BACKGROUND: To present our experience on orbital and periorbital tissue changes after proton beam radiation therapy (PBRT) in patients with intraocular tumors, apart from treatment outcomes and disease control. METHODS: Medical records of 6 patients with intraocular tumors who had been treated with PBRT and referred to oculoplasty clinics of two medical centers (Seoul National University Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center) from October 2007 to September 2014 were retrospectively reviewed. The types of adverse effects associated with PBRT, their management, and progression were analyzed. In anophthalmic patients who eventually underwent enucleation after PBRT due to disease progression, orbital volume (OV) was assessed from magnetic resonance (MR) images using the Pinnacle3 program. RESULTS: Among the six patients with PBRT history, three had uveal melanoma, and three children had retinoblastoma. Two eyes were treated with PBRT only, while the other four eyes ultimately underwent enucleation. Two eyes with PBRT only suffered from radiation dermatitis and intractable epiphora due to canaliculitis or punctal obstruction. All four anophthalmic patients showed severe enophthalmic features with periorbital hollowness. OV analysis showed that the difference between both orbits was less than 0.1 cm before enucleation, but increased to more than 2 cm3 after enucleation. CONCLUSION: PBRT for intraocular tumors can induce various orbital and periorbital tissue changes. More specifically, when enucleation is performed after PBRT due to disease progression, significant enophthalmos and OV decrease can develop and can cause poor facial cosmesis as treatment sequelae.
Canaliculitis ; Child ; Dermatitis ; Disease Progression ; Enophthalmos ; Humans ; Lacrimal Apparatus Diseases ; Medical Records ; Melanoma ; Orbit ; Protons* ; Retinoblastoma ; Retrospective Studies ; Seoul

PURPOSE: To compare the clinical effects of the single wide-diameter bicanalicular silicone tube and the double bicanalicular silicone tube in endonasal dacryocystorhinostomy (DCR) with canalicular trephinization for canalicular obstruction. METHODS: We retrospectively reviewed the records of 121 patients with monocanalicular or common canalicular obstruction who had undergone endonasal DCR with random bicanalicular insertion of either double silicone tubes (insertion of two tubes into each canaliculus) or a single wide-diameter (0.94 mm) silicone tube. The tubes were removed at around 3 months after surgery. RESULTS: This study included 79 eyes of 61 patients in the double-tube intubation group and 68 eyes of 60 patients in the single wide-diameter tube intubation group. Anatomical success, evaluated by syringing, was achieved in 72 of the 79 eyes (91.1%) in the double-tube intubation group and 60 of the 68 eyes (88.2%) in the single wide-diameter tube intubation group. Functional success was achieved in 65 of the 79 eyes (82.3%) in the double-tube intubation group and 61 of the 68 (89.7%) eyes in the single wide-diameter tube intubation group. There were no significant differences in the success rates of surgery between the two groups. One patient in the double-tube intubation group underwent conjunctivodacryocystorhinostomy (CDCR) and two in the wide-diameter tube intubation group underwent CDCR or reintubation to treat recurrence. CONCLUSIONS: Intubation using a single wide-diameter tube during endonasal DCR is as effective as double-tube intubation for the treatment of canalicular obstruction, with a lower rate of complications such as inflammation or patient discomfort.
Canaliculitis ; Dacryocystorhinostomy ; Humans ; Inflammation ; Intubation ; Lacrimal Duct Obstruction ; Recurrence ; Retrospective Studies ; Silicon* ; Silicones*

PURPOSE: To report the therapeutic effect of squeezing the punctum and lacrimal canaliculus using Q-tips in canaliculitis patients. METHODS: From March 2004 to February 2014, 42 eyes of 42 patients diagnosed with canaliculitis at our clinic were retrospectively analyzed. To remove the discharge and concretions, the punctum and lacrimal canaliculus were squeezed using Q-tips without invasive procedures. RESULTS: The mean patient age was 56.39 years and mean follow-up period was 10.6 months. No statistical significance was observed in terms of rate of disease occurrence and mean age between males and females. Among the eyes analyzed, 30 (71.4%) were cured with only 1 squeezing procedure, 12 eyes (28.6%) required more than 2 procedures; 1 eye (2.3%) recurred and the period until recurrence was 3.8 months. CONCLUSIONS: Most studies support surgical management as the definitive therapy for canaliculitis to remove concretions that serve as a reservoir for bacteria. The gold standard treatments are curettage or canaliculotomy; however, these are not safe procedures and may result in epiphora in post-procedure patients due to the risk of lacrimal pump dysfunctioning or scarring of the canalicular system following invasive procedure. Squeezing punctum and lacrimal canaliculus only using Q-tips is effective in removing the canalicular concretions and without causing complications in the canalicular system.
Bacteria ; Cicatrix ; Curettage ; Female ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Male ; Recurrence ; Retrospective Studies ; Canaliculitis

PURPOSE: To report a case of Pseudomonas fluorescens infection following endoscopic dacryocystorhinostomy and silicone tube intubation in a healthy patient who was using steroid nasal spray. In addition, a literature review is conducted. CASE SUMMARY: A 72-year-old female patient came to our clinic with tearing and hyperemia in the right eye. Ten months prior, she had undergone endoscopic dacryocystorhinostomy and silicone tube intubation due to nasolacrimal duct obstruction in the right eye. Six months after the first operation, dacryocystorhinostomy revision with silicone tube exchange was performed due to obstruction of the nasal bony orifice. In addition, the patient was using a steroid nasal spray. On slit lamp examination, conjunctival injection, marked inflammation and punctal edema around the tube were observed. The silicone tube was removed and the tube cultured. Pseudomonas fluorescens was isolated from the tube contents. The patients was treated with topical 0.3% gatifloxacin 4 times a day, methylol cephalexin lysinate 1000 mg 3 times a day and the nasal spray was discontinued. Two weeks later, all symptoms were resolved after treatment with antibiotic treatment. CONCLUSIONS: A case of Pseudomonas fluorescens canaliculitis which occurred in healthy patient who was using steroid nasal spray is presented with a literature review. Pseudomonas fluorescens canaliculitis can be treated by using proper antibiotics.
Anti-Bacterial Agents ; Cephalexin ; Corneal Ulcer ; Dacryocystitis ; Dacryocystorhinostomy ; Edema ; Eye ; Female ; Fluoroquinolones ; Humans ; Hyperemia ; Inflammation ; Intubation ; Nasolacrimal Duct ; Porphyrins ; Pseudomonas ; Pseudomonas fluorescens ; Silicones ; Canaliculitis

PURPOSE: To report on the clinical manifestations, species and treatments of patients with chronic canaliculitis. METHODS: From August 2003 to February 2012, 77 eyes of 77 patients who were diagnosed with chronic canaliculitis at our hospital were retrospectively analyzed. RESULTS: The mean period from the onset of symptoms to diagnosis was 4.7 months. The most common systemic disease associated with chronic canaliculitis was diabetes (18 eyes, 23%), and 13 eyes (17%) were related to punctual plug insertion. Main symptoms consisted of epiphora with discharge and pouting punctum. In the culture results of 55 eyes, streptococci, staphylococci, and actinomyces among other bacteria were identified. Seventy-two eyes (94%) were cured with one-snip punctoplasty with curettage. CONCLUSIONS: Chronic canaliculitis is rare, and the clinical aspect can be obscured by chronic conjunctivitis, thus the diagnosis is often delayed. In patients who have systemic diseases such as diabetes or past history of punctual plug insertion, chronic canaliculitis should be differentiated by observing the punctum more closely. If the diagnosis is accurate at the time, chronic canaliculitis could be easily cured by a relatively simple procedure such as one-snip punctoplasty with curettage.
Actinomyces ; Bacteria ; Conjunctivitis ; Corneal Ulcer ; Curettage ; Dacryocystitis ; Eye ; Humans ; Lacrimal Apparatus Diseases ; Retrospective Studies ; Canaliculitis

PURPOSE: Traumatic telecanthus can result from naso-ethmoid-orbital fractures. Repair of the medial canthal tendon(MCT) using transnasal wiring is regarded as a choice of method to treat telecanthus, however, is often complicated by incomplete anchoring and drift of canthus, extrusion of wire, in-fracture of orbital bone, and eye damage. The authors introduced oblique transnasal wiring method through the Hiraga's epicanthopalsty incision instead of well-known classical bicoronal approach. METHODS: Five patients with traumatic telecanthus were treated with this method. Though the Hiraga's epicanthoplasty incision, we could approach the operative field; the medial orbital wall and detached MCT. Oblique transnasal wiring was performed as following steps. After slit skin incision on the contralateral nasal recession area, drill holes were made from this point to the superior and posterior point of lacrimal sac of deformed eye. A 2-0 wire was double-passed through the holes and MCT. Traction was applied to ensure pulling the MCT and the wires were twisted in the contralateral nose, securing the MCT in the correct position. RESULTS: All patients except 1 person showed improvement and rapid recovery. On average each canthus was moved 5.6mm medially. In all cases, there were no eyelashes disappear, lacrimal canaliculitis, lacrimal duct injury, or infections. CONCLUSION: The Hiraga's epicanthoplasty incision could give sufficient operative field to reattach the MCT in traumatic telecanthus patients. And the oblique transnasal wiring technique is effective for the Asians who have flat nose and exophthalmic eye. The authors conclude that this technique could be a simple, safe and scarless method to correct traumatic telecanthus.
Asian Continental Ancestry Group ; Corneal Ulcer ; Craniofacial Abnormalities ; Dacryocystitis ; Dietary Sucrose ; Eye ; Eyelashes ; Humans ; Mandrillus ; Nose ; Orbit ; Skin ; Traction ; Canaliculitis

