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1.  Idiopathic isolated orbicularis weakness 
Eye  2012;26(5):746-748.
Purpose
Orbicularis weakness is commonly associated with seventh nerve palsy or neuromuscular and myopathic conditions such as myotonic dystrophy and myasethenia gravis. We report four cases of idiopathic isolated orbicularis weakness.
Methods
All four cases were female and the presenting symptoms of ocular irritation and epiphora had been present for over 7 years in three patients. All patients had lagophthalmos and three had ectropion. Three patients underwent full investigations which excluded known causes of orbicularis weakness. Two patients underwent oribularis oculi muscle biopsy and histological confirmation of orbicularis atrophy.
Results
All patients underwent surgery to specifically address the orbicularis weakness with satisfactory outcomes and alleviation of symptoms in all cases. Isolated orbicularis weakness may be a relatively common entity that is frequently overlooked.
Conclusion
Early recognition of this condition may lead to better management and prevent patients undergoing unnecessary surgical procedures.
doi:10.1038/eye.2012.5
PMCID: PMC3351068  PMID: 22322997
orbicularis weakness; VII nerve palsy; platinum lid implant
2.  Angle closure in fellow eye with prophylactic pilocarpine treatment 
doi:10.1136/bjo.85.10.1260b
PMCID: PMC1723714  PMID: 11596579
3.  Aspirin and warfarin therapy in oculoplastic surgery 
The British Journal of Ophthalmology  2000;84(12):1426-1427.
BACKGROUND/AIMS—There are no nationally agreed guidelines on preoperative management of patients who are on aspirin or warfarin therapy. There is considerable evidence that complication rates in anticoagulated patients are low whereas there are higher rates of thromboembolic complications in those whose therapy is manipulated. This survey aimed to establish oculoplastic specialist and non-specialist ophthalmic surgeons' current management practice of patients before oculoplastic surgery who are taking aspirin or warfarin and to assess the rate of complications in these patients.
METHOD—An anonymous postal questionnaire survey of all ophthalmic consultants and specialist registrars in the Wessex region along with oculoplastic specialists in the Southern region.
RESULTS—The overall response rate was 92%. Preoperative management was influenced both by type of operation and by type of surgeon. A statistically significant higher proportion of surgeons would consider altering warfarin compared with aspirin treatment. For all procedures, non-specialists are unlikely to stop aspirin therapy, and are less likely to stop warfarin before all procedures apart from dacrocystorhinostomy. A significant proportion of surgeons (18%) would allow insufficient time for the coagulation status of the patient to change after altering treatment. A considerable proportion of surgeons (54%) reported that they had seen complications as a result either of stopping or continuing anticoagulation therapy.
CONCLUSIONS—In this survey, at least half the surgeons questioned would consider stopping warfarin before oculoplastic procedures. Over half of all surgeons have seen complications related to aspirin or warfarin, some of which were serious. A suggested approach to minimising patient risk is given.


doi:10.1136/bjo.84.12.1426
PMCID: PMC1723338  PMID: 11090488
5.  Painful blind eye: efficacy of enucleation and evisceration in resolving ocular pain 
AIMS—To assess the effectiveness of enucleation or evisceration in relieving pain from painful blind eyes.
METHODS—24 patients with intractable ocular pain underwent enucleation or evisceration with or without an orbital implant.
RESULTS—Complete pain relief was achieved in all patients at an average time of 3 months (range 1-15 months). Seven patients required further medical or surgical treatment in addition to removal of the globe.
CONCLUSION—Enucleation and evisceration were effective in relieving ocular pain in all patients with a painful blind eye in our study. However, complications of surgery and orbital implants can cause recurrent pain.


doi:10.1136/bjo.84.4.437
PMCID: PMC1723427  PMID: 10729307
6.  Phenotypic heterogeneity may occur in congenital fibrosis of the extraocular muscles 
BACKGROUND/AIMS—Congenital fibrosis of the extraocular muscles (CFEOM) is an autosomal dominant, non-progressive disorder characterised by congenital ptosis and external ophthalmoplegia. CFEOM has previously been divided into several clinical entities; general fibrosis syndrome, strabismus fixus, vertical retraction syndrome, and congenital fibrosis of the inferior rectus. The purpose of this study was to identify families with CFEOM in this geographical region in order to perform a study of the clinical presentation of this disorder and to estimate its minimum prevalence in the population.
METHODS—Four families were identified with CFEOM in the Wessex region from whom a full history with a pedigree was obtained. All individuals underwent ophthalmological examination.
RESULTS/CONCLUSION—This study shows that several of the CFEOM entities can be present within one family suggesting that these are variants of the same condition. It is suggested that subclassification is, therefore, not appropriate. The minimum prevalence of this disorder was found to be 1/230 000

 Keywords: congenital fibrosis; extraocular muscles; phenotypic heterogeneity
PMCID: PMC1722617  PMID: 9797671
10.  Localised unilateral blepharochalasis. 
Images
PMCID: PMC504978  PMID: 7848988
12.  Superior oblique tendon lengthening for acquired superior oblique overactions. 
Two patients who presented with compensatory head postures and diplopia are described. They both had marked unilateral superior oblique overaction, in one patient due to a large, incomitant skew deviation. Each underwent a superior oblique tendon lengthening procedure using a segment of silicone 240 retinal band as an expander, in combination with a contralateral superior rectus recession. Both achieved an excellent result with an improvement of the compensatory head posture and an increase in the field of binocular single vision. This surgical procedure is proposed as an option in the management of superior oblique overaction, including certain cases of skew deviation.
Images
PMCID: PMC504763  PMID: 8199114
13.  Posterior lens capsule abscess due to Propionibacterium acnes and Staphylococcus epidermidis following extracapsular cataract extraction. 
A case of posterior lens capsular abscess occurring many months after an extracapsular cataract extraction is presented. This was caused by a mixed infection involving Propionibacterium acnes and Staphylococcus epidermidis. The significance of Staph epidermidis after such a long postoperative period is uncertain, but the case shows features typical of secondary endophthalmitis due to P acnes, including a long delay in onset and a grumbling course not brought under control by medical treatment. It supports the theory that the nidus of infection is localised in the posterior lens capsule by showing development of a visible capsular abscess with associated vitreous involvement. The subsequent removal of the capsule and vitreous, despite leaving the intraocular lens in place, led to complete resolution of the inflammation. Both organisms have previously been found to be sequestered in the posterior lens capsule by histological and microbiological examination of excised capsular specimens. It is important to consider them as possible causative agents in the formation of a postoperative capsular abscess.
Images
PMCID: PMC1042546  PMID: 1768656
14.  Complete infarction of the eye complicating a choroidal malignant melanoma. 
Infarction of malignant melanoma of the choroid has been previously reported, but infarction of the whole eye in association with infarction of melanoma is a rare event that has not been previously described. We present such a case and discuss the possible pathogenesis.
Images
PMCID: PMC1042433  PMID: 1873265
15.  Letter: Economies in the N.H.S. 
British Medical Journal  1974;4(5938):233.
PMCID: PMC1612350  PMID: 4419914

Results 1-15 (15)