640 AMERICAN JOURNAL OF OPHTHALMOLOGY NOVEMBER, 1984

We have used this instrument success­fully for suture removal in our practice without difficulty or complications. In a few cases where the sutures were buried deep in the tissue we use fine scissors and curved forceps.

This design can be adapted to curved and straight forceps of various sizes and used for the removal of small lesions and foreign bodies from the eye.

R E F E R E N C E

1. Lobel, D., and Blumenthal, M.: A tool and method of preparing razor blade fragments for micro­surgery. Arch. Ophthalmol. 101:811, 1983.

OPTOKINETIC NYSTAGMUS TAPE

L E N W O R T H JOHNSON, M.D. , AND GREGORY B. K R O H E L , M.D.

Department of Ophthalmology, Albany Medical College.

Inquiries to Gregory B. Krohel, M. D., Department of Ophthalmology, Albany Medical College, Albany, NY 12208.

We have found a readymade optokinet-ic tape that is inexpensive yet effective, even in infants. Yard Sticks* (Figure) consist of 18 individual colorful stickers

Figure (Johnson and Krohel). Testing optokinetic nystagmus with a Yard Stick tape.

( 2 X 2 inches each) that are adherent to a yard-length strip, and enclosed in a plas­tic case. Intended as peel-off stickers for children (and some adults), the individual stickers have various designs such as video games, spaceships, fantasy crea­tures, animals, Popeye characters, and the like. Since the stickers can be peeled off, the Yard Sticks should be kept in the plastic case provided. The average price for the Yard Sticks is less than $1.00. The Yard Stick tapes can be obtained at sever­al toy stores and some greeting card shops.

*Yard Sticks are produced by Free Lance, Inc., Willow Grove, PA 19090. We, the authors, have no financial interest in the Free Lance Corporation.

CORRESPONDENCE

Correspondence concerning recent articles or other material published in THE JOURNAL should be submitted within six weeks of publi­cation. This correspondence must be typed and prepared in the same way as Letters to THE JOURNAL.

Every effort will be made to resolve contro­versies between the correspondents and the authors of the article before formal publica­tion.

Diagnosing Sarcoidosis by Transconjunctival Biopsy of the

Lacrimal Gland

EDITOR: In the article, "Diagnosing sarcoidosis

by transconjunctival biopsy of the lacri­mal gland" (Am. J. Ophthalmol. 97:573, May 1984), by R. N. Weinreb, it is evi­dent that sarcoid granulomas often in­volve the lacrimal glands. They are not only there, they also disturb tear secre-

VOL. 98, NO. 5 CORRESPONDENCE 641

tion. Many patients complain of foreign body sensation of the eyes; some also complain of lacrimation during the onset of the disease. In many patients the symptoms are transient; the granulomas fade away and the function of the acinar tissue returns to normal. In some cases, however, healing proceeds to fibrosis, leading to deterioration of the function of the lacrimal glands. In my prospec­tive study1 concerning ophthalmic changes in sarcoidosis in 281 unselected patients with histologically confirmed sarcoidosis, 32 (13%) showed decreased lacrimal secretion in the Schirmer I test (less than 7 mm in five minutes). Of these, 22 showed a permanent decrease of lacrimal secretion, with severe dry eye symptoms in 11 after five years of observation. These findings stress the importance of Schirmer testing in pa­tients suspected of having sarcoidosis.

However, lacrimal gland biopsy in the diagnostic work-up of sarcoidosis cannot be recommended. It is a procedure not without complications.2 The levator apo-neurosis can be damaged, leading to blepharoptosis. By excising part of the palpebral lobe of the gland some or all the ducts of the orbital portion of the gland can be damaged. By excising part of the gland, in some cases, the only functioning glandular tissue may also be excised. The result of the operation made for diagnostic purposes can thus be a dry eye.

Dr. Weinreb did not examine the conjunctivas of his patients and choose them for biopsy. The conjunctivas in sarcoidosis are affected at least as often as the lacrimal glands. In my studies,1

conjunctival granulomatosis was the most frequent ophthalmic sarcoid change. It was found in 17% of all the biopsy samples (37 of 218) and even in 41% of the samples taken from suspi­cious nodules (27 of 66).

The conjunctivas also offer a much easier site for a biopsy than the lacrimal

glands. If suspicious nodules are seen under biomicroscopic control the biopsy is performed by removing one nodule.

The sarcoid conjunctival nodules look characteristic in slit-lamp examination. They are yellow, often isolated, and usually larger than the reddish follicles normally seen in the conjunctivas. The histologie interpretation is easy and often the biopsy specimen is full of the granulomatous mass.

During the last few years many new methods have been applied to the diag­nosis of sarcoidosis, for example, estima­tion of angiotensin-converting enzyme level, bronchoalveolar lavage, and galli­um scanning. Nevertheless, the impor­tance of confirming the diagnosis of sar­coidosis by biopsy has not decreased. For an ophthalmologist, the site of choice for the biopsy is the conjunctiva.

ANNI KARMA, M.D. Turku, Finland

REFERENCES 1. Karma, A.: Ophthalmic changes in sarcoidosis.

Acta Ophthalmol. (Kbh.) Suppl. 141, 1979. 2. Stallard, H. B.: Dacryo-adenectomy. In Stall-

ard, H. B. (ed.): Eye Surgery. Bristol, John Wright and Sons Ltd., 1965, pp. 289-291.

Reply EDITOR:

Dr. Karma states that the conjunctiva should be the biopsy site of choice for an ophthalmologist when the diagnosis of sarcoidosis is considered. Certainly, conjunctival biopsy has been a valuable diagnostic adjunct in certain patients and Dr. Karma's investigations have provided helpful information in this re­gard. Conjunctival biopsy is easily per­formed and there are few postoperative complications. This is an excellent tissue to use for biopsy when there is a suspi­cious conjunctival lesion. However, re­sults of biopsy of normal-appearing con­junctiva have not been as uniformly successful. This lack of uniformity may