INTRODUCTIONInvasive fungal pan-sinusitis can present atypically with severe acute visual loss with minimal anterior orbital inflammation. We describe 2 such cases with a background of uncontrolled diabetes.

CLINICAL PICTURERespective clinical presentations of orbital apex and cavernous sinus syndromes were associated with isolation of Aspergillus galactomannan and Rhizopus.

TREATMENTUrgent extensive surgical debridement and systemic antifungal is necessary.

OUTCOMEClinical improvement of the ocular motor nerves can be expected within 2 months of treatment but visual loss is usually permanent.

CONCLUSIONUnderlying pansinusitis is an important differential for acute visual loss, especially in uncontrolled diabetics. Early treatment determines outcome.

Adult ; Antifungal Agents ; therapeutic use ; Antigens, Fungal ; analysis ; Aspergillosis ; complications ; diagnosis ; therapy ; Aspergillus ; immunology ; isolation & purification ; Debridement ; methods ; Diabetes Complications ; blood ; complications ; therapy ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mucormycosis ; complications ; diagnosis ; therapy ; Rhizopus ; immunology ; isolation & purification ; Sinusitis ; complications ; diagnosis ; therapy ; Tomography, X-Ray Computed ; Vision, Low ; diagnosis ; etiology ; therapy

INTRODUCTIONThis study reviews the differences in demographics and surgical outcomes between ectropion in Asian and non-Asian eyes.

MATERIALS AND METHODSMedical records of surgically corrected ectropion cases from January 2002 to December 2006 were reviewed. Preand postoperative lid-globe apposition was graded: grade 0 with normal lid-globe apposition, grade 1 with punctal ectropion, grade 2 with partial lid eversion and scleral show, grade 3 with conjunctival hyperemia and thickening and grade 4 as for grade 3 with exposure keratitis.

RESULTSSixty-nine eyes in 50 patients underwent surgical correction of lower lid ectropion, making up 3.3% of all lid procedures performed. Eighty-four percent of patients were above 50 years of age, 72% were males and 88% were Chinese. Involutional change was the commonest aetiology, accounting for the majority of bilateral cases. The mean duration to surgery was 10.0 ± 16.0 months. The most frequent preoperative severity grade was 2. Lateral tarsal strip (LTS) was the commonest procedure performed, comprising 91.3% of eyes. The mean duration of postoperative review was 19.4 ± 19.2 months (range, 1 to 74 months). Postoperative improvement of at least one grade was observed in 98% while normal lid-globe apposition was achieved in 76% of eyes.

CONCLUSIONSInvolutional change is the most common cause of ectropion amongst both Asians and non-Asians. Ectropion is less prevalent amongst Asians as a result of anatomical differences and possibly reduced sun exposure. The LTS procedure is the most commonly performed surgical procedure for the successful correction of ectropion in both Asians and non-Asians.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Blepharoplasty ; methods ; Child ; Child, Preschool ; Ectropion ; surgery ; Eyelids ; surgery ; Female ; Humans ; Infant ; Male ; Middle Aged ; Postoperative Period ; Preoperative Care ; Retrospective Studies ; Time Factors ; Young Adult