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Purpose: To present a modification of the reversible tarsorrhaphy that can be opened and reclosed as necessary by caretakers and the patient. Methods: Retrospective case series of patients who underwent the reversible tarsorrhaphy. Materials included intravenous (IV) tubing as bolsters and 4–0 polypropylene suture. The 4–0 suture is first passed through and through one end of IV tubing approximately 20 mm in length. Starting on the lateral upper lid and approximately 4 mm above the lash line, the suture is placed through the skin and into the tarsus. The suture exits through the eyelid gray line. These steps through the eyelid are repeated in the opposite direction. An air knot is tied above the upper eyelid near the base of IV tubing. A second air knot can be tied higher to provide a handle easily allowing the caretaker to close the eyelid. Results: Included were 13 patients (ages 21–95-yeas), indications included lagophthalmos secondary to cicatricial changes from burns (2), keratouveitis (1), neurogenic palsy (3), neurotrophic ulcer (6), and cicatricial changes from skin cancer (1). There were no reported difficulties in maintaining the tarsorrhaphy by either family members or healthcare providers. The first tarsorrhaphy for each patient lasted between 3–19 weeks, with an average of 8 weeks. All were well tolerated. Conclusions: The caretaker-reversible tarsorrhaphy can be used as a temporizing measure. The technique balances the need for ocular protection with the need for examination/treatment by health care professionals and, equally importantly, the patients and caretakers. [ABSTRACT FROM AUTHOR]

There are no standards in diagnostic and therapeutic approaches to eye care in incomplete eyelid closure due to unresolved facial palsy (FP). Loading of the upper eyelid (UELL) with gold weights (GWs) or platinum chains (PCs) is a highly effective procedure for the correction of lagophthalmos. Despite this, the procedure is used infrequently in our country because of the relatively high price of the implant and the lack of reimbursement. The aim of this research was to assess the factors influencing medical expenditures in this group of patients and to analyze utility costs for the UELL procedure with the use of GW and PC compared to tarsorrhaphy. Material and methods The costs of 88 surgical procedures (40 GWs, 11 PCs and 37 tarsorrhaphies) and medical expenditures before and after surgery were calculated based on reporting of materials, staff salaries and the SF-36 questionnaire. Distribution quartiles of the cost per QALY measure (dependent variable) was assessed via an ordered logistic regression model with eight explanatory variables. Results The calculated total cost of the surgery was US$209 for tarsorrhaphy, US$758 for UELL with a GW and US$1,676 for UELL with a PC. Bootstrapped costs per QALY values (CUI) in 88% of cases were below the US$100,000 cutoff. Etiology and duration of facial palsy and presence of Bell's phenomenon were factors that significantly influenced the CUI. Patient gender and age, history of previous eyelid surgery, and presence of corneal sensation were found to be not significant (p > 0.1). Calculated ICER for GW was US$1,241.74/1QALY and ICER for PC was US$13,181.05/1QALY compared to tarsorrhaphy. Conclusions Eye protection in patients with FP should be a crucial element of health policy. Findings suggest UELL procedure with a GW or a PC to be a cost-effective procedure with GW being the most cost-effective. [ABSTRACT FROM AUTHOR]

Purpose: To study and compare the demographic and clinical profile of acute ocular burns (AOB) in children and adults. Methods: This retrospective case series included 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to two tertiary eye care centers within one month of sustaining AOB. Data regarding demographics, causative agents, severity of injury, visual acuity (VA), and treatment were collected and analyzed. Results: Males were more commonly affected particularly among adults (81% versus 64%, P < 0.00001). Among children, 79% sustained domestic injuries, whereas 59% of adults had work-place injuries (P < 0.0001). Most cases were due to alkali (38%) and acids (22%). Edible lime (chuna, 32%), superglue (14%), and firecrackers (12%) in children, and chuna (7%), insecticides, lye, superglue (6% each), toilet cleaner (4%) and battery acid (3%) in adults, were the main causative agents. The percentage of cases with Dua grade IV-VI was greater in children (16% versus 9%; P = 0.0001). Amniotic membrane grafting and/or tarsorrhaphy were needed in 36% and 14% of affected eyes in children and adults, respectively (P < 0.00001). The median presenting VA was logMAR 0.5 in children and logMAR 0.3 in adults (P = 0.0001), which improved significantly with treatment in both groups (P < 0.0001), but the final VA in eyes with Dua grade IV-VI burns was poorer in children (logMAR 1.3 versus logMAR 0.8, P = 0.04). Conclusion: The findings clearly delineate the at-risk groups, causative agents, clinical severity, and treatment outcomes of AOB. Increased awareness and data-driven targeted preventive strategies are needed to reduce the avoidable ocular morbidity in AOB. [ABSTRACT FROM AUTHOR]

