We describe a retrospective case report of dacryoadenitis associated with orbital inflammatory disease in a patient with confirmed SARS-CoV-2 infection. A 22-year-old previously fit and healthy male presented with 4-day history of right ocular redness, eyelid swelling and blurred vision associated with discomfort and pain in the lacrimal gland area. He was found to have right acute dacryoadenitis based on clinical examination and orbital imaging. One day after initiation of oral antibiotic and non-steroidal anti-inflammatory therapy, he developed worsening of the orbital inflammation and partial ophthalmoplegia. Oral steroids were commenced resulting in rapid resolution of symptoms within a few days and clinical stability at 2 months. The patient did not have any systemic features of COVID-19 but he was in close contact with his mother and with his partner who both had respiratory symptoms and tested positive for SARS-CoV-2 antigen (PCR testing) 4 weeks prior. PCR testing from nasopharyngeal swab was negative for SARS-CoV-2 RNA; however, the serological test was positive for IgM/IgG SARS-CoV-2 antibodies. Extensive laboratory workup including infectious and autoimmune screening and chest x-ray were unremarkable. Orbital inflammatory disease due to infectious process or immunological response may potentially occur in COVID-19 patients, although the causal relationship remains uncertain.

We promote a simple, reversible temporary tarsorrhaphy technique and describe how to place a 4/0 polypropylene suture, on a round-body needle, into the upper and lower tarsal plate to create a strong suture tarsorrhaphy. This technique has been found to be extremely effective over 20 years’ experience with minimal patient discomfort or complications. The eyelid margin anatomy is not disrupted and maintains its normal architecture and contour following release of the tarsorrhaphy. This temporary suture tarsorrhaphy technique is inexpensive, safe and easy to learn and above all comfortable for the patient. It can be performed in most clinical settings, without the risk of lid margin damage and subsequent lash growth distortion. It is appropriate for both for short- and medium-term eye protection.

To describe a new, simple, quick, and minimally invasive surgical technique for managing medial canthal tendon laxity. The technique works by creating a directed posterior lamellar scar. Sutures are preplaced in firm medial canthal tissue, and a triangular diathermy burn is made between this fixation point and the medial tarsal plate (sparing the canaliculus). This area is then plicated horizontally by bringing the preplaced sutures through the medial tarsal plate. The authors report a retrospective case note review of a consecutive case series of 55 patients (59 procedures). All patients with moderate to severe medial canthal tendon laxity underwent a medial thermoplasty procedure in addition to standard surgery for correcting their eyelid malposition (entropion, ectropion, or symptomatic lax eyelids). The study cohort included 30 men and 25 women, with a mean age of 77 years (range 51–93). Epiphora was the commonest presenting complaint (47%) followed by ocular irritation (44%), with the remainder heaving a combination of symptoms. Lower eyelid ectropion (n = 30, 51%) and entropion (n = 26, 44%), constituted the most common indications for surgery. The average postoperative follow-up period was 16 months (range 3–63 months). Fifty-three eyes (90%) had complete resolution of symptoms, while 2 (3.4%) had partial reduction of epiphora. With regard to the eyelid margin position, 57 eyelids (96.6%) were anatomically in a normal position, while 2 operations failed despite early satisfactory results. In terms of correction of medial canthal tendon laxity, 49 cases (83%) were deemed successful. There were no major complications, nor any significant long-term sequelae. Posterior medial canthal thermoplasty provides a simple, effective, and safe option for addressing medial canthal tendon laxity.