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Background: Ocular coherence tomography angiography (OCTA) is available in varying size and resolution. We sought to characterise associations of cardiometabolic factors with retinal microvascular changes using 3 × 3, 6 × 6 and 8 × 8‐mm OCTA scans to determine differences in detection with varying scan size. Methods: Cross‐sectional study of 247 cardiovascular patients from a single‐centre tertiary‐care hospital. Demographic, comorbidity and medication data were obtained. Patients underwent 3 × 3, 6 × 6 and 8 × 8‐mm macula OCTA scanning using Carl Zeiss CIRRUS HD‐OCT Model 5000. Angioplex and AngioTool software was used to quantify vascular parameters in the superficial capillary plexus. Results: Increasing age, hypertension, dyslipidaemia, diabetes, chronic kidney disease, coronary artery disease and peripheral vascular disease were associated with reductions in vessel density, vessel perfusion, average vessel length and/or junction density in 3 × 3‐mm OCTA (P <.05 for all). Conversely, smoking was associated with increased vessel density, vessel length and junction density in 3 × 3‐mm OCTA (P <.05 for all). Associations of vessel abnormalities with cardiometabolic factors were progressively weakened and statistically attenuated in 6 × 6 and 8 × 8‐mm OCTA scans. In multivariate analyses, dyslipidaemia remained an independent predictor of reduced vessel density, average vessel length and junction density (P <.05). Conclusions: Cardiometabolic factors are associated with multiple retinal microvascular changes in 3 × 3‐mm OCTA scans. These associations were weakened and progressively attenuated in OCTA scans of larger 6 × 6 and 8 × 8‐mm size. These findings advance our understanding of microcirculatory dysfunction and may have future implications for the screening and management of patients with cardiometabolic risk factors. Additional studies are required to further investigate these important associations. [ABSTRACT FROM AUTHOR]

Cutaneous sebaceous carcinoma occurs almost exclusively on the head and neck and has a significant propensity for recurrence and metastasis. It is easily mistaken for benign conditions, resulting in inappropriate management. Thus, it is important to maintain a high index of suspicion. Despite previous reports, sebaceous carcinoma may occur with similar frequency in Asians and whites. Recent genetic data suggest there are multiple mutational groups of sebaceous carcinoma, paving the way for targeted treatment. After a diagnosis, investigations for staging and for Muir–Torre syndrome should be considered. The available evidence on the treatment options for sebaceous carcinoma is discussed, and specific recommendations for management are made. [ABSTRACT FROM AUTHOR]

Importance: Triaging of outpatient referrals to ophthalmology services is required for the maintenance of patient care and appropriate resource allocation. Machine learning (ML), in particular natural language processing, may be able to assist with the triaging process. Background: To determine whether ML can accurately predict triage category based on ophthalmology outpatient referrals. Design: Retrospective cohort study. Participants: The data of 208 participants was included in the project. Methods: The synopses of consecutive ophthalmology outpatient referrals at a tertiary hospital were extracted along with their triage categorizations. Following pre‐processing, ML models were applied to determine how accurately they could predict the likely triage categorization allocated. Data was split into training and testing sets (75%/25% split). ML models were tested on an unseen test set, after development on the training dataset. Main Outcome Measure: Area under the receiver operator curve (AUC) for category one vs non‐category one classification. Results: For the main outcome measure, convolutional neural network (CNN) provided the best AUC (0.83) and accuracy on the test set (0.81), with the artificial neural network (AUC 0.81 and accuracy 0.77) being the next best performing model. When the CNN was applied to the classification task of identifying which referrals should be allocated a category one vs category two vs category three priority, a lower accuracy was achieved (0.65). Conclusions and Relevance: ML may be able to accurately assist with the triaging of ophthalmology referrals. Future studies with data from multiple centres and larger sample sizes may be beneficial. [ABSTRACT FROM AUTHOR]

Importance: This study introduces a new technique in the assessment of nasolacrimal drainage with magnetic resonance imaging. Background: To describe a new dynamic magnetic resonance dacryocystography (MRDCG) protocol and report normative findings on asymptomatic lacrimal drainage systems. Design: A prospective observational study at the Royal Adelaide Hospital. Participants: Seventeen patients with unilateral epiphora were prospectively recruited. Methods: Patients underwent dynamic MRDCG. The time‐resolved angiography with interleaved stochastic trajectories (TWIST) sequence was used to visualise contrast flow through the lacrimal drainage system. Main Outcome Measures: Tear transit times and anatomical dimensions were measured. Results: Dynamic MRDCG with TWIST sequence reliably demonstrated contrast flow. Tear transit times and anatomical dimensions were comparable to previously reported values in other imaging modalities. Conclusions and Relevance: Dynamic MRDCG provides good structural and temporal resolution to the assessment of lacrimal outflow obstructions. The physiological nature of this modality allows potential assessment for functional obstruction and future research on tear flow assessment. [ABSTRACT FROM AUTHOR]

Importance: This study assesses the interobserver agreement on dacryocystography (DCG) and dacryoscintigraphy (DSG) findings. Background: There are no standard grading criteria to guide the interpretation of conventional DCG and DSG findings and therefore there may be a degree of subjectivity. This study evaluates the level of interobserver agreement in the interpretation of DCG and DSG findings. Design A retrospective observational study at the Royal Adelaide Hospital. Participants: A total of 165 patients who presented with epiphora with 276 DCGs and 290 DSGs performed were included in this study. Methods: DCG and DSG images were obtained, anonymized, randomized and interpreted by three independent oculoplastic surgeons. Standard grading criteria were set for both DCG and DSG images. Data from all observers were analysed for interobserver agreement using Kappa (κ) statistics, generated using a variation of Cohen's kappa for multiple observers. Main Outcome Measures: Level of interobserver agreement (κ values) in the grading of DCG and DSG findings. Results: There was an overall moderate interobserver agreement for DCG findings (κ = 0.55), with the highest agreement on interpreting canalicular obstruction (κ = 0.80), followed by proximal nasolacrimal duct obstruction (κ = 0.67) and normal patency (κ = 0.63). There was an overall fair interobserver agreement for DSG findings (κ = 0.36), with the best being moderate agreement (κ = 0.42‐0.50) for interpreting pre‐sac delay and post‐sac proximal delay. Conclusions and Relevance: DCG offers good reliability in interpreting patent and obstructed systems. On the other hand, DSG has poor agreement and highlights some of the limitations in the ability to guide epiphora management. [ABSTRACT FROM AUTHOR]