Purpose: To study and compare the demographic and clinical profile of acute ocular burns (AOB) in children and adults. Methods: This retrospective case series included 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to two tertiary eye care centers within one month of sustaining AOB. Data regarding demographics, causative agents, severity of injury, visual acuity (VA), and treatment were collected and analyzed. Results: Males were more commonly affected particularly among adults (81% versus 64%, P < 0.00001). Among children, 79% sustained domestic injuries, whereas 59% of adults had work-place injuries (P < 0.0001). Most cases were due to alkali (38%) and acids (22%). Edible lime (chuna, 32%), superglue (14%), and firecrackers (12%) in children, and chuna (7%), insecticides, lye, superglue (6% each), toilet cleaner (4%) and battery acid (3%) in adults, were the main causative agents. The percentage of cases with Dua grade IV-VI was greater in children (16% versus 9%; P = 0.0001). Amniotic membrane grafting and/or tarsorrhaphy were needed in 36% and 14% of affected eyes in children and adults, respectively (P < 0.00001). The median presenting VA was logMAR 0.5 in children and logMAR 0.3 in adults (P = 0.0001), which improved significantly with treatment in both groups (P < 0.0001), but the final VA in eyes with Dua grade IV-VI burns was poorer in children (logMAR 1.3 versus logMAR 0.8, P = 0.04). Conclusion: The findings clearly delineate the at-risk groups, causative agents, clinical severity, and treatment outcomes of AOB. Increased awareness and data-driven targeted preventive strategies are needed to reduce the avoidable ocular morbidity in AOB.

Facial paralysis decreases eye protection mechanisms leading to ocular problems up to corneal ulceration, and blindness. This study aimed to evaluate the outcomes of periocular procedures for recent facial paralysis. Medical records of patients with unilateral recent complete facial palsy who did periocular procedures at the Maxillofacial Surgery Department of San Paolo Hospital (Milan, Italy) between April 2018 and November 2021 were retrospectively reviewed. 26 patients were included. All patients were evaluated 4 months after surgery. The first group included 9 patients who underwent upper eye lid lipofilling and midface suspension with fascia lata graft; they had no ocular dryness symptoms and no need for eye protection measures in 33.3% of cases, significant reduction of ocular symptoms and need for eye protection measures in 66.6% of patient, 0–2 mm lagophthalmos in 66.6% and 3–4 mm lagophthalmos in 33.3%. The second group of 17 patients who underwent upper eyelid lipofilling, midface suspension with fascia lata graft and lateral tarsorrhaphy, had no ocular dryness symptoms and no need for eye protection measures in 17.6% of patient, significant reduction of ocular symptoms and need for eye protection measures in 76.4% of patient, 0–2 mm lagophthalmos in 70.5%, 3–4 mm lagophthalmos in 23.5% and one patient 5,8%had 8 mm lagophthalmos and persistent symptoms. No ocular complication, cosmetic complain or donner site morbidity were reported. Upper eyelid lipofilling, midface suspension with fascia lata graft and lateral tarsorrhaphy decrease ocular dryness symptoms and need for eye protection measures and improve lagophthalmos: the association of the reinnervation with these complementary techniques is therefore highly recommended in order to immediately protect the eye. [ABSTRACT FROM AUTHOR]

