Lower Fornix Research Articles

Efficacy of Amniotic Membrane Grafting Compared to Mucous Membrane Grafting in Reconstruction of Contracted Eye Socket: A Systematic Review and Meta-Analysis

Abstract Background Successful reconstruction of contracted sockets requires the implantation of an allograft or auto graft. Amniotic membrane and oral mucosa are still the most commonly used substitutes for reconstruction of large conjunctival defects in contracted eye sockets. Aim of the Work To conduct a systematic review and meta-analysis estimating the efficacy of amniotic membrane versus mucous membrane grafting in reconstruction of mild to moderate contracted eye sockets. Materials and Methods A comprehensive literature search was conducted across the following databases: Google scholar, PubMed, MEDS, web of science, EMBASE and Cochrane Library for published studies from the 1st of January 1990 to the 1st of December 2022. According to the inclusion and exclusion criteria, four studies (published between 2006 and 2018) were included in the presented meta-analysis; they included 72 patients with mild to moderate contracted eye sockets. Results This study demonstrated a higher average upper fornix (UF) depth among patients in amniotic membrane grafting (AMG) group as compared to patients in mucous membrane grafting (MMG) group with a difference of + 1.08 mm in favor of AMG group, the overall effect is border line significant P = 0.06. Also, a higher average lower fornix (LF) depth was found among patients in AMG group compared to patients in MMG group with a mean difference of + 0.99 mm in favor of AMG group, the overall effect is highly statistically significant P < 0.0001. The average socket volume was higher in AMG group in comparison to patients in MMG group with a mean difference of + 0.14 mm in favor of AMG group, and the overall effect is border line significant P = 0.05. A lower percentage of complications was found in AMG group (21.6%) as compared to MMG group (26%) with no significant difference statistically; P value >0.05. Conclusion The presented analytical study revealed that AMG achieves superior clinical results in comparison to the MMG in reconstruction of mild to moderate cases of contracted sockets regarding socket volume, and upper and lower forniceal widening. It also carries lower risk of complications.

Long-term Outcome of Conjunctival Transposition Flaps for Contracted Sockets.

To assess the efficacy, and reintervention rate, of a conjunctival transposition technique in the treatment of contracted fornices in anophthalmic sockets. Retrospective case-note review of patients with contracted anophthalmic sockets who received a novel conjunctival mucosal transposition flap for augmentation of socket lining. Contracted anophthalmic sockets were categorized as grade 1 (minimal contraction), grade 2 (inferior and/or superior fornix), grade 3 (advanced scarring of the entire upper and lower fornices), and grade 4 (severe palpebral phimosis, recurrent cases, and irradiated sockets). Of 32 patients (56% male), 53% had mild-to-moderate contracted anophthalmic sockets (grades 1 or 2). The transposition flap was combined with secondary ball implantation (3 cases), ball exchange (1 case), primary orbital floor (1 case), or revisional floor (3 cases) implantation. By an average follow up of 9.2 years, 16% (5 cases with grade 3 or 4) required additional relining, with another patient declining further surgery; this yielding an overall anatomic success of 81% (100% in grades 1 and 2; 60% in grades 3 and 4). At the last follow up, 91% of patients had adequate socket lining and 94% reported a comfortable socket with stable prostheses. Having results similar to free grafting but without remote donor-site morbidity, this novel transposition flap satisfactorily addresses mild-to-moderate fornix contracture, and most patients achieve stable and comfortable prosthetic wear. Some patients with severe contracted anophthalmic sockets required further autologous grafting: this generally arose because the transposition flap included tissue from above the socket's horizontal raphé (with later contracture of the upper fornix).

