Chalazion-mimicked eyelid angiosarcoma in a young Asian with good prognosis: a case report.

BACKGROUND: Angiosarcoma is an extremely rare malignant tumor. So far, only about 42 cases of angiosarcoma involving the eyelids have been reported. Eyelid angiosarcoma occurs more frequently in elderly Caucasian males and is prone to misdiagnosis. We present a case report in a young Asian male patient with eyelid angiosarcoma that was misdiagnosed as a chalazion. CASE PRESENTATION: A 46-year-old South Korean male with no underlying disease had a right lower lid mass. The lesion was initially misdiagnosed as a chalazion at a local clinic, but a diagnosis of eyelid angiosarcoma was made after the first biopsy trial. PET-CT was performed to ensure that there was no metastasis in the whole body. Surgical excision with enough surgical margin was used alone for treatment and reconstruction was performed with a tarsoconjunctival advancement flap (modified Hughes procedure), which helped ensure good cosmesis. No recurrence was observed 4 years and 5 months after the surgery. CONCLUSIONS: The current study presents the first case of chalazion-mimicked eyelid angiosarcoma in a young Asian male aged under 50 years. This case shows that even if a benign eyelid disease is suspected in a young patient, an incisional biopsy must be performed to confirm whether the lesion is malignant. Since the prognosis is good for the case of eyelid angiosarcoma, if there is no clear evidence of distal metastasis, surgical resection should be performed with an enough safety margin.

Clinical Features and Outcomes of Patients with Orbital Schwannoma.

PURPOSE: To report the clinical features, treatment, and outcome of 11 patients with orbital schwannoma in Korean patients. METHODS: The medical records of 11 orbital schwannoma patients treated between April 2007 and April 2021 were retrospectively reviewed. The demographic data, clinical characteristics, radiological features, and outcomes were reviewed. RESULTS: The mean age at the time of diagnosis was 49.00 ± 14.45 years. The most common initial symptom was ocular protrusion (n = 7), and other symptoms were decreased visual acuity ( n = 5), restriction of eye movement ( n = 4), swelling ( n = 3), and pain ( n = 2). Locations of tumors were superomedial; followed by the orbital apex and inferolateral. The most common shape seen in our patients was beads like multilobulated appearance; followed by a round, oval, fusiform, and dumbbell shape. MRI of T1-weighted revealed isointense or hypointense, whereas the T2-weighted indicated hyper or isointense lesion. Five patients had optic neuropathy at presentation, and 1 of them showed improved vision after surgery. Complete or incomplete excision was performed for all. Surgical complications include decreased vision and paraesthesia. There has been no recurrence to date. CONCLUSIONS: Orbital schwannoma is a rare disease and it is difficult to distinguish it from other orbital tumors because the initial symptoms are nonspecific. Differential diagnosis by combining the shape, location, and contrast enhancement findings seen on computed tomography and magnetic resonance imaging can be helpful in surgical treatment. Complete excision gives the best results without recurrence, but if the patient is in an inaccessible location, only surgery to reduce the volume can satisfy the patient without recurrence.

Blepharoptosis among Korean adults: age-related prevalence and threshold age for evaluation.

BACKGROUND: To evaluate the prevalence of blepharoptosis among Korean adults and the characteristics of blepharoptosis patients, and to determine an appropriate age threshold for recommending blepharoptosis evaluation. METHODS: The Korean National Health and Nutrition Examination Survey (KNHANES-V) was conducted in 2010-2012. We extracted data on 17,878 Korean adults aged more than and equal to 19 years included in KNHANES-V, and determined blepharoptosis prevalence according to age, to determine the cutoff age for recommending blepharoptosis evaluation. We also determined the possible association between blepharoptosis and obesity parameters, such as body mass index (BMI) and waist circumference (WC). RESULTS: There was astrong association between older age and the prevalence of blepharoptosis. The cutoff age for recommending blepharoptosis evaluation was 63 years for males, 70 years for females, and 66 years for all patients. Patients with a high BMI and large WC had a higher prevalence of blepharoptosis in all age groups except for those aged over 80 years. The association of blepharoptosis with BMI according to age group showed that in the 50-59 and 60-69 years age groups, blepharoptosis prevalence and BMI were higher. However, in the 70-79 and 80-89 years age groups, extremely obese patients (BMI > 30) showed a decreased blepharoptosis prevalence. CONCLUSIONS: Moderate to severe blepharoptosis can result in poor visual function and exacerbate headaches and depression, leading to decreased quality of life. This study proposed an appropriate age threshold for recommending evaluation of patients with blepharoptosis among the general population of Korea.