Background: Amongst the chemical warfare agents, blistering (vesicant) agents can be significant materials. The most important agent in this group is sulfur mustard (mustard gas) which is known as “King of chemical warfare (CW) agents “. Exposure to this agent, seriously causes damages in several organs, such as the eyes. This article reviews the ophthalmological aspects of sulfur mustard with reference of its management. Methods: A wide-ranging search in PubMed databases, Thomson Reuters and Scopus was done and different aspects of chemical properties of sulfur mustard, its mechanism of action and effects on eyes, clinical finding, diagnostic evaluation, initiate actions, pharmaceutical and surgical interventions was reported. Results: Sulfur mustard can alkylate DNA and RNA strands and break down structures of protein and lipid of cell membrane. This may impair cell energy production, and leads to cell death. Exposure to sulfur mustard, therefore, causes such problems for organs, including irreversible damage to the eyes. Conclusion: Understanding the mechanism of the sulfur mustard effect and the early training in prevention injuries will cause fewer complications and damage to organs, including the eyes. Washing the eyes with tap water or eyewash solutions, using mydriatic drops, anti- inflammatory drugs, matrix metalloproteinase inhibitors and antibiotics may help to the management of poisoning. Surgical interventions including tarsorrhaphy, amniotic membrane transplantation, stem cell transplantation and corneal transplantation could reduce the harm to the victims.

Congenital ectropion is a rare condition affecting newborns, in which the upper eyelid is turned outwards. Its etiology and pathogenesis, while not yet clear, are associated with congenital lid disorders such as blepharophimosis syndrome, congenital ichthyosis, Down syndrome, and birth trauma, with a higher incidence among Africans. This article reports three cases of this rare condition and their subsequent nonsurgical management. It is important to diagnose this condition early to institute swift conservative care, rule out associated conditions, and ensure good vision in the patient.

Objectives: The objective of the study was to evaluate the technique of tarsorrhaphy combined with sutureless amniotic membrane transplantation in the treatment of resistant ocular surface pathologies. Methods: In this study, the post-operative results of patients who underwent tarsorrhaphy combined with sutureless amniotic membrane between May 2016 and July 2021 were evaluated. In this technique, we have placed the amniotic membrane on the ocular surface, and then simple tarsorrhaphy has been performed. We used this technique in our six patients during COVID-19 pandemic period at the bedside. The outcomes of corneal epithelial healing, visual acuity, pain score, patient tolerance, and adverse events were evaluated. Results: Fourteen patients (eight females and six males) were included in the study. The mean age of the patients was 65.7 years (range 9-96 years). The mean follow-up period was 9 months (range 6-12 months). In all cases, epithelial defect healed completely and it was seen that this new technique facilitated resolution of pain and inflammation and promoted epithelialization in our 14 cases with resistant ocular surface pathologies. Post-operative pain score was significantly lower than pre-operative pain score (p<0.05). Conclusion: Our results demonstrate that tarsorrhaphy with sutureless amniotic membrane accelerates the ocular surface healing process and increases the efficiency of amniotic membrane. This method has an important advantage that it can be performed at bedside. Patients and ophthalmologists need such an innovative treatment which is effortless, effective, and practical especially for the pandemic period. [ABSTRACT FROM AUTHOR]

A fledgling feral pigeon with systemic protozoal infection was referred with corneal protrusion in the right eye after being treated for a corneal ulcer for 12 days. Ophthalmic examination revealed a corneal bulla covering almost the entire central cornea and preventing the eyelids from closing. Gelatinous corneal stroma with numerous heterophils surrounding the corneal bulla was also detected on cytologic examination. Bullous keratopathy and melting keratitis in the right eye were diagnosed. Temporary tarsorrhaphy with topical eye drops was prescribed for a week; however, the bulla persisted. A modified nictitating membrane flap was created under general anesthesia and maintained for 2 weeks. The corneal bulla resolved, and corneal thickness was restored. The pigeon was presented again with recurrence of the corneal bulla in the right eye after 45 days. Alternative surgical options were recommended; however, the pigeon was euthanized because the protozoa‐induced intra‐oral and intra‐aural masses caused malformation of the beaks, which made voluntary feeding impossible. [ABSTRACT FROM AUTHOR]

