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Orbit and Oculoplasty - I Free Papers AIOC in Mobile App Orbit and Oculoplasty - I Free Papers AIOC in Mobile App ‘AIOS Edu’ app on your mobile from play store or visit www.aiosedu.org Contents ORBIT AND OCULOPLASTY - I Comparative Study of Probing Vs Probing with Intubation for Naso Lacrimal Obstruction in Children ---------------------------------------------------- 713 Dr. Shreya Shah, Dr. Prerana Shah, Dr. Nirav Patel, Dr. Amisha Jain Should We Perform Levator Resection in Congenital Ptosis Patients with Poor Levator Function ------------------------------------------------------------------- 718 Dr. Adit Gupta, Dr. Tarjani Dave, Dr. Milind Naik Lamellar Icthyosis: A Chronic Struggle ------------------------------------------ 723 Dr. Pratheeba Devi J, Dr. Nirmala Subramanian, Dr. Nivean M Adult Onset Xanthogranulomatosis with Massive Involvement of all Four Eyelids ----------------------------------------------------------------------------------------- 728 Dr. Ravindra Mohan E, Dr. Arthi Dwarakanath Corneal Topography and Higher order Aberrations in Blepharoptosis-731 Dr. Rath Suryasnata, Dr. Sujata Das, Dr. Kapil Arunkumar Bhatia Correction of Lagophthalmos with Modified Full-Thickness Upper Lid Blepharotomy and Lower Lid Lift ---------------------------------------------------- 742 Dr. Roshmi Gupta Intravenous Methylprednisolone in Moderate to Severe Thyroid Associated Orbitopathy (TAO) in Indians ----------------------------------------- 746 Dr. Shweta Gupta, Dr. Usha Singh, Dr. Manpreet Singh, Dr. Zoramthara Are Frozen Section Margin Control and Conjunctival Map Biopsy Mandated in Sebaceous Gland Carcinoma of the Eyelid? --------------------------------- 755 Dr. Fairooz PM, Dr. Santosh G Honavar, Dr. Vemuganti Geeta Kashyap Neoadjuvant Systemic Chemotherapy in the Management of Eyelid Sebaceous Gland Carcinoma --------------------------------------------------------- 766 Dr. Swathi Kaliki, Dr. Anuradha Ayyar, Dr. Tarjani Dave, Dr. Milind Naik Orbit and Oculoplasty Free Papers OrbiT and OCULOpLasTy - i Chairman: Dr. Gupta V P l Co-Chairman: Dr. Sujatha Y Convenor: Prof. Dr. Ravindra Mohan E l Moderator: Dr. Poonam Jain Comparative Study of Probing Vs Probing with Intubation for Naso Lacrimal Obstruction in Children Dr. Shreya Shah, Dr. Prerana Shah, Dr. Nirav Patel, Dr. Amisha Jain ongenital NLD obstruction is the most common cause of epiphora in Cchildren. The most common location is at the opening of NLD system because of imperforate valve of Hasner.1 Other causes of obstruction may be atypical in the NLD to end, within the bony nasal lacrimal canal, in the wall of maxillary sinus or below the inferior turbinate. Chronic epiphora must be carefully evaluated to rule out other causes of lacrimation such as conjunctivitis, punctual occlusion, canalicular stenosis, amniotocele, dacryoocystocele, epiblepharon, entropion, or ectropion. Congenital glaucoma is usually associated with photophobia and excess 713 lacrimation. Embryologically, the lacrimal system proceeds from proximal to distal and 30% of full term newborns present with an imperforate valve of Hasner2 Most infants undergo spontaneous valve opening by age 6 weeks, but the remaining 10% may require probing of the nasolacrimal system. Probing is known modality of treatment as far as NLD obstruction in children are concernedrecurrence of NLD obstruction is also very common, particularly if the age is above one year. If conservative treatment does not relieve symptoms of tearing due to nasolacrimal obstruction, probing may be indicated between 6 and 13 months of age. Intubation can give result in failure cases MATERIALS AND METHODS A prospective interventional study was conducted at Drashti Netralaya, Dahod. All pediatric patients with congenital NLD obstructions are included in the study. All patients with reason of excess lacrimation other than NLD obstruction., acquired NLD block, trauma to lacrimal passages and high risk for general anesthesia were excluded from the study. 73rd AIOC 2015, New Delhi Instruments used during the procedure are lacrimal probing instruments include a punctual dilator, Bowman probes, Lacrimal irrigation cannula, Irrigation tip, BSS-filled syringe, Lacrimal intubation system (Crawford silicone stent set 28-0185, jedmed Instrument Company, St. Louis, Mo.) Retrieval hook to Silastic intubation tube (supplied with the lacrimal intubation set). We recommend general endotracheal anesthesia for children during nasolacrimal probing. Mask anesthesia can be used when the silastic tube is removed. After induction of general anesthesia, neurosurgical cottonoids moistened with oxymetazoline hydrochloride 0.05% (Afrin spray) are placed medial and lateral to the inferior turbinate. The cottonoids are removed after 5–10 min. We perform the probing first through the