There has been uncertainty about the demographics and anatomical distribution of cutaneous sebaceous carcinoma. This study aims to investigate these uncertainties by analysing data from various countries. Data were obtained from cancer registries of the United States, England, Norway and Taiwan, and incidence rates were calculated with uniform age‐adjustment. sebaceous carcinoma was more commonly reported in males than females in white populations, whereas the inverse was true in Taiwan. Ocular sebaceous carcinoma was more commonly reported in females than males in all populations, despite male predominance in white populations. The majority (approx. 70–90%) occurred on head and neck in Asians and whites. Age‐adjusted incidence rate (to the 2000–2025 WHO World Standard Population) ranged from 0.07 to 0.18 per 100 000 person‐years and was not higher in Taiwanese than in white populations. [ABSTRACT FROM AUTHOR]

Platinum chains are used in the treatment of upper lid lagophthalmos in facial nerve palsy. She subsequently had a left upper lid platinum chain inserted for upper lid lagophthalmos 11 years ago. [Extracted from the article]

Vismodegib, a hedgehog pathway inhibitor, is an emerging therapeutic agent that has demonstrated positive results in the management of basal cell carcinoma (BCC) not amenable to surgical excision.[1] Various side effects have been reported with the use of vismodegib, with all patients developing at least one treatment-related side effect; most commonly, muscle spasms, dysgeusia, alopecia and weight loss.[1] Although listed as a potential side effect, adverse cutaneous rashes have been uncommonly reported with the use of vismodegib. Biopsy from an area of the maculopapular eruption demonstrated focal suprabasal acantholysis and dermal lymphoplasmacytic inflammatory infiltrate consistent with acantholytic dyskeratosis, suggestive of a drug eruption similar to Grover's disease (Figure). In our cases, both patients developed a pruritic rash while receiving vismodegib therapy, responsive to treatment with topical emollients and steroids. [Extracted from the article]

Epiphora is a common presenting symptom of nasolacrimal obstruction. We performed dacryoendoscopic-assisted nasolacrimal duct intubation on patients with epiphora from a variety of nasolacrimal disorders at the Royal Adelaide Hospital, between November 2015 and June 2018. Six months following stent removal, improvement in epiphora was reported in 13 of 23 (56.5%) patients, with no improvement in 10 of 23 (43.5%) patients (two patients were lost to follow-up). [Extracted from the article]

Abstract: Background: Pediatric cataract is an important cause of blindness and visual impairment in children. A large proportion of pediatric cataracts are inherited, and many genes have been described for this heterogeneous Mendelian disease. Surveys of schools for the blind in Bhutan, Cambodia, and Sri Lanka have identified many children with this condition and we aimed to identify the genetic causes of inherited cataract in these populations. Methods: We screened, in parallel, 51 causative genes for inherited cataracts in 33 probands by Ampliseq enrichment and sequencing on an Ion Torrent PGM. Rare novel protein coding variants were assessed for segregation in family members, where possible, by Sanger sequencing. Results: We identified 24 rare (frequency <1% in public databases) or novel protein coding variants in 12 probands and confirmed segregation of variants with disease in the extended family where possible. Of these, six are predicted to be the cause of disease in the patient, with four other variants also highly likely to be pathogenic. Conclusion: This study found that 20%–30% of patients in these countries have a mutation in a known cataract causing gene, which is considerably lower than the 60%–70% reported in Caucasian cohorts. This suggests that additional cataract genes remain to be discovered in this cohort of Asian pediatric cataract patients. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 49-year-old woman with orbital cellulitis following the use of facial soft-tissue fillers who was taken to the hospital because of cheek inflammation. Observing erythematous area in her left cheek after a subcutaneous triamcinolone injection. Extracting staphylococcus aureus, proteus mirabilis and enterococcus faecalis from conjunctival swabs of patient.

We report two cases of orbital emphysema following endoscopic sinus surgery. Computed Tomography (CT) confirmed orbital emphysema (Figure), with a clinical examination at the time demonstrating no visual disturbance and normal IOP. [Extracted from the article]

The article presents a case study of a 61-year-old man presented with right-sided epiphora, a lower lid mass and binocular vertical diplopia and that Magnetic resonance imaging (MRI)showed a homogenous right-sided inferior orbital mass. It notes that Clinicians should consider sarcoidosis when presented with a cutaneous lesion in association with a cutaneous scar, either as a primary presentation or disease recurrence.

The article presents a case study of a 25-year-old indigenous female presented to a rural hospital with drowsiness, confusion, fever and left eyelid swelling with purulent discharge. It notes the radiological difficulties in diagnosis of an IOWFB and also the surgical challenges posed by such an injury and that IOWFBs can be successfully diagnosed and surgically removed.

The article discusses the blink assessment of a person with partial left facial nerve palsy with a digital point and shoot camera and that blink rate can be qualitatively and quantitatively assessed using the slow-motion function of affordable point-and-shoot digital cameras.

Perineural invasion ( PNI) occurring in non-melanoma skin cancers ( NMSC) is associated with an increased risk of locoregional recurrence and reduced disease-free survival. This necessitates early and accurate diagnosis, appropriate risk-stratification and a clear management strategy. The diagnosis of PNI is based on careful clinical assessment, imaging and histopathology. Surgery, preferably with margin control, and definitive or adjuvant radiotherapy ( ART) are established treatment strategies for PNI. Clinical uncertainty remains over the role of ART in incidental PNI. This review synthesises current literature to ascertain which clinicopathological features impart a higher risk to individuals with PNI in NMSC, in order to provide treatment algorithms, including the identification of patient subsets that are most likely to benefit from ART. This includes those with extratumoural PNI, involvement of larger-calibre nerves, tumour invasion beyond dermis, recurrent tumour or diffuse intratumoural spread. Patients with clinical PNI may be optimally managed by a multidisciplinary head and neck cancer service that is best placed to offer skull base surgery and intensity-modulated radiation therapy ( IMRT). The management options presented are stratified by histological subtype and a new classification of PNI into low-risk, medium-risk and high-risk groups. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 46-year-old man with an orbital apocrine hidrocystoma containing sebaceous gland elements. It is mentioned that the symptoms mimicked dermoid cyst and computed tomography was performed to confirm. The article adds that an anterior orbitotomy, with full excision of the tumor was performed and histopathology examination revealed apocrine hidrocystoma and immunohistochemistry confirmed the diagnosis.

Background: To review the distribution of pathology in lacrimal gland biopsies performed in an Australian cohort. Design: Retrospective review. Participants: Two hundred sixty-eight lacrimal gland biopsies from 263 patients. Methods: Pathology archives in South Australia and Victoria were searched for lacrimal gland biopsies performed between 1 January 1997 and 31 December 2012. Data retrieved included the year of biopsy, the histopathological diagnosis, patient age and gender. Main Outcome Measures: Distribution of pathology affecting the lacrimal gland; patient age and gender. Results: The distribution of lacrimal gland pathology was: inflammations and vasculitides 50.0%, lymphomas 19.8%, lymphoid hyperplasias 12.3%, benign epithelial tumours 7.8% (all pleomorphic adenomas), malignant epithelial tumours 4.1%, dacryops 3.0% and miscellaneous 3.0%. The mean age was 52 years, with lymphoma affecting the oldest patient group (64.6 years) and sarcoidosis the youngest (40.6 years). Of the patients with biopsy-confirmed dacryoadenitis, biopsy revealed a specific diagnosis in 34% of cases. Immunoglobulin G4-related disease was the most common 'specific' dacryoadenitis. Significantly more pleomorphic adenomas were diagnosed in the period 1997-2004 than the period 2005-2012 inclusive, but there were no other significant changes in the distribution of pathology over time. Conclusions: Two thirds of dacryoadenitis was 'nonspecific', two thirds of epithelial tumours were pleomorphic adenomas and approximately two thirds of all lacrimal gland biopsies were accounted for by inflammations and lymphoid hyperplasias. The ratio of inflammations to neoplasias will be significantly influenced by the clinician's threshold for biopsying patients presenting with features of dacryoadenitis. [ABSTRACT FROM AUTHOR]

Background To determine the proportion of different subtypes of periocular BCC in South Australia. Design Retrospective review. Participants One thousand seven hundred thirteen consecutive periocular basal cell carcinoma ( BCC) excision specimens. Methods Histological analysis of consecutive periocular BCC specimens. Main Outcome Measures Date of resection, patient age at resection, gender, tumour location, histological subtype and perineural invasion. Results From 2006 to 2012, a total of 1713 consecutive periocular BCC excision specimens were analysed. The mean age at resection was 68.8 years (median: 71, range: 21-101). Most specimens (56.4%) were removed from male patients. 52.7% involved the lower eyelid, 29.0% the medial canthus, 10.9% the lateral canthus and 7.5% the upper eyelid. The main histological subtypes identified were nodular (65.7%), infiltrative (17.5%), superficial (12.6%) and micronodular (4.2%). Of the specimens, 25.6% had more than one subtype. The most common subtype combinations were nodular with infiltrative (49.7%), and nodular with superficial (26.0%). Conclusions The majority of periocular BCC were located on the lower lid and classified histologically as nodular. Infiltrative BCC occurred more frequently than the superficial subtype. As the proportion of mixed BCC containing aggressive subtypes is high, surgical excision with margin control should be considered for periocular BCC. [ABSTRACT FROM AUTHOR]

Background Orbital compartment syndrome ( OCS) is an ophthalmic emergency that requires urgent surgical decompression to preserve vision. Objective To describe the clinical presentation, management and outcomes for patients with traumatic OCS. Methods Retrospective case series of eight patients with OCS secondary to blunt trauma presenting to the Royal Adelaide Hospital between 2004 and 2013. Results All patients had acute, painful decrease in visual acuity and proptosis. Common examination findings included a relative afferent pupillary defect, periorbital oedema, ophthalmoparesis and chemosis. All patients underwent surgical decompression in the form of a lateral canthotomy or cantholysis. Three patients who were decompressed within 2 h after injury recovered fully. One patient who sustained a macular hole at the time of injury recovered four lines of Snellen acuity after being decompressed within 1 h. Another patient recovered three lines of Snellen acuity after undergoing decompression at 2.5 h post-injury. The remaining patients had minimal visual recovery, with postoperative visual acuities ranging from hand movements to no perception to light. Of these patients, one was decompressed at 2 h, while the remaining underwent decompression at 4 and 6 h post-injury. Conclusions Prompt decompression is essential for visual recovery in OCS, which appears maximal if performed within 2 h of injury. All patients presenting with history and examination findings suggestive of OCS should undergo emergency canthotomy and cantholysis prior to any additional investigations to minimise visual loss. [ABSTRACT FROM AUTHOR]

Background The rate of postoperative haemorrhage has been reported inconsistently in retrospective studies of endoscopic dacryocystorhinostomy but has not been evaluated prospectively with the powered endoscopic technique. The purpose of this study was to assess the rate of postoperative haemorrhage in patients undergoing powered endoscopic dacryocystorhinostomy. Design A prospective, single-surgeon, observational case series. Participants Cases 18 years old or more were included if they presented with radiologically confirmed primary acquired nasolacrimal duct obstruction. Exclusion criteria included evidence of canalicular disease, ectropion or facial palsy, and previous surgery on the lacrimal drainage system. One hundred seventy-four cases fulfilled the criteria for inclusion. The mean age of patients was 62.9 years, 65% were female. Methods Powered endoscopic dacryocystorhinostomy. Main Outcome Measure Postoperative haemorrhage. Significant haemorrhage was defined as that which necessitated packing, cautery, surgical intervention, a blood transfusion or delayed discharge. Results The rates of total and significant postoperative haemorrhage were 1.7% and 0.6%, respectively. Antithrombotic agents were ceased on a case-by-case basis according to physician recommendation. Aspirin was stopped in 4 of 16 patients taking this agent preoperatively, and warfarin was stopped in one of three patients. Conclusion Significant postoperative haemorrhage following endoscopic dacryocystorhinostomy is rare. Further studies are required to assess whether antithrombotic agents significantly increase the risk of bleeding. The decision to cease agents should be made on a case-by-case basis in consultation with a physician. [ABSTRACT FROM AUTHOR]

