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Purpose. To compare the outcomes of transcanalicular diode laser-assisted dacryocystorhinostomy (TCL-DCR), nonendoscopic endonasal dacryocystorhinostomy (NEN-DCR), and external dacryocystorhinostomy (EXT-DCR) as first-line treatments for functional epiphora. Methods. This multicenter, retrospective, case-control study included 135 eyes of 135 patients with functional epiphora (86 females and 49 males). Functional epiphora was diagnosed based on a patent lacrimal system with a delay in the fluorescein dye disappearance test (FDDT) or dacryoscintigraphy (DSG) and no ocular surface or eyelid abnormalities. The patients were treated with TCL-DCR (2008–2011) or Ext-DCR (2005–2008, 2011–2017) at Beyoglu Eye Research Hospital (Istanbul, Turkey) and NEN-DCR at Carrot Eye Surgery Clinic affiliated with the McMaster University (Hamilton, ON, Canada) (2010–2016). Success was defined as the absence of epiphora and the normalization of an earlier delayed FDDT after surgery. Results. The TCL-DCR, NEN-DCR, and EXT-DCR groups consisted of 38, 47, and 50 eyes with 25.9, 44.2, and 45.9 months of follow-up. The success rate for TCL-DCR was 65.8%, 70.2% for NEN-DCR, and 84.0% for EXT-DCR. During the follow-up period, 13.2% of TCL-DCR cases and 6.4% of NEN-DCR cases developed an anatomic obstruction of the lacrimal system. Conclusion. The EXT-DCR group had a higher success rate in the management of functional epiphora than the NEN-DCR and TCL-DCR groups and was significantly safer in terms of an iatrogenic anatomic block of the lacrimal system.

An 18 year old male with open globe injury, eyelid lacerations and orbital wall fractures related to severe blunt trauma was referred to our clinic for primary evisceration and eyelid repair. As the patient refused the removal of the eye; the globe, eyelids and canaliculi were sutured primarily first. After a month the patient accepted the removal of the eye due to progressive phthisis bulbi and underwent evisceration 5 weeks following the injury. He has been followed up for 2 years after the second surgery with an acceptable cosmetic result and without any complication. Although very rare, it is very important to remember that there is a risk of sympathetic ophthalmia (SO) in severe eye injuries and prophylaxis by removing the eye is controversial.

A 61-year-old male presented with 20 x 15 mm diffuse, hyperpigmented lesion that covered the right upper eyelid and which had been present for 2 years. Lesion was diagnosed as actinic keratosis (AK). Since the patient refused surgery and reconstruction, he was treated with imiquimod (IMQ) 5% cream once a day, 5 times per week for 6 weeks. Lesion gradually reduced in size and no clinically evident residual keratosis was observed after treatment. No post-therapy excision was performed to assess histological clearance of AK for cosmetic reasons. Although surgery is first-line treatment for these lesions, in case of refusal to undergo surgery, when lesion is superficial and diffuse and in region where reconstruction would be difficult, treatment with IMQ may be preferred.

Context (Background): Imiquimod (IMQ) 5% cream is an immunomodulatory and antitumorigenic agent, which was used as a topical treatment regimen, who had periocular basal cell carcinoma (BCC). Aim: This study aims to present three cases with large BCC at the medial canthal area treated with IMQ 5% cream. Materials and Methods: IMQ 5% cream was used in three patients with ages 45, 49, and 73 who preferred medical treatment over surgery. Following incisional biopsy IMQ cream was used once a day, 5 times a week and the patients were followed up weekly during 12 week treatment period and monthly after the clearance of the lesion. Results: Erythema and erosion on the surface of the lesion, injection of conjunctiva, burning and itching sensation, epiphora and punctate keratitis were seen in all patients during the treatment period. The ophthalmic side effects could be managed by topical lubricating eye drops and the inflammatory reactions resolved within 1 month after cessation of therapy. The patients were followed up for at least 3 years without tumor recurrence and the biopsies taken from the suspected area were found to be tumor free. Conclusion: Surgical excision of carcinoma of the eyelid at medial canthal area can be difficult without causing damage to the lacrimal system and reconstruction of the defect may need grafts or flaps. IMQ may provide an alternative therapy to surgery in certain cases.

A 26-year-old woman with chronic irritation and infection of left upper eyelid and history of ocular trauma with unknown foreign object(s) was referred to oculoplastic clinic of our hospital. Multiple black micro foreign objects were seen in left upper eyelid skin, skin was edematous, fistula of the skin was present, and the globe was deviated inferiorly. On computerized tomography, multiple intraorbital foreign objects were observed at superior aspect of the orbita. Foreign object, 2 x 1 x 0.5 cm in size, localized tangentially to the globe with convex side facing intact eyeball, was surgically excised. Multiple metallic micro particles were also removed. The patient recovered well from injury within 6 months of surgery. Intraorbital foreign bodies may be mislocated in radiological imaging in trauma patients. Surgeon should always be alert for surprises during surgery on such patients.