Background: Amongst the chemical warfare agents, blistering (vesicant) agents can be significant materials. The most important agent in this group is sulfur mustard (mustard gas) which is known as "King of chemical warfare (CW) agents ". Exposure to this agent, seriously causes damages in several organs, such as the eyes. This article reviews the ophthalmological aspects of sulfur mustard with reference of its management. Methods: A wide-ranging search in PubMed databases, Thomson Reuters and Scopus was done and different aspects of chemical properties of sulfur mustard, its mechanism of action and effects on eyes, clinical finding, diagnostic evaluation, initiate actions, pharmaceutical and surgical interventions was reported. Results: Sulfur mustard can alkylate DNA and RNA strands and break down structures of protein and lipid of cell membrane. This may impair cell energy production, and leads to cell death. Exposure to sulfur mustard, therefore, causes such problems for organs, including irreversible damage to the eyes. Conclusion: Understanding the mechanism of the sulfur mustard effect and the early training in prevention injuries will cause fewer complications and damage to organs, including the eyes. Washing the eyes with tap water or eyewash solutions, using mydriatic drops, anti-inflammatory drugs, matrix metalloproteinase inhibitors and antibiotics may help to the management of poisoning. Surgical interventions including tarsorrhaphy, amniotic membrane transplantation, stem cell transplantation and corneal transplantation could reduce the harm to the victims. [ABSTRACT FROM AUTHOR]

Congenital upper eyelid eversion is a rare condition characterized by the prolapse of chemosed palpebral conjunctiva from everted eyelids. Initial conservative management option commonly used in the treatment was unsuccessful in resolving the condition in our patient. However, temporary tarsorrhaphy resulted in satisfactory resolution. This case gives further credence to the effectiveness of temporary tarsorrhaphy as a surgical option in the management of congenital upper eyelid eversion.

Red Serow Capricornis rubidus is an elusive herbivore native to the montane forests of the Himalaya. Currently it is categorized as 'Vulnerable' in the IUCN Red List and placed under Schedule I species of the Wildlife Protection Act, 1972. A serow was presented with complaints of mild inappetence, irritability, sporadic scratching of head over the enclosure barrier and serous ocular discharge from the left eye. Based on detail clinical examination, the animal was diagnosed with unilateral conjunctivitis, corneal oedema, and ulcerative keratitis. A combination of Xylazine @ 1.5mg/ kg body weight and Zolatile® (zolazepam and tiletamine) @ 2.5 mg/kg body weight was used to chemically restrain the animal, followed by auriculo-palpebral nerve block using 1 ml of 2 % lignocaine hydrochloride. The affected eye was adequately cleaned with isotonic sterile Normal Saline solution (NSS). Combination of 0.5 ml of ceftriaxone and 0.5 ml of flubiprofen was injected into upper and lower palpebral conjunctiva. The cornea and the third eyelid flap were carefully sutured using 5-0 and 3-0 Vicryl, respectively. Finally, tarsorrhaphy was done using 2-0 nylon. Postoperative care consisted of an antibiotic regimen of Cephalaxin @ 20 mg/ kg body weight b-i.d-twice in a day for seven days along with probiotic supplement (Vizylac®) and Vitamin A capsules (Aquasol A®) orally once daily for the next 30 days. The animal showed complete recovery within 30 days of proper treatment, monitoring, care and management. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to analyze the different etiologies of ectropion and entropion and helps in understanding the anatomical abnormalities responsible for the occurrence of entropion and ectropion, which is key to planning a successful surgical procedure. Methodology: It is a prospective study of 40 patients with ectropion and entropion studied for 17 months. Detailed slit lamp examination of lid abnormality, keratinization, trichiasis, corneal exposure was performed and axial length was measured. Results: The prevalence of ectropion and entropion put together was 0.064%. Paralytic ectropion ranks first among the different etiologies occupying 65.38%. The senile cause is the highest (78.57%) among the etiologies of entropion. The mean axial globe length of affected eyes in senile ectropion is 21.96 mm and in senile entropion is 20.73 mm. Conclusion: Eyelid malpositions have a low prevalence of 0.064%. The difference in the mean axial globe length between senile ectropion and entropion for this small sample size was found to be statistically significant. The overall percentage of conjunctival and corneal complications was found to be significantly higher in ectropion than in entropion.

A 5-year-old Japanese boy presented to the emergency room of our hospital because his right eye had been glued shut for 2 h following instillation of cyanoacrylate adhesive. The clinical examination showed redness of the right upper and lower lid skin; the right eyelid margins adhered to each other because of matting of the eyelashes, and crystallized glue was found within the matted eyelashes. The “hook” technique, which separates the eyelids using a blunt-tip device, was performed to separate the lids. The technique seems to be simple and safe for physicians such as ophthalmology residents to use to treat cyanoacrylate-induced adhesion of the eyelids of patients who often first present to their local emergency room as in our case.

