An interesting surgery I performed today...

I performed an interesting case today on a patient with constant tearing and irritation in her eyes.  On examination, she has has very lax (or loose) lower lids which do not help in her ability to blink well and drain her tears effectively. You can see this by the rounding to her eyelids in the corner of each eye.  In addition she has small, stenotic openings to her tear drainage system.  The tiny openings you see along the eyelid (close to the nose) actually drain the tears from the ocular surface into the nose and mouth. In order to help her, I had to address both of her problems which were causing her to tear constantly. First, I performed a lower lid resuspension technique to allow for tighter and better positioned lower lids in order to help her blink more effectively. This is also called an ectropion repair.  Next, I attempted to dilate her stenotic tear drainage system to allow for better drainage by placing a baloon dilator to dilate the canaliculi.  My team and I recently published the use of this in a prior medical study (see below link).  Silicone tubes were then placed to intubate the tear drainage system and I will remove those in my office in several weeks. Overall, she tolerated everything well and was home the same day. 

 

See link to my prior blog on our study on canalicular stenois.

 

What are effective scar treatments???

This is a great article summarizing the challenges in scar treatment.  I actually find silicone sheets quite effective for some early scars.  In cases of hypertrophic healing (excessive scarring) or abnormally raised edges, carefully thought-out regimen of low dose steroid injections may be beneficial.  Care must be taken not to inject high doses of steroids around thin skin, such as the eyelids, though.  Laser resurfacing can also be helpful in selected cases.   Read more in LA Times!

Is a Well-Rested Doctor a Better Doctor?

Do better hours for medical students and residents result in better patient care? It's difficult to tell since no real well-controlled study has been published.

Work hour limits have improved the lifestyle of junior doctors, but decreasing their fatigue seems to have had little effect on how patients actually do. Read more in NY Times.