The purpose of this report is to describe a modified surgical iridocyclectomy technique and lensectomy for the removal of a recurrent iris cyst and a cataract in a child. A 3-year-old boy underwent uncomplicated standard iridocyclectomy for the removal of an enlarging congenital epidermal iris cyst. In the postoperative period, the cyst recurred. A second surgical intervention was performed using a modified iridocyclectomy technique. Sclerocorneal dissection of the involved quadrant was performed. After a lensectomy, an additional deep lamellar dissection of the peripheral cornea was undertaken prior to iris cyst removal and pupil reconstruction. This modified two-layered iridocyclectomy technique permits an elegant access to the iris lesion and allows the construction of a two-layered watertight wound, reducing the risk of hypotony and wound ectasia. We believe it also allows a better control of astigmatism and is a safe procedure in the pediatric population, particularly during the amblyogenic period.

PURPOSE: To describe the history, symptoms, and clinical signs and discuss the treatment of blepharokeratoconjunctivitis. METHODS: Eight children (five girls and three boys), ranging in age from 3.5-13 years, were clinically diagnosed with blepharokeratoconjunctivitis. Microbiology studies were performed in four of the eight children. Treatment consisted of lid hygiene, oral erythromycin suspension, and preservative-free steroids. Duration of therapy was directed by clinical improvement. RESULTS: Average age at onset was 3.2 years (range: 0.5-8 years). Lid disease, conjunctival redness, and inferior superficial corneal vascularization were consistent features (100%). Other signs were punctate corneal epithelial staining, inferior subepithelial vascularization and infiltrate, conjunctival phlyctenules, corneal phlyctenules, and circumferential pannus. Microbiology testing demonstrated coagulase-negative staphylococcus and Propionibacterium acnes. Average follow-up was 8.3 months (range: 2-23 months). All patients had relief of symptoms within 2-3 weeks. Clinical signs took more time to regress but all had progressive improvement of the ocular surface by 2 months. Blepharokeratoconjunctivitis reactivated in all patients during follow-up, and repeat therapy was administered. CONCLUSION: Blepharokeratoconjunctivitis in childhood is a chronic inflammatory process that can have different presentations. It can be successfully treated with oral erythromycin and topical steroids.