Human Meibum Age, Lipid-Lipid Interactions and Lipid Saturation in Meibum from Infants.

Tear stability decreases with increasing age and the same signs of instability are exacerbated with dry eye. Meibum lipid compositional changes with age provide insights into the biomolecules responsible for tear film instability. Meibum was collected from 69 normal donors ranging in age from 0.6 to 68 years of age. Infrared spectroscopy was used to measure meibum lipid phase transition parameters. Nuclear magnetic resonance spectroscopy was used to measure lipid saturation. Increasing human meibum lipid hydrocarbon chain unsaturation with age was related to a decrease in hydrocarbon chain order, cooperativity, and in the phase transition temperature. The change in these parameters was most dramatic between 1 and 20 years of age. Meibum was catalytically saturated to determine the effect of saturation on meibum lipid phase transition parameters. Hydrocarbon chain saturation was directly related to lipid order, phase transition temperature, cooperativity, changes in enthalpy and entropy, and could account for the changes in the lipid phase transition parameters observed with age. Unsaturation could contribute to decreased tear film stability with age.

Pilot study of the influence of eyeliner cosmetics on the molecular structure of human meibum.

BACKGROUND/AIMS: It has been suggested that eye makeup could interact with human meibum causing a decrease in the stability of the tear film. The aim of this pilot study was to measure makeup-human meibum interactions in vitro. METHODS: Human meibum-makeup interactions were quantified by measuring order-to-disorder lipid phase transitions using infrared spectroscopy. RESULTS: Makeup products exhibited lipid phase transition temperatures that were much higher than those for meibum. One product increased the lipid phase transition temperature by 4.2°C when combined with human meibum causing a large increase (from 30 to 49%) in the order of the meibum-lipid hydrocarbon chains and significantly decreased the minimum frequency, enthalpy and entropy of the phase transition of human meibum. Another eyeliner caused no significant (p < 0.05) change in the phase transition parameters of human meibum. CONCLUSION: Infrared spectroscopy may be used to measure interactions between human meibum and makeup. One makeup product increased the lipid order (viscosity) which could have adverse effects on tear film stability. Modern cosmetics are highly regulated and relatively safe to use; however, it could be beneficial to design makeup products that do not interact with meibum, especially since women have a higher prevalence of dry eye symptoms.

Ketamine and intraocular pressure in children.

STUDY OBJECTIVE: We determine the increase in intraocular pressure during pediatric procedural sedation with ketamine, and the proportion of children whose increase might be clinically important (at least 5 mm Hg). METHODS: We prospectively enrolled children aged 8 to 18 years, chosen to receive ketamine sedation in a pediatric emergency department. We measured intraocular pressure before sedation, immediately after ketamine administration, 2 minutes post-drug administration, and every 5 minutes thereafter until recovery or 30 minutes after the final dose. We descriptively report our observations. RESULTS: For the 60 children enrolled, the median intraocular pressure increase was 3 mm Hg (range 0 to 8 mm Hg). Fifteen children had a brief greater than or equal to 5 mm Hg increase in intraocular pressure from baseline. CONCLUSION: In this study of ketamine sedation in children with healthy eyes, we observed mild increases in intraocular pressure that at times transiently exceeded our bounds for potential clinical importance (5 mm Hg).

13C and 1H NMR ester region resonance assignments and the composition of human infant and child meibum.

Recent NMR studies suggest that unsaturation may contribute to tear film instability in adults and loss of cholesteryl esters and squalene could reduce tear film stability in adults with meibomian gland dysfunction. The proton resonances were tentatively assigned in those studies. In this current investigation, meibum from seven infants and children, one adult and a pool of adult meibum have been analyzed using an NMR spectrometer with greater sensitivity and spectral resolution. The goals of this work are to confirm/correct the previous assignments and to determine possible age-related changes in composition. The initial resonance assignments were confirmed using heteronuclear single quantum correlation spectroscopy. Because there were no significant interferences in the spectral region corresponding to the resonances for cholesteryl and wax esters, the areas of these resonances were used to calculate their molar ratios. We calculated a wax ester:cholesteryl ester molar ratio of 1:0.57 ± 0.05 for all our meibum samples and there were no age-related differences. At lower film thicknesses, the rate of evaporation measured in vitro was lower for wax esters mixed with a long chain cholesteryl ester compared to wax esters alone. However, the film thicknesses tested were non-physiological. Longer chain cholesteryl esters increase the interactions between hydrocarbon chains. Hydrocarbon chains were more saturated in meibum from infants and children compared to adults. Unsaturation may contribute to tear film instability in adults. Loss of cholesteryl ester and squalene could destabilize tear film in adults with meibomian gland dysfunction.

