Objective: To define the clinical and optical coherence tomography (OCT) morphology of the lacrimal punctum and assess the age-related changes across 8 decades of life in a normal population.
Methods: A total of 1310 high-magnification slit-lamp, Fourier-domain OCT (FD-OCT), and optical coherence tomography angiography (OCTA) images were obtained from 320 puncta of normal asymptomatic individuals representing the Indian population. The punctum and peri-punctal area were defined with the help of 2 rims (inner punctal rim and outer punctal rim ) and 3 zones (white zone [Wz], separation zone [Sz], and peri-punctal vascularity). FD-OCT images were used to measure the external punctal diameters and internal lacrimal punctal diameters and the reflectivity patterns of the 3 punctal layers. OCTA was used to assess the branching and extent of vascular networks.
Results: The upper puncta were narrower and more circular than the lower puncta across the decades. The elevation of the punctal papilla began in the upper puncta in the fifth decade, involved the lower puncta in the sixth decade, and gradually became exaggerated by the eighth decade. A typical punctal narrowing in previously wide puncta began to appear in the sixth decade of life, peaks in the seventh decade, and reverses gradually and spontaneously by the end of the eighth decade of life. The third and fourth decades saw a narrowing of the Sz with prominent vascularity crossing the Sz to reach the Wz. The Sz became indistinct in the fifth and sixth decades of life. The FD-OCT showed gradual thickening and dominance of the fibrous layer from the fifth to eighth decade of life. The clinical vascularity in the peri-punctal region increases from the third decade onwards, with vascular networks becoming increasingly dense, intricate, and branched as the age progresses.
Conclusion: The present study defined and characterized the involutional changes in a normal population’s first–eighth decades of life. Significant morphological changes were noticed across the different age groups with several clinical implications.

Objective: To develop a method of injecting a volume of up to 50% of the lacrimal gland (LG) volume whilst minimizing patient discomfort and maximizing accurate delivery.This method was used in a randomized placebo-controlled trial aimed at elucidating the therapeutic effect of allogeneic stem cells in 40 patients with aqueous deficient dry eye disease (ADDE). These patients had a small LG, suffered from sensitivity to light and found lid eversion painful.Methods:Stem cells:The authors have recently conducted a safety study for injection of mesenchymal stem cells to the LG of 7 patients with ADDE. One transconjunctival injection of a volume of maximally 50% of the LG was well tolerated in all 7 patients (ref 1) Ultrasonography and injection into the LG:Traditionally injection into the LG is performed by everting the upper eyelid and aiming the needle towards the palpebral lobe (ref 2)Ultrasound can provide real-time images of the LG and can be used to safely guide the needle ensuring the correct placement within the gland capsule. This reduces the risk of injury to the eye and adjacent structures and enables transcutaneous injection.Ultrasound scans were performed using a GE Logiq E10 (Milwaukee, Wisconsin, USA) ultrasound machine with 5-16 ML and 6-24 MHz transducers. Ultrasound was performed by two expert rheumatological ultrasonographers. We recorded the injection and observed an enlargement of the LG ensuring delivery within the lacrimal gland before the needle was removed.Results:The position of the injection needle within the LG was documented in all 40 patients. Injection of the stem cells (N=20) or vehicle (N=20) led to an enlargement of the glandular structures in all cases.Conclusion:Ultrasound guidance of injection into the lacrimal gland enables injection on a closed eye causing minimum patient discomfort and maximum certainty of accurate “drug” delivery. No adverse reactions related to this injection procedure were observed.[LT1] 

References:1.      Møller-Hansen M et al. Safety and feasibility of mesenchymal stem cell therapy in patients with aqueous deficient dry eye disease. Ocul Surf. 2021 Jan;19:43-52. doi: 10.1016/j.jtos.2020.11.013. Epub 2020 Nov 28. PMID: 33253910.2.      Riemann R et al Successful treatment of crocodile tears by injection of botulinum toxin into the lacrimal gland: a case report. Ophthalmology 1999; 106: 2322–2324.

Purpose:

To evaluate the effectiveness of lacrimal gland botulinum toxin injections for epiphora.

Methods:

Patients receiving incobotulinum toxin A injection (Xeomin 2.5 - 5 units) injected into the palpebral lobe of the lacrimal gland for epiphora of any cause were prospectively recruited. Epiphora was graded at baseline and at 2-6 months using the TEARS score. This is a validated measure of tearing frequency (T), clinical effects (E), activity limitation (A) and reflex tearing (R). The underlying aetiology was recorded, along with duration of treatment effect, complications and whether the patient went on to undergo further injections.

Results:

Thirty-four patients were recruited with a mean age of 62.2 (+/- 15.1) years. Of these, 23 (68%) had gustatory epiphora secondary to facial nerve synkinesis. Other aetiologies included eyelid malposition (18%) and canalicular or nasolacrimal obstruction (12%). There were no complications reported. The effect duration lasted a median 13 weeks (range 6 – 26). Over half (52%) saw a reduction in tearing frequency (T), with 33% gaining >= 2-point improvement. Improvements in clinical effects (E) and activity limitation (A) were seen in 48% and 55% of patients respectively, with 30% and 33% respectively gaining >= 2-point improvement. Improvements in R scores were observed in 42% with 24% seeing >= 2-point improvements. There was no significant difference in the proportion responding favourably when comparing gustatory and non-gustatory epiphora. Additional injections were sought in 91% of patients with gustatory epiphora vs 50% of those with other causes (p<0.01). 

Conclusion:

Incobotulinum toxin A administered to the lacrimal gland is a safe and effective treatment option for epiphora, with clinical improvements seen in most patients regardless of aetiology. Patients with gustatory epiphora secondary to facial nerve synkinesis are more likely to undergo repeat injections compared with other aetiologies. The TEARS score provides validated quantitative and qualitative outcome data that can be used to support treatment decisions and provide evidence of value for commissioners.

Abstract

Purpose: Many patients present with complaints of tearing but have a normal lacrimal outflow work up. To investigate how dacryoscintigraphy (DSG) may aid in their diagnosis and management.

Methods: A retrospective case series was performed on patients with symptomatic tearing despite no identified external cause and normal lacrimal probing and irrigation (i.e., functional epiphora). Many of these patients had been diagnosed by other providers with “dry eye”, but failed to improve with artificial tear supplementation. All patients with normal office evaluation underwent DSG testing.  If DSG demonstrated normal evacuation of tears into the nose no intervention was undertaken. We recommended surgery to enhance entry of tears through the puncta and canaliculi into the lacrimal sac for those with delayed tear flow prior to entering the lacrimal sac (pre-sac) and dacryocystorhinostomy for those with delayed tear flow after the lacrimal sac (post-sac). Surgical success was defined as epiphora being resolved or improved. Surgical failure was defined as epiphora being unchanged or worse when compared to the preoperative timepoint.

Results: Fifty five patients (86 sides) were identified for DSG testing. Of these, 96% (53 patients, 79 sides) had abnormal DSG findings indicating delayed clearance of tears through the lacrimal outflow system. A pre-sac delay was observed in 14 cases (18.2%) and post-sac delay in 63 (81.8%). Overall surgical success was 83.1% across the cohort. Success was 100% in the pre-sac group and 79.4% in the post-sac group (p = 0.06). Mean follow-up time was 22 months (Standard Deviation = 21 months).

Conclusion: Many patients present with complaints of tearing but have a normal lacrimal outflow work up. DSG revealed an anatomic location of impaired lacrimal outflow in 96% of cases. Surgery to correct the anatomic localization of outflow restriction allowed a better than 80% successful resolution of epiphora.

Objective: Congenital Nasolacrimal duct obstruction (CNLDO) is a relatively common problem in children with Down Syndrome (DS). Probing and irrigation (PI) may be less successful with monocanalicular stent intubation (MSI), thus raising some concern regarding the preferred treatment in this population. Our purpose was to describe the surgical outcome of PI along with MSI in children with DS compared with non-DS patients.

Methods: A single-center retrospective medical chart review was performed for all children who underwent PI with MSI as primary treatment for congenital NLDO between 2009 and 2020. The diagnosis of NLDO was based on the history, ocular examination, and dye disappearance test. All procedures were performed by a single surgeon (WRK). Main outcome measure was surgical success defined as resolution of symptoms after surgery.

Results: A total of 1020 patients participated in the study, 1001 children without DS and 19 children with DS, 48.6% female and 52.4% male. A total of 1469 eyes were operated on the non-DS group and 35 eyes on the DS group. The mean age at procedure was 1.9±1.4 years (range: 0.1 – 18.1), the mean follow-up time was 35.0 months. No difference was found in age and gender between both groups.

A higher rate of right NLDO was observed in the DS group (100% vs. 73.2%, p=0.006). Patients with DS had more bilateral obstructions (84.2% vs. 46.8%, p=0.001) and had lower success rate (57.1% vs 92.4%,p<0.0001). No difference was found between nasolacrimal stenosis grade as appreciated during the procedure or rates of stent loss after the procedure. The median time to failure was 3.1 months in the DS group, and 5.2 months (range: 0.7-43.2) in the non-DS group. The hazard ratio comparing Down’s syndrome patients to Down’s syndrome-free patients was 6.6 (95% CI: 3.2-13.7, P<0.001).

Conclusions: CNLDO in DS has unique characteristics. It is more likely to be bilateral and to involve the right nasolacrimal system, and less likely to resolve after initial probing with monocanalicular stent intubation. However, in most patients, the procedure was successful, thus withholding the need for more aggressive primary treatment modalities such as balloon dacryoplasty or DCR. Therefore, we believe that probing with monocanalicular stent intubation remains a viable primary treatment option for DS patients.

Purpose: To assess mid-term outcomes of minimally-invasive endoscopy-guided transcaruncular laser-assisted StopLoss Jones tube (SLJT) implantation for severe canalicular obstructions in primary surgeries.

Method: We retrospectively identified patients who underwent an endoscopy-guided transcaruncular SLJT implantation as the primary surgery for complete canalicular dacryostenosis. The procedure was conducted under an 810-nm diode laser's assistance. Patients were followed up for a minimum of 1 year postoperatively. Surgical and functional success rates, intraoperative and postoperative complications, and the necessity for secondary surgery are evaluated.

Result:Thirty-two eyes in 32 patients were identified, including 19 (59%) of canalicular agenesis and 13 (41%) of acquired canalicular obstruction. Primary surgical success was achieved in 30 of the 32 cases (94%). Two patients (6%) required secondary surgery to replace an SLJT with a shorter one. Ultimately, all cases showed well-placed functioning tubes. Seven of the 32 cases (22%) presented conjunctival scarring, conjunctival granuloma tissue, with or without tube-associated irritation of the ocular surface. In the one-year follow-up of 32 patients, complete functional success was achieved in 84%, and five patients (16%) complained about ocular surface discomfort. In the two-year follow-up of 15 patients, complete functional success was achieved in 12 patients (80%), and three patients (20%) suffered from ocular surface discomfort. No sink-in, migration, extrusion, nor crack of the tube was observed during the follow-up.

Conclusion: Endoscopy-guided transcaruncular diode laser-assisted SLJT implantation appears to be a promising minimally invasive approach for the primary treatment of severe canalicular dacryostenosis. It has shown a high functional success rate and might avoid the risk of tube malposition and extrusion, septal and turbinate injury, nasal adhesion, drainage failure, ethmoiditis, postoperative bleeding, and cutaneous scars.

     Background: Congenital nasolacrimal duct obstruction (CNLDO) is usually secondary to a blockage at the valve of Hasner by a membranous tissue. Silicone lacrimal intubation is indicated if conservative and/or probing treatments fail to resolve CNLDO. The purpose of this study is to assess the success rate and complications of Lacrijet monocanalicular stent (FCI S.A.S, Paris, France) intubation in children treated for CNLDO.

        Methods: Retrospective review study which included children with CNLDO that were intubated with Lacrijet monocanalucilar silicone tube.The Lacrijet tube remained in place for 11-15 weeks post operatively and was removed in the clinic with topical anesthesia. Operative time was recorded for each case. All children were evaluated using the following parameters preoperatively and postoperatively: tear meniscus height, Fluorescein dye disappearance test, and MUNK score. 

         Results: The study included 20 eyes with mean age of 26.25 ± 11.25 months. 17 eyes (85%) had undergone probing previously. Mean operation time of Lacrijet intubation was 8.5 minutes (95%CI 7.04 – 9.95). Mean follow-up period was 204.65 ± 105.27 days. Lacrijet intubation resulted in statistically significant improvements in tear meniscus height (P < .001), fluorescein dye disappearance test (P < .001), and MUNK score (P < .001) in all children. Two different sizes of Lacrijet intubations were used. Complete success was obtained in all cases. No complications were observed.

         Conclusions: Lacrijet lacrimal intubation has a high rate of success, shortens surgical time and has a low rate of complications in children with CNLDO.

Aim:Many factors can affect external-Dacryocystorhinostomy (ex-DCR) success.It was reported that chronic inflammation score (CIS) can aid to determine the outcomes of endoscopic DCR.However, to date there is no study evaluating the relationship between ex-DCR outcomes and CIS.Therefore, this study was conducted to find out if there is an effect of CIS on the surgical outcomes of Ex-DCR.

