There are no standards in diagnostic and therapeutic approaches to eye care in incomplete eyelid closure due to unresolved facial palsy (FP). Loading of the upper eyelid (UELL) with gold weights (GWs) or platinum chains (PCs) is a highly effective procedure for the correction of lagophthalmos. Despite this, the procedure is used infrequently in our country because of the relatively high price of the implant and the lack of reimbursement. The aim of this research was to assess the factors influencing medical expenditures in this group of patients and to analyze utility costs for the UELL procedure with the use of GW and PC compared to tarsorrhaphy.Material and methods The costs of 88 surgical procedures (40 GWs, 11 PCs and 37 tarsorrhaphies) and medical expenditures before and after surgery were calculated based on reporting of materials, staff salaries and the SF-36 questionnaire. Distribution quartiles of the cost per QALY measure (dependent variable) was assessed via an ordered logistic regression model with eight explanatory variables.Results The calculated total cost of the surgery was US$209 for tarsorrhaphy, US$758 for UELL with a GW and US$1,676 for UELL with a PC. Bootstrapped costs per QALY values (CUI) in 88% of cases were below the US$100,000 cutoff. Etiology and duration of facial palsy and presence of Bell\'s phenomenon were factors that significantly influenced the CUI. Patient gender and age, history of previous eyelid surgery, and presence of corneal sensation were found to be not significant (p > 0.1). Calculated ICER for GW was US$1,241.74/1QALY and ICER for PC was US$13,181.05/1QALY compared to tarsorrhaphy.Conclusions Eye protection in patients with FP should be a crucial element of health policy. Findings suggest UELL procedure with a GW or a PC to be a cost-effective procedure with GW being the most cost-effective.

UNASSIGNED: To study and compare the demographic and clinical profile of acute ocular burns (AOB) in children and adults.
UNASSIGNED: This retrospective case series included 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to two tertiary eye care centers within one month of sustaining AOB. Data regarding demographics, causative agents, severity of injury, visual acuity (VA), and treatment were collected and analyzed.
UNASSIGNED: Males were more commonly affected particularly among adults (81% versus 64%, P < 0.00001). Among children, 79% sustained domestic injuries, whereas 59% of adults had work-place injuries (P < 0.0001). Most cases were due to alkali (38%) and acids (22%). Edible lime (chuna, 32%), superglue (14%), and firecrackers (12%) in children, and chuna (7%), insecticides, lye, superglue (6% each), toilet cleaner (4%) and battery acid (3%) in adults, were the main causative agents. The percentage of cases with Dua grade IV-VI was greater in children (16% versus 9%; P = 0.0001). Amniotic membrane grafting and/or tarsorrhaphy were needed in 36% and 14% of affected eyes in children and adults, respectively (P < 0.00001). The median presenting VA was logMAR 0.5 in children and logMAR 0.3 in adults (P = 0.0001), which improved significantly with treatment in both groups (P < 0.0001), but the final VA in eyes with Dua grade IV-VI burns was poorer in children (logMAR 1.3 versus logMAR 0.8, P = 0.04).
UNASSIGNED: The findings clearly delineate the at-risk groups, causative agents, clinical severity, and treatment outcomes of AOB. Increased awareness and data-driven targeted preventive strategies are needed to reduce the avoidable ocular morbidity in AOB.

The main goal in the treatment of lagophthalmos is prevention of serious corneal complications. Based on the results of 2453 surgeries performed in patients with lagophthalmos, a detailed analysis of modern surgical techniques was carried out highlighting their advantages and disadvantages. The article describes in detail the most effective methods of static correction of lagophthalmos, their features and indications, and presents the results of using an original palpebral weight implant.
Основной задачей лечения при лагофтальме является предотвращение серьезных роговичных осложнений. Основываясь на результатах 2453 операций у пациентов с лагофтальмом, проведен подробный анализ современных хирургических методик, корригирующих несмыкание век, освещены их преимущества и недостатки. Детально рассмотрены наиболее эффективные методики статической коррекции, особенности и показания для их применения, результаты постановки оригинального пальпебрального утяжеляющего имплантата.

