Evaluation of quality of life in patients with Graves´ ophthalmopathy, before and after orbital decompression.

Graves' ophthalmopathy (GO) is a potentially sight threatening orbital disease that can have a large negative impact on the quality of life of the patient. Studies on long-term effects of GO on the quality of life are few. The aim of this study is to evaluate the health-related quality of life in patients with GO, before and after orbital decompression surgery. This is a prospective, longitudinal, interventional study in which patients who had orbital decompression were given the Graves´ ophthalmopathy quality of life questionnaire (GO-QOL) before and after surgery. The GO-QOL is a disease specific instrument to measure health-related quality of life. The answers are transformed into scores from 0-100 on 2 subscales. Higher score indicates better health. An additional patient satisfaction questionnaire was also given post-surgery. A significant, long-term, improvement in quality of life after orbital decompression was noted (p < 0.001, paired t-test). 50 patients were included and follow-up time was 5.3 ± 1.2 years (mean ± SD). The QOL-scores increased 28 ± 35 and 26 ± 31 points, respectively, on the two subscales, "visual functioning" and "appearance" (mean ± SD). The patient satisfaction questionnaire showed that 88% of the patients would recommend orbital decompression to a fellow patient. Persistent disturbing oscillopsia was seen in 2% and persistent disturbing infraorbital nerve hypoesthesia in 8% of the patients. Orbital decompression surgery has a positive effect on quality of life for patients with severe GO. The GO-QOL questionnaire showed significant improvement in QOL-scores even many years after surgery.

Malignant solitary fibrous tumour of the orbit.

PURPOSE: We aimed to report a case of orbital solitary fibrous tumour (SFT) in a child and to review the relevant literature. METHODS: We describe an SFT in a 13-year-old boy with a 1-month history of painless proptosis in the left eye. RESULTS: Magnetic resonance imaging revealed a well circumscribed mass filling most of the left intraconal orbit. The lesion was excised and histopathological examination revealed a malignant SFT. Postoperative follow-up for 18 months was uneventful. CONCLUSIONS: Malignant SFT of the orbit should be included in the differential diagnosis of paediatric orbital tumours. Complete surgical excision remains the preferred method of management and the longterm prognosis is guarded.

Treatment of idiopathic sclerosing inflammation of the orbit (myositis) with infliximab.

PURPOSE: We report the successful use of infliximab in a young patient with idiopathic sclerosing orbital inflammation (myositis). METHODS: We describe the patient's medical records and review the literature. RESULTS: Idiopathic myositis in this patient could not be satisfactorily treated with corticosteroids or chemotherapy. Biopsy showed sclerosing orbital inflammation. The patient had a prompt and sustained response with infliximab and methotrexate treatment. CONCLUSIONS: Infliximab and methotrexate might be considered in patients with idiopathic sclerosing orbital inflammation (myositis).

Eyelid botulinum toxin injections for the dry eye.

The injection of botulinum toxin into the medial lower eyelid causes a local paralysis of the orbicularis oculi muscle. The paralysis leads to a decreased action of the lacrimal pump and an improved lubrication of the ocular surface. The injection reduces the discomfort in eyes of patients with Sjögren's syndrome.

Lacrimal drainage capacity and symptomatic improvement after dacryocystorhinostomy in adults presenting with patent lacrimal drainage systems.

AIM. To determine the rate of symptomatic improvement after dacryocystorhinostomy (DCR) in patients with epiphora and insignificant obstruction to preoperative lacrimal syringing, and to measure the conductance of the postoperative lacrimal drainage anastomosis. METHODS. Retrospective cohort study of patients with symptomatic epiphora and patent tear ducts, with at least two-year follow-up after DCR. Patients underwent structured telephone interview together with clinical examination for lacrimal drainage capacity using the saline drop test.(1) RESULTS. Thirty-seven of 383 adult patients having had DCR were noted to have patent tear ducts at preoperative examination. Ten patients with previous surgery were excluded and two other patients were excluded because of other factors contributory to epiphora. Of the remaining 25 patients, 22 (aged 35-75 years at surgery; median 56 years) underwent a structured telephone interview: Of the 13 (60%) who felt that symptoms had improved, 9 (41%) were relieved of indoor epiphora and 11 (50%) thought the procedure was an overall success. Seventeen patients underwent clinical examination. The lacrimal drainage anastomosis was patent in all patients and the saline drop test result was well within the normal range in 3/4 patients who had persistent indoor epiphora. CONCLUSION. Of patients with epiphora due to minor nasolacrimal duct stenosis, open DCR produces a marked improvement or cure of symptoms in 50%. The lacrimal drainage capacity was well within the normal range in 3/4 patients with persistent postoperative lacrimal symptoms, suggesting that other factors (such as hypersecretion) may be significant in this group of patients with 'functional block'.

Lacrimal drainage capacity, age and blink rate.

PURPOSE: The aim of this study was to investigate the influence of blink rate on lacrimal drainage capacity in different age groups. METHODS: The drop test for lacrimal drainage capacity was recently described by us. In the drop test, drops of 10 &mgr;l, 15 &mgr;l or 20 &mgr;l of lukewarm saline are repeatedly instilled in the tear film during three minutes. Excessive saline solution is then removed and the volume drained by the lacrimal passages is calculated. The drop test was performed in 40 individuals of two age groups, 10-30 years and 60-80 years. The drop test results were recorded when the subjects tried to blink at frequencies of 90 and 180 blinks/three minutes. RESULTS: The drop test results were significantly higher in the young than in the old subjects. At the lower blink rate, the lacrimal drainage capacity was 363 &mgr;l/3 min. in the young and 155 &mgr;l/3 min. in the old subjects. At the higher blink rate, the lacrimal drainage capacity was 520 and 200 &mgr;l/3 min., respectively. The increases in lacrimal drainage capacity with increasing blink rate were significant in both age groups. CONCLUSION: The lacrimal drainage capacity increased with increasing blink rate in both younger and older subjects. The lacrimal drainage capacity was significantly lower in the old age group at each blink frequency, indicating that other factors than blink rate are responsible for the lower lacrimal drainage capacity in older age.