Long-term Follow-up Results of Primary Canaliculitis Patients.

Objectives: To evaluate the demographic characteristics, clinical presentation, microbiologic profile, and treatment results of patients with primary canaliculitis. Materials and Methods: Patients diagnosed and treated for primary canaliculitis between May 2014 and May 2021 were analyzed retrospectively. Results: There were 26 patients with primary canaliculitis, including 17 females (65.4%) and 9 males (34.6%) with a mean age of 50.6±16.4 years (range: 9-80 years). Canaliculitis affected the right eye in 11 patients, the left eye in 13 patients, and bilateral involvement was seen in 2 patients. Inferior canaliculus involvement was more frequent (73%). The most common complaint was epiphora (46.1%). Five patients (19.2%) were wrongly diagnosed as chronic conjunctivitis. The time interval between the beginning of symptoms and canaliculitis diagnosis was 18.2±14.3 months (range: 1-60 months). Canaliculotomy and curettage of canalicular content with dacryolith removal were performed in 23 patients. After surgery, antibiotic irrigation of the canaliculus was added to the treatment regimen in 12 of these 23 patients. Intracanalicular antibiotic therapy was administered to the remaining 3 patients. The most cultured organism was Actinomyces (6 patients). Gemella (1 patient), Porphyromonas (1 patient), Candida parapsilosis (1 patient), Citrobacter koseri (1 patient) were also grown in culture. The follow-up time of patients was 26.2±23.7 months (range: 6-83 months). All symptoms and findings resolved in all patients in one month. In two patients, recurrence occurred at 4 and 16 months after surgical treatment. With appropriate treatment, no further recurrence was seen in either patient over 24-month follow-up. One patient presented with iatrogenic canaliculus blockage during follow-up. Conclusion: Primary canaliculitis is often overlooked and can be misdiagnosed. The most common symptom was epiphora. All patients with epiphora and chronic conjunctivitis should be examined carefully for canaliculitis.

The influence of microorganisms on early relapses after external dacryocystorhinostomy.

PURPOSE: Understanding the influence of microorganisms in patients with acquired nasolacrimal duct obstruction (NLDO) and investigating their effect on recurrence after external dacryocystorhinostomy (DCR). METHODS: This prospective study included 50 patients. Evaluations were made before, on the first postoperative day and monthly after DCR. Nasolacrimal silicon tubes (NST) were removed after three months. Before the DCR, swab samples were taken from both hands and lower conjunctival fornices and from the lacrimal sac during the first DCR and from the relapsed cases during the second DCR. RESULTS: Growth was observed in 90 (45%) cultures out of 200 and a total of 23 different strains were identified altogether. Staphylococcus aureus (40%) and Streptococcus pneumoniae (28%) were dominantly isolated which were all resistant to penicillin, tetracycline and erythromycin. Lacrimal syringing (LS) was successful in patients (100%) on the first postoperative day. After three months, before NST removal, purulent discharge from the punctum was observed in five patients, and blockage was detected by LS. S. pneumoniae was isolated from all five patients' obstructed side conjunctival cultures. Additionally, from their lacrimal sac, S. pneumoniae (4 patients), Capnocytophaga gingivalis, and Candida spp. (1 patient) strains were isolated. S pneumoniae was isolated in four out of five patients from the ipsilateral conjunctival and lacrimal sac cultures which obtained from the subsequent DCR. CONCLUSION: Our results showed that S. pneumoniae was an isolated and persistent strain in cases with early recurrence even after a successful DCR.

Factors Affecting the Incidence of Ptosis after Trabeculectomy.

Objectives: The aim of this study was to investigate the incidence of postoperative ptosis after primary trabeculectomy and the possible factors contributing to ptosis. Materials and Methods: A total of 312 patients (339 eyes) who underwent trabeculectomy with mitomycin-C between 2015 and 2020 were retrospectively evaluated. Patients who had regular follow-up for at least 6 months and no history of ptosis or ptosis surgery were included. Age, sex, glaucoma type, preoperative and postoperative intraocular pressure, preoperative and postoperative antiglaucoma medications, number of antiglaucoma drops, duration of antiglaucoma medication use, history of eye itching due to antiglaucoma medication-associated allergy, duration of follow-up, postoperative needling, needling time, and ocular massage were recorded. Ptosis was defined as ≥2 mm reduction in margin-reflex distance 1 from preoperative levels. Ptosis that had not improved for at least 6 months was considered persistent ptosis. Multivariate logistic regression was used to determine potential predictors of ptosis development. Results: Ptosis after trabeculectomy was observed in 35 of 339 eyes (10.3%). Thirty eyes of 30 patients (8.8%) had transient ptosis and 5 eyes of 4 patients (1.5%) had persistent ptosis. Preoperative duration of antiglaucoma medication use, drug(s) used (prostaglandin analogs, beta-blockers, alpha-2 agonists, carbonic anhydrase inhibitors, or combinations of these), needling time, and ocular massage after trabeculectomy did not differ significantly between groups (p>0.05). Needling and eye itching due to antiglaucoma medication-associated allergy were significantly higher in patients with ptosis (p<0.05). Conclusion: Ptosis after trabeculectomy is an important problem for glaucoma patients. It has been observed that needling and a history of eye itching due to antiglaucoma drug-associated allergy may increase the risk of ptosis.

Unilateral Ciliary Madarosis in a Child After Coronavirus Disease 2019 (COVID-19) Infection.

Coronavirus disease 2019 life-threatening signs have aroused a great deal of attention since the beginning of the pandemic. In the initial stages of the pandemic, the pediatric population was mostly protected, and the symptoms in affected children were mild. Here, the authors present a 7-year-old boy with left upper eyelid ciliary madarosis that developed 9 weeks after coronavirus disease 2019 infection. During comprehensive ophthalmologic examination, no conjunctival injection, chemosis, erythema, or crusts on the eyelids and no other meibomian gland disease findings were detected. Comprehensive laboratory workup was performed to exclude any other possible causes of ciliary madarosis. All laboratory parameters tested within normal limits. In addition to the patient's ocular surface and physical examination findings, laboratory results and the timing of the symptoms as well as spontaneous recovery at follow-up visits led the authors to conclude that telogen effluvium was to cause of the isolated, unilateral ciliary madarosis in this case.

Comparison of the two techniques for involutional lower eyelid entropion: A retrospective study.

Evaluation of the surgical outcome and the patient satisfaction between the modified Wies technique and the Jones retractor plication technique for involutional lower eyelid entropion without horizontal eyelid laxity. Patients who underwent the modified Wies technique (group 1) and the Jones retractor plication technique (group 2) for correction of involutional lower eyelid entropion without horizontal eyelid laxity between January 2014 and January 2020 were retrospectively reviewed. Patients with horizontal eyelid laxity; cicatricial, congenital or iatrogenic entropion; and less than 6 months of follow-up time were excluded. The main outcome measures were the recurrence rate, correct anatomical position of the eyelid, symptom relief, and postoperative complications for both groups. 37 patients (41 eyes) in Group 1 and 34 patients (34 eyes) in Group 2 were enrolled in the study. Mean age ± SD was 75.6 ± 8.5 years in Group 1 and 73.4 ± 7.9 years in Group 2 (p:0.255). The mean follow-up time (range) was 24.3 (6-80) months in group 1 and 25.3 (6-78) months in group 2 (p:0.818). Two patients in Group 1 and seven patients in Group 2 had a recurrence during the follow-up period (p:0.07). Based on the results of the study, it seems that the modified Wies technique may be a good alternative in suitable patients, as it has satisfactory surgical results.