Facial paralysis decreases eye protection mechanisms leading to ocular problems up to corneal ulceration, and blindness. This study aimed to evaluate the outcomes of periocular procedures for recent facial paralysis. Medical records of patients with unilateral recent complete facial palsy who did periocular procedures at the Maxillofacial Surgery Department of San Paolo Hospital (Milan, Italy) between April 2018 and November 2021 were retrospectively reviewed. 26 patients were included. All patients were evaluated 4 months after surgery. The first group included 9 patients who underwent upper eye lid lipofilling and midface suspension with fascia lata graft; they had no ocular dryness symptoms and no need for eye protection measures in 33.3% of cases, significant reduction of ocular symptoms and need for eye protection measures in 66.6% of patient, 0-2 mm lagophthalmos in 66.6% and 3-4 mm lagophthalmos in 33.3%. The second group of 17 patients who underwent upper eyelid lipofilling, midface suspension with fascia lata graft and lateral tarsorrhaphy, had no ocular dryness symptoms and no need for eye protection measures in 17.6% of patient, significant reduction of ocular symptoms and need for eye protection measures in 76.4% of patient, 0-2 mm lagophthalmos in 70.5%, 3-4 mm lagophthalmos in 23.5% and one patient 5,8%had 8 mm lagophthalmos and persistent symptoms. No ocular complication, cosmetic complain or donner site morbidity were reported. Upper eyelid lipofilling, midface suspension with fascia lata graft and lateral tarsorrhaphy decrease ocular dryness symptoms and need for eye protection measures and improve lagophthalmos: the association of the reinnervation with these complementary techniques is therefore highly recommended in order to immediately protect the eye.

UNASSIGNED: The objective of the study was to evaluate the technique of tarsorrhaphy combined with sutureless amniotic membrane transplantation in the treatment of resistant ocular surface pathologies.
UNASSIGNED: In this study, the post-operative results of patients who underwent tarsorrhaphy combined with sutureless amniotic membrane between May 2016 and July 2021 were evaluated. In this technique, we have placed the amniotic membrane on the ocular surface, and then simple tarsorrhaphy has been performed. We used this technique in our six patients during COVID-19 pandemic period at the bedside. The outcomes of corneal epithelial healing, visual acuity, pain score, patient tolerance, and adverse events were evaluated.
UNASSIGNED: Fourteen patients (eight females and six males) were included in the study. The mean age of the patients was 65.7 years (range 9-96 years). The mean follow-up period was 9 months (range 6-12 months). In all cases, epithelial defect healed completely and it was seen that this new technique facilitated resolution of pain and inflammation and promoted epithelialization in our 14 cases with resistant ocular surface pathologies. Post-operative pain score was significantly lower than pre-operative pain score (p<0.05).
UNASSIGNED: Our results demonstrate that tarsorrhaphy with sutureless amniotic membrane accelerates the ocular surface healing process and increases the efficiency of amniotic membrane. This method has an important advantage that it can be performed at bedside. Patients and ophthalmologists need such an innovative treatment which is effortless, effective, and practical especially for the pandemic period.

UNASSIGNED: Amongst the chemical warfare agents, blistering (vesicant) agents can be significant materials. The most important agent in this group is sulfur mustard (mustard gas) which is known as \"King of chemical warfare (CW) agents \". Exposure to this agent, seriously causes damages in several organs, such as the eyes. This article reviews the ophthalmological aspects of sulfur mustard with reference of its management.
UNASSIGNED: A wide-ranging search in PubMed databases, Thomson Reuters and Scopus was done and different aspects of chemical properties of sulfur mustard, its mechanism of action and effects on eyes, clinical finding, diagnostic evaluation, initiate actions, pharmaceutical and surgical interventions was reported.
UNASSIGNED: Sulfur mustard can alkylate DNA and RNA strands and break down structures of protein and lipid of cell membrane. This may impair cell energy production, and leads to cell death. Exposure to sulfur mustard, therefore, causes such problems for organs, including irreversible damage to the eyes.
UNASSIGNED: Understanding the mechanism of the sulfur mustard effect and the early training in prevention injuries will cause fewer complications and damage to organs, including the eyes. Washing the eyes with tap water or eyewash solutions, using mydriatic drops, anti- inflammatory drugs, matrix metalloproteinase inhibitors and antibiotics may help to the management of poisoning. Surgical interventions including tarsorrhaphy, amniotic membrane transplantation, stem cell transplantation and corneal transplantation could reduce the harm to the victims.

A fledgling feral pigeon with systemic protozoal infection was referred with corneal protrusion in the right eye after being treated for a corneal ulcer for 12 days. Ophthalmic examination revealed a corneal bulla covering almost the entire central cornea and preventing the eyelids from closing. Gelatinous corneal stroma with numerous heterophils surrounding the corneal bulla was also detected on cytologic examination. Bullous keratopathy and melting keratitis in the right eye were diagnosed. Temporary tarsorrhaphy with topical eye drops was prescribed for a week; however, the bulla persisted. A modified nictitating membrane flap was created under general anesthesia and maintained for 2 weeks. The corneal bulla resolved, and corneal thickness was restored. The pigeon was presented again with recurrence of the corneal bulla in the right eye after 45 days. Alternative surgical options were recommended; however, the pigeon was euthanized because the protozoa-induced intra-oral and intra-aural masses caused malformation of the beaks, which made voluntary feeding impossible.

