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Trigeminal trophic syndrome (TTS) is a condition whereby persistent facial ulceration presents consequent to central or peripheral insult to the trigeminal nerve. Lesions are created by repetitive self-inflicted manipulation and trauma of dysaesthetic skin within the trigeminal dermatome. We discuss four cases with aetiologies varied from presumed microvascular compromise to resection of cerebral meningioma, cerebrovascular accident, and herpes zoster ophthalmicus. We discuss the management of the under-recognised associated periocular skin ulcerations that result from physical manipulation of dysesthic skin and prove to be persistent and challenging to treat. Patient education and counselling are crucial in understanding and preventing the detrimental effect of physical manipulation of the skin. Occlusive dressings can reduce recurrent trauma. Topical lubricants, antibiotics, or autologous serum may be needed in cases with corneal involvement or exposure. Surgical interventions may be used, but frequently fail if the underlying neurological pathology and skin manipulation has not been adequately addressed. TTS should be suspected in persistent or recurrent facial ulceration with concomitant anaesthesia and paraesthesia in the trigeminal distribution, with alar nasi involvement being a key feature.

Aim: To assess the efficacy of 2-0 prolene brow suspension surgery in paediatric ptosis with poor levator function., Materials and Methods: Retrospective review of cases that underwent 2-0 Prolene brow suspension surgery between 1997-2007. Primary surgical success was defined as post-operative lid height clear of the pupil and asymmetry of 2 mm or less., Results: Twenty-seven patients (37 lids) were included in the study. The mean follow-up period was 71 months (range 2-173). There were 10 recurrences giving an overall success rate of 72.9%. The complication rate was 5.4%., Conclusions: Prolene brow suspension surgery in most patients has a long-lasting effect with a low complication rate. Success rates are comparable to other non-autogenous materials. This may obviate the need for a more definitive secondary procedure in the future.

Purpose: To review our experience with 5% topical Imiquimod in the treatment of periocular tumours., Methods: Imiquimod, an imidazoquinoline, is an immune response modifier which has been shown to have potent anti-viral and anti-tumour activity. We present a retrospective case series of 5 patients who received topical Imiquimod for various eyelid tumours. Two patients were diagnosed with basal cell carcinoma of the eyelid, one patient with actinic keratosis, one with intraepidermal squamous cell carcinoma (Bowen's disease) and one patient had concomitant squamous cell carcinoma and intraepidermal squamous cell carcinoma., Results: All 5 patients, with various eyelid neoplastic/pre-neoplastic pathology, responded well with clinical resolution, to treatment with topical Imiquimod. There were few adverse reactions to periocular use of 5% Imiquimod, with only 1 patient developing a chemical conjunctivitis which resolved on dose reduction., Conclusions: There is limited experience and published literature on the use of topical 5% Imiquimod in the treatment of periocular tumours. In our experience, it is a safe and effective treatment for periocular lesions, including actinic keratosis, intraepidermal squamous cell carcinoma, basal cell carcinoma and squamous cell carcinoma. To our knowledge, this is the first published description of the successful use of 5% Imiquimod in treating moderately differentiated squamous cell carcinoma of the eyelid.

Research into the clinical management of amblyopia has, most recently, focussed on the effectiveness of amblyopia treatment. Given the mounting evidence that the condition is treatable, an important priority is the detection of individuals with the condition. Here, we review critically the means by which this can be achieved. We conclude that intensive early screening can produce improved outcomes but that the effectiveness of real-life screening programmes is very dependent on the coverage they obtain. An almost entirely neglected subfield of amblyopia treatment research is the identification of reasons why parents and children often fail to comply with occlusion therapy. Here, we examine a psychological approach to this problem and find it to be informative in predicting compliance. Lastly, we consider the disability arising from strabismus, again from a psychological perspective, and find that on a range of psychosocial well-being indicators, strabismus surgery results in significant gains.

Introduction: The rationale for preschool vision screening programmes has recently been questioned. Evidence about the effects of early treatment is needed, but it is not known how early the target conditions can reliably be detected. In this study, an intensive programme comprising several different screening methods, used at different ages up to 37 months, was compared with the usual practice of visual surveillance and ad hoc referrals., Methods: Two groups were randomly selected from children in a population birth cohort study. The control group (n = 1461) received visual surveillance only. The intervention group (n = 2029) was offered in addition a programme of regular visual assessments by orthoptists testing visual acuity, ocular alignment, stereopsis and non-cycloplegic photorefraction., Results: The intervention group programme yielded more children with amblyopia (1.6% vs. 0.5%, p < 0.01), and was more specific (95% vs. 92%, p < 0.01), than the control programme. The individual components of the intervention programme were compared. The cover test and visual acuity tests were poorly sensitive until the children were 37 months, but were always >99% specific. Photorefraction was more sensitive than acuity testing at all ages below 37 months, with specificity >95% at 31 and 37 months., Conclusions: Photorefraction would have detected more children less than 37 months of age with straight-eyed amblyopia than did visual acuity testing, but with more false positives. At 37 months, photorefraction plus a cover test would have been comparable in effectiveness to visual acuity testing plus a cover test.

Successful surgical treatment of peri-ocular basal cell carcinomas requires complete excision. Mohs' micrographic surgery achieves this, but is not readily available in all hospitals. The standard 3-4 mm margin does not guarantee complete excision and histology is often not available until after a repair has been undertaken. The 3-4 mm margin has evolved to deal with all forms of BCC. In our opinion, this margin is unnecessarily large for nodular/ulcerative BCC. We report our interim results of excision of localised BCCs using a 2 mm margin in conjunction with a delayed repair following confirmation of histological clearance. Thirty-one patients were treated in this manner; there have been no recurrences after an average follow-up period of 36 months (range 24-57 months).

Many different surgical procedures have been described for the treatment of involutional lower lid entropion. Two commonly performed operations, namely, the Wies and Quickert procedures were analysed to assess the success rates and the factors responsible for their failures. The failure rates were 26% and 5% for the Wies and Quickert procedures, respectively. Most of the failures in these procedures were attributed to untreated lid laxity and the mean time of recurrence was 8 months. We therefore stress the importance of careful lid examination, in particular for horizontal lid laxity, as this will influence the choice of surgical procedure and ultimately the success of treatment.

We present the methodology of a population-based Randomised Controlled Trial, comparing an intensive programme of primary preschool vision screening by orthoptists with the usual non-specialist screening. The aims of the trial are to compare the effectiveness and costs of intensive orthoptic screening with non-specialist measures. The orthoptic screening programme will be evaluated both as a composite package and in terms of the screening value of the individual tests at specific ages. This trial is nested within a large population-based longitudinal study. Additional demographic and developmental data on the children in the trial are therefore available. The results of the trial will be used to help clarify which methods of preschool ophthalmic population screening are best in terms of disease detection and cost efficiency.