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East Grinstead West Sussex, United Kingdom

Sagili S.,Corneo Plastic Unit
Scottish medical journal | Year: 2012

Dry eye disease (DED) is a frequent problem in ophthalmology, causing considerable morbidity. DED is a multifactorial disease and requires a comprehensive approach in identifying the potential contributing factors. Often, clinicians overlook the fact that systemic medications are a cause of dry eye. We report two patients who developed symptoms and signs of DED secondary to systemic antihypertensive medication that improved following cessation of systemic medication. Source


Zamora-Alejo K.,University of Adelaide | Moore S.,University of Adelaide | Leatherbarrow B.,Corneo Plastic Unit | Norris J.H.,University of Adelaide | And 4 more authors.
Clinical and Experimental Ophthalmology | Year: 2013

Periorbital inflammation following regional anaesthesia is commonly attributed to hyaluronidase allergy. This case series suggests an alternative explanation in some patients. Design: Retrospective case series. Participants: Seven patients presenting with postoperative non-infectious periorbital inflammation following peribulbar or sub-tenons anaesthesia, presenting at four different institutions, are described. Methods: Data on patient demographics, operative data, clinical presentation, treatment and allergy testing were collected among the four institutions. Main Outcome Measures: Response to treatment and allergy testing were noted among the patients included in this study. Results: Seven patients (five female) underwent uneventful phacoemulsification under a peribulbar or sub-tenon's block, all including hyaluronidase with concentrations ranging 50-250IU/mL. The onset of inflammatory symptoms and signs varied from 12h to 3days after the surgery. The most common form of presentation was lid swelling and chemosis. Patients were treated with oral corticosteroids, with good clinical response. Four patients underwent skin prick and intradermal testing to the local anaesthetic used, and to the suspect and a control hyaluronidase batch. The results were all negative, excluding allergy as the aetiology of this toxic periorbital syndrome, in at least these four patients. Conclusion: Hyaluronidase toxicity, potentially related to concentration of hyaluronidase, may be a cause of postoperative periorbital inflammation after cataract surgery, rather than hypersensitivity. © 2012 Royal Australian and New Zealand College of Ophthalmologists. Source


Sagili S.,Corneo Plastic Unit | Selva D.,University of Adelaide | Malhotra R.,Corneo Plastic Unit
Orbit | Year: 2012

Lacrimal scintigraphy (LS) or dacryoscintigraphy can demonstrate abnormalities in 80%-95% of patients with symptoms of epiphora and a patent lacrimal system on syringing and up to 40% asymptomatic individuals. Precise localization of the site of delay may not always be possible due to lack of anatomic detail on LS. LS is considered useful in patients with epiphora with delayed tear clearance and patency to syringing and suspected to have either nasolacrimal duct (NLD) stenosis or lacrimal pump failure. It remains unclear, however, as to whether LS can reliably distinguish between the two. The literature reports considerable variation in the technique, normative data, analysis, and interpretation of LS. Qualitative or visual analysis is simpler to perform and to our knowledge used more frequently in comparison to quantitative analysis. There is little extra information to be gained from LS in cases with complete NLD obstruction or severe NLD stenosis on syringing. © 2012 Informa Healthcare USA, Inc. Source


Shunmugam M.,St. Thomas Hospital | Morley A.M.S.,St. Thomas Hospital | Graham E.,St. Thomas Hospital | D'Cruz D.,St. Thomas Hospital | And 2 more authors.
Orbit | Year: 2011

Wegener's granulomatosis can involve the orbit and sometimes the optic nerve. This usually occurs as a result of contiguous spread from affected sinuses or extraocular muscles, or from a vasculitic posterior optic neuropathy. However, we present an unusual case of isolated orbital apex infiltrative disease in a patient with known Wegener's granulomatosis. This initially caused painless optic neuropathy and progressed to painful ophthalmoplegia and blindness. Optic nerve biopsy, performed to exclude methotrexate-induced lymphoma, confirmed optic nerve infiltration. The condition was refractory to high-dose pulsed methylprednisolone but the patient gained symptomatic relief from rituximab. Wegener's granulomatosis should be considered in cases of isolated posterior optic neuropathy, and close attention should be placed on imaging the orbital apex. © 2011 Informa Healthcare USA, Inc. Source


Malhotra R.,Corneo Plastic Unit | Salam A.,Corneo Plastic Unit
Orbit | Year: 2012

Aponeurotic ptosis surgery is conventionally performed under local anaesthetic to allow adjustment of eyelid height and contour. This may not be possible where general anaesthesia (GA) is required. Purpose: We describe our experience using a tranconjunctival posterior approach "white-line" levator advancement (WLA) in patients undergoing aponeurotic ptosis correction under a GA. Materials and Methods: Retrospective review of a consecutive series of 20 patients with primary aponeurotic ptosis undergoing posterior approach WLA ptosis repair under GA. The procedure involves exposing the posterior surface of the levator aponeurosis and advancement through tarsus onto its anterior surface if exposed already, or to skin. All patients underwent pre- and postoperative photographs and final outcomes were assessed at minimum 3 months. Outcome measures included pre- and post-marginal reflex distance (MRD), symmetry of height, contour, fold and complications including dry eye. Results: Twenty patients undergoing 40 procedures were included. Mean age was 58 (2287) years. Mean preoperative MRD was 1.3. Preoperative phenylephrine test was positive all patients. The mean postoperative MRD was 3.5mm. Although all 20 patients achieved their desired lid height and contour, one patient had a 2mm asymmetry, with a final success rate of 95% (19/20 patients). Conclusion: We suggest that a posterior approach white-line advancement is an ideal technique to correct even severe aponeurotic ptosis in patients requiring surgery under GA. Preoperative positive phenylephrine test is a good predictor of postoperative height and contour without the need for per-operative adjustment. Précis: Aponeurotic ptosis surgery for patients under general anaesthesia using a simple posterior approach white-line advancement achieves predictability of lid height, symmetry and contour and is an ideal option for phenylephrine-positive ptosis. Copyright © 2012 Informa Healthcare USA, Inc. Source

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