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Speciality Spotlight
Oculoplastic
Surgery
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K Tsubota, Y Monden, Y Yagi et al (Tokyo Dental College, Chiba, Japan; Keio Univ, Tokyo; Kurume Univ, Japan)
New Treatment of Dry Eye: The Effect of Calcium Ointment Through Eyelid Skin Delivery.
Br J Ophthalmol 83: 767-770, 1999
Petrolatum applied to the lower-lid skin is an effective way of delivering slow releasing drugs to the ocular surface. Petrolatum based calcium ointment significantly improved symptoms, tear dynamics and ocular staining in patients with dry eye. Some of the benefits may be the result of lipids in the petrolatum vehicle.
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Afonso AA, Monroy D, Stern ME. Et al (Univ of Miami, Fla; Allergan Inc, Irvine, Calif)
Correlation of Tear Fluorescein Clearance and Schirmer Test Scores with Ocular Irritation Symptoms
Ophthalmology 106: 803-810, 1999
No single test has been found to be universally abnormal in patients with complaints of eye irritation. Fluorescein clearance test (FCT) and Schirmer 1 test results were compared and correlated with severity of ocular irritation symptoms, clinical signs of meibomian gland disease, corneal fluorescein staining scores, and sensitivity of the cornea and conjunctiva.
The FCT had greater predictive value than the Schirmer 1 test for determining ocular irritation. It correlated better with age, meibomian dysfunction, and reduced corneal and conjunctival sensation.
Reduced tear clearance was identified as a risk factor for ocular irritation, even in subjects with normal Schirmer scores.
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Lucarelli MJ, Lemke BN (Univ of Wisconsin – Madison; Davis Duehr Dean Clinic, Madison, Wis)
Small Incision External Levator Repair: Technique and Early Results.
Am J Ophthalmol 127: 637-644, 1999
A new surgical technique and early results of small incision external levator repair of aponeurogenic blepharoptosis are described. Patients with unilateral or bilateral aponeurogenic blepharoptosis were chosen for external levator repair through an 8mm skin incision.
Patients with horizontal upper lid laxity, those who needed blepharoplasty, and patients with previous eyelid surgery or concurrent brow surgery were excluded.
Surgery was carried out on 28 eyelids of 17patients. There were no significant intraoperative complications.
Satisfactory lid position was observed in 25 of 28 lids. No patients requested reoperation.
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Nasr AM, Haik BG, Fleming JC, et al (King Khaled Eye Specialist Hosp, Riyadh Saudi Arabia; Univ of Tennessee, Memphis, Tulane Univ, New Orleans, La)
Penetrating Orbital Injury with Organic Foreign Bodies
Ophthalmology 106: 523-532, 1999
Penetrating orbitocranial injuries have a higher mortality rate than other types of head trauma. With the exception of copper, most metallic foreign bodies and glass particles are well tolerated.
Organic foreign bodies may cause inflammatory reactions progressing to fungal cellulitis, abscess and death. This retrospective study describes the clinical features, diagnostic workup and management of nineteen patients with penetrating injuries and retained organic foreign bodies. Foreign bodies were detected by CT in 42% of patients and by MRI in 57%.
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De Quan Li, Sao-Bing Lee, et al (Dept. of Ophth, Bascom Palmer Eye Inst. and Depts of Medicine and Cell Biology & Anatomy, Univ of Miami School of Medicine)
Overexpression of Collagenase (MMP-1) and Stromelysin (MMP-3) by Pterygium Head Fibroblasts.
Arch Ophthalmol, vol.119, Jan.2001, pg.71-80
The balance between matrix metalloproteinase (MMPS) and the tissue inhibitors of metalloproteinases (TIMPS) determines the extent of degradation and remodelling of connective tissue.
Pterygium head fibroblasts express increased mRNA, protein and activities of MMP-1 and MMP-3.
The authors conclude that the over expression of MMP-1 and MMP-3, (previously linked with UV exposure in dermal fibroblasts, explaining the pathologic finding of elastotic degeneration), may lead to alteration of pterygium head fibroblasts by UV light. This is in turn might be responsible for corneal invasion.
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Stevenson D, and The Cyclosporin A Phase 2 Study Group (Mercy Hosp Professional Bldg, New Orleans, La; et al)
Efficacy and Safety of Cyclosporin A Ophthalmic Emulsion in the Treatment of Moderate-to-Severe Dry Eye Disease: A Dose-Ranging, Randomized Trial.
Ophthalmology 107: 967-974, 2000
Recent, population-based surveys have reported millions of people throughout the world affected by Kerato Conjunctivitis Sicca (KCS) or dry eye disease. As many as 17 to 25% of patients report symptoms of KCS.
Patients with uncontrolled KCS are more susceptible to endophthalmitis resulting from ocular infections. Chronic KCS results from an underlying cytokine and receptor mediated inflammatory process, which affects the lacrimal gland acini and ducts.
