Quality of life improvement in dry eye patients after intense pulsed light therapy compared to punctal plugs.

PURPOSE: The purpose of the study was to evaluate the quality of life (QOL) improvement in evaporative dry eye patients after treatment with intense pulsed light (IPL) therapy compared to punctal plug insertion. METHODS: A prospective comparative interventional study included 30 patients with moderate-to-severe evaporative dry eye. Patients' QOL affection before and after treatment was assessed by the Ocular Surface Disease Index (OSDI) questionnaire. Fifteen patients were treated with IPL therapy (Group 1). The other 15 patients were treated with silicone punctal plug insertion (Group 2). RESULTS: Improvement of patients' QOL was noticed in all patients of Group 1, with significant improvement of OSDI score from a mean value of 56.9 to 22.9 (P = 0.001). Improvement was noticed in 80% of Group 2 patients (mean OSDI score pretreatment: 53.8 and posttreatment: 31.7, P = 0.017). The tear breakup time (TBUT) in Group 1 significantly improved from a mean of 3.2 s to 5.9 s (P = 0.001), whereas it showed no significant changes in Group 2 (mean TBUT pretreatment: 3.6 s and posttreatment: 3.9 s, P = 0.654). Complications occurred in 13.3% in Group 2, including punctal granuloma and proximal canalicular obstruction. No adverse effects were recorded in Group 1. CONCLUSION: IPL therapy had better results with more improvement of patients' QOL compared to punctal plugs. It also showed a better safety profile with no reported complications.

Unilateral surgery for pediatric sensory exotropia: clinical characteristics and surgical results.

BACKGROUND: To delineate the clinical characteristics and surgical outcomes of large angle sensory exotropia in pediatric patients. METHODS: The medical records of 54 large angle exotropia ≥40 PD patients aged from 1 to 18 years who were operated on between 2018 and 2021 and were followed up for 1 year were reviewed and contacted. Clinical characteristics and surgical outcomes were analyzed retrospectively. Patients were divided into two groups, group S patients had supermaximum recession resection and group E had augmented recession by lateral rectus muscle elongation with an autograft from the resected medial rectus muscle in the same eye. The clinical characteristics and results of both groups were compared. RESULTS: The mean age of the studied patients with sensory exodeviation at the time of surgery was 8.3 ± 4.2 years. Mean of the duration of exotropia was 6.9 ± 2.2 years, and the mean of postoperative follow-up was 14.3 ± 4.2 months. Surgical success was achieved in 73.07% of group S and 82.14% of group E. Recurrence was more common with anterior segment pathology. Larger post-operative distant angles were strongly related to poorer visual acuities P = 0.001 and not related to the age of onset or the duration. Narrowing of the palpebral fissure improved in both groups at the last follow up P = 0.336. The limitation of abduction in both groups improved in the last follow up P = 0.145. CONCLUSION: The outcome of monocular surgery for sensory exotropia in children is satisfactory with no significant differences in results between lateral rectus muscle tendon autograft elongation technique and supermaximum recession resection. Recurrence is more common with anterior segment pathology. Larger post-operative distant angle of deviation is strongly related to poorer visual acuity. CLINICAL TRIAL REGISTRATION: This study was retrospectively registered at clinicaltrials.gov (ID: NCT04286945) on 25-2-2020.

Clinical and imaging characteristics of orbital metastatic lesions among Egyptian patients.

PURPOSE: The aim of the study was to review the demographic, clinical, and imaging features of Egyptian patients with orbital metastases. METHODS: The study was a retrospective study of patients with orbital metastatic lesions over the last 15 years. RESULTS: The study included 37 patients. Male patients represented 54.1%. The primary tumor was breast carcinoma in 21.6% of patients, with hepatocellular carcinoma (HCC) in 16.2% and cutaneous malignant melanoma in 13.5% of patients. Bronchogenic carcinoma, prostatic carcinoma, and thyroid adenocarcinoma was the primary tumor in 8.1% of cases each. The most common primary tumor in children was neuroblastoma (42.9% of pediatric patients). In 24.3% of patients, there was no history of cancer, and the orbital metastatic lesion was the first presentation of the disease. Proptosis and/or globe displacement was the presenting feature in 78.4%, followed by diplopia and limited ocular movements in 35.1%, inflammatory manifestations in 10.8%, and ptosis in 5.4%. In 54.1% the lesion involved the right orbit and in 5.4% bilateral involvement was found. Orbital imaging showed infiltrative lesion in 62.2%, mass lesion in 21.6%, isolated muscle thickening in 10.8%, and bone metastasis in 5.4%. All cases of HCC showed osteoclastic changes, and all cases of prostatic carcinoma were osteoblastic lesions. CONCLUSION: Orbital metastasis from HCC represented a higher incidence when compared to previous studies, probably due to the increased incidence of HCC found in the Egyptian population. Orbital metastasis can display a variety of clinical and imaging features, and a high index of suspicion is required, as 24.3% showed negative history of cancer.

Lacrimal fossa lesions: a review of 146 cases in Egypt.

PURPOSE: The incidence and clinical and imaging criteria of different pathological forms of lacrimal fossa lesions in the Delta region of Egypt were studied. METHODS: A retrospective study of patients with lacrimal fossa lesions for the past 10 years was conducted. A total of 146 cases were identified. Their medical records were reviewed for clinical and imaging data (computed tomography scan, magnetic resonance imaging scan, or both). A definitive diagnosis based on pathological examination of biopsies was also reviewed. RESULTS: Among the patients reviewed, 43.15% had inflammatory lacrimal gland lesions, 26.71% had lymphoproliferative lesions, and 21.92% had epithelial lesions; 8.22% had rare lesions (5.48% were dacryops and 2.74% had hemangioma). The study included 71.92% benign lesions and 28.08% malignant lesions, which were distributed between 19.18% malignant lymphoma and 8.9% malignant epithelial tumors. According to the pathological origin of the lesions, they may be classified into 78.08% nonepithelial lesions and 21.92% epithelial lesions (16.44% epithelial tumors, and 5.48% dermoid cysts). CONCLUSION: Lacrimal fossa lesions show a wide pathological range. Inflammatory lesions are most frequent, followed by lymphoproliferative and epithelial lesions. Analysis of clinical and radiological criteria is helpful in the differential diagnosis of lacrimal gland lesions.

Orbital metastasis from hepatocellular carcinoma: report of 6 cases.

A series of 6 consecutive cases of orbital metastasis from hepatocellular carcinoma (HCC) were reported in the last 5 years. All patients were men. The age of patients ranged between 47 and 70 years. Four patients presented with recent onset of unilateral proptosis, 1 patient presented with inflammatory manifestations, and 1 patient presented with unilateral ptosis. Pain was present in 4 patients. Three patients had a previous history of HCC, while the orbital affection was the first manifestation of the disease in 3 cases. All patients had chronic hepatitis C. CT scan of 5 patients showed a mass in upper lateral orbital quadrant, and 1 patient had the mass in the upper central orbit. Bone changes (thinning, notching, or erosion) were detected in all patients. Diagnosis was confirmed by incision biopsy in all cases. Life span of 5 patients in the study had a mean of 10.2 (±2.3) months.