Long-term outcomes of unilateral orbital fat decompression for thyroid eye disease

Background

The aim of this study was to evaluate the long-term outcomes after unilateral orbital fat decompression in patients with thyroid eye disease.

Design

Retrospective, comparative, cross-sectional study

Participants

Thirty-three orbits of 33 patients were included in this study. Of the 33 patients, 13 underwent fat decompression (group A), and the other 20 had bony decompression (group B).

Methods

The medical records of patients who underwent orbital decompression to reduce proptosis for thyroid eye disease were retrospectively reviewed. The degrees of proptosis were measured by Hertel exophthalmometry preoperatively and over a follow-up period of more than 3 years. We evaluated the change in proptosis after surgery.

Main outcome measures

Postoperative change in exophthalmos.

Results

A recurrence in proptosis from fat decompression was seen in ten patients (76.9 %) in group A and in only two patients (10 %) in group B. The amount of regression due to surgery after 3 years was 2.3 ± 1.4 mm and 0.7 ± 0.9 mm in groups A and B respectively. The tendency of regression was more prominent in group A than in group B.

Conclusion

The long-term effect of unilateral orbital fat decompression for the reduction of proptosis in patients with thyroid eye disease may be weak, leading to regression. Care should be taken when determining the extent of fat decompression with consideration for this tendency.     

Results of diplopia and strabismus in patients with severe thyroid ophthalmopathy after orbital decompression

Purpose:

It has been frequently stated that the orbital decompression, in patients with thyroid ophthalmopathy, does not usually improve extraocular muscles function and that after the operation there is often a deterioration of these functions. The purpose of this article is evaluation of extraocular muscles function after applying personal method of 3 wall orbital decompression.

Materials And Methods:

Retrospective review of case records of 119 patients with severe thyroid ophthalmopathy seen and treated by the author between December 1986 and December 2010. All patents underwent 3 wall orbital decompression combined with removal of the periorbital, intraorbital and retrobulbar fat. Correction of coexistent eyelid retraction and deformities were also performed.

Results:

Comparison of preoperative and postoperative results was conducted in 65 patients three months after 3 wall decompression. All patients showed a significant reduction of exophthalmos [5-11 mm, 7.2 mm on average], reduction of intraocular pressure, marked improvement in ocular muscle function as well as considerable reduction in or disappearance of subjective symptoms. There were no cases of subsequent impairment of ocular motility. Strabismus surgery was performed in 6 patients with residual diplopia. There was an improvement in vision in 68% patients who had impaired vision before the operation. Less evident relapse of exophthalmos was recorded in 3 cases only and only one patient required unilateral reoperation.

Conclusion:

It can be concluded that this method of orbital decompression is logical, based on an understanding of the pathology, has less complication rates, is relatively easy to perform, gives very good functional and aesthetic long term results and allows rapid recovery.     

Inferior rectus muscle recession as a treatment for vertical diplopia following cataract extraction

Background

Persistent vertical diplopia may occur after cataract surgery as a rare complication of retro- or parabulbar anesthesia. This is probably caused by structural changes in the muscles, altering muscular elasticity and function and thus complicating setting of the dosage for corrective strabismus surgery. The aim of our study was to investigate the effect of strabismus surgery in this specific motility disorder.

Methods

The findings from 15 consecutive patients (six women, nine men, median age 76 years), who had undergone initial strabismus surgery in our eye clinic between 2007 and 2010 due to vertical diplopia following cataract surgery, were investigated retrospectively. In all cases, cataract surgery had been performed under retro- or parabulbar anesthesia.

Results

Preoperatively, all affected eyes (five right eyes, ten left eyes) showed hypotropia with elevation deficiency and overaction of the inferior rectus muscle and/or superior oblique muscle on down-gaze. The median vertical deviation in primary position was 9.1 deg (min. 4.6, max. 24.7), measured with the alternate prism cover test, and 8 deg (min. 3.5, max.18) at the tangent screen of Harms. In all cases, the inferior rectus muscle was recessed 3 to 6 mm (median 3.5 mm). On the first day after surgery, the median angle of squint in primary position was 2.3 deg (min. 0, max. 10.2), when measured with the alternate prism cover test, with a mean dose–effect relationship of 1.8?±?0.7 deg angle reduction per millimetre recession (median 1.9 deg/mm). In the postoperative period, eight patients examined after 2 to 20 months (median 3.5 months) showed a median vertical deviation of 5.7 deg (min. 1.7, max. 11.3), with a mean dose–effect relationship of 1.7?±?1.3 deg/mm (median 1.8 deg/mm), but the values ranged widely. Four patients were not examined but interviewed by telephone. There was no feed-back from three patients. Six of 12 follow-up patients had no complaints, three had prisms to correct a persisting angle, and three patients needed further squint surgery.

Conclusions

The efficacy of inferior rectus muscle recession for correction of hypotropia following cataract surgery with local anesthesia ranged widely. In this condition, operating on one muscle is a good option for correction of squint angles of less than 12 deg. Squint angle enlargement can occur in the postoperative course, and may necessitate further surgery.     

Granularzelltumor der Orbita

Background

Granular cell tumors (Abrikossoff’s tumor) are very rare, mostly benign tumors of neurogenic origin which preferentially occur in the upper aerodigestive tract. Granular cell tumors rarely originate in the orbit and are therefore a diagnostic and therapeutic challenge.

Method and patients

A 42-year-old male patient presented to the Orthoptic Department of the University Eye Clinic in Salzburg with motility disturbances and diplopia in the right eye. The clinical examination revealed right-sided exophthalmos and shrinking of the choroid and retina due to a retrobulbar mass. The radiological examination showed an infiltrative tumor 1.7?×?1.3 cm in size in the lower temporal quarter of the orbit. Due to the localization a sonographically controlled fine needle puncture was carried out for preoperative diagnostics by a specialist in clinical cytology. The cytological examination confirmed the presence of a granular cell tumor. The tumor was excised via a conjunctival access route.

Results

Motility testing in the postoperative course control showed an improvement in the findings and the exophthalmos was clearly regressive. Vision improved from 0.5 preoperatively to 1.0 postoperatively. During the postoperative observational period of 12 months no recurrences occurred. Clinical control examinations are planned every 3 months and imaging controls every 6 months.

Conclusion

Granular cell tumors of the orbit should be included in the differential diagnostics of orbital tumors despite the low incidence. A sonographically controlled fine needle puncture is an adequate procedure with respect to the diagnostics and further therapy for poorly differentiated tumors of the orbit with a suspicion of infiltrative growth and for which in toto resection is questionably possible. A complete surgical excision should be the aim of treatment of granular cell tumors. Continuous clinical and imaging control is necessary to enable early recognition of recurrences.     

Treatment for diplopia in patients with myasthenia gravis

Background

The purpose of this study was to describe the treatment experiences and outcomes of patients with myasthenia gravis (MG) whose initial presenting symptom was diplopia

Methods

A retrospective review was performed on a group of patients with MG whose initial presenting symptom was diplopia.

Results

The mean age of onset was 45.5?±?16.9 years, and the mean follow-up period was 45.4?±?39.7 months. Exotropia with vertical heterotropia was the most common type of deviation. The mean horizontal deviation was 20.1?±?17.9 prism diopters, and the mean vertical deviation was 14.8?±?11.1 prism diopters. Limitation of eye movement was found in 20 patients (71.4 %) during the follow-up period. After conventional treatment for MG, six patients (21.4 %) showed a good response with resolution of diplopia. Four patients (14.3 %) showed a partial response to treatment. Eighteen patients (64.3 %) showed minimal or no response; among them, ten (35.7 %) had an angle of deviation of 15 prism diopters or more. Six patients underwent strabismus surgery. Four were symptom free, and satisfactorily aligned after surgical treatment. One patient had intermittent diplopia despite the small amount of deviation, and one patient experienced recurrence of exotropia with diplopia during the 10-year follow-up. In multivariable analysis, the only factor associated with the need for strabismus surgery was the initial angle of deviation (p?=?0.016).

Conclusions

Patients with MG who have a larger angle of deviation at presentation tend to require strabismus surgery after stabilization of the disease. Strabismus surgery is one treatment option for patients with MG who have a large angle of deviation and respond poorly to conventional treatment.     

Management of strabismus with hemianopic visual field defects

Background

Hemianopia and strabismus leads to severe disturbance of visual orientation and diplopia under binocular conditions if the deviated eye has a normal retinal localization.

Subjects and methods

Four cases with homonymous (two) and bitemporal (two) hemianopia and strabismus will be described with respect to binocular visual field and diplopia/confusion. All of them were recommended for strabismus surgery. Preoperatively, prism adaptation test was carried out to analyze functional results and fusional competence. In three of the four cases, strabismus surgery was successfully performed to avoid diplopia/confusion. All three patients revealed normal retinal correspondence. Furthermore, in two cases surgery led to an extension of binocular visual field; in one case with a bitemporal hemianopia and hemifield-slide phenomenon, blurred central vision and reading problems reduced significantly postoperatively. In one patient with anomalous retinal correspondence due to early childhood trauma exotropia led to an extension of the binocular visual field. In this case, strabismus surgery would have been unfavourable.

Results

Case 1 showed a homonymous hemianopia to the left and acquired exotropia of the right eye, leading to binocular diplopia. Case 2 with homonymous hemianopia to the right and exotropia of right eye revealed anomalous retinal correspondence after history of perinatal brain injury, resulting in absence of diplopia and enlargement of visual field to the right. Cases 3 and 4 with bitemporal hemianopia suffered from sensory disturbances caused by additional acquired strabismus. The exodeviation of the right eye in case 3 led to a restriction of binocular visual field with overlap of the nasal parts causing diplopia, whereas the esodeviation of case 4 resulted in a “gap” between the nasal parts (blind area).

Conclusion

Depending on the extent of visual field defects and on retinal correspondence, functional consequences for binocular vision and binocular visual field should be considered prior to surgery. In normal retinal correspondence, strabismus surgery will be indicated in most cases because of diplopia. However, surgery might result in a reduction of binocular visual field. Preoperatively, it is important to map monocular and binocular visual fields, to examine retinal correspondence, and to undertake prism adaptation test to imitate the postoperative functional result and risk of double vision.     

Adult hypertropia: a guide to diagnostic evaluation based on review of 300 patients

Purpose

To highlight the key clinical features of various aetiologies of adult hypertropia and to discuss the diagnostic approach towards evaluation of vertical double vision.

Methods

This is a retrospective cross-sectional study. A total of 300 consecutive patients with vertical diplopia were evaluated by a single neuro-ophthalmologist and strabismologist in a tertiary care setting from 2005–2008. The medical records of all patients with vertical diplopia coded with one of the following diagnoses; hypertropia, diplopia, thyroid eye disease, fourth nerve palsy, ocular myasthenia, congenital strabismus, and third nerve palsy were reviewed. The main outcome measures were determination of aetiologies of hypertropia.

Results

Fourth nerve palsy and thyroid eye disease were the most common causes of vertical diplopia in our series and comprised more than 50% of patients. The other causes of vertical diplopia were ocular surgery, orbital fracture, neurosurgery, childhood strabismus, skew deviation, third nerve palsy, myasthenia gravis, and decompensated hyperphorias. Ocular motility deficits were seen in 33% of the cohort of whom thyroid eye disease comprised the largest group. Orbital ultrasonography was sensitive in detecting thyroid orbitopathy.

