PURPOSE: To analyze the improvement of symptoms and signs of dry eye after surgical punctual occlusion and to evaluate the effects of secondary systemic disease in dry eye patients. METHODS: From March 2011 to July 2014, 15 eyes of 8 dry eye patients with a history of punctal plug insertion underwent surgical punctal occlusion. Schirmer test was measured based on mean 2.9 mm. The patients consisted of 4 dry eye patients with Sjogren's disease, 1 with rheumatoid arthritis, 1 with graft-versus-host disease (GVHD), and 2 with no secondary systemic disease. Preoperative and postoperative ophthalmic examinations of log MAR visual acuity, subjective symptoms, corneal staining (National Eye Institute [NEI] score), and tear break-up time (BUT) were performed and the effects of secondary systemic disease in dry eye patients were evaluated. The results of surgical punctual occlusion were analyzed. RESULTS: All patients showed a statistically significant improvement of log MAR visual acuity, subjective symptoms, corneal staining (NEI score), and tear BUT. The patients with rheumatoid-related diseases showed improved symptoms after surgery, but the patient with GVHD showed no significant improvement after surgery. Among the study patients, 80.0% showed completely closed punctum and 20.0% showed partial recanalization. CONCLUSIONS: Surgical punctal occlusion is an effective alternative in patients with severe aqueous deficient dry eye who show recurrent punctal plug loss or complications associated with punctal plugs.
Arthritis, Rheumatoid ; Graft vs Host Disease ; Humans ; Sjogren's Syndrome ; Tears ; Visual Acuity

PURPOSE: This study is executed to identify and report the treatment effects of oral mucosa grafting of prosthetic eye patients who have shallow conjunctival socket caused by socket contraction. METHODS: Conjunctival sac reconstruction was performed by using the lower lip mucosa to 11 eyes of 11 patients diagnosed with contracted conjunctival sac at the ophthalmic clinic from August 2009 to May 2015, and a retrospective analysis was performed with medical record data from the patients who were followed-up after surgery. RESULTS: Within the follow-up period, prosthetic eye insertion was possible for all 11 eyes of the 11 patients. All of them were satisfied in an aesthetic aspect, and were able to maintain deep conjunctival sac without receving findings of graft absorption, or re-contracted or shallow conjunctival sac during the follow-up period. On the donor region, normal epithelialization occurred. Concerning the donor region for the first week after surgery, the mean score of the patients' pain was 3.18 +/- 0.94 points measured by a numerical rating scale, and no infection, bleeding, contraction, or cicatrix was revealed during the follow-up period. There were hypoesthesia, pararthria, and paresthesia (tingling sense) for post-complications from the donor region, and four patients out of the 11 patients complained of discomfort resulting from post-complications; whereas the remaining seven patients did not complain of discomfort. CONCLUSIONS: Oral mucosa can be considered as a good graft for contracted conjunctival sac reconstruction for patients who cannot wear a prosthetic eye.
Absorption ; Cicatrix ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypesthesia ; Lip ; Medical Records ; Mouth Mucosa* ; Mucous Membrane ; Paresthesia ; Retrospective Studies ; Tissue Donors ; Transplants*

PURPOSE: To investigate the surgical results of early and delayed repair of orbital wall fracture after multiple subgrouping of patients by time between the operation and injury. METHODS: Eighty-eight eyes of 88 patients who underwent orbital wall fracture repair from January 2002 to December 2014 and who were followed up for more than 3 months postoperatively were included in this study. We divided the 88 patients into three groups: Early surgery group (surgery within 2 weeks after the injury), slightly delayed surgery group (surgery between 3 weeks and 2 months after the injury), delayed surgery group (surgery after 2 months of the injury). Preoperative and postoperative ocular motility, diplopia, and the degree of enophthalmos were analyzed retrospectively. RESULTS: The early surgery group consisted of 30 eyes; slightly delayed surgery group, 42 eyes; and delayed surgery group, 16 eyes. The mean duration between injury and surgery was 8.6 +/- 22.5 weeks in all patients, 1.5 +/- 0.5 weeks in the early surgery group, 3.5 +/- 1.3 weeks in the slightly delayed surgery group, and 35.3 +/- 44.7 weeks in the delayed surgery group. All patients were followed up for a mean of 12.9 +/- 10.8 weeks. Gaze limitation in all directions showed improvement in all groups, with the most shown in up gaze limitation. There were no significant differences in the degree of improvement between preoperative and postoperative gaze limitation among the three groups. Enophthalmos improved as well, without any significant differences among the three groups. CONCLUSIONS: Improvement in ocular motility limitation and enophthalmos after orbital wall fracture repair did not vary significantly according to the duration between the surgery and injury. Therefore, surgical repairment even for old orbital fractures may successfully treat enophthalmos or diplopia and relieve symptoms.
Diplopia ; Enophthalmos ; Humans ; Orbit* ; Orbital Fractures ; Retrospective Studies

