Measurement of the Area of Corneal Exposure Using Digital Image and Its Application During Assessment for Blepharoplasty.

BACKGROUND: The normal morphological and functional values of orbits vary according to race, sex, and age. We measured the palpebral fissure using the marginal reflex distance (MRD1), marginal limbal distance (MLD), and vertical height of the palpebral fissure (VHPF). Unfortunately, these measurements are all one-dimensional figures that measure the distance between two points; they have limitations when it comes to measuring the three-dimensional ocular surface. Therefore, this study used the area of corneal exposure (ACE), which shows a two-dimensional area, to measure changes between the sizes of eyes according to age. MATERIALS AND METHODS: This study was conducted using preoperative photographs of Koreans in Daegu city, Korea, who underwent plastic surgery in our department except for eyelid surgery. We divided the subjects into eight groups, including ten males and ten females in each decade of age, from age 10 to over 80 years. A total of 160 people were recruited who were followed up for photograph analysis using Adobe Photoshop 7.0 software. RESULTS: In terms of the mean value, the ACEs were 73.3 ± 2% in male subjects and 77.1 ± 2% in female subjects, and values for female subjects were greater than those for male subjects (p < 0.05). Significant differences in ACEs were observed according to age. The peak level of growth in the ACE was reached between 20 and 29 years of age. After the 20 s, a gradual decrease was observed (p < 0.05). CONCLUSION: The peak level of growth in the ACE was reached between 20 and 29 years of age. The growth pattern can be classified as continuously decreasing after reaching the peak level. The data from this study are significant in that they can be used as comprehensive data for normal eyelid values according to age. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Combination of 0.05% Azelastine and 0.1% Tacrolimus Eye Drops in Children With Vernal Keratoconjunctivitis: A Prospective Study.

Aims: To compare the efficacy of the combination of 0. 05% azelastine and 0.1% tacrolimus eye drops with 0.1% tacrolimus monotherapy in pediatric patients with vernal keratoconjunctivitis (VKC). Methods: Prospective study. Seventy-six patients with VKC were randomized 1:1 into monotherapy group with 0.1% tacrolimus or combination therapy group with 0.1% tacrolimus and 0.05% azelastine. The Ocular Surface Disease Index (OSDI) scores and the signs of conjunctival hyperemia, corneal involvement, and palpebral conjunctiva papillae were assessed at baseline and at 1, 2, and 6 weeks after treatment. Results: Two groups were comparable in age, sex, duration of VKC, OSDI, and clinical signs of VKC at baseline. Significant improvements in OSDI score and clinical signs were observed in both groups at all follow-up visits (all p < 0.001), compared with baseline. The combination therapy group showed a larger decrease in OSDI score from baseline (10.30 ± 0.9) compared with monotherapy group (7.30 ± 0.7, p =0.0085) at 1 week. Greater improvements in conjunctival hyperemia and conjunctival papillae were identified in the combination therapy group, compared with in the monotherapy group, at all follow-up visits (all p < 0.05). The corneal involvement scores in the combination group is significantly lower than the monotherapy group at 2 weeks after the treatment (p = 0.0488). No severe adverse effect was found in either group during the study. Conclusions: Compared with a monotherapy of 0.1% tacrolimus, the combination of 0.05% azelastine and 0.1% tacrolimus eye drops lead to faster and greater improvements in clinical signs and symptoms of vernal keratoconjunctivitis in pediatric patients.

The Associations of Conjunctival Vasculature and Serum Hemoglobin in the Moderate Anemia

PURPOSE: This study was conducted to determine the correlation of anemia and conjunctival vasculature on slit lamp biomicroscopy. METHODS: Through random sampling, 118 subjects who were either inpatients or outpatients in the hematology department were selected for examination. Palpebral conjunctival hue (PCH) and bulbar conjunctival blood column (BCBC) were observed by a single physician to whom the diagnosis and hemoglobin level of the patient were strictly masked. Three different threshold levels were defined for anemia : <10 mg/dl, <11 mg/dl, and <12 mg/dl. RESULTS: Mean hemoglobin concentration was 10.39+/-2.9 mg/dl. Sensitivity of the BCBC and PCH for anemia was 86% and 41%, respectively. Specificity of BCBC improved with increasing hemoglobin threshold level for anemia. BCBC was significantly associated only with anemia of hemoglobin <12 mg/dl (p<0.02). PCH was significantly associated only with anemia of <11 mg/dl (p<0.05). BCBC showed a significant association with anemia: sensitivity was higher and specificity was slightly less than PCH. CONCLUSIONS: It was not easy to detect moderate anemia solely on slit lamp biomicroscopic findings unless hemoglobin concentration was given. In conclusion, BCBC was useful in detecting moderate anemia than PCH.