Conclusion

In the majority of patients, the aetiologies of hypertropias can be ascertained by history and careful ophthalmic examination alone. Fourth nerve palsy and thyroid eye disease were the most common causes of vertical diplopia in this series.     

Modified orbital decompression for dysthyroid orbitopathy

PURPOSE: The transantral approach to orbital decompression remains useful for the management of exophthalmos associated with dysthyroid orbitopathy. However, the risk of postoperative diplopia is a concern. Preservation of the anterior periorbita may help support the orbital contents and decrease the incidence of diplopia. METHODS: The medical records were reviewed of 15 consecutive patients who underwent 30 transantral orbital decompressions for proptosis associated with dysthyroid orbitopathy. The procedures were completed in standard fashion, including removal of the inferomedial bony strut between the medial orbital wall and the floor. However, stripping of the periorbita was only done posteriorly; the anterior 10 to 15 mm of periorbita were left intact. RESULTS: Six patients had preoperative diplopia that persisted after decompression. Of the nine patients without diplopia preoperatively, none developed diplopia. Proptosis was reduced a mean of 3.5 +/- 2.6 mm. CONCLUSIONS: Preservation of the anterior periorbita during transantral orbital decompression reduces the risk of postoperative diplopia. An adequate reduction in proptosis is also achieved.     

Pilotstudie zu einem Heidelberger Doppelbildfragebogen

Purpose

To test the visual-function-related quality of life in patients with diplopia, we designed a new questionnaire: the Heidelberg diplopia questionnaire.

Patients and methods

In a prospective study, 51 patients with different ocular motility diseases (congenital and acquired) were asked about their everyday life impairment. The questionnaire encompasses the following subscales: duration of diplopia, spatial perception, motion in space, driving difficulties, difficulties at work, near vision, social function, and subjective complaints.

Results

The median composite questionnaire score correlated well with the patients’ subjective complaints (Spearman’s rho 0.70, p=0.000001) and their driving difficulties. There was a weak correlation with the clinical assessment of diplopia in the field of binocular vision based on the suggestions of Haase and Steinhorst and of Kolling.

Conclusion

The Heidelberg diplopia questionnaire records patients’ subjective complaints concerning diplopia. This study serves as the starting point for further studies in this field.     

Customized Orbital Decompression Surgery Combined with Eyelid Surgery or Strabismus Surgery in Mild to Moderate Thyroid-associated Ophthalmopathy

Purpose

To evaluate the efficacy and safety of customized orbital decompression surgery combined with eyelid surgery or strabismus surgery for mild to moderate thyroid-associated ophthalmopathy (TAO).

Methods

Twenty-seven consecutive subjects who were treated surgically for proptosis with disfigurement or diplopia after medical therapy from September 2009 to July 2012 were included in the analysis. Customized orbital decompression surgery with correction of eyelid retraction and extraocular movement disorders was simultaneously performed. The patients had a minimum preoperative period of 3 months of stable range of ocular motility and eyelid position. All patients had inactive TAO and were euthyroid at the time of operation. Preoperative and postoperative examinations, including vision, margin reflex distance, Hertel exophthalmometry, ocular motility, visual fields, Goldmann perimetry, and subject assessment of the procedure, were performed in all patients. Data were analyzed using paired t-test (PASW Statistics ver. 18.0).

Results

Forty-nine decompressions were performed on 27 subjects (16 females, 11 males; mean age, 36.6 ± 11.6 years). Twenty-two patients underwent bilateral operations; five required only unilateral orbital decompression. An average proptosis of 15.6 ± 2.2 mm (p = 0.00) was achieved, with a mean preoperative Hertel measurement of 17.6 ± 2.2 mm. Ocular motility was corrected through recession of the extraocular muscle in three cases, and no new-onset diplopia or aggravated diplopia was noted. The binocular single vision field increased in all patients. Eyelid retraction correction surgery was simultaneously performed in the same surgical session in 10 of 49 cases, and strabismus and eyelid retraction surgery were performed in the same surgical session in two cases. Margin reflex distance decreased from a preoperative average of 4.3 ± 0.8 to 3.8 ± 0.5 mm postoperatively.

