Lacrimal fistula (LF) is a rare abnormality of the lacrimal system. Patients with LF are usually asymptomatic, and thus, treatment is unnecessary. During surgery on a patient with LF, the fistula may fall into the range of dissection. In such cases, fistula management becomes important. A 19-year-old woman visited our department to receive incisional blepharoplasty and medial epicanthoplasty, and a preoperative physical examination revealed LF. During surgery, we found the fistula tract to be within the dissection field, and thus, the LF was cut and cauterized. One year after the surgery, inflammation and hypertrophy of the remnant lacrimal duct occurred. The wound was stabilized by creating an opening that reconnected the stump and the overlying skin. Through this case, we hope to establish the appropriate strategy for managing LF detected during medial epicanthoplasty. As seen in our case, cauterization should be avoided because of the high recurrence rate of LF. Instead, as definitive treatment, fistulectomy should be performed, or the fistula should be moved along with the skin flap when a small skin flap is transferred.
Blepharoplasty ; Cautery ; Female ; Fistula* ; Hope ; Humans ; Hypertrophy ; Inflammation ; Lacrimal Apparatus ; Physical Examination ; Recurrence ; Skin ; Wounds and Injuries ; Young Adult

Lacrimal fistula (LF) is a rare abnormality of the lacrimal system. Patients with LF are usually asymptomatic, and thus, treatment is unnecessary. During surgery on a patient with LF, the fistula may fall into the range of dissection. In such cases, fistula management becomes important. A 19-year-old woman visited our department to receive incisional blepharoplasty and medial epicanthoplasty, and a preoperative physical examination revealed LF. During surgery, we found the fistula tract to be within the dissection field, and thus, the LF was cut and cauterized. One year after the surgery, inflammation and hypertrophy of the remnant lacrimal duct occurred. The wound was stabilized by creating an opening that reconnected the stump and the overlying skin. Through this case, we hope to establish the appropriate strategy for managing LF detected during medial epicanthoplasty. As seen in our case, cauterization should be avoided because of the high recurrence rate of LF. Instead, as definitive treatment, fistulectomy should be performed, or the fistula should be moved along with the skin flap when a small skin flap is transferred.
Blepharoplasty ; Cautery ; Female ; Fistula* ; Hope ; Humans ; Hypertrophy ; Inflammation ; Lacrimal Apparatus ; Physical Examination ; Recurrence ; Skin ; Wounds and Injuries ; Young Adult

In Korea, lateral canthoplasty, along with medial epicanthoplasty, has become popular over the past years to widen the horizontal length of the palpebral fissure. However, the effect of the surgery differs greatly depending on the shape and structure of the eyes. If over-widened, complications such as eversion, scarring, and conjunctival exposure may occur. Thus, the author of this study suggests a more effective and safe method for lateral canthal lengthening that causes minimal complications. A total of 236 patients underwent lateral canthoplasty between July 2007 and December 2015. For each patient, a triangular flap 4-5 mm away from the lateral canthus was elevated and rotated 45 degrees laterally while the continuity of the lower eyelid gray line was maintained. A new lateral canthus was created by fixating the rotation flap to the lateral orbital rim with minimal skin trimming and tension-free sutures, preventing relapse and maintaining a triangular shape. In more than 95% of cases, effective and satisfactory extension was achieved. On average, a 3 mm extension of the lateral canthus was achieved. There were minor complications such as wound dehiscence, webbing, and scarring, which were easily corrected. The author not only extended the lateral canthus 3-4 mm laterally but also maintained the continuity of the gray line on the lower lid as a more natural-looking triangular shape, while minimizing complications such as webbing and conjunctival exposure.
Cicatrix ; Eyelids ; Humans ; Korea ; Lacrimal Apparatus ; Methods ; Orbit ; Recurrence ; Skin ; Sutures ; Wounds and Injuries

