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Two patients with chronic Wegener's granulomatosis presented with worsening proptosis and visual acuity. Both patients had been maintained on long-term corticosteroids, which led to masking of the signs of orbital sepsis with potentially life-threatening implications.Eye (2007) 21, 246–248. doi:10.1038/sj.eye.6702211; published online 13 January 2006 [ABSTRACT FROM AUTHOR]

BACKGROUND: Mersilene mesh (polyester fibre) is commonly used in ptosis surgery for frontalis suspension as it is readily available and cheap. Management of extrusion can be challenging. We report three cases of extrusion where extremely thick mesh or extremely thin tissue may have contributed to the extrusion. METHODS: Retrospective case note study of three adult patients who developed chronic mesh extrusion. RESULTS: Extrusion and chronic infection occurred 5-12 months after surgery. Despite systemic antibiotics, all three patients required surgical excision of mesh from the eyelid up to the brow, which was curative. CONCLUSION: These cases illustrate the need for a systematic approach and the need in some cases to excise the mesh to prevent recurrent infection.Eye (2004) 18, 640-642. doi:10.1038/sj.eye.6700681 [ABSTRACT FROM AUTHOR]

We describe a patient presenting with a red eye who was found to have conjunctival non-Hodgkin's lymphoma of the mucosa-associated lymphoid tissue (MALT) type. [ABSTRACT FROM AUTHOR]

Purpose: To design a diagrammatic record of lacrimal disease using easily interpretable symbols., Methods: This diagrammatic record was developed from existing models. A simple outline for the eyelids, lacrimal drainage apparatus and nose is used. The periocular, lid, dye test, syringing and nasal findings are represented by standard symbols., Results: Examples illustrating a range of lacrimal findings, before and after surgery, are shown., Conclusions: A diagrammatic record of lacrimal findings which can be easily understood offers a sound basis for planning and monitoring lacrimal surgery. It is not necessary to memorize each diagram, only the principles on which they are drawn.

An 81-year-old man had a keratotic eyelid lesions for 20 years. He eventually sought treatment by ophthalmic plastic surgery. Clinically, the lesion resembled a keratoacanthoma. Findings from histologic examination of the excision biopsy specimen showed a squamous cell carcinoma. The lesion was completely excised. This case demonstrates the difficulty in making a correct clinical diagnosis of a keratotic eyelid lesion. Performing a histologic examination of nonregressed keratotic lesions is essential to exclude a squamous cell carcinoma.

Rigid nasal endoscopy is a reliable technique that can be used to assist in the preoperative nasal evaluation, operative tube positioning, and management after surgery. Postoperative function can be evaluated by using a passive dye test (FEDT) viewed directly, and minor interventions carried out without the need to remove the tube or do excessive probing. Endonasal endoscopy facilitates the maintenance of tube function with minimal manipulation and patient discomfort, and is fast and efficient. Its use should help improve tube retention and function. A detailed study over a number of years is necessary to provide convincing evidence for improving clinical standards. Lester T Jones wrote: The postoperative care of such a patient (having a glass bypass tube) should be in the hands of a physician who is willing to look into the nose, as inspection of the length and position of glass tube is most important. Endoscopic endonasal assistance helps the ophthalmologist to fulfill his criteria.

Background: 5-Fluorouracil is a pyrimidine analogue that inhibits DNA synthesis and is commonly used in the treatment of carcinomas of the breast, gastrointestinal tract and genitourinary tract. Excessive tearing that resolves on cessation of treatment is commonly described as a side effect of the drug. Permanent stenosis of the punctum and canaliculus is extremely rare, with only 12 cases reported in the world literature. We present three cases of established lacrimal outflow obstruction in patients who were treated with CMF (cyclophosphamide, methotrexate, 5-fluorouracil), a widely used regimen for metastatic breast cancer. Patient 1 had right distal stenosis of her lower canaliculus and was syringed patent during dacryocystography with resolution of epiphora. Patient 2 had proximal blockage of all canaliculi and underwent bilateral canaliculodacryocystorhinostomy with silicone tubes that temporarily relieved symptoms until tube removal. The proximal canalicular blockage recurred due to underlying extensive fibrosis. Patient 3 had right proximal common canalicular stenosis and left distal canalicular blocks but declined surgery., Conclusion: With the rise in the incidence of breast carcinoma it is important that the attention of both ophthalmologists and oncologists should be drawn to the potential ocular toxicity of systemic 5-fluorouracil chemotherapy, which may lead to lacrimal canalicular fibrosis with permanent epiphora. The management of these patients is challenging as there is a continuous spectrum of canalicular involvement from focal to diffuse; therefore early referral is recommended. Moreover as no consensus has been reached as how best to manage this unique small group of patients, we review the literature and discuss the implications for treatment.