Conclusions

The customized orbital decompression procedure decreased proptosis and improved diplopia, in a range comparable to those achieved through more stepwise techniques, and had favorable cosmetic results when combined with eyelid surgery or strabismus surgery for mild to moderate TAO.     

Effects of l-arginine on anatomical and electrophysiological deterioration of the eye in a rodent model of nonarteritic ischemic optic neuropathy

Purpose

The aims of this study were to clarify the effectiveness of l-arginine (1) for reducing the severity of anatomical changes in the eye and improving visual function in the acute stage of a rodent model of nonarteritic ischemic optic neuropathy (rNAION) and (2) in preventing those changes in anatomy and visual function.

Methods

For the first aim, l-arginine was intravenously injected into rats 3 h after rNAION induction; for the second aim, rNAION was induced after the oral administration of l-arginine for 7 days. The inner retinal thickness was determined over time by optical coherence tomography, and the amplitude of the scotopic threshold response (STR) and the number of surviving retinal ganglion cells (RGCs) were measured. These data were compared with the baseline data from the control group.

Results

Both intravenous infusion of l-arginine after rNAION induction and oral pretreatment with l-arginine significantly decreased optic disc edema in the acute stage and thinning of the inner retina, reduced the decrease in STR amplitude, and reduced the decrease in the number of RGCs during rNAION.

Conclusion

Based on these results, we conclude that l-arginine treatment is effective for reducing anatomical changes in the eye and improving visual function in the acute stage of rNAION and that pretreatment with l-arginine is an effective therapy to reduce the severity of the condition during recurrence in the other eye.     

Static Ocular Counterroll: Video-based Analysis After Minimizing the False-Torsion Factors

Purpose

To determine the validity and usefulness of a newly developed measurement method of static ocular counterrolling (s-OCR) that eliminates false-torsion factors and to test the Jampel hypothesis that s-OCR does not exist.

Methods

A lightweight measurement device, consisting of a video camera, a coaxial light source, and a laser pointer projecting a fixation target on the wall, was fixed to a subject's head by means of a mouthpiece. In 11 healthy adults (mean age: 30 ± 15 years), digital images of the right eye were captured while the subject kept his head tilted at a randomly selected angle ranging from 0° to 50°. By a frame-by-frame analysis of movements of the corneal light reflex and the iris patterns, OCR was evaluated.

Results

Torsional eye movement in the opposite direction to head tilt was found in all subjects. The amount of torsion continuously increased until the head-tilt angle reached 40°. The average (± SD) amplitude of a fitted sine curve was 7.6 ± 3.2° (range: 4.3°–10.3°), and the individual amplitude was significantly larger than the test–retest repeatability of the measurement (±1.7°).

Conclusions

The measurement method used in this study provided good test–retest repeatability and ease of application. The characteristics of torsional eye movements that we observed after minimizing the false-torsion factors agree with previous reports supporting the existence of s-OCR. Jpn J Ophthalmol 2005;49:497–504 © Japanese Ophthalmological Society 2005     

Plattenepithelkarzinom der Bindehaut mit Orbitainvasion

Background

Here we present a case of a female patient with squamous cell carcinoma with orbital invasion who insisted on a globe-sparing excisional biopsy rather than a more invasive procedure.

Case

A 48-year-old patient presented with a conjunctival tumor at the medial canthus of the right eye. The visual acuity in this eye was 1.0. MRI showed a 25 mm×12 mm tumor, with orbital invasion, no metastasis, but on CT scan damage of the lamina papyracea was suspected. Histology of a punch biopsy confirmed a moderately differentiated, squamous cell carcinoma. As requested by the patient, simple tumor excision with a 5-mm safety margin, reconstruction of the lower fornix with amniotic membrane, and adjuvant mitomycin C therapy were performed. Intraoperatively the medial orbital wall was found to be intact. No local or systemic recurrence has occurred 3.5 years postoperatively. The patient’s VA is still 1.0; no visual field defects are detectable, and there are only minor upper lid levator restriction and diplopia in maximum upgaze.

