Evaluation of outcomes of lower eyelid entropion and ectropion surgical repair.

<b><br>Introduction:</b> The imbalance of external and internal forces acting on the lower eyelid can result in entropion and ectropion, both of which cause ocular irritation and loss of proper eye protection. Potential complications of untreated cases include recurrent inflammation of the conjunctiva and cornea, conjunctival neovascularization, corneal abrasion or perforation, and ultimately even loss of vision. Although various surgical techniques are used to address this problem, their long-term outcome and effectiveness are still under discussion. </br> <b><br>Aim:</b> To evaluate outcomes of surgery for entropion and ectropion, including a modified Wheeler's method for entropion correction.</br> <b><br>Methods:</b> A non-comparative study (prospective and retrospective groups) included 100 patients operated on in two university hospitals' plastic surgery departments for lower eyelid entropion or ectropion, following formal ethics approval. The prospective group included 50 patients assessed preoperatively and at 3 and 12 months postoperatively. The retrospective group was comprised of 50 patients (2012-2018), whose preoperative documentation and clinical examinations were analyzed. The main outcome measures were change between pre- and postoperative patient-reported symptoms (VAS scale), ectropion/entropion grading scale (EGS/EnGS), quality of life (WHOQOL-BREF), and occurrence of complications.</br> <b><br>Results:</b> The differences in the severity of all symptoms before and after surgery evaluated with the VAS scale were statistically significant in both groups (p <0.05). We observed 6 recurrences (12%) in the prospective group and 9 (18%) in the retrospective group, with minor complications. Very good functional and esthetic postoperative results were confirmed in 70% (79) of the whole group and in 13 patients (81.3%) treated with the modified Wheeler's method. In the prospective group, the Mann- Whitney U test for dependent variables revealed significant improvement in the somatic, psychological, and environmental domains, with no significant change in the social relationships domain.</br> <b><br>Conclusions:</b> The results following entropion/ectropion surgery prove the effectiveness of the methods used. Complementing them with the modified Wheeler's method brought an increase in the number of very good outcomes. Surgery of lower eyelid malposition contributed to reduced symptoms and improved quality of life. The rates of postoperative sequelae were low.</br>.

Inferiorly Based Rotation Flaps for Infraorbital Cheek Defects.

BACKGROUND: The infraorbital cheek is a common location for cutaneous malignancy and thus surgical defects. Reconstruction in this region must maintain nearby free margins to ensure optimal cosmetic and functional outcomes. Large defects may require a flap using lateral or inferior tissue reservoirs. OBJECTIVE: To examine outcomes of inferiorly based rotation flaps in the repair of infraorbital cheek defects and highlight pearls for optimal long-term results. METHODS: Chart review of patients with a defect of the infraorbital cheek repaired with an inferiorly based rotation flap between February 2010 and December 2018 at a single academic institution. The Visual Analog Scale (VAS) was used for scar assessment. RESULTS: Sixty-five patients underwent extirpation of a cutaneous malignancy resulting in defects ranging from 1.0 × 1.0 to 4.5 × 5.5 cm (mean area = 4.8 cm2). Most of the patients did not experience complications. Ectropion occurred in 7 patients. The mean VAS score was 11.6. CONCLUSION: An inferiorly based rotation flap yields acceptable outcomes for infraorbital cheek defects and can be considered for defects as large as 5.5 cm. Using pearls for surgical execution presented in this article may allow reconstructive surgeons to include this flap in their repertoire.

Neonatal-Onset Congenital Ectropion Uveae: A Distinct Phenotype of Newborn Glaucoma.