Lipid order, saturation and surface property relationships: a study of human meibum saturation.

Tear film stability decreases with age however the cause(s) of the instability are speculative. Perhaps the more saturated meibum from infants may contribute to tear film stability. The meibum lipid phase transition temperature and lipid hydrocarbon chain order at physiological temperature (33 °C) decrease with increasing age. It is reasonable that stronger lipid-lipid interactions could stabilize the tear film since these interactions must be broken for tear break up to occur. In this study, meibum from a pool of adult donors was saturated catalytically. The influence of saturation on meibum hydrocarbon chain order was determined by infrared spectroscopy. Meibum is in an anhydrous state in the meibomian glands and on the surface of the eyelid. The influence of saturation on the surface properties of meibum was determined using Langmuir trough technology. Saturation of native human meibum did not change the minimum or maximum values of hydrocarbon chain order so at temperatures far above or below the phase transition of human meibum, saturation does not play a role in ordering or disordering the lipid hydrocarbon chains. Saturation did increase the phase transition temperature in human meibum by over 20 °C, a relatively high amount. Surface pressure-area studies showing the late take off and higher maximum surface pressure of saturated meibum compared to native meibum suggest that the saturated meibum film is quite molecularly ordered (stiff molecular arrangement) and elastic (molecules are able to rearrange during compression and expansion) compared with native meibum films which are more fluid agreeing with the infrared spectroscopic results of this study. In saturated meibum, the formation of compacted ordered islands of lipids above the surfactant layer would be expected to decrease the rate of evaporation compared to fluid and more loosely packed native meibum. Higher surface pressure observed with films of saturated meibum compared to native meibum suggests greater film stability especially under the high shear stress of a blink.

Technique for the Management of Extensive Ocular Surface Lipodermoid Involving the Cornea of Children.

PURPOSE: Ocular surface lipodermoids with corneal involvement may require surgical intervention; if deep, ocular surface reconstruction with lamellar corneal tissue or amniotic membrane may be needed. We describe a staged technique using autologous ipsilateral simple limbal epithelial transplantation. METHODS: After verifying sparing of Descemet membrane, the conjunctival portion of the lipodermoid was debulked in the first stage. Six weeks later, the corneal portion was excised, followed by autologous ipsilateral simple limbal epithelial transplantation to promote rapid reepithelialization of the residual stromal bed. Temporary tarsorrhaphy was used for patient comfort and to expedite ocular surface healing. RESULTS: Three eyes of 3 children with grade III large ocular surface lipodermoids that encroached the visual axis and hindered proper eyelid closure underwent surgery without complications. In all cases, the visual axis was cleared and eyelid closure was improved. At the last follow-up (mean 35.7 months, median 36.0 months), the bed of the original dermoid showed minimal haze in 1 case, while 2 eyes developed small pseudopterygium; best spectacle-corrected visual acuity improved from 20/200 to 20/70 in the first case, from fix and follow to 20/50 in the second case, and remained fix and follow in the last case, but this child had congenital hydrocephalus with severe developmental delay. CONCLUSIONS: This surgical technique is a promising option for children with grade III large ocular surface lipodermoids given its effectiveness in clearing the visual axis and in improving eyelid closure. Moreover, it does not require lamellar corneal transplantation or intervention to the fellow eye.

Functionalization of titanium based metallic biomaterials for implant applications.

Surface immobilization with active functional molecules (AFMs) on a nano-scale is a main field in the current biomaterial research. The functionalization of a vast number of substances and molecules, ranging from inorganic calcium phosphates, peptides and proteins, has been investigated throughout recent decades. However, in vitro and in vivo results are heterogeneous. This may be attributed partially to the limits of the applied immobilization methods. Therefore, this paper highlights the advantages and limitations of the currently applied methods for the biological nano-functionalization of titanium-based biomaterial surfaces. The second part describes a newer immobilization system, using the nanomechanical fixation of at least partially single-stranded nucleic acids (NAs) into an anodic titanium oxide layer as an immobilization principle and their hybridization ability for the functionalization of the surface with active functional molecules conjugated to the respective complementary NA strands.

Cellular response of titanium and its alloys as implants.

The cellular response of osteocytes to commercially pure titanium (α) and its alloys (α + ß and ß) has been tested in a culture media, and the results have been supplemented by analyses from various techniques such as inductively coupled plasma atomic emission spectroscopic (ICP-AES) analysis, X-ray photoemission spectroscopy (XPS), scanning electron microscopy (SEM), metallography, and electrochemical measurements. These results have been correlated with respect to the presence of various alloying elements in these alloys to qualify them for human application. The newer ß alloys have been examined for their potential use as implants. These results serve as a preliminary baseline to characterize the best alloy system for a comprehensive long-term investigation.

Bilateral Acute Angle-Closure Glaucoma: A Case Report of an Unusual Cause of Acute Headache in a Child.

INTRODUCTION: Acute angle-closure glaucoma (AACG) is typically considered a disease of adulthood. However, AACG may occasionally be seen in children. The clinical presentation is similar to adults, including headache, vomiting, and eye pain. However, the etiology of angle closure in children is different and most often associated with congenital anterior segment abnormalities. A precipitating factor of AACG in children with previous established, anterior segment abnormalities is eye dilation, which may occur during routine ophthalmological examination with topical mydriasis, or physiologic mydriasis upon entering a dark room. CASE REPORT: We describe a 5-year-old child with a history of severe prematurity and retinopathy of prematurity (ROP) presenting with bilateral AACG following a routine outpatient, dilated ophthalmological examination. While angle-closure glaucoma has previously been reported in cases of ROP, a bilateral acute attack of AACG following pupil dilation in regressed ROP has hitherto been unreported. CONCLUSION: Given the association of ROP and AACG, it can be expected that as the survival rate of premature infants improves, the incidence of ROP and AACG may also increase. It is therefore prudent for the emergency physician to have AACG on the differential for pediatric patients with headache and eye pain.

Effect of povidone-iodine addition on the corrosion behavior of cp-Ti in normal saline.

The effect of various concentrations of povidone-iodine (PI) on the corrosion behavior of a commercially pure titanium alloy (Ti-1) has been investigated in normal saline solution to simulate the povidone-iodine addition in an oral environment. The open circuit potential, electrochemical impedance spectroscopy and potentiodynamic polarization measurements have been used to characterize the electrochemical phenomena occurring on the alloy surface. The open circuit potential values for Ti-1 in various concentrations of PI shift considerably towards noble direction as compared to pure normal saline. In the potentiodynamic polarization curve for Ti-1 in various solutions, the cathodic current density has increased for all concentrations of PI and the anodic current density has decreased. Only the 0.1% PI concentration is able to inhibit corrosion of Ti-1 in normal saline and the other higher concentrations studied, accelerate corrosion. The EIS data for Ti-1 in normal saline and in various concentrations of PI follows a one time constant circuit, suggesting the formation of a single passive film on Ti-1 which is not altered by the addition of PI to normal saline.

Evaluation of subjective and objective cyclodeviation following oblique muscle weakening procedures.

PURPOSE: To evaluate the subjective and objective cyclodeviational changes following different weakening procedures on superior and inferior oblique muscles. DESIGN: Comparative case series. MATERIALS AND METHODS: In a prospective institution based study, 16 cases of A pattern horizontal strabismus having superior oblique overaction were randomized to superior oblique weakening procedures: either silicon expander or translational-recession. Similarly, 20 cases of V pattern horizontal strabismus with inferior oblique overaction were randomized for inferior oblique weakening procedures: either 10 mm Fink's recession or modified Elliot and Nankin's anteropositioning. Cyclodeviation was assessed subjectively with the synoptophore and objectively using the fundus photograph before surgery and 3 months postoperatively. Change in cyclodeviation was measured by subjective and objective methods. The index of surgical effect (ISE) was defined as the net torsional change postoperatively. RESULTS: The difference between the extorsional change induced by the two superior oblique procedures, silicone expander (-6 degrees ) and translational recession (-11.3 degrees), was statistically significant (P=0.001). Translational recession caused more extorsional change (ISE=296%) than silicone expander surgery (ISE=107%). The two inferior oblique weakening procedures, Fink's recession (+2.5 degrees) and modified Elliot and Nankin's anteropositioning (+4.7 degrees) produced equitable amount of intorsional shift with no statistical difference (P=0.93). Objective measurements were significantly more than the subjective measurements. CONCLUSIONS: Different weakening procedures on oblique muscles produce different changes in cyclodeviation, which persists even up to 3 months. Subjective cyclodeviation is less than the objective measurements indicating partial compensation by sensorial adaptations.

Recurrence of amblyopia after occlusion therapy.

