Characteristics and Success Rates of Same Day or Asynchronous Bilateral External Dacryocystorhinostomy.

PURPOSE: To evaluate the characteristics of bilateral nasolacrimal duct obstruction (NLDO) carriers and success rates of same day (simultaneous) or asynchronous (different day) bilateral dacryocystorhinostomy (DCR). METHODS: This retrospective study included patients with bilateral NLDO who underwent bilateral external DCR between January 2010 to August 2015 at the King Khaled Eye Specialist Hospital, Saudi Arabia. Postoperative success rate was considered as subjective perception of no tearing bilaterally or failure if unilateral or bilateral tearing persists after surgery. Data were statistically analyzed with P <0.05 indicating significance. RESULTS: Of 57 patients undergoing bilateral DCR, 32 (56%) had same-day surgeries and 25 underwent asynchronous surgery. The median duration of follow up was 7 months. The success rates were similar for the same day group [61.3%-95% CI 49.4-73.2)] and for the asynchronous group [54.2% (95% CI 40.4-68.0)]. Success rate was not correlated to the age, gender, or use of stents. CONCLUSIONS: The authors strongly recommend bilateral same-day external DCR to treat bilateral NLDO since the success rate of the procedure is similar to the asynchronous surgery, allowing a full treatment in just 1 operative visit.

Dacryocystectomy: Indications and Results at Tertiary Eye Hospital in Central Saudi Arabia.

PURPOSE: To report indications and success rates of dacryocystectomy (DCT) in a tertiary hospital. METHODS: A retrospective chart review was performed of all patients who underwent DCT at the King Khaled Eye Specialist Hospital, Saudi Arabia, from 2008 to 2015. Data included patient demographics, symptoms before and after surgery, and complications. Univariate analysis using parametric and non-parametric methods was performed. RESULTS: Forty-seven DCT surgeries were performed over the study period. The median age of patients was 58.2 ± 2 years old, 63.8% were female, 60% of surgeries were performed on the left side, and 8% of patients underwent bilateral simultaneous DCT. Chronic dacryocystitis was the surgical indication for DCT for all of the patients and 23.5% of them had dry eye preoperatively. Successful treatment was observed in 80.8% of patients and 8.5% complained of tearing after DCT. CONCLUSION: The main indication for DCT in our hospital was chronic dacryocystitis with good outcomes for elderly patients with dry eyes.

Retrobulbar Injections for Blind Painful Eyes: A Comparative Study of Retrobulbar Alcohol Versus Chlorpromazine.

PURPOSE: The purpose of the study was to evaluate 2 agents used during retrobular injections to relieve pain in blind eyes. METHODS: This masked prospective randomized study compared retrobulbar injections for blind painful eyes that were divided into 2 groups: eyes in group 1 (G-I) received 1.5 mL of absolute alcohol (ethanol) and those in group 2 (G-II) received 1.5 mL of chlorpromazine (25 mg/mL). The pain was graded before, during, and after intervention using a verbal numeric visual analog scale. Intraocular pressure (IOP) and adverse events were also recorded. Complete success was defined as no pain after injection. Treatment failures were classified as further intervention (evisceration-enucleation) or no change in visual analog scale pain scores. RESULTS: Both groups included 16 patients each. Complete success was achieved in 7 of 16 (43.7%) patients in G-I and in 6 of 16 (37.5%) in G-II. The failure rate was 5 of 16 (31.3%) in G-I and 6 of 16 (37.5%) in G-II. Postoperative adverse events occurred in 33.3% of patients in G-I and 56% of patients in G-II. Transient eyelid edema was more prominent in G-II. Reduction in IOP occurred after injection in both groups. In G-I, IOP decreased from a mean of 24.3 to 14 mm Hg. In G-II, IOP decreased from 27 to 15 mm Hg. Five of the 7 (71.4%) patients with initial IOP>45 mm Hg suffered from severe pain. After injection, only 1 patient with an IOP>27 mm Hg had moderate pain. CONCLUSIONS: Retrobulbar alcohol or chlorpromazine decreased IOP and reduced pain in approximately two-thirds of blind painful eyes with few postoperative complications. However, 33% of patients required further intervention to manage pain.

Success Rates of Conventional Versus Endoscope-Assisted Probing for Congenital Nasolacrimal Duct Obstruction in Children 12 Years and Younger.