PURPOSE: To describe neonatal-onset congenital ectropion uveae (N-CEU) as a distinct clinical entity of newborn glaucoma (NG) and to study its significance toward the severity and outcome of NG. DESIGN: Prospective clinical cohort study. METHODS: The study took place at a tertiary care postgraduate teaching institute. It included consecutive patients with NG who presented between July 1, 2016 and September 30, 2017, with a minimum postoperative follow-up of 1 year. Infants with any ocular anomaly apart from CEU were excluded. Patients with N-CEU were compared with those with neonatal-onset primary congenital glaucoma (N-PCG). All infants underwent goniotomy or trabeculotomy, with trabeculectomy depending on corneal clarity. Clinical features at presentation and outcome 1 year after surgery were defined as good or satisfactory if intraocular pressure was ≤16.0 mm Hg under anesthesia without or with topical medications, respectively, and poor if the infant required additional surgery. RESULTS: Twenty eyes of 10 patients with N-CEU were compared with 16 eyes of 9 patients with N-PCG. Infants with N-CEU had significantly worse corneal clarity (mean grade 2.0 ± 0.7 vs 1.4 ± 0.8; P = .026) and poorer outcomes compared with those with N-PCG. Seven of 16 (43.7%) eyes with N-PCG had a cornea clear enough at presentation for a goniotomy compared with only 2 of the 20 (10%) eyes with N-CEU (P = .026). Thirteen of 16 (81.2%) eyes with N-PCG had a good or satisfactory outcome compared with 6 of 20 (30%) eyes with N-CEU (P = .001). CONCLUSIONS: N-CEU appears to be distinct from the unilateral CEU in older patients described in the literature and may be considered a poorer prognosis phenotype of neonatal-onset glaucoma.

A Novel Method for Lower Blepharoplasty: Repositioning of the Orbital Septum Using Inverted T-Shaped Plication.

BACKGROUND: Numerous techniques have been used for lower blepharoplasty. The techniques can be classified into four principles: excision of excess fat, septal reset, orbital fat repositioning, and reinforcement of the attenuated orbital septum. OBJECTIVES: We modified the conventional approach of septal reinforcement to utilize an inverted T-shaped plication with preservation of the orbital fat, repositioning the septum below the arcus marginalis to refine tear-trough deformity. METHODS: From April 2010 to September 2015, 93 individuals underwent bilateral lower blepharoplasty. Retrospective chart reviews were performed, and the results and complications during the follow-up period were recorded and photographed. RESULTS: The patients comprised 76 women and 17 men. Thirteen, 33, and 47 patients exhibited mild, moderate, and severe fat herniation, respectively, accompanied by tear-trough deformity. A total of 70 and 23 patients underwent lower blepharoplasty via subciliary and transconjunctival approaches, respectively. We performed inverted T-shaped plication of the orbital septum in mild and moderate cases and X-shaped plication in severe cases, and in moderate and severe cases, we performed septal repositioning simultaneously. The mean follow-up period was 25 months. When immediate mild lid retraction or lid malposition was observed, it recovered without specific treatment within 1 to 2 weeks. No permanent lid malposition or ectropion was observed in any of the patients. CONCLUSIONS: Septal plication with inverted T-shape or X-shape can minimize the downward forces that affect postoperative eyelid malposition and ectropion. Further, these procedures provide sufficiently strong reinforcement of the orbital septum to restore infraorbital fat herniation.

Ectropion in Facial Tissue Expansion in the Pediatric Population: Incidence, Risk Factors, and Treatment Options.

BACKGROUND: Despite advances in the field of tissue expansion, the face is especially difficult to reconstruct using this technique due to its dynamic nature and high incidence of distortional scarring. This article aimed to review complications seen in pediatric facial tissue expansion, specifically ectropion, as well as its restorative treatment. METHODS: A retrospective chart review of pediatric patients treated by tissue expansion for congenital facial lesions, trauma, or burns at Children's Hospital Los Angeles from January 2000 to present was performed. Patients were analyzed for preoperative diagnosis, reconstruction area, tissue expander location, number and fill volume of expanders, incidence of complications, including ectropion, and type of revision surgery. RESULTS: A total of 88 patients with 150 expander reconstructions were examined. The total complication rate was 43.1% with an 11.3% rate of ectropion. Of the 10 cases of ectropion, 9 were treated with canthoplasty, whereas 1 was managed conservatively. In addition to canthoplasty, full-thickness skin graft was preformed in 1 patient, Z-plasty in 1, and lid switch in 2. DISCUSSION: Tissue expansion is a safe and effective method of reconstruction for facial defects in the pediatric population despite complication rates being higher than other areas of the body. Specifically, ectropion can be a devastating complication, often requiring surgical correction. As such, careful planning should go into orientation and design of the reconstruction, and staged procedures should be strongly considered. Additionally, and possibly the most important, is setting patient and parental expectation about the possibility of ectropion and the necessity often for multiple corrective surgeries.

