Evaluation of anxiety and pain in eyelid surgery patients: a pilot study.

OBJECTIVE: A high level of preoperative anxiety may have negative consequences on the medical and psychological outcomes of a surgical intervention. The present study aims to identify the factors associated with high preoperative anxiety in eyelid surgery patients and to determine whether there is a relationship between preoperative anxiety and the pain felt during and after the procedure. DESIGN: Prospective single-centre pilot study between December 2017 and April 2018. PARTICIPANTS: Consecutive patients undergoing elective eyelid surgery. METHODS: The Amsterdam Preoperative Anxiety and Information Scale and a numeric rating scale were used to evaluate preoperative anxiety and need for information as well as peroperative and postoperative pain. RESULTS: Thirty-two patients were included. Mean age at surgery was 65.8 years. Most patients underwent lateral canthoplasty (44%) or ptosis surgery (25%), and all had local anaesthesia. Thirty-eight percent of the patients had a high level of preoperative anxiety (i.e., unsuited to the situation of the surgical stress). Factors associated with higher levels of preoperative anxiety were female sex, age under 65 years, no previous oculoplastic surgery, and unilateral surgery. Patients who felt pain during and after the procedure were found to have had higher levels of preoperative anxiety than the patients who felt no pain. CONCLUSIONS: A high level of preoperative anxiety may increase the pain felt by the patient during and after the surgical procedure. It is therefore important to implement anxiolytic measures before an eyelid surgery is performed, especially in patients who have a risk of elevated preoperative anxiety.

A Case of Velocardiofacial Syndrome With Bilateral Inferior Punctum and Canalicular Agenesis.

A 16-year-old girl diagnosed with velocardiofacial syndrome complained of occasional bilateral ocular discharge. Examination revealed an agenesia of the inferior puncti and canaliculi, while the irrigation through the superior puncta was patent on both sides. Dacryocystorhinostomy with insertion of Lester Jones tubes is not considered for the time being because of the absence of epiphora. To the best of the authors' knowledge, this is the second reported case of lacrimal system agenesia in velocardiofacial syndrome.

Colon cancer and IgG4-related disease with orbital inflammation and bilateral optic perineuritis: A case report.

RATIONALE: Immunoglobulin G4-related disease (IgG4-RD) is an inflammatory condition of unknown cause. Cancer might be related to the development of certain IgG4-RD but to date, little literature documents it. PATIENT CONCERNS: A 78-year old man presented with unilateral proptosis responsive to steroids, initially attributed to nonspecific orbital inflammation. DIAGNOSIS: Right hemicolectomy was performed because of a suspicious lesion which turned out to be tubulovillous adenoma on histological analysis. Eight months after the surgery, a mass infiltrating the mesentery was found and biopsy revealed IgG4-RD. INTERVENTIONS: Both the orbital inflammation and abdominal mass infiltrating the mesentery were responsive to steroids and rituximab administered to treat IgG4-RD. OUTCOMES: In the course of IgG4-RD, the patient developed bilateral optic perineuritis, causing bilateral visual loss. Colon cancer with synchronous multiple liver metastases was found 1 year after rituximab treatment. LESSONS: This case raises the possibility of IgG4-RD being a paraneoplastic syndrome in some patients. Cancer screening should probably be performed in some elderly patients diagnosed with IgG4-RD.

Bilateral self-inflicted infectious dacryoadenitis.

The aim of this report is to present a case of a patient with bilateral lacrimal gland abscesses in the course of dacryoadenitis. A 45-year-old female patient with a long history of cocaine abuse presented with bilateral bacterial dacryoadenitis and upper lid inflammation with purulent discharge from a palpebral wound of the right upper lid. The diagnosis was confirmed with microbiology culture and an orbital CT scan, which revealed lacrimal gland abscesses. The patient admitted to vigorous eye scratching, which we believe was the mechanism responsible for the process. The infection resolved on targeted antibiotic therapy. This is the first reported case of bilateral infectious dacryoadenitis produced in a self-inflicted mechanism in a cocaine addict.

