Kira L. Segal

Evaluation of the canalicular entrance into the lacrimal sac: an anatomical study.

Purpose: The purpose of this study was to investigate the prevalence of a common canalicular entrance in the lacrimal sac and to investigate the anatomy of the canalicular/lacrimal sac junction with direct visualization using a novel cadaveric dissection technique. Methods: Preserved cadavers were dissected to allow direct visualization of the canalicular entrance(s) to the lumen of the lacrimal sac. The prevalence of a common canaliculus and the anatomical variations of the canalicular/lacrimal sac mucosal fold of tissue were recorded. Results: One hundred twenty-four lacrimal systems (95 cadavers; 43 female, 52 male) were included in the study analysis. Overall, 123 lacrimal systems demonstrated a common canaliculus entering the lacrimal sac. Only one demonstrated 2 separate orifices (right orbit; male) in the sac (0.08%; 95% confidence interval, 0.1%–4.4%). Seventy-four lacrimal systems had some variation of a canalicular/lacrimal sac mucosal fold (59.7%). The remaining 50 (40.3%) had no visible canalicular/lacrimal sac mucosal fold. Conclusions: This study provides direct anatomical evidence that the prevalence of separate canalicular orifices in the lacrimal sac is lower than previously reported (<1%). Additionally, the presence of a valve-like structure at the canalicular/lacrimal sac junction is common. These observations can potentially play a role in evaluating and treating lacrimal system pathology.

Evaluation and Treatment of Perioperative Corneal Abrasions

Purpose. To evaluate perioperative risk factors for corneal abrasion (CA) and to determine current care for perioperative CA in a tertiary care setting. Methods. Hospital-based, cross-sectional study. In Operating Room and Post-Anesthesia Care Units patients, a comparison of cases and controls was evaluated to elucidate risk factors, time to treatment, and most common treatments prescribed for corneal abrasions. Results. 86 cases of corneal abrasion and 89 controls were identified from the 78,542 surgical procedures performed over 2 years. Statistically significant risk factors were age (P = 0.0037), general anesthesia (P < 0.001), greater average estimated blood loss (P < 0.001), eyes taped during surgery (P < 0.001), prone position (P < 0.001), trendelenburg position (P < 0.001), and supplemental oxygen en route to and in the Post-Anesthesia Care Units (P < 0.001). Average time to complaint was 129 minutes. 94% of cases had an inpatient ophthalmology consult, with an average time to consult of 164 minutes. The most common treatment was artificial tears alone (40%), followed by combination treatment of antibiotic ointment and artificial tears (35.3%). Conclusions. Trendelenburg positioning is a novel risk factor for CA. Diagnosis and treatment of perioperative corneal abrasions by an ophthalmologist typically require three hours in the tertiary care setting.

Proprioceptive Phenomenon With Involutional Ptosis: Evidential Findings in Anophthalmic Ptosis.

Purpose: To determine the effect of ptosis on compensatory frontalis contraction in patients without visual input and to identify if a sensory stimulus contributes to brow elevation. Methods: A prospective study. Clinical photographs were measured by 2 masked oculoplastic surgeons to determine brow height in 8 patients with unilateral ocular prosthesis in 3 conditions: at baseline, after a gold weight was applied to the upper eyelid inducing acute ptosis, and with the gold weight plus topical anesthetic. The measured brow height was then compared between the 3 scenarios. Results: Mean brow height increased after application of the gold weight when compared with baseline, and this difference reached significance (p = 0.012). After topical anesthetic was applied, the mean brow height decreased but not back to baseline. When mean brow height during the gold weight with topical anesthesia was compared with baseline and with the gold weight only scenarios, the difference was not significant (p > 0.05). Conclusions: Frontalis contraction is observed when acute ptosis is simulated in anophthalmic patients, confirming that a contracted visual field cannot be the only stimulus for compensatory brow elevation. A sensory or proprioceptive mechanism is suggested but not confirmed by the trend of reduction in brow elevation with topical anesthesia.

Management of Acute Conjunctivitis

Acute conjunctivitis can be caused by viral, bacterial, and allergic sources. There is growing need for rapid diagnostics and effective therapies given the significant economic burden and pervasive nature of the disease. Additionally, with growing microbial resistance, practice guidelines should encourage appropriate use of antibiotics, limited to clinical situations with proven benefit. New in-office detectors may enable rapid definitive diagnosis among clinically similar entities. Development of and studies examining steroid-sparing immunomodulators for conjunctivitis are warranted.

Comparison of the extrusion rate of Crawford tubes.

