Are You Missing an Entropion? The Test of Induced Entropion 2.

PURPOSE: Entropion is the inward turning of the eyelid. The most common type of entropion is involutional, a combination of eyelid laxity, lower eyelid retractor weakness, and orbicularis oculi override. Unfortunately, the condition can be intermittent and remain undiagnosed, leading to ocular surface damage. In suspected cases, clinicians can use provocation techniques to elicit the condition. These include the forced closure of the eyelids, the tetracaine provocation test, and the test of induced entropion (TIE). The authors present an alternative diagnostic test: the TIE-2. METHODS: The TIE-2 test is performed by asking the patient to look down while the examiner holds the upper eyelid open and high to prevent downward movement. The patient is then asked to close their eyelids as tightly as possible. An entropion will then be induced. To illustrate the technique, the authors present 2 patients seen in the oculoplastics clinic with symptoms and signs suggestive of intermittent entropion, in whom conventional provocation tests were unsuccessful. RESULTS: In both cases, conventional methods did not provoke an entropion. However, the TIE-2 test successfully induced an entropion, leading to the correct diagnosis and appropriate management. CONCLUSION: When there is suspicion of intermittent entropion that is not revealed with existing provocation tests, the TIE-2 is a simple and useful diagnostic tool.

The lower lid diamond: a simple entropion repair to correct both horizontal and lower-lid retractor laxity.

PURPOSE: To describe a simple technique for involutional entropion correction and to present the findings of a pilot study. METHODS: Consecutive case series of 42 procedures. Patients presenting with involutional entropion in the absence of lateral canthal tendon laxity (lateral canthus could be distracted 1 cm or more medially) underwent a modified full-thickness eyelid shortening combined with retractor plication. Main outcome measures were correction of entropion and cosmesis of the surgical site at final follow up. RESULTS: At final follow up, 92% of patients had a satisfactory eyelid position with no recurrence of entropion and a cosmetically satisfactory scar. CONCLUSIONS: This is a useful technique with a higher success rate than everting sutures and is particularly suitable for patients for whom rapid surgery is needed or a lateral canthotomy is best avoided.

A novel technique to facilitate dacryocystectomy using viscoelastic substances.

The procedure of dacryocystectomy is described in a patient with Wegener's granulomatosis where bone preservation is essential for future reconstructive procedures. With the aid of canalicular clamps, viscoelastic substance is used to distend the lacrimal sac thereby facilitating easier dissection. We describe the use of canalicular clamping and injection of a viscoelastic substance into the lacrimal sac to facilitate easier dissection during dacryocystectomy.

Refractive expectations of patients having cataract surgery.

PURPOSE: To assess the refractive expectations of patients having elective cataract surgery. SETTING: Queen's Medical Centre, Nottingham, King's Mill Hospital, Sutton-in-Ashfield, and Kidderminster District Hospital, United Kingdom. METHODS: A prospective questionnaire study of patients attending a preoperative assessment clinic for elective cataract surgery was performed. Only first-eye cataract surgery patients were included. Patients were excluded if they had visually impairing ocular comorbidity or if they were mentally unable to complete the questionnaire. RESULTS: One hundred eighty-nine questionnaires were received. Mean patient age was 74 years (range 41 to 97 years). Sixty-four percent of respondents were women, and 90% were retired. On 10-point Likert scales (0 lowest, 10 highest), median patient scores for the perceived likelihood of needing spectacles after surgery were 8 for both distance and near correction. Patients already wearing distance correction thought it significantly more likely that they would need distance glasses postoperatively than those who did not (median likelihood scores 9 and 1, respectively; P<.0001). Similar differences in expectations were demonstrated for near correction. Median score of the importance of not needing spectacles was 8 for both distance and near. Men scored this higher than women, but only for distance. There was a weak negative correlation between the importance of spectacle independence and patient age. CONCLUSIONS: Patients who already wear spectacles expect to need them after cataract surgery. Those not already wearing spectacles do not expect to need them. This latter group is at particular risk for refractive disappointment and complaint. In general, patients consider the opportunity to be free of glasses as very important.

Frontal sinus mucocoele: a rare cause of ptosis.

A 73-year-old man, with no medical history of note, presented with a 4-week history of an isolated left-sided ptosis and associated periorbital and retro-orbital discomfort. His pupils were spared, his eye movements were not restricted and he was not proptosed. A prompt CT orbits and head scan revealed a large left frontal sinus mucocoele that had eroded into the left orbit. The patient had successful endoscopic sinus surgery under the ear, nose and throat team and 1 month later was seen in ophthalmology clinic. His ptosis and discomfort had fully resolved and he had no neurological sequelae from the surgery.