Preschool vision screening: a prospective comparative evaluation.

We have reviewed the results of a pilot study of preschool screening by orthoptists for vision defects which was introduced in Newcastle in 1987. We have compared the visual outcomes, at age 7 years, of children who were screened at age 3 years by either orthoptists, health visitors or general practitioners in three matched, geographically defined cohorts. Manifest, large angle strabismus presented at the same age, and in roughly equal numbers in each cohort. Orthoptic screening detected many more cases of amblyopia associated with microtropia and anisometropia, but the b overall amblyopia prevalence at age 7 years was similar in each cohort. This study does not provide evidence to support the nationwide introduction of primary orthoptic preschool vision screening, and highlights the need for a prospective treatment trial of amblyopia associated with microtropia and anisometropia.

Superior oblique tendon expansion in the management of superior oblique dysfunction.

Traditional superior oblique weakening procedures may be unpredictable and lead to superior oblique underaction. The use of 240 retinal band as a spacer to lengthen the superior oblique tendon has been proposed as a more controlled approach than superior oblique tenotomy and related procedures. The use of this technique is reported in a patient with diplopia following an orbital floor blow out fracture, and in a child with Brown's superior oblique tendon sheath syndrome.

The bilobed flap in medial canthal reconstruction.

BACKGROUND: Although several techniques for repair of medial canthal defects have been described, most have shortcomings which prevent satisfactory repair. We describe the use of a bilobed flap which allows for optimal reconstruction in this area. SURGICAL TECHNIQUE: A bilobed flap was used to repair 36 medial canthal defects in 35 patients. The primary lobe is usually slightly smaller than the defect. The secondary lobe is smaller than the primary though of equal length, fashioned so that its axis lies within the relaxed skin tension lines of the face to allow direct closure with minimal tension. All patients achieved a satisfactory cosmetic and functional repair. CONCLUSION: We recommend this technique as an excellent means of repairing all types of medial canthal defect. The technique allows reconstruction to be performed in a single stage with rapid rehabilitation and minimal morbidity.

Angiosarcoma of the eyelid.

BACKGROUND: Angiosarcomas are uncommon malignant tumours of vascular endothelium. They frequently affect the face and scalp, but to our knowledge there are only three reports of eyelid involvement. METHODS/RESULTS: We report a case of angiosarcoma arising from the eyelid skin in a 79-year-old woman. Treatment was surgical with wide excision and staged reconstruction of the defect. Systemic oncological work-up for metastatic disease was negative. Adjuvant systemic chemotherapy and radiotherapy were considered but were not felt to be of proven benefit and were not used. The patient died seven months after presentation from a myocardial infarct. CONCLUSION: Angiosarcoma should be considered in the differential diagnosis of unusual or atypical eyelid lesions. Management is wide surgical excision, although adjuvant systemic therapy should be considered in selected cases in consultation with an oncologist.

Ocular complications of bone marrow transplantation.

Forty-one patients who had undergone bone marrow transplantation were examined. Nineteen (63%) of the 30 who had received fractionated total body irradiation (TBI) had cataracts in comparison with only 1 (9%) of the 11 non-irradiated patients. No significant differences in steroid therapy were demonstrated between these groups of patients. Dry eyes were observed in eight irradiated patients, seven of whom had preceding graft-versus-host disease. Superficial punctate staining of the bulbar conjunctiva was observed in 25 (83%) of the irradiated group and, in milder form, in five (45%) of the non-irradiated group. Our data suggest that the incidence of cataract following fractionated TBI is influenced not only by the total dose of radiation but also by its rate of administration (defined by midline tissue dose rate and fractionation schedule). In addition dry eyes and conjunctival staining may be exacerbated by TBI, though other aspects of conditioning may also be implicated.

Prognostic significance of the pattern visual evoked potential in ocular hypertension.

This paper reports a prospective study on 49 ocular hypertensive patients to evaluate the prognostic significance of transient abnormalities in the pattern visual evoked potential (VEP) in the development of glaucoma. Seven of 24 patients with VEP abnormalities at diagnosis of ocular hypertension developed glaucomatous field defects in the follow-up period as compared with none of 25 patients with normal VEPs at diagnosis. We conclude that appropriately designed pattern VEP testing is a valuable complement to careful (preferably computerised, static) perimetry. In addition, our findings support the contention that, in glaucomatous disease of the optic nerve, rudimentary pattern processing mechanisms--that is 'Y'-type units of the magnocellular pathways--may be affected earlier than luminance processing mechanisms.

The value of plain radiography in suspected intraocular foreign body.

Patients presenting to an eye casualty department with a history of exposure to high velocity particles often undergo radiological investigation to rule out clinically undetected intraocular foreign bodies (IOFB). We reviewed the indications for and the results of X-rays performed in our eye department over a five year period to determine the effectiveness of such screening. Our results suggest that most of the X-rays are performed needlessly and that radiological investigation could be restricted to those patients with clinical evidence of penetrating ocular and orbital trauma and patients with subconjunctival haemorrhage.