Methods:Lacrimal sac specimens of the 30 naive ex-DCR patients were scored according to these 3 histopathological features:the intensity of inflammatory cell infiltration (IC), the density of fibrosis (F) and the degree of capillary proliferation (CP).Each features were scored as 1 for mild, 2 for moderate and 3 for severe.The total score was CIS.The surgical outcomes were assessed subjectively (+/- epiphora) and objectively (+/- syringing).Histopathological features and CIS were compared between successful and unsuccessful results.

Results:The subjective success rate was 86.7% and the objective rate was 90%.For both subjective and objective outcomes;IC, F and CP were significantly different between successful and unsuccessful patients(for subjective outcomes;p=0.02, 0.001 and 0.001; for objective outcomes;p=0.03, 0.01 and 0.007 respectively).Total mean CIS was 3.80±1.24 and it was higher in both objectively and subjectively unsuccessful cases than in successful cases(6.33±0.57 vs. 3.52±0.94, p=0.004 and 6.25±0.50 vs. 3.42±0.81, p<0.001;respectively).

Conclusion:CIS were found to be higher in unsuccessful ex-DCR than in successful.CIS can be a useful prognostic factor for ex-DCR outcomes.This study should be regarded as a pilot study and must be validated with a larger sample size.

Introduction

During the Covid-19 pandemic, dacryocystorhinostomy (DCR) technique was modified to reduce risk of viral transmission through exposure to nasal mucosa during the tube removal and to reduce the number of post-operative visits.

Methods

We retrospectively reviewed case notes from patients who had DCR (external and endonasal) in 2020 at Moorfields Eye Hospital, comparing 2 groups:

Group A. Lacrimal intubation technique requiring post-operative removal via nasal cavity – tied bicanalicular silicone stents, or:

Group B. Lacrimal intubation not requiring post-operative manipulation via nasal cavity - self-retaining monocanalicular stents or untied bicanalicular silicone stent with intranasal silicone sleeve.

Exclusion criteria:

• no lacrimal intubation

• obstruction proximal to nasolacrimal duct

• primary insertion of Lester Jones tubes

Primary outcome was success or failure, measured by symptomatic improvement (epiphora or discharge). Secondary outcomes include number of post-operative appointments, wound healing and complications. We compared outcomes between group A vs B, and whether outcomes differed in external DCR with suture vs glue skin closure. Chi-squared and T-test were used.

Results

114 DCR (61% external; 39% endonasal) were performed from 1st January to 31st December 2020 for nasolacrimal duct obstruction. Median age was 58 years (range 5-92; 26% male, 74% female). 19 (14%) patients met exclusion criteria. Group A (n=87) success was 87%; post-operative complications arose in 9% (most commonly cheesewiring (2%), hypertrophic scarring (2%) and epistaxis (2%)). 

In group B (n=27), neither success (92%, p=0.488) nor post-operative complications (4%, p=0.319; one case of mild infection) were significantly different to group A.

Success did not differ between patients who had skin closure with glue (95% success, 28% of patients) or sutures (88% success, 72% of patients, p=0.367) during external DCR. Average number of post-operative appointments was lower in patients who had skin closure with glue (1.89) compared to sutures (3.25, p<0.001). No wound healing issues or post-operative cellulitis were reported in either group.

Conclusions

Variations in lacrimal intubation and skin closure during DCR can avoid high-risk exposure to nasal mucosa and reduce post-operative appointments without compromising success or complication rates. These modifications in DCR developed during the pandemic may have a long-term value.

Purpose: To assess the long-term efficacy of 4-mm coronary balloon catheter dacryoplasty in revision endoscopic dacryocystorhinostomy (RevEnDCR).

Methods: Retrospective interventional case-series of patients who underwent RevEnDCR aided by a 4-mm coronary balloon catheter (CBC) dacryoplasty. The indications for the surgery were previously failed DCRs by external or endoscopic approach where the ostium showed near total cicatrization with or without the presence of organized granuloma threatening the internal common opening (ICO). The coronary balloon (4 × 10 mm, SPALNO, Cardiomac, Haryana, India) with the guidewire was used and a minimum of >12 months of follow-up was considered for analysis.

Results:Ten lacrimal systems of eight patients with mean age of 48.8 years underwent CBC-assisted revision endoscopic DCR. Of the 10 failed DCRs, 6 had a previous external approach DCR and 4 were endoscopic DCRs. Grossly stenosed ostium with near total cicatricial closure were noted in half of the patients (50%, 5/10) while the remaining half, in addition, showed organized granulomas threatening the ICO. The surgical technique using CBC was found to be minimally invasive, easy to perform with multiple advantages like uniform clearance of the area in front of ICO and more predictable lacrimal sac flaps. At a mean follow-up of 20 months, anatomical and functional success were achieved in 90% (9/10) of the eyes.

Conclusion: The coronary balloon catheter-assisted revision endoscopic DCR is a minimally invasive and viable alternative in select group of patients of failed DCR with near total cicatrisation or organized granulomas threatening ICO.

In the array of lateral orbitotomy procedures, the lateral fornix approach is less well known. It involves a curvilinear conjunctival incision in the lateral fornix, situated behind the equator of the globe. Dissection remains posterior to the lateral orbital tubercle of Whitnall. The technique allows exposure of the lateral orbit for repair of orbitozygomatic fractures and defects, to access extra- and intraconal lesions, and to perform lateral orbital decompression. The advantage of the lateral fornix approach is wide access to the lateral orbit without severing the anatomy of the lateral canthal ligament. The secretory tear ducts of the lacrimal gland require identification to avoid injury. In this presentation, the technique and applications are described.

Abstract title: Development of endoscopic orbital surgery - the progression of a tertiary referral centre

Format: Oral

Authors: Ahmad Aziz, Vickie Lee, Rajni Jain, Catherine Rennie, William Grant

Affiliation: Imperial College Healthcare NHS Trust, UK

Introduction/purpose: Transorbital neuroendoscopic surgery is gaining in popularity with ENT and neurosurgeons as an approach with improved visualisation of the orbit. Here we present with pictures and videos the benefits of an endoscopic approach to the orbit.

Methods: An endoscopic approach has been used in the procedures of enucleation, orbital abscess drainage, orbital decompression, access to the orbital apex and biopsy of lesions in the medial orbit posterior to the globe. We present a sample of the techniques used and the examples of the visualisation achieved with this approach.

Results: An endoscopic approach to the orbit has been used successfully in a busy London tertiary referral centre. There is superior visibility compared to traditional anterior orbital approaches of the posterior orbit and optic nerve.

