Surgical Correction of Giant Fornix Syndrome

Farmer, Lachlan; Rajak, Saul; McNab, Alan A.; Hardy, Thomas G.; Selva, Dinesh

doi:10.1097/iop.0000000000000611

Cited by 6 publications

(8 citation statements)

References 9 publications

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“…This process minimises superior fornix dead space and the potential for developing a nidus of infection. In a case series of six surgical patients, five reported complete resolution of symptoms and all reported symptomatic improvement by 18 months 18. Alternatively, hyaluronic acid gel filler has also been used for functional treatment of GFS.…”

Section: Discussionmentioning

confidence: 99%

Bilateral, chronic, bacterial conjunctivitis in giant fornix syndrome

et al. 2022

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Giant fornix syndrome (GFS) results in chronic, relapsing conjunctivitis in elderly patients with enophthalmos and enlarged fornices, in which infectious material collects and perpetuates inflammation. A 98-year-old woman presented with persistent, bilateral, purulent conjunctivitis; corneal epithelial defects and progressive blepharospasm that did not respond to artificial tears, topical antibiotics and steroids and amniotic membrane grafts. Additional findings of deep-set orbits with enlarged upper fornices were diagnostic of GFS. Over the next 2 months, she responded to a combination of topical and systemic antibiotics, autologous serum eye drops, povidone-iodine forniceal rinses, and hypochlorous acid treatment of the eyelashes. GFS is an important diagnostic consideration in elderly patients with chronic conjunctivitis and deep-set orbits.

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Section: Discussionmentioning

confidence: 99%

Bilateral, chronic, bacterial conjunctivitis in giant fornix syndrome

et al. 2022

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“…In the current literature, there are 3 series on conjunctival resection techniques. [6][7][8] Nabavi et al advocated both upper and lower conjunctival resections with the Putterman clamp. The amount of conjunctiva excised was determined by the amount of redundancy intraoperatively (4-10 mm), 6 and no sutures were placed to close the conjunctiva.…”

Section: Discussionmentioning

confidence: 99%

“…6 Farmer et al and Vahdani et al described a similar conjunctival resection (4-5 mm resection and nonspecified, respectively). 7,8 However, whether the disease resolution is related to the amount of resection is not known. Moreover, there are few publications on GFS in the literature and only 1 case report in the Asian population.…”

mentioning

confidence: 99%

Giant Fornix Syndrome: How Much Conjunctiva Should Be Resected?

Lam

Szeto

Yuen

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To characterize clinical profiles of Chinese patients with giant fornix syndrome (GFS), compare surgical outcomes with amount of Müller's muscle-conjunctival resection (MMCR), and elicit risk factors for those who have prolonged recovery after MMCR.Methods: Retrospective, observational, interventional cohort study on GFS eyes. Two treatment groups were established: limited MMCR-as defined by 8 mm or less resection; maximal MMCR-as defined by 10-12 mm resection. Good responders were defined as eyes exhibiting disease resolution within 3 months after surgery. Primary outcome was disease resolution, secondary outcome was ptosis improvement.Results: Mean age was 81.9 years old (range, 76-89), with 6 (75%) females and 2 (25%) males. All 10 eyes presented with discharge, partial ptosis, and conjunctival injection. In the limited MMCR group, time to symptom resolution was longer at 5.56 months, while maximal MMCR group was 2.02 months (p = 0.004). Limited MMCR group also had lower primary surgical success and required additional surgery compared with maximal MMCR group (p = 0.008). At mean follow up of 34.4 months (range, 11-65 months), all eyes achieved disease resolution, no recurrence, and ptosis improvement.Conclusions: In the largest series on Chinese eyes with GFS to date, GFS is mainly a disease in elderly females. Maximal MMCR has a higher rate of surgical success with no additional complications. For those who underwent MMCR, additional treatment such as topical steroids and fortified antibiotics do not affect time to recovery. These findings may help ophthalmologists consider maximal MMCR as a definitive surgical treatment in GFS eyes.

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“…Adding a cotton-tipped applicator soaked in povidone-iodine to perform the sweep has, in some cases, sufficiently eradicated the infection without the need for systemic antibiotics . Lastly, in individuals with chronically relapsing, medically intolerant cases of GFS, surgical reconstruction to reduce forniceal depth and minimize coagulum formation can successfully improve symptoms …”

Section: Discussionmentioning

confidence: 99%

“…1 Lastly, in individuals with chronically relapsing, medically intolerant cases of GFS, surgical reconstruction to reduce forniceal depth and minimize coagulum formation can successfully improve symptoms. [6][7][8] Giant fornix syndrome may be misdiagnosed or inappropriately managed, potentially leading to delayed treatment, risk of irreversible corneal changes, and possible loss of visual acuity. This Clinical Challenge exemplifies how GFS should be considered in some patients with chronic, relapsing conjunctivitis and potentially managed using medication, a fornix sweep, and surgical reconstruction if necessary.…”

Section: This Patient's Symptoms Of Ptosis and Recurrent Conjunctivit...mentioning

confidence: 99%