Lacrimal System Disorders Research Articles

The effect of topical steroids and non-steroidal anti inflammatory drugs on epiphora of unknown cause: Optical coherence tomography study.

The aim of this study is to evaluate using topical non-steroidal antiinflammatory and low-potency steroid drugs for the treatment of epiphora without an underlying cause using anterior segment-optical coherence tomography (AS-OCT) and Munk epiphora grading system. Thirty patients with epiphora who had no underlying cause were evaluated prospectively.A detailed ophthalmological examination, tear meniscus height on slit-lamp, fluorescein tear break-up time, schirmer test, lisamin green conjonctival staining, lacrimal syringing of the upper and lower canaliculus were done in all patients. The patients with contact lens wear,punctal stenosis, lacrimal system disorders, dry eye disease, eyelid malpositions, pterygium, conjunctivochalasis, conjunctivitis, blepharitis, ocular infection, and corneal disease, used topical anti-glaucomatous drugs were excluded. All patients were treated with a combination of topical low-potency drug (loteprednol etabonate 0.5%) twice daily for ten days and topical non-steroidal anti-inflammatory drug (nepafenac 0.3%)once a day for 1 month. Before and after the medical treatment protocol, tear meniscus area (TMA) and tear meniscus height (TMH) were measured by AS-OCT and patients were asked to subjectively rate their epiphora according to the Munk epiphora grading system. The effectiveness of treatment were evaluated by AS-OCT measurements and the Munk epiphora grading system. Fourteen males and sixteen females were included. The mean age at presentation was 60.1±7.35 years and duration of symptoms was 10.03±5.08 months. The mean duration of follow-up was 8.7±3.2 months. Munk epiphora grading system was significantly decreased from 2.5 to 1.6 after treatment (p: 0.004). TMH and TMA were significantly decreased on AS-OCT (TMH:402vs 309µm, p:0.001, TMA:0.797vs 0.347 mm2, p=0.006).Six of thirty patients subjectively reported that their symptoms had not improved but TMH and TMA were significantly decreased on AS-OCT. The combined use of topical non-steroidal anti-inflammatory and low-potency steroid drops may be a good option in patients with epiphora who does not have an underlying cause.

Pediatric ocular disease in an ophthalmic surgical mission trip to belize: A 7-year review

Purpose: The purpose is to identify the various causes of ocular disease and surgical interventions undertaken in children (0–18 years of age) seen during an annual ophthalmic surgical trip to Belize. Methods: A retrospective, cross-sectional review of records from seven annual surgical trips conducted by the World Pediatric Project providing pediatric ophthalmologic clinical and surgical care to Belize from 2013 to 2019 was performed. Results: The charts of 313 patients who received care during the surgical mission trips were examined. From these 313 patients, there were 545 independent clinical encounters, yielding 405 diagnoses. Patients aged 6–10 years were most commonly seen (32.1%) followed by those 2–5 years old (28.1%). The most common pathophysiology seen was strabismus/ocular motility disorder (151 diagnoses; 37.4%), followed by refractive issues (69 diagnoses; 17.1%), eyelids and/or lacrimal system disorders (53 diagnoses; 13.1%), disorders of the retina/vitreous (30 diagnoses; 7.4%), lens abnormalities/cataract (28 diagnoses; 6.9%), amblyopia (23 diagnoses; 5.7%), disorders of the cornea/conjunctiva (23 diagnoses; 5.7%), trauma (13 cases; 3.2%), conditions affecting the globe/orbit (7 diagnoses; 1.7%), other (6 diagnoses; 1.5%), and glaucoma (1 diagnoses, 0.2%). Conclusion: This study identified the most frequently diagnosed ocular conditions encountered during annual surgical mission trips to Belize. The most prevalent pathophysiology encountered was strabismus/ocular motility disorders, followed by refractive issues. The most common refractive issues encountered were myopia and astigmatism. This is the first study detailing pediatric ocular disease in Belize.

Oculoplastic surgical services in Nigeria: status and challenges.