Phlyctenular Conjunctivitis Treated with Homoeopathy: A Case Report

AbstractPhlyctenular conjunctivitis (PC) is characterised by formation of a whitish nodule on bulbar conjunctiva near or at the limbus with a localised conjunctival congestion. It is considered as an allergic reaction to endogenous bacterial protein. Conventional treatment includes use of topical steroids in simple PC, but if there is some degree of secondary infection or corneal involvement then combined steroid-antibiotics are used though there are high chances of recurrence. Homoeopathic literature has medicines listed for PC. The case reported was a female aged 60 years suffering from PC in right eye since 5 days and had no relief from local conventional treatment. She had complaints of redness, foreign body sensation and whitish discharge from the eye. Phlycten was at 6 o'clock position below the limbus with much conjunctival congestion around it and in the lower fornix. Homoeopathic Hepar sulphuris 30C resolved nodule within a week but the patient had itching of eye at the inner canthus, especially in the morning. Homoeopathic Natrum muriaticum 30C helped to resolve conjunctival congestion in the fornix and itching of eye within a week. Both medicines were prescribed on the basis of local signs and symptoms. There was no recurrence in the last 5 months. This case report with ocular photographs during follow-up provides documentary evidence about effectiveness of homoeopathy in PC.

Comparison of Topical Instillation From Single-dose and Multidose Eye Drop Containers in Glaucoma: A Multicenter Randomized Cross-sectional Trial.

We compared the quality of instillation of topical treatments from single-dose (SGD) or multidose (MTD) containers in glaucoma patients and showed neither a significant difference between the type of container nor a significant relationship to upper limb mobility. To describe and compare the quality of instillation of topical treatments with SGD or MTD containers in glaucoma patients. To assess factors likely to influence instillation, particularly the upper limb mobility. This multicenter, cross-sectional study included open-angle glaucoma patients with the same self-instilled treatment over at least 3 months. Patients were asked to successively self-administer a drop of artificial tears from SGD and MTD containers in front of an observer. The order of instillation (eye and container) was randomized. Correct instillation was defined as the administration of 1 drop in the lower fornix, without any contact between the tip of the device and the ocular surface. The Quick Disabilities of the Arm, Shoulder, and Hand self-questionnaire assessed upper limb mobility. A total of 239 eyes from 173 patients were included. For the worst eye group 33% of patients performed correct instillation with MTD versus 32% using SGD (P=1). In the best eye group, 31.7% patients performed a correct instillation with MTD administration versus 27.5% with SGD (P=0.327). Multivariate analysis showed a significant association between an inadequate SGD instillation, old age (P=0.021), the severity of the visual field deficits (P=0.035), and a low quality of life score (P=0.028). No association existed between the Quick Disabilities of the Arm, Shoulder, and Hand score and the quality of instillation. These results suggest that the handling of single-use containers should be practiced by patients and evaluated by physicians, especially for the elderly population and those with advanced glaucoma. No difference in instillation quality was found between SGD and MTD.

Recurrent contracted sockets treated with personalized, three-dimensionally printed conformers and buccal grafts.

Purpose:Recurrent contracted sockets are complex situations where previous surgeries have failed, disabling the wear of an ocular prosthesis. A combined method of surgery and long-term fixation using custom-made, three-dimensional (3D) printed conformers is evaluated.Methods:Retrospective case series of nine patients with recurrent excessive socket contraction and inability to wear a prosthesis, caused by chemical burns (n = 3), fireworks (n = 3), trauma (n = 2) and enucleation and radiotherapy at childhood due to optic nerve glioma (n = 1) with three average previous socket surgeries (range 2–6). Treatment consisted of a buccal mucosal graft and personalized 3D-printed conformer designed to be fixated to the periosteum and tarsal plates for minimal 2 months. Primary outcome was the retention of an ocular prosthesis. Secondary outcome was the need for additional surgeries.Results:Outcomes were measured at final follow-up between 7 and 36 months postoperatively (mean 20 months). Eight cases were able to wear an ocular prosthesis after 2 months. Three cases initially treated for only the upper or only the lower fornix needed subsequent surgery for the opposite fornix for functional reasons. Two cases had later surgery for cosmetic improvement of upper eyelid position. Despite pre-existing lid abnormalities (scar, entropion, lash deficiency), cosmetic outcome was judged highly acceptable in six cases because of symmetric contour and volume, and reasonably acceptable in the remaining two.Conclusions:Buccal mucosal transplant fixated with a personalized 3D-designed conformer enables retention of a well-fitted ocular prosthesis in previously failed socket surgeries. Initial treatment of both upper and lower fornices is recommended to avoid subsequent surgeries for functional reasons.

