PURPOSE: To evaluate factors affecting the outcome of silicone tube intubation in patients with nasolacrimal duct obstruction. METHODS: A retrospective study of the outcome of silicone tube intubation performed from August 2001 to August 2009 in 98 patients (132 eyes) with nasolacrimal duct obstruction was conducted. Improvement was defined as the disappearance of epiphora after silicone tube intubation and success was defined as maintenance of improvement by the time of the final patient follow-up. Recurrence was also defined as appearance of epiphora after silicone tube extubation. RESULTS: The success rate was 76.5% (101 eyes), failure rate was 8.3% (11 eyes), and recurrence rate was 15.2% (20 eyes). Preoperative canaliculus irrigation test was significantly correlated with symptomatic improvement and recurrence after silicone tube intubation (p = 0.003 and 0.045, respectively). The mean time that patients experienced recurrence was 43.7 months after silicone tube intubation, according to Kaplan-Meier survival analysis. CONCLUSIONS: Preoperative canaliculus irrigation test is a simple and effective tool to estimate the outcome of silicone tube intubation. This outcome should be considered in the stage of planning treatment in nasolacrimal duct obstruction patients.
Follow-Up Studies ; Humans ; Intubation ; Lacrimal Apparatus Diseases ; Nasolacrimal Duct ; Recurrence ; Retrospective Studies ; Silicones

PURPOSE: The aim of this study is to evaluate the effects and complications of mixed injections of botulinum neurotoxin A (BoNT-A), triamcinolone acetonide, 5-fluorouracil (5-FU) in patients with Graves upper eyelid retraction. METHODS: Twenty-four eyes of 17 patients with a mean age of 43.9 years showed symptoms of Grave's upper eyelid retraction (GUER). They received mixed injections of BoNT-A 4 IU/0.1 mL, triamcinolone acetonide 4 mg/0.1 mL and 5-FU 5 mg/0.1 mL via subconjunctival injection. The response to treatment and the presence of adverse effects were followed up for 9.0 ± 6.0 months and evaluated retrospectively. RESULTS: Margin reflex distance 1 decreased significantly from 5.6 ± 1.2 mm to 4.7 ± 1.1 mm at 1 month after injection. Tarsal platform show increased significantly from 1.4 ± 1.3 mm to 1.8 ± 1.3 mm, and tear break up time increased significantly from 5.2 ± 3.1 seconds to 10.3 ± 7.8 seconds. When success was defined as the correction amount of GUER being larger than 1 mm, the success rate was 66.7%. Kaplan-Meier survival analysis showed that GUER correction effects last longer in patients with a duration of disease longer than 6 months. There were no severe adverse effects such as diplopia, blepharoptosis and intraocular pressure elevation. CONCLUSIONS: Mixed injections of BoNT-A, triamcinolone acetonide and 5-FU, which compensate the side effects of solitary injection and enhances the anti-fibrotic effect, improves the eyelid position and tear film stability in the patients with GUER. It is an effective and safe method for treating GUER with long maintenance with less adverse effects.
Blepharoptosis ; Botulinum Toxins, Type A ; Diplopia ; Eyelids* ; Fluorouracil* ; Humans ; Injections, Intraocular ; Intraocular Pressure ; Reflex ; Retrospective Studies ; Tears ; Triamcinolone Acetonide ; Triamcinolone*

PURPOSE: To evaluate clinical features of periorbital spasm and facial asymmetry in the patients who recovered poorly from Bell's palsy and facial trauma and to investigate the effect of Botulinum toxin A as a treatment for periorbital spasm and facial asymmetry. METHODS: Between November 2001 and January 2010, Botulinum toxin injection was performed in 17 patients who had blepharospasm and facial asymmetry following poor recovery from facial palsy. The past history, trauma history, clinical manifestation of blepharospasm, Botulinum toxin A injection dose, injection site, frequency of injection, and duration of effect was evaluated. Data was analyzed using the Mann-Whitney U test, SPSS 12.0. RESULTS: The mean number of injections was 2.7 +/- 2.4 times and the mean dose per injection unit was 12.2 +/- 1.2 units. The Botulinum toxin effect lasted 6.9 +/- 5.5 months in Bell's palsy patients, and 8.0 +/- 4.2 months in trauma patients. There was no significant difference between the 2 groups. Most patients reported improvement of periorbital spasm and facial asymmetry. After treatment, 1 patient complained of epiphora and 1 patient complained of ptosis; conservative treatment was performed for these patients. CONCLUSIONS: Blepharospasm can be treated and a cosmetic improvement in facial symmetry can be achieved by Botulinum toxin A injection in the patients who recover poorly from facial palsy.
Bell Palsy ; Blepharospasm ; Botulinum Toxins ; Cosmetics ; Facial Asymmetry ; Facial Nerve ; Facial Paralysis ; Humans ; Lacrimal Apparatus Diseases ; Paresis ; Spasm ; Synkinesis

PURPOSE: To evaluate histopathologic properties of eyelid skin and conjunctiva and the association between clinical manifestation and histopathologic findings. METHODS: A prospective study was conducted on the histologic findings of the upper eyelid skin and conjunctiva performed from November 2009 to February 2010 in 27 patients for upper eyelid blepharoplasty procedures. Histopathologic studies were performed for specimens collected from the upper eyelid skin and inferotemporal bulbar conjunctiva. Preoperative photographs of the upper eyelid and conjunctiva were taken to grade clinical severity of dermatochalasis and conjunctivochalasis. RESULTS: Decrease of collagen density and elastic degeneration in the eyelid skin and conjunctiva were significantly associated with aging (p < 0.001, p = 0.001, p = 0.001, p < 0.001). Clinical severity of dermatochalasis was correlated with a decrease of collagen density and elastic degeneration in the eyelid skin, and clinical severity of conjunctivochalasis was associated with a decrease of collagen density, elastic degeneration and lymphangiectasia in conjunctiva (p < 0.001). CONCLUSIONS: Change of collagen fiber and elastic fiber in the eyelid skin and conjunctiva was observed with aging. Relaxation of the eyelid skin and conjunctiva was correlated with histologic findings.
Aging ; Blepharoplasty ; Collagen ; Conjunctiva ; Elastic Tissue ; Eyelids ; Humans ; Prospective Studies ; Relaxation ; Skin

PURPOSE: To determine the success rate of probing for the treatment of congenital nasolacrimal duct obstruction and to identify the clinical factors affecting the success rates. METHODS: The records of probing procedures from January 2005 to January 2015 were reviewed. The present study included 200 eyes of 174 patients with congenital nasolacrimal duct obstruction. Successful probing was defined as complete resolution of epiphora 3 months after treatment. Success rates were compared between the 2 groups in terms of sex, age, laterality, and previous probing. RESULTS: A total of 200 eyes of 174 children (109 eyes of 94 males and 91 eyes of 80 females; mean age, 7.51 ± 3.39 months) had undergone the probing procedure. The overall success rates of primary probing were 81.5%, with an 80.7% success rate in males (88 eyes of 109 eyes) and 82.5% in females (75 eyes of 91 eyes). Success rates were 83.5% for the 91 eyes in children aged 0 to 6 months, 80.0% for the 90 eyes in children 6 to 12 months, and 78.9% for the 19 eyes in children over 12 months. No statistical significances were found among age groups. The probability of treatment success was lower in bilateral disease (p < 0.05; 86.4-67.3%). Twenty-four of 37 eyes with unsuccessful primary probing underwent secondary probing, resulting in a 70.8% success rate. Silicone tube insertion was performed in 4 eyes repeatedly, however, the procedures were unsuccessful. The overall success rate was 90%. CONCLUSIONS: The success rates among various age groups were not statistically significant. The probability of treatment success was lower in bilateral cases. Probing is an effective first-line treatment in children diagnosed with nasolacrimal duct obstruction. Close observation and appropriate treatment should be considered in patients with bilateral disease.
Child* ; Female ; Humans ; Lacrimal Apparatus Diseases ; Male ; Nasolacrimal Duct* ; Silicon ; Silicones

PURPOSE: To determine the success rate of probing for the treatment of congenital nasolacrimal duct obstruction and to identify the clinical factors affecting the success rates. METHODS: The records of probing procedures from January 2005 to January 2015 were reviewed. The present study included 200 eyes of 174 patients with congenital nasolacrimal duct obstruction. Successful probing was defined as complete resolution of epiphora 3 months after treatment. Success rates were compared between the 2 groups in terms of sex, age, laterality, and previous probing. RESULTS: A total of 200 eyes of 174 children (109 eyes of 94 males and 91 eyes of 80 females; mean age, 7.51 ± 3.39 months) had undergone the probing procedure. The overall success rates of primary probing were 81.5%, with an 80.7% success rate in males (88 eyes of 109 eyes) and 82.5% in females (75 eyes of 91 eyes). Success rates were 83.5% for the 91 eyes in children aged 0 to 6 months, 80.0% for the 90 eyes in children 6 to 12 months, and 78.9% for the 19 eyes in children over 12 months. No statistical significances were found among age groups. The probability of treatment success was lower in bilateral disease (p < 0.05; 86.4-67.3%). Twenty-four of 37 eyes with unsuccessful primary probing underwent secondary probing, resulting in a 70.8% success rate. Silicone tube insertion was performed in 4 eyes repeatedly, however, the procedures were unsuccessful. The overall success rate was 90%. CONCLUSIONS: The success rates among various age groups were not statistically significant. The probability of treatment success was lower in bilateral cases. Probing is an effective first-line treatment in children diagnosed with nasolacrimal duct obstruction. Close observation and appropriate treatment should be considered in patients with bilateral disease.
Child* ; Female ; Humans ; Lacrimal Apparatus Diseases ; Male ; Nasolacrimal Duct* ; Silicon ; Silicones

