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Purpose: To evaluate the role of viral infections in the pathogenesis of primary acquired nasolacrimal duct obstruction. Methods: The study included 48 patients diagnosed with primary acquired nasolacrimal duct obstruction undergoing dacryocystorhinostomy surgery. Prior to dacryocystorhinostomy surgery, nasal swab sample was taken from the inferior meatus at the same side. During dacryocystorhinostomy, tissue biopsy sample (2 × 2 mm) was taken from the junction area of the lacrimal sac and nasolacrimal duct. Following nucleic acid extraction, polymerase chain reaction was performed. Results: The patients consisted of 9 (18.8%) men and 39 (81.2%) women with a mean age of 51.0 ± 14.3 years. Qualitative polymerase chain reaction showed viral genome in the nasal swabs of 10 (20.8%) patients, including coronavirus 229E (three cases), coronavirus HKU1 (two cases), respiratory syncytial virus (two cases), coronavirus OC43 (one case), coronavirus NL63 (one case), and adenovirus (one case). In the dacryocystorhinostomy samples, viral genomes were detected in four (8.3%) cases, including respiratory syncytial virus (two cases), coronavirus HKU1 (one case), and adenovirus (one case). There was a statistically significant agreement between nasal mucosal swab and dacryocystorhinostomy biopsy samples in terms of respiratory syncytial virus positivity (kappa = 1.000, p = 0.001). Conclusion: Although the viral genome was detected in the samples, a direct relationship between viruses and pathogenesis of primary acquired nasolacrimal duct obstruction could not be revealed because of the low number of positive results. However, considering the profibrotic characteristics of specific viruses such as respiratory syncytial virus and adenovirus, viral infections may be one of the many predisposing factors of primary acquired nasolacrimal duct obstruction.

PURPOSE To evaluate the risk factors for posterior capsule rupture with or without vitreous loss (PCR +/- VL) in extracapsular cataract extraction (ECCE). METHODS The charts of 2794 consecutive patients who had ECCE with or without intraocular lens implantation between January 1992 and December 1997 were reviewed retrospectively. Probable risk factors included age, sex, operated eye (right or left), presence of diabetes mellitus, systemic hypertension, history of vitreous loss in the other eye (if operated), type of cataract, axial length of the eye, preoperative visual acuity, glaucoma, presence of pseudoexfoliation, preoperative shallow anterior chamber and experience of surgeon (resident, general ophthalmologist, cataract surgeon). We compared 192 patients who had PCR +/- VL with complete data and 275 randomly selected patients who had no complications, using multiple logistic regression analysis. RESULTS Two hundred and fifty-four patients (9.09%) had PCR and 197 (7.05%) had PCR + VL. The surgeon's experience (p < 0.0005), glaucoma (p < 0.005), type of cataract (p < 0.005), presence of pseudoexfoliation (p < 0.05) and systemic hypertension (p < 0.05) were significant risk factors. CONCLUSIONS Patients with risk factors such as glaucoma, pseudoexfoliation, traumatic cataract and systemic hypertension should be operated by experienced surgeons.

Purpose. To estimate the incidence and the factors that may play a role in the etiology of eyelid malpositions after cataract extraction. Methods. We followed up 124 patients for six months after cataract extraction. Palpebral aperture, levator function, height of the upper lid crease, lower eyelid laxity and position of the punctums were recorded preoperatively and postoperatively. Post-cataract ptosis was defined as a 2 mm or greater drop in the lid margin after correcting for any change in the fellow eye. Results. None of the patients developed ectropion or entropion, but five (4%) developed punctal ectropion after surgery. The incidence of post-cataract ptosis was 7.3% at six months. Age, sex, preoperative measurements of levator function, lid crease and dermatochalasis were not predictive for the development of ptosis at six months. However, there was a significant difference in the preoperative palpebral fissure width between the patients with ptosis and those without (pConclusions. Several factors are involved in the development of post-cataract ptosis. Temporary ptosis may be related to the myotoxicity of the local anesthetic. The presence of ptosis on the first postoperative day is the best predictor for the development of ptosis at six months.

Purpose To report a major complication of intralesional corticosteroid injection for the treatment of a chalazion. Methods A 28-year-old woman presented with a 4-day history of decreased vision in her left eye that developed after corticosteroid injection to her upper eyelid for the treatment of chalazion. The visual acuity was 20/20 in her right and finger counting in her left eye. Anterior segment examination showed an inferior corneal opacity with positive Seidel test and cataract. Results A soft contact lens was applied to cornea and antibiotic therapy was given to prevent endophthalmitis. Cataract was removed by lens aspiration and a posterior chamber intraocular lens was implanted. After surgery, the visual acuity increased to 20/20 in her left eye. Conclusions Inadvertent corneal penetration and traumatic cataract are possible and serious complications of intralesional corticosteroid injection.