AIM To compare the outcomes of dacryocystorhinostomy (DCR) using traditional Crawford tubes (TCT) and Crawford tubes with suture (CTS) in the lumen. METHODS Retrospective case series consisting of patients who underwent DCR between 2008 and 2013. RESULTS A total of 61 DCRs were performed on 50 patients. Patients who underwent DCR using CTS had higher rates of prolapse compared to the TCT group (50% vs 9.4%; P=0.003). Stent removal occurred earlier in patients who received CTS (3.3mo vs 5.1mo; P=0.004). Success rates were equivalent between the two groups (75% vs 81.1%; P=0.684). CONCLUSION CTS in the lumen increases the risk of prolapse, prompting earlier tube removal in patients following DCR for nasolacrimal duct obstruction (NLDO). Earlier removal of tubes does not appear to significantly decrease success rates.

Eponymous women in ophthalmology: syndromes with prominent eye manifestations named after female physicians

Many eponymic syndromes were characterized when few women had entered medicine. Nearly simultaneous with the growth of women in ophthalmology has been a decreased emphasis on eponyms in favor of descriptive [1, 2] or biochemical [2–4] terminology. The decline in eponym use has been fueled by calls to eliminate the possessive form [2], concerns regarding inaccuracy as knowledge of disease pathogenesis has evolved [3, 4], worries that using different eponyms across languages stymies global scientific discussion [1], and the realization of inhumane activities by some individuals to whom eponyms were previously attributed [1, 3]. Nonetheless, it is of important historical relevance to identify and celebrate the women who distinguished themselves by helping to characterize syndromes associated with their names. For this report, we culled print and electronic media for eponymous eye syndromes named after female ophthalmologists. Public records, obituaries, images, and other resources were compared to determine gender. Only syndromes listed in OMIM were reviewed to avoid inclusion of arcane eponyms. Syndromes in which the only ophthalmicrelated features are craniofacial abnormalities, optic atrophy, and/or cortical blindness were excluded in order to focus inclusion on eye-related syndromes. Two eponymous female ophthalmologists were identified: Ester Elisabeth Gröenblad and Mette Warburg. Gröenblad-Strandberg disease is pseudoxanthoma elasticum (PXE), characterized by ectopic mineralization and fragmentation of elastic fibers primarily in the eye, skin, and cardiovascular system. Ophthalmic findings include angioid streaks, peau d’orange fundus, and choroidal neovascularization. Gröenblad, a Swedish ophthalmologist, established the syndromic association of angioid streaks with the skin findings in collaboration with dermatologist James Strandberg. Walker-Warburg syndrome causes brain abnormalities and retinal dysplasia. Neurosurgeon Arthur Earl Walker reported a case of hydrocephalus, lissencephaly, microphthalmos, and retinal dysplasia in 1942; additional authors subsequently presented cases. Warburg, a Danish ophthalmologist, suggested in 1971 that the findings represented a yet-uncharacterized syndrome. Today, the syndrome is referred to as muscular dystrophy-dystroglycanopathy with brain and eye anomalies, and genetic sequencing has led to subtype classification. During our search for eponymous ophthalmologists, we identified several female non-ophthalmologist physicians who characterized syndromes with prominent eye manifestations (Table 1). As is common among eponyms, the syndromes identified herein were not all named after the original discoverers, a phenomenon described as Stigler’s Law of Eponymy [5]. The skin and eye findings of PXE had been described before Gröenblad and Strandberg established the syndromic association. Cases of Walker-Warburg syndrome were reported by Walker and others as many as 30 years prior to Warburg’s papers, but eponymous credit is given to her due to her summative assessments of the syndrome. Warburg also described Norrie syndrome but named it in tribute after Gordon Norrie, a Danish ophthalmologist. The plethora of historical eponyms leaves open the possibility that our report is incomplete. Additionally, binary gender categories may unintentionally exclude or mischaracterize some individuals. * Sarah H. Van Tassel sjh2006@med.cornell.edu

Endoscopic dacryocystorhinostomy following radioactive iodine thyroid ablation

ABSTRACT This article evaluates the efficacy of endoscopic dacryocystorhinostomy (eDCR) for nasolacrimal duct obstruction (NLDO) in patients exposed to radioactive iodine (RAI) for treatment of thyroid carcinoma. Retrospective chart review of 7 eDCR procedures was performed on 6 patients, aged 18 or older, with prior RAI treatment, who underwent eDCR between January 1, 2008 and December 31, 2013 for treatment of epiphora due to NLDO. Average time to tube removal was 159 days, and average follow-up was 341 days. One patient noted complete epiphora relief at the time of their final visit. Partial symptom relief was noted by 3 patients, and recurrent epiphora was noted by 2 patients. In complex patients with RAI-associated NLDO, eDCR may be a reasonable option for relief of epiphora. Appropriate counseling, including the risks of incomplete symptom relief and need for additional surgery, should be discussed pre-operatively with these patients.