Background The study aimed to review the presentation and long-term visual outcomes of patients with orbitotemporal neurofibromatosis. Design Retrospective case series. Participants Patients with orbitotemporal neurofibromatosis presenting from 1981 to 2009. Methods Demographic data, examination findings, causes of vision impairment and interventions performed were recorded for each patient from presentation through subsequent follow-up encounters. Visual impairment was defined as an ipsilateral Snellen acuity of <6/12. Main Outcome Measures The proportion of patients with visual impairment or enucleation, the rate of new vision loss during follow up; and causes for vision loss or enucleation. Results Thirty-seven patients (17 female) were included. Median presenting age was 15 years (range 2-45) with an average follow up of 7.4 years (range 0.5-20.3). Visual impairment occurred in 54% of patients at presentation. Causes were amblyopia (13 of 37), optic atrophy (4 of 37), previous enucleation/evisceration (2 of 37), and optic nerve glioma (1 of 37). At presentation, 76% of patients had ptosis, and 51% had strabismus. Thirty-one patients had surgery, with an average of two procedures per patient. At final follow up, 62% had visual impairment. The rate of visual decline was 2% per patient-years. Causes of visual decline were two patients with optic nerve atrophy, one with exposure keratitis and one whose cause was unknown. Five blind patients had enucleation. Conclusions The first series of orbitotemporal neurofibromatosis to focus on visual outcomes was presented. Vision loss is common, with a high prevalence of amblyopia. Close monitoring from an early age is needed to prevent visual impairment. [ABSTRACT FROM AUTHOR]

. IgG4-related orbital disease (IgG4-ROD) is a recently described condition that may account for a significant proportion of idiopathic lymphoplasmacytic or sclerotic orbital lesions. This study is the first meta-analysis of published cases and reveals several differences between IgG4-related disease affecting the orbit and that affecting the pancreas. IgG4-ROD affects a slightly younger group of patients, affects men and women approximately equally, is commonly associated with salivary gland lesions, is associated with a relatively higher serum IgG4 and may confer an increased risk of non-Hodgkin Lymphoma. Its pathogenesis may involve an immune response to antigen exposure in the upper aerodigestive tract. [ABSTRACT FROM AUTHOR]

Background Invasive fungal sinusitis is a rare condition that usually occurs in immunocompromised patients and often presents as an orbital apex syndrome. It is frequently misdiagnosed on presentation and is almost always lethal without early treatment. Design Retrospective case series of 14 consecutive patients with biopsy-proven invasive fungal sinusitis from four tertiary hospitals. Participants Fourteen patients (10 men and 4 women; age range 46-82 years). Methods Retrospective chart review of all patients presenting with invasive fungal sinusitis between 1994 and 2010 at each hospital, with a close analysis of the tempo of the disease to identify any potential window of opportunity for treatment. Main Outcome Measures Demographic data, background medical history (including predisposing factors), symptoms, signs, radiological findings, histopathological findings, treatment approach and subsequent clinical course were recorded and analysed. Results Only one patient was correctly diagnosed at presentation. Only two patients were not diabetic or immunocompromised. The tempo was acute in two patients, subacute in nine patients and chronic in three patients. In the subacute and chronic cases, there was about 1 week of opportunity for treatment, from the time there was a complete orbital apex syndrome, and still a chance for saving the patient, to the time there was central nervous system invasion, which was invariably fatal. Only two patients survived - both had orbital exenteration, as well as antifungal drug treatment. Conclusions Invasive fungal sinusitis can, rarely, occur in healthy individuals and should be suspected as a possible cause of a progressive orbital apex syndrome. [ABSTRACT FROM AUTHOR]

There are over 300 million people living in the world today who are visually impaired and a further 45 million who are blind. The large majority (90%) of these people live in developing countries, and up to 75% of blindness are avoidable. With cataracts being the major cause of blindness and visual impairment, many ophthalmic aid programmes are aimed at alleviating the enormous burden caused by this readily treatable disease. Having said that, caution should be exercised that short surgical visits to remote rural areas that are not coordinated with local national eye care managers should be discouraged because they do little for the development of sustainable eye care programmes. With this in view, it has become imperative to design blindness prevention and ophthalmic support programmes that are workable, comprehensive, economical and sustainable. [ABSTRACT FROM AUTHOR]

A bstract Background: To analyse the microscopic anatomy of the orbicularis oculi muscle in patients with congenital epiblepharon and to determine whether hypertrophy of the orbicularis oculi muscle, which is considered as a possible cause of this eyelid malposition, exists. Methods: Sixty-seven eyelids with congenital epiblepharon of 41 Japanese patients, as well as 30 control eyelids of 24 Japanese patients with other eyelid pathologies (upper eyelid: fourteen blepharoptosis, one trichiasis and two retractions; lower eyelid: five involutional entropions, one trichiasis and seven retractions) were analysed. These controls contained no orbicularis pathology such as cicatrization or orbitopathy. The muscle specimens were obtained from the central part of the pretarsal orbicularis oculi muscle during surgery. The specimens were stained with haematoxylin & eosin. Only specimens with cross-sectional areas that included large muscle fibres were selected. In each section, 10 muscle fibres were measured across their smallest diameter, thereby avoiding inaccurate measurements of muscle kinking occurring during the processing or by any obliquity of the plane of section. Measurements of the muscle fibre diameter were made with a digital measure. Results: There were no significant differences in the average diameter of the muscle fibres between the patients with congenital epiblepharon and the control group. Conclusions: There was no evidence of orbicularis oculi muscle hypertrophy in congenital epiblepharon. [ABSTRACT FROM AUTHOR]