upper canaliculus and then through the lower canaliculus. Surgical procedure The length of the Bowman probe is measured prior to using the dilator in order to assess length of passage through the nasolacrimal canal or nose, repectively. The upper canaliculus is dilated carefully with a blunt punctual dilator 714 for a distance of 2 mm. The punctal dilator is withdrawn and a no. 0 or 1 Bowman probe is passed immediately after withdrawal of the punctual dilator vertically for 2 mm and then reoriented horizontally. Little resistance is felt when passing the probe into the nose. You may feel a rubbery resistance or “pop” when passing through the valve of Hasner. The probe is passed 18–20 mm in children before entering the nose through the obstructed site typically at the valve of Hasner. The probe may be identified into the nares either by direct or endoscopic visualization or palpated with a periosteal elevator. Medial infracture or displacement of the inferior turbinate may be necessary if the turbinate prevents visualization of the inferior meatus and the probe within it. Prior to passing the Crawford probe and tube, the Bowman probe is passed through the nasolacrimal duct before passing the stent in order to define the anatomy of the passage and direction of the probe. This will define the length of the tube required to the probe through the ostium of the duct and into the nares. The Crawford metal probes are thinner and more difficult to pass than the firm Bowman probe. The olive tips are placed first through the upper canalicular and nasolacrimal duct, and then the lower canaliculus. They may be received with the Crawford hook or small haemostat. Orbit and Oculoplasty Free Papers Figure 1: age wise distribution of all Figure 2: age wise distribution of patients patients participating in study who underwent probing with and without stent Once both stents have been passed into the nose, proper positioning of the loop of silastic tubing within the eye should be evaluated in the eye. The metallic probes are pulled off or cut off. The loose tubing is pulled anteriorly using needle holders and, four more knots are completed preferably tying the knots over a no. 1 Bowman probe. The tied tubes are then allowed to retract into the nose. Observe for intranasal bleeding at this time. Prior to extubation, if bleeding is noted, gently pack the nose with a narrow merocel dampened with xylocaine and epinephrine (Figure). Post-op care 715 Topical Antibiotics combined with steroid if no infection,systemic antibiotics,nasal decongestants Tube removal Generally, the tube is left in place for at least 6 months after intubation and once symptoms are stable.4 If there is unroofing or stretching of the canaliculus, earlier removal may be considered. After 3–6 months, the tube can be removed .It can sometimes be done in the office but in most instances requires mask anesthesia in the operating room. An antibiotic/steroid eye drop four times daily is recommended for 10 days after removal of the tube. All data were filled up in pretested online format during first visit and follow up visits, all data from the system exported in to excel sheet and data analyzed with SPSS-15 software. Analyses done with cross tabulation and for Pearson’s x2 test used for significance as well as Anova used for comparative study. RESULTS Out of 117 enrolled patients, 82 underwent probing only and 35 underwent probing along with monocanalicular or bicanalicular intubation. 73rd AIOC 2015, New Delhi Table 1: Age and Sex Distribution Sex Total F M F AGE 0 TO 0.5 28 23 51 0.6 TO 1 9 10 19 1.1 TO 3 12 17 29 >3 6 12 18 Total 55 62 117 Table 2: Distribution of Procedures Number (n) Percentage (%) Probing+intubation 35 29.9 Probing only 82 70.1 Table 3: Type of Intubation Intubation Number(n) Percentage (%) Silicone bicanalicular 29 82.85 Silicone monocanalicular 6 17.15 Total 35 100 716 Table 4: Comparative study with and without Intubation Variable Intubation No Intubation P Watering Yes 08 02 0.000 No 27 41 No Follow Up 00 39 Total 35 82 Discharge Yes 00 20 0.000 No 35 23 No Follow Up 00 39 Total 35 82 Swelling Yes 00 09 0.000 No 35 34 No Follow Up 00 39 Total 35 82 Age Category 0 To 0.5 03 48 0.000 0.6 To 1 03 16 1.1 To 3 14 15 >3 15 03 Follow Up 0 To 50 02 00 0.000 Duration 51 To 100 07 82 (Days) 101 To 300 26 00 35 82 Orbit and Oculoplasty Free Papers There was significant difference in outcome in patients undergoing probing with and without intubation and it is not dependent on age of presentation and duration of follow up. DISCUSSION Out of 117 enrolled patients, 82 underwent probing only and 35 underwent probing along with monocanalicular or bicanalicular intubation. When we have compared our results with other studies Frick et. al. reported. The relative cost-effectiveness of these
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