PURPOSE: To determine the stability of visual acuity (VA) after a standardized occlusion regimen in children with strabismic and/or anisometropic amblyopia. DESIGN: Retrospective, population-based, consecutive observational case series. PARTICIPANTS: Four hundred forty-nine patients younger than 10 years who underwent an occlusion trial for amblyopia and were observed until there was a recurrence of amblyopia or for a maximum of 1 year after decrease or cessation of occlusion therapy. METHODS: We performed a retrospective chart review of all patients treated by occlusion therapy for strabismic and/or anisometropic amblyopia at our institution over a 34-year period. Of the 1621 patients identified in our database, 449 met the eligibility criteria and were included in this study. Patients having at least a 2 logarithm of the minimum angle of resolution (logMAR)-level improvement in VA by optotypes or a change from unmaintained to maintained fixation preference during the course of occlusion therapy were included. A recurrence of amblyopia was defined as > or =2 logMAR levels of VA reduction or reversal of fixation preference within 1 year after a decrease or cessation of occlusion therapy. MAIN OUTCOME MEASURE: Recurrence of amblyopia after a decrease or cessation of occlusion therapy and its relationship with patient age and VA of the amblyopic eye at the time of decrease or cessation of occlusion therapy. RESULTS: Of 653 occlusion trials, 179 (27%) resulted in recurrence of amblyopia. The recurrence was found to be inversely correlated with patient age. There was no statistically significant association between the recurrence of amblyopia and VA of the amblyopic eye at the end of maximal occlusion therapy. CONCLUSIONS: There is a clinically important risk of amblyopia recurrence when occlusion therapy is decreased before the age of 10 years. The risk of recurrence is inversely correlated with age (P<0.0001).

Orbital magnetic resonance imaging of extraocular muscles in chronic progressive external ophthalmoplegia: specific diagnostic findings.

INTRODUCTION: Chronic progressive external ophthalmoplegia (CPEO) is characterized by slowly progressive bilateral ophthalmoplegia and blepharoptosis. Molecular diagnosis is problematic because sporadic mitochondrial DNA deletions can be causative. We sought findings using magnetic resonance imaging (MRI) that might support the diagnosis of CPEO. METHODS: Two men (ages 31 and 47 years) and 3 women (ages 40-49 years) with CPEO and symptom durations of 8 months to 28 years underwent high-resolution (2-mm slice thickness, 312 micron pixels), surface coil, T1-weighted orbital MRI in coronal planes. Images were analyzed quantitatively to determine extraocular muscle (EOM) sizes and were compared with 10 age- and gender-matched normal volunteers, one subject with myasthenia gravis, and with 30 subjects having EOM paralysis caused by oculomotor, trochlear,0 and abducens neuropathies. RESULTS: EOM function was clinically diminished in CPEO, most markedly for the superior rectus (SR) and levator muscles. All EOMs in CPEO exhibited unusual qualitative T1 MRI signal abnormalities. Unlike the profound EOM atrophy typical of neurogenic paralysis, anterior volumes of medial rectus, lateral rectus, and inferior rectus muscles in CPEO were not smaller than normal (p>0.003). Anterior volumes of the SR muscle-levator complex and superior oblique were significantly reduced (p<0.003). Denervated EOMs exhibited statistically significant volume reduction when compared with normal and CPEO groups. Volume of the SR muscle-levator complex was the same in subjects with CPEO and oculomotor palsies. CONCLUSIONS: CPEO is associated with minimal EOM volume reduction despite clinically severe weakness. This combination of findings may be specific for CPEO and could resolve the diagnostic dilemma in difficult cases.

Periosteal fixation in third-nerve palsy.

PURPOSE: We present a new technique of anchoring the eyeball to the nasal periosteum using a nonabsorbable suture in acquired isolated third-nerve paresis. METHODS: This was a case series of 4 consecutive adult subjects with isolated third-nerve paresis. After a 12-mm lateral rectus muscle recession in all 4 subjects, we passed 5-O double-armed polyester (NW683 Ethibond; Ethicon, Division of Johnson and Johnson Ltd., Aurangabad, India) on spatulated needles through the periosteum overlying the anterior lacrimal crest (exposed as in a Dacryocystorhinostomy procedure) at its superior part. The needles were brought anterior to the medial rectus muscle insertion and tightened enough to align the eye in 8-10 prism diopters adducted position. RESULTS: Ocular alignment in the primary gaze was satisfactory at 6-12 months of follow up. CONCLUSIONS: The use of a nonabsorbable polyester suture to anchor the globe to the nasal periosteum is an additional technique that holds promise to align the eyes in the primary gaze.

Long-term outcome of pediatric aphakic glaucoma.

PURPOSE: To determine the long-term outcome in pediatric patients with aphakic glaucoma. METHODS: A retrospective analysis of 130 patients diagnosed with aphakic glaucoma between 1969 and 2004 was performed. A total of 36 patients (55 eyes) were included in this study after excluding those who had cataract extraction after age 10 and those patients with other ocular conditions, systemic syndromes, traumatic cataracts, congenital glaucoma, or inadequate follow-up (less than 1 year). Outcome variables studied included visual acuity, number of medication changes required over the course of the follow-up, maximum number of medications used at a time for more than 6 months to control intraocular pressures, and surgical interventions required. Mean follow-up period was 18.7 years (range, 6.9-35 years). RESULTS: At the time of last follow-up, 54.5% of the patients had visual acuity 20/40 or better, 34.5% had 20/50 to 20/200, and 11% had acuity worse than 20/200. During the course of follow-up, 34% required 1 to 2 medication changes for controlling glaucoma, 33% required 3 to 5 medication changes, and 33% required 6 or more medication changes. Thirty-six percent of the eyes required a maximum of 1 to 2 medications for more than 6 months during the course of follow-up, 33% required 3, and 31% required 4 or more medications for controlling intraocular pressure. Of the 55 eyes, 15 eyes (27%) required surgical intervention. Six of the 15 eyes (40%) required 1 surgery, 8 eyes (53%) required 2 to 3 surgeries, and 1 eye (7%) required 4 to 6 surgeries. CONCLUSION: Patients with glaucoma after pediatric cataract surgery can have a good visual outcome although multiple medications and surgical interventions may be required to control the glaucoma.

Bilateral dissociated vertical deviation in a case of congenital hereditary endothelial dystrophy.

Dissociated vertical deviation (DVD) is an intermittent anomaly of the non-fixing eye. Although association of DVD with sensory visual deprivation owing to congenital or acquired opacities of the ocular media has been reported, its association with congenital hereditary endothelial dystrophy (CHED) has not been reported hitherto. We report a case having a bilateral asymmetric DVD, in a know case of bilateral CHED.

Evaporation and Hydrocarbon Chain Conformation of Surface Lipid Films.

PURPOSE: The inhibition of the rate of evaporation (Revap) by surface lipids is relevant to reservoirs and dry eye. Our aim was to test the idea that lipid surface films inhibit Revap. METHODS: Revap were determined gravimetrically. Hydrocarbon chain conformation and structure were measured using a Raman microscope. Six 1-hydroxyl hydrocarbons (11-24 carbons in length) and human meibum were studied. Reflex tears were obtained from a 62-year-old male. RESULTS: The Raman scattering intensity of the lipid film deviated by about 7 % for hydroxyl lipids and varied by 21 % for meibum films across the entire film at a resolution of 5 µm2. All of the surface lipids were ordered. Revap of the shorter chain hydroxyl lipids were slightly (7%) but significantly lower compared with the longer chain hydroxyl lipids. Revap of both groups was essentially similar to that of buffer. A hydroxyl lipid film did not influence Revap over an estimated average thickness range of 0.69 to >6.9 µm. Revap of human tears and buffer with and without human meibum (34.4 µm thick) was not significantly different. Revap of human tears was not significantly different from buffer. CONCLUSIONS: Human meibum and hydroxyl lipids, regardless of their fluidity, chain length, or thickness did not inhibit Revap of buffer or tears even though they completely covered the surface. It is unlikely that hydroxyl lipids can be used to inhibit Revap of reservoirs. Our data do not support the widely accepted (yet unconfirmed) idea that the tear film lipid layer inhibits Revap of tears.

Isolated superior oblique tucking: an effective procedure for superior oblique palsy with profound superior oblique underaction.

