In this study we reviewed the results of 215 operations for intermittent and alternating exotropia of the total, 120 cases had a bilateral rectus muscle recessions and 95 cases had lateral rectus muscle recession and medial rectus muscle resection. The patient in the bilateral rectus muscle recessions group ranged from 2 to 31 years of age, averaging 9.8 years, and the follow up period after operation ranged from 2 months to 25 months averaging 5.4 months. The patient in the latral rectus muscle recession and medial rectus muscle resection group ranged from 4 to 53 years of age, averaging 18.6 yeras, and the post-operative follow up period ranged from 2 to 30 months, averaging 5.8 months. The success rate of operation in bilateral rectus muscle recessions group was 83.3%(100/120), and that in lateral rectus muscle recession and medial rectus muscle resection group was 88.8%(84/95). This difference in success rate between two groups was not statistically significant.
Exotropia* ; Follow-Up Studies ; Humans

Persistent physical stimulation and foreign body contact in prosthesis wearers may develop secondary infection, frequent conjunctival injection and responses such as giant papillary conjunctivitis. In 77 patients wearing prostheses, the bilateral conjunctival flora was studied and compared with the expect of conjunctival floral change. The predominent organisms were essentially the same in both sides: Staphylococcus epidermidis, Staphylococcus aureus followed by streptococcus. The incidence of bacterial isolation on the anophthalmic side (67.5%) was significantly higher than on the healthy side (32.5%). Especially the incidence of potential pathogenic bacterial isolation(Staphylococcus aureus, Streptococcus, Gram negative bacilli)(27.9%) was significantly higher on the anophthalmic side than on the healthy side(6.5%). The conjunctival smear study showed the higher incidence of polymorpho nucleoleukocyte and bacteria on the anophthalmic side. The isolation rates of the moderate to marked responded conjunctiva(46.9%) was lower than on the mild responded conjunctiva(69.2%) . The wearing time of the prostheses, the frequency of cleaning of prostheses, type of cleaner and topical drops used did not effect the incidence of bacterial isolation of conjunctival sac. Therfore these results showed that persistent physical stimulation and foreign body contact with prosthesis wearing may alter the microbial flora of the conjunctival sac.
Bacteria ; Coinfection ; Conjunctivitis, Allergic ; Foreign Bodies ; Humans ; Incidence ; Physical Stimulation ; Prostheses and Implants* ; Staphylococcus aureus ; Staphylococcus epidermidis ; Streptococcus

The objective of this study was to ascertain the elationship between the various ocular traumas and the change of pulsatile ocular blood flow[POBF] measured with Ocular Blood Flow Tonograph[OBF Laboratories, UK Ltd.]. We tested POBF with Ocular Blood Flow Tonograph 3 times repeatedly within 48 hours after trauma in the 33 ocular trauma patients.In all the trauma eyes, heart rate[HR]and intraocular pressure[IOP]were higher and pulse amplitude [PA], pulse volume[PV], POBF were lower than in all the fellow eyes.In the hyphema group, HR, IOP, PA, PV, POBF were higher, especially IOP and OBF%S.D.were statically significant, than in non-hyphema group.In the orbital fracture group, only POBF and OBF%S.D.were higher than those of in non-fracture group. Therefore, these results show the change of POBF after various ocularinjuries in the ocular trauma patients.The further studies to follow up the serial change of POBF are necessary.
Heart ; Humans ; Hyphema ; Orbital Fractures

The clinical analysis on the etiologies was done along with frequency of the patient's complaints of epiphora.The etiologies of the fifty-four patients screened by fluorescein dye disappearance test were classified by the causative location of the lacrimal pathway. The average of the patient's ages was 48.7 years old and average duration of symptom was 26.1 months.The causative locations were punctum[35.2%], nasolacrimal duct, lacrimal pump and nasal cavity in following order.The most common causes of each group were senile lid laxity[5.6%] for lacrimal pump, conjunctivochalasis and punctual atresia[11.1%]for lacrimal pump, idiopathic narrowing[9.3%]for canaliculus and idiopathic narrowing[16.6%]for nasolacrimal duct.Probing was the most common past history[18.5%]and the kinds of treatment were dacryocystorhinostomy, punctoplasty, lid tightening, probing, and conjunctivod acryocystorhinostomy. These data are expected to be a useful guide of rapid diagnosis and appropriate treatment for the epiphora patients without complicate processes and discomfort.
Dacryocystorhinostomy ; Diagnosis ; Fluorescein ; Humans ; Lacrimal Apparatus Diseases* ; Nasal Cavity ; Nasolacrimal Duct

