Effect of endoscopic marsupialization of paranasal sinus mucoceles involving the orbit: a review of 27 cases.

Paranasal sinus mucoceles (PSMs) can involve the orbit because the topographic anatomies of the paranasal sinuses and orbit are interrelated. We encountered 27 patients with PSMs involving the orbit that caused orbital symptoms. In this study, we evaluated the frequent symptoms and signs of PSMs involving the orbit, and report postoperative changes of orbital symptoms including the effects on visual acuity. A retrospective chart review, radiologic evaluation, and interviews were conducted after Institutional Review Board approval was obtained. Over the past 11 years, we encountered 27 patients with PSMs involving the orbit. We classified the patients according to orbital symptoms and PSM origin, and evaluated the surgical outcomes. A total of 27 patients (17 males and 10 females) with PSMs involving the orbit were included in the present study. The mean patient age was 51.0 ± 9.7 years (range 32-90) and the mean follow-up period was 20.5 months (range 2-84). Proptosis (15/27, 56%) was the most common symptom. Other common symptoms included orbital pain (9/27, 33%), decreased visual acuity or vision loss (9/27, 33%), and diplopia (7/27, 26%). All symptoms except for vision loss were improved by endoscopic marsupialization regardless of the disease period. Four out of five patients with decreased visual acuity experienced complete recovery. The remaining patient showed partial improvement after surgery. Four patients who were blind when they initially visited the hospital did not show any improvement after surgery. For PSM patients with decreased visual acuity, we can predict that vision will improve after surgery regardless of the disease duration. However, blindness will probably not resolve after endoscopic marsupialization. Even if the orbital symptoms (except for blindness) have persisted for a long time, surgery could still produce positive outcomes.

An analysis of 733 surgically treated blowout fractures.

PURPOSE: To evaluate current patient demographics and surgical outcomes from a large series of 733 surgically treated orbital fractures from an ophthalmologist's perspective. METHODS: We reviewed the medical records of 733 patients with orbital fracture, who were treated surgically by one of the authors at Gil Hospital, Gachon University, from May 2000 until September 2007. Data regarding patient demographics, signs and symptoms at presentation, cause of injury, nature of fracture, associated ocular and nonocular injury, surgical outcome and complications were collected. RESULTS: Male patients outnumbered female patients, and blowout fracture occurred most frequently between the ages of 20 and 29 years (mean age 30.7 years). Violent assault was the leading cause of the fractures, followed by fall/slip and traffic accidents. Common signs and symptoms were periorbital ecchymosis, ocular motility restriction, diplopia and enophthalmos. In the pediatric group, diplopia and ocular motility restriction were the most common. Subconjunctival hemorrhage, hyphema and commotio retinae were the most commonly associated ocular injuries. As for the location of fractures, medial wall fractures were the most common, followed by fractures of the inferior wall, and both medial and inferior walls, in order. The most common type of fracture was the 'comminuted' one. In the pediatric group, the percentage of trapdoor-type fracture was higher than in the adult group. Forty-four percent of the patients had diplopia preoperatively and 8.7% postoperatively. The average measurement of difference in the enophthalmos (> or = 2 mm) patient population was improved from 2.62 (+/-SD 0.9) to 1.73 (+/-SD 1.3) after surgery. Ocular motility restriction was preoperatively noted in 297 patients (40.5%), and only 18 patients (2.5%) showed restriction after surgery. CONCLUSION: Young male individuals are at the highest risk for orbital fractures. There are marked differences in the clinical symptomatology and findings between pediatric and adult orbital fractures. Diplopia, enophthalmos and ocular motility restriction improved by repair of fracture.

Temporary unilateral neurogenic blepharoptosis after orbital medial wall reconstruction: 3 cases.

PURPOSE: We report 3 cases of unilateral blepharoptosis after orbital medial wall reconstruction and describe the cause and clinical outcome. METHODS: Observational case series. RESULTS: Three previously healthy patients underwent reconstruction for orbital medial wall fracture. All 3 patients had complete unilateral upper eyelid ptosis with no levator palpebrae superioris muscle function immediately after their recovery from anesthesia. Additional findings included minimal eyelid ecchymosis, eyelid edema and subconjunctival hemorrhage, which all presented preoperatively. All 3 patients had full conjugated ocular motility in the entire field of gaze and no anisocoria. With oral steroid therapy, all 3 patients recovered completely with normal symmetric lid height and levator function within 1 month. CONCLUSION: Isolated neurogenic blepharoptosis after medial orbital wall reconstruction is a rare but favorable disease that may result from ischemic damage at the end portion of the superior branch of the oculomotor nerve in the orbit. High-dose steroid therapy early in the course of the disease was effective, and complete resolution was achieved within 1 month.

Efficacy of dye disappearance test and tear meniscus height in diagnosis and postoperative assessment of nasolacrimal duct obstruction.