Surgical Intervention of Periocular Infantile Hemangiomas in the Era of ß-Blockers.

PURPOSE: To examine the role of adjuvant surgical resection of infantile hemangiomas after systemic ß-blocker therapy. METHODS: This is a multicentered retrospective study. Standard protocol for oral propranolol was employed by the referring physicians. Ocular indications for surgery included ptosis obstructing the visual axis, high degrees of astigmatism causing amblyopia, or disfigurement from residual tumor. Patients underwent complete excision or debulking. RESULTS: Eleven girls and 4 boys were surgically treated with mean operative age of 34.4 months. Patients were followed for a mean of 19.6 months after surgery. Four patients required surgical treatment due to an inability to tolerate medical therapy secondary to drug-related side effects (including bradycardia). The other 11 patients proceeded to surgery due to residual eyelid and orbital lesions despite medical treatment. All 15 patients underwent orbitotomy for residual hemangioma excision. Four patients also underwent simultaneous levator advancement at the time of excision. In all cases, there was resolution of ptosis with clearing of the visual axis. No complications were incurred during the surgical treatment and there were no hemangioma recurrences. CONCLUSIONS: This is the first study to report surgical management of periocular infantile hemangiomas recalcitrant to standard therapy in the ß-blocker era. In patients with infantile hemangioma who have failed medical therapy, adjuvant surgical treatment still plays an important role. For patients with persistent tumor causing ocular sequelae, surgical intervention aimed at soft tissue debulking and ptosis repair can be successful in achieving excellent functional and aesthetic outcomes with minimal side effects.For patients with periocular infantile hemangiomas with residual soft tissue deformity following propranolol therapy, surgical treatment plays an important role in improving functional and cosmetic outcomes with minimal side effects.

Intricacies of Upper Blepharoplasty in Asian Burden Lids.

Differences between Oriental and Caucasian eyelids have been explained in great detail in several reports in the past. The purpose of this article is to discuss the functional aspects of Asian double fold upper blepharoplasty and to present techniques that help to improve both the functional and cosmetic outcomes and satisfaction after surgery. The eyes of Asians are relatively small with thick skin in the eyelids and periorbital area. They typically lack the upper eyelid crease (creating the so-called double eyelid) due to burden factors like thick skin, hypertrophied orbicularis oculi muscle (OOM), submuscular fibroadipose tissue, thick orbital septum, abundant preaponeurotic fat, and lower positioned transverse ligament. Asian eyes may also have a superior visual field defect due to skin overriding the upper lid margin (skin-OOM-fat complex slide down). These burden factors result in the eyelashes appearing short and becoming misdirected and pressed toward the globe, causing functional discomfort. As a compensatory mechanism, Asian people tend to engage the frontalis muscle to lift the eyebrow to help them open their eyes. Along with aesthetic enhancement, double-eyelid surgery in Asian burden lids can improve the functional deficiencies helping the patients to open the eyes more easily. In addition, treatment of the Mongolian fold (medial epicanthal fold), caused by medial hypertrophy of preseptal OOM, augments the surgical results. In this report, we present the appropriate preoperative assessment, surgical technique, and postoperative care that should be employed to achieve consistently good functional and aesthetic outcomes in these patients.

Complete Excision of a Simple Dacryops Using Fibrin Sealant and Trypan Blue Mixture.

A 69-year-old woman presented to the oculofacial plastic service with a painless superotemporal subconjunctival mass in the OS. Over the past year, the lesion had been progressively enlarging, resulting in horizontal diplopia with lateral gaze. Visual acuity was within normal limits with no evidence of optic neuropathy. On examination, the lesion was tense, transilluminated, and was clinically consistent with a simple dacryops. Complete excision of the lesion was planned under local anesthesia with monitored care. To facilitate complete removal of the lesion, fibrinogen and a mixture of thrombin and trypan blue were injected to fill the cyst cavity. This blue-stained fibrin clot allowed for easy visualization of the border and ensured complete excision without collateral damage to surrounding normal tissue. Simple dacryops is often difficult to remove completely with its capsule intact and this technique allows for clear delineation of the cyst and preservation of epithelial integrity for complete and efficient removal.

Surgical Feasibility of Curtler-Beard Reconstruction for Large Upper Eyelid Defect.

