Tonopen versus Goldmann applanation tonometry for detecting restrictive thyroid eye disease.

PURPOSE: In thyroid eye disease (TED), intraocular pressure (IOP) measurements are taken in both the primary and upgaze positions to elicit restrictive muscle disease. The aim of this study was to assess whether the IOP when measured with the eyes in upgaze (the Goldmann applanation tonometer [GAT] head applanating the inferior/peripheral cornea) is similar when compared with the central corneal IOP in upgaze using the Tono-Pen XL. METHODS: IOP was measured with the GAT on the central cornea in primary gaze and on the inferior cornea in upgaze. IOP was measured with the Tono-Pen XL in the central cornea in both primary gaze and upgaze. The outcome measure was the difference in IOP readings between the GAT and the Tono-Pen XL for patients with restrictive TED. RESULTS: Fifty-two patients were included in the study; 31 patients with restrictive TED and 21 control patients. In the control group, there was no significant difference in Tono-Pen XL and GAT readings for both primary gaze and upgaze (p = 0.99). Both instruments detected an increase in IOP with upgaze in patients with restrictive TED compared with controls (p = 0.0006). There was no significant difference between the 2 instruments' readings in upgaze for patients with restrictive TED (p = 0.39). CONCLUSIONS: Both the GAT and the Tono-Pen XL can be used to establish IOP in patients with restrictive TED.

Iatrogenic eyelid granulomata.

The authors report a possible association between posaconazole, a new systemic antifungal, and eyelid granulomata. A 12-year-old boy presented with a 2-week history of bilateral eyelid granulomata. They were noted to reduce in size and symptoms when posaconazole was discontinued. Symptoms increased when the drug was restarted.

Can eyelid taping predict the benefit of a lateral tarsal strip procedure in patients with eyelid laxity and functional epiphora?

PURPOSE: To determine whether taping of the lower eyelid laterally and upward onto the temple region (to mimic a lateral tarsal strip procedure) can effectively predict whether lateral tarsal strip surgery will lead to resolution or improvement in functional epiphora by correcting eyelid laxity. METHODS: A case series of 28 eyes in 20 patients with symptomatic epiphora and equivocal lateral eyelid laxity were identified. The inclusion criteria included patent nasolacrimal systems on syringing with no other eyelid malposition or obvious cause for epiphora. Patients underwent taping of the lower eyelid using micropore tape to the temple region in the outpatient clinic for a period of 1 hour. The patients were asked to spend that time in conditions that would exacerbate their epiphora (e.g., outdoors). At the end of the hour the patients were recalled for subjective reassessment of epiphora. RESULTS: The mean age of the patients was 69 years. Eighteen patients (25 eyes) had subjective improvement in their epiphora when taped; this group was offered subsequent lateral tarsal strip surgery. Two patients (3 eyes) had no improvement in symptoms when taped. Postoperative follow-up showed decreased epiphora in 14 patients (20 eyes) of the 18 patients (25 eyes) operated. In 4 patients (5 eyes), although eyelid taping was beneficial, surgery did not resolve the epiphora. CONCLUSIONS: Temporary tightening of the lower eyelid with micropore tape to mimic the effect of lateral tarsal strip surgery can identify those patients who may benefit from an eyelid-tightening procedure. Patients who did not benefit from eyelid taping can avoid potentially unnecessary eyelid surgery.

Ophthalmic manifestations of paranasal sinus mucocoeles.

PURPOSE: To investigate the ophthalmic manifestations of paranasal sinus mucocoeles. METHODS: A retrospective study of all patients (1992-1998) diagnosed with paranasal sinus mucocoeles. All patients had a CT scan. RESULTS: Of the 45 patients, only 3 (6.7%) did not have ophthalmic symptoms or signs. The most common (64.4%) presenting feature was peri-orbital swelling, often associated with pain and tenderness. Other presenting features included diplopia, proptosis, hypoglobus, diplopia, decreased colour vision, epiphora, facial swelling and nasal polyps. The frontal sinus was the most commonly (70%) involved site. CONCLUSIONS: Paranasal sinus mucocoeles present most commonly with ophthalmic symptoms and signs. Patients with this condition are therefore highly likely to present initially to the ophthalmology department. Awareness of the aetiology of this condition is important so that appropriate and timely referral is made to the otolaryngologists to ensure appropriate management of this condition.

