From Addressing Aesthetics and Soft Tissue to Visual Performance: Multifaceted Satisfaction Assessment in a Multicenter Study of Patients With Dermatochalasis.

BACKGROUND: In this study, we seek to answer the question: Does blepharoplasty for dermatochalasis alter visual performance? OBJECTIVES: We seek to determine the impact of blepharoplasty on visual performance (refraction, contrast sensitivity, and visual field) in patients with dermatochalasis. METHODS: A total of 146 eyelids of 74 patients, 48 (64.9%) females and 26 (35.1%) males ranging from 40 to 68 years old, with dermatochalasis were analyzed prospectively. Refraction, contrast sensitivity, visual acuity, higher-order aberrations (HOAs), and mean deviation index (MDI) in the Humphrey visual field were evaluated and recorded before and at 2, 4, and 6 months after upper eyelid blepharoplasty. RESULTS: At the latest follow-up, uncorrected and corrected distance visual acuity showed no significant differences (P > .05). Patients' contrast sensitivity increased significantly at all spatial frequencies under both conditions (P < .05) except at 12 cycles per degree in the photopic condition (P = .947). Mean astigmatism significantly decreased from -1.17 ± 0.83 to -0.89 ± 0.66 postoperatively (P ≤ .001). Total HOAs decreased significantly from 0.59 ± 0.13 µm to 0.51 ± 0.09 µm (P < .01) after surgery. The root mean square of the spherical aberration (P < .01), vertical trefoil (P = .018), horizontal trefoil (P < .01), horizontal coma (P < .001), and vertical coma (P < .01) decreased significantly. The MDI of the Humphrey visual field increased significantly postoperatively at all times compared with preoperatively (P < .05). The Blepharoplasty Outcomes Evaluation questionnaire showed significant favorable satisfaction with visual quality indexes (P < .001). CONCLUSIONS: Upper lid blepharoplasty, in addition to its aesthetic effect, is an effective intervention to promote visual function and quality of life.

Late probing for congenital nasolacrimal duct obstruction.

PURPOSE: To report the results of late nasolacrimal duct probing in patients with congenital nasolacrimal duct obstruction (NLDO). METHODS: This retrospective study was performed on a consecutive series of patients with congenital NLDO who underwent late (after 15 months of age) nasolacrimal duct probing for the first time. RESULTS: Over a period of five years, 158 patients including 75 (47.4%) male and 83 (52.6%) female subjects with mean age of 3±4.2 years (range, 15 months to 37 years) underwent initial probing for NLDO. Nasolacrimal duct probing was performed unilaterally in 78% and bilaterally in 22% of the patients. Success rate was 75% overall, 72% in unilateral cases and 83% in bilateral instances. Success rate was not correlated with age at intervention. CONCLUSION: Nasolacrimal duct probing seems to be reasonably successful for treatment of congenital NLDO in patients older than 15 months who are seen for the first time. Silicone intubation or dacryocystorhinostomy should be reserved for refractory cases.

Traumatic subluxation of the globe into the maxillary sinus.

Fractures of the orbit most commonly involve the orbital floor, and enophthalmos is a common sign of orbital fractures. Complete globe dislocation in the maxillary sinus, however, has rarely been reported. Herein we report on an 18-year-old man referred to us 1 week following a car accident. At presentation, the globe was not seen within the right orbit. CT revealed a large orbital floor fracture with globe dislocation in the right maxillary sinus. The patient underwent repair of the fracture using a Medpor implant together with repositioning of the globe. Preoperative vision was no light perception, which remained unchanged during follow-up.