Conclusion

In view of this case the choice of surgical treatment for malignant tumors of the conjunctiva with orbital invasion – between exenteration or a minimally invasive procedure – should be carefully discussed with the patient. A follow-up of 5 years is strongly recommended.     

The Management of Patients with Thyroid Eye Disease After Bilateral Orbital 3 Wall Decompression

Introduction: Thyroid eye disease is the most common cause of unilateral and bilateral proptosis in adults. Orbital decompression surgery may cause and/or worsen a pre-existing ocular motility disorder.

Methods: A retrospective review was carried out of all bilateral 3 wall orbital decompressions for severe thyroid eye disease performed between January 2002 and December 2004 by one surgeon. Subsequent surgeries were recorded.

Results: Seventy-four patients were identified, 59 (80%) females and 15 (20%) males. Mean age at the time of decompression was 46 years. Fifteen (20%) patients complained of diplopia due to strabismus prior to decompression surgery and 20 (27%) developed new diplopia postsurgery. Twenty patients (27%) required no further intervention following decompression surgery; the remainder underwent an average of 2.5 procedures. Strabismus surgery was performed in 32 (43%) patients. The mean time from the decompression to first strabismus surgery was 12 months. Forty-three (58%) patients underwent lid surgery. The mean time from decompression to first lid surgery was 16 months.

Conclusion: This study demonstrates how this group of complex patients required multiple surgical procedures within an extended timescale, therefore requiring several in- and outpatient visits.     

Aberrationen höherer Ordnung bei Blickbewegungen

Background

Wavefront-guided corneal surgery is a standard therapeutic option for correcting refractive errors. If the wavefront measured preoperatively is influenced by an incorrect alignment of the bulb, the ablation profile could be distorted and the quality of vision reduced.

Method

Wavefront analysis was done on 49 eyes, examining the primary gaze of the bulb as well as abduction, adduction, elevation, and depression.

Results

The study demonstrated a significant influence of eye movements on astigmatic aberrations. Horizontal eye movements have a stronger influence than vertical ones do. Adduction especially leads to changes; here, RMS showed a significant difference.

Conclusions

Eye movements have a significant effect on wavefront profiles. The amount of aberration induced is generally very low. In individual cases, the numbers of aberrations induced by eye movements are in ranges reported to reduce the postoperative quality of vision when the ablation profile is taken into account.     

Neovascular Glaucoma After Branch Retinal Artery Occlusion

Background

Neovascular glaucoma (NVG) occurring after branch retinal artery occlusion (BRAO) might not be as rare as previously thought. We report a case of unilateral NVG after BRAO.

Case

A 72-year-old man with chronic heart failure suffered from BRAO in the left eye. Funduscopic examination showed retinal edema and many cotton wool spots in the superotemporal retina.

Observations

Five weeks later, he had increased blurring of vision due to a second BRAO in the inferotemporal retina of the left eye. Three days later, he felt pain and had severe visual loss in the left eye. In the presence of angle neovascularization, intraocular pressure (IOP) in the left eye rose to 35?mmHg. Immediate focal photocoagulation to the affected retina diminished the neovascularization and lowered the IOP.

Conclusion

It is possible for NVG to occur as a complication of BRAO. Jpn J Ophthalmol 2005;49:388–390 © Japanese Ophthalmological Society 2005     

Microscopic polyangiitis complicated by oculomotor nerve palsy

Background

Microscopic polyangiitis (MPA) is a necrotizing vasculitis of the small vessels. Among the nerve lesions of MPA, the incidence of multiple mononeuritis is high, but cranial nerve palsy is rarely reported.