PURPOSE: To report long-term surgical outcomes of Cutler-Beard reconstructive surgery in patients with large full-thickness upper eyelid defects following malignant tumor excision. METHODS: The medical records of 5 consecutive patients with full-thickness upper eyelid defects following tumor resection who underwent Cutler-Beard surgery were reviewed retrospectively between April 2005 and November 2018. Surgical procedure comprises 2 stages: first, complete tumor resection followed by bridged full-thickness lower eyelid advancement flap; second, separation of the closed eyelid with eyelid margin repair 7 to 9 weeks later. Postoperative anatomical, functional and cosmetic outcomes, and complications were evaluated during follow-up at 22 to 77 months. RESULTS: Patients were in the age group of 49 to 75 years, including 3 (60%) females and 2 (40%) males. Three of the 5 patients (60%) exhibited sebaceous cell carcinoma and 2 (40%) showed squamous cell carcinoma. Three patients (60%) underwent Cutler-Beard surgery after recurrence of primary carcinoma following previous operation. Three patients underwent revision surgery with entropion, 2 underwent correction for wound dehiscence and 1 was treated with symblepharon lysis. No serious or permanent ocular complications were observed during the operation or follow-up with the patients. The procedure resulted in good aesthetic quality and acceptable sequelae at the donor site. CONCLUSIONS: Cutler-Beard procedure for the reconstruction of large and full-thickness upper eyelid defects is an effective procedure with satisfactory long-term results, although a few patients may require minor revision surgery.

Association between pterygium, sun exposure, and serum 25-hydroxyvitamin in a nationally representative sample of Korean adults.

PURPOSE: Ultraviolet-B (UVB) light exposure is the major risk factor for developing a pterygium, and serum 25-hydroxyvitamin D (25(OH)D) level is an objective measure of UVB light exposure. In this study, we investigated the association between pterygium, sun exposure, and serum 25(OH)D. METHODS: This population-based, cross-sectional study comprised 12,258 adults (aged ≥19 years) participating in the fifth annual Korea National Health and Nutrition Examination Survey from 2010 to 2012. The enrolled subjects underwent interviews, clinical examinations, and laboratory investigations. The serum 25(OH)D levels were measured, and pterygium was examined by using a slit lamp. We used three adjusted logistic regression models and selected covariates as potential confounders. RESULTS: The overall prevalence of pterygium was 7.09, and 53.1% of these subjects were women. The prevalence of pterygium was higher in elderly subjects and those who lived at low latitudes. In multivariate analysis with adjustment for confounding factors, subjects with a serum 25(OH)D level > 30 ng/mL, 25-30 ng/mL, and 15-20 ng/mL had an odds ratio (OR) (95% confidence interval [CI]) of 1.565 (1.035-2.366), 1.545 (1.086-2.198), 1.8 (1.358-2.386), and 1.535 (1.216-1.938), respectively, compared to those with a serum 25(OH)D level < 15 ng/mL. Subjects with a daily sun exposure > 5 h had an OR (95% CI) of 1.761 (1.395-2.223) compared to subjects with a daily sun exposure < 2 h. CONCLUSION: The present study provides epidemiological evidence of an association of daily sun exposure and serum 25(OH)D levels with pterygium in a representative Korean population.

CD34 + tumours of the orbit including solitary fibrous tumours: a six-case series.

BACKGROUND: To report six cases of CD34+ fibroblastic mesenchymal tumours, which are uncommon neoplasms in the orbit. CASE PRESENTATION: Six patients presenting with proptosis and palpable mass who were later diagnosed with fibrous solitary tumours, fibrous histocytoma or haemangiopericytoma in the orbit were included. All patients received radiologic examinations and surgical excision for histopathology and immunohistochemistry examinations. Five patients had no recurrence after a minimum follow-up of 12 months. One patient (case 6) experienced recurrence twice, and had debulking surgeries each time. At present, the patient still has remnant tumour in the orbit, but no growth has been detected during the past two years. The tumour size will be closely monitored. CONCLUSIONS: Even though fibroblastic tumours are rarely found in the orbit, they can present as a palpable mass with proptosis. Complete surgical excision is important for long-term prognosis, and immunohistochemical study is helpful for confirming pathologic diagnosis.

A cyclic vertical deviation with dysthyroid ophthalmopathy: a case report.

