Comparison of four Combined Procedures for Correction of Involutional Lower Eyelid Entropion.

BACKGROUND: To evaluate 4 combined techniques for entropion repair which address the horizontal laxity by either lateral tarsal strip (LTS) or Bick's procedure (BP) and the vertical laxity by everting sutures (ESs) or lower lid retractor plication (LLRP). METHODS: Retrospective, comparative consecutive clinical series. A total of 261 procedures were performed on 227 patients. Patients were divided in the following groups based on the procedure type: Group 1: LTS + ES (n = 115), Group 2: LTS + LLRP (n = 77), Group 3: BP + ES (n = 25), and Group 4: BP + LLRP (n = 44). RESULTS: The study cohort included 132 males and 95 females. The mean age was 76.2 ±â€Š8.3 years. The mean follow-up was 13 months (range 3-58). At last follow-up, the cure rate was 92% in the LTS + ES and 90% LTS + LLRP groups, in contrast to 100% in BP + ES and BP + LLRP groups (P = 0.035). Overcorrection was observed in 2 patients from LTS + ES and 5 from LTS + LLRP group. There was no statistically significant difference in terms of symptoms outcomes among 4 groups. Complications were relatively minor with no statistically significant difference between the 2 groups (P = 0.13). The reoperation rate was 7% and 6.5% in groups 1 and 2 (P = 1.0), respectively, to none in groups 3 and 4. CONCLUSION: Bick's procedure in conjunction with either ES or LLRP, provides a quick, simple, and effective means for addressing the main pathogenic factors of involutional entropion. This study found a lower recurrence rate and consecutive ectropion formation in Bick's compared to LTS groups.

The management of periorbital cellulitis secondary to sinonasal infection: a multicenter prospective study in the United Kingdom.

BACKGROUND: Periorbital cellulitis is a potential sight-threatening complication of sinusitis. The majority of patients improve with medical management. Previous studies have suggested significant variations in practice and lack of evidence regarding the optimal management of this condition. METHODS: A prospective study was conducted over a 12-month period at 8 centers in the United Kingdom assessing the management of patients requiring inpatient treatment for periorbital cellulitis secondary to sinonasal infections. RESULTS: A total of 143 patients were recruited, of whom 40 were excluded. Of the remaining 103 patients, 5 (4.9%) were diagnosed with neurosurgical complications. This resulted in 98 patients admitted with periorbital cellulitis secondary to an upper respiratory tract infection/sinusitis. A total of 72 were children, of whom 12 (16.7%) required surgical intervention; and of 26 adults, 5 (19.2%) required surgery: the most common antimicrobial regimes administered were intravenous ceftriaxone (with or without metronidazole), and co-amoxiclav. The use of both ceftriaxone and metronidazole from admission was associated with the shortest duration of inpatient stay (3.8 days) in comparison to ceftriaxone alone (5.8 days) or co-amoxiclav (4.5 days) and a reduction in number of patients requiring surgical intervention. There was also an association between the early use of intranasal decongestants and steroids and reduction in requirement for surgical intervention. CONCLUSION: For a condition where swab and blood cultures are often negative, this study supports the use of ceftriaxone in combination with metronidazole. The administration of intranasal decongestants and corticosteroids correlated with a smaller percentage of those progressing to surgery in those with and without periorbital abscesses.