This leads to abnormalities in the tear film and disruption of the homeostasis of the ocular surface.
Topical treatment with cyclosporin A (0.05 to 0.1%) has been shown to reduce cell-mediated inflammatory responses in inflammatory ocular surface diseases.
In a study of 162 patients, 129 patients received cyclosporin A emulsion in various concentrations ranging from 0.05 to 0.4%, while 33 patients received vehicle only. A post treatment observation period of 4 weeks revealed that cyclosporin A emulsions were safe and effective (maximally 0.05 and 0.1%) in improving ocular manifestations of KCS.
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Varyd SJ, Rose GE (Moorfields Eye Hosp, London)
Prevention of Cellulitis After Open Lacrimal Surgery: A Prospective Study of Three Models.
Ophthalmology 107: 315-317, 2000
Two hundred sixty-five patients requiring open dacryocystorhinostomy (DCR) were enrolled in a prospective, nonrandomized study for a 16-month period. They were divided into 3 groups.
(1) Administration of IV broad-spectrum antibiotic treatment immediately after induction of anesthesia.
(2) Intraoperative lavage of the rhinostomy site immediately after suture of the anterior mucosal flaps.
(3) Post-operative course of oral antibiotic therapy.
It was found that intraoperative antibiotic treatment (group 1) and post-operative broad-spectrum antibiotic (group 3) were equally effective in preventing post-operative soft-tissue cellulitis (compared with group 2).
The advantages of administering antibiotic therapy intraoperatively are compliance and cost-efficiency.
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Sahlin S, Chen E, Kaugesaar T, et al (St. Erik’s Eye Hosp, Stockholm; Univ Hosp of Linkoping, Sweden)
Effect of Eyelid Botulinum Toxin Injection on Lacrimal Drainage
Am J Ophthalmol 129: 481-486, 2000
Botulinum toxin A, 3.75 IU, was injected into the medial part of 13 lower eyelids in 13 healthy subjects and into the medial part of 9 lower eyelids in 9 patients with dry eyes.
The authors conclude that botulinum toxin injected into the medial part of the eyelid reduces lacrimal drainage, suggesting a new way of treatment of dry eye. Further research is advocated to determine the clinical value of this approach.
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Kubis KC, Danesh-Meyer HV, et al (Thomas Jefferson Med College, Philadelphia; Univ of Auckland, New Zealand)
The Ice Test Versus the Rest Test in Myasthenia Gravis
Ophthalmology107: 1995-1998, 2000
The ice test is one among several diagnostic tests to establish myasthenia gravis (MG) as the cause of ptosis.
In previous reports, only qualitative descriptions of the ice test results were provided. This prospective study was conducted to quantify the effect of the ice test in patients with myasthenic and non-myasthenic ptosis and to compare the ice test with the rest test.
The effect of ice was compared with that of rest by the application of a surgical glove filled with ice or with cotton, respectively. Improvement in lid elevation in mm. after application of the glove was recorded.
The median improvement of ptosis in patients with MG was 2 mm with the rest test and 4.5 mm with the ice test. There was no improvement in ptosis in patients without MG in either test.
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Esmaeli B, Ginsberg L, et al (MD Anderson Cancer Ctr, Houston)
Squamous Cell Carcinoma With Perineural Invasion Presenting as a Tolosa-Hunt-Like Syndrome: A Potential Pitfall in Diagnosis
Ophthal Plast Reconstr Surg 16: 450-452, 2000
Perineural invasion occurs in 2% to 14% of patients with squamous cell carcinoma (S.C.C) of the facial skin, typically involving Vth and VIIth cranial nerves.
The authors present a case report of a 51-year male who presented as a Tolosa-Hunt-like syndrome. Definitive radiological evidence of perineural invasion was lacking initially.
The patient presented with a 2-month history of binocular vertical diplopia (diagnosed as trochlear nerve palsy). He had a history of SCC of the right forehead, excised 6 months earlier.
In the following weeks, right sided facial pain developed and the diplopia worsened. 2 months later, follow-up examination showed involvement of 5th and 6th cranial nerves (right side).
Vision was 20/20 either side and there was no proptosis. MRI scans of brain and orbit were negative for orbital or intracranial tumor. A week later, vision worsened to 20/40 and there was an afferent pupillary defect (right eye). Paralysis on the right side now involved 3rd, 4th, 5th and 6th cranial nerves. Perineural invasion secondary to SCC was confirmed by supra orbital nerve biopsy.
The authors conclude that perineural invasion from cutaneous cancers of the head and neck can present as a Tolosa-Hunt-like syndrome with lack of radiologic findings.
The best chance of local and regional tumor control is afforded by a combination of surgery and postoperative radiotherapy.