Case

A female patient with oculomotor nerve palsy associated with MPA.

Observations

The 68-year-old patient was admitted to our hospital with a high fever, numbness and weakness of the extremities, and muscle weakness. Multiple mononeuritis and purpura were observed. The urine was positive for occult blood and protein and the creatinine level was 1.2 mg/dL, indicating renal impairment. The levels of C-reactive protein (15.5 mg/dL) and myeloperoxidase-antineutrophil cytoplasmic antibody titers (600 ELISA units) were elevated. MPA was diagnosed, and 45 mg/day prednisolone was initiated. On the fifth day after the initiation of treatment, the patient suddenly developed diplopia and blepharoptosis of the left eye. Anisocoria and decreased light reflex as well as limited supraduction, infraduction, and adduction were also observed in the eye. Left oculomotor nerve palsy was diagnosed. The palsy gradually improved with continued prednisolone treatment.

Conclusions

We encountered a rare case of MPA complicated by oculomotor nerve palsy.     

Behandlung des schweren rezidivierenden Pterygiums mit Symblepharonbildung

Background

This retrospective study reports on four patients with severe recurrent symblepharopterygium formation and extensive subconjunctival scarring who were treated with a novel surgical technique combining free limbal autografting and amniotic membrane transplantation.

Patients and methods

The surgical technique included symblepharolysis, meticulous removal of subconjunctival scar tissue, ipsilateral free limbal autograft and homologous amniotic membrane transplantation.

Results

There were no intraoperative or postoperative adverse events and three patients had no manifestation of recurrence of pterygium, symblepharon or diplopia during a mean follow-up period of 172?±?18 weeks (39?±?4 months) postoperatively. Only one patient had persistent symblepharon and experienced a recurrence of pterygium approximately 40 weeks (9 months) after surgery.

Conclusion

The results suggest that ipsilateral autologous limbal and homologous amniotic membrane transplantation can be an effective therapeutic approach in the treatment of recurrent pterygium with symblepharon formation.     

Glaukom und trockenes Auge

Purpose

Current concepts and future perspectives for therapy and prevention of dry eye in glaucoma patients are described.

Methods

Own clinical and experimental findings and PubMed based literature search (keywords: glaucoma and dry eye).

Results

Ocular surface disease is the main long-term complication of glaucoma therapy. Prevention of ocular surface inflammation by preservative-free antiglaucoma eye drops and concurrent dry eye therapy are important

Conclusions

It is mandatory to treat dry eye prior to and during glaucoma therapy. Preservative-free glaucoma medication can help to ameliorate the problem.     

Intraoperative Quantification Using Finger Force for Involutional Blepharoptosis without Postoperative Lagophthalmos

Purpose

To report intraoperative quantification using finger force for involutional blepharoptosis, which helps in the prevention of postoperative lagophthalmos.

Methods

We carried out levator resection on 20 involutional blepharoptic eyelids. Fissure height was examined intraoperatively to evaluate the extent of resection. If a patient presented more than 3?mm of lagophthalmos in voluntary eyelid closure but could fully open the eye, we forcibly closed the eyelid, using a finger, after voluntary eyelid closure. If more than 3?mm of lagophthalmos was still observed after forced eyelid closure, we corrected eyelid tension until lagophthalmos became less than 2?mm.

Results

Six of the ten patients (20 eyelids) presented with full eyelid opening but more than 3?mm of lagophthalmos in voluntary eyelid closure. After the upper eyelids were forcibly lowered, all six eyelids showed less than 2?mm of lagophthalmos. There were no cases of lagophthalmos 1 month postoperatively.

Conclusions

Additional finger force makes precise quantification of blepharoptosis surgery possible and prevents postoperative lagophthalmos.?Jpn J Ophthalmol 2006;50:135–140 © Japanese Ophthalmological Society 2006