No secret hiding place? Absence of SARS-CoV-2 on the ocular surface of 1145 hospitalized patients in a pandemic area

ObjectivesThe aims of this study were to evaluate the isolated prevalence of real-time reverse transcriptase-polymerase chain reaction (RT-PCR)–confirmed SARS-CoV-2 on the ocular surface without systemic infection in hospitalized asymptomatic patients and to determine the risk for ophthalmologists and medical staff to be infected by prescreened asymptomatic patients in a tertiary eye care center.MethodsIn this prospective, observational study, bilateral swaps of the conjunctiva in the lower fornices as well as nasopharyngeal swaps were collected in 1145 hospitalized asymptomatic patients of a tertiary eye care center. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis was performed for each swap to evaluate the prevalence of SARS-CoV-2. Demographic data and potential risk factors for an isolated infection of the ocular surface were noted.ResultsTwo thousand two hundred eighty-eight (99.9%) of all 2290 tested eyes had negative results in the RT-PCR analysis of the conjunctival swabs. One patient had bilateral false-positive results in the conjunctival swabs. None of the 1145 patients had any positive RT-PCR-confirmed result in the nasopharyngeal swabs.ConclusionsThe risk for an isolated conjunctival viral activity in patients with a negative nasopharyngeal swab-based RT-PCR seems to be absent or extremely low, suggesting no need to perform additional conjunctival swabs in patients with negative nasopharyngeal swabs. Furthermore, the risk of a work-related SARS-CoV-2 infection due to direct contact with preselected asymptomatic patients in an eye care center is very low, especially when additional hygiene standards and safe distances are respected carefully. This might reassure medical staff and reduce the fear of SARS-CoV-2 infection.

The treatment outcome of conjunctival resection for conjunctivochalasis: A case report

Conjunctivochalasis was defined as loose and nonedematous redundant conjunctiva located between the ocular globe and eyelids, especially at the lower fornix. These redundant conjunctival folds cause a range of symptoms, including grittiness, dryness, epiphora and blurry vision etc. due to the interior nasal punctum blockage and decreased tear film stability. Decreased tear film stability, pooling tears in the eyelid cul-de-sac, tear meniscus disruption, increasing mechanical friction, cause corneal epithelial damage and ocular surface inflammation. Conjunctivochalasis is a common ocular surface disease but well overlooked and often misdiagnosed with dry eye, meibomian gland disease or allergic conjunctivitis. The difficulty in diagnosing conjunctivochalasis is that the symptoms are non-specific, the onset is insidious and many clinicians do not recognize the significance of the conjunctival folds. Surgical treatment is indicated when refractory to medical management (artificial tears, anti-inflammation eyedrops) in order to reconstruct the conjunctival surface and tear menicus function. To better understand the efficacy of surgical management of conjunctivochalasis, we report a case of conjunctival resection before and three months after surgery.

Assessment of Prevalence and Risk Factors of Dry Eye Disease among Study Group

Background: Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance. The present study was conducted to assess prevalence and risk factors of dry eye diseases among the study group. Subjects and Methods: The present study was conducted from February 2018 to July 2018 on 184 patients of both genders visiting the Department of Ophthalmology Mediciti institute of medical sciences with eye complaints. Slit-lamp biomicroscopy with a cobalt blue filter was used to investigate the tear film layer, and the interval from the last blink to the appearance of the first random dry spot on the cornea was noted. Schirmer’s test was performed. Whatman filter paper no 41 was placed in the lower fornix at the lateral one-third of the lower lid margin. Results: Age groups 40-50 years had 52, 50-60 years had 98 and 60-70 years had 34 patients. There were 110 males and 74 females. The difference was significant (P< 0.05). 64 (58.1%) males and 40 (54%) had a dry eye disease. The prevalence found to be 61.9%. The severity of DED was mild in 25%, moderate in 46% and severe in 29%. The difference was significant (P< 0.05). Risk factors of DED were steroid use in 14%, smoking in 56%, alcoholism in 24%, computer job in 78%, systemic allergy in 4%, ocular allergy in 32%, contact lens use in 17% and previous ocular surgery in 7%. The difference was significant (P< 0.05). Conclusion: The author found that the prevalence rate of dry eyes was 61.9%. Risk factors of DED were steroid use, smoking, alcoholism, computer job, systemic allergy, ocular allergy, contact lens use and previous ocular surgery.