To assess the status and challenges of oculoplastic surgical services in Nigeria. An IRB-exempt, web-based survey was distributed to Ophthalmological Society of Nigeria members via e-mail. Information regarding demographics, type and location of practice, subspecialization training, availability and barriers of oculoplastic surgical services, pattern of oculoplastic diseases and surgical procedures was obtained. Responses were analyzed using standard statistical methods. Forty-four percent (155/356) of ophthalmologists invited completed the online survey. Of these respondents, 104 (67.1%) do provide oculoplastic surgical services with 8 (5.2%) trained in oculoplastic surgery. Respondents reported most commonly treating eyelid trauma (98.1%), orbital inflammatory diseases (92.1%) and lacrimal system disorders (86.5%) with globe removal procedures (98.1%), eyelid reconstruction (92.1%) and lacrimal drainage procedures (84.5%) being the most common procedures performed in their practices. Barriers to availability of oculoplastic surgical services identified by respondents were few trained oculoplastic surgeons (92.9%), lack of training centers (70.3%) and accessibility of services (60%). On multivariable analysis, predictors of availability of oculoplastic surgical services were greater number of years in practice (P < 0.001) and subspecialty training (P < 0.001). The availability and geographical distribution of oculoplastic surgical services in Nigeria are suboptimal with training deficiencies identified as the main challenge. Strategies to improve availability of oculoplastic care should entail a sustainable training program for this emerging subspecialty and physician deployment to under-resourced areas of the country.

Antonio Scarpa (1752-1832): Father of Italian Ophthalmology

Antonio Scarpa (1752-1832) was a prominent scholar who contributed greatly to otolaryngology, orthopedics, ophthalmology, neuroanatomy, and surgery. In 1801, he published a textbook on ophthalmology, the first Italian textbook on this subject and the most propagated European ophthalmic textbook in the first half of the 19th century. The book included important descriptions of lacrimal system disorders, many oculoplastic procedures, and the first description of posterior staphyloma.

Clinical Profile and Management Outcome of Acute Dacryocystitis: Two Decades of Experience in a Tertiary Eye Care Center

Aim: To report the demographic profile, clinical presentation, and management outcome of acute dacryocystitis. Methods: Retrospective study of 347 eyes of 320 patients, who presented to the Ophthalmic Plastic Clinic of a tertiary eye care center over a period of 22 years from January 1990 to March 2012 with acute dacryocystitis, were reviewed for demographic profile, clinical presentation, and management outcome. The numbers of patients with lacrimal disorders during the same period were retrieved to assess the incidence of acute dacryocystitis. Successful anatomical outcome was defined as patency on irrigation and a successful functional outcome was defined as resolution of infection and epiphora. Results: The mean age at presentation was 37 years. The female to male ratio was 2:1. There was no difference in the laterality between the right and the left eyes. Bilateral disease was noted in 8.4% (27/320) patients. 23% (80/347) eyes presented with lacrimal abscess while 2.8% (10/347) eyes had orbital cellulitis. Intensive medical care with hospital admission was needed in 4.4% (14/320) patients. The mean time to resolution of acute symptoms was 10 days. 5.6% (18/320) patients developed a fistula, among which 83% (15/18) were following a spontaneous rupture of the lacrimal abscess. Dacryocystorhinostomy was performed in 82.5% (264/320) patients with an anatomical success of 94.5% and a functional success of 93.5%. Conclusions: Acute dacryocystitis comprises 2.4% of all patients presenting with lacrimal system disorders. Fistula formation is a sequel more commonly seen with spontaneous rupture of a lacrimal abscess. The long-term outcomes in patients presenting with acute dacryocystitis are good with a surgical success rate of 94.3%.

Methicillin-Resistant Staphylococcus aureus Ocular Infection: A 10-Year Hospital-Based Study

To characterize the patient demographics, clinical features, and antibiotic susceptibility of ocular infections caused by methicillin-resistant Staphylococcus aureus (MRSA), including community-associated (CA) and healthcare-associated (HA) isolates. Retrospective, observational study. Patients (n = 519) with culture-proven S. aureus ocular infections seen between January 1, 1999, and December 31, 2008, in Chang Gung Memorial Hospital. Data collected included patient demographics and clinical information. Antibiotic susceptibility was verified by disc diffusion method. Proportion of MRSA in S. aureus ocular infections and the clinical characteristics, diagnoses, and antibiotic susceptibility patterns of CA-MRSA versus HA-MRSA ocular infections. We identified 274 patients with MRSA ocular infections, which comprised 181 CA-MRSA and 93 HA-MRSA isolates. The average rate of MRSA in S. aureus infections was 52.8% with a stable trend, whereas the annual ratio of CA-MRSA in ocular MRSA infections averaged 66.1% and tended to increase over the 10-year interval. Patients with ocular CA-MRSA were younger. Lid and lacrimal system disorders were more common, but keratitis, endophthalmitis, and wound infection were less common among CA-MRSA cases than HA-MRSA cases. Both CA-MRSA and HA-MRSA isolates were resistant to clindamycin and erythromycin, but CA-MRSA was more susceptible to sulfamethoxazole/trimethoprim. Community-associated MRSA is an important pathogen of ocular infections; CA-MRSA and HA-MRSA ocular infections differ demographically and clinically, but both strains were multi-resistant in Chang Gung Memorial Hospital, one of the biggest referral centers in Taiwan. In a country with a high prevalence of MRSA, ophthalmologists should be aware of such epidemiologic information.