OBJECTIVE: To explore the diagnostic role of computed tomographic dacryocystography (CTDCG) in lacrimal path damage and provide operative approach guidance for the endoscopic transnasal dacryocystorhinostomy (DCR). METHOD: Twenty-eight cases with lacrimal path damage underwent CTDCG. The following reconstruction techniques including volume rendering (VR), multiple planar reconstruction (MPR), maximum intensity projection (MIP) and three-dimensional reconstruction (3-d R) were done on the real-time workstation. The morphology of dacryocyst, displacement fracture of the lacrimal fossa (FS) and the relationship between the uncinate process (UP) and the FS were observed. The thickness of inner walls of anterosuperior and posteroinferior aspects of lacrimal fossa was measured. RESULT: The morphology of dacryocyst, the displacement fracture of the lacrimal fossa and the block site of the lacrimal passage could be displayed clearly by CTDCG with the following reconstruction techniques including VR, MPR, MIP and 3-d R, 6 cases of canaliculus obstruction, 14 cases of lacrimal sac obstruction, 8 cases of lacrimonasal duct obstruction were showed. Meanwhile the relationship between the UP and the FS could also be showed clear. The average bony thickness of the anterosuperior part of FS was (2.96 +/- 0.30) mm, while the bony thickness of the posteroinferior half was (0.02 +/- 0.005) mm, and the distance between the top and bottom of dacryocyst to the operculum of the middle turbinated (OMT) are (6.80 +/- 1.50) mm, (4.00 +/- 1.80) mm respectively (P < 0.05). CONCLUSION The morphology of dacryocyst, the displacement fracture of the lacrimal fossa, block site of the lacrimal passage and the relationship between the UP and FS can be clearly displayed by CTDCG, which provide operative approach guidance for the endoscopic transnasal dacryocystorhinostomy.
Adolescent ; Adult ; Dacryocystorhinostomy ; Endoscopy ; Female ; Humans ; Lacrimal Apparatus ; diagnostic imaging ; injuries ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods ; Young Adult

OBJECTIVETo evaluate the clinical effects of one-passage, double-passage and circular canalicular intubations in repairing lacerations of canaliculus.

METHODSA total of 109 eyes in 109 cases of canalicular laceration were repaired with three types of silicone intubations, among which 23 with one-passage canalicular intubation, 51 with double-passage canalicular intubation, and 35 with circular canalicular intubation. The average follow-up period was 12-15 months.

RESULTSThe wound/junction of the lacrimal canaliculi was ruptured in 5 cases (9.80%) of the double-passage group, 3 cases (8.57%) of the circular group, and 8 cases (34.78%) of the one-passage group. The rupture incidence of the one-passage group was significantly higher than that of the other two groups (X(2) equal to 9.416, P less than 0.01). During the intubation, canaliculitis was observed in 12 cases (23.53%) of the double-passage group, while only 3 cases (8.57%) in the circular group and 8 cases (34.78%) in the one-passage group. The circular group had significantly lower incidence of canaliculitis than the other two groups (X(2) equal to 6.095, P less than 0.05). After extubation 6 months after laceration repair, the lacrimal passage remained patent with canalicular irrigation in 46 cases (90.20%) in the double-passage group, 30 cases (85.71%) in the circular group and 15 cases (65.22%) in the one-passage group. Six months after surgery, the canalicular patency in the one-passage group was significantly lower than that of the other two groups (X(2) equal to 7.390, P less than 0.05).

CONCLUSIONSCircular canalicular intubation is more stable and has less surgical complications than the double-passage and one-passage canalicular intubations. It is also more effective clinically 12-15 months after laceration surgery.

Adolescent ; Adult ; Child ; Female ; Humans ; Intubation ; Lacerations ; surgery ; Lacrimal Apparatus ; injuries ; Male ; Middle Aged ; Silicones

OBJECTIVETo investigate the necessity of modification to the traditional pigtail probe and evaluate its efficiency and therapeutic effect in searching the nasal cut ends and anastomosing the lacerated lacrimal canaliculus.