PREVALENCE OF DRY EYE IN PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN: A HOSPITAL BASED COMPARATIVE STUDY.

Objectives: This present study was to evaluate the prevalence and severity of dry eye with respect to age in premenopausal and postmenopausal women.
 Methods: Visual acuity was assessed on Snellen’s chart and anterior segment evaluation was done with slit lamp biomicroscope. Ocular surface Disease Index (OSDI) questionnaire was completed and grading done. Dry eye evaluation was done with Schirmer I, by placing a special filter paper in the lower fornix and Tear film Break-Up time was done by an impregnated fluorescein strip moistened with saline which was instilled into the lower fornix.
 Results: 64(32%), 42(21%) and 35(17.5%) women were belonged in age group of 61-70 years, > 7o years and 51-60 years respectively. dry eye was seen in 6(6%) premenopausal and 47(47%) in postmenopausal women. Higher prevalence of dry eye 29(45.31%) was seen in age 61-70 years. 11(26.19%) prevalence was seen in age > 70 years. Premenopausal women had mainly 6(100%) mild dry eye. 22(46.81%) Postmenopausal women had 22(46.81%), 14(29.79%) and 11(23.40%) mild, moderate and severe grade of dry eye respectively.
 Conclusions: Dry eye was commonly seen in older age postmenopausal women. Premenopausal women had mainly mild dry eye. Postmenopausal women had commonly mild to moderate grade of dry eye. Hence, early detection of dry eye is important to arrest the progression of dry eye as well as to prevent the complications that can reduce corneal transparency and reduce vision. Environmental and behavioural modifications such as taking breaks while reading, keeping the computer monitors at eye level, use of UV protective glasses and humidification of the environment can be tried.
 Keywords: Dry eye, premenopausal, postmenopausal, age group

Assessment of conjunctival flora in eyes with lacrimal passage obstruction before and after successful dacryoendoscopic recanalisation

BackgroundTo investigate conjunctival bacterial flora in eyes with lacrimal passage obstruction before and after dacryoendoscopic recanalisation with lacrimal tube intubation.MethodsOne-hundred fifty eyes with lacrimal passage obstruction that were successfully treated...

Congenital Microphthalmia with Orbital Cyst: A Case Series

Microphthalmos results from incomplete invagination of the optic vesicle or closure of the embryonic fissure. We present three patients with unilateral congenital microphthalmia with cyst. None of them had vision in the affected eye since birth. There was gradually increasing left eye orbital mass encroaching towards lower fornix and lower eyelid ectropion. On examination and investigations, patients had large orbital cyst with microphthalmia pushing the eyeball superiorly and posteriorly in affected orbit. Microphthalmic globe with cyst was surgically excised and histopathologically studied. Orbital cavity was big enough to occupy the conformer and the prosthetic eye after 6 weeks. Diagnosis was confirmed as large communicating orbital cyst with microphthalmia without systemic association in all the patients. None of the mothers of patients had regular antenatal check up. All the parents had consanguineous marriage. Antenatal check up with ultrasound at 14 to16 weeks of pregnancy is important for genetic counselling. Targeted abdominal ultrasound examination of pregnant women focused on the orbital region of foetus is recommended, in mothers who have children with congenital eye anomalies. Keywords: congenital anomaly; cyst; eye; microphthalmos.