The prevalence of glaucoma in patients undergoing surgery for eyelid entropion or ectropion.

PURPOSE AND DESIGN: The aim of this study was to establish the prevalence of known glaucoma in patients undergoing ectropion or entropion surgical repair. In this study, retrospective review of case series was performed. PARTICIPANTS: All patients who underwent ectropion or entropion surgery in a tertiary medical center between 2007 and 2014 were included. The etiology of eyelid malpositioning was involutional or cicatricial. METHODS: The medical files of the study participants were reviewed for the presence and type of glaucoma, medical treatment, duration of treatment, and the amount of drops per day. These data were compared to a matched control group of 101 patients who underwent blepharoplasty for dermatochalasis in the same department during the same period. MAIN OUTCOME MEASURE: In this study, the prevalence of glaucoma in individuals with ectropion or entropion was the main outcome measure. RESULTS: A total of 227 patients (57% men, mean age: 79.2 years) who underwent ectropion or entropion surgery comprised the study group and 101 patients who underwent upper blepharoplasty for dermatochalasis comprised the control group. Compared to four patients in the control group (4%, P=0.01), 30 of the study patients (13.2%) had coexisting glaucoma. Of 30 glaucomatous patients, 25 had primary open-angle glaucoma for a mean duration of 10.3 years. The glaucomatous patients were treated with an average of 2.7 antiglaucoma medications. CONCLUSION: An increased prevalence of known glaucoma in patients undergoing ectropion or entropion repair surgery was found. This observation may indicate that the chronic usage of topical anti-glaucoma eyedrops may lead to an increased risk of developing eyelid malpositions, especially in elderly patients.

Alterações palpebrais: frequência de ocorrência e perfil dos portadores em amostra populacional brasileira / Eyelid disorders: frequency of occurrence and profile of carriers in a Brazilian population sample

Objetivo: Apresentar a frequência de ocorrência das alterações palpebrais em uma amostra populacional brasileira, assim como as características de seus portadores. Métodos: Estudo transversal utilizando amostra populacional aleatorizada, realizado nos anos de 2004/2005, em nove cidades da região centro-oeste do estado de São Paulo. Foram examinadas 7654 pessoas sendo os participantes avaliados segundo variáveis demográficas e exame oftalmológico completo. As alterações palpebrais foram avaliadas por meio de exame externo usando lanterna e lâmpada de fenda. Os dados obtidos foram analisados estatisticamente. Resultados: As alterações palpebrais como a triquíase e o ectrópio foram mais relacionadas às características homens, brancos, queixa de redução de acuidade visual para perto. Foi realizado tratamento cirúrgico em 72,7% das triquíases detectadas, assim como 28,5% dos ectrópios. Já os casos de ptose palpebral foram relacionados ao sexo feminino, brancas, com queixa de diminuição da acuidade visual para perto e 26,3% necessitaram de cirurgia. Entrópio foi detectado em um caso, masculino, branco e epibléfaro foi observado em um indivíduo do sexo feminino, parda. Conclusão: A alteração palpebral mais presente na população geral brasileira é a triquíase, seguida da ptose palpebral e do ectrópio. Os autores chamam a atenção para o fato de os portadores não possuírem queixas relacionadas às alterações palpebrais.

