The use of fibrin tissue glue in the repair of cicatricial ectropion of the lower eyelid.

PURPOSE: To evaluate the effectiveness of full-thickness skin graft adhesion using fibrin tissue glue (TISSEEL) in cicatricial ectropion repair of the lower eyelid. METHOD: This study was a prospective case series. Nine eyes of 8 consecutive patients with cicatricial ectropion were included. All patients underwent a conjunctival approach lower eyelid retractor plication, lateral tarsal strip, and insertion of a full-thickness skin graft secured with TISSEEL. Symptoms of epiphora, eye and eyelid irritation, discharge, and graft size were recorded pre- and postoperatively. RESULTS: All of the patients were satisfied with their postoperative appearance, and the symptoms of eye and eyelid irritation, discharge, and visual disturbance were eliminated. Fifty-five percent of patients had complained of watering some or all of the time preoperatively, whereas only 33% admitted to occasional watering postoperatively. The average size of the graft reduced by 18% at 1 week, 39% at 1 month, and 40% at 3 months from the initial size. CONCLUSIONS: Fibrin tissue glue used to attach a full-thickness skin graft during cicatricial ectropion repair is an effective technique and may offer additional benefits over sutured graft fixation. Most of the reduction in graft size occurred in the first postoperative month, which indicates that the time window for modulation of the graft is in the first few weeks after surgery. The vertical graft length was affected to a greater extent than the horizontal length.

Indoor soccer-related eye injuries: should eye protection be mandatory?

BACKGROUND: Our objectives were to present the spectrum of eye injuries caused by indoor soccer, as seen at our institution, and to initiate discussion as to whether eye protection should become mandatory for this indoor sport. METHODS: Chart review of patients presenting to our institution with eye injuries from indoor soccer. RESULTS: Five cases were identified from 2001-2005, all occurring during the winter or late fall. Each injury was due to contact with the soccer ball itself. Initially, all 5 patients presented with commotio retinae (1 with a prominent retinal and vitreous hemorrhage and 2 with smaller retinal hemorrhages), 2 with hyphema and traumatic mydriasis, 1 with subconjunctival hemorrhage, and 1 with upper lid edema and ecchymosis. Three resolved uneventfully with 20/20 or better vision; however, in 2 there were findings of choroidal rupture with chorioretinal scarring. One of these had 20/20 vision and a discontinuous choroidal rupture peripherally, and the other had 20/40 vision and extensive chorioretinal scarring. One patient also showed a peculiar persistent iris scar. INTERPRETATION: Soccer-related eye injuries have been recognized as an important ophthalmologic problem in Europe and now increasingly so in North America. With the increasing popularity of indoor soccer in Canada, serious eye injuries have become more prevalent. On the basis of the prevalence and the nature and mechanism of the ocular trauma, we believe there may be a need to make eye protection mandatory for all forms of soccer.

Consecutive exotropia following surgically corrected cyclic esotropia.

INTRODUCTION: Cyclic esotropia is a rare form of strabismus consisting of regular intervals of esotropia alternating with periods of orthophoria in a rhythmic/cyclic manner. In the vast majority of cases, surgery appears to permanently correct the esotropia, with no sequelae after years of follow-up. We report a case of consecutive exotropia in a patient five years after bilateral medial rectus recessions for cyclic esotropia. METHODS: A case report involving review of a clinical chart. RESULTS: A two-year-old male presented with right esotropia and mild amblyopia. He was treated with patching and following resolution of the amblyopia he developed a cyclic esotropia. Surgical correction was performed for the full amount measured on a "manifest" day. Following the surgery, he was orthophoric and demonstrated binocular vision. He remained stable for five years, and then returned with occasional diplopia and an intermittent exotropia. CONCLUSION: Cyclic esotropia is a rare disorder of ocular motility that spontaneously appears and disappears at regular intervals. After surgical correction, the deviation disappears and recurrence of esotropia is very infrequent. We present the first reported case of consecutive exotropia following surgical correction of a cyclic esotropia.

West Nile chorioretinitis.

CASE REPORT: The clinical course of 2 Canadian cases of West Nile chorioretinitis is described. The patients developed visual-field disturbances shortly after flu-like illnesses and were referred for retinal evaluation. Full ophthalmologic examination included Snellen visual acuity testing, applanation tonometry, slit-lamp examination, dilated fundus examination, fundus photography, and fluorescein angiography. Both patients developed self-limited cases of chorioretinitis exhibiting characteristic fundus and fluorescein angiographic findings. COMMENTS: Since the introduction of West Nile virus to Canada and its progressive spread across the country, more patients will present to their eye specialists with chorioretinitis. In cases of chorioretinal inflammation, West Nile virus infection should be included in the differential diagnosis.