Silicon tube frontalis suspension in simple congenital blepharoptosis.

BACKGROUND: Ptosis is an abnormally low position of the upper eyelid. Congenital ptosis should be corrected in early years of childhood. The aim of this study was to assess the efficacy and complications of frontalis suspension using silicon tube for simple congenital blepharoptosis with poor levator function. METHODS: A prospective study was performed on 33 children who underwent frontalis suspension using silicon tube from Jan 2008 to Jun 2011 with a minimum of 6 month follow-up. Functional success was defined when 3 criteria were met: (a) satisfactory lid height defined as margin-to-reflex distance > or = 3.5 mm with minimal frontalis action (brow up); (b) satisfactory lid symmetry (< or = 2 mm asymmetry in margin-to-reflex distance) between two lids; and (c) satisfactory cosmesis, i.e., normal lid contours. RESULTS: The mean follow-up duration was 9 months (range 6.5-27 months). The functional success rate was 91.4% (32/35 eyes). Three eyes had complications. In one eye (2.8%), recurrence of ptosis due to slippage of knot was seen, one eye developed infection of tract, and one with bilateral ptosis developed abnormal tenting of one of the lid. CONCLUSION: In simple congenital ptosis with poor levator function, frontalis suspension using silicon tube has good efficacy and an excellent safety profile. The results of frontalis suspension using silicon tube are comparable to fascia lata and superior to other non-autogenous materials.

Complications of nose and paranasal sinus disease.

BACKGROUND: Diseases of nose and paranasal sinuses can complicate to involve the orbit and other surrounding structures because of their close proximity. These diseases are usually infective or can be neoplastic in origin. METHOD: All the patients presenting in ENT or Eye Departments of Ayub Teaching Hospital during the one year study period who had complicated nose or paranasal sinus disease were included in the study. A detailed history and examination followed by CT scanning and laboratory investigations to assess the type and extent of the disease, was carried out. RESULTS: Infections were the most common cause of complicated sinus disease 11 (75%). The rest of the 4 (25%) cases were tumours. 12 (80%) of the cases presented with proptosis. In I of these 12 cases. there was complete blindness. In 2 (13%) of the cases there was only orbital cellulitis. Two of these patients had facial swelling and 2 had nasal obstruction and presented as snoring. Two patients presented with history of weight loss and these patients had malignant tumour of the paranasal sinuses. One patient presented with early signs of meningitis. In 1 case subperiosteal scalp abscess (Pott's puffy tumour) was the only complication noted. CONCLUSION: Nose and paranasal sinus diseases can complicate to involve mostly the orbit, but sometimes brain, meninges and skull bones can also get involved.

Status of children in blind schools in the northern areas of Pakistan.

BACKGROUND: Prevalence of blindness in Pakistan is estimated to be 0.9%, which comes to about 1.25 million persons. A significant number of these are persons under 20 years of age. To make these children useful citizens in future, special facilities are to be provided to these children for their education and training. A study was done to find out the visual status of the students studying in a blind school in Abbottabad, Pakistan, the only such facility in the region. METHOD: A total of 50 patients were examined during our visit to the blind school in Abbottabad. Age of the patients ranged from 6 to 27 years (mean: 12.32 years). All the students, who were otherwise healthy, were included in the study. RESULT: The most common disorder identified was malformed globe or traumatic eyes (16 cases, 32%), in most of the cases, leading to phthisis bulbi. Other conditions noticed were Retinitis Pigmentosa (10 cases, 20%), Keratoconus, Optic atrophy, Buphthalmos (6 cases each, 12%), corneal opacity (4 cases, 8%) and retinal detachment (2 cases 4%). CONCLUSION: We should work towards betterment of these schools by providing them with more funds, equipment and manpower. Regular visits of Ophthalmologists to these schools may be helpful. Genetic counselling should be arranged for the families.

An unusual case of bloody tears.

Conjunctival bleeding is usually caused by non accidental or accidental conjunctival laceration, conjunctival tumors and nasolacrimal sac tumors. We report here a rare case of conjunctival bleeding which was self induced using cinnamon bark.

Frequency of ocular complications of leprosy in institutionalized patients in NWFP Pakistan.

BACKGROUND: There is no systemic disease, which so frequently gives rise to disorders of the eye as leprosy does. The study was conducted to determine the prevalence and gravity of ocular complications in institutionalized leprosy patients in NWFP. It is important to provide necessary information to leprosy health workers and general physicians in order to sensitize them to early detection and treatment or referral to appropriate centre. METHODS: A prospective study of ocular complications of leprosy patients was conducted at the leprosy centre of Lady Reading Hospital Peshawar and the Leprosy Hospital Balakot, district Mansehra. The study included a record of the name, age, sex, type, duration of disease and completion of multi-drug therapy (MDT). Classification of the patients was done according to Ridley and Jopling 5-group system. Visual acuity was tested by Snellen chart and those patients having a vision of less than 3/60 were labelled as blind. Ocular adnexa were examined by naked eye and lacrimal sac regurgitation test was done. Slit lamp biomicroscopy was done for anterior segment examination and direct ophthalmoscope was used for fundoscopy. RESULTS: The authors studied 143 patients in the above mentioned leprosy centres. Out of these, 59 had lepromatous leprosy, 39 borderline tuberculoid leprosy, 9 tuberculoid leprosy, 33 borderline lepromatous leprosy, and 33 borderline leprosy. The majority of patients came from the northern districts of NWFP, including Malakand division and district Mansehra. The male to female ratio was 4:1. The age of the patients ranged from 14 to 80 years and the duration of the disease ranged from 1 year to 48 years. Ocular complications were found in 73% of the patients. These complications included loss of eyebrows in 57 patients, loss of eyelashes in 37, corneal changes (including opacity, ulceration, and/or anaesthesia) in 44, iridocyclitis in 31, lagophthalmos in 36, ectropion in 13, and chronic dacryocystitis in 3. Of the total of 15 (11%) patients who went blind from ocular complications, 16 eyes did so due to corneal opacities, 6 eyes due to cataract, 5 eyes due to chronic anterior uveitis and one eye due to corneal ulcer, panophthalmitis and phthisis bulbi each. CONCLUSIONS: A significant number of leprosy patients (73%) have ocular complications. The frequency of ocular complications increases with the increasing age and duration of disease of the patients.