PURPOSE: To compare efficacy and complications of isolated unilateral superior oblique tucking in patients with unilateral superior oblique palsy (SOP). METHOD: A retrospective analysis of 24 cases of unilateral SOP, 13 Acquired (group 1), and 11 Congenital (group 2), who underwent isolated unilateral superior oblique tuck over a 13-year period was performed. RESULTS: The mean preoperative vertical deviation in primary gaze was 10 +/- 3 PD for group 1 and 12 +/- 5 PD for group 2 and mean vertical deviation in lateral gaze of affected superior oblique was 19 +/- 5 PD for group 1 and 21 +/- 9 PD for group 2. The mean postoperative vertical deviation in primary gaze for group 1 after a mean follow-up period of 15 +/- 21 months was 1 +/- 3 PD; for group 2 after a mean follow-up period of 17 +/- 13 months was 2 +/- 3 PD, and in lateral gaze of affected superior oblique was 3 +/- 5 PD for group 1 and 5 +/- 6 PD for group 2. The mean correction of vertical deviation in primary gaze at last follow-up was 8 +/- 2 PD for group 1 and 9 +/- 5PD for group 2 ( P > 0.05) and in the lateral gaze field of affected superior oblique muscle was 16 +/- 4 PD for group 1 and 15 +/- 5 PD for group 2 ( P > 0.05). The mean preoperative torsion was 9 +/- 4 degrees for group 1 and 9 +/- 2 degrees for group 2; mean postoperative torsion was 1.2 +/- 2.2 degrees for group 1 and 1 +/- 1 degrees for group 2. The mean torsion corrected for group 1 was 8 +/- 3 degrees and for group 2 was 8 +/- 2 degrees ( P > 0.05). Only one patient in group 1 and three patients in group 2 required reoperation to correct residual deviation. A mild postoperative limitation to elevation in adduction was seen in all cases but was asymptomatic and lessened over time. CONCLUSION: Isolated unilateral superior oblique tucking corrected a large amount of the vertical deviation and torsion with minimal complications in selective patients of both congenital and acquired superior oblique palsy. Superior oblique tucking is a safe and effective procedure and can be considered in patients with SOP meeting selective criteria.

High-resolution magnetic resonance imaging demonstrates varied anatomic abnormalities in Brown syndrome.

INTRODUCTION: Although Brown syndrome classically is considered to be limited to the SO tendon sheath and trochlea, it does not always respond to SO surgery. We investigated mechanisms of Brown syndrome by magnetic resonance imaging (MRI). METHODS: Three patients with congenital and 8 with acquired Brown syndrome were compared with matched normal subjects under a prospective protocol of high-resolution, multipositional orbital MRI using surface coils. Muscle size and contractility were determined using digital image analysis. RESULTS: Five of 8 patients with acquired Brown syndrome had a history of trauma or surgery and demonstrated extensive scarring, avulsion, or fracture of the trochlea. One of the 8 had a cyst in the SO tendon. One congenital and one acquired case demonstrated inferior displacement of the lateral rectus (LR) pulley in adduction, with a normal SO tendon-trochlear complex. Such cases of Brown syndrome responded to surgical stabilization of the LR pulley. Two congenital cases had clinical findings of ipsilateral SO palsy confirmed on MRI by atrophy or absence of the SO belly. In congenital absence of the SO belly, the anterior tendon was present but terminated directly on the trochlea. CONCLUSION: High-resolution MRI demonstrates a variety of abnormalities in patients presenting with Brown syndrome, including atrophy or absence of the SO belly. Management in Brown syndrome should be tailored to the pathophysiology of the individual patient.

Lateral rectus resections in divergence palsy: results of long-term follow-up.

INTRODUCTION: Lateral rectus resections have been previously advocated as surgical options to treat patients with divergence palsy who do not respond well to prisms. This study was undertaken to review the results and long-term follow-up of patients with divergence palsy who underwent lateral rectus resections at our institution. METHODS: Retrospective review of 29 patients (age 35-83 years) with divergence palsy. Five subjects underwent unilateral lateral rectus resection between 4.5 and 5.5 mm on adjustable suture and 24 subjects underwent bilateral lateral rectus resection between 3 and 7 mm on adjustable sutures. RESULTS: Preoperatively, all patients had diplopia at distance and an esodeviation, which was greater at distance (mean 14.7 +/- 5.1Delta) than at near (mean 4.7 +/- 3.5Delta). Twenty-five subjects had previously been treated with prisms. Postoperative follow-up period ranged from 6 to 96 months (mean 38.7 +/- 27.3 months). The angle of deviation at distance was significantly reduced to -0.1 +/- 3.2Delta postoperatively ( P < 0.0001). The angle of deviation at near reduced significantly to -2.2 +/- 3.3Delta postoperatively ( P < 0.0001). No patient was overcorrected for near. Two patients experienced recurrent postoperative diplopia at distance subsequently at 1 and 4 years, which was corrected with prism glasses and lateral rectus re-resection. CONCLUSION: Lateral rectus resection in patients with divergence palsy is an effective and stable procedure in patients with divergence palsy over long-term follow-up periods, with minimal risk of overcorrections at near.