A bstract Background: Periorbital inflammation following regional anaesthesia is commonly attributed to hyaluronidase allergy. This case series suggests an alternative explanation in some patients. Design: Retrospective case series. Participants: Seven patients presenting with postoperative non-infectious periorbital inflammation following peribulbar or sub-tenons anaesthesia, presenting at four different institutions, are described. Methods: Data on patient demographics, operative data, clinical presentation, treatment and allergy testing were collected among the four institutions. Main Outcome Measures: Response to treatment and allergy testing were noted among the patients included in this study. Results: Seven patients (five female) underwent uneventful phacoemulsification under a peribulbar or sub-tenon's block, all including hyaluronidase with concentrations ranging 50-250 IU/mL. The onset of inflammatory symptoms and signs varied from 12 h to 3 days after the surgery. The most common form of presentation was lid swelling and chemosis. Patients were treated with oral corticosteroids, with good clinical response. Four patients underwent skin prick and intradermal testing to the local anaesthetic used, and to the suspect and a control hyaluronidase batch. The results were all negative, excluding allergy as the aetiology of this toxic periorbital syndrome, in at least these four patients. Conclusion: Hyaluronidase toxicity, potentially related to concentration of hyaluronidase, may be a cause of postoperative periorbital inflammation after cataract surgery, rather than hypersensitivity. [ABSTRACT FROM AUTHOR]

A bstract Background: A prospective observational study in a university hospital setting to study the immunohistochemical (IHC) characteristics of non-neoplastic human lacrimal sac epithelium. Methods: Twenty paraffin-embedded specimens of human lacrimal sac were studied using monospecific monoclonal antibodies to 34 beta E12, cell adhesion molecule (CAM 5.2), epithelial membrane antigen (EMA), cytokeratins (CK) 7 and 20, estrogen receptor and progesterone receptor. The distribution and histologic location of IHC staining were examined qualitatively, and the IHC stains scored as positive (+) or negative (−). Results: The haematoxylin-eosin stains were reviewed for tissue morphology. All 20 specimens were positive for 34 beta E12, CAM 5.2, EMA and CK 7 and negative for CK 20, estrogen receptor and progesterone receptor. Conclusion: To our knowledge, this is the first study to characterize the IHC properties of human lacrimal sac epithelium. This epithelium appears to possess consistent IHC properties as it stains for 34 beta E12, CAM 5.2, EMA and CK 7 and this information would be potentially useful in differentiating tumours arising in the region of the lacrimal sac. [ABSTRACT FROM AUTHOR]

A bstract The term 'functional block' is used to encompass the concept of lacrimal drainage dysfunction in the presence of anatomical patency. There is significant variability in the nomenclature, clinical and investigative criteria used in the literature to define this entity. This has led to confusion and lack of comparability of studies looking at this group. The clinical features, investigative findings and treatment options in this group of patients are described. In addition, the need to differentiate between nasolacrimal stenosis and 'functional block' is emphasized, as evidence suggest patients with nasolacrimal duct stenosis have better outcomes with dacryocystorhinostomy. To better define the disease entity and enable comparability of future studies, it was proposed that this entity be replaced by the term functional epiphora with no delay, pre- or post-sac delay. [ABSTRACT FROM AUTHOR]

A bstract Background: The microscopic and macroscopic anatomy of the anterior and posterior Tenons capsule is described. Methods: An observational anatomic study of twelve orbits of 6 cadavers (mean age 79.5 years) were examined microscopically and 8 orbits of 4 cadavers (mean age 76.8 years) were examined macroscopically. After orbital exenteration, an X-shaped incision was made in the specimens to include the posterior part of the globe. The sections were divided into four parts: superomedial; inferomedial; superolateral; and inferolateral. In the macroscopically examined specimens, the eyelids and globes were removed from the exenterated tissues and the appearance of Tenons capsule was studied. Results: In the microscopic study, Tenons capsule covered the sclera beneath the conjunctiva and contained smooth muscle fibres in the anterior area. This anterior fascia, which had a thick appearance, reached the globe equator. From there, the capsule of the orbital fat, which contained no smooth muscle fibres, enveloped the sclera and reached the optic nerve. This was defined as the posterior capsule. In the macroscopic specimens, Tenons capsule had a thick and fibrous white appearance in the anterior area. More posteriorly, the capsule was thinner and more translucent. This thin capsular part was generally larger in the lateral area than in the medial area. Conclusions: Tenons capsule is composed of an anterior thick fibrous tissue comprising the orbital smooth muscle network and the posterior thin fibrous capsule of the orbital fat. [ABSTRACT FROM AUTHOR]

A bstract Background: To estimate the proportion of cataract surgery performed at various visual acuity and lens opacity thresholds that would coincidentally treat early angle-closure disease, and to estimate the effect of this surgery on the incidence of primary angle-closure glaucoma. Design: Cross-sectional, population-based survey in Meiktila, Myanmar. Participants: Total of 2076 inhabitants, 40 years of age and over were included. Methods: Eyes with cataract-induced visual impairment, and primary angle-closure disease were identified. Analyses were stratified by various pinhole-corrected visual acuity and Lens Opacity Classification System III scores thresholds. Main Outcome Measures: The dual role of cataract surgery in primary cataract treatment and primary angle-closure glaucoma prevention was estimated. Results: Of 4153 eyes available for analysis, 261 eyes were either primary angle-closure suspect or primary angle closure; 975 eyes had a visual acuity of <6/18 and Lens Opacity Classification System III score ≥3 on the nuclear or cortical scales. Of these, 86 eyes had either primary angle-closure suspect or primary angle closure. If cataract surgery were performed on all 975 eyes, this would potentially prevent up to 86 cases of primary angle-closure glaucoma in this population; 8.82% (95% confidence interval 7.12-10.78%) of the cataract surgery would address the cataract and prevent primary angle-closure glaucoma. This would achieve a 38.46% (95% confidence interval 20.23-59.43%) relative reduction in the incidence of primary angle-closure glaucoma in the adult population. Conclusion: In populations with a high prevalence of both visually significant cataract and angle-closure disease, quality cataract extraction can serve a dual role of visual restoration and reducing the incidence of angle-closure disease in the population: killing two birds with one stone. [ABSTRACT FROM AUTHOR]

