirmary. Botulinum toxin A (2.5-5 units) was injected into the palpebral lobe of the lacrimal gland on the worst affected side via a transconjunctival approach under topical anaesthesia. Patients underwent a Schirmer test and provided a subjective evaluation of their epiphora symptoms, indoors and outdoors, at baseline and at 1, 4 and 13 weeks after injection. The mean score for symptoms indoors and outdoors was calculated. RESULTS: Fourteen patients agreed to take part in the study. Subjective epiphora scores improved in 8 out of the 11 patients (72.7%) who completed 13 weeks of follow-up. Schirmer test results showed objective reduction in tearing from baseline but did not strongly correlate with the subjective epiphora scores. Transient mild ptosis and diplopia were experienced by two patients. CONCLUSION: The results from this small pilot study are encouraging, although larger, controlled trials are needed to assess the optimal dose of BTX-A, its long-term efficacy and safety, and the role of multiple injections.

Otago Glaucoma Surgery Outcome Study. Atypical late failure of drainage following clear cornea trabeculectomy.

BACKGROUND: Bleb scarring is the major cause of late drainage failure following the standard trabeculectomy. To overcome this, Cairns described a modification of his original technique, which he termed the clear cornea trabeculectomy. The essential feature was communication between the anterior chamber and subconjunctival space without intraoperative disturbance of the conjunctival or Tenon's tissue. As there is little published data on Cairns' clear cornea trabeculectomy, this study aimed to assess the long-term success of this procedure relative to conventional trabeculectomy. METHODS: Patients who underwent clear cornea trabeculectomy at Dunedin Hospital were identified. Cases in which late failure occurred were subject to a detailed review. Records of all patients in whom late failure of drainage occurred following conventional trabeculectomy performed since 1985 were also reviewed. The nature of late drainage failure associated with these different procedures was assessed. RESULTS: Late failure of drainage occurred in three of 21 eyes following clear cornea trabeculectomy. In each case there was an accelerated drainage failure with a dramatic rise in intraocular pressure. Consequent visual loss occurred in two patients. Late failure occurred in 32 of the 450 cases of conventional trabeculectomy, in all of which the pressure rise was gradual and less acute. CONCLUSIONS: This report highlights a previously unreported type of late failure associated with clear cornea trabeculectomy, which may result in significant visual loss. This reinforces the view that the standard Cairns' trabeculectomy is a safer procedure.

Ocular surface squamous neoplasia: report of an unusual case and review of the literature.

OBJECTIVE: To describe a case of leukoplakia and underlying intraepithelial squamous cell neoplasia of the palpebral conjunctiva presenting in a patient wearing an ocular prosthesis. METHODS: The clinical presentation, histopathological findings and surgical outcome are described in a 62-year-old man in whom leukoplakic lesions of the palpebral conjunctiva in a socket fitted with an ocular prosthesis were noted in addition to squamous cell carcinoma of the lower lid skin. RESULTS: Histopathological examination revealed islands of squamous cell carcinoma in the skin lesion and squamous cell carcinoma-in-situ in the leukoplakic conjunctival specimen. Successful tumour excision and lid reconstruction were performed. CONCLUSION: This report highlights the successful treatment of long-standing conjunctival squamous cell carcinoma-in-situ associated with an ocular prosthesis and a general tendency to pre-neoplastic lesions of the skin. Regular examination of the sockets of patients wearing long-standing ocular prostheses is recommended.