Chronic inflammation and fibrosis are the most common histopathologic findings in lacrimal sac specimens obtained during DCR. Only two cases of lymphoma (0.4%) were encountered in the series, one of which had a suspicious lacrimal sac appearance during surgery while the other case (0.2% of all specimens) was unsuspected. The rate of malignant etiology for NLD obstruction is low enough to justify lacrimal sac biopsy only in suspicious cases.

Vision may be preserved in pediatric VKH panuveitis using steroids and methotrexate for the control of inflammation, lensectomy-vitrectomy for visual improvement, and synechiolysis for IOP control.

A single transcutaneous injection of Dysport is safe and effective for treatment of lid retraction due to TED. Minor complications such as ptosis and diplopia may occur, however, this modality may offer temporary relief for patients with dysthyroid lid retraction awaiting orbital decompression or strabismus surgery or both.

Purpose:We compared the effectiveness of three active vision therapy approaches for convergence insufficiency (CI).Methods:This randomized clinical trial included patients meeting the eligibility criteria and with symptomatic CI, who were allocated into three groups. In the home-based vision orthoptic therapy (HBVOT) group, patients performed the pencil push-up procedure 15 min/day for 5 days/week. In the office-based vision orthoptic therapy (OBVOT) group, patients underwent 60-min orthoptic therapy using a major amblyoscope twice weekly with additional home orthoptic therapy. In the augmented office-based vision orthoptic therapy (AOBVOT) group, patients performed orthoptic exercises using 3-diopter over-minus lenses and a base-out prism in addition to major amblyoscope therapy, and additional home reinforcement was prescribed during the same time period.Results:All 84 subjects (mean age, 26.8 ± 8.3 years) showed a statistically significant improvement in near exophoria, positive fusional vergence (PFV) at near, near point of convergence (NPC), stereoacuity, and Convergence Insufficiency Symptom Survey (CISS) scores at follow-up. Exophoria decreased by 64%, 68%, and 85% in the HBVOT, OBVOT, and AOBVOT groups, respectively (P = 0.2). PFV increased by 68%, 100%, and 100% in the HBVOT, OBVOT, and AOBVOT groups, respectively (P < 0.001). NPC decreased (improved) by 86%, 89%, and 96% in the HBVOT, OBVOT, and AOBVOT groups, respectively (P = 0.4). The CISS scores decreased by 75%, 96%, and 100% in the HBVOT, OBVOT, and AOBVOT groups, respectively (P = 0.003).Conclusion:Our results showed that in adults with CI, the augmented office-based orthoptic treatment was relatively more effective than the other treatments.

Purpose:The purpose of this study was to evaluate the demographics and clinical features of eyelid masses in a tertiary eye hospital over a 10-year period.Materials and Methods:A retrospective chart review was performed for patients admitted with eyelid tumors from 2000 to 2010. Data were collected and analyzed on the demographic features, location of the tumor, types of treatment, and pathologic findings.Results:A total number of 182 patients were evaluated of which, 82 cases were benign and 100 cases were malignant neoplasms. The most common benign tumors included melanocytic nevi (35%), papilloma (19.5%), and cysts (11%). The most frequent malignant tumors included basal cell carcinoma (BCC) (83%), squamous cell carcinoma (8%) and sebaceous gland carcinoma (6%). The most common site for malignancy was the lower lid followed by the upper lid. BCC recurred in 16 cases that were most frequent in the lower lid.Conclusion:Melanocytic nevus, papilloma and cysts are the most common benign lesions and BCC is the most common malignant lesion in the eyelids. Recurrence is a feature of BCC especially in the lower lid.

The great majority of patients undergoing strabismus surgery, especially younger subjects, those undergoing operation on cyclovertical muscles, and subjects with higher baseline heart rate, experience OCR during strabismus surgery. During surgery on cyclovertical muscles, the amount of pull is usually more due to more difficult exposure.

To evaluate the demographic and clinical features of orbital cellulitis (OC) and preseptal cellulitis (PC) in a tertiary eye hospital over a 10-year period. This is a retrospective study of files of patients defined as OC or PC admitted to Labbafinejad Hospital, Tehran, Iran, in which clinical specificities and results of treatment and complications were reviewed. A total of 93 records of patients with OC or PC were identified from 1997 to 2007. 42 % of the patients had orbital and 58 % had PC. OC was found to be twice as common in males but PC occurred equally in both sexes. The mean ages ± SD of patients with OC and PC were 27.4 ± 23.9 and 19.1 ± 23.3 years, respectively. 97.8 % of involvements were unilateral. The most common complaint of the patients was change in lid appearance and the most common season of involvement was spring in both groups. Sinusitis was the most common background in 53.8 % of OC and 24.1 % of PC patients, and the sinus most commonly involved was the ethmoid. Surgical intervention was needed in 48.7 % of orbital and 14.8 % of PC. The only complication seen in OC was external ophthalmoplegia in a case which needed operation. In our geographical region, orbital and PC are seen most frequently in young patients in spring and their most common background is ethmoiditis; complications may be prevented by appropriate medical and/or surgical management.

PurposeTo assess outcomes of levator resection for the surgical correction of congenital and acquired upper lid ptosis in patients with fair to good levator function and evaluation of the relationship between demographic data and success of this operation.MethodsIn a retrospective study, medical records of patients with blepharoptosis who had undergone levator resection over a 10-year period and were followed for at least 3 months were reviewed.ResultsOverall, 136 patients including 60 (44.1%) male and 76 (55.9%) female subjects with a mean age of 20 ± 13.8 years (range, 2 to 80 years) were evaluated, of whom 120 cases (88.2%) had congenital ptosis and the rest had acquired ptosis. The overall success rate after the first operation was 78.7%. The most common complication after the first operation was undercorrection in 26 cases (19.1%), which was more prevalent among young patients (p = 0.06). Lid fissure and margin reflex distance (MRD1) also increased after levator resection (p < 0.001). Age, sex, type of ptosis, amblyopia, levator function, MRD1, lid fissure and spherical equivalent were not predictive of surgical outcomes of levator resection.ConclusionsLevator resection has a high rate of success and few complications in the surgical treatment of congenital and acquired upper lid ptosis with fair to good levator function. Reoperation can be effective in most cases in which levator resection has been performed.