A bstract Background: To analyse the anatomy of the medial canthal tendon in Caucasians and to clarify the true anatomical nature of its posterior limb. Methods: This was an experimental anatomic study. Seven Caucasian cadavers (11 eyelids; age range: 78-101 years at death). Anatomical dissection and histological examination of cadaveric eyelids fixed in 10% buffered formalin was performed. The axial sections were made in parallel with the eyelid margin at 1 mm superior or inferior to the upper or lower eyelid margins, respectively. The histological specimens were first dehydrated and embedded in paraffin and then divided into 7 µm thickness sections and stained with Masson's trichrome. Microscopic photographs were taken with a digital camera system attached to the microscope. Results: The posterior limb of the medial canthal tendon was not detected in any of the specimens. The medial check ligament supported the posterior aspect of Horner's muscle and inserted into the medial orbital wall through the periosteum. The lacrimal diaphragm around the posterior lacrimal crest ran almost parallel to Horner's muscle and was usually difficult to distinguish from the tendon of Horner's muscle. Conclusions: The posterior limb of the medial canthal tendon was not detected in any of the studied specimens. This anatomical structure appears to be Horner's muscle, and the lacrimal diaphragm. [ABSTRACT FROM AUTHOR]

A bstract Purpose: There is a paucity of published data on the management of upper eyelid cicatricial entropion. We report on our results using such techniques as lamella repositioning, recession or augmentation and terminal tarsal rotation. Design: Observational retrospective case series. Participants: Consecutive cases of upper eyelid cicatricial entropion of two specialist oculoplastic centres (Corneoplastic Unit, East Grinstead, UK and South Australian Institute of Ophthalmology, Adelaide, Australia) were reviewed over a 7-year period. Methods: All patients underwent anterior lamellar repositioning or terminal tarsal rotation. Main Outcome Measures: Success was defined by two definitions: anatomical success was defined where the lid margin was restored to its normal position. Complete success was defined where there were no eyelashes touching the globe. Gain or loss (≤ or ≥2 Snellen lines) in best corrected visual acuity using a Snellen chart and resolution of any corneal epitheliopathy at final follow-up were also recorded (as graded by experienced oculoplastic consultants). Results: Fifty-two procedures were performed on 41 patients (11 bilateral). All patients underwent either an anterior lamellar repositioning or a terminal tarsal rotation. Trachoma, previous upper lid surgery, Stevens-Johnson syndrome and meibomian gland dysfunction were the commonest underlying diagnoses. Ninety-eight per cent of the group had a normal anatomical lid position at follow-up. Nine eyelids (17%) of the group had recurrence of trichiasis. Conclusion: This large case series demonstrates that upper eyelid cicatricial entropion is managed effectively utilizing procedures that involve recession and reposition. We recommend that excision of tissue is avoided, especially in pathology that has a progressive immunological cicatricial drive. [ABSTRACT FROM AUTHOR]

To examine the concentrations of elastic fibres in Whitnall ligament and the intermuscular transverse ligament (ITL), and to examine the anatomic relationships between Whitnall ligament and its surrounding structures. Observational anatomic study. Full thickness sagittal sections of 12 upper eyelids (6 right and 6 left), fixed in 10 % buffered formalin, were studied in 10 Asian cadavers (mean age at death: 77.1 years, range: 62-92 years). We analysed the concentrations of elastic fibres in Whitnall ligament and the ITL, as well as examined the relationship between Whitnall ligament and the connective tissue septa, the ITL and the levator palpebrae superioris (LPS) muscle. Concentrations of elastic fibres in Whitnall ligament and the ITL, relationship between Whitnall ligament and its surrounding structures. The concentration of elastic fibres in Whitnall ligament was low compared to the ITL. In most specimens, both Whitnall ligament and the ITL were loosely attached to the LPS muscle through areas of adipose tissue or cavities. Although in all specimens, connective tissue septa were demonstrated next to Whitnall ligament, they were more often directed parallel to the ligament rather than radially to it. Both Whitnall ligament, with its low concentration of elastic fibres, and the ITL, with its high content of elastic fibres, show loose attachments to the LPS muscle through areas of adipose tissue or cavities. Whitnall ligament may work as the check ligament of the LPS muscle as well as part of the pulley system with the ITL. [ABSTRACT FROM AUTHOR]

An 80-year-old man presented with an 8-week history of painless swelling in the right lacrimal gland region with infero-medial dystopia of the globe. The lesion was excised and histology confirmed an orbital plasmacytoma. Multiple myeloma screening was negative and a solitary extramedullary plasmacytoma arising from the lacrimal gland was diagnosed. The patient was subsequently treated with radiotherapy. [ABSTRACT FROM AUTHOR]

Our review aims to provide an update of management protocols for congenital nasolacrimal duct obstruction (CNDO). Although early probing performed before the age of 1 year was traditionally recommended, many reports have since confirmed high frequencies of spontaneous resolution during the first year of life. Accordingly, a ‘wait-and-see’ approach, combined with conservative therapies, is judged to be the best option in infants aged < 1 year. By contrast, persistent obstruction beyond 1 year of age warrants probing as a first-line interventional therapy. However, the optimal timing for probing remains controversial. Although there remains a high possibility of spontaneous resolution after the first year of age, this must be balanced against the decrease in success rates for probing that accompanies advancing age. If conservative management fails, persistent CNDO beyond 1 year of age should be managed either by further observation or by primary probing according to the severity of symptoms. In patients in whom probing fails, advanced treatment such as balloon catheter dilation, silicone tube intubation or dacryocystorhinostomy may be considered. [ABSTRACT FROM AUTHOR]

The article presents case studies of a 58-year-old man with painless, enlarging, palpable lesion deep to his medial lower lid and a large lesion was identified instantly post-septally. And a 33-year-old woman with progressive left ptosis and vertical diplopia in upgaze, the magnetic resonance imaging scan demonstrated a left supero-anterior orbital cystic lesion.