METHODSEighty-seven patients (including 87 eyes) suffering from canalicular laceration were randomized into two groups: 41 patients treated with traditional pigtail probes (Group A) and 46 with modified pigtail probes (Group B). During the reconstruction of the lacerated canaliculi, the traditional pigtail probe and the modified pigtail probe were used respectively to seek for the nasal cut ends of lacerated lacrimal canaliculi. Peripherally inserted central catheter (PICCTM) silicone tube with diameter of 0.95 mm was intubated as a stent for 4-6 months. The surgical outcomes were retrospectively analyzed after stent removal.

RESULTSIn Group B, the primary success rate of searching the nasal cut ends of lacerated lacrimal canaliculi was 93.48% (43/46) and the final success rate was 97.83% (45/46). No false passage formed in Group B. Statistical significance was found between Group A and Group B as the primary success rates of searching the nasal cut ends (X(2) equal to 10.522, P less than 0.01) and the false passage forming rates were concerned (X(2)) equal to 4.704, P less than 0.05), whereas no significance was found between the two groups as the final success rates were concerned (X(2) equal to 0.007, P larger than 0.05). The mean time of searching the nasal cut ends of lacerated lacrimal canaliculi in Group B was (5.02+/-0.73) minutes and the mean time of operation was (33.90+/-4.84) minutes, and both were significantly shorter than those of Group A (t(1) equal to 9.779, t(2) equal to 10.700, P less than 0.01). The cure rate of Group B was 95.65%, though higher than that of Group A, no statistical significance was found (Z equal to -0.007, P larger than 0.05). Totally, 2 patients (2.30%) were found to be absent of common canaliculus and underwent bicanalicular nasal intubation in the two groups.

CONCLUSIONSPigtail probes are efficient and convenient apparatus for searching the nasal cut ends of the lacerated lacrimal canaliculi in the reconstruction of canalicular laceration. Necessary or proper modifications to the pigtail probes can minimize the risk of iatrogenic damages or complications and enhance the efficiency and therapeutic effect of canalicular repair.

Adolescent ; Adult ; Anastomosis, Surgical ; instrumentation ; Equipment Design ; Eye Injuries ; surgery ; Female ; Humans ; Intubation ; instrumentation ; Lacerations ; surgery ; Lacrimal Apparatus ; injuries ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; instrumentation ; Young Adult

PURPOSE: We report a simple and effective method of identifying the medial cut end of lower canalicular laceration cases. METHODS: Twenty-seven eyes with lower canalicular lacerations as a result of trauma were involved in the study. Surgery was performed within 48 hours after injury for canalicular reconstruction. Upper canalicular probing was utilized to identify the medial cut end of deep canalicular lacerations when difficulties were encountered. Total time from the initiation of the probing procedure to the identification of the medial cut end of the lower canaliculus was measured. RESULTS: A total of 27 eyes with lower canalicular lacerations were reconstructed. In 20 eyes, the medial lacerated end was located by upper canalicular probing. The mean time from initiation of the probing procedure to identification of the medial cut end of the lacerated canaliculus was 2 minutes. CONCLUSIONS: We conclude that upper canalicular probing in patients with lower canalicular lacerations significantly reduces the time from the initiation of the operation to the identification of the medial cut end of the lower canaliculus.
Adolescent ; Adult ; Aged ; Child ; Diagnostic Techniques, Ophthalmological ; Eye Injuries/*radiography/surgery ; Eyelids/*injuries ; Female ; Humans ; Intubation/methods ; Lacerations/*radiography/surgery ; Lacrimal Apparatus/*injuries/radiography/surgery ; Male ; Middle Aged ; Ophthalmologic Surgical Procedures ; Time Factors

