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Our retrospective review of a series of patients referred to our practice for tearing revealed a significant proportion of patients whose tearing etiology was other than a nasolacrimal duct obstruction. Of particular interest is the fact that 40% of patients had dry eye with reflex tearing, and the majority of these improved with lubrication. These patients were all identified by performing a Schirmer test to quantify the basal tear production. We believe that the Schirmer test is a useful diagnostic tool in assessing patients with tearing and ensuring that the appropriate management approach is undertaken.

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Direct, indirect, or diffuse forces may injure canaliculi but direct penetrating injuries were more common than avulsive injuries. More serious injuries (orbital fractures, globe rupture, other body injuries, and head trauma) were more commonly seen when diffuse trauma was involved.

The Bio-Eye orbital implant represents a porous orbital implant that is biocompatible with orbital tissues and allows fibrovascular ingrowth and improved motility when coupled to the overlying artificial eye. It is more expensive than other commercially available porous orbital implants, such as synthetic FCI3 HA, porous polyethylene (Medpor), and aluminum oxide (Bioceramic) implant. Problems encountered with its use are similar to those problems seen in patients with the synthetic FCI3 hydroxyapatite and aluminum oxide orbital implants.

Review of the charts of patients who underwent orbital decompression surgery for thyroid-related orbitopathy revealed a preoperative prevalence of diplopia of 26% and a postoperative prevalence of 40.7%. Amongst the patients with preoperative diplopia (n = 32), 28.1% (n = 9) had complete resolution of their diplopia after decompression, while 65.6% (n = 21) remained stable and 6.3% (n = 2) worsened. The incidence of new-onset diplopia was 29.7% in this case series of orbital decompression using a transcaruncular and swinging eyelid approach for medial wall and strut-sparing floor decompression. Rates of new-onset diplopia were significantly higher when periorbita was opened (40.0%, n = 82) compared with when it was left intact (11.8%, n = 37) CONCLUSIONS:: It has previously been reported in the literature that orbital decompression for thyroid-related orbitopathy can cause diplopia in a significant number of cases. This provides the rational for performing orbital decompression prior to strabismus surgery in the management of thyroid-related orbitopathy. In this case series, the authors noted resolution of diplopia in a significant proportion (28.1%) of patients with preexisting diplopia. This is rarely commented on in other articles but is important in the preoperative discussion. An incidence of new-onset diplopia of 29.7% was identified. Opening the periorbita was associated with an increased incidence of new-onset diplopia.

Implant exposures can occur anytime postimplant placement. This review discovered an implant exposure rate of 9.1%, with the majority of the exposures occurring after the postoperative follow-up period. Patients with porous orbital implants should be followed on a long-term basis to detect this complication.

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