Conclusion: The use of an endoscope in the orbit has a learning curve but offers enhanced visualisation in what is a small operative field and improved access to posterior orbital lesions. We recommend the use of the endoscope in cases where access can be limited and visualisation poor.

Background: Non-specific orbital inflammation (NSOI) and IgG4-related-orbital-disease (IgG4-ROD) are often challenging to differentiate. Furthermore, it is still uncertain how chronic inflammation, like IgG4-ROD, can lead to Mucosa-associated lymphoid tissue (MALT) lymphoma. Therefore, we aimed to evaluate the diagnostic value of gene expression analysis to differentiate orbital autoimmune diseases and elucidate genetic overlaps.

Methods: First, we established a database of NSOI, IgG4 ROD and MALT patients of our orbital center (2000-2019). In a consensus process, three typical patients of the above mentioned three groups (mean age 56.4±17y) at similar locations were selected. Afterwards, RNA was isolated using the RNeasy-FFPE-kit (Qiagen) from archived paraffin-embedded tissues. The RNA was then subjected to gene expression analysis (NanoString nCounter®) including a total of 1364 target genes. The most significantly up- and downregulated genes were used for a machine learning algorithm to distinguish entities. All statistical analyses were calculated using the Ri386 statistical programming environment (v4.0.3).

Results:

Using a set of marker genes the decision-tree-based algorithm could distinguish between the three entities with a high probability (p<0.0001). Interestingly, gene expression patterns showed a characteristic overlap of lymphoma with IgG4-ROD and NSOI. In contrast, IgG4-ROD shared only altered expression of one gene regarding NSOI.

Conclusion: Genetic expression analysis has the potential for faster and more secure differentiation between NSOI and IgG4-ROD. After this screening process for marker genes, a validation in a larger cohort is undergoing to verify the results. MALT-lymphoma and IgG4-ROD showed markedly more genetic similarities, which points towards the possible progression to lymphoma.

Background: Solitary fibrous tumours (SFT) are rare tumours with an intermediate malignant potential. The risk factors for aggressive behaviour of these tumours are still poorly understood. We detail a series of orbital SFT managed in a specialised centre in order to contribute to a better understanding of these rare tumours.

Patients and methods: 15 patients with orbital SFT treated in our centre between 01/01/2013 and 30/11/2021 have been selected. Clinical, radiological and histo-pathological characteristics are described and analysed.

Results: On the 15 lesions included, 4 lesions are secondary addressed recurrences with infiltration of surrounding tissue. These 4 lesions have been treated with a further surgical resection: 2/4 with preservation of the globe, the optic nerve and/or the oculomotor muscles with remaining tumour tissue controlled by adjuvant treatments (1/4 gamma-knife, 1/4 proton therapy), and 2/4 with exenteration up to the vital neurosurgical structures with later recurrence from the intracranial tumour tissue and metastasis in spite of adjuvant treatment.

On the 11 primary lesions managed in our centre, 8/11 lesions have been completely removed with no recurrence. 3/11 lesions have been near-totally removed due to infiltration of the surrounding noble tissues. Radiological and histo-pathological considerations are detailed.

Discussion: Orbital SFT are rare tumours with a potential malignancy with still poorly understood prognostic criteria. Our single-centre series of orbital cases is one of the largest series described in the literature. Discussion and comparison with recent studies pinpoint the need of meta-analysis.

Conclusion: Considering the rarity of orbital SFT, our additional data should contribute to a better understanding of these tumours with malignant potential.

Background:

Orbital exentration is a standard treatment for severe orbital involvement in mucormycosis when it has its indications in addition to other medical remedies.

Normally, Orbital exenteration removes the entire contents of the bony orbit, including the globe, extraocular muscles and periorbital fat, and many times includes the eyelids.

It leads to several functional, esthetic and psychological problems for the patients.

In many cases of orbital mucormycosis, only orbital apex is involved and the anterior orbit including the globe and eyelids are not necrotic and logically and potentially do not need debridment.

If there is any technique not to debride the uninvolved tissues including the globe and eyelids, we will be able to avoid the devastating effects of a total or subtotal orbital exentration.

In this presentation, we introduce a technique to remove and debride the necrotic tissues behind the globe including the orbital apex but sparing the uninvolved orbital tissues including the globe and eyelids.

 Methods:

 Case series, Endoscopic endonasal orbital surgery approach

Results:

The surgery was done in 4 proved sino-orbito-nasal post-covid mucormycosis patients with severe orbital apex necrosis that were given indications of orbital exentration by at least 2 oculoplastic surgeons.All eyes had no light perception with frozen movements.

The technique was endoscopically and endonasally removal of the necrotic tissues of the whole orbital apex including the medial and lateral necrotic bony wall and apex necrotic soft tissues. We will show the technique and all cases one by one. In all of four patients, globe,eyelids and anterior orbital tissues were saved. We followed up them between 4 to 8 months until we were sure there was not any sign of the infection recurrence.
Conclusion:

Many cases of severe mucormycosis have already lost their vision due to orbital apex involvement, and frozen eye is observed in many; hence, the surgeon needs not to worry about vision loss perioperatively and can remove even the optic nerve in the case of involvement.

Sparing the globe and uninvolved tissue with the aid of endoscopic-power-assisted surgeries can bring the feasibility of avoiding a rather disfiguring and catastrophic procedure and eliciting the need for further complex reconstruction.

Indroduction; Exophthalmos caused by thyroid eye disease is usually treated by orbital decompression, which involves resection of orbital fat and bone. The most common postoperative complication of orbital decompression is new-onset diplopia (NOD). However, almost reports concern diplopia in the primary position, and there are no reports showing changes in the entire visual field. In this study, we investigated how the fusion image area (FIA) changes after orbital decompression surgery, which mainly involves microscopic resection of the orbital intra/extraconal fat, using the binocular single vision (BSV) test.

Methods: Of 76 patients (150 eyes) with thyroid eye disease who underwent bilateral orbital fat decompression under general anesthesia at Oculofacial Clinic Tokyo between January and December 2021, 29 (58 eyes) who were available for a 6-month follow-up were enrolled. Patient age and sex, postoperative changes in Hertel exophthalmometer measurements, amount of orbital fat removed, and BSV were recorded. FIA was defined as the average of the four locations from the primary position at which diplopia was felt, which were measured using the BSV test.

The surgery was performed through a conjunctival incision in the inferior fornix, excising the anterior orbital fat, extraconal fat and then intraconal fat entering between the lateral and inferior rectus muscles and between the medial and inferior rectus muscles, being careful to avoid nerves and blood vessels. The excised fat was placed in an empty syringe without air to measure the volume after blood was removed with gauze.

Results: The 31 patients (28 women, three men) had a mean age of 43.4±13.2 years (range, 19–72). Mean ocular protrusion decreased 3.6mm from 20.0±3.2 mm preoperatively to 16.4±3.0 mm postoperatively. The average amount of fat removed was 3.8±1.6 mL; accordingly, the volume of orbital fat needed to improve the exophthalmos by 1 mm was 1.1 mL. FIA was changed  from 43.7° preoperatively to 44.2° (P=0.38), 44.5° (P=0.31), and 44.4° (P=0.34) at 1, 3, and 6 months, respectively, after surgery. At 6 months postoperatively, none of 30 patients without preoperative diplopia in the primary position developed NOD in the primary position. One patient had all field diplopia throughout follow up duration.

Conclusion: The fusion area was not decreased significantly at 1,3 months and 6 months after  orbital fat decompression. There were no cases of residual NOD postoperatively.

Background: The most common blood tests to evaluate patients with Thyroid Eye Disease (TED) are: Thyroid Stimulating Hormone (TSH), T3, T4. However, it is known that those blood tests are not correlated with the severity of TED. In recent years, a new blood test for Thyroid Stimulating Immunoglobulins (TSI) is in use. However, there is not enough evidence about the correlation between the TSI level to Thyroid Eye Disease (TED). Therefore, the purpose of this current study was to evaluate the correlation between TSI and TED and to examine if TSI is a good predictor for the severity of the disease. 

Methods:  A retrospective review of medical records of all patients who attended the TED clinic at Sheba Medical Center, Israel from January 2020 to April 2022 and had a TSI results was performed. The retrieved data included: demographics, comprehensive ophthalmic examination findings, orbital and eyelids evaluation, clinical activity scores (CAS) and laboratory test results.

 Results: 60 patients (43 females) had a known TED and had a documented TSI result.

The mean TSI  at presentation was 1171.35 while at the end of follow up,it was 517.98 (P=0.012). TSI values were found to be positively correlated with IOP (P=0.01) and eyelids measurements of PF (P=0<0.01) and MRD1 (P<0.01) while negatively correlated with Pattern Standard Deviation result (P=0.05).

TSI values > 500 were also found positively correlated with the clinical activity score (CAS) (P=0.02) and eyelids measurements of PF (P=0.02), MRD1 (P=0.01) and MRD2 (P=0.003) while negatively correlation with Pattern Standard Seviation result (P=0.015).

TSI values > 500 were found to be significantly correlated with medical treatment- high dose steroids (P=0.05), steroid treatment according to the European Group on Graves’ Orbitopathy protocol (P=0.02) and Radioactive iodine (P=0.03).

Conclusions: TSI value is correlated with the presentation of the clinical features of TED. TSI can be considered as a good predictor factor for the activity of the disease as well as the number of surgical and medical interventions. Therefore, It is recommended to add this blood test to the panel of blood tests for patients with TED. 

Abstract: A new era in anophthalmic socket surgery began with the introduction of coralline hydroxyapatite (HA) in the late 1980’s. The HA implant represented a new generation of buried spherical implant with an interconnecting system of pores that allowed host fibrovascular ingrowth. By drilling into the HA implant and inserting a peg, the orbital implant could be directly coupled to the overlying prosthetic eye, producing life-like movement of the prosthesis. Although HA implants significantly increased the cost of rehabilitating the anophthalmic socket (e.g., higher implant costs, wrapping material costs, additional surgeries to implant a peg, confirmatory bone scan etc.), the proposed advantages of a lower migration rate, lower extrusion rate, resistance to infection, and enhanced motility were used to justify the added expense. The author reviews his 30-year experience with a variety of these porous implants as well as the literature and reports that there is no evidence to corroborate a lower migration rate, a lower extrusion rate, and a lower infection rate. With respect to enhanced motility, there is no difference from that of a non-porous implant unless a coupling peg has been used. As with innovative implant designs from the past (e.g., Mules, Rudemann, Cutler), the initial wave of enthusiasm with porous implants has been tempered as an increasing number of surgeons recognize the touted advantages have little scientific data to support them and the implants associated with numerous risks and complications that may be difficult to manage. They are not the gold standard as some once thought.

Purpose: To evaluate the outcomes of transcutaneous Restylane injection in patients with anophthalmic socket syndrome.

Methods: Twenty-six patients with anophthalmic socket syndrome were treated with transcutaneous injections of Restylane. Patient satisfaction was evaluated using the validated Face-Q scale. A subset of patients (n=12) was followed for ultrasound filler dimensions over time. Three-dimensional images (Figure 1) were also acquired in 11 cases to evaluate both changes in filler volume and upper eyelid crease height (UECH) symmetry. Follow-up was scheduled at 3 months and annually after surgery.

Results: One year post-injection, significant improvement was observed on the FACE-Q scales for psychological well-being (p=0.04), social functioning (p=0.02), satisfaction with facial appearance (p=0.04) and satisfaction with eyes (p=0.02) in the ‘Restylane-only’ group (n=19). Based on echography, no significant differences were observed in the axial, anteroposterior and craniocaudal filler dimensions over 4 years. Compared to baseline, median filler volume based on 3-D imaging significantly increased one year after a single injection (3.35 mm³, IQR: 2.76-4.48 mm³) (p=0.003) and remained stable up to 4 years (p=0.392). Median UECH difference between the prosthetic and the healthy fellow eye significantly decreased from baseline (4.9mm, IQR:1.6-8.6mm) to final follow-up (0.33mm, IQR: 0.16-1.21mm) (p<0.001).

Conclusions: Transcutaneous injection of Restylane improved significantly patient satisfaction scores, lid crease symmetry and superior sulcus volume in patients with anophthalmic socket syndrome. Volumetric measurements remained stable up to at least 4 years after injection. This represents a long-lasting feasible nonsurgical alternative for the management of upper eyelid crease asymmetry and superior sulcus deformity. 

Purpose: To describe a non-surgical method to reshape shallow fornices in contracted sockets that cannot be adequately fitted with a prosthesis, and to prevent fornices’contraction following socket surgery.Methods: Thirty-two patients unable to retain the prosthesis due to a contracted socket were retrospectively reviewed. Ten patients had a moderately contracted socket and preferred to avoid surgery; in 8 patients the surgery was contraindicated for medical reasons; 14 patients had previously been submitted to mucous-membrane graft or dermis-fat graft. In all cases the socket was fitted with a customised conformer; a mark was made on the conformer at the centre of the eyelid opening. The conformer was then removed from the socket and a cylindrically shaped handle was glued onto the previously marked area to form the so-called compressor. This device was inserted into the socket with two patches positioned on the top of the handle to keep the compressor stable. In 14 patients who underwent reconstructive surgery, the device was positioned immediately after removal of the temporary tarsorrhaphy in order to avoid graft retraction. The compressor is kept 24 hours a day for a week, and afterwards it is alternated with a prosthesis or a conformer during the daytime, until a customized prosthesis can be properly retained into the socket .Results: The use of the compressor allowed the deepening of the fornices in non-surgical patients, and reduced graft contraction and stabilised the fornices after reconstructive surgery. After the treatment, all patients were able to wear a prosthesis.Conclusion: This procedure is effective in permitting the reshaping of shallow fornices in contracted sockets. It is very beneficial in patients who are unfit for surgery. By reducing socket contraction, the compressor increases the success rate of surgery, with good patient satisfaction and the advantage of reducing the chances to having to undergo further interventions.

Introduction

To assess patient demographics, clinical indications, over a fifteen-years period in Manchester (United Kingdom) and to investigate the systemic co-morbidities associated with orbital implant exposure in patients with anophthalmic sockets.

Methods:

Retrospective review of patients who underwent enucleation or evisceration at a single tertiary oculoplastic centre between January 1, 2007 and January 1, 2022. The data collected included patient demographics, surgical indication, implant size, implant exposure rate and other postoperative complications. Medical comorbidities, including peripheral or coronary vascular disease, inflammatory conditions, diabetes, malignancy, history of smoking or substance abuses were also recorded. Univariate and multivariate analysis was used to determine clinical and demographic factors that have impact on post-operative outcomes.

Results:

After excluding patients with incomplete data, two hundred and seventy patients underwent eye removal surgery over a fifteen-year period. Implant exposure was seen in 21 (7.8%) patients. The most common indication for eye removal surgery was painful blind eye (147, 54.4%), followed by trauma (31, 11.5%), severe infection (30, 11.1%) and malignancy (29, 10.7%). Significantly more patients with the following clinical or demographic factors experienced implant exposure: malignancy (29.4% vs 4.7%, p=0.002), substance addiction (50.0% vs 5.6%, p=0.021) and smoking (37.5% vs 4.3%, p=0.001). Multivariate logistic regression model revealed that history of smoking, secondary implant, and use of porous implant materials were significant predictors of implant exposure (p=0.017, 0.008, 0.045, respectively).

Conclusion:

This report shed novel insights in the impact of medical comorbidities on patients with orbital implant exposure. Understanding the pathophysiology of implant exposure and taking a holistic approach are crucial to preoperative planning and postoperative care.

Aim: Phantom eye syndrome (PES) is a poorly understood and underestimated complication of eye amputation (EA). Seeing with the amputated eye, referred to as phantom vision (PV), is undoubtedly the most intriguing and confusing complication experienced by anophthalmic patients. The aim of the study was to assess PV prevalence, clinical features and risk factors after EA.

Methods: A multicentric questionnaire-based study was conducted between April 2016 and July 2017. Patients >18 years who underwent EA >3 months ago had a socket examination before inclusion. Data recorded included patients’ demographics, and preoperative, surgical and postoperative features.

Results: One hundred patients (53 men) with a mean age of 65.1 years (29-92; SD=13.0) were included. EA indications were: uveal melanoma (n=24, 24%), trauma (n=20, 20%), retinal detachment (n=20, 20%), glaucoma (n=14, 14%) and endophthalmitis (n=12, 12%). Thirty (30%) patients experienced PV. Elementary and complex visual hallucinations were experienced by 80% and 20% of patients, respectively. PV usually appeared within the first postoperative month and tended to decrease over time. Risk factors for PV were the preoperative use of proton beam therapy (p=0.006), uveal melanoma (p=0.014), enucleation (p=0.015), anxiety with a HAD score ≥8 (p=0.042), depression with a HAD score ≥8 (p=0.030), phantom eye pain (p=0.044) and phantom eye sensations (p=0.002).

Conclusion: PV was reported by one third of our patients. Despite being widely misunderstood, ophthalmologists and neurologists should be aware of this complication to adequately reassure patients.

Canaliculitis is described as inflammation of the lacrimal canaliculus, most caused by infection. Of the symptoms, epiphora is common and can have significant impact on patients’ quality of life. Conservative management alone is often trialled but is rarely curative. In comparison, various forms of surgical techniques have been described for more definitive management. Marsupialisation involves incising into the canalicular space and suturing the edges to form a surface extending from the interior to exterior, allowing the space to remain open and drain. This study aims to evaluate the effectiveness of marsupialisation in the treatment of canaliculitis and specifically, the impact on pre-existing and post-operative epiphora.

A retrospective, single centre study was conducted. Patients treated for canaliculitis via marsupialisation between years 2006 to 2021 in a tertiary hospital ophthalmology unit were included. 45 patients were identified through electronic patient records (EPR). Data was collected via EPR, physical notes, and telephone surveys. Data collected included demographics, presenting complaints, presence of pre- and post-operative epiphora, Munk scale classification of epiphora, and postoperative complications. The presenting complaints investigated included redness, epiphora, discharge, pain, and swelling. Post-operative complications reviewed included redness, lid malposition, exposure of conjunctiva, and non-resolution.

68% of the patients were found to have pre-operative epiphora with an average Munk scale grading of five, indicating constant epiphora. Of these patients, 86% of patients experienced an improvement or resolution of epiphora post-operatively, 9% had a similar severity of epiphora post-operatively, and 5% had worsening of epiphora. Of the 32% of patients who did not suffer from epiphora pre-operatively, none developed new epiphora post-operatively.

Epiphora is a debilitating symptom for those with canaliculitis and was found in a large proportion of canaliculitis patients prior to treatment. This retrospective study suggests marsupialisation to be an effective and safe surgical technique in managing epiphora in such patients.

Purpose: It was aimed to evaluate the results of simultaneous bilateral endoscopic dacryocystorhinostomy (DCR).

Method: Simultaneous bilateral endoscopic DCR was applied to patients with bilateral acquired nasolacrimal duct obstruction who applied to Marmara University, Department of Ophthalmology between 2020-2022. Patients with punctal - canaliculi occlusion and a history of previous DCR were excluded from the study. Only Kerrison punch and curettes were used for bone excision in all cases, and lacrimal intubation was applied to all eyes. History of dacryocystitis, duration of symptoms and surgery, complications, and functional and anatomical success parameters were evaluated.

Results: Twenty-four eyes of 12 patients were included in the study. The female ratio was 4/12 (33.3%), and the mean age of the patients was 50.9±9.1 years. Six eyes (25%) had a history of dacryocystitis. The mean time to development of symptoms was 9.21±4.14 months. The mean operation time per eye was 37.08±6.41 (min:25-max:50) minutes. The functional and anatomical success rates at 3 months were 91.7% (n=22) and 95.8% (n=23), respectively; and 6 months success rates were 87.5% (n=21) and 91.7% (n=22), respectively. While no perioperative complication was observed, the hematoma was seen in 4 eyes (16.6%), and intranasal bleeding occurred in 2 eyes (8.3%) postoperatively. In one of the anatomically unsuccessful eyes, the lacrimal intubation tube extruded on the 3rd postoperative day, and another eye had a history of dacryocystitis.

Conclusion: Simultaneous endoscopic DCR can be applied as a useful method in bilateral acquired nasolacrimal duct obstructions with its high anatomical and functional success rate, short operation time, and low complication rates.

Purpose: The authors describe their experience with the treatment of postoperative subcutaneous injections of 5-fluorouracil (5-FU) in a subset of patients that underwent different eyelid surgeries, to treat or prevent cicatricial sequela. 

Methods: A retrospective case series review of patients with post-operative eyelid cicatricial changes treated with a series of subcutaneous 5-FU injections to the area of the scar. 

Results: We present 5 cases (in 4 patients) of cicatricial changes after eyelid surgery treated with a series of 4 weekly injections of 0.3ml 5-FU in a concentration of 50mg/ml. Two patents after eyelid reconstruction secondary to eyelid trauma, one patient after upper and lower eyelid aesthetic blepharoplasty, and one patient after bilateral cicatricial ectropion repair, combined with basal cell carcinoma excision. All patients presented with lagophthalmos and secondary corneal changes. All patient showed resolution of lagophthamos corneal dryness. None of the patient required secondary revision and no drug side effects were notes. 

Conclusions: The use of post-operative injectable 5-FU for the treatment and prevention of cicatricial changes after eyelid surgery appears to be both effective and safe.

Background:

The direction is always towards interventions that are more conservative preserving as much of the normal tissues as possible.

And so, levator palpebrae superioris tucking is to be considered in correcting ptosis of the upper eyelids.

Since 2017, this has been the sole technique for correction of ptosis to the eyelids with levator palpebrae superioris muscle function ranging between moderate to good.

Method:

135 eyelids with moderate to good LPS function were done.

The incision to the skin is only 20 - 25 mm.

The LPS was tucked to the tarsus after freeing it from the orbital septum and fats.

Postoperative outcome measures included: level of the eyelid, contour of the eyelid and postoperative lagophthalmos.

The follow up was done at 1 week and then monthly along 6 months from the surgery.

Results: 

The position of the upper eyelid was good in 75% of the cases after 6 months from surgery. Eyelid contour was normal in 70% of the cases. Postoperative lagopthalmos was not seen in any case with proper closure of the eyelids.

Conclusion:

The LPS tucking preserves the normal fibers of the muscle, in case there is any recurrence later on that makes it much easier. Doesn't affect the closure of the eyelids and minimizes the possibility of any lagophthalmos. The small incision on the skin in the crease preserves the cosmetic aspect.

Purpose:  To describe a modified approach for the anterior lamella reconstruction during full thickness reconstruction with a tarsoconjunctival flap or free tarsal graft.

Methods:  This is a retrospective review of 6 patients with greater than 80%, full-thickness eyelid defects after tumor resection requiring reconstruction. For lower eyelid defects, a traditional tarsoconjunctival flap from the upper eyelid was used to rebuild the posterior lamella.  For upper eyelid defects, a free tarsal graft from the contralateral eyelid was used.  In all cases, the anterior lamella was supplied from an adjacent myocutaneous flap in a bucket handle configuration.  To prevent anterior lamellar shortening, a full thickness skin graft is placed in the resulting defect after mobilization of the bucket handle. Data collection included: tumor type and location, size of eyelid defect, presence of canalicular involvement, post-operative eyelid position, patient satisfaction, and complication rates.

Results:  Six eyelids in 6 patients underwent Mohs micrographic excision of basal cell carcinoma followed by reconstruction with a bucket handle flap. There was one male and 5 females, with the age ranging from 68 to 96 years old (mean of 81 years). Five patients presented with lower eyelid involvement and 1 with upper eyelid involvement. The defect size ranged from 80% to 100% of the eyelid. Four patients had canalicular involvement and required bicanalicular nasolacrimal stent placement. After reconstruction, all patients showed good eyelid apposition to the globe. No eyelid malposition, lagophthalmos, corneal decompensation, or epiphora was noted postoperatively. All patients expressed satisfaction with their results. Average follow up time was 12 months (range of 5 to 21 months).

Conclusion:  The bucket handle flap for full-thickness eyelid reconstruction is a simple technique that allows for preservation of all anatomical layers of the anterior lamella. This technique shows promising functional and aesthetic outcomes

Introduction:

The injection of hyaluronic acid is an aesthetic medicine procedure that is very commonly used, particularly for dark under-eye circles. We know a lot about the immediate complications. What about the complications when the product ages?

Materials and Methods:

The authors reviewed the files of about fifty patients injected in the dark under-eye circles with a 10-year follow-up and tried to highlight the aging of the product by comparing the different photos.

Results:

There are still late complications related to the aging of the product. We often find a progressive swelling linked to an increase in hydrophilicity and a hyperpigmentation of the area related to a probable chronic inflammatory reaction, as well as a migration of the product.

Conclusion:

Hyaluronic acid injections in dark circles are not harmless. We know very well the short-term complications, but we don’t know as much the late complications. Should we continue to inject dark circles with hyaluronic acid?

Keywords: Dark under-eye circles, hyaluronic acid, complications.

Introduction:

Surface electromyography is being widely used in skeletal muscles function assessment. However, in eyelid muscles examination, surface electromyography is used only in experimental studies, mainly regarding developing the blinking periorbital prothesis. Nevertheless, surface electromyography has a potential to be used in monitoring of the orbicularis oculi muscle recovery after eyelid surgery, trauma, paralysis or planning the best surgical approach. Developing reliable technique may increase the feasibility of surface electromyography in clinical practice. One of the main limitations is crosstalk with adjacent muscles. We propose placing the electrode in the mid-pretarsal area of the upper eyelid.  

Material and methods: 126 surface electromyography examinations in 39 controls and 29 ptotic patients were conducted. Silver-chloride electrodes with the dimensions of 5x8 mm were used. The electrode was placed in the central portion of the upper eyelid horizontally, 5mm above the lash line. The orbicularis oculi muscle function was assessed in the primary gaze and while performing maximal eyelid closure using Root Mean Square in controls and ptotic patients before and after ptosis surgery.

Results: We found significantly lower Root Mean Square values of the maximal contraction of the orbicularis oculi muscle 2 weeks after surgery (p<0.05). After 6 months there were no statistically significant differences in Root Mean Square values compared to the preoperative results. No technical difficulties in the electrode instillation, performing the examination and interpretation of the results was observed.