PURPOSE: To report the relative frequency and clinical characteristics of patients with benign eyelid tumors. METHODS: A retrospective study of 192 consecutive patients admitted to Korea University Ansan Hospital with benign eyelid tumor between January 2009 and December 2014 was undertaken, and clinical records including age, sex, involved site, and pathology of tumors were reviewed retrospectively. All eyelid tumors were confirmed histopathologically. RESULTS: The sexual distribution revealed 87 males and 105 females with benign eyelid tumors. The mean age at diagnosis was 42.6 +/- 19.2 years. Molluscum contagiosum (5.5 +/- 3.5 years) and pilomatrixoma (14.0 +/- 15.6 years) were generally found in younger individuals, while seborrheic keratosis (60.2 +/- 15.8 years) and squamous cell papilloma (50.5 +/- 13.4 years) occurred predominantly in elderly patients. Tumors were most common on the upper lid (63.0%). The four most frequent subtypes were melanocytic nevus (37.5%), epidermal cyst (8.3%), squamous cell papilloma (5.7%), and seborrheic keratosis (5.2%). CONCLUSIONS: The most common histopathological diagnosis of benign eyelid tumors was melanocytic nevus. The results of this study provide epidemiological information that will be useful for diagnosis and therapy of such tumors.
Aged ; Diagnosis ; Epidermal Cyst ; Eyelids* ; Female ; Gyeonggi-do ; Humans ; Keratosis, Seborrheic ; Korea ; Male ; Molluscum Contagiosum ; Nevus, Pigmented ; Papilloma ; Pathology ; Pilomatrixoma ; Retrospective Studies

PURPOSE: To investigate the clinical features, surgical treatments, and their outcomes in conjunctival squamous papilloma. METHODS: A retrospective chart review was conducted on 31 patients with 32 eyes that were treated for conjunctival papilloma from October 2000 to February 2015 in Seoul National University Hospital and Seoul National University Bundang Hospital. RESULTS: Among the 31 patients, 9 patients had papilloma which recurred after previous surgical excision at another hospital. Twenty-five eyes had one papilloma lesion, 2 eyes had 2 lesions, and 5 eyes had more than 3 lesions. The most affected location of papilloma was the tarsal conjunctiva. The recurrent group displayed a tendency to have multiple lesions. Surgical excision without any adjuvant therapy was performed in 13 eyes; surgical excision and cryotherapy in 15 eyes; surgical excision, cryotherapy, and topical interferon alfa-2b in 3 eyes; and surgical excision and amniotic membrane transplantation in 1 eye. The mean postoperative follow up period was 11.1 months. There were 5 cases of recurrence and the mean time of recurrence after surgical excision was 4.22 months (range, 3 days to 9 months). Among 5 cases of recurrence, 3 cases were after surgical excision only, 1 case was after surgical excision and cryotherapy, and 1 case was after surgical excision, cryotherapy, and topical interferon alfa-2b. These 5 recurred cases were retreated with surgical excision and cryotherapy, surgical excision and topical interferon alfa-2b, or surgical excision, cryotherapy, and topical interferon alfa-2b. CONCLUSIONS: Conjunctival squamous papilloma is likely to recur even though the tumor is completely removed. Therefore, long-term postoperative follow up may be necessary for recurrence.
Amnion ; Conjunctiva ; Cryotherapy ; Follow-Up Studies ; Humans ; Interferons ; Papilloma* ; Recurrence ; Retrospective Studies ; Seoul

