AIMS: Hyperlacrimation due to ocular surface or lid abnormality was ruled out and apposition of l... more AIMS: Hyperlacrimation due to ocular surface or lid abnormality was ruled out and apposition of lower punctum to globe was checked. SUBJECTS AND METHODS: This was a pilot study at a tertiary eye care center where 40 patients of proximal canalicular block <8 mm on probing were divided into two equal groups. The external CDCR group underwent routine dacryocystorhinostomy with partial carunculectomy. A tract was created from canthus to nasal cavity with von Graefe knife. In the laser CDCR group, the osteotomy was created using 980 mm diode laser with a power of 8 W. Glass tubes of appropriate length were placed and fixed using 5-0 polypropylene with our "mirror tuck technique." Results were analyzed using the Chi-square test for parametric and ANOVA test for nonparametric variables using SPSS software. RESULTS: Success defined as patency on syringing was achieved in 18 patients in the laser group and 16 in the external CDCR group which was comparable (P > 0.05). Complications include tube extrusion, dislocation, conjunctival overgrowth, and sump syndrome. CONCLUSION: Laser and external CDCRs are both effective and safe procedures for the treatment of proximal canalicular blocks with comparable success rates and complications.
Abstract: Silicon rods are widely employed for frontalis sling suspension. However, on passing th... more Abstract: Silicon rods are widely employed for frontalis sling suspension. However, on passing through the tissues, at times, the silicon rod gets detached from the stainless steel needle. This occurs more commonly in patients of blepharophimosis syndrome, in which hypoplasia of superior orbital rim with deficiency of skin between lid and brow, causes difficulty in passage of the needle when it is manipulated upwards from lid towards the brow. To overcome these problems we describe the use of an 18 G intravenous catheter to railroad the needle with the silicon rod, obviating the blind upward maneuvers with the needle and protecting against the damage to the silicon rod –needle assembly. The technique is easily reproducible, safe and can be used in all silicon rod suspensions.
Many oculoplastic conditions like ectropion, entropion, ptosis, lid lacerations, canalicular trau... more Many oculoplastic conditions like ectropion, entropion, ptosis, lid lacerations, canalicular trauma and dacryocystitis are commonly seen in everyday practice of any ophthalmologist. Delay in treatment of entropion and ectropion can lead to blindness due to development of secondary changes in cornea. Neglecting a child with severe ptosis can result in irreversible visual loss. Incorrect primary repair of lacerated lid and failure to repair the torn canaliculi are difficult to handle at a later stage even by an expert surgeon. Long-standing blocked distal lacrimal passages may result in suppurative infections with skin excoriation. This review elucidates the correct approach to some common oculoplastic diseases so as to achieve a timely intervention and referral and thereby avoid preventable complications.
Purpose: The study aims to compare the effectiveness and complications of transconjunctival retra... more Purpose: The study aims to compare the effectiveness and complications of transconjunctival retractor plication (TRP) with lateral tarsal strip (LTS) and the polypropylene sling (PS) surgery for treatment of involutional lower lid ectropion. Method: A prospective randomised pilot study was conducted on 30 eyes of 30 patients suffering from epiphora having horizontal eyelid laxity >6mm and age >50 years at a tertiary care centre from December 2014 to March 2015. They were randomly divided into two equal groups for TRP with LTS (group A) and PS (group B). Success was defined as relief in epiphora and lid laxity ≤4mm at 12 months post operatively. Result: There were 19 male and 11 female patients with age ranging from 55-80 years. The mean grade of ectropion was 2.80±1.32 in group A and 2.87±1.60 in group B. The preoperative horizontal laxity increased with the grade of ectropion (p <0.001) while medial canthal laxity was variable. The average surgical time per procedure in gr...
Silicon rods are widely employed for frontalis sling suspension. However, on passing through the ... more Silicon rods are widely employed for frontalis sling suspension. However, on passing through the tissues, at times, the silicon rod gets detached from the stainless steel needle. This occurs more commonly in patients of blepharophimosis syndrome, in which hypoplasia of superior orbital rim with deficiency of skin between lid and brow, causes difficulty in passage of the needle when it is manipulated upwards from lid towards the brow. To overcome these problems we describe the use of an 18 G intravenous catheter to railroad the needle with the silicon rod, obviating the blind upward maneuvers with the needle and protecting against the damage to the silicon rod –needle assembly. The technique is easily reproducible, safe and can be used in all silicon rod suspensions.
