Intracranial arachnoid cyst; an unusual cause of epiphora.

PURPOSE: To describe a case of unilateral intracranial arachnoid cyst in association with enophthalmos and epiphora on the same side. METHODS: Case report. RESULTS: A young man with symptoms of unilateral epiphora is described. He had a large intracranial arachnoid cyst with an unusually large orbit leading to enophthalmos and symptomatic epiphora on that side. Radiological features of the orbit and associated pneumosinus dilatants are described. We also offer hypotheses to describe the paradoxical occurrence of an expanding intracranial mass and inward growth of the orbit and paranasal sinuses. CONCLUSION: A new cause for enophthalmos is described.

Temporary Gortex (polytetrafluoroethylene) spacer for the treatment of fornix shortening following severe alkali chemical injury.

BACKGROUND: Gortex is an inert, smooth, flexible material, which is well tolerated in situ. We describe a case of fornix shortening secondary to alkali injury, which was treated successfully with a temporary Gortex patch. METHOD: Retrospective case report. RESULTS: A patient with Grade IV chemical injury developed significant symblepharon formation 47 days after the initial injury. Following an initial failed mucous membrane graft the patient had a Gortex patch sutured into the upper lid fornix which acted as a spacer to allow epithelisation of the bulbar conjunctiva. The Gortex patch was removed after 25 days, and at 6 months' follow-up, there was no recurrence of symblepharon formation. CONCLUSION: Industry-related severe ocular chemical injury is a rare occurrence. It can lead to symblepharon formation and destruction of the conjunctival fornix. In this case a Gortex spacer was successfully used to prevent symblepharon formation and reform the upper eyelid fornix after severe chemical injury.

The role of intravenous methylprednisolone immunosuppression in the management of active thyroid eye disease.

PURPOSE: To analyze the efficacy of intravenous methylprednisolone (IVMP) immunosuppression in the management of active thyroid eye disease (TED). METHODS: This is a consecutive case series of 36 patients treated with 1 g of IVMP over 3 days, between January 2000 and January 2008. The indications for this treatment were moderate to severe active TED with or without optic nerve compression. RESULTS: There were 32 hyperthyroid, 2 hypothyroid, and 2 euthyroid patients in this series. Nine patients presented with optic nerve compromise, 3 had severe active TED and 24 had moderately active TED. Twenty-seven patients received one course of IVMP and nine patients received two courses. All patients had tapering oral prednisolone over 1 month following the IVMP. The mean improvement in proptosis was 1.31 mm (range = 0-3 mm). Optic nerve function improved in seven of nine patients (77.8%). Extra ocular muscle movement improved in 18 patients (50%). Overall benefit from IVMP was seen at 1/12 in 27 patients (75%) and at 3/12 in 30 patients (83%). After IVMP one patient underwent radiotherapy and three patients had nonsteroidal immunosuppression. CONCLUSIONS: IVMP immunosuppression is effective in 83% of patients. The effect lasts from 3 months to 8 years, with a mean of 15 months in 30.5%. It remains a useful modality of treatment especially when the optic nerve or cornea is threatened because of moderate to severe active TED. We encountered no severe side effects of pulsed IVMP and 3 g over 3 days is a safe dose.

Views of glaucoma patients on aspects of their treatment: an assessment of patient preference by conjoint analysis.

PURPOSE: To determine by conjoint analysis which factors in the management and treatment of glaucoma were of most importance to patients and to relate these factors to the patient's clinical glaucoma condition. METHODS: An interview-based study was performed. Demographic and visual function data are recorded. Participants completed the Visual Function Questionnaire-25 and ranked 10 hypothetical patient scenarios that contained different risks of moderate visual loss, postoperative complications, long-term blindness, use of topical medication, and glaucoma surgery. Conjoint analysis was performed to determine the relative importance of these factors for individuals and the group as a whole. RESULTS: Eighty-two patients were interviewed from two consultants' outpatient clinics. Forty-five were male and 37 female. Seventy-nine were white. The most important factors to patients with glaucoma were the risk of moderate visual impairment and the risk of blindness, with an importance of 38% and 27%, respectively. The use of topical medication had an importance of 11%. Proceeding to surgical intervention (trabeculectomy) had an importance of 15%, and the small risk of visual deterioration after surgery (trabeculectomy) had an importance of 9%. CONCLUSIONS: To patients, the most important factors regarding glaucoma and its treatment are the risks of moderate visual loss (the ability to continue to drive) and long-term blindness. The treatment methods used are of much less importance.

Repeatability of ocular blood flow pneumotonometry.

PURPOSE: To establish the repeatability of ocular blood flow (OBF) pneumotonometry and its agreement with Goldmann tonometry. DESIGN: Instrument evaluation study. PARTICIPANTS: Ten female healthcare professionals. METHODS: Intraocular pressure (IOP) was measured by one experienced ophthalmologist in both eyes of 10 healthy female subjects on 10 different occasions at the same time of day. The two methods were performed by alternate allocation, and laterality was chosen by random order. Repeatability coefficients and agreement plots were calculated by using the Bland-Altman method. MAIN OUTCOME MEASURES: Intraocular pressure repeatability coefficients. RESULTS: Mean IOPs were 15.6 mmHg (right) and 15.1 mmHg (left) by OBF pneumotonometry and 12.6 mmHg (right) and 12.4 mmHg (left) by Goldmann tonometry (P < 0.001). The repeatability coefficients were 7.06 (right) and 7.66 (left) for the OBF pneumotonometer and 4.81 (right) and 3.87 (left) for the Goldmann tonometer. With regard to agreement, the OBF pneumotonometer read significantly higher than did the Goldmann tonometer. The mean bias for the right eye was 2.92 (95% limits of agreement, -4.37 to 10.20), and for the left eye it was 2.68 (95% limits of agreement, -3.93 to 9.28). CONCLUSIONS: In our group of healthy females, the repeatability of the OBF pneumotonometer was worse than that of the Goldmann tonometer. This casts doubt on the value of the OBF pneumotonometer as a tool for measuring IOP. The agreement plots indicate that the OBF pneumotonometer may produce significant numbers of false-positive results in screening programs.