Effect of Eyelid Margin Cleaning on Conjunctival and Eyelid Bacterial Flora Before Intraocular Surgery

ABSTRACTPurpose: To compare the bacterial cultures of the lower eyelid margins and lower fornices between ocular irrigations with and without eyelid margin cleaning before intraocular surgery.Methods: A prospective study was carried out that included 102 eyes from 51 patients undergoing intraocular surgery between December 2016 and April 2017. In each patient, the surgical eye (control group) only received ocular irrigation and the opposite eye (study group) received ocular irrigation with eyelid margin cleaning. Normal saline solution was used in all procedures. In each group, samples from the lower eyelid margins and lower fornices were cultured before and after cleaning. Povidone iodine and antibiotic eye drops were instilled after specimen collection.Results: The most common bacterial isolate of all groups was Staphylococcus spp. There were no statistically significant differences of positive cultures between the control and study groups in either lower eyelid margins (Odds ratio [OR], 2.19; 95% CI, 0.84–5.72) nor lower fornices (OR, 0.93; 95% CI, 0.43–2.00). In addition, there were no statistically significant differences of positive cultures between before and after eyelid cleanings from both lower eyelid margins (OR, 2.74; 95% CI, 0.53–14.24) and lower fornices (OR, 0.73; 95% CI, 0.21–2.57).Conclusions: Eyelid margin cleaning with normal saline solution immediately before intraocular surgery did not help to decrease microbial loading on the ocular surfaces. The rate of bacterial contamination, however, was not increased which could be due to not performing eyelid compression.

Fusidic acid vs ofloxacin prophylaxis before cataract surgery.

To evaluate the safety and efficacy of two self-administrated antibiotics in eliminating conjunctival microbial flora. A total of 133 patients operated for cataract surgery were divided into three groups. The first group (A), 55 patients, received fusidic acid drops (1%) two times per day during the 3 days before the surgery; a second group (B), 55 patients, received ofloxacin (0.3%) four times per day during the 3 days before the surgery; and the third group (C), 23 patients, did not receive any topical antibiotic before the surgery. On the day of the surgery, cultures were taken from the lower fornix. In Group A, 28 cultures (50.9%) were sterile, and 27 (49.1%) were positive for the presence of microbial agents. In Group B, 25 cultures (45.4%) were sterile, and 30 (54.5%) were positive for the presence of microbial agents. In Group C, 5 cultures (21.7%) were sterile, and 18 (78.2%) were not. Staphylococcus epidermidis was the most common micro-organism isolated in all the groups. Statistical analysis does not reveal a significant difference between Groups A and B for the sterile cultures (p=0.7) (chi-square test), but a statistically significant difference is present between the treated and not treated patients (p= 0.05) (chi-square test). A preoperative prophylaxis is useful in eliminating conjunctival micro-organism, and both antibiotics (fusidic acid and ofloxacin) are efficient.

Atropine for the Prevention of Progression in Myopia - Data, Side Effects, Practical Guidelines

The prevalence of myopia has increased worldwide in recent decades. In East Asia's metropolises ≥ 80% of young adults are affected. This dramatic increase is mainly caused by changes in lifestyle and behaviour. Atropine has been used for more than 100 years to arrest myopia progression. It has become an evidence-based treatment regimen in the last decade, although the exact mechanism of the effect of treatment is still unknown. Atropine eye drops can slow myopia progression by an average of - 0.54 dioptres (D)/year in Asian children and - 0.35 D/year in Caucasian children. However, a non-response rate of about 10% has been found. Treatment should be established in schoolchildren only (age ≥ 6 years) with myopia ≤ - 2 D (spherical equivalent, cycoplegic refraction) and with documented myopic progression of - 0.5 D in the preceding year. 0.01% eyedrops should be instilled into the lower fornix at bedtime. Atropine 0.01% therapy is well tolerated. Atropine is usually administered for 2 years since efficacy is somewhat better in the second year. During treatment, a 6-month follow-up with cycoplegic refraction and axial length measurement is recommended. After the 2-year period, atropine withdrawal is justified if progression is less than - 0.25 D/year in the second year. Even after atropine has been stopped, follow-up examinations are needed to detect any rebound. Atropine-therapy is resumed if progression is again higher than - 0.5 D/year. Topical atropine is used off-label.

