Purpose To evaluate the corneal sensitivity and nerve morphology in dry eyes. Methods A total of 32 eyes of 16 patients (10 Sjogren's syndrome and six non-Sjogren's syndrome) and 19 eyes of 10 age-matched controls were studied. Sensitivity of the central cornea was measured by the Cochet-Bonnet aesthesiometer. The morphology of corneal nerves was studied by in vivo confocal microscopy (ConfoScan 2.0, Fortune Technologies Srl, Vigonza (PD), Italy). Sub-basal epithelial nerve plexus, subepithelial nerve plexus, and stromal nerves were localized and evaluated for the number of nerves, thickness, reflectivity, and tortuosity for each frame. Results The mean corneal sensitivity of dry eye patients (5.6 mm/grs/S) was found significantly lower than that of the control (5.0 mm/grs/S) group (Po0.01). Although the subepithelial nerves were thicker in dry eyes (mean: 6.3871.18 lm) than control eyes (mean: 5.7271.27 lm), this difference was not significant (P40.05). Conclusion Decreased corneal sensitivity is not associated with morphological changes of corneal nerves in dry eyes.

Purpose To compare the thickness of the ciliary bodies of eyes with unilateral high axial myopia with their relatively normal fellow eyes. Methods A total of 19 patients with unilateral high axial length (AL) were included in the study. Mean patient age was 28. 4±10.4 (11-44) years. All eyes underwent ultrasound biometry to measure the AL, and ultrasound biomicroscopy to measure the anterior chamber depth, ciliary body thickness (CBT), and ciliary process thickness (CPT), ciliary muscle thickness (CMT). The results were compared between each subject's high myopic eye and relatively normal fellow eye. Results The mean AL was 27.24±1.52 mm (range: 25.16-30.21 mm) in high myopic eyes and 23.64 ± 0.86 mm (range: 22.47-25.10 mm) in normal fellow eyes. The median ± 95% confidence interval of CBT, CPT, and CMT was 1.350±0.034, 0.626±0.072, and 0.698±0.057 mm, respectively, in high myopic eyes and 1.211±0.050, 0.535±0.064, and 0.644±0.065 mm, respectively, in normal fellow eyes. The anterior chamber depth, CBT, CPT, and CMT were significantly higher in myopic eyes compared with their relatively normal fellow eyes (Po0.05). CMT significantly increased with age in both groups (Po0.05). There was no significant correlation between age and CBT in both the groups (P40.05). Conclusion The CBT, CMT, and CPT are significantly higher in eyes with unilateral high axial myopia than in their relatively normal fellow eyes.

One hundred and eight patients (111 eyes) underwent conjunctivodacryocystorhinostomy with a Jones tube for treatment of epiphora resulting from canalicular obstruction. Sixty-nine patients (63.9%) were females and thirty-nine (36.1%) were males. Their ages ranged from 9 to 64 years, the mean age being 30.1 years. The causes of lacrimal drainage abnormalities included idiopathy (76 cases, 68.5%), trauma (15 cases 13.5%), tumors (8 cases, 7.2%) congenital abnormalities (6 cases, 5.4%) and conjunctival inflammation (6 cases, 5.4%). Twenty-eight (36.8%) eyes in the idiopathic group had previous failed dacryocystorhinostomies. The operation was successful in 90.1% of the eyes with relief of epiphora. Fifty-one out of 111 (45.9%) eyes had complications. Extrusion of the tube was the most frequent complication occurring in 20 (18%) eyes. Malposition (12 eyes 10.8%), infection (12 eyes, 10.8%) and obstruction of the tube (7 eyes, 6.3%) were the other major complications. Of the 20 eyes with tube extrusion, 11 experienced recurrent tube losses. Five of 11 eyes were free of epiphora after tube loss. Four out of five had the tube in place for 2 to 5 years and one had the tube, in place for one year. The remaining 6 eyes which had the tubes for 6 months to 3 years were complicated by epiphora. Our experience confirms the general belief that the tube should stay in place forever. The large majority of our patients could wear their tubes successfully and have done so in our practice for as long as 10 years.

Eyes with congenital ptosis have an increased incidence of astigmatism and a bow tie pattern on corneal topography. These features are associated with the presence of amblyopia.

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Nasolacrimal duct probing is advocated as a primary treatment in children younger than 9 years of age before proceeding to more complex treatment options. Unsuccessful probing may result from the selection of nonmembranous obstructions rather than the increased age of the patients.

The aim of this study was to determine the diagnostic accuracy of gadolinium-enhanced three-dimensional (3D) fast spoiled gradient-recalled (FSPGR) MR dacryocystography in patients with epiphora. Bilateral nasolacrimal systems of 19 patients suspected of having nasolacrimal canal obstruction were evaluated with MR dacryocystography. A sterile 0.9% NaCl solution containing 1:100 diluted gadolinium chelate was instilled into the bilateral conjunctival sacs of the patients. The 3D FSPGR sequence was used with 1.0-T scanner with the following parameters: TR 9.3 ms; TE 2 ms; flip angle 20; 256x224 matrix; 13- or 26-cm field of view; and 1-mm slice thickness. Seventeen patients had digital dacryocystography for comparison which we considered standard of reference. Thirty-four nasolacrimal systems were evaluated with MR and digital dacryocystography. Discrepancies between the findings of both methods were detected in 2 patients. The overall sensitivity of MR in detecting the obstruction was 100%. Magnetic resonance helped to determine the canalicular and ductal obstruction in 100% of the patients and the saccular obstruction in 80% of the patients. We conclude that 3D FSGR technique for MR dacryocystography is a reliable and noninvasive method in the evaluation of the obstruction level in the lacrimal system in patients with epiphora.

Purpose: To report the ultrasound biomicroscopy (UBM) findings of anterior segment tumors and simulating conditions. Methods: Thirty-five patients underwent UBM. Of those, 16 had histopathologically or cytopathologically diagnosed tumors, and 19 had clinically diagnosed lesions. Results: The study material comprised 13 iris pigment epithelial (IPE) cysts, 7 ciliary body melanomas, 4 iris melanomas, 4 iris nevi, 3 intraocular invasions of conjunctival squamous cell carcinoma, 2 ring melanomas of the anterior chamber angle, 1 medulloepithelioma and 1 pars plana cyst. On UBM, all IPE cysts presented as cystic lesions with a thin cyst wall and no solid components. All ciliary body melanomas showed low to medium reflectivity, with cavitation in one case and extraocular extension in another. Iris melanomas presented as anterior (stromal) iris lesions with medium to high internal reflectivity. There was irregularity and convex bowing of the posterior iris plane in iris melanomas, a feature not seen in iris nevi. Intraocular invasion of conjunctival squamous cell carcinoma was evidenced as areas of medium to high reflectivity in the ciliary body and iris, loss of the acute angle shape and highly reflective spots in the anterior chamber. Conclusions: UBM was particularly useful in the diagnosis of IPE cysts, in the visualization of small ciliary body melanomas, in the differentiation of iris melanomas from iris nevi and in the demonstration of intraocular invasion from conjunctival squamous cell carcinoma.