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A 19-year-old girl presