Sameera Irfan

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Abstract

Aims: To evaluate the usefulness of orbicularis bi-pedicle flap, a simple surgical technique to reconstruct shallow, upper or lower eyelid defects with loss of more than two-thirds of the lid tissue. Materials and Methods: This prospective interventional study was conducted at a two tertiary referral centers in Lahore, Pakistan from Jan 2011 - Dec 2018. 17 consecutive cases were included: 4 primary, 9 with recurrent tumour and 4 secondary cases with an excised tumour and eyelid defect. The upper lid was affected in 6 cases and lower lid in 11 cases. The median age of patients was 62 years (range 45 - 71 years), with 9 female and 8 male patients. The posterior lamella was reconstructed by mobilising forniceal conjunctiva while donor sclera was used to replace the tarsus. To reconstruct anterior lamella, orbicular bi-pedicle flap was mobilised, covered by a free skin graft. Post-operative follow-up was after 1, 2 weeks and then after 1, 3, 6 months and 1 year. At each visit, functional, aesthetic, visual outcome and patient satisfaction was assessed. Results: Patient satisfaction was 100%. Lagophthalmos in 3 cases (27%), 2 mm lid retraction in 2 cases (18%) following upper lid reconstruction. No complication noted after lower lid reconstruction. Conclusions: Orbicularis bi-pedicle flap is a simple, single-staged technique, with short learning curve and minimal complications. It is particularly useful in single-eyed patients. Keywords: Lid reconstruction, Lid tumor excision, Lid margin defects, Orbicularis bipedicle flap.

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Abstract

Introduction: A prospective, interventional study was conducted to determine whether surgical intervention can be avoided in infants with CNLDO by a proper conservative management. Materials and Methods: The study was conducted from March 2013 till December 2019. 338 prospective cases presenting with epiphora, eyelid discharge and regurgitation on lacrimal sac compression were included in the study. Out of these, 166 were females (49.11%) and 172 males (50.88%). The age at enrolment was 1-47 weeks (median 23 weeks, mode 21 weeks), with 31 premature babies, (9.2%). The cases were divided into Primary (41 cases, 12.13%), who presented early with no prior therapy & Secondary categories (297, 87.86%), who presented late and had been using topical antibiotics and sac massage. Patients’ care-takers were taught the proper technique of lacrimal sac compression with a cottontip. Topical Tobramycin eyedrops were prescribed 3 times daily for 5 days only to cases with a purulent discharge or eyelid swelling. Regular follow-up was conducted at 1, 3, and at 6 months after the initial visit. Results: 316 cases (93.49%) had a complete resolution of epiphora and discharge on lacrimal sac compression. 22 cases (6.50%) were symptomatic at the end of study and needed surgical probing. A complete resolution of symptoms and signs was significantly higher in unilateral cases than bilateral (p=0.001). There was no significant difference amongst genders (p=0.684), or amongst primary versus secondary cases (p=0.062); they all responded to the correct conservative management. Conclusion: CNLDO can be resolved conservatively by a proper technique of sac compression and eyelid cleaning, which must be performed regularly, and continued till the infant is one year old, in order to avoid recurrent symptoms. Keywords: Congenital nasolacrimal duct obstruction (CNLDO), Epiphora, Lacrimal sac compression.

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