Ultrasound biomicroscopy and histopathology of sclerocornea.

PURPOSE: We present a clinicopathologic case report of sclerocornea with the intent of showing the usefulness of ultrasound biomicroscopy (UBM) and the correlation of histopathologic findings. METHODS: An infant with congenital bilateral sclerocornea was seen for an evaluation under anesthesia. Dense opacification of both corneas prevented adequate examination of both anterior and posterior segments of the eye. UBM was performed preoperatively with subsequent corneal transplantation of the left eye. The corneal button was submitted for histopathologic examination. RESULTS: Preoperative UBM proved helpful in assessing the status of the cornea as well as the anterior chamber and its structures. Findings on histopathologic examination correlated well with the results on UBM and confirmed the diagnosis of sclerocornea. CONCLUSION: We recommend the use of UBM in assessing opacified corneas to assist in obtaining a diagnosis, to highlight potential associated structural anomalies, and to help guide decisions regarding surgical management.

Infantile ulcerative keratitis secondary to congenital entropion.

Congenital entropion is a rare eyelid anomaly that can cause chronic corneal erosions or ulceration. The diagnosis may be easily overlooked by both the pediatrician and the ophthalmologist, particularly when the lids are tightly closed in the crying child. We present three cases of congenital entropion associated with corneal ulceration. Each patient underwent a complete ophthalmologic examination. Examination under anesthesia, including corneal scrapings for culture and photography, was performed before surgical repair of the entropion. There were two cases of lower lid entropion and one case of upper lid entropion. In all three cases symptoms were present since birth, and the diagnosis was overlooked by the treating pediatrician. Corneal ulceration ultimately developed in all three cases. Cultures revealed Staphylococcus aureus in one case, and coagulase negative Staphylococcus in another case. Cultures were negative in one case. In all three patients the ulcers healed rapidly after surgical entropion repair. Congenital upper or lower lid entropion is an uncommon condition that does not spontaneously improve and is an important cause of corneal ulceration in infants. Recognition of this condition is often difficult, and early surgical intervention to repair the lid deformity may help to avoid permanent corneal scarring and visual loss.

Comparison of balloon dacryocystoplasty to probing as the primary treatment of congenital nasolacrimal duct obstruction.

PURPOSE: In children older than 18 months, primary probing procedures for congenital nasolacrimal duct obstruction (CNLDO) are thought to have lower rates of success. This study compares the results of primary probing to balloon dacryocystoplasty (DCP) in children stratified by age category. METHODS: In a retrospective chart review, 29 eyes with CNLDO that underwent balloon DCP in children older than 18 months were identified and age-matched to 29 eyes that underwent probing. The eyes were divided into 3 age categories: category 1 (18-24 months), category 2 (24-36 months), and category 3 (>36 months). RESULTS: Of the 29 eyes treated with balloon DCP (mean age, 37.1 months), 26 were successfully treated. Twenty-five of the 29 matched probed eyes (mean age, 31.1 months) were successfully treated, resulting in an overall success rate of 90% for balloon DCP and 86% for primary probing. Within each age category, the success rate varied but did not show an advantage to balloon DCP. The presence of crusting and expressible discharge from the puncta during preoperative evaluation predicted a successful probing (OR, 16; 95% CI, 1.3-192). CONCLUSION: Overall, balloon DCP did not appear to present an advantage as compared with primary probing as the initial treatment in these children. Primary probing has an impressive overall success rate that did not diminish in the children older than 36 months.

Conservative treatment of congenital dacryocele.

PURPOSE: To study prospectively the effectiveness of medical management of congenital dacryoceles. METHODS: All patients presenting with congenital dacryocele that were not infected were treated with warm compresses, massage, and topical antibiotics. Dacryoceles that did not resolve with at least two weeks of medical management were probed. Dacryoceles that were infected were treated with intravenous (IV) antibiotics in addition to warm compresses and massage. RESULTS: Seventeen patients with 21 dacryoceles were studied over a 3 1/2-year period. All patients were examined by the authors and treatment was initiated prior to 3 weeks of age. Sixteen dacryoceles resolved with medical management in 1 to 6 days. Three of these 16 dacryoceles were infected and patients were hospitalized at the time of initial ophthalmic evaluation (2 to 4 days of life). One additional dacryocele became infected after 2 days of medical management (4th day of life), requiring hospital admission and IV antibiotics. All four infected dacryoceles resolved within 24 hours of the initiation of IV antibiotics, warm compresses, and massage. Five dacryoceles were probed after not resolving within 14 to 31 days of medical management. One dacryocele required a repeat probing. CONCLUSIONS: Medical management can be effective in the treatment of congenital dacryoceles; 76% of dacryoceles in this series resolved after 6 days of medical management.