We report four unusual cases of upper eyelid retraction following periorbital trauma. Four previously healthy patients were evaluated for unilateral upper eyelid retraction following periorbital trauma. A 31-year-old man (Case 1) and a 24-year-old man (Case 2) presented with left upper eyelid retraction which developed after blow-out fractures, a 44-year-old woman (Case 3) presented with left upper eyelid retraction secondary to a periorbital contusion that occurred one week prior, and a 56-year-old man (Case 4) presented with left upper eyelid retraction that developed 1 month after a lower canalicular laceration was sustained during a traffic accident. The authors performed a thyroid function test and orbital computed tomography (CT) in all cases. Thyroid function was normal in all patients, CT showed an adhesion of the superior rectus muscle and superior oblique muscle in the first case and diffuse thickening of the superior rectus muscle and levator complex in the third case. CT showed no specific findings in the second or fourth cases. Upper eyelid retraction due to superior complex adhesion can be considered one of the complications of periorbital trauma.
Accidents, Traffic ; Adult ; Eye Injuries/*complications/surgery ; Eyelid Diseases/*etiology/radiography ; Female ; Humans ; Lacerations/complications/surgery ; Lacrimal Apparatus/*injuries ; Male ; Middle Aged ; Oculomotor Muscles ; Orbital Fractures/*complications/surgery ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the therapeutic effects of two anastomoses (canaliculus-to-lacrimal sac anastomosis and end-to-end anastomosis) on nasolacrimal laceration for over 7 mm from the broken end to the dacryon.

METHODSA total of 71 patients (44 males and 27 females, aged 16-55 years, mean equal to 34.32 years) with fresh canalicular laceration were treated in our hospital from March 2003 to April 2008. Under a microscope, 37 patients were treated with lacrimal sac anastomosis (the treatment group) and 34 with end-to-end anastomosis (the control group), detaining silicone tubes till 3 months later.

RESULTSThe cure rate of the treatment group (89.19%) was significantly higher than that of the control group (55.56%). Class I cure rates were 70.27% in the treatment group and 47.06 % in the control group, and the difference between the two groups was significant (P less than 0.05). Postoperative inflammatory reactions had significant influences on the two kinds of anastomosing methods, but no significant difference was found between the two groups (P larger than 0.05).

CONCLUSIONSWhen the distance from the broken end to the dacryon is over 7 mm, especially when it is necessary to find the paranasal broken end of the lacrimal canaliculus with dacryocystotomy, canaliculus-to-lacrimal sac anastomosis is a better treatment method than end-to-end anastomosis for laceration of lacrimal canaliculus.

Adolescent ; Adult ; Anastomosis, Surgical ; Female ; Humans ; Lacerations ; surgery ; Lacrimal Apparatus ; injuries ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Treatment Outcome

PURPOSE: To report the clinical effect of a superior-inferior sliding conjunctival flap for pterygium using fibrin tissue adhesives (Tisseel(R); Baxter Healthcare Corporation, Glendale, CA) instead of sutures. METHODS: After the primary pterygial tissue was removed from the sclera, a superior-inferior sliding conjunctival flap was created. The fibrin tissue adhesive (Tisseel(R)) was composed of two solution types: fibrinogen containing aprotinin solution and a CaCl solution containing thrombin. The two solutions with 27 G needle were applied on the bare sclera in sequence, and the conjunctival flap was attached into the bare sclera within 5 seconds. We performed this procedure with a fibrin tissue adhesive instead of sutures in three patients, and follow-up for recurrence of pterygium and postoperative complications. RESULTS: The superior-inferior sliding conjunctival flaps were attached into the bare sclera in all patients using fibrin tissue adhesives. We didn't find any significant postoperative complications such as ocular pain, epiphora, foreign body sensation, wound defect, or dehiscence. CONCLUSIONS: A superior-inferior sliding conjunctival flap constructed with fibrin tissue adhesives should be a useful management tool for the inhibition of the recurrence of pterygial.
Aprotinin ; Delivery of Health Care ; Fibrin Tissue Adhesive* ; Fibrin* ; Fibrinogen ; Follow-Up Studies ; Foreign Bodies ; Humans ; Lacrimal Apparatus Diseases ; Needles ; Postoperative Complications ; Pterygium* ; Recurrence ; Sclera ; Sensation ; Sutures ; Thrombin ; Tissue Adhesives ; Wounds and Injuries