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Ziel dieser Arbeit ist es, einen Uberblick uber die wichtigsten Lidfehlstellungen zu geben und deren Behandlungsoptionen aufzuzeigen. Die praoperative Evaluierung, Atiologie und Formen der Blepharoptosis und des Ek- und Entropiums werden dargestellt und anhand von Literatur und aus eigener Erfahrung Behandlungsoptionen vorgestellt. Erst durch die Kenntnis der Atiologie und der zugrundeliegenden Pathogenese der verschiedenen Lidfehlstellungen kann eine optimale Therapieoption gewahlt und damit die besten Ergebnisse erzielt werden.

Purpose: To evaluate ocular surface characteristics and tear film function following modified Hughes flap for eyelid reconstruction. Methods: This is an institutional study including 18 patients (6 male, 12 female) who underwent a tarsoconjunctival flap for reconstructing the lower eyelid’s posterior lamella in one eye between 2005 and 2010. The median age of the patients was 72 (49–93) years at the time of surgery and 77 (51–97) years at the time of evaluation. The median follow-up time was 34 (9–69) months. All patients had large malignant or semi-malignant lid tumours. Data for subjective symptoms (OSDI questionnaire), lid margin morphology, tear break-up time (BUT), vital staining, Schirmer test, impression cytology, tear film osmolarity, lipid layer interference patterns, meibography and the size of the tumour and flap were recorded and compared with the contralateral side. Results: Statistical analysis of the data revealed a significant difference between the surgically treated lid and the untreated side in meibomian gland loss, more lid margin abnormalities in the upper and lower eyelid (p

Purpose We investigated the effects of a visual picking system on ocular comfort, the ocular surface and tear function compared to those of a voice guided picking solution. Design Prospective, observational, cohort study. Method Setting: Institutional. Study Population: A total of 25 young asymptomatic volunteers performed commissioning over 10 hours on two consecutive days. Main Outcome Measures: The operators were guided in the picking process by two different picking solutions, either visually or by voice while their subjective symptoms and ocular surface and tear function parameters were recorded. Results The visual analogue scale (VAS) values, according to subjective dry eye symptoms, in the visual condition were significantly higher at the end of the commissioning than the baseline measurements. In the voice condition, the VAS values remained stable during the commissioning. The tear break-up time (BUT) values declined significantly in the visual condition (pre-task: 16.6 sec and post-task: 9.6 sec) in the right eyes, that were exposed to the displays, the left eyes in the visual condition showed only a minor decline, whereas the BUT values in the voice condition remained constant (right eyes) or even increased (left eyes) over the time. No significant differences in the tear meniscus height values before and after the commissioning were observed in either condition. Conclusion In our study, the use of visually guided picking solutions was correlated with post-task subjective symptoms and tear film instability.

Purpose To evaluate the long-term prevalence of canaliculitis associated with the use of SmartPlugs. Methods This retrospective study included 42 eyes of 25 dry eye patients at our institution who received a SmartPlug insertion between 2004 and 2008. Irrigation of the lacrimal system was performed in all patients prior to SmartPlug insertion to ensure the patency of the system. The median follow-up time was 7.9 (5.6–10.5) years after plug insertion. Results Six patients (seven eyes) of 25 patients (42 eyes) developed canaliculitis. The prevalence of canaliculitis per patient was 24%, and the prevalence of canaliculitis per SmartPlug was 16.6%. The median time from SmartPlug insertion to the onset of canaliculitis was 4.7 (1.4–6.0) years. The median age of the affected patients was 61.5 (36–74) years. Five of these patients were women and one was man. The pathogens were identified as Actinomyces in four eyes and as Staphylococcus aureus in three eyes. In five patients (six eyes), the canaliculitis was resolved by the application of topical antibiotics and repeated lacrimal irrigations with antibiotics and povidone-iodine. In one patient, a canaliculotomy was necessary to cure the condition. Conclusions The late onset of complications after SmartPlug insertion requires long-term observation to identify the majority of complications associated with SmartPlugs. In our patients with a follow-up of up to 10.5 years, the use of SmartPlugs was associated with the highest prevalence of canaliculitis published thus far.

To evaluate ocular surface characteristics and tear film function following modified Hughes flap for eyelid reconstruction.This is an institutional study including 18 patients (6 male, 12 female) who underwent a tarsoconjunctival flap for reconstructing the lower eyelid's posterior lamella in one eye between 2005 and 2010. The median age of the patients was 72 (49-93) years at the time of surgery and 77 (51-97) years at the time of evaluation. The median follow-up time was 34 (9-69) months. All patients had large malignant or semi-malignant lid tumours. Data for subjective symptoms (OSDI questionnaire), lid margin morphology, tear break-up time (BUT), vital staining, Schirmer test, impression cytology, tear film osmolarity, lipid layer interference patterns, meibography and the size of the tumour and flap were recorded and compared with the contralateral side.Statistical analysis of the data revealed a significant difference between the surgically treated lid and the untreated side in meibomian gland loss, more lid margin abnormalities in the upper and lower eyelid (p0.001) and increased fluorescein staining of the cornea (p=0.031). For the operated side, the median OSDI score was higher (17.2 versus 14.7), and the median BUT value was shorter (4.2 versus 5.6 seconds) compared with the median values of the contralateral side.Despite the favourable cosmetic and functional results of the Hughes tarsoconjunctival flap, our results indicate that this procedure does affect the ocular surface health in the treated eyes.