Purpose: To compare and study the clinical outcome of tarsorrhaphy and amniotic membrane transplant in the healing of persistent corneal epithelial defects in terms of clinical improvement and symptomatic relief. Methods: This was an interventional, prospective study in which a total of 60 patients with persistent epithelial defects (PED's), randomly divided into two groups of 30 patients each who underwent tarsorrhaphy (Group A) or amniotic membrane transplantation (Group B) with a 4-week-follow-up period, were included. The main parameters studied were the size of an epithelial defect, total healing time, pain score, and complications. Results: The study included 60 eyes of 60 patients with PED. The healing time was 9.83 ± 6.51 days in Group A (median = 9.50 days, IQR = 1–7 days) vs. 18.33 ± 13.46 days (median = 19.50 days, IQR = 1–21 days) in Group B. A total of ten eyes (16.7%) did not heal at the end of 4 weeks. Conclusion: There was a significant reduction in the area of epithelial defect at the end of the 1 week and 2 week follow up postoperatively, in both the treatment forms. The mean healing time in patients of Group A was less as compared to that of the patients in Group B.

Isolated alacrimia is a rare condition often reported with salivary gland agenesis in the literature. Children with the isolated absence of the lacrimal gland can have normal tear film but not during emotional stimuli. Microblepharon is a congenital anomaly with abnormally small eyelids due to vertical shortening, which leads to incomplete blink, exposure keratopathy, and corneal ulceration. The combined occurrence of both the conditions in our case led to ocular surface keratinization and visual impairment. Here, we report a case of isolated lacrimal gland agenesis in association with microblepharon in a 2-year-old child.

The paper is focused on combined burn injuries of the eye, face and other body parts in acute care patients treated in non-ophthalmic hospital departments. Purpose: to develop patterns of actions by ophthalmologists and burn doctors at various stages of multiple burn injuries in patients treated in burn units. Materials and methods. 158 burn patients were given full clinical and instrumental examination. Group 1 included 95 patients hospitalized in the department of eye traumatology and reconstructive surgery after being treated in burn units elsewhere, while group 2 consisted of 63 patients examined and treated simultaneously by ophthalmologists and burn doctors from the start of admission to burn units. Results. The patients in Group 1 developed serious ophthalmic complications, ranging from ulceration or perforation of outer eye coats, swollen cataracts, hypopyon, cicatricial eyelid deformation, lagophthalmos etc. to eye apple atrophy, all caused by the absence of eye surgery assistance at early stages of burn treatment. Conclusion. The proposed patterns and range of surgical assistance including that given in the early stages of treatment, prevented the development of severe complications to the eye and the annexa, reduced the rehabilitation period and improved the functional prognosis of combined burn eye injuries. For citation: Chentsova E.V., Makarov P.V., Verigo Е.N., Petrova A.O., Smirnov S.V. Patterns of treatment of combined burn eye injuries in patients hospitalized in burn units. Russian ophthalmological journal. 2018; 11 (3): 37-42 (In Russian). doi: 10.21516/2072-0076-2018-11-3-37-42

Amniotic membrane grafts (AMGs) are commonly used to treat a variety of ophthalmologic conditions. Complications exist with permanent tarsorrhaphies, including the risk of re-fusion following tarsorrhaphy separation. We report a novel application of amniotic graft in lieu of skin grafts to protect the exposed marginal surface during the initial re-epithelialization period following release of a permanent tarsorrhaphy. We present a 24-year-old man who sustained an 80% total body surface area burn from a motor vehicle accident 16 months prior to presentation at our Oculoplastic service for evaluation of residual lagophthalmos. His original permanent tarsorrhaphies were removed; however, re-fusion occurred temporally in both sides. During a second attempt, AMGs were secured over the eyelid margins, leading to a successful tarsorrhaphy takedown without re-fusion. Periocular burn injuries present particular challenges, as cicatricial changes continue to evolve and viable skin graft areas diminish with each successive graft. In the setting of recurrent auto-tarsorrhaphy, the AMG has shown to be a viable alternative to standard skin grafting. This case demonstrates excellent results in a skin graft sparing procedure that is effective and efficient. Amniotic membrane grafting reduces morbidity by foregoing skin graft donor sites and can achieve similar functional and cosmetic results to standard skin grafting with reduced overall surgical time. As such, AMGs have the potential to supplant standard skin grafting in cases of recurrent auto-tarsorrhaphy, particularly in the setting of diminished available healthy skin tissue. [ABSTRACT FROM AUTHOR]