OBJECTIVE: To report the effectiveness of the surgical procedure of the tarsoconjunctival flap (FTC) in patients with severe ocular surface impairment refractory to previous conventional treatments.
METHODS: A retrospective, noncomparative, consecutive case series.
RESULTS: Pillar tarsoconjunctival flap (PTCF) was performed in eight eyes of eight patients. Three patients had neurotrophic corneal ulcer (NCU), three had exposure keratopathy and two had corneal melting. Seven of them had satisfactory postoperative results, showing total corneal re-epithelialization that lasted throughout the postoperative follow-up (mean 10.33 ± 2.65 months [SD], range 6 to 12 months). Mean time for the re-epithelization was 11.28 ± 8.97 days [SD] (range 4 to 30 days).
CONCLUSIONS: This study suggest PTCF is a valid alternative to tarsorrhaphy in cases of persistent epithelial defect (PED) or NCU resistant to conventional treatments. Notwithstanding, prospective comparative trials comparing PTFC with conventional and/or novel therapies in PED or NCU are needed to corroborate these findings.

OBJECTIVE: To evaluate the role of tarsorrhaphy and its effectiveness in the treatment of patients with thyroid eye disease (TED).
METHODS: The study identified the patients who required tarsorrhaphy for corneal lesions associated with TED among the total number of 457 patients who underwent tarsorrhaphy at the Research Institute of Eye Diseases over the past 20 years.
RESULTS: Overall, 477 tarsorrhaphy surgeries (457 patients) were performed, including temporary and permanent, partial and complete. The corneal involvement in TED was the indication for tarsorrhaphy in 81 patients (101 tarsorrhaphies). TED patients were divided depending on the date of operation, and it was found that 61 tarsorrhaphies were performed in the period from 2000 to 2009, and 40 similar interventions were performed in the period from 2010 to 2019.
CONCLUSIONS: The reduction in the number of tarsorrhaphy surgeries in patients with TED in the last decade due to improvement of techniques for bony decompression of the orbit and increase in the number of these operations allowed significant reduction of the degree of proptosis and, as a consequence, the exposure surface area of the eye. However, despite all the successes achieved in orbital surgery, tarsorrhaphy still remains an affordable technique that can always be used in case of corneal lesions in thyroid eye disease.
UNASSIGNED: Оценить роль тарзорафии и ее эффективность в лечении пациентов с эндокринной офтальмопатией (ЭОП).
UNASSIGNED: Из общего числа 457 пациентов, которым в ФГБНУ «НИИ глазных болезней» за последние 20 лет была выполнена тарзорафия, выделены пациенты с поражением роговицы при ЭОП, которым потребовалось проведение этой операции.
UNASSIGNED: Выполнено 477 тарзорафий, включая временную и перманентную, частичную и полную. Поражение роговицы при ЭОП послужило показанием для проведения тарзорафии у 81 пациента (101 тарзорафия). При разделении пациентов с ЭОП в зависимости от даты выполнения операции было выявлено, что в период с 2000 по 2009 г. выполнена 61 тарзорафия, а в период с 2010 по 2019 г. — 40 аналогичных вмешательств.
UNASSIGNED: Сокращение количества проводимых тарзорафий у пациентов с ЭОП в последнее десятилетие связано с совершенствованием методик проведения костной декомпрессии орбиты и увеличением числа этих операций, что позволило значительно уменьшить степень экзофтальма и, как следствие, обнажение поверхности глаза. Однако, несмотря на все успехи, достигнутые в орбитальной хирургии, тарзорафия все же остается доступной методикой, к которой всегда можно прибегнуть в случае поражения роговицы при эндокринной офтальмопатии.

The successful management of infectious keratitis is usually achieved with a combination of tools for accurate diagnosis and targeted timely antimicrobial therapy. An armamentarium of surgical interventions is available in the acute stage which can be resorted to in a step wise manner or in combination guided by the response to treatment. Simple surgical modalities can facilitate accurate diagnosis e.g. corneal biopsy and alcohol delamination. Surgery to promote epithelial healing can vary from tarsorrhaphy, amniotic membrane transplantation or conjunctival flaps depending on the extent of infection, visual prognosis, availability of tissue and surgeon\'s experience. Collagen crosslinking has been increasingly utilized with successful results to strengthen the cornea and reduce the infective load consequently the need for further elaborate surgical interventions. It has shown encouraging results specially in superficial bacterial and fungal keratitis but for deeper infections, viral and acanthamoeba keratitis, its use remains questionable. When globe integrity is compromised, corneal gluing is the most commonly used procedure to seal small perforations. In larger perforations/fulminant infections a tectonic/therapeutic graft is advisable. Partial thickness grafts are increasingly popular to treat superficial infection or internally tamponade perforations. Peripheral therapeutic grafts face challenges with potential requirement for a manually fashioned graft, and increased risk of rejection due to proximity to the limbal vessels. Late stage visual rehabilitation is likely to require further surgical interventions after complete resolution of infection and inflammation. A preliminary assessment of corneal sensation and integrity of the ocular surface are key for any successful surgical intervention to restore vision.