The purpose of this study is to investigate the effect of thyroid eye disease (TED) on the measurement of corneal biomechanical properties and the relationship between these parameters and disease manifestations. A total of 54 eyes of 27 individuals with TED and 52 eyes of 30 healthy control participants were enrolled. Thyroid ophthalmopathy activity was defined using the VISA (vision, inflammation, strabismus, and appearance/exposure) classification for TED. The intraocular pressure (IOP) measurement with Goldmann applanation tonometer (GAT), axial length (AL), keratometry, and central corneal thickness (CCT) measurements were taken from each patient. Corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF) and noncontact IOP measurements, Goldmann-correlated IOP (IOPg) and corneal-compensated IOP (IOPcc) were measured with the Ocular Response Analyzer (ORA) using the standard technique. Parameters such as best corrected visual acuity, axial length, central corneal thickness, and corneal curvature were not statistically significant between the two groups (p > 0.05). IOP measured with GAT was higher in participants with TED (p

Objectives: To investigate the results of different surgical techniques for treating cases of dissociated vertical deviation (DVD). Materials and Methods: A retrospective review of medical records was performed, including 94 eyes of 47 patients who had undergone bilateral superior rectus (SR) recessions (Group 1), bilateral SR recession with posterior fixation sutures (Group 2), or bilateral inferior oblique (IO) anterior transposition surgery (Group 3) for treatment of DVD. Nineteen patients underwent secondary procedures (SR weakening or IO anterior transposition) because of unsatisfactory results. The amount of the DVD in primary position before and after surgery, postoperative success ratios, and probable complications were evaluated. The Wilcoxon signed ranks test and chi-squared test were used for statistical evaluations. Results: In 69% of the 32 eyes in group 1, 65% of the 20 eyes in group 2, and 79% of the 42 eyes in group 3, satisfactory control of the DVD in primary position was achieved. All eyes undergoing both SR weakening and IO anterior transposition had a residual DVD of less than 5 prism diopters (pd). Of the total of 94 eyes, in 26 (89.6%) of 29 eyes that had a preoperative DVD angle of more than 15 pd [ten eyes from group 1, seven eyes from group 2, and nine eyes from group 3], the residual DVD angle after surgery was more than 5 pd. However, in the 65 eyes with preoperative DVD of 15 pd or less (21from Group 1, 12 from Group 2, and 32 from Group 3), the residual DVD angle after the operation was less than 5 pd. Two eyes of 2 patients had -1 limitation to elevation after surgery. Conclusion: Only IO anterior transposition or SR weakening surgery appear to be a successful surgical approaches in the management of patients with mild- and moderate-angle (≤15 pd) DVD. Weakening both the SR and IO muscles yield a greater success in the management of patients with large-angle (>15 pd) DVD. (Turk J Ophthalmol 2014; 44: 132-7)

Purpose: The purpose of this study was to evaluate the near point of convergence break in Turkish population with normal binocular vision and to obtain the normative data for the near point of convergence break in different age groups. Such database has not been previously reported. Material and Method: In this prospective study, 329 subjects with normal binocular vision (age range, 3-72 years) were evaluated. The near point of convergence break was measured 4 times repeatedly with an accommodative target. Mean values of near point of convergence break were provided for these age groups (≤10, 11-20, 21-30, 31-40, 41-50, 51-60, and >60 years old). A statistical comparison (one-way ANOVA and post-hoc test) of these values between age groups was performed. A correlation between the near point of convergence break and age was evaluated by Pearson’s correlation test. Results: The mean value for near point of convergence break was 2.46±1.88 (0.5-14) cm. Specifically, 95% of measurements in all subjects were 60 year-old age groups in the near point of convergence break values (p=0.0001, p=0.0001, p=0.006, p=0.001, p= 0.004). A mild positive correlation was observed between the increase in near point of convergence break and increase of age (r=0.355) (p

Spasm of the near reflex is a rare disorder that involves intermittent and variable episodes of esotropia, pseudomyopia, and pupillary myosis. It is usually functional in origin and is seen mainly in young patients. Treatment options for spasm of the near reflex have had variable success. In instances where the etiology of spasm of the near reflex was suspected to be hysteria, psychotherapy has proven beneficial. We report the case of an 11-year-old girl who had functional spasm of the near reflex. The symptoms persisted for two years. Symptomatic relief was achieved by cycloplegia and spectacle correction (added plus lenses at near). The patient also underwent psychological counseling. In our case, the functional spasm of the near reflex spontaneously resolved after 2 years. (Turk J Ophthalmol 2014; 44: 161-3

Molluscum contagiosum is a common viral skin infection in children with dome-shaped umbilicated nodules. Diagnosis is based on clinical appearance. An eight-year-old child presented to our clinic with multiple molluscum contagiosum nodules on the right lower and upper eyelid and one small papule on the left upper eyelid. Only a couple of lesions were squeezed with expression of cheesy material from the center of the lesions. In the follow-up period, beside resolution of the squeezed lesions, all other lesions disappeared spontaneously and no new lesion was observed in the following one year. This method is costless, neither needs a chemical agent nor results in scarring, so can be the first choice of treatment. (Turk J Ophthalmol 2014; 44:158-60)

Cyclic esotropia is a rare form of strabismus characterized by alternating periods of esotropia and orthophoric (or almost orthophoric) eye position. Herein, we discuss two children with cyclic esotropia and their surgical treatment results. A six-year-old boy was brought to our clinic with the typical complaint of a convergent squint which had been appearing and disappearing in a regular 24-hour cycle over a period of four years. He had a large deviation angle with associated suppression and no binocular function for a 24-hour cyclic pattern, but he had a small angle of esotropia with fusion and stereopsis for another 24 hours. He had undergone strabismus surgery on the left eye at another clinic 3 years ago. The other patient was a ten-year-old girl who was brought to our clinic with the reoccurring complaint of esotropia on alternating days over a period of four years. We determined that a large deviation angle with near-distance disparity and a 24-hour cyclic pattern were present. For both cases, we planned strabismus surgery according to the amount of deviation on the esotropic day. Following the surgery, the eyes have continued to remain permanently straight during the follow-up period. (Turk J Ophthalmol 2014; 44: 164-6)