Purpose: to show the frequency of occurrence of the eyelid disorders in a Brazilian population sample, as well as the characteristics of the carriers. Methods: a transversal study using a random population sample was carried out in the years 2004/2005, involving nine cities of the middle west region of the State of São Paulo - Brazil. We had 7654 participants which were evaluated according to demographic variables and complete ophthalmological examination. The eyelid disorders were detected using a lantern and slit lamp. Data were statistically analyzed. Results: eyelid disorders such as of trichiasis and ectropion were more related to the characteristics men, whites, complaining of reduced near visual acuity and 72.7% of trichiasis underwent surgical treatment, as well as 28.5% of patients with ectropion. Ptosis was related to the females, whites, complaining of reduced near visual acuity and 26.3% required surgery. Entropion was detected only in one case, male, white and a case of epiblepharon was observed in a female, brown. Conclusion: the most frequent palpebral disorder observed in the Brazilian general population is trichiasis, followed by ptosis and ectropion. The authors call attention to the fact that carriers do not have complaints related to the eyelid disorders.

Incidence of lower eyelid complications after a transconjunctival approach: influence of repeated incisions.

Although many authors have described advantages of the transconjunctival approach, few reports describe risks of postoperative lower eyelid complications with repeated incisions. The objective of this study was to investigate whether the incidence of postoperative lower eyelid complication using the transconjunctival approach was different, depending on the time of incision. Patients who underwent orbital bony surgery at the Kanazawa Medical University Hospital between 1996 and 2012 were reviewed. Patients were divided into a group that underwent single transconjunctival incision and a group that underwent repeated incisions. Intraoperative and postoperative complications, including eyelid ectropion, entropion, and scleral show, were compared between the groups. A total of 154 transconjunctival incisions were made in 145 patients (mean age, 35.6 y; 99 men and 46 women), who were observed for a mean of 14 months (range, 6-97 mo). Two patients had eyelid lacerations with inferior lacrimal canaliculus injuries. Lower eyelid malposition requiring operative correction occurred in 3 of the 140 patients in group A (2.1%) and in 3 of the 14 patients in group B (21.4%) (P = 0.01). The total postoperative complication rate in patients with a single incision was 5.0% (n = 7), and that for repeated incisions (2-5 times) was 35.7% (n = 5) (P = 0.001). The total complication rate of transconjunctival incision was slightly high. Although repeated incision cases were significantly more frequent, the eyelid could be corrected without visible scarring although eyelid complications occurred.

Traumatology of the facial skeleton in octogenarian patients: a retrospective analysis of 96 cases.

AIM: The aim of this retrospective study was to evaluate the frequency and distribution of maxillofacial trauma patients over 80 years, with regard to type and environment of accidents as well as treatment and complications. PATIENTS AND METHODS: Data for 94 patients (96 cases; aged 80-94 years) with maxillofacial fractures were retrospectively analysed. RESULTS: Data of 30 male and 64 female patients with an average age of 85 years were analysed. In 90% of the study population, the cause of fractures was a fall, followed by traffic accidents (9%) and assault (1%). Seventy-two patients had fractures of the midface, 10 had factures of the mandible, 9 had fractures of both the midface and mandible and 5 had fractures of the neurocranium and midface. Surgical intervention was required in 57% of the patients. Post-operative complications were: four cases of diplopia, two cases of infected plates, four cases of lower eyelid ectropion and in one case a retrobulbar haematoma. CONCLUSION: Facial trauma in the elderly can often be treated conservatively unless the patient complains of functional problems. Due to co-morbidities, special attention should be paid to hypertension, anticoagulant agents and the surgical approach.

The V-Y advancement flap is equivalent to the Mustardé flap for ectropion prevention in the reconstruction of moderate-size lid-cheek junction defects.

BACKGROUND: Lid-cheek junction defects represent a reconstructive challenge because of the susceptibility of the lower eyelid to ectropion. To minimize the inferior tension placed on the lid margin, classic teaching advocates for the use of cervicofacial rotation-advancement flaps as popularized by Mustardé. Despite this approach, ectropion can still be problematic, and elevation of the cheek poses its own set of potential complications. An inferior-to-superior V-Y advancement flap has also been described, but its use is often limited because of the perceived increased risk of ectropion. This study attempts to define this risk by investigating the incidence of postoperative ectropion between cervicofacial and V-Y flaps for the reconstruction of lid-cheek junction defects. METHODS: All patients who underwent reconstruction of lid-cheek junction defects performed by the senior author (D.L.B.) between January of 2002 and March of 2009 were reviewed retrospectively. Only cervicofacial (n = 11) and V-Y flaps (n = 23) were included in the analysis. Patient demographics, defect size, operative time, hospital stay, and postoperative complications were extracted from the clinical record. RESULTS: Nine patients in the cervicofacial group (82 percent) and three patients in the V-Y group (13 percent) experienced a postoperative complication (p = 0.0002). Three cases of ectropion were observed, including two patients in the cervicofacial group (18 percent) and one in the V-Y group (4 percent, p = 0.24). All cases resolved with conservative management. CONCLUSIONS: No difference in ectropion rate was found between the cervicofacial and V-Y groups. The versatility of the V-Y advancement flap is perhaps underestimated in this clinical context. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Involutional entropion and ectropion of the lower eyelid: prevalence and associated risk factors in the elderly population.

PURPOSE: To determine the prevalence of involutional entropion and ectropion of the lower eyelid in the elderly population; to examine how these disorders are related to gender, age, skin color, and axial ocular globe projection; and to define the incidence of associated ocular surface and pathologic eyelid findings. METHODS: An ophthalmic survey was conducted in 24,565 elderly people. All participants underwent ophthalmic examination by general ophthalmologists to identify entropion and ectropion. Information about associated ocular surface and pathologic eyelid findings were collected from all patients with involutional eyelid malposition. Patients with involutional entropion and ectropion underwent measurements of the axial ocular globe projection. The Pearson chi-square test and the Mann-Whitney U test were performed. RESULTS: The prevalence of involutional entropion was 2.1%; 1.9% in men and 2.4% in women. The prevalence of involutional ectropion was 2.9%; 5.1% in men and 1.5% in women. Dry eye syndrome, lower retractor laxity, and superficial punctate keratopathy were seen significantly more often in patients with involutional entropion than in those with involutional ectropion (p < 0.001). Chronic conjunctivitis was significantly more common in patients with involutional ectropion than in those with involutional entropion (p < 0.001). The axial ocular globe projection was significantly smaller in patients with involutional entropion than in those with involutional ectropion (p < 0.001). CONCLUSIONS: The prevalence of involutional entropion and ectropion in the elderly population is 2.1% and 2.9%, respectively. The axial ocular globe position plays a pathogenic role in involutional lower eyelid malposition.

[Eyelid ectropium prevalence and carriers characteristics in a population from the Center-Western region of São Paulo State]. / Prevalência do ectrópio palpebral e características dos portadores na população da região Centro-Oeste do Estado de São Paulo.

PURPOSE: To present the characteristics of individuals and the prevalence of ectropium eyelid in a random sample of the state of São Paulo, Brazil. METHODS: Data were collected during the Project on Prevention of Blindness, Faculty of Medicine of Botucatu - UNESP, a systematic random household sample was obtained. We evaluated 10,432 individuals, residents in 11 cities of the health regional located in the Central-Western region of the state of São Paulo. The results were submitted to statistical analysis to evaluate descriptive variables and the prevalence of ectropium eyelid. RESULTS: Seventy-one ectropium eyelid patients were detected, with an estimated prevalence of 0.68%. The prevalence was not similar in all the studied municipalities. Most people with ectropium eyelid presented age over 70 years and were male. Cataract was concurrently present in 28.0% of them. CONCLUSION: The prevalence of ectropium population in the Central-Western region of São Paulo state is 0.68%. The ectropium eyelid affect mainly male, over 70 years relating sun light exposition and with normal visual acuity.

Prevalência do ectrópio palpebral e características dos portadores na população da região Centro-Oeste do Estado de São Paulo / Eyelid ectropium prevalence and carriers characteristics in a population from the Center-Western region of São Paulo State

OBJETIVO: Apresentar as características dos portadores e a prevalência do ectrópio em uma amostra populacional aleatória do Estado de São Paulo, Brasil. MATERIAL E MÉTODOS: Os dados foram colhidos durante a realização do Projeto de Prevenção da Cegueira da Faculdade de Medicina de Botucatu-UNESP, com amostra domiciliar sistemática aleatória. Foram avaliados 10.432 indivíduos, residentes em 11 municípios da regional de saúde localizada na região Centro-Oeste do Estado de São Paulo. Os resultados obtidos foram submetidos a análise estatística para avaliação de variáveis descritivas e da prevalência do ectrópio palpebral. RESULTADOS: Foram detectados 71 portadores de ectrópio palpebral, com prevalência estimada de 0,68 por cento. A prevalência não foi semelhante nos Municípios estudados. A maioria dos portadores de ectrópio apresentava idade acima dos 70 anos e era do sexo masculino. Vinte e oito por cento dos portadores de ectrópio apresentavam catarata concomitantemente. CONCLUSÃO: A prevalência do ectrópio na população Centro-Oeste do Estado de São Paulo é de 0,68 por cento. O ectrópio palpebral ocorre mais frequentemente em homens, geralmente idosos, expostos ao sol, mais na pálpebra inferior e com acuidade visual corrigida normal.

PURPOSE: To present the characteristics of individuals and the prevalence of ectropium eyelid in a random sample of the state of São Paulo, Brazil. METHODS: Data were collected during the Project on Prevention of Blindness, Faculty of Medicine of Botucatu - UNESP, a systematic random household sample was obtained. We evaluated 10,432 individuals, residents in 11 cities of the health regional located in the Central-Western region of the state of São Paulo. The results were submitted to statistical analysis to evaluate descriptive variables and the prevalence of ectropium eyelid. RESULTS: Seventy-one ectropium eyelid patients were detected, with an estimated prevalence of 0.68 percent. The prevalence was not similar in all the studied municipalities. Most people with ectropium eyelid presented age over 70 years and were male. Cataract was concurrently present in 28.0 percent of them. CONCLUSION: The prevalence of ectropium population in the Central-Western region of São Paulo state is 0.68 percent. The ectropium eyelid affect mainly male, over 70 years relating sun light exposition and with normal visual acuity.

Eye involvement in inherited epidermolysis bullosa: experience of the National Epidermolysis Bullosa Registry.

PURPOSE: To determine the frequency of ocular manifestations in inherited epidermolysis bullosa (EB) within the continental United States and to define the estimated cumulative risks of developing nonscarring (blisters or erosions) and scarring corneal manifestations within each major EB subtype over time. DESIGN: Observational (cross-sectional and longitudinal). METHODS: Up to 16 years of longitudinal follow-up was conducted on 3,280 consecutively enrolled patients in the National EB Registry, an epidemiologic study funded by the National Institutes of Health. Data were stratified by major EB type and subtype. Frequencies of occurrence were determined for eight variables (corneal erosions or blistering; corneal scarring; symblepharons; blepharitis; ectropions; lacrimal duct obstruction; impaired vision; blindness) by contingency tables, and cumulative risks were generated by life table analysis technique. RESULTS: The most common ocular manifestations were corneal erosions and blisters. Frequencies mirrored relative severity of skin disease, with 74.10% of all patients with recessive dystrophic EB, Hallopeau-Siemens (RDEB-HS) and 47.50% of all patients with junctional EB, Herlitz (JEB-H) experiencing at least one episode. Lower frequencies were noted for corneal scarring. Symblepharons and ectropions were most commonly seen in inversa RDEB and JEB-H, respectively. Blindness was reported in 6.47% of RDEB-HS patients. The cumulative risks of nonscarring and scarring corneal lesions in JEB-H at age 5 are 83.18% and 27.08% and at age 25 are 83.18% and 72.22%. With time, the cumulative risk of each in RDEB-HS approached that reported in JEB-H patients. CONCLUSION: Ocular disease activity, particularly corneal, is common in some EB subtypes. Careful ophthalmologic examination should become an integral part of the management of all patients with inherited EB.

