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Tarsoconjunctival rotational flap and the use of skin of prepuce are very helpful and seems to be an adequate method of reconstruction of large eyelid defect in male patients when the usual donor sites for skin grafts are not available as in infants.

Purpose:To study the cosmetic outcome of external dacryocystorhinostomy (Ex-DCR) and to detect the factors affecting it.Patients and Methods:Prospective randomized interventional study included forty patients who were treated by 40 Ex-DCRs. In twenty patients, medial canthal vertical incision was used and in the other twenty cases, subciliary incision was used. The skin was closed using vicryl 6-0 or prolene 6-0 interrupted sutures, and each one was randomly used in twenty patients (10 patients of each incision type). Cosmetic outcome was evaluated 6 months postoperative by the patients and by an oculoplastic surgeon on a four grades scale. Cosmetic results and its correlation to patients’ age, sex, skin complexion, type of incision, and type of skin sutures were studied.Results:The mean scar grading was 0.98 ± 1.0 and 1.3 ± 1.0 in patients’ and examiner's assessment. About 27.5% described their scars as cosmetically significant. The cosmetic outcome was significantly affected by the type of incision with only 5% significant scars in subciliary incision group. Prolene 6-0 suture was associated with better cosmetic results with 15% significant scars. 50% of dark-skinned patients showed cosmetically significant scars. Although no correlation was found between patients’ age and cosmetic outcome, pediatric patients showed higher tendency to scar visibility with mean scar grade 1.2 ± 1.0 and 1.5 ± 0.9 in patients’ and examiner's assessment.Conclusion:Dark skinned and pediatric patients are more prone to visible Ex-DCR scar. The use of subciliary approach and prolene 6-0 skin sutures is associated with more favorable cosmetic outcome.

Aim: Evaluation of the role of silicone intubation in non-complicated External dacryocystorhinostomy (Ext-DCR). Background: Silicone intubation is described as a step of Ext-DCR. It was proposed that it may prevent obstruction involving the osteotomy or the common canaliculus. However, its necessity in non-complicated Ext-DCR is controversial. Objective: To study the effect of intubation and its duration on the results of non-complicated Ext-DCR. Methods: A prospective randomized interventional study that included 75 Ext-DCRs. Patients with a high risk of failure were not included. Patients were randomly distributed between 3 equal groups with either traditional 3 months intubation (group A), short-term intubation for 2-3 weeks (group B), or non-intubation (group C). Results: The success rate was 92%, 96%, and 92% in groups A, B, and C, respectively, with no significant differences (P = 0.853). Temporary foreign body sensation was reported in 16% in group A and 12% in group B. No significant complications were recorded in any of the 3 groups. Conclusion: Intubation (either short-term or 3 months) did not affect the results of Ext-DCR, which gives more evidence that it is not necessary in non-complicated cases.