PURPOSE: To compare the success rates for congenital nasolacrimal duct obstruction (CNLDO) treated with conventional probing versus endoscope-assisted probing. METHODS: A retrospective nonrandomized comparison of the success rates in children (0 to 12 years) with CNLDO who underwent conventional probing or endoscope-assisted probing. Success was defined as absence of tearing or negative fluorescein dye disappearance test. Stent was evaluated. RESULTS: A total of 270 patients with CNLDO comprised the study population. The mean age was 37 months in the conventional probing group and 48.5 months in the endoscope-assisted probing group. The subjective and objective success rates were 76.1% and 75.9%, respectively, in the conventional probing group and 95.7% and 95.7%, respectively, in the endoscope-assisted probing group. The success rates were higher for both methods in the endoscope-assisted probing group (P < .005). The success rate decreased in older children in the conventional probing group (100% < 6 months; 62.5% > 48 months) and remained stable in the endoscope-assisted probing group (100% < 6 months; 97% > 48 months). Stent did not improve success. CONCLUSIONS: Endoscope-assisted probing increased success in older children and children with bilateral obstruction. [J Pediatr Ophthalmol Strabismus. 2016;53(5):292-299.].

The Versatile Lid Crease Approach to Upper Eyelid Margin Rotation.

Lid margin rotational procedures have been used to correct cicatricial trachomatous entropion since the 19(th) century. There are two basic types of surgeries used for lid margin rotation. The first type is based on through-and-through approach combining tarsotomy and the use of sutures on the anterior lamella. The second type of surgery was suggested by Trabut, who proposed a tarsal advancement by posterior approach. We demonstrate that using a lid crease incision combines the basic mechanisms of the anterior and posterior approaches and in addition, addresses a variety of lid problems commonly found in the aged population with cicatricial entropion. After tarsal plate exposure, a tarsotomy through conjunctiva is performed as described by Trabut. Then, instead of using external sutures secured by bolsters, internal absorbable sutures can be used to simultaneously advance the distal tarsal fragment and exert strong tension on the marginal orbicularis muscle. Sixty lids of 40 patients underwent surgery with a lid crease incision. The follow-up ranged from 1 to 12 months (mean 3.0 months ± 2.71). Forty percent of the patients (24 lids) had more than 3 months of follow-up. Adequate margin rotation was achieved in all lids but one that showed a medial eyelash touching the cornea.

Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures.

PURPOSE: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. METHODS: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. RESULTS: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. CONCLUSIONS: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures / Abordagem via sulco palpebral superior para a rotação marginal no entrópio cicatricial tracomatoso sem o emprego de suturas externas

ABSTRACT Purpose: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Methods: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. Results: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. Conclusions: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

RESUMO Objetivo: Descrever uma técnica de rotação marginal superior para a correção do entrópio cicatricial combinando incisão via sulco palpebral, tarsotomia e tração na lamela anterior sem o emprego de suturas externas. Métodos: Técnica cirúrgica. Os passos críticos da cirurgia incluem exposição completa da superfície anterior do tarso até a linha dos cílios e tarsotomia horizontal a 3 mm da margem palpebral, produzindo dois segmentos tarsais, marginal e distal. O fragmento distal é avançado sobre o marginal por meio de 3 suturas biagulhadas absorvíveis 6.0 passadas entre a margem do segmento tarsal distal e o músculo orbicular marginal. Dessa maneira, além da superposição tarsal as suturas tracionam o orbicular marginal evertendo simultaneamente a margem palpebral e a linha ciliar. Nenhum fio é exteriorizado. O retalho pretarsal miocutâneo era fechado com suturas de catugt 6,0. Resultados: Resultados: A técnica descrita foi utilizada em hospital terciário na Arábia Saudita, em 2013 e 2014. Sessenta pálpebras superiores de 40 pacientes (23 mulheres e 17 homens) foram operadas. A idade dos pacientes variou de 44 a 99 anos (média= 70,9 ± 13,01 anos). A cirurgia foi bilateral em 21 pacientes. O seguimento variou de 1 a 12 meses (média= 3,0 ± 2,71 meses). Em 24 pálpebras (40%) o seguimento foi superior a 3 meses. A posição da margem palpebral foi considerada boa em todos os casos. Somente 1 paciente com entrópio unilateral apresentou recidiva da triquíase (2 cílios). Conclusão: A margem palpebral de pacientes com entrópio cicatricial pode ser evertida utilizando-se incisão no sulco palpebral e suturas internas. A técnica descrita combina os princípios das cirurgias de Wies e Trabut e tem como principais vantagens incisão cosmética no sulco palpebral e o não uso de suturas externas. Adicionalmente, o acesso pelo sulco palpebral permite a correção de condições associadas, como dermatocálase, ptose ou retração palpebral.