Does azithromycin given to women in labour decrease ocular bacterial infection in neonates? A double-blind, randomized trial

BackgroundVertical transmission can result in neonatal infection and disease. Reducing the transmission of bacterial pathogens from mother to infant may be an effective means of preventing neonatal infection, including bacterial conjunctivitis.MethodsIn a double-blind, randomized trial, we assessed the effect of administering a single dose of oral azithromycin to women in labour on bacterial colonization of the neonate. A reduction in purulent neonatal conjunctivitis was a secondary objective of the trial. Ocular samples were collected from the lower fornix of infants presenting with clinical signs of purulent conjunctivitis during the first eight weeks of life. Incidence of purulent conjunctivitis was compared between trial arms. Bacterial infection was assessed using PCR and incidence of purulent conjunctivitis due to bacteria was also compared between arms.ResultsForty of 843 infants (4.7%) presented clinical signs of purulent conjunctivitis. No significant difference in incidence of purulent conjunctivitis was seen between azithromycin and placebo arms [4.3% (18/419) versus 5.2% (22/424), OR = 0.82, 95% CI (0.44,1.54), p = 0.628]. S. aureus was the most commonly identified pathogen, detected in 38% of cases. Incidence of purulent-conjunctivitis due to bacterial infection was lower in the azithromycin arm [1.2% (5/419) versus 3.8% (16/424), OR = 0.31, 95% CI (0.12–0.82), p = 0.025)]. The incidence of gram-positive bacteria was also lower in the azithromycin arm [1.0% (4/419) versus 3.3% (14/424), OR = 0.28, 95%CI (0.10–0.82), p = 0.029].ConclusionsOral azithromycin given to women during labour may have the potential to reduce the incidence of bacterial neonatal conjunctivitis.Trial registrationClinicalTrials.gov, identifier NCT01800942, registration date 26 Feb 2013.

Autologous fat transfer with SEFFI (superficial enhanced fluid fat injection) technique in periocular reconstruction

ABSTRACTPurpose: To evaluate the aesthetic and functional outcomes of autologous fat transfer using the SEFFI (superficial enhanced fluid fat injection) technique for reconstruction of the periocular area.Methods: Autologous fat injections prepared with the 0.5 mL and 0.8 mL SEFFI technique were used in four patients for periocular rehabilitation.Results: Case 1 (C1): A patient with left-sided progressive facial hemiatrophy underwent ipsilateral volumizing with 0.8 SEFFI in the superior, temporal, and inferior periorbital areas, and 0.5 SEFFI in both eyelids. C2: A 21-year-old female with a post trauma frontal scar, left ptosis, and lower eyelid retraction was treated with 0.5 SEFFI applied in the scar area associated with an upper eyelid conjunctivomullerectomy and resection of the lower eyelid retractors. C3: A patient with previous left-eye evisceration and orbital floor and medial wall fractures underwent socket reconstruction with buccal mucosal graft in the lower fornix and 0.5 SEFFI injections in both superior and inferior eyelids. SEFFI was also applied in the intraorbital space for correction of the enophthalmos. C4: A patient with lower lid retraction post blepharoplasty was treated with 0.8 SEFFI injections in lower eyelids and malar areas, complemented with a bilateral lateral cantopexy.Conclusions: Autologous fat transfer with SEFFI technique is an effective and safe procedure in cases of periocular rehabilitation.

Conjunctival lymphoma in right eye: Case report

Abstract Case report A 43-year-old woman presented with a salmon-colored patch of 0.7 mm diameter in the right eye that extended into the lower fornix in the bulbar and tarsal conjunctiva, with irregular edges, and highly vascularized. Incisional biopsy was performed, showing it to be a low-grade conjunctival non-Hodgkin B cell lymphoma (or a mucosa associated lymphoid tissue [MALT] lymphoma). Discussion The lesion remained stable for 24 months of follow-up, when a relapse of the condition occurred, producing an enlargement of the initial lesion. The definitive diagnosis is made by biopsy of the affected tissue and histopathologic study.

