Evidence related to the effectiveness of combination drug therapy for the treatment of osteoporosis is currently considered insufficient. Therefore, this study was performed to clarify the effects of monotherapy, and combination therapy, with a bisphosphonate (minodronic acid hydrate), a bone resorption inhibitor, and calcitonin (elcatonin), which is effective for the alleviation of pain due to vertebral fractures in osteoporotic patients. Study participants comprised of 51 female subjects with post-menopausal osteoporosis, whose main complaint was acute lower back pain caused by vertebral fractures. Subjects were randomly allocated into three groups and then administered with either intramuscular injections of elcatonin at a dose of 20 units weekly, minodronic acid hydrate at a dose of 1 mg daily, or a combination of these two drugs. As primary endpoints, time-dependent changes in levels of pain were assessed using a visual analog scale from baseline to 6 months of duration. In addition, we examined the effects of monotherapies, and a combination therapy on bone resorption, with changes in bone mineral density at 4 sites and advanced hip assessment parameters from baseline to 6 months. A two-tailed significance level of 5% was used for hypothesis testing. Elcatonin monotherapy showed some alleviation of pain immediately after any vertebral fractures, which was more than in the minodronic acid hydrate monotherapy group. In addition, the minodronic acid hydrate monotherapy group experienced more effective inhibited bone resorption than the elcatonin monotherapy group. In the combination therapy, the efficacy for alleviating pain and inhibiting bone resorption was equivalent to the effect observed in the elcatonin and minodronic acid hydrate monotherapy groups respectively, with further improved values of bone mineral density observed in the femoral neck and lumbar vertebrae, and in parameters of advanced hip assessment compared with both monotherapy groups. Combination therapy with elcatonin and minodronic acid hydrate appears to be an effective treatment for osteoporosis patients with lower back pain, caused by fresh vertebral fractures.

Purpose. To examine changes in the position of the lower eyelid punctum and tear meniscus height (TMH) after correction of horizontal laxity of the lower eyelid in involutional lower eyelid entropion. Methods. This prospective, observational study included 42 sides of 36 patients with involutional entropion who underwent a lateral tarsal strip procedure or transcanthal canthopexy (+ lower eyelid retractor advancement). The horizontal distance from the medial margin of the lower lacrimal punctum to the medial canthus was measured using ImageJ software. TMH was measured using anterior segment optical coherence tomography. All measurements were performed preoperatively, at postoperative 3‐month and at postoperative 6‐month. Results. The lower lacrimal punctum significantly shifted laterally at 3‐month follow‐up and slightly returned toward its original position at 6‐month follow‐up (Friedman’s test, P < 0.001). Although the differences did not reach statistical significance, TMH in the lower eyelid increased at 3‐month follow‐up and then slightly decreased at 6‐month follow‐up (Friedman’s test, P = 0.076). Conclusions. The results of this study imply that lateral shift of the lower lacrimal punctum prevents effective drainage of tears accumulated in the lacrimal lake, resulting in increased TMH after correction of horizontal laxity of the lower eyelid in involutional entropion.

Purpose: Facial nerve palsy is frequently associated with both epiphora and dry eye, and orbicularis oculi muscle weakness or paralysis is the main cause of these symptoms. Eyelid pressure is a quantitatively measurable parameter for evaluating the tone and function of the orbicularis oculi muscle. The aim of this study was to examine the relationship between eyelid pressure and lacrimal status in patients with mild facial nerve palsy. Methods: This prospective, interventional study included 10 patients with unilateral facial nerve palsy. The severity of facial nerve palsy was determined using the CADS scale (cornea, static asymmetry, dynamic function, and synkinesis). Eyelid pressure was measured using a blepharo-tensiometer. Lacrimal status was quantified through tear meniscus height (TMH), clinical assessment of meibomian gland dysfunction (MGD) (eyelid margin abnormalities, Marx line, meibum expression, and loss of meibomian glands), corneal fluorescein staining, tear break-up time, and Schirmer test I results. Results: All 10 patients suffered from mild facial nerve palsy without eyelid ectropion or entropion, or gustatory epiphora. Lower eyelid pressure during forceful eye closure was significantly decreased in affected eyes (P = 0.007), but upper eyelid pressure during forceful eye closure and static upper and lower eyelid pressure were not significantly different between the affected and unaffected sides (P > 0.050). The TMH, MGD, and dry eye measurements showed no significant difference between the affected and unaffected eyes (P > 0.050). Conclusions: Mild facial nerve palsy is associated with decreased lower eyelid pressure during forceful eye closure. However, no other differences in upper eyelid pressure during forceful eye closure, static eyelid pressure, TMH, MGD, or dry eye disease symptoms were noted. These results imply that eyelid pressure slightly decreases due to mild facial nerve palsy, but this change may be clinically negligible.

A 48-year-old man visited the emergency department of our hospital with swelling of the left upper and lower eyelids from the day before. On the first examination, he had severe swelling of the left upper and lower eyelids, proptosis, and chemosis. Left intraocular pressure was 33 mmHg. Computed tomographic images showed an orbital abscess in the anterosuperolateral orbital space, maxillary and ethmoidal sinusitis, and dacryocystitis. The orbital abscess was not contiguous to maxillary and ethmoidal sinusitis and dacryocystitis. Ground-glass appearance was seen in the frontal, maxillary, and ethmoid bones, and most of the space of the frontal sinus was obliterated due to the expansion of the frontal bone. Emergent drainage of orbital abscess, dacryocystorhinostomy, and endoscopic sinus surgery were performed under general anesthesia. Intravenous tazobactam/piperacillin was administered. A culture test of the sinus pus and orbital abscess showed growth of Streptococcus intermedius (2+). At one month postoperatively, there was no recurrence of orbital abscess, paranasal sinusitis, and dacryocystitis.

A 74-year-old woman had a six-month history of decreased vision in the left eye. On the first examination, her left best-corrected visual acuity was 0.02, and Goldmann visual field test revealed a central scotoma in the left eye. Magnetic resonance imaging demonstrated lesions around the optic nerve on both sides and enlargement of the lacrimal gland and superior rectus/levator palpebrae superioris muscles on both sides and the medial and inferior recti muscles on the left side. Systemic computed tomography revealed bilaterally enlarged mediastinal and supraclavicular lymph nodes. The blood test results included an elevated soluble interleukin-2 receptor. Pathological examination of the specimens harvested from the lacrimal gland on both sides, left levator palpebrae superioris muscle, and the lesion around the optic nerve on the left side showed lymphocytic infiltration with noncaseating epithelioid granuloma. After the biopsy, the patient underwent two cycles of steroid pulse therapy, followed by oral prednisolone. Although the lesions were reduced after steroid treatment, the left vision did not recover.