Many oculoplastic conditions like ectropion, entropion, ptosis, lid lacerations, canalicular trau... more Many oculoplastic conditions like ectropion, entropion, ptosis, lid lacerations, canalicular trauma and dacryocystitis are commonly seen in everyday practice of any ophthalmologist. Delay in treatment of entropion and ectropion can lead to blindness due to development of secondary changes in cornea. Neglecting a child with severe ptosis can result in irreversible visual loss. Incorrect primary repair of lacerated lid and failure to repair the torn canaliculi are difficult to handle at a later stage even by an expert surgeon. Long-standing blocked distal lacrimal passages may result in suppurative infections with skin excoriation. This review elucidates the correct approach to some common oculoplastic diseases so as to achieve a timely intervention and referral and thereby avoid preventable complications.
Background: Recovery of Bell`s phenomenon after levator resection is unpredicatable. Delayed reco... more Background: Recovery of Bell`s phenomenon after levator resection is unpredicatable. Delayed recovery can result in vision threatening corneal complications. Aim: To study the variability of Bell’s phenomenon and time taken for its recovery following levator resection for blepharoptosis and to correlate it with the amount of resection. Methods: A prospective observational study was conducted on 32 eyes of 32 patients diagnosed as unilateral simple congenital blepharoptosis who underwent levator resection at a tertiary care center between July 2013 and May 2015. Patients were followed up for 5 months and correction of ptosis, type of Bell`s, duration of Bell`s recovery and complications were noted. Results: The study group ranged from 16-25 years with 15:17 male: female ratio. There were 9 mild, 16 moderate and 7 severe ptosis. Satisfactory correction was achieved in all cases. Good Bell`s recovery occurred in 13 eyes on first post-op day, in 2-14 days in 19 eyes and 28 days in 1 eye...
Ophthalmic plastic and reconstructive surgery, Jan 20, 2016
To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy... more To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation, with and without intubation, in patients suffering from primary acquired nasolacrimal duct obstruction, at 1 year of follow up. A prospective, randomized interventional pilot study was conducted at a tertiary care center, in accordance with the guidelines of Declaration of Helsinki. Sixty eyes of 60 adult patients with primary acquired nasolacrimal duct obstruction were included. The participants were divided randomly into 2 equal groups (A and B-without and with bicanalicular intubation, respectively). An osteotomy was first created using 980 nm diode laser (set at 8W continuous mode) transcanalicularly and then enlarged intranasally using Blakesley's nasal forceps, followed by bicanalicular silicon intubation in group B patients. The tubes were removed at the end of 8 weeks. The ostium size was assessed endoscopically at 8 weeks and again at the end of...
The sump syndrome was initially described in relation to patients who had undergone external dacr... more The sump syndrome was initially described in relation to patients who had undergone external dacryocystorhinostomy. Here we report a case of sump syndrome that developed following laser conjunctivodacryocystorhinostomy (CDCR) due to tube displacement after a bout of forceful sneezing. Unlike cases of external dacryocystorhinostomy where flaps are sutured, there is a potential space created by the sac remnants in laser CDCR. Hence, any displacement of the tube will lead to the improper drainage of secretions with superadded infections of the contents (as occurred in this case). Therefore, in laser CDCR, it is imperative to create an appropriately placed osteotomy with a correctly sized tube that is well secured to avoid displacement along with patient education regarding tube care.
The purpose of this study is to study the operative difficulties and success rate of transcanalic... more The purpose of this study is to study the operative difficulties and success rate of transcanalicular laser-assisted endoscopic dacryocystorhinostomy in patients of chronic dacryocystitis with deviated nasal septum (DNS). A prospective interventional clinical study of 36 consecutive patients suffering from chronic dacryocystitis with nasolacrimal duct obstruction with DNS undergoing primary TCLADCR from March to June 2011 was carried out. Diode laser was used to create a 16-mm(2) ostium which was enlarged to 64 mm(2) using Blakesley&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s forceps. Success was defined as anatomical patency and absence of symptoms at 12 months of follow-up. Out of the 36 patients, 25 were females with ages 20-72 years, and 19 were left sided. There were 12 high, 12 mid and 12 basal DNS towards the side of surgery, mild to moderate in severity. Intraoperatively there was difficulty in visualising the aiming beam in the nose, tedious manipulation of endoscope and excessive bleeding in 3 patients. Increased bleeding and failures were significantly higher in high DNS (Fisher exact test-2 tailed: 0.0045). The procedure was successful in 94.4 % cases with average ostium size of 21.94 mm(2) at 12 months and no statistically significant difference in success rates between mild and moderate DNS (Fisher exact test-2 tailed: 1.000). Also there was no difference in the complication rate between mild and moderate DNS (Fisher exact test-2 tailed: 0.0841). TCLADCR is an effective procedure in patients with mild to moderate mid and basal DNS and obviates the need for multiple procedures and a cutaneous scar.
Silicon rods are widely employed for frontalis sling suspension. However, on passing through the ... more Silicon rods are widely employed for frontalis sling suspension. However, on passing through the tissues, at times, the silicon rod gets detached from the stainless steel needle. This occurs more commonly in patients of blepharophimosis syndrome, in which hypoplasia of superior orbital rim with deficiency of skin between lid and brow, causes difficulty in passage of the needle when it is manipulated upwards from lid towards the brow. To overcome these problems we describe the use of an 18 G intravenous catheter to railroad the needle with the silicon rod, obviating the blind upward maneuvers with the needle and protecting against the damage to the silicon rod -needle assembly. The technique is easily reproducible, safe and can be used in all silicon rod suspensions.
Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological Society, 2014
We report a case of naso-cutaneous fistula due to thermal injury during transcanalicular laser da... more We report a case of naso-cutaneous fistula due to thermal injury during transcanalicular laser dacryocystorhinostomy followed by superadded infection with coagulase negative staphylococcus in a diabetic patient. The case highlights the importance of meticulous wound care in the management and possibility of its occurrence even with minor thermal injury in immunocompromised patients.
AIMS: Hyperlacrimation due to ocular surface or lid abnormality was ruled out and apposition of l... more AIMS: Hyperlacrimation due to ocular surface or lid abnormality was ruled out and apposition of lower punctum to globe was checked. SUBJECTS AND METHODS: This was a pilot study at a tertiary eye care center where 40 patients of proximal canalicular block <8 mm on probing were divided into two equal groups. The external CDCR group underwent routine dacryocystorhinostomy with partial carunculectomy. A tract was created from canthus to nasal cavity with von Graefe knife. In the laser CDCR group, the osteotomy was created using 980 mm diode laser with a power of 8 W. Glass tubes of appropriate length were placed and fixed using 5-0 polypropylene with our "mirror tuck technique." Results were analyzed using the Chi-square test for parametric and ANOVA test for nonparametric variables using SPSS software. RESULTS: Success defined as patency on syringing was achieved in 18 patients in the laser group and 16 in the external CDCR group which was comparable (P > 0.05). Complications include tube extrusion, dislocation, conjunctival overgrowth, and sump syndrome. CONCLUSION: Laser and external CDCRs are both effective and safe procedures for the treatment of proximal canalicular blocks with comparable success rates and complications.
Abstract: Silicon rods are widely employed for frontalis sling suspension. However, on passing th... more Abstract: Silicon rods are widely employed for frontalis sling suspension. However, on passing through the tissues, at times, the silicon rod gets detached from the stainless steel needle. This occurs more commonly in patients of blepharophimosis syndrome, in which hypoplasia of superior orbital rim with deficiency of skin between lid and brow, causes difficulty in passage of the needle when it is manipulated upwards from lid towards the brow. To overcome these problems we describe the use of an 18 G intravenous catheter to railroad the needle with the silicon rod, obviating the blind upward maneuvers with the needle and protecting against the damage to the silicon rod –needle assembly. The technique is easily reproducible, safe and can be used in all silicon rod suspensions.