BACKGROUND: Cyclic strabismus is a very rare condition of ocular motility characterized by alternating strabismus and orthotropia. We report a patient with a 48-h cycle of vertical deviation associated with dysthyroid ophthalmopathy that spontaneously resolved. CASE PRESENTATION: A 40-year-old woman experienced sudden onset vertical double vision. She had already been diagnosed with hyperthyroidism. Asymmetric enlargement of the inferior and medial rectus muscles was demonstrated in her left eye on computed tomography, and was compatible with dysthyroid ophthalmopathy. She clearly described the "every-other-day" pattern of diplopia that spontaneously switched around 8 o'clock every night. She exhibited left hypotropia of 35 prism diopters on a bad day, and 7 prism diopters on a good day. CONCLUSIONS: This case illustrates that cyclic vertical deviation may spontaneously resolve along with the course of the underlying diseases that initiated the cyclic deviation, especially in patients with conditions involving motor component changes such as dysthyroid ophthalmopathy.

Refractive error characteristics in patients with congenital blepharoptosis before and after ptosis repair surgery.

BACKGROUND: We examined the effect of surgical repair on the pattern of refractive errors in Korean patients with congenital blepharoptosis. METHODS: We reviewed the clinical records of 54 patients with congenital blepharoptosis who attended our hospital from 2006 to 2012 and underwent a detailed refractive examination before and after ptosis repair surgery. Among them, 21 of the patients whose refractive data was available for both before and after the surgery were included in order to observe the effect of ptosis repair surgery on refractive error characteristics. The astigmatism groups were divided into three subgroups: with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism (OA). We also evaluated the severity of astigmatism. RESULTS: Before surgery, the ptotic eyes had more severe astigmatism and a greater percentage of OA than the fellow eyes. The changes in astigmatism magnitude before and after surgery were not significant, but the proportion of subjects with OA increased significantly. In ptotic eyes, amblyopia was found in 14 eyes (20.9 %). 3 eyes (4.5 %) were from solely occlusive visual stimulus deprivation due to severe ptosis, and 11 eyes were from refractive errors. Among refractive errors, amblyogenic astigmatism made up to the largest proportion of patients (8 patients, 11.9 %). CONCLUSIONS: Ptotic eyes had more severe astigmatism and more OA than fellow eyes. Amblyogenic astigmatism was more common in ptotic eyes. A change in astigmatism toward the OA axis was significantly detected after surgery, and that can be possible amblyogenic cause. Therefore, the correction of astigmatism before and after ptosis repair surgery is very important to prevent amblyopia.

Surgical Outcomes of Deep Superior Sulcus Augmentation Using Acellular Human Dermal Matrix in Anophthalmic or Phthisis Socket.

Patients with anophthalmic or phthisis socket suffer from cosmetic problems. To resolve those problems, the authors present the surgical outcomes of deep superior sulcus (DSS) augmentation using acellular dermal matrix in patients with anophthalmic or phthisis socket. The authors retrospectively reviewed anophthalmic or phthisis patients who underwent surgery for DSS augmentation using acellular dermal matrix. To evaluate surgical outcomes, the authors focused on 3 aspects: the possibility of wearing contact prosthesis, the degree of correction of the DSS, and any surgical complications. The degree of correction of DSS was classified as excellent: restoration of superior sulcus enough to remove sunken sulcus shadow; fair: gain of correction effect but sunken shadow remained; or fail: no effect of correction at all. Ten eyes of 10 patients were included. There was a mean 21.3 ±â€Š37.1-month period from evisceration or enucleation to the operation for DSS augmentation. All patients could wear contact prosthesis after the operation (100%). The degree of correction was excellent in 8 patients (80%) and fair in 2. Three of 10 (30%) showed complications: eyelid entropion, upper eyelid multiple creases, and spontaneous wound dehiscence followed by inflammation after stitch removal. Uneven skin surface and paresthesia in the forehead area of the affected eye may be observed after surgery. The overall surgical outcomes were favorable, showing an excellent degree of correction of DSS and low surgical complication rates. This procedure is effective for patients who have DSS in the absence or atrophy of the eyeball.

Suggestion of response evaluation criteria in patients with ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML).

Ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML) has been recognized as most common primary orbital malignancy. However, little was known about the response criteria for OAML. Our aim was to suggest response criteria for nonconjunctival OAML; the response evaluation of which using the conventional response criteria is inappropriate. A retrospective chart review of 34 eyes from 30 patients diagnosed with nonconjunctival OAML was conducted, focusing on the change in tumor size based on linear bi-dimensional and three-dimensional methods in magnetic resonance imaging (MRI) of the orbit. The maximum tumor response period of each case was investigated, and the expected optimal response period was calculated using regression analysis. In 30 evaluable patients, the median time taken for the maximum tumor response was 6 months (range, 3-18). More than 75 % of patients attained maximal tumor response in 6 months after initial therapy for follow-up period, the median value of which was 30 months (range, 15-77). Based on the regression analysis, it took 4.7 months for the maximum diameter (2r) of tumor to decrease by 50 % of initial lesion size. We cautiously suggest that optimal response could be defined as 50 % reduction of the maximum diameter in 6 months since the treatment was initiated, and that only observation without additional therapy is enough for nonconjunctival OAML, if optimal response is achieved.

