Incision-sparing management of canaliculitis.

PURPOSE: To report our results of canaliculitis treatment with our incision-sparing technique which includes dilation of the punctum and compression of the canaliculus to express the sulphur granules, curettage and irrigation of the canaliculus with antibiotic solutions, and topical antibiotic use. METHODS: The medical records of all patients treated for canaliculitis between October 2009 and March 2013 were rewiewed. The punctum of affected canaliculus was dilated under local anesthesia. Then, starting just distal to common canaliculus, the horizontal canaliculus was compressed along its entire length using either a forceps or a cotton tip applicator on the conjunctival surface and a curette on the skin. Compression was repeated until no more sulphur granules appeared and the swelling of the canaliculus disappeared. A chalazion curette was inserted into canaliculus to evacuate any residual concretions. The canaliculus were irrigated with antibiotic solutions and the patients were prescribed topical antibiotic solutions for one month Patients with follow-up less than 3 months after the intervention were excluded from the study. RESULTS: Nine patients met criteria for canaliculitis. There were 1 male and 8 female patients. Median age of the patients was 53 years (range 36-72 years). All patients had unilateral lower canaliculitis. Mean duration of the symptoms was 13.4 months (range 4-36 months). We followed up all patients for at least 3 months after the intervention. The signs and symptoms resolved completely in all patients within 1 month and recurrence was not observed in any patient. No patients reported epiphora after the procedure. CONCLUSION: Our incision-sparing technique is effective in the treatment of canaliculitis. We suggest that minimally invasive or incision-sparing techniques be attempted before canaliculotomy to decrease postoperative complications rates.

A simple approach to the repeatability of the Schirmer test without anesthesia: eyes open or closed?

PURPOSE: To compare the repeatability of the Schirmer test (ST) administered with the eyes open (STo) with the repeatability of the ST administered with the eyes closed (STc). METHODS: STo and STc without anesthesia were alternately applied with 1-day intervals for a total of 6 times on 28 eyes of 14 healthy volunteers. The intraclass correlation coefficients (ICCs) and their 95% confidence intervals (CIs) were calculated to assess test-retest reliability of the STo and STc. RESULTS: STc scores were found to be statistically lower than the STo scores in general (right eyes: t = 2.033, P = 0.048; left eyes: t = 3.474, P = 0.004). The ICC was 0.632 (right eyes) and 0.618 (left eyes) for STo and 0.943 (right eyes) and 0.933 (left eyes) for STc. CONCLUSIONS: Our study suggests that administering the ST with the patient's eyes closed produces less variable results and more repeatability than STo in normal subjects. Although our results may not extend to dry eye patient populations, we propose that STc without anesthesia can be considered by those ophthalmologists who frequently use the ST as an adjunct to the differential diagnosis of dry eye in patients presenting with ocular discomfort, making ST a more reliable test in everyday practice.

Recurrent aphthous stomatitis: investigation of possible etiologic factors.

OBJECTIVE: To investigate the association of serum vitamin B(12), folic acid, iron, calcium, magnesium, and phosphorus levels as well as family history and cigarette smoking with recurrent aphthous stomatitis (RAS). METHODS: Thirty-four patients with RAS and 32 control subjects were included in this controlled prospective screening study. Both groups received a questionnaire, and serum screening tests were performed. The collected data were analyzed using chi(2) test and binary logistic regression analysis. RESULTS: Family history was found to be the most significant predisposing factor for RAS among the investigated ones. Regarding the serum tests, only vitamin B(12) was found to have significant correlation with RAS. Patients with vitamin B(12) deficiency, positive family history, and nonsmoking status have been found to have the highest risk for having RAS. CONCLUSIONS: RAS is a multifactorial disease. Positive family history, vitamin B(12) deficiency, and nonsmoking status are among the important predisposing factors.

Treatment of congenital nasolacrimal duct obstruction with high-pressure irrigation under topical anesthesia.

PURPOSE: To evaluate the effectiveness, safety, and success rate of high-pressure irrigation (HPI) applied under topical anesthesia in outpatient treatment of congenital nasolacrimal duct obstruction. METHODS: HPI was applied under topical anesthesia to 39 eyes of 32 consecutive patients with congenital nasolacrimal duct obstruction. If obstructive symptoms persisted after the first attempt, treatment was repeated within 1 month. Patients were divided in two age groups: 7 to 12 months and 12 to 18 months. The two groups were compared in terms of the number of attempts needed to resolve the obstruction. RESULTS: Thirty-nine eyes that had failed conservative treatment underwent high-pressure irrigation. The overall success rate was 31 of 39 (79.48%) at the first attempt; complete success (8/8, 100%) was achieved at the second attempt. The success rate in the younger group was 18 of 22 (81.8%) at the first attempt and 4 of 4 (100%) at the second attempt. The success rate in the older group was 13 of 17 (76.5%) at the first attempt and 4 of 4 (100%) at the second attempt. There was no statistically significant difference between the two groups regarding the number of attempts needed to relieve the symptoms (p > 0.05). There was no statistically significant difference in massage times and age between cases resolved at the first and second attempts (p > 0.05). CONCLUSIONS: HPI can be attempted as an alternative second-step treatment or as a transition procedure between conservative and invasive methods. HPI has the advantage of being less invasive than other secondary methods, and its application under topical anesthesia seems to be safe and effective.