Prevalence and associations with ectropion in an older population: the Blue Mountains Eye Study.

The aim of this study was to describe the prevalence of eyelid ectropion and its associations with sunlight-related and other ocular variables, plus systemic factors, in an older Australian population. The Blue Mountains Eye Study examined 3654 persons aged 49-97 years. Examination recorded ectropion and other ocular signs. The questionnaire assessed sunlight-related and systemic variables. Ectropion was present in either eye of 143 subjects (3.9%) and was bilateral in 101 (70.6%). A marked age-related increase in prevalence was observed with ectropion found in 0.3% of persons aged < 60 years, 1.2% of ages 60-69 years, 6.7% of ages 70-79 years and 16.7% of those aged 80 years or older Ectropion prevalence was higher in men (5.1%) than women (3.0%), age-adjusted odds ratio 2.1 (95% confidence interval 1.5-3.0). Statistically significant associations were found between ectropion and history of skin cancer removal, increased skin sun sensitivity, lighter iris colour and presence of pingueculum, as well as current smoking, hypertension, diabetes and stroke.

Complications of sinusitis in Ibadan, Nigeria.

Nowadays the complications arising from sinusitis are rare since the introduction of antibiotics. However sinusitis and its complications are still life-threatening and if neglected may result in high morbidity and mortality. It is the purpose of this study to draw attention to the effects of the spread of infection beyond the sinus wall and thus to influence the clinician in his management in order to prevent the subsequent spread of the disease, and secondly make him aware of the sinogenic origin of these complications when he sees them. A retrospective study of 90 patients with sinusitis seen over a ten year period between 1988 and 1997 in the ENT Department, University College Hospital, Madan was (lone and those that had complications were further analysed to meet the objectives of this study. There were 90 patients seen with sinusitis over the ten years period, out of which 33 (37%) cases had complications, 17 males and 16 females (M.F.1:1). The average age of cases with complications was 28 years (age range 2.5 - 75 years). 66.6% of the complications cases occurred in age group under 30 years of age. Thus children and young adults were mostly affected. Twenty-six cases (79%) of chronic sinusitis developed complications while in acute sinusitis there were 7 cases (21%). The site affected most commonly by complications was the orbit (41%) followed by Sinus wall (32%), orophyarynx (18%), intracranial (5%); no car complications were seen. The type of complications seen at various sites and their incidence were also highlighted. Thus with this study it is hoped that clinicians would be reminded that complications of sinusitis still occur and hence be aware of the necessity to recognize and prevent them as rapidly as possible to avoid serious consequences.

Eyelid malpositions after cataract surgery.

PURPOSE: To estimate the incidence and the factors that may play a role in the etiology of eyelid malpositions after cataract extraction. METHODS: We followed up 124 patients for six months after cataract extraction. Palpebral aperture, levator function, height of the upper lid crease, lower eyelid laxity and position of the punctums were recorded preoperatively and postoperatively. Post-cataract ptosis was defined as a 2 mm or greater drop in the lid margin after correcting for any change in the fellow eye. RESULTS: None of the patients developed ectropion or entropion, but five (4%) developed punctal ectropion after surgery. The incidence of post-cataract ptosis was 7.3% at six months. Age, sex, preoperative measurements of levator function, lid crease and dermatochalasis were not predictive for the development of ptosis at six months. However, there was a significant difference in the preoperative palpebral fissure width between the patients with ptosis and those without (p<0.05). There was a positive correlation between the mean volume of local anesthetic and the degree of ptosis on the first postoperative day (p<0.05, r: 0.1873). The presence and amount of ptosis on the first postoperative day was the best predictor of post-cataract ptosis at six months (p<0.001). CONCLUSIONS: Several factors are involved in the development of post-cataract ptosis. Temporary ptosis may be related to the myotoxicity of the local anesthetic. The presence of ptosis on the first postoperative day is the best predictor for the development of ptosis at six months.