Orbital implantation of submandibular salivary gland for dry eye syndrome

Dry eye syndrome or keratoconjunctivitis sicca is a disorder with reduction of tear secretion. In recent times, tear supplements form a major product by several pharmaceutical companies. In earlier days, parotid gland duct transfer into lower fornix through subcutaneous route had been performed. Among the three pairs of salivary glands, submandibular salivary gland secretion has the consistency more watery and akin to tears. Since the transfer of it is autologous, no rejection occurs and tissue acceptance with the resumption of secretary property is immediate and permanent.

Success of patient training in improving proficiency of eyedrop administration among various ophthalmic patient populations.

PurposeThe purpose of this study is to evaluate the success and usefulness of patient education in eyedrop self-administration technique via an educational handout and a short instructional video.Patients and methodsWe conducted a prospective study that included 34 patients who were self-administering ophthalmic drops. Of the total patients included, 12% had used drops for <12 months, and 88% had used drops for >12 months. Average age of patients in the study was 67 years, with an age range of 19–91 years. Of the total patients included, 82% had glaucoma, 6% had dry eyes, and 12% did not have a specific diagnosis. Subjects were video recorded and assessed by a trained observer on two occasions: at baseline and after they viewed a demonstrational video and handout. A maximum score of 15 points was awarded based on 15 criteria. A written self-assessment was administered at the end of each study.ResultsPre- and post-teaching assessment scores improved significantly with education. Patients initially scored an average 2.53 points compared to a post-education score of 6.15 out of 15 points, demonstrating a 2.43 (P=0.008) factor of improvement. After education, 94% of patients versus 47% pre-teaching (P=0.0001) pulled down their lower eyelids. A total of 91% pre-teaching versus 59% post-teaching (P=0.0042) patients squeezed one drop into the lower fornix, 74% pre-teaching versus 26% post-teaching (P=0.0002) patients released the eyelid and closed the eye for 1 minute, and 56% pre-teaching versus 3% post-teaching (P=0.0001) patients applied nasal digital pressure on each eye. We found no significant difference in score changes between those who previously received education and those who had not (P=0.37). A total of 91% patients responded in a postassessment survey that they now feel more confident of their ability to self-administer eyedrops as their doctor prescribed and that the educational materials were responsible.ConclusionParticipants demonstrated an immediate and statistically significant improvement in several areas of proper eyedrop self-administration after exposure to a demonstration video and instructional handout.

Upper and lower conjunctival fornix depth in healthy white caucasian eyes: a method of objective assessment.

PurposeEvaluating anti-scarring therapies require objective assessment of scarring, and knowledge of normal fornix anatomy. Measurement of conjunctival scarring has focused on inferior fornix shortening, although the superior fornix is often overlooked. There are data on normal fornix depth (FD) in South Asians, but there are no studies investigating normal conjunctival FD in white Caucasians. We designed a fornix depth measurer (FDM) for objective measurement of upper and lower conjunctival FD. The purpose of this study was to evaluate intra- and inter-observer variability, and to establish a reference for normal conjunctival FD in an ethnically white Caucasian population.Patients and methodsProspective cross-sectional study evaluating conjunctival FD in 252 clinically normal white Caucasian participants aged 20-80. Paired observers evaluated inter- and intra-observer variability. Data was analyzed using Bland-Altman plots and analysis of variance.ResultsFor white Caucasian subjects, mean upper and lower conjunctival fornix depths were 15.6 mm (95% confidence interval (CI), 12.5-18.8) and 10.9 mm (95% CI, 8.0-13.7), respectively. Females have smaller FDs (upper FD 15.3 mm±1.6 females, 16.2 mm±1.4 males, P<0.001; lower FD 10.6 mm±1.3 females, 11.3 mm±1.4 males, P<0.001). There was a progressive decline in FD with age (upper fornix depth 16.3 mm±1.2 at age 20-29, and 15.0 mm±1.8 at age 80+ (P=0.04)). There was 94-100% intra-observer and inter-observer agreement for upper and lower fornix measurements.ConclusionsUsing a slightly different custom-designed FDM, central conjunctival fornix depth in white Caucasian eyes appears to be similar to data previously reported in South Asian eyes. Fornix depth measurements were repeatable and reproducible.