Integrated orbital implants--a comparison of hydroxyapatite and porous polyethylene implants.

PURPOSE: A retrospective case note review was undertaken to elucidate any differences in the cosmetic results and rate of serious complications between hydroxyapatite (HA) and porous polyethylene (PP) orbital implants. METHODS: Patients who had undergone orbital implant surgery during the period 1993 to 1997 by a single surgeon were identified. Twenty-six patients had an HA implant and twenty-six had received a PP implant. All patients were reviewed in the ocular prosthetics department in a masked manner. The orbits were scored for post-enucleation socket syndrome (PESS) score, and quantification of implant mobility was done. Data analysis was conducted using Mann-Whitney U test for two independent samples. RESULTS: There was no significant difference in PESS scores in patients with an HA or a PP implant. Implant elevation was better in patients with secondary (p = 0.029) and exchange (p = 0.042) PP implants. Only one patient in each of the HA and PP groups suffered significant implant exposure that required dermis fat and mucous membrane graft cover. CONCLUSIONS: The complication rates and PESS scores were identical between the HA and PP implant groups. The implant mobility was better in the PP group. In clinical practice, the choice of the type of orbital implant inserted may also be governed by other factors such as surgeon experience, ease of use, and cost.

Ophthalmic management of facial nerve palsy: a review.

Facial nerve palsy affects individuals of all ages, races, and sexes. Psychological and functional implications of the paralysis present a devastating management problem to those afflicted, as well as the carriers. Since Sir Charles Bell's original description of facial palsy in 1821, our understanding and treatment options have expanded. It is essential that a multidisciplinary approach, encompassing ophthalmologists; Ear, Nose, and Throat surgeons; plastic surgeons; and psychologists work closely to optimize patient management in a staged approach. Although the etiology remains unknown, strong histological, cerebral spinal fluid, and radiological evidence suggests a possible association with herpes simplex virus in idiopathic facial nerve palsy (Bell's palsy). The use of steroids has been suggested as a means of limiting facial nerve damage in the acute phase. Unfortunately, no single randomized control trial has achieved an unquestionable benefit with the use of oral steroid therapy and thus remains controversial. In the acute phase, ophthalmologists play a pivotal role in preventing irreversible blindness from corneal exposure. This may be successfully achieved by using intensive lubrication, medical therapy (botulinum toxin), or surgery (upper lid weighting or tarsorraphy). Once the cornea is adequately protected and recovery deemed unlikely, longer term planning for eyelid and facial reanimation may take place in an individualized manner. Onset is sudden and management potentially lengthy. Physician empathy, knowledge, and experience are essential in averting long-term lifestyle and psychological discomfort for patients.

Intraoperative fluorouracil in endonasal laser dacryocystorhinostomy.

BACKGROUND: Although endonasal laser dacryocystorhinostomy (ELDCR) offers many advantages compared with conventional techniques, postoperative scarring leading to occlusion of the rhinostomy is more common with ELDCR. OBJECTIVE: To investigate whether fluorouracil applied to the rhinostomy site intraoperatively has an effect on the outcome. PARTICIPANTS: We randomly allocated 155 consecutive patients (201 procedures) to a control group and a fluorouracil group. Patients and investigators were masked to the choice of treatment. METHODS: All patients underwent ELDCR. A pledget soaked in isotonic sodium chloride solution or 0.5-mg/mL fluorouracil, randomly allocated by the pharmacy, was applied to the rhinostomy site for 5 minutes at the time of surgery. Patients were followed up for 12 months and their symptoms were assessed at each visit. RESULTS: Among patients followed up for 12 months or longer, ELDCR procedures performed with topical application of fluorouracil to the rhinostomy site were successful in 65 (76%), compared with 52 (63%) for the control group. This was not statistically significant when patients who failed to attend follow-up at or after 12 months were not counted as successfully treated (P =.21, chi(2) test). Even if those who failed to attend for follow-up were counted as successes, the effect of fluorouracil did not reach significance at the.05 level (P =.08, chi(2) test). CONCLUSION: The topical application of fluorouracil failed to increase the patency rates in ELDCR.