Lacrimal Gland Changes on Orbital Imaging after Glaucoma Drainage Implant Surgery.

PURPOSE: This study evaluates the radiographic appearance of lacrimal gland tissue after placement of a glaucoma drainage implant (GDI) to characterize the impact of the device on the gland's imaging patterns. METHODS: We performed retrospective chart review of departmental records at two urban academic medical centers, which were systematically searched using procedure codes to identify adult glaucoma patients who underwent unilateral superotemporal GDI from January 1995 to December 2015. Radiology records were cross-checked to identify the subset of patients who underwent postoperative orbital CT or MRI. Chart review collected data on glaucoma diagnosis, management, examination findings, and clinical complaints. Imaging studies were reviewed for orbital changes using qualitative assessment of the radiographic appearances and computer-guided calculations to quantify asymmetries. RESULTS: A review of all eye operations in the inclusion period identified 315 patients with GDI, 13 of whom were eligible for inclusion. Elapsed time from device placement to imaging averaged 41.9 months, and the average clinical follow-up was 56.4 months. Radiographic lacrimal gland changes were appreciable in 69% (9 of 13) of patients, most commonly with posterior displacement and flattening of the gland (7 of 13). ImageJ analysis revealed significantly smaller lacrimal glands in orbits with GDI (P = 0.04). No clear correlation was found between gland changes and clinical dry eye symptoms. CONCLUSION: GDI placement was associated with radiographically-appreciable lacrimal gland changes in two-thirds of patients, with changes occurring in a predictable pattern of lacrimal gland flattening, posteriorization, and volume loss. Radiographic changes correlated with clinical symptoms in few patients.

Ocular injuries from fireworks: the 11-year experience of a US level I trauma center.

PurposeCharacterize ocular trauma and visual outcomes from firework injuries at a level I trauma center.MethodsRetrospective review of all firework injuries at Harborview Medical Center between 2003 and 2013.ResultsThree hundred and twenty-seven patients sustained firework injuries, of which 100 (31%) sustained ocular injuries. The average age of all patients who sustained fireworks injuries was 24.2 years, 89% were male and 54% of injuries occurred within 48 h of 4 July. Ocular injuries were most commonly caused by mortars (24%) and rockets (22%). Rockets were associated with four times the frequency of ocular injuries as compared with non-ocular injuries (P<0.001). Spectators were more likely to sustain ocular injuries than non-ocular injuries (P=0.001). The most common injuries sustained were corneal abrasions (67%), hyphemas (42%), eyelid injuries (39%), and ruptured globes (17%). Twenty-eight percent of patients with ocular injuries required surgical intervention. Ruptured globes occurred in 17% of patients, with the majority being complex corneoscleral lacerations. Fifty-eight percent of patients who sustained ruptured globes were left with no light perception in the affected eye. Average follow-up was 188 days. Average visual acuity significantly improved from logMAR 1.8±1.6 at presentation to logMAR 1.3±1.8 at last follow-up.ConclusionsFirework-related ocular trauma frequently results in vision-threatening pathology. Prompt referral to and treatment by ophthalmologists is critical. This study documents the dangers inherent in the personal use of fireworks and provides data that may help guide public policy to decrease the frequency of these devastating injuries.

Effect of autologous fat injection on lower eyelid position.

PURPOSE: To evaluate the effect of autologous periorbital fat injections on lower eyelid position. METHODS: Retrospective review of patients treated with autologous periorbital (malar/eyelid tear trough) fat injections for aesthetic purposes by a single surgeon (S.N.) between March 2007 and June 2011. The primary outcome, lower eyelid position as defined by marginal reflex distance 2 and inferior scleral show, was measured by standardizing and comparing pretreatment and posttreatment follow-up digital photos. Photographs were randomized and measured by 2 masked investigators. RESULTS: Seventy patients (5 male; mean age, 53; range, 33 to 77 years) were treated with autologous fat injections to the malar and lower eyelid tear trough for aesthetic purposes. A mean decrease in marginal reflex distance 2 of 0.5 mm in both OS and OD was found when pre- and posttreatment measurements were compared. Primary and secondary mean follow-up period was at 117 and 316 days, respectively. The effect of the autologous periorbital fat injection was not diminished (n=21) between follow-up periods. A mean change in scleral show of 0.5 mm was found when pre- and posttreatment measurements were compared. The overall mean follow-up period for scleral show was 125 days. Minor complications occurred in 7% (n=5) of patients who had postinjection subcutaneous induration. CONCLUSION: Autologous fat injections are well tolerated and have potential to be an effective adjuvant or primary treatment for mild lower eyelid retraction.