Permanent blindness after endoscopic sinus surgery.

Few cases of ophthalmic complications have been reported following sinus endoscopic surgery with current techniques. Irreversible damage to orbital structures was found in a 21-year-old patient referred to our department for evaluation after sinus endoscopic surgery and ipsilateral amaurosis.

Hyaluronic acid treatment for upper eyelid retraction after glaucoma filtering surgery.

A 51-year old female presented with upper lid retraction after glaucoma filtering surgery. After two surgical procedures to correct the retraction with only transient effect, she was finally treated with hyaluronic acid gel filling achieving good aesthetic and functional result.

Predictability of conjunctival-Müellerectomy for blepharoptosis repair.

PURPOSE: To assess the predictability of the algorithm used to determine the amount of tissue resection for conjunctival-Müellerectomy during blepharoptosis repair. METHODS: A consecutive case series of all patients undergoing conjunctival-Müellerectomy during blepharoptosis repair between July 2001 and February 2005. All of the cases had a positive phenylephrine test, and the mean preoperative upper marginal reflex distance (MRD1) was +1.60 mm (range: -1 +/-3.5 mm). Each patient underwent excision according to the following algorithm: 10 mm of resection for 2 mm of ptosis, 8 mm of resection for 1.5 mm of ptosis, and 6 mm of resection for 1 mm of ptosis. RESULTS: Fifty-five patients underwent conjunctival-Müellerectomy during blepharoptosis repair on 73 eyelids, using the above algorithm. Thirty-seven cases were unilateral and 18 were bilateral. The mean postoperative MRD1 was +3.42 mm (range 0-+4.5 mm). Postoperative symmetry was found in 42 of 55 patients (76.4%) after one surgical procedure. Patient satisfaction based on contour, symmetry and height after one repair was achieved in 52 of 55 patients (94.55%). There were three reoperations for previous undercorrection. CONCLUSION: This algorithm quantifies conjunctival-Müellerectomy during blepharoptosis repair. Excellent and very predictable results are obtained by a technique that is both simple and achievable in a short operating time.

Comparison between motility of biointegratable and silicone orbital implants.

PURPOSE: To determine if there is a difference in motility between biointegratable orbital implants and silicone orbital implants in patients undergoing ocular evisceration. DESIGN: A retrospective comparative study. METHODS: We compared motility measuring the excursion of a mark on the conjunctiva at the center of the implant in eviscerated patients with silicone implants and biointegratable implants after same evisceration technique. RESULTS: Silicone implants had 0.5-mm increased movement in inferior and medial duction compared with biointegratable implants. The later had 0.1 mm of increased movement compared with silicone implants in lateral gaze. The greatest difference was in superior gaze, in which silicone implants had 1.5 mm more excursion than biointegratable implants. No significant difference was observed in horizontal and vertical movements between both groups. CONCLUSIONS: In our analysis, there does not seem to be any advantage, in terms of motility, in using biointegratable implants if "pegging" is not planned. Further studies are required.

Frontalis muscle flap advancement with a pulley in the levator aponeurosis in patients with complete ptosis and deep-set eyes.

PURPOSE: To offer an alternative to frontalis sling techniques to achieve a more horizontal traction vector force with the frontalis muscle flap. The proposed technique avoids malpositions such as pulling the upper eyelid in an anterior plane during maximum opening and ptosis of the eyelashes. METHODS: The technique, performed in 5 patients with complete unilateral ptosis and an absence of levator function, consisted of advancing a flap of frontalis muscle and creating a pulley with the aponeurosis of the levator muscle. Mean follow-up was 12 months. RESULTS: Ptosis was corrected in all 5 patients, with good aesthetic outcome. There were no cases of anterior eyelid advancement, entropion, or eyelash ptosis. The only complication was 1 case of lagophthalmos with corneal erosion. CONCLUSIONS: In this preliminary series, the technique was safe and effective for correcting severe blepharoptosis, with good aesthetic and functional results even in patients with deep-set eyes and without the eyelid malpositions that commonly occur in frontalis sling techniques.