1/2. Lid surgery to reduce discomfort produces an unexpected improvement in visual acuity--a case presentation.A significant cause of blindness in leprosy is corneal scarring secondary to corneal anaesthesia and lagophthalmos (Brand & ffytche 1985). Such patients may continue to experience considerable ocular discomfort, particularly when there is associated ectropion of the lower lid, with inflammation of the exposed tarsal conjunctiva (Courtright & Johnson 1991). Where visual outcome is no longer the primary consideration, one may hesitate to subject patients to surgery, particularly in relatively unsophisticated field conditions, attempting instead to relieve the patient's discomfort by conservative treatment such as frequent topical ocular lubricants, use of protective spectacles or eye shades etc. A case is presented here in which minor surgery aimed solely at relieving ocular discomfort resulted in an unexpected improvement in visual acuity. This suggests that there are instances where a more aggressive approach to treatment of even severely damaged eyes could prove more rewarding than anticipated.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/2. The use of bank sclera to correct lid retraction.Twenty-two scleral grafts were inserted in patients with retracted lids, the youngest patient was two years old at time of surgery. Two patients were operated on under local anaesthesia and the remainder under general anaesthesia. In the patients with thyroid disease larger grafts were required, the temporal side of the graft being 3 mm greater vertically than the nasal. Our first cases were undercorrected, so we used grafts of a size at least twice that required to lower the lid. Other complications were rare. For ptosis overcorrections, and congenital lid retraction, the graft should be 2 mm bigger horizontally and vertically than the amount required to lower the lid.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |