Thursday, July 13, 2017

A Patient with Headache and Blurred Vision.

This patient who had had cataract surgery 5 years ago complained of increasing blurriness of vision and headache. Examination did not show any opacities of the posterior capsule or any retina diseases, however, refraction showed high astigmatism of 2.00 D. In addition, she had excessively high eyebrows. The symptoms were attributable to droopy eyelids: astigmatism can occur when the droopy eyelids press on the globe and the headache due to constant use of the forehead muscle to elevate the eyebrows in an attempt to open the eyes.
After consultation, bilateral ptosis (droopy eyelid) surgery was done using the posterior approach. After the operation, her vision improved due to reduction of the astigmatism to -0.75 and the headache disappeared when the eyebrows returned to normal height.
Headache due to constant excessive use of forehead 
muscle to open the eyes.

One day after ptosis (droopy eyelid) operations.

Normal eye opening two weeks after droopy eyelid surgery.

Thursday, November 10, 2016

Doc, can you do something about my sausage lip?

Having a full lip can make a person more sensuous and attractive. However, an artificial pump-up lips which are not proportional to one's face can make one an object of ridicule.

Natural versus unnatural lips.

This woman had lip injection  in a beauty saloon two years ago to give her a better pout. She was told the injection consisted of hyaluronic acid. Two years later, the lips remained swollen and the upper lip had poor contour with the left side bigger than the right. She was depressed as people ridiculed her for having "sausage lips". 

Swollen upper lip with asymmetrical contour.

Side view of the lips

She consulted a few aesthetic physicians and had injections including steroid and hyalurodinase to reduce the swelling but to no avail. Examination showed the lips to be thickened and hard to touch, it was likely that she was injected with silicone rather than hyaluronic acid. The only treatment of choice is to surgically remove the granuloma. 

Surgical removal of the granuloma and to reshape the contour 
of the upper lip.

Excised lip tissue showing granuloma.

Post lip reduction with good contour.

Side view of the upper lip post lip reduction.

Sunday, September 11, 2016

Doc, Can You Straighten My Eyes? VI

Patients with high myopia may sometimes develop a very significant convergent squint which is not only cosmetic disfiguring but severely affect the vision. The mechanism is thought to be herniation of the globe outside the muscle cone usually between the superior and lateral rectus (as mentioned in previous post). Surgical correction is often complex as simple recession/resection technique is usually insufficient to significantly correct the malposition. One way of correcting this difficult squint is with muscle transposition. However, it is important to inform the patients that more than one operation may be needed for good outcome.

Surgical procedure showing transposition of muscles for myopic strabismus fixus. 
The medial rectus was released and allowed to hang back by 8mm. a. The superior 
rectus is isolated; b. the superior rectus is split into two equal halves; c. the lateral rectus 
is isolated and split into two equal halves; d e and f. a 5/0 silk is used to tie the upper 
half of the rectus at 15mm from its origin of insertion to the lateral half 
of the superior rectus. The technique strengthen the lateral rectus 
and push the globe back into the muscle cone.

Diagramtic presentation of the procedure shown in the photos.

This patient has residual convergent squint but is able to perform 
her daily activities without help. 

Despite the located lenses due to high myopia, this patient regains good vision after 
the surgery while awaiting surgical removal of the dropped lenses.

This patient has residual hypotropia but is pleased with his appearance.