Botulinum toxin chemodenervation is widely used for the treatment of acute paralytic strabismus. We reviewed the effect of botulinum toxin chemodenervation for the treatment of chronic paralytic strabismus. Between 1996 and 1998, 13 patients with chronic paralytic strabismus were treated with botulinum toxin chemodenervation. The palsy of extraocular muscle persisted for at least 6 months. Each patient received an injection of 1.25 to 5 units of botulinum toxin[Botox]to the antagonist muscle of the paralytic muscle and two patients received injections two times. The follow-up was more than 6 months [mean 7.62 months].2 patients were treated with surgery of horizontal muscles and 3 patients were treated with muscle transposition surgery before injection. The mean preinjection deviation was 36.7PD and the mean strabismus angle after injection was 19.2PD and improving rate of the strabisbismus angle was 47.6%. The final deviations of 6 patients were within 10PD[46.2%]and 4 of 7 patients with final deviation above 10PD were treated with surgery later. Ptosis occurred in 4 patients[30.8%]and hypertropia occurred in 4 patients[30.8%]. In addition to the prevention of muscle contracture with botulinum toxin injection, it is likely that the therapeutic effect of botulinum toxin is produced by permanent alteration in the muscle and influence on the peripheral and central nervous system. Therefore botulinum toxin chemodenervation can be considered as a primary therapy or a subsequent therapy of surgery for chronic paralytic strabismus and further study is needed.
Botulinum Toxins* ; Central Nervous System ; Contracture ; Follow-Up Studies ; Humans ; Muscles ; Nerve Block* ; Paralysis ; Strabismus*

We reviewed the clinical characteristics and surgical results of patients who had consecutive esotropia after exotropia surgery with at least 6 months of follow-up. The number of transient esotropic cases with more than 10 prism diopter postoperatively was 105[9%] in total 1128 cases and persistent esotropic cases at least for six months after surgery was 24[2%]. Significant correlations were found between the development of consecutive esotropia and the presence of amblyopia[p=0.04], poor stereopsis[p=0.02], suppression of the Worth 4-dot test[p<.01], and recession-resction surgery[p=0.02]. The corrective surgery for consecutive esotropia was performed on 12 cases[1.1%] with unilateral lateral rectus advancement[7 cases], bilateral lateral rectus advancement[3 cases], unilateral medial rectus recession[1 case] and bilateral medial rectus recession[1 case]. All of them showed good results.
Esotropia* ; Exotropia* ; Follow-Up Studies ; Humans

PURPOSE: To understand the ophthalmic clinical features and outcomes of facial nerve palsy patients who were referred to an ophthalmic clinic for various conditions like Bell's palsy, trauma, and brain tumor. METHODS: A retrospective study was conducted of 34 eyes from 31 facial nerve palsy patients who visited a clinic between August 2007 and July 2017. The clinical signs, management, and prognosis were analyzed. RESULTS: The average disease period was 51.1 ± 20.6 months, and the average follow-up duration was 24.0 ± 37.5 months. The causes of facial palsy were as follows: Bell's palsy, 13 cases; trauma, six cases; brain tumor, five cases; and cerebrovascular disease, four cases. The clinical signs were as follows: lagophthalmos, 24 eyes; corneal epithelial defect, 20 eyes; conjunctival injection, 19 eyes; ptosis, 15 eyes; and tearing, 12 eyes. Paralytic strabismus was found in seven eyes of patients with another cranial nerve palsy (including the third, fifth, or sixth cranial nerve). Conservative treatments (like ophthalmic ointment or eyelid taping) were conducted along with invasive procedures (like levator resection, tarsorrhaphy, or botulinum neurotoxin type A injection) in 17 eyes (50.0%). Over 60% of the patients with symptomatic improvement were treated using invasive treatment. At the time of last following, signs had improved in 70.8% of patients with lagophthalmos, 90% with corneal epithelium defect, 58.3% with tearing, and 72.7% with ptosis. The rate of improvement for all signs was high in patients suffering from facial nerve palsy without combined cranial nerve palsy. CONCLUSIONS: The ophthalmic clinical features of facial nerve palsy were mainly corneal lesion and eyelid malposition, and their clinical course improved after invasive procedures. When palsy of the third, fifth, or sixty cranial nerve was involved, the prognosis and ophthalmic signs were worse than in cases of simple facial palsy. Understanding these differences will help the ophthalmologist take care of patients with facial nerve palsy.
Bell Palsy ; Brain Neoplasms ; Cerebrovascular Disorders ; Cranial Nerve Diseases ; Cranial Nerves ; Epithelium, Corneal ; Eyelids ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Humans ; Paralysis ; Prognosis ; Retrospective Studies ; Strabismus ; Tears

