[Eyelid surgery for refractory filamentary keratitis].

PURPOSE: Cases of filamentary keratitis that are unresponsive to conventional medical treatment methods are often encountered in the clinical setting. Here we report on cases of filamentary keratitis that showed no recurrence for long periods after performing eyelid surgery. SUBJECTS AND METHODS: Enrolled were 17 eyes of 13 patients with filamentary keratitis who had eyelid surgery (4 men and 9 women ranging in age from 54-89 years; mean age: 73.6 years). Ptosis operations were performed with blepharoptosis (14 eyes of 11 patients) and entropion operations were performed on cases with filamentary keratitis but without entropion (3 eyes of 2 patients). RESULTS: Following blepharoptosis, the filamentary keratitis disappeared in all cases except in one which experienced a recurrence of filamentary keratitis probably due to the recurrence of ptosis. However, the filamentary keratitis in that case also disappeared following reoperation for the blepharoptosis. After entropion surgery, the keratitis disappeared in all cases with eye drops. CONCLUSION: The satisfactory, long-term postoperative results obtained in this study suggest that eyelid surgery is an effective treatment for filamentary keratitis unresponsive to conventional medical treatment methods.

Histopathology of blepharoptosis induced by prolonged hard contact lens wear.

PURPOSE: To clarify histopathologically the structural features of blepharoptosis in prolonged hard contact lens wearers. DESIGN: Retrospective case-control study. METHODS: Biopsy specimens from identical sites at the levator aponeurosis and Mueller muscle from 15 long-term hard contact lens wearers were examined histopathologically (group 1). They comprised two men and 13 women with bilateral blepharoptosis ranging in age from 26 to 59 years (mean +/- SD, 44.4 +/- 10.70 years). The average length of hard contact lens wear was 25.4 years (range 12 to 40 years), and the average spherical equivalent refractive error was -9.100 diopters (range -2.825 to -20.375 diopters). We also examined specimens from 15 patients with involutional blepharoptosis who underwent levator resection; they comprised three men and 12 women ranging in age from 64 to 79 years (mean +/- SD, 72.3 +/- 4.38 years). RESULTS: All patients in group 1 manifested fibrosis and negligible fatty degeneration in Mueller muscle. In group 2, we detected mild fibrosis in Mueller muscle and fatty degeneration of the aponeurosis and Mueller muscle. CONCLUSIONS: Prolonged hard contact lens wear induces fibrosis in Mueller muscle and may result in contact lens-induced blepharoptosis.