Many oculoplastic conditions like ectropion, entropion, ptosis, lid lacerations, canalicular trau... more Many oculoplastic conditions like ectropion, entropion, ptosis, lid lacerations, canalicular trauma and dacryocystitis are commonly seen in everyday practice of any ophthalmologist. Delay in treatment of entropion and ectropion can lead to blindness due to development of secondary changes in cornea. Neglecting a child with severe ptosis can result in irreversible visual loss. Incorrect primary repair of lacerated lid and failure to repair the torn canaliculi are difficult to handle at a later stage even by an expert surgeon. Long-standing blocked distal lacrimal passages may result in suppurative infections with skin excoriation. This review elucidates the correct approach to some common oculoplastic diseases so as to achieve a timely intervention and referral and thereby avoid preventable complications.
Purpose: The study aims to compare the effectiveness and complications of transconjunctival retra... more Purpose: The study aims to compare the effectiveness and complications of transconjunctival retractor plication (TRP) with lateral tarsal strip (LTS) and the polypropylene sling (PS) surgery for treatment of involutional lower lid ectropion. Method: A prospective randomised pilot study was conducted on 30 eyes of 30 patients suffering from epiphora having horizontal eyelid laxity >6mm and age >50 years at a tertiary care centre from December 2014 to March 2015. They were randomly divided into two equal groups for TRP with LTS (group A) and PS (group B). Success was defined as relief in epiphora and lid laxity ≤4mm at 12 months post operatively. Result: There were 19 male and 11 female patients with age ranging from 55-80 years. The mean grade of ectropion was 2.80±1.32 in group A and 2.87±1.60 in group B. The preoperative horizontal laxity increased with the grade of ectropion (p <0.001) while medial canthal laxity was variable. The average surgical time per procedure in gr...
Silicon rods are widely employed for frontalis sling suspension. However, on passing through the ... more Silicon rods are widely employed for frontalis sling suspension. However, on passing through the tissues, at times, the silicon rod gets detached from the stainless steel needle. This occurs more commonly in patients of blepharophimosis syndrome, in which hypoplasia of superior orbital rim with deficiency of skin between lid and brow, causes difficulty in passage of the needle when it is manipulated upwards from lid towards the brow. To overcome these problems we describe the use of an 18 G intravenous catheter to railroad the needle with the silicon rod, obviating the blind upward maneuvers with the needle and protecting against the damage to the silicon rod –needle assembly. The technique is easily reproducible, safe and can be used in all silicon rod suspensions.
Many oculoplastic conditions like ectropion, entropion, ptosis, lid lacerations, canalicular trau... more Many oculoplastic conditions like ectropion, entropion, ptosis, lid lacerations, canalicular trauma and dacryocystitis are commonly seen in everyday practice of any ophthalmologist. Delay in treatment of entropion and ectropion can lead to blindness due to development of secondary changes in cornea. Neglecting a child with severe ptosis can result in irreversible visual loss. Incorrect primary repair of lacerated lid and failure to repair the torn canaliculi are difficult to handle at a later stage even by an expert surgeon. Long-standing blocked distal lacrimal passages may result in suppurative infections with skin excoriation. This review elucidates the correct approach to some common oculoplastic diseases so as to achieve a timely intervention and referral and thereby avoid preventable complications.
Background: Recovery of Bell`s phenomenon after levator resection is unpredicatable. Delayed reco... more Background: Recovery of Bell`s phenomenon after levator resection is unpredicatable. Delayed recovery can result in vision threatening corneal complications. Aim: To study the variability of Bell’s phenomenon and time taken for its recovery following levator resection for blepharoptosis and to correlate it with the amount of resection. Methods: A prospective observational study was conducted on 32 eyes of 32 patients diagnosed as unilateral simple congenital blepharoptosis who underwent levator resection at a tertiary care center between July 2013 and May 2015. Patients were followed up for 5 months and correction of ptosis, type of Bell`s, duration of Bell`s recovery and complications were noted. Results: The study group ranged from 16-25 years with 15:17 male: female ratio. There were 9 mild, 16 moderate and 7 severe ptosis. Satisfactory correction was achieved in all cases. Good Bell`s recovery occurred in 13 eyes on first post-op day, in 2-14 days in 19 eyes and 28 days in 1 eye...
Ophthalmic plastic and reconstructive surgery, Jan 20, 2016
To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy... more To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation, with and without intubation, in patients suffering from primary acquired nasolacrimal duct obstruction, at 1 year of follow up. A prospective, randomized interventional pilot study was conducted at a tertiary care center, in accordance with the guidelines of Declaration of Helsinki. Sixty eyes of 60 adult patients with primary acquired nasolacrimal duct obstruction were included. The participants were divided randomly into 2 equal groups (A and B-without and with bicanalicular intubation, respectively). An osteotomy was first created using 980 nm diode laser (set at 8W continuous mode) transcanalicularly and then enlarged intranasally using Blakesley's nasal forceps, followed by bicanalicular silicon intubation in group B patients. The tubes were removed at the end of 8 weeks. The ostium size was assessed endoscopically at 8 weeks and again at the end of...
The sump syndrome was initially described in relation to patients who had undergone external dacr... more The sump syndrome was initially described in relation to patients who had undergone external dacryocystorhinostomy. Here we report a case of sump syndrome that developed following laser conjunctivodacryocystorhinostomy (CDCR) due to tube displacement after a bout of forceful sneezing. Unlike cases of external dacryocystorhinostomy where flaps are sutured, there is a potential space created by the sac remnants in laser CDCR. Hence, any displacement of the tube will lead to the improper drainage of secretions with superadded infections of the contents (as occurred in this case). Therefore, in laser CDCR, it is imperative to create an appropriately placed osteotomy with a correctly sized tube that is well secured to avoid displacement along with patient education regarding tube care.
The purpose of this study is to study the operative difficulties and success rate of transcanalic... more The purpose of this study is to study the operative difficulties and success rate of transcanalicular laser-assisted endoscopic dacryocystorhinostomy in patients of chronic dacryocystitis with deviated nasal septum (DNS). A prospective interventional clinical study of 36 consecutive patients suffering from chronic dacryocystitis with nasolacrimal duct obstruction with DNS undergoing primary TCLADCR from March to June 2011 was carried out. Diode laser was used to create a 16-mm(2) ostium which was enlarged to 64 mm(2) using Blakesley&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s forceps. Success was defined as anatomical patency and absence of symptoms at 12 months of follow-up. Out of the 36 patients, 25 were females with ages 20-72 years, and 19 were left sided. There were 12 high, 12 mid and 12 basal DNS towards the side of surgery, mild to moderate in severity. Intraoperatively there was difficulty in visualising the aiming beam in the nose, tedious manipulation of endoscope and excessive bleeding in 3 patients. Increased bleeding and failures were significantly higher in high DNS (Fisher exact test-2 tailed: 0.0045). The procedure was successful in 94.4 % cases with average ostium size of 21.94 mm(2) at 12 months and no statistically significant difference in success rates between mild and moderate DNS (Fisher exact test-2 tailed: 1.000). Also there was no difference in the complication rate between mild and moderate DNS (Fisher exact test-2 tailed: 0.0841). TCLADCR is an effective procedure in patients with mild to moderate mid and basal DNS and obviates the need for multiple procedures and a cutaneous scar.
Silicon rods are widely employed for frontalis sling suspension. However, on passing through the ... more Silicon rods are widely employed for frontalis sling suspension. However, on passing through the tissues, at times, the silicon rod gets detached from the stainless steel needle. This occurs more commonly in patients of blepharophimosis syndrome, in which hypoplasia of superior orbital rim with deficiency of skin between lid and brow, causes difficulty in passage of the needle when it is manipulated upwards from lid towards the brow. To overcome these problems we describe the use of an 18 G intravenous catheter to railroad the needle with the silicon rod, obviating the blind upward maneuvers with the needle and protecting against the damage to the silicon rod -needle assembly. The technique is easily reproducible, safe and can be used in all silicon rod suspensions.
Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological Society, 2014
We report a case of naso-cutaneous fistula due to thermal injury during transcanalicular laser da... more We report a case of naso-cutaneous fistula due to thermal injury during transcanalicular laser dacryocystorhinostomy followed by superadded infection with coagulase negative staphylococcus in a diabetic patient. The case highlights the importance of meticulous wound care in the management and possibility of its occurrence even with minor thermal injury in immunocompromised patients.
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