PURPOSE: To report the clinical features and treatment of canaliculitis associated with SmartPlug punctal plug insertion. METHODS: Case selection criteria included patients with canaliculitis, who were managed at Seoul National University Hospital from January 2006 to October 2008, presenting with a history of punctal plug insertion. The operation reports were reviewed to identify patients in whom SmartPlug was discovered during the operation. Six patients (8 eyes) were identified, and a retrospective chart review was performed for all the patients. RESULTS: The mean age of the patients was 34.3+/-8.6 years, and there were 1 men and 5 women. Common symptoms were mucous discharge (6 eyes) and conjunctival injection (2 eyes). The mean time from insertion of the plug to onset of symptoms was 27.0+/-27.0 months (range 4 to 77 months). All patients underwent surgical removal of the punctal plug by one-snip punctoplasty, canalicular retrograde compression using 2 cotton-tipped applications (2 eyes), or canalicular curettage (6 eyes). All patients had resolution of symptoms after the procedure. CONCLUSIONS: Canaliculitis should be considered when there is conjunctival discharge or injection in patients with SmartPlug. One-snip punctoplasty and retrograde compression of canaliculus can be attempted preferentially as a minimally-invasive treatment option.
Corneal Ulcer ; Curettage ; Dacryocystitis ; Female ; Humans ; Male ; Patient Selection ; Retrospective Studies ; Canaliculitis

PURPOSE: To report on the treatment approach of canaliculitis related to SmartPLUG use and its clinical manifestation. METHODS: A retrospective chart review of eight patients who had canaliculitis after the insertion of the SmartPLUG was conducted. RESULTS: Seven out of eight cases with canaliculitis related to the SmartPLUG required extraction of the SmartPLUG. While four cases were removed with only retrograde massage, two cases required surgical treatment. CONCLUSIONS: Canaliculitis related to SmartPLUG use is rarely reported. However, canaliculitis as a complication is difficult to treat and often leads to surgery. In canaliculitis related to SmartPLUG use, retrograde massage as a non-surgical method for the simple and effective removal of the SmartPLUG can be beneficial.
Corneal Ulcer ; Dacryocystitis ; Humans ; Massage ; Retrospective Studies ; Canaliculitis

PURPOSE: To investigate the incidence and clinical course of canaliculitis after dacryocystorhinostomy (DCR) with silicone tubes. METHODS: A retrospective analysis was performed on 521 eyes in 484 patients who had undergone DCR with silicone tubes between October 1994 and May 2006. RESULTS: Canaliculitis occurred in 11 eyes (2.1%). The mean age of the 10 patients involved in this study was 62.1 years (47~71 years) with a mean follow-up period of 11.1 months (6~36 months). The mean onset of canaliculitis was 3.2 months (1~5 months) after the surgery. All cases of canaliculitis were resolved with antibiotic treatment after silicone tube removal, and the surgical outcomes were successful in all patients. CONCLUSIONS: The incidence of canaliculitis after DCR with silicone tubes was rare. In such cases, the final surgical outcome was successful after appropriate treatment.
Corneal Ulcer ; Dacryocystitis ; Dacryocystorhinostomy ; Eye ; Follow-Up Studies ; Humans ; Incidence ; Retrospective Studies ; Silicones ; Canaliculitis

Actinomycosis of nasal cavity and paranasal sinuses is a rare chronic infectious disease. Canaliculitis is an uncommon condition which is developed from various causes. A case of canaliculitis due to actinomyces-infected nasolacrimal stent is reported.
Actinomycosis ; Communicable Diseases ; Corneal Ulcer ; Dacryocystitis ; Nasal Cavity ; Paranasal Sinuses ; Stents ; Canaliculitis