Keratoconus was found in 1.12% of patients seeking refractive surgery, with no gender preference. Most cases had bilateral affection. Astigmatism was the most common refractive error to be associated with keratoconus.

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 evaluate the recent intraoperative lagophthalmos formula method for levator resection in determining postoperative lid height in congenital ptosis on Egyptian patients. Methods: This is a prospective case series which included 20 eyelids of 17 Egyptian children with congenital ptosis whose levator function is 4 mm or better. They underwent levator muscle resection guided by the recently presented intraoperative lagophthalmos formula. Preoperative Margin-to-Reflex Distance 1 (MRD1) and levator function were measured then intraoperative palpebral fissure opening was determined from formula: Intraoperative lagophthalmos = 9.08 − (0.48 × Preoperative MRD1) − (0.26 × Levator function). Success was defined as postoperative MRD1 ⩾ 3 mm and difference between both eyelid height ⩽1 mm at 6 months. Results: From 20 eyelids, there were five cases with mild (25%), 11 with moderate (55%), and four with severe (20%) ptosis. They showed success in four cases (80%), eight cases (73%), and three cases (75%) in each degree respectively with an overall success of 15 cases (75%). Conclusion: Proposed intraoperative lagophthalmos formula showed relatively good results in predicting postoperative eyelid level in Egyptian children with simple congenital ptosis with fair to good levator function.

The study aims at evaluating eyebrow elevation as a prognostic factor for frontalis sling procedure success in patients suffering from severe congenital ptosis with poor levator function. Patients and Methods: This is a retrospective study that included 66 eyelids of 57 patients selected from a surgical log database between January 2016 and June 2019. All of them underwent frontalis suspension surgery for treating severe congenital myogenic ptosis with poor levator function. Based on the absence or presence of brow elevation, patients were divided into two groups: 1 and 2, respectively. The latter was further subdivided into subgroup A with unilateral brow elevation and subgroup B with bilateral brow elevation. All included cases completed 6 months of follow-up after surgery. Postoperative functional outcomes in the form of margin reflex distance (MRD1) and palpebral aperture (PA) were recorded and correlated to preoperative brow elevation status. Results: Both principal groups showed improvement of MRD1 and PA compared to the preoperative values. There was no statistically significant difference between both groups for the tested parameters in the 1st postoperative week. By the 6th postoperative month, MRD1 and PA showed statistically significant higher values in group 2 compared to group 1 (p<0.001). However, the difference between subgroups A and B was statistically insignificant for the same parameters. Conclusion: Eyebrow elevation is significantly associated with the success of frontalis suspension procedure. Hence, brow position evaluation should be included in the preoperative assessment of patients undergoing frontalis suspension for congenital ptosis.

Aim: To evaluate the role of anterior segment-optical coherence tomography (AS-OCT) in the diagnosis of punctal stenosis and to compare punctal parameters before and after medical treatment. Patients and Methods: The study was conducted on 40 eyes of 24 patients who had acquired inflammatory punctal stenosis and had persistent epiphora (persistent epiphora group-PEG), and 20 eyes of 10 subjects with normal punctal openings as a control group (control group-CG). We measured the outer punctal diameter (OPD), recorded the visibility of the internal punctum and punctal depth (PD) using AS-OCT, before and 1 month after treatment with preservative free methylprednisolone 5% eye drops. Punctal diameter, tear meniscus height (TMH) and Munk's score were compared to the control group before and after treatment. Results: The mean OPD of the PEG before treatment (455.5 ± 174 µm) was significantly smaller than that of the CG (590.9 ± 106.6 µm) (P= 0.002). The mean OPD of the PEG significantly increased to 484.6 ± 175.5 µm after treatment (P <0.001). Also, the visibility of vertical canaliculus lumen and PD were restored in 70% of eyes. The TMH was much higher in the PEG than in the CG before treatment (P<0.05). However, after treatment the difference was not statistically significant. Conclusion: AS-OCT parameters were useful in monitoring and measuring the efficacy of medical treatment in relieving punctal edema, which subsequently resulted in reducing the epiphora symptoms.