XXXX : clinical presentation and surgical outcome.

@entity1 @entity751 @entity9467
PURPOSE: To describe the clinical signs and outcome of surgery in cases with @entity751 and highlight the clinical presentation of this syndrome. METHODS: A retrospective review of records of @entity1 with @entity751 who underwent surgery between January 2002 and July 2007. The position of the punctum, nasal bridge prominence, Hertel exophthalmometry and the presence of inferiorly directed sharp angulation of the medial canthus was noted. The @entity1 underwent anterior canthal tendon release, punctoplasty or medial conjunctivoplasty or a combination of these. RESULTS: Of the 13 cases, 10 had been treated medically elsewhere. The mean age of onset was 20.7 years. Most of the @entity1 were male 10 (76.9%). A prominent nasal bridge was demonstrable in 9 (69.2%) @entity1 and sharp inferior angulation of the medial canthus, the 'beak' sign was present in 9 (69.2%) cases. Anterior canthal tendon release alone was performed in 4 @entity1 , in combination with punctoplasty in 5 and with conjunctivoplasty in 4. Watering resolved in 10 @entity1 . 3 @entity1 who had a combination of anterior canthal tendon release and punctoplasty had persistent but asymptomatic @entity9467 . DISCUSSION: @entity751 is characterised by the abnormal anterior insertion of the medial canthal tendon with displacement of the punctum out of the lacrimal lake. Most cases present with unexplained watering. Surgical management by anterior canthal tendon release with or without conjunctivoplasty or lower lid retractor plication is usually successful.
