Muller's muscle resection for ptosis and relationship with levator and Muller's muscle function.

PURPOSE: Results of Muller's muscle resection in patients with ptosis and its relationship with levator and Muller's muscle function. METHODS: Prospective review of medical records of all pateints who underwent open sky Mullerectomy for correction of upper eyelid ptosis. The study period was from January 2008 to July 2009. Levator function, MRD1, Phenylepherine test result and extent of ptosis correction were recorded. Excised muscle tissue in few cases were subjected to histopathology. RESULTS: In 11 patients who underwent 13 mullerectomy procedures for correction of upper eyelid ptosis, MRD1 increased an average by 2.54 mm. The amount of ptosis correction was 4.28 mm in pateints with either good levator function and/or Muller's action and 1mm in patients where both responses to phenylepherine and levator functions were poor. Histopathology revealed both straited and smooth muscle tissue in the excised specimens in all cases. CONCLUSION: Mullerectomy porbably involves plication of the posterior layer of the levator aponeurosis. Results of Muller's muscle resection is good in patients with good levator function and/or good Mullers action and poor if both Muller and levator function are poor.

Extramedullary pasmacytoma masquerading as chalazion.

Extramedullary plasmacytoma (EMP) is a rare entity that belongs to the category of non-Hodgkin lymphoma. EMP make up 4% of all plasma cell tumors and occur mainly in the upper aerodigestive tract. Primary plasmacytoma involving the orbit is rare. There is a relation between solitary plasmacytoma and subsequent development of multiple myeloma. As no predictors of progression have been identified patients need indefinite follow-up. The authors report a case of EMP involving the eyelid in an otherwise healthy adult female.

Acute dacryocystitis causing orbital cellulitis and abscess.

PURPOSE: Acute dacryocystitis commonly presents as preseptal cellulitis as lacrimal sac lies anterior to the orbital septum and hence infection localizes in the preseptal space. The purpose of this study is to describe presentation and management of cases of acute dacryocystitis presenting as orbital cellilitis and abscess secondary to acute dacryocystitis. METHOD: This retrospective, non-comparative, interventional case series included 6 patients presenting with orbital cellulitis and abscess secondary to acute dacryocystitis. All patients underwent drainage of abscess under general anesthesia. External dcaryocystorhinostomy was advised as the definitive treatment for all pateints. RESULT: Abscess was localized in the extraconal space in 4 patients and in the intraconal space in 2 patients. Patients with intraconal abscess had visual loss on presentation while vision could be preserved in patients with abscess in extraconal space. Both patients with intraconal abscess had history of acute dacryocystitis. CONCLUSION: Acute dacryocystitis is an ophthalmic emergency that can cause orbital cellulitis with abscess formation, and even vision loss, if left untreated.

Pterygium-induced corneal refractive changes.

To study the effect of pterygium on corneal topography, a retrospective analysis of 151 eyes with primary pterygia was done. All cases underwent videokeratography preoperatively and one month postoperatively. Statistical analysis of average corneal power (ACP), corneal astigmatism, surface regularity index (SRI) and surface asymmetry index (SAI) was done before and one month after surgery. Topographic indices were compared statistically for various grades of pterygia. Increase in the grade of pterygia had a significant effect on topographic indices. Corneal astigmatism reduced from 4.40+/-3.64 diopter (D) to 1.55+/-1.63D ( P value < 0.001) following surgery. The regularity of corneal surface improved and asymmetry of the cornea reduced one month after surgery. Pterygium leads to significant changes in corneal refractive status, which increase with the increase in the grade of pterygia and improve following pterygium excision.

Role of fine needle aspiration cytology in diagnosis of eyelid sebaceous carcinoma.

Sebaceous carcinoma of the ocular adnexa is a malignant neoplasm which can exhibit aggressive local behavior and can metastasize to regional lymph nodes and distant organs. The neoplasm is known to masquerade as other benign and less malignant lesions, resulting in delay in diagnosis and relative high morbidity and mortality. Fine needle aspiration cytology (FNAC) of recurrent upper eyelid nodules treated elsewhere as chalazion was done. Cytological smears were suggestive of malignancy. Subsequently histopathology confirmed the diagnosis of sebaceous gland carcinoma. Eyelid reconstruction was done after histopathologically confirmed tumor-free margins. The article highlights the role of FNAC in early diagnosis and subsequent appropriate surgical management of eyelid sebaceous gland carcinoma to prevent recurrence and metastasis.

Congenital eversion of upper eyelids: case report and management.

Congenital eversion of the upper eyelids is a rare condition, the exact cause of which remains unknown. It is more frequently associated with Down's syndrome and black babies. If diagnosed early and treated properly, the condition can be managed without surgery. We report a case of congenital bilateral severe upper eyelid eversion in a normal infant, born by vaginal delivery. The case was conservatively managed by lubricants, antibiotics and eyelid patching.

Split-conjunctival grafts for double-head pterygium.

PURPOSE: To describe the technique of split-conjunctival grafts (SCG) for double-head pterygia and to evaluate its postoperative outcome. METHOD: A retrospective analysis of seven eyes with primary double-head pterygium was done. All eyes received pterygium excision with split-conjunctival grafts harvested from the superior quadrant. All patients were followed up for recurrence of the lesion and incidence of complications. RESULTS: No recurrence was noted with a mean follow-up of 17.7 +/- 6 months. CONCLUSION: Split-conjunctival graft is a useful procedure for double-head pterygium.

Traumatic wound dehiscence 14 years following penetrating keratoplasty.

Penetrating keratoplasty eyes are at greater risk of laceration than intact corneas due to persistent wound weakness, even years after surgery. We report a case of traumatic wound dehiscence by fingertip injury 14 years following penetrating keratoplasty.

Effect of pterygium excision on pterygium induced astigmatism.

Pterygium is known to affect refractive astigmatism, which can have a significant impact on vision. This study was undertaken to evaluate the effect of pterygium excision on refractive astigmatism. Thirty-six eyes with primary pterygium with astigmatism of 2D or more were analysed before and after pterygium excision. Astigmatism increased with the increase in the grade of pterygium (P = 0.000001). The preoperative refractive cylinder decreased from 4.60 +/- 2D to 2.20 +/- 2.04D (P = 0.00001) after pterygium excision.