Eyeworld

55 EW FEATURE May 2018 • Navigating the red eye Editors' note: The physicians have no financial interests related to their comments. Contact information Beckman: kenbeckman22@aol.com Gill: gill@eyeface.org and oral antibiotics. "They took multiple cultures of the mucopuru- lent discharge but nothing helped." Dr. Gill stressed that it's hard to diagnose in the clinic, even with eyelid eversion, because the fornix is very deep and patients tend to be inflamed and uncomfortable. "For this patient, I took her to the OR and planned to correct the ptosis eyelid with a conjunctival Muller's muscle resection (transcon- junctival approach)," he said. "With a lid margin traction suture in place through the upper eyelid and a Desmarres retractor (and anesthe- tized eyelid), I was able to evert maximally and clean out the fornix with betadine." He then resected the redundant conjunctiva in the fornix while doing the ptosis repair. "She has done exceptionally well with no recurrence of infection for more than a year now," Dr. Gill said. Oculopastics for lid surgery Dr. Gill said that since he is an ocu- lofacial plastic surgeon, he treats a lot of ectropion, lagophthalmos, and lash trauma cases. "The manage- ment of all of the above is surgical, and each case is managed uniquely," he said. Overall, the surgical goal is that the upper and lower eyelid move naturally and close fully. "Surgery can involve anything from simple lateral canthoplasty to more complex eyelid margin reconstruc- tion with local skin flaps or tissue grafts as needed," he said. If these are mild or temporary, Dr. Beckman said, patients may do well with lubricants, plugs, or tradi- tional dry eye therapy. If not, they need surgical repair, he said. "It may be as easy as removing lashes for trichiasis or more complex, such as surgical repair for exposure, ectropi- on, etc." Conjunctival chalasis "I trial these patients on topical anti-inflammatory and anti-aller- gy medications first," Dr. Gill said. "Conjunctivochalasis can be treated with fine electroepilation cautery, but most general ophthalmologists and cornea specialists resect the conjunctiva." Dr. Beckman starts with his typical dry eye therapy, including lubricants, anti-inflammatories, etc. If more severe, patients can do well with conjunctival cautery or even resection, he said. EW UCLA Department of Ophthalmology Annual Seminar June 8-9, 2018 UCLA Stein Eye Institute • RPB Auditorium 49th Doheny Memorial Lecturer Stephen D. McLeod, MD Professor & Chair Department of Ophthalmology University of California, San Francisco 49th Jules Stein Lecturer Carol L. Shields, MD Professor & Director Ocular Oncology Service Wills Eye Hospital 16th Bradley R. Straatsma Lecturer Vinit B. Mahajan, MD, PhD Associate Professor of Ophthalmology Stanford University 16th Thomas H. Pettit Lecturer David S. Rootman, MD Professor of Ophthalmology & Visual Sciences University of Toronto UCLA Stein Eye Institute Doheny Eye Institute

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