PURPOSE: To report a case of visual deterioration and atrophied retina after pars plana vitrectomy (PPV) and silicone oil tamponade for the treatment of retinal detachment with previous encircling scleral buckling. CASE SUMMARY: A 29-year-old female visited for treatment of rhegmatogenous retinal detachment (RRD) in the right eye which was not completely resolved after encircling scleral buckling. Logarithm of minimal angle of resolution (log MAR) and best corrected visual acuity (BCVA) was 0.3. Retinal detachment from 3 to 8 O'clock without macular involvement was identified. Pars plana vitrectomy, endophotocoagulation and silicone oil tamponade were performed. During the operation, retinal dialysis and retinal break at the superonasal periphery were observed. The patient complained of central scotoma at 2 days postoperatively and hyper-reflection of the inner retina was identified on optical coherence tomography (OCT). At 2 weeks postoperatively, the OCT image revealed a thin retina and impending macular hole. After 2 months, the silicone oil was removed. Although the retina was well attached, the retina remained atrophied and the log MAR BCVA was 0.16. CONCLUSIONS: We report a rare case with deteriorated visual acuity after PPV and silicone oil tamponade for the retreatment of RRD in an atopic dermatitis patient.
Adult ; Dermatitis, Atopic ; Dialysis ; Female ; Humans ; Reoperation* ; Retina* ; Retinal Detachment* ; Retinal Perforations ; Retinaldehyde* ; Retreatment ; Scleral Buckling ; Scotoma ; Silicon ; Silicone Oils ; Silicones ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy

PURPOSE: To report a case of endothelial keratitis occurred after reactivation of herpes simplex virus following immunosuppressant therapy for Kaposi's varicelliform eruption. CASE SUMMARY: A 23-year-old female was referred for ocular pain and blurred vision. She had atopic dermatitis and was diagnosed with Kaposi's varicelliform eruption on her face after using an immunosuppressant. Slit lamp examination revealed central corneal edema in the right eye. She was initially diagnosed with contact lens-induced keratitis. Subsequently, the contact lens was removed and topical antiviral agent used for prevention of ocular involvement. Four days after treatment, Wesseley immune ring of deep stromal haze and cells in the anterior chamber were present. She was diagnosed with endothelial keratitis caused by reactivation of herpes simplex virus after using an immunosuppressant. Topical steroid, hypertonic saline eye drops and cycloplegic eye drops were added to the treatment for the progression of endothelial keratitis. Corneal edema was decreased 2 weeks after treatment and anterior chamber cells decreased 1 month after treatment. There was no recurrence during the follow-up period. CONCLUSIONS: Patients diagnosed with Kaposi's varicelliform eruption after using immunosuppressants should have an ophthalmic examination to confirm ocular involvement; use of appropriate eye drops is necessary for the treatment of corneal involvement.
Anterior Chamber ; Corneal Edema ; Dermatitis, Atopic ; Female ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Kaposi Varicelliform Eruption* ; Keratitis* ; Ophthalmic Solutions ; Recurrence ; Simplexvirus ; Slit Lamp ; Young Adult

PURPOSE: To determine whether retinal nerve fiber layer (RNFL) thickness and optic nerve head parameters differ in the amblyopic and normal fellow eyes of hyperopic anisometropic amblyopic patients using spectral domain optical coherence tomography (SD-OCT). METHODS: This study included 30 patients with hyperopic anisometropic amblyopia; patient eyes were divided into 30 anisometropic amblyopic eyes and 30 normal fellow eyes. RNFL thickness, disc area, rim area, average cup-to-disc ratio, and cup volume were obtained using SD-OCT. Axial length was obtained using the IOL Master®, and the interocular differences between group were analyzed. RESULTS: Nasal quadrant RNFL thickness of amblyopic eyes was significantly thicker than that of normal fellow eyes in amblyopic patients (p = 0.010). Among optic nerve parameters, cup volume of amblyopic eyes was significantly smaller than that of normal fellow eyes (p = 0.021). No significant relationship between refractive error and RNFL thickness was observed, and a significant positive linear relationship was observed between neural rim area and RNFL thickness (rho = 0.426, p = 0.005). CONCLUSIONS: SD-OCT analysis of hyperopic anisometropic amblyopic eyes demonstrated a significant increase in nasal RNFL thickness compared to fellow non-amblyopic eyes. No optic nerve head parameters except cup volume showed significant change.
Amblyopia* ; Humans ; Nerve Fibers* ; Optic Disk ; Optic Nerve ; Refractive Errors ; Retinaldehyde* ; Tomography, Optical Coherence*

PURPOSE: To analyze the clinical aspects of consecutive esotropia after intermittent exotropia reoperation and study the prognosis and associated risk factors. METHODS: The present study included 34 patients with intermittent exotropia who underwent reoperation; incidence rate, risk factors, treatment methods and prognosis of the postoperative consecutive esotropia were analyzed. RESULTS: Of the 34 patients, 12 developed consecutive esotropia that persisted longer than a month after the reoperation; a higher incidence rate was observed in patients with esodeviation greater than 16 prism diopter (PD) on postoperative day 1 and in patients who received unilateral lateral muscle recession and medial muscle resection during the operation (p < 0.05). Conversely, factors such as age, deviation angle, refractive power, anisometropia, lateral incomitance and oblique muscle dysfunction prior to the reoperation did not affect the incidence of consecutive esotropia. The patients who developed consecutive esotropia received conservative treatments such as alternative occlusion therapy and fresnel prism wearing; 10 of 12 patients showed significant clinical improvements. CONCLUSIONS: Consecutive esotropia frequently occurs after intermittent exotropia reoperation if the patient had esodeviation greater than 16 PD on postoperative day 1 or received unilateral lateral muscle recession and medial muscle resection. The conservative treatments of the consecutive esotropia showed good clinical response and improved prognosis.
Anisometropia ; Esotropia* ; Exotropia* ; Humans ; Incidence ; Prognosis ; Reoperation ; Risk Factors

PURPOSE: To evaluate the efficacy and safety of brinzolamide 1%/brimonidine 0.2% fixed combination (BBFC) in normal tension glaucoma (NTG) patients. METHODS: This prospective study included patients treated with brinzolamide 1% monotherapy, brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy, as well as newly diagnosed NTG patients. The enrolled patients who used brinzolamide 1% or brimonidine 0.2% switched to BBFC and newly diagnosed NTG patients were treated with BBFC. The patients receiving brinzolamide 1% or brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy switched antiglaucoma drugs to BBFC. Newly diagnosed NTG patients used BBFC as the first therapy. The study consisted of 1 screening/baseline visit and 3 follow-up visits conducted after 1, 4, 8, 12 and 24 weeks of treatment. Intraocular pressure (IOP), mean deviation value and adverse drug reactions were evaluated before treatment and after treatment with BBFC. RESULTS: The mean IOP in the brinzolamide 1% monotherapy group was 13.5 ± 1.6 mm Hg and the mean IOP after switched from brinzolamide 1% monotherapy to BBFC was 12.1 ± 1.5 mm Hg. The mean IOP in the brimonidine 0.2% monotherapy group was 14.2 ± 1.3 mm Hg and the mean IOP after switched from brimonidine 0.2% monotherapy to BBFC was 11.7 ± 1.5 mm Hg. The mean IOP was 11.9 ± 2.1 mm Hg in the brinzolamide 1% and brimonidine 0.2% concomitant therapy group and the mean IOP after switched from brinzolamide 1% and brimonidine 0.2% concomitant therapy to BBFC was 12.0 ± 1.1 mm Hg. The mean IOP and reduction rate were 10.7 ± 2.1 mm Hg and 35.5%, respectively,in the newly diagnosed NTG patients treated with BBFC. There was no serious adverse drug reaction causing ocular damage. CONCLUSIONS: BBFC provides a significant IOP reduction and is a safe antiglaucoma medication for NTG patients.
Brimonidine Tartrate ; Drug-Related Side Effects and Adverse Reactions ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Low Tension Glaucoma* ; Prospective Studies