PURPOSE: In the present study, a case of recurrent nasolacrimal duct obstruction as ectrodactyly-ectodermal dysplasia-cleft syndrome is reported. CASE SUMMARY: An 18-year-old male complained of epiphora in both eyes. By the age of 1, he was diagnosed with nasolacrimal duct obstruction and received left side dacryocystotomy, both sides silicone tube insertion and, right side endoscopic dacryocystorhinostomy. The general findings showed microdontia and, bilateral ectrodactyly. An irrigation test showed ‘regurgitation without pus’ and Jones test showed ‘negative’ in both sides. Complete obstruction was observed on dacryocystography and the patient underwent endoscopic conjunctivodacryocystorhinostomy with Jones tube at right side and endoscopic dacryocystorhinostomy at left side. The chromosome test showed normal findings. CONCLUSIONS: Nasolacrimal duct obstruction in ectrodactyly-ectodermal dysplasia-cleft syndrome is usually caused by dysplasia of the nasolacrimal duct and accompanied by dysplasia of lacrimal punctum and canaliculus. Providing proper care for nasolacrimal duct obstruction in ectrodactyly-ectodermal dysplasia-cleft syndrome is important. Furthermore, the high failure rate should be considered.
Adolescent ; Dacryocystorhinostomy ; Humans ; Lacrimal Apparatus ; Lacrimal Apparatus Diseases* ; Male ; Nasolacrimal Duct ; Silicon ; Silicones

PURPOSE: To report two cases of lacrimal drainage obstruction associated with the anticancer drug S-1 (tegafur, gimeracil, oteracil ; TS-1(R), Taiho Pharmaceutical, Japan). CASE SUMMARY: (Case 1) A 34-year-old male who had previously undergone a total gastrectomy for treatment of gastric cancer visited with epiphora in both eyes that had developed 6 months after S-1 treatment. On examination, a right canalicular obstruction and left punctal and nasolacrimal partial obstruction were noted. Endoscopic dacrycystorhinostomy with lacrimal trephinization was done in the right eye and punctoplasty with punctal membrane removal and silicone tube intubation were performed in the left eye and the epiphora were successfully treated. (Case 2) A 60-year-old male who was treated with S-1 for gastric cancer presented with tearing in both eyes that had developed 2 months after S-1 treatment. Ophthalmic examinations revealed a right nasolacrimal partial obstruction in the right eye and lacrimal sac obstruction in the left. Silicone intubations were performed on both sides and the epiphora were successfully treated. CONCLUSIONS: Lacrimal drainage obstructions may develop after S-1 treatment. Therefore, ophthalmologic evaluations should be performed in patients treated with S-1 to detect lacrimal drainage obstruction.
Adult ; Drainage ; Eye ; Gastrectomy ; Humans ; Intubation ; Lacrimal Apparatus Diseases ; Male ; Membranes ; Middle Aged ; Oxonic Acid ; Pyridines ; Silicones ; Stomach Neoplasms ; Tears

No abstract available.

Systemic lupus erythematosus is a multisystemic autoimmune disease in which the kidneys are frequently involved. Clinical diagnosis of SLE is based on the criteria of American Rheumatism Association (ARA). A few cases who were classified as SLE by the ARA criteria but were antinuclear antibody (ANA)-negative have been reported. It was reported that critical factor in ANA positivity is the choice of substrate. It is generally accepted that the cultured cell of human origin, especially HEP-2 cell, is better than tissue section or animal cells. Thus, the ANA test is negative only in approximately 2M of SLE patients when human tissue culture cells are used as substrate. We report a 25-year-old man admitted to our hospital because of generalized edema. He was found to have active lupus nephritis(WHO class IV), photosensitivity and pancytopenia. The result of FANA test which used HEP-2 cell as substrate was repeatedly negative, but anti-ds DNA and anti-Ro antibody were positive.
Adult ; Animals ; Antibodies, Antinuclear ; Autoimmune Diseases ; Cells, Cultured ; Diagnosis ; DNA ; Edema ; Humans ; Kidney ; Lupus Erythematosus, Systemic ; Lupus Nephritis* ; Pancytopenia ; Rheumatic Diseases