A letter to the editor is presented regarding the case of a 32-year-old woman with dacryoadenitis associated with adenoviral keratoconjunctivitis.

Purpose: To determine the cataract surgical coverage and investigate the barriers to cataract surgery in the Kandy District of central Sri Lanka. Methods: A population-based, cross-sectional ophthalmic survey of the inhabitants of rural villages in central Sri Lanka was conducted; there were 1721 eligible subjects and 1375 participated (79.9% participation rate). The recorded data included age, gender, education, district, corrected visual acuity, dilated slit-lamp examination and stereoscopic fundus examination. Lens opacity was graded using the Lens Opacities Classification System III. Participants with cataract-induced visual impairment (acuity <6/18 in the better eye) were also invited to respond to a verbal questionnaire about barriers to cataract surgery. Results: Cataract surgical coverage per individual for visual acuity cut-offs of <6/18, <6/60 and <3/60 was 41.9%, 76.8% and 82.7%, respectively; and per eye was 34.0%, 60.3% and 65.2%, respectively. Cataract surgical coverage was higher for men than women, and two-thirds refused referral for surgery, for the following reasons: no desire to improve vision, fear of surgery and lack of awareness were the most frequently reported barriers. Cataract surgical coverage in central Sri Lanka is higher than that in neighbouring developing regions. Surgical uptake may be improved through better community education. [ABSTRACT FROM AUTHOR]

The role of intubation in routine dacryocystorhinostomy (DCR) surgery is unclear, with there being little evidence in favour of this practice, which appears to have largely come about as a result of history, anecdote and the evolution of DCR surgery. In this paper, a brief history of intubation in DCR surgery is presented and the evidence base is analysed. [ABSTRACT FROM AUTHOR]

Background: To determine normal exophthalmometric values for a Sri Lankan population and investigate their demographic, physical, refractive and ocular biometric correlates. Methods: The Kandy Eye study was a population-based, cross-sectional study. By randomized cluster sampling, 1721 eligible participants, who were 40 years old and over were identified; 1375 participated. Exophthalmometry was performed with Hertel's exophthalmometer. Participants' demographics including age, gender and ethnicity were recorded. Height, weight, body mass index, non-cycloplegic refraction and ocular biometry were measured with standardized methods. Summary statistical analysis was performed for exophthalmometric values and relationships with other factors were tested using Pearson product–moment correlation coefficient analysis, standard single and multiple linear regression analysis. Results: A total of 1341 subjects were included in the analysis. Exophthalmometric values for the population had a mean of 15.82 mm, standard deviation of 2.73 mm and range of 10.46–21.28 mm. Exophthalmometric values for men were significantly higher than women. There were no significant differences between the racial groups' exophthalmometric values (Sinhalese, Tamils, Moors). Exophthalmometric values were significantly correlated with age, gender, height, weight, body mass index, base and axial length but not to refractive spherical equivalents. Only gender, weight, base and axial length were independent predictors for exophthalmometric values after adjusting for confounders. Conclusion: In this Sri Lankan population, our study provided the first reported estimates of a normal exophthalmometric range and determined gender, weight, base and axial length as its correlates. Sri Lankans are the first population to demonstrate this relationship between weight and exophthalmometric values and also showed that refraction is not a cause for pseudo-proptosis. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to determine the cataract surgical coverage and investigate the barriers to cataract surgery as reported by those with cataract-induced visual impairment in rural Myanmar. Methods: A cross-sectional, population-based survey of inhabitants 40 years of age and over from villages in the Meiktila District (central Myanmar); 2481 eligible participants were identified and 2076 participated. Data recording included corrected visual acuity, dilated slit lamp examination and stereoscopic fundus examination. Lens opacity was graded using the Lens Opacities Classification System III. Participants with cataract-induced visual impairment (acuity < 6/18 in better eye) were also invited to respond to a verbal questionnaire about barriers to cataract surgery. Results: Cataract surgical coverage for visual acuity cut-offs of <6/18, <6/60 and <3/60 was 9.74%, 20.11% and 22.3%, respectively, for people and 4.18%, 9.39% and 13.47%, respectively, for eyes. Cataract surgical coverage was higher for men than women, but gender was not associated with refusal of services. Of the 239 who responded to the extra questionnaire, 216 were blind or had low vision owing to cataract. Three quarters refused referral for surgery: cost and fear of surgery were the most frequently reported barriers. Conclusion: Cost plays a large role in the burden of cataract in this region. Implementation of educational programmes, reforms to local health service and subsidization of ophthalmic care may improve the uptake of cataract surgery. [ABSTRACT FROM AUTHOR]

Enophthalmos can be defined as a relative, posterior displacement of a normal-sized globe in relation to the bony orbital margin. Non-traumatic enophthalmos has a wide variety of clinical presentations and may be the first manifestation of a number of local or systemic conditions. It may present with cosmetic problems such as deep superior sulcus, pseudoptosis or eyelid retraction; or functional problems such as diplopia or exposure keratopathy. There are three main pathogenic mechanisms: structural alterations in the bony orbit; orbital fat atrophy; and retraction. Evaluation of enophthalmos patients includes orbital imaging and a thorough ophthalmic and systemic examination. In this review, we discuss the presenting features of non-traumatic enophthalmos and include a brief description of the more important causes. An approach to the clinical evaluation of these patients is also discussed together with a brief overview of the principles of management. [ABSTRACT FROM AUTHOR]

Background: Diabetes is an increasing problem in Myanmar with more than three million people affected. There are no data on awareness of diabetic retinopathy among the general practitioners (GPs) or diabetic population of Myanmar. This study aims to evaluate the awareness of diabetes-related eye disease among GPs and diabetic patients in Yangon, Myanmar. Design: A cross-sectional survey. Methods: From the Myanmar Medical Association Registry of 978 practicing GPs in Yangon, 200 were randomly selected and a structured questionnaire was sent to each. Each GP was asked to give a separate questionnaire to the first five diabetic patients who attended their practice. Results: One hundred GPs and 480 patients returned the questionnaires. Although 99% of GPs were aware that diabetes could result in loss of vision, 49% never examined the fundi of their diabetic patients. Of the diabetic patients, 86% were aware that diabetes could damage their eyesight. Although 92% realized they should visit an ophthalmologist regularly, only 57% had seen an ophthalmologist. Patients who never attended school were less likely to visit an ophthalmologist than those with tertiary education (odds ratio 0.24; 95% confidence interval 0.09, 0.66). Patients with diabetes for less than 2 years were less likely to visit an ophthalmologist than those with diabetes for more than 10 years (odds ratio 0.21; 95% confidence interval 0.9, 0.44). There was no association between age, gender or work status and the likelihood of having seen an ophthalmologist. Conclusion: Although both GPs and diabetic patients are aware of the need for regular fundal screening, just over half the patients had been screened. There exists a need for programmes in Myanmar to induce a behavioural change in diabetic patients with regards to screening examinations. [ABSTRACT FROM AUTHOR]

Purpose: To study the association between adult stature and ocular biometric parameters and refraction. Methods: In a population-based cross-sectional ophthalmic survey of 2418 adults (≥40 years old) living in the rural villages in central Myanmar, height and weight were measured using a standardized protocol, and body mass index was calculated. Non-cycloplegic refraction and corneal curvature were determined by an autorefractor. Ultrasound pachymetry was performed and ocular biometry, including axial length, anterior chamber depth, lens thickness and vitreous chamber length were measured using A-mode ocular ultrasonography. Results: Height and weight were significantly correlated with age, gender and all the ocular biometric parameters, except lens thickness. After adjusting for age and gender, taller and heavier persons had eyes with longer axial length, deeper anterior and vitreous chambers, and flatter and thicker corneas than shorter persons. Height was not significantly correlated with refraction, and heavier persons tended to be less myopic ( P < 0.001). Multivariate linear regression models revealed consistent results with the findings for association between height, weight and ocular biometry and refractive error. Conclusions: Adult stature is independently associated with vitreous chamber length and corneal radius in this Burmese population. Heavier persons were slightly hyperopic. [ABSTRACT FROM AUTHOR]

Purpose: To determine the central corneal thickness (CCT) and its demographic associations among Aboriginal people attending eye clinics in remote South Australia. Methods: A clinic-based cross-sectional study was conducted involving opportunistic sampling of patients. Eligible participants underwent measurement of CCT by ultrasound pachymetry. The results were compared with a group of Caucasian control patients. Results: All patients (189) who were invited to participate in the study had their CCT measured. The mean age was 44.8 ± 14.5 years, and women comprised 57.7% of the sample. The control group consisted of 115 Caucasian participants. The mean age was 47.1 ± 14.8 years, and women accounted for 55.7% of the sample. Mean CCT for Aboriginal participants was 514.9 ± 30.5 μm in the right eye and 515.6 ± 30.5 μm in the left eye ( t = 1.1, P = 0.3). Mean right CCT for Caucasian participants was 544.6 ± 31.9 μm and mean left CCT in this group was 547.1 ± 32.2 μm ( t = 4.6, P < 0.001). There was a significant difference between the right ( t = 8.4, P < 0.001) and left ( t = 8.8, P < 0.001) CCT of Aboriginal and Caucasian participants. Conclusions: The CCT among Aboriginal patients attending eye clinic in remote South Australia was significantly thinner than that of a Caucasian control group. Thinner corneas among this group of Aboriginal patients may indicate a need to adjust intraocular pressure according to CCT and to be more vigilant for glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To report the risk factors associated with primary open-angle glaucoma (POAG) in the Burmese population. Methods: The Meiktila Eye study, a population-based cross-sectional study, included inhabitants 40 years of age and over from villages in the Meiktila District. Of 2481 eligible participants identified, 2076 participated in the study and sufficient examination data to diagnose glaucoma in at least one eye was obtained in 1997 participants. The ophthalmic examination included slit-lamp examination, tonometry, gonioscopy and dilated stereoscopic fundus examination. Definitions adhered to the International Society for Geographic and Epidemiological Ophthalmology's recommendations. Univariate and multivariate analyses of potential risk factors were performed. Results: The overall prevalence of POAG was 2.0% (95% CI 0.9–3.1). In the univariate analysis, increasing age ( P = 0.024), spherical equivalent ( P = 0.01), axial length ( P = 0.023) and intraocular pressure (IOP; P < 0.001) were significantly associated with POAG. And in the multivariate analysis, myopia <0.5 D ( P = 0.049), increasing age and IOP ( P < 0.001) were significant risk factors for POAG. Conclusion: POAG in this Burmese population was associated with increasing age, axial myopia and IOP. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence of distance refractive error among Aboriginal people attending eye clinics in remote South Australia. Methods: A clinic-based cross-sectional study was conducted that involved opportunistic sampling of Aboriginal people attending eye clinics in remote South Australia. There were 189 individuals who were invited to participate in the study all of whom underwent ophthalmic examination. This examination included measurement of pinhole-corrected visual acuity and non-cycloplegic autorefraction. Results: Automated refractive error examinations were performed on 148 people within this sample. The mean age was 44.8 ± 14.5 years and women comprised 57.7% of the sample. The overall mean refractive error was −0.01 ± 1.8 D (SD). The prevalence of myopia (spherical equivalent (SE) < −0.5 D), high myopia (SE less than or equal to −6.0 D), hypermetropia (SE > 0.5 D), astigmatism (cylinder at least −0.5 D) and anisometropia (difference in SE of >0.5 D) was 31.1%, 0.7%, 33.1%, 55.8% and 45.9%, respectively. Further analyses revealed significant age-related trends with both myopia and hypermetropia. There were no gender associations with any form of refractive error. Of those people with clinically significant refractive error, 51/148 (34%), only four people owned distance spectacles. Conclusions: There continues to be a level of uncorrected distance refractive error within these patients. This represents a need to screen for refractive error among Aboriginal people in remote locations and to provide them with appropriate spectacle correction. [ABSTRACT FROM AUTHOR]