Traumatic subarachnoid hemorrhage (SAH) is a common finding following traumatic brain injury. In some cases, it can be associated with hydrocephalus. This type of hemorrhage is mostly caused by the rupture of small vessels in the brain and is usually managed conservatively. We present a case of a 60-year-old woman who presented with traumatic luxation of the eye following a fall. This resulted in diffuse SAH (Fisher grade IV) with associated hydrocephalus. We also report on 3 previous similar cases found in the literature. Avulsion of the ophthalmic artery was found to be the cause of the traumatic SAH. Apart from cerebrospinal fluid diversion using an external ventricular drain, the case was managed conservatively. There was no evidence of delayed clinical or radiologic vasospasm. Traumatic avulsion of the ophthalmic artery may result in diffuse SAH, mimicking that of aneurysmal rupture. This case shows that management of early complications, such as hydrocephalus and seizures, should be the main aim. Surgical or endovascular treatment of the injured artery, however, would be unnecessary. [ABSTRACT FROM AUTHOR]

Purpose: To compare and study the clinical outcome of tarsorrhaphy and amniotic membrane transplant in the healing of persistent corneal epithelial defects in terms of clinical improvement and symptomatic relief.Methods: This was an interventional, prospective study in which a total of 60 patients with persistent epithelial defects (PED's), randomly divided into two groups of 30 patients each who underwent tarsorrhaphy (Group A) or amniotic membrane transplantation (Group B) with a 4-week-follow-up period, were included. The main parameters studied were the size of an epithelial defect, total healing time, pain score, and complications.Results: The study included 60 eyes of 60 patients with PED. The healing time was 9.83 ± 6.51 days in Group A (median = 9.50 days, IQR = 1-7 days) vs. 18.33 ± 13.46 days (median = 19.50 days, IQR = 1-21 days) in Group B. A total of ten eyes (16.7%) did not heal at the end of 4 weeks.Conclusion: There was a significant reduction in the area of epithelial defect at the end of the 1 week and 2 week follow up postoperatively, in both the treatment forms. The mean healing time in patients of Group A was less as compared to that of the patients in Group B. [ABSTRACT FROM AUTHOR]

We report the case of a 1-year-old child who presented with complaints of redness and defective vision since birth. The child had no systemic abnormalities. On examination, complete keratinization of the bulbar conjunctiva and cornea was noted with dry, lustreless and irregular surface. Corneal sensation was intact. Orbital MRI revealed bilateral agenesis of the lacrimal gland with normal salivary glands. The child was given vitamin supplementation, cyclosporine eye drops along with lubricants and tape tarsorrhaphy in the night. Permanent occlusion of both the lower puncta was done. There was decreased ocular surface congestion, with frequent wetting of the ocular surface, which continued in the months to follow. We present a case of isolated bilateral lacrimal gland agenesis with normal salivary glands, a rare cause of dry eye in children. An early diagnosis and conservative management can help in maintaining functional vision in such cases. [ABSTRACT FROM AUTHOR]

We report our experience with a modified tarsorrhaphy (MT) technique in patients with facial nerve palsy (FNP). This study involved a retrospective chart review of patients with FNP undergoing MT over a 10-year period in one Medical Center. Patient demographics, presence of lagophthalmos, occurrence of eyelid malpositions, recurrent retraction, and repeat procedures were noted from medical records. Twenty patients (11 females, mean age 38 years) were included. Mean follow-up was 41 months (range 6–132). All patients had lagophthalmos prior to surgery compared with four on last follow-up. The number of patients with punctate epithelial erosions (PEEs) reduced from nine preoperatively to five postoperatively. While seven patients used lubricating drops prior to surgery, two stopped lubrication completely and five reduced the amount after surgery. No patients developed a new-onset lower eyelid malposition. No recurrence or postoperative complications were noted. This MT technique avoids grey line split and excision of orbicularis muscle or skin. It improves lower eyelid retraction and reduces lagophthalmos in FNP. [ABSTRACT FROM AUTHOR]

A 1 yr old male panther chameleon (Furcifer pardalis) was presented with a persistently closed right eye. The ophthalmological examination performed under general anesthesia demonstrated a large corneal ulcer encompassing 50% of the right cornea. Because of the extent of the corneal ulcer and the condition of the eye, the animal was diagnosed as being blind and suffering with severe pain. The authors recommended enucleation to eliminate these symptoms and to avoid any future complications. Two days after surgery, the panther chameleon started hunting on his own. One year after surgery, the panther chameleon is clinically healthy. [ABSTRACT FROM AUTHOR]

Purpose: Conjunctival chemosis is a common, usually benign, complication of ocular and oculoplastic surgery. After enucleation, evisceration, or secondary ball implant, however, conjunctival edema can cause conformer extrusion, forniceal eversion, and shortening which may complicate the future fitting of a prosthesis. This longitudinal chart review aimed to estimate the efficacy of a temporary suture tarsorrhaphy to minimize postoperative edema and improve conformer retention.Methods: We retrospectively reviewed the charts of 415 consecutive patients undergoing enucleation, evisceration, and secondary ball implantation between 1990 and 2016. Three-hundred twenty-eight patients had complete data which was analyzed for age, gender, surgical details, complications, and follow-up.Results: We identified 328 eyes that underwent enucleation (48%), evisceration (3%), or secondary implantation (49%) during the study period. Eighty-nine patients had a suture tarsorrhaphy at the time of surgery, and 239 did not. There was a statistically significant incidence of postoperative conjunctival edema in the no tarsorrhaphy group. There was also a significantly increased rate of conformer loss associated with conjunctival edema. Need for further surgery was not uncommon with 64% and 43% of patients requiring a secondary procedure in the no tarsorrhaphy and tarsorrhaphy groups respectively.Conclusions: Temporary suture tarsorrhaphy is a simple and effective procedure that reduces conjunctival edema and increases conformer stability when performed at the time of enucleation, evisceration, or secondary ball implantation. [ABSTRACT FROM AUTHOR]

Anamnesis: a colt showing a whitish coloration accompanied by abundant secretion on the left eye was examined. Clinical and laboratory findings: at ophthalmological examination, signs of melting ulcer were observed. Culture isolation revealed positive growing of Flavobacterium sp. and Gram-negative rods. Treatment approach: several keratectomies and tarsorrhaphies, as well as exhaustive antiproteinases, antiinflammatory, and antibiotic treatments, were conducted. Treatment focused on reducing inflammatory response, eliminating infective organisms, and promoting epithelial healing. Colt showed complete recovery of vision after 3 months. Conclusions: clinical management of melting ulcer implies exhaustive, though unexpensive, treatment.Anamnesis: se examinó un potro que presentó una coloración blanquecina acompañada de abundante secreción en el ojo izquierdo. Hallazgos clínicos y de laboratorio: al examen oftalmológico se observaron signos de ulcera fundente. El aislamiento por cultivo mostró crecimiento de Flavobacterium sp. y cocos Gram negativos. Abordaje terapéutico: se realizaron varias queratectomías y tarsorrafias, además de un tratamiento exhaustivo con antiproteinasas, antiinflamatorios y antibióticos enfocado a reducir la respuesta inflamatoria, eliminar los microorganismos infecciosos y promover la cicatrización epitelial. 3 meses después, el potro mostró recuperación completa de la visión. Conclusiones: el manejo clínico de la úlcera fundente es demandante, pero no es un tratamiento costoso.Antecedentes: foi examinado um potro que apresentava uma coloração esbranquiçada acompanhada por abundante secreção no olho esquerdo. Achados clínicos e de laboratório: ao exame oftalmológico foram encontrados sinais de úlcera colagenolítica. O isolamento por cultura apresentou crescimento de Flavobacterium sp. e cocos Gram negativos. Abordagem terapêutica: foram realizadas várias ceratectomias e tarsorrafias, além da instauração de um tratamento exaustivo com antiproteinases, anti-inflamatórios e antibióticos voltado para a redução da resposta inflamatória, a remoção de micro-organismos infecciosos e a estimulação da cicatrização epitelial. 3 meses depois o potro apresentou completa recuperação da visão. Conclusões: o manejo clínico da úlcera colagenolítica é exigente, mas não é um tratamento caro.