A patient with combined corneal and ingrowing conjunctival tissue tattooing by micropigmentation method.

PURPOSE: This report describes the clinical efficacy of combined corneal and conjunctival micropigment tattooing for the treatment of a corneoconjunctival opacity. CASE SUMMARY: Combined corneal and conjunctival micropigment tattooing was performed on a 39-year-old man who had a cosmetic problem due to traumatic corneoconjunctival opacity. After removal of the corneal epithelium, a 30-gauge needle filled with dye was placed into the corneal stroma. The dye was injected into the stroma and conjunctiva. The patient was followed up for 24 months postoperatively. Although some of the dye dissipated, the majority of it remained in place 24 months after surgery. The patient had no specific postoperative complications and was satisfied with the surgical results. We obtained cosmetically good results. CONCLUSIONS: Combined corneal and conjunctival micropigment tattooing can be an effective treatment for patients with a corneoconjunctival opacity.

Current status of contact lenses usage in Korea: A population-based cohort study 2021.

PURPOSE: To investigate trends in contact lens usage in a nationally representative sample of the Korean population in 2021. METHODS: For this retrospective study, we analyzed data of 3,601 Korean participants aged 10-59 years, from the Korea National Health and Nutrition Examination Survey (KNHANES 2021 version), who underwent eye examination, of whom 1,136 individuals (274 men and 862 women) were contact lens users. The demographic trend among Korean contact lens wearers was examined using statistical analyses to investigate the changes in their contact lens-wearing experience, duration of lens use, type of lens used, location of purchase, presence of an Eye Care Practitioner(ECP)'s prescription, lens-related ophthalmic complications, and type of lenses worn at the time of complications, according to sex. Multivariable logistic regression analysis was conducted to examine the association of each variable with the rate of complications and use of soft lenses. RESULTS: The average age of the contact lens users was 33.42±0.33 years, with 70.36% (weighted percentage) of users being women who used contact lenses for significantly longer periods than men (p<0.001). Additionally, only wearing of cosmetic lenses was significantly correlated with the occurrence of complications (p = 0.006), and 6.76% of users purchased lenses without a prescription. Multivariate analysis among the contact lens users revealed a significant relationship between the complication rate and female sex (p = 0.002), pre-existing eye disease diagnosed by ECPs (p = 0.0288), and duration of contact lens use (p<0.0001). CONCLUSION: We identified sex differences in contact lens usage trends in Korea. The main changes observed were an increase in middle-aged lens users and a decrease in female users compared to that in the early 2000s. In addition, contact lens complications were significantly associated with sex and pre-existing eye disease. Therefore, those wearing contact lenses for extended periods should exercise caution and consult eye care specialists in the presence of any symptoms.

Surgical outcomes of acellular human dermal grafts for large conjunctiva defects in orbital implant insertion.

PURPOSE: We report the surgical outcomes of acellular human dermal allografts for repair of large conjunctiva defects in primary or secondary orbital implant insertion. METHODS: This retrospective chart review examined 12 eyes in 12 patients who underwent primary or secondary orbital implant insertion using Medpor® and acellular human dermal allografts to decrease conjunctival tension. Only patients with at least 6 months follow-up were included. The procedure was successful if there was no exposure until the last eye-clinic visit and the patient could wear a prosthesis. It failed if additional surgery was needed to correct the orbital implant exposure. RESULTS: The mean follow-up was 24.5 (range 6-54) months. Seven patients had primary orbital implant insertion, and five had secondary orbital implant insertion with acellular human dermal allografts. All enrolled patients had successful outcomes without exposure of the central conjunctiva. Two underwent additional surgery to correct fornix contracture and regain a cosmetically good prosthesis. Of these, one patient received additional acellular human dermal grafts and had a fair outcome. The other patient ultimately required fornix reconstruction with an autologous graft using oral mucosa. CONCLUSION: Orbital implant insertion with acellular human dermis grafts had good surgical outcomes. The procedure could be effective for patients with insufficient conjunctival tissue to cover an orbital implant and a high probability of developing orbital implant exposure if tension was created by excessive direct conjunctival closure.