OBJECTIVE: To evaluate the efficacy of the fluorescein dye disappearance test (FDDT) and measurement of tear meniscus height (TMH) in the diagnosis and postoperative assessment of nasolacrimal duct obstruction (NLDO). METHODS: The study group included 42 eyes of 42 patients who had a diagnosis of primary acquired nasolacrimal duct obstruction (PANDO) or functional nasolacrimal duct obstruction (FNDO) and underwent endoscopic transnasal dacryocystorhinostomy. The control group included 38 eyes of 38 people without tearing. The values of the FDDT, TMH and tearing symptom score (TSS), which was evaluated in five levels based on patients' history taking, were measured before surgery, and 1 day, 2 weeks, 1, 3 and 6 months after surgery. The values of the FDDT, TMH and TSS in the study group were compared with those of the control group. RESULTS: The preoperative values of the FDDT, TMH and TSS were 0.7 +/- 0.4, 0.22 +/- 0.08 mm and 1.6, respectively, in the control group and 3.0 +/- 0.8, 0.53 +/- 0.15 mm and 4.4, respectively, in the study group. These differences were statistically significant. Also, at each follow-up, the postoperative values of the FDDT and TMH decreased significantly compared to their preoperative values in the study group. The postoperative TSS decreased significantly compared to the preoperative values at each follow-up except at postoperative 1-day follow-up. There were no significant differences in the preoperative values of the FDDT, TMH and TSS between the types of NLDO. The TSS had positive correlations with the FDDT and TMH before and after surgery. CONCLUSION: These results suggest that the FDDT and TMH measurement might be effective in the diagnosis and postoperative assessment of NLDO.

Clinical study of endoscopic endonasal conjunctivodacryocystorhinostomy with Jones tube placement.

PURPOSE: To evaluate the efficacy of endoscopic endonasal primary conjunctivodacryocystorhinostomy (CDCR) and revision CDCR after primary CDCR. METHODS: Twenty-four patients who had undergone endoscopic endonasal CDCR with a Jones tube and who were followed up for over 6 months at our hospital were reviewed retrospectively. Our analysis included success rate, operation times, and causes of failure. RESULTS: The indications for revision CDCR were Jones tube prolapse and inadequate tube length. The initial success rate in the primary and revision groups were 78.6% (11/14) and 100% (10/10), respectively, and their mean operation times were 24 min (+/- 6.3) and 21 min (+/- 6.1), respectively. Main causes of failure included inaccurate tube length and abnormal tube position. CONCLUSIONS: Endoscopic endonasal CDCR appears to be a reasonable revision and primary approach, because it allows Jones tube length to be measured accurately during surgery, and an 18- to 20-mm Jones tube length was used in most cases.

Eyelid splitting with follicular extirpation using a monopolar cautery for the treatment of trichiasis and distichiasis.

PURPOSE: To assess the efficacy of eyelid splitting coupled with follicular extirpation via monopolar cautery in the treatment of trichiasis and distichiasis. METHODS: Between March 2000 and October 2003, this surgery was performed on 52 eyelids from 45 patients, with a mean follow-up period of 14.3 months (ranging from 12.3 to 17.6 months) . Under local anesthesia and a surgical microscope, a chalazion clamp is positioned on the eyelid, and a no. 11 scalpel is employed to make an incision located immediately anterior and parallel to the abnormal eyelash line. Each of the abnormal hair follicles is then removed via cautery with a monopolar needle. No sutures are involved in this procedure. RESULTS: Forty-four eyelids of 40 patients (84.6%) were successfully treated without recurrence or any residual symptoms. Repeat surgery was then performed on eight eyelids, with successful results in six cases. The cumulative success rate for this procedure was 96.1%. No complications were noted in the treated area, including lid deformities, granuloma formation, infections, and others. CONCLUSIONS: Eyelid splitting coupled with follicular extirpation via cautery with a monopolar needle, a procedure which requires no sutures, constitutes a simple and effective method for the treatment of both trichiasis and distichiasis and is associated with favorable functional and cosmetic results.

Clinical analysis of benign eyelid and conjunctival tumors.

PURPOSE: To assess the relative frequency and clinicopathologic characteristics of benign conjunctival tumors. METHODS: A retrospective study of 80 consecutive patients admitted to our hospital with benign eyelid and conjunctival tumor between April 2000 and November 2002 was undertaken, and clinical records including age, sex and involved site of tumors and pathology slides of the patients were reviewed retrospectively. RESULTS: Twenty-three males and 33 females presented with benign eyelid tumors and 12 males and 12 females with conjunctival tumors. Mean age was 42.3 and 29.7 years, respectively. The lower eyelid was involved in 27 (48.2%) of eyelid tumors and the medial conjunctiva in 14 (58.3%) of conjunctival tumors. The most frequent tumor was intradermal nevus (44.6%), seborrheic keratosis (16.1%) and compound nevus (10.7%) in eyelid tumors, and compound nevus (29.2%) and intradermal nevus (25.0%) in conjunctival tumors. CONCLUSION: This report will provides a basic analysis of benign eyelid and conjunctival tumors.

Clinical study of single-suture inferior retractor repair for involutional entropion.

PURPOSE: To evaluate the clinical efficacy of a simplified single-suture inferior retractor repair technique for involutional entropion. METHODS: A retrospective study of 20 patients (26 eyelids), followed for 6 months at our hospital, who showed no severe horizontal lid laxity were operated on for involutional entropion. After subciliary incision, the inferior retractor was identified and repaired by reattaching the superior edge of the inferior retractor to the inferior edge of the lower tarsus by a single suture using 5-0 prolene. RESULTS: 26 eyelids of 20 patients (80.8%) were treated successfully without recurrence. Complications were seen in 5 eyelids, 2 were overcorrections and 3 were recurrences of entropion. Recurred cases were reoperated on and showed good postoperative results after the second surgery. CONCLUSIONS: The simplified single-suture inferior retractor repair had good results in patients with involutional entropion without severe horizontal lid laxity. Moreover, this procedure had a short operation and recovery time. In unilateral cases, we could achieve more symmetric appearance when compared with bilateral surgeries.