Orbital inflammation developing from epidemic keratoconjunctivitis in an adult.

INTRODUCTION: We report a rare case of epidemic keratoconjunctivitis (EKC) that developed into an orbital inflammation in an adult. CASE PRESENTATION: A 67-year-old Korean man, who had been diagnosed with EKC and treated for conjunctival injection and chemosis in the right eye for 4 days, was referred to Oculoplastics as orbital cellulitis was suspected. At the point of referral, clinical features such as decreased visual acuity, severe eyelid swelling, chemosis, follicles, corneal edema, limitations in lateral eye movement, and diplopia were observed in the right eye. Orbital cellulitis was suspected according to orbital computed tomography scan images, but there was no response to systemic antibiotics. Systemic steroid was administered instead, and then his symptoms and signs started to improve. The final diagnosis of this patient was orbital inflammation related to EKC based on the facts that there was no response to antibiotics, that he presented with contralateral symptoms and signs, that pseudomembrane formation occurred in both eyes, and that the symptoms resolved completely after 2 weeks. CONCLUSION: Clinicians need to consider the possibility of orbital inflammation developing from EKC, even in an adult patient, and treat the patient properly if the EKC symptoms and signs, such as conjunctival injection and follicles, are accompanied with symptoms and signs similar to orbital cellulitis.

Prognosis of upper eyelid epiblepharon repair in down syndrome.

OBJECTIVE: To evaluate the recurrence rate after upper eyelid epiblepharon repair in patients with Down syndrome. DESIGN: Retrospective, observational study. METHODS: Total of 578 Korean children (21 with Down syndrome patients, 557 with non-Down syndrome patients), who had undergone epiblepharon repair and were followed up for more than 2 months, were included in this study. The recurrence rate was compared between two groups at 2, 6 months after surgery. Recurrence was defined as the re-appearance of cilia touching to cornea. The recurrence rate was also analyzed according to whether patients had undergone concomitant z-medial epicanthoplasty or not. RESULTS: Lower eyelid epiblepharon repair was performed on 22 eyelids of Down syndrome patients, and 1072 eyelids of non-Down syndrome patients. At 3 months after surgery, the recurrence rate was not significantly different between two groups (P = 1.00). Upper eyelid epiblepharon was repaired on 40 eyelids of Down syndrome patients, and 204 eyelids in non-Down syndrome patients. At 2 and 6 months after surgery, the recurrence rate was significantly higher in Down syndrome patients (27.5% and 29.4%) than non-Down syndrome patients (3.4% and 4.6%) (P = 0.000, P = 0.004, respectively). The recurrence rate of upper eyelid epiblepharon repair was not affected in both groups whether Z-epicanthoplasty was combined or not (P = 1.00 in both groups). CONCLUSIONS: In Down syndrome patients, the recurrence rate after upper eyelid epiblepharon repair was higher than non-Down syndrome patients. The effect of combined Z-medial epicanthoplasty was limited in both groups.

Clinical results of laser in situ keratomileusis with superior and nasal hinges.

PURPOSE: To compare the differences in the clinical results of LASIK with a nasal corneal flap and with a superior corneal flap. SETTING: Department of Ophthalmology, Kangnam St. Mary's Hospital, Seoul, Korea. METHODS: This randomized prospective study comprised 30 patients whose age and degrees of myopia were similar. In 1 group (25 eyes), a superior hinge was made and in the other group (25 eyes), a nasal hinge was made. Uncorrected visual acuity (UCVA), spherical equivalent (SE), astigmatism, and corneal topographical change before surgery and 1 week and 2 and 6 months after surgery were compared. The tear breakup time (BUT) and the Schirmer test before surgery and 2 months postoperatively were also compared. RESULTS: At 6 months, there were no significant between-group differences in UCVA, SE, astigmatism, and corneal ablation decentration (P >.05). At 2 months, the results of BUT and the Schirmer tests were 6.80 seconds and 9.54 mm, respectively, in the nasal hinge group (P >.05) and 5.08 seconds and 6.05 mm, respectively, in the superior hinge group (P <.05). CONCLUSIONS: There were no between-group differences in UCVA, SE, astigmatism, and corneal ablation decentration at 6 months, but the BUT and Schirmer test results were aggravated after LASIK in the superior hinge group.