Diagnosis and therapy of lacrimal system diseases by micro lacrimal endoscope

The lacrimal endoscope is applied to the diagnosis and therapy of the disorders of the lacrimal system in combination with laser or micro drills under orthophoria. The changes of mucous membranes, the characteristics of pathological changes and the predilection sites of lacrimal system diseases were initially approached. One hundred and forty six pairs of eyes of 128 patients with lacrimal system disease were observed by the lacrimal endoscope in the Ophthalmology Department of Tongji Hospital from June 2006 to March 2007. The dynamic changes in mucous membranes, lesion sites, secreted substances and formation of membrane could be observed under orthophoria. Combined with laser or micro drill, the endoscope was applied to the therapy of lacrimal system disorders and the difference before and after the treatment was observed. Results are as follows: (1) The examination and therapy using the lacrimal endoscope were completed under topical anesthesia in 122 patients, and 6 patients of neonatorum dacryocystitis were examined and treated under general anaesthesia. All patients reported painless. (2) Sharp images of the lacrimal system were obtained by the endoscope. Normal lacrimal mucosal membrane was smooth and light pink, expanded and unobstructed during irrigation. In chronic dacryocystitis patients, the inhomogeneous colour of mucosal membranes was red and white, with different degrees of fibrotic membranes at the superior, middle and inferior parts of the nasolacrimal canals and secreted substances at sac could be observed. The lacrimal ducts could not be expanded and obstructed during irrigation. The patients with lacrimal system obstruction had different extents of membrane formation, and stenosis or complete obstruction of the lacrimal duct could be observed, and the corresponding mucosal membrane was not smooth which could not be expanded and obstructed during irrigation. (3) After the treatment by the endoscope combined with laser or micro drill, the major proliferation of the membrane disappeared and the lacrimal duct was unobstructed during irrigation. The cure rate and effective rate were 80.1% and 93.1%, respectively. The lacrimal endoscope is a new method in the diagnosis of lacrimal system diseases. Through a combination with laser or micro drill to carry out the therapy under orthophoria, it will bring a great change to the diagnosis and therapy of lacrimal system diseases.

Síndrome de Down e alterações de vias lacrimais

OBJETIVO: Caracterizar as alterações de vias lacrimais em portadores de síndrome de Down. MÉTODOS: Estudo retrospectivo descritivo envolvendo 11 olhos de 8 pacientes com diagnóstico de síndrome de Down, acompanhados no período de 1995 a 2001. RESULTADOS: Todos os pacientes apresentaram quadro de dacriocistite crônica com obstrução no ducto nasolacrimal. Um paciente cursou também com canaliculite por Strepto- coccus sp e outro paciente apresentava ausência do ponto lacrimal inferior. Cinco pacientes foram submetidos à dacriocistorrinostomia, três à sondagem e intubação das vias lacrimais. A epífora foi resolvida em 4 olhos. CONCLUSÕES: Existem poucos relatos acerca do comprometimento das vias lacrimais em pacientes com síndrome de Down. A caracterização e a resolução cirúrgica do mecanismo obstrutivo lacrimal são importantes, uma vez que há interferência na qualidade de vida desses pacientes. No presente estudo, verificou-se que a obstrução da via lacrimal ocorreu no ducto nasolacrimal. O prognóstico cirúrgico foi ruim em 83,4% das intubações e em 57,2% das dacriocistorrinostomias. Causas do insucesso cirúrgico podem estar relacionadas à maior fibrose pós-operatória nesses pacientes e à dificuldade de colaboração dos mesmos no controle pós-cirúrgico. Estudos posteriores são necessários para verificação das presentes observações.