Conclusions: By placing the electrode in the mid-pretarsal area of the upper eyelid, one can easily perform fast examination and achieve repeatable results, which may enhance the feasibility of surface electromyography in clinical practice. Eyelid surface electromyography may be an useful diagnostic tool in an objective and quantitative post-operative orbicularis oculi muscle recovery monitoring.

Background

During the COVID pandemic, we conducted oculoplastic teleclinics via Attend Anywhere, a virtual consultation platform provided by the National Health Service (NHS), due to reduced clinic capacity and social distancing requirements.

Purpose

The aim of this study is to to assess the efficacy of Attend Anywhere clinics for the oculoplastic service and identify the cohort of patients suitable for virtual consultations by analyzing the outcome patterns.

Methods

100 consecutive patients seen over 5 weeks were included in study.

Results

Patients ranged from 6-93y, 67% of patients were >60 years old, 17% were >80 years old.

There were 46 video consultations, 36 phone consultations and 12 face to face consultations. 6 patients did not attend.

There were 46 new and 54 follow up patients (29 post-operative patients).

We were able to offer definitive treatment for 25%, discharge 34%; 37% required face to face consultation, 4 further video consultations.

Of the 9 patients listed for surgery, 5 were listed from video consultation, for lower lid malpositions and dermatochalasis, 4 patients had a biopsy prior to  definitive surgery. All the patients listed for minor operations were able to be listed following video consultation.  27patients had to be brought back face to face for assessment such as ptosis measurements, syringing and lid lesion malignancy before further decision on surgery could be made.

25% of patients had technical difficulties, including not having internet connection or video enabled devices.  Despite these problems consultation was successfully supplemented with telephone consultation.

Conclusions

Video consultation is effective for oculoplastic clinics despite real-world difficulties and can be adapted to a hybrid model of consultation to reduce departmental footfall, limit the exposure of the elderly to COVID risk and save on costs related to multiple hospital visits.

Purpose: To report the epidemiology, indications and surgical outcomes of oculoplastic surgeries in very old patients (≥ 90 years old).

Methods: A retrospective, tertiary single center study was carried out on the medical charts of 114 patients aged 90 years old and older who underwent oculoplastic procedures from 2010 to 2019. Data retrieved from the medical records included: past medical and ocular history, indication for surgery, type of surgery, intra and post-operative complications, pathological analysis for removed tissues, and surgical outcome in the last follow-up.

Results: 128 surgeries were performed in 114 patients (male: female = 1:1). The mean age was 92.95 years old (± 3.12 SD). Six patients (5.2%) were older than 100 years old. The most common indication for surgery was lower lid malpositioning (32%). Mass/lesion excision was performed in 34 procedures (25%). 43 biopsies were analyzed. Basal cell carcinoma was the most common pathological diagnosis (32%). 20% of the patients had glaucoma and 15% had neovascular age related macular degeneration. Hypertension was the most common associated systemic comorbidity (79 patients, 69%). 80% of the surgeries were done under local anesthesia. In seven patients (5.2%) - surgical revision was required. One patient suffered from minor stroke one day postoperatively. The same patient had orbital-skin fistulas after orbital exenteration

Conclusion: In our experience, oculoplastic surgeries in the elderly population are safe without significant complications and can usually be performed under local anesthesia. Advanced age should not prevent surgery, especially if the procedure may improve vision and quality of life.

Background

Our previous study of 92 outpatients identified lack of digital skills, access to technology and low confidence in digital healthcare as contributors to digital exclusion. Patients expressed interest in digital skills workshops and schemes to enhance access to internet and devices.

Methods

Oculoplastic outpatients at Moorfields Eye Hospital who had previously declined video consultations (VC) - and those attending parallel clinics eager to improve digital skills - were invited for training to use our VC platform, take ‘selfie’ photos, and send them via email – using departmental laptops, tablets and patients’ devices. We secured internet data packs to donate to patients who lack internet access and require frequent telemedicine access.

Pre- and post-workshop surveys explored patients’ confidence with online services, inclination to use VC and perceived utility of the workshop using a 10-point Likert scale (0 ‘extremely unlikely’ à 10 ‘extremely likely’). Two-tailed paired T-test was used to assess significance of rating differences before and after the workshop. Qualitative feedback was analysed thematically.

Results

Feedback was obtained from 38 of 51 (75%) patients (average age 66 years - 47% male, 53% female).

Patients reported greater inclination to use (mean rating 6.9/10 vs 5.5/10, p=0.002) – and felt more confident with (mean rating 6.7/10 vs 5.3/10, p=0.0002) – VCs after attending the workshop compared to before.

Patients found the workshop useful (mean rating 7.6/10) and were likely to recommend it to family and friends (mean rating 7.9/10). Most common suggestions were for interpreters for patients with limited command of English.

Preliminary findings suggest that loaning SIM cards to patients who frequently need telemedicine has improved healthcare accessibility.

Conclusion

Patients consider digital skills workshops useful to improve confidence and motivation with using Oculoplastic online services. Scaling these and aiding internet (data and device) connectivity may help address increasing issues of exclusion as services become more reliant on teleophthalmology.

Aim - We describe a unique one of a kind setup at Royal London Hospital which is a tertiary trauma referral center with oculoplastic fellow as part of weekly maxillofacial trauma clinic.

Methods- Role of the fellow is to examine patients with orbital fractures presenting to the maxillofacial clinic. Assessments include- visual acuity, pupil reaction, ocular motility (performed by specialist orthoptist) and exophthalmometry. Additionally screen for signs of retinal detachment and acute ophthalmic concerns. If red flags are noted from the above, the patient is streamed to a same urgent ophthalmology clinic for detailed assessment including dilated fundus examination. The fellow is also regularly involved in maxillofacial theaters for repair of orbital fractures, complex eyelid laceration, canthal repair, etc. 

Results- We present a cross section of patients seen from March 2022 to May 2022 (3 months). The average number of patients seen with orbital fractures 9.6 (range 7 - 15); median 9. A total of 61 patients were seen with orbital fracture during this period. Out of these, 16 patients (26.2%) were streamed for urgent same day ophthalmology review, 9 patients (14.7%) required further orthoptic assessment (including Hess chart). 3 patients (4.9%) were referred to specialist ophthalmic clinic and 4 patients (6.5%) were planned for either a joint surgical procedure with oculoplastics or required further multidisciplinary (MDT) discussion

Conclusion- We highlight a scope for collaboration and multidisciplinary input in improving patient outcomes. The presence of oculoplastic fellow in maxillofacial trauma clinics helps streamline patient flow and improve patient experience. This also offers a unique training opportunity and a framework for designing facial trauma service.