Eyelid-associated complications after autogenous fat injection for cosmetic forehead augmentation.

BACKGROUND: We report two cases of unilateral upper eyelid swelling with multiple small lumps as an unusual complication of autogenous fat injection for cosmetic forehead augmentation. CASE PRESENTATION: Two female patients were referred to our clinic for unusual unilateral eyelid swelling, with multiple small lumps. The duration of symptoms differed in each case, but both patients had a history of autogenous fat injection for cosmetic forehead augmentation at a local plastic surgery clinic. The lumps were small (diameter 5 mm~10 mm), palpable, hard, and nonmobile, and were evaluated by magnetic resonance imaging (MRI). Lumps from the eyelids of two patients were excised under general anesthesia. All of the masses were located deeply and found near the superior orbital rim or lateral orbital rim. The lumps exhibited chronic inflammation with fibrosis. Some of the lumps showed foamy histiocytic aggregation and foreign body lipogranuloma, resulting from iatrogenic fat injection. After excision, all masses and swelling disappeared, and moderate ptotic eyelid or lagophthalmos of affected eyes also improved. CONCLUSIONS: To our knowledge, eyelid swelling with multiple lumps in the eyelid is a very rare complication of autogenous fat injection for cosmetic forehead augmentation. This report should be helpful for ophthalmic clinicians who encounter these unusual symptoms.

Comparison of endoscopic revision for failed primary external versus endoscopic dacryocystorhinostomy.

BACKGROUND: To compare differences in endoscopic revision after previously failed lacrimal surgery that involved either external or endoscopic dacryocystorhinostomy. DESIGN: Retrospective, comparative, nonrandomized clinical study. PARTICIPANTS: We assessed 77 patients (82 surgeries) treated for recurrent nasolacrimal duct obstruction. METHODS: Electronic medical records for patients with recurrent epiphora who underwent endoscopic revisional dacryocystorhinostomy, after previous external or endoscopic dacryocystorhinostomy at Seoul St. Mary's Hospital from 2004 to 2010, were reviewed. MAIN OUTCOME MEASURES: Data regarding the lacrimal drainage system, comprehensive eye examination, surgical outcome and preoperative/perioperative transnasal endoscopy were analysed. RESULTS: In total, 77 patients underwent 82 endoscopic revisional dacryocystorhinostomy procedures. A success rate of 84% was achieved for cases of previous external dacryocystorhinostomy and 80.7% for previous endoscopic dacryocystorhinostomy (P = 0.722). For preoperative nasal endoscopy, more of the patients who underwent previous external dacryocystorhinostomy exhibited a hypertrophic middle turbinate and severe septal deviation when compared with patients who underwent previous endoscopic dacryocystorhinostomy (P = 0.031, P = 0.001, respectively). For perioperative nasal endoscopy, more of the patients who underwent previous endoscopic DCR exhibited a smaller ostium when compared with patients who underwent previous external dacryocystorhinostomy (P = 0.031). CONCLUSIONS: The success rate of revisional dacryocystorhinostomy in the previous external dacryocystorhinostomy group was slightly higher than that in the previous endoscopic dacryocystorhinostomy group. Differences in preoperative and perioperative endoscopic findings were detected between the groups. Clarifying these differences in endoscopic revision will help improve the surgical outcomes of primary surgery involving either external or endoscopic dacryocystorhinostomy.

DIY guide-needle-assisted conjunctivodacryocystorhinostomy (CDCR).

In this study, we introduce DIY guide-needle-assisted conjunctivodacryocystorhinostomy (CDCR), in which a guide needle helps in measuring the initial Jones tube length for insertion and reduces unnecessary handling for tube changes. Three CDCR procedures were conducted in which the length of the Jones tube was calculated using a 22-gauge DIY guide needle, and a prospective study of tube position change and migration, (a major cause of CDCR failure) was done. Wound healing was almost complete within 4 weeks postoperatively in the osteotomy site, but in cases of partial middle turbinectomy, a little more time was necessary. There was a slight change in Jones tube position in the nasal cavity compared with the expected position of original tube tip, but no tube migration from the caruncle fixation position had occurred by the final follow-up time. This guide-needle-assisted CDCR has multiple advantages, such as easy measurement of the proper initial tube size, utilization of the initial needle path, and easy replacement of tubes. Finally, this approach to CDCR can be readily applied because it uses materials ordinarily found in hospitals to create the devices needed for the procedure, so there is no additional cost.