Purpose: To evaluate the relationship between the position and direction of a silicone tube in the nasal cavity after silicone tube intubation and clinical features. Methods: This study included 70 eyes of 52 patients who were diagnosed with nasolacrimal duct obstruction and had silicone intubation surgery. The position and direction of the silicone tube were compared after tube intubation and before extubation. An intranasal swap culture was performed before tube intubation, and the removed silicone tubes were cultured. Results: The length of the silicone tube decreased from 8.7 ± 3.1 mm after intubation to 7.3 ± 3.1 mm before extubation, and the direction of the tube moved backward in the nasal cavity (p < 0.05). The bacterial culture rate changed from 94.3% before intubation to 75.7% before extubation. The most common Gram-positive bacteria (both preoperative and postoperative) was coagulase- negative Staphylococcus aureus. The most common Gram-negative bacteria were converted from Klebsiella aerogenes to Stenotrophomonas maltophilia. The fungal culture rate changed from 7.1% to 51.4%, and the culture rate increased when the silicone tube direction was moved backward (p < 0.05). The length and direction of the silicone tubes were not correlated with clinical symptoms or changes in eyelid height. Conclusions The length of the silicone tube in the nasal cavity decreased, and the tube tended to move in a posterior direction after silicone tube intubation. Considering the increase in the intra-nasal fungal culture rate, it is better to place the silicone tube in the anterior part of the nasal cavity from the inferior meatus. To clarify further the fungal infection and its clinical findings, a study of cultures with respect to location in the lacrimal system would be required.

Purpose: To evaluate the postoperative stereopsis changes in strabismus patients over 10 years of age after surgical correction. Methods: We reviewed, retrospectively, the medical records of 193 patients (99 men and 94 women) who underwent strabismus surgery from March 2002 to August 2019 at our hospital. Patients were classified into an exotropia group, an esotropia group, or a combined strabismus group (having horizontal and vertical strabismus simultaneously), according to their strabismus type. These groups were further divided into three groups based on pre-operative stereopsis findings classified as poor (above 4,000 seconds [s] of arc), fair (between 4,000 to 100 s of arc), or good (below 100 s of arc). The stereopsis conditions before and after surgery were compared. Results: Overall, the stereopsis of patients over 10 years of age who underwent surgery improved from 2.45 ± 0.69 logarcsec to 2.85 ± 0.58 logarcsec (p < 0.001) after surgery regardless of strabismus type. Stereopsis in exotropia patients was 2.33 ± 0.71 logarcsec before surgery and improved to 2.15 ± 0.56 logarcsec (p < 0.001) after surgery. Stereopsis in esotropia patients was 0.85 ± 0.58 logarcsec before surgery and 2.48 ± 0.11 logarcsec after surgery (p = 0.002). Stereopsis of combined strabismus patients was 2.44 ± 0.76 logarcsec before surgery versus 2.20 ± 0.54 logarcsec after surgery (p = 0.133). The degree of stereopsis improvement was highest for the esotropia, group followed by the combined strabismus, and exotropia groups. Conclusions Surgical correction of various types of strabismus may be helpful for binocular function in patients over 10 years of age.

Purpose: To investigate the effect of botulinum A toxin (BTXA) chemodenervation in paralytic strabismus patients without surgical correction. Methods: A retrospective chart review of 51 patients who were diagnosed as paralytic strabismus and underwent BTXA chemodenervation was performed. The patients were divided into four groups according to the cause of paralytic strabismus of vasculopathy, neoplasm, trauma, and idiopathic. They were also divided into two groups of early and late treatment according to the initiation time of BTXA chemodenervation after the onset of strabismus (3 months), and of the initial strabismus type of exotropia and esotropia. We investigated the changes of angle of deviation and diplopia after BTXA chemodenervation. Results: The average deviation of angles decreased by 25.2 prism diopter (PD) (35.1 to 9.9 PD) in total patients, and the overall success rate was 64.7% (33 by 51), and the there was no statistically significant difference in success rate between each group divided by the cause of paralytic strabismus. According to the treatment timing, the deviation of the angle decreased by 28.0 PD (36.8 to 8.8 PD) in the early treatment group, and 21.3 PD (33.5 to 12.2 PD) in late treatment group at the time of the last postinjective follow-up. According to the initial strabismus type, the average angle of deviation decreased by 20.3 PD (35.6 to 15.3 PD) in exotropia group by cranial nerve 3 palsy, and 24.4 PD (32.5 to 8.1 PD) in esotropia by cranial nerve 6 palsy. Conclusions BTXA chemodenervation reduced the angle of deviation and the number of patients with diplopia regardless of the cause of paralytic strabismus. Early BTXA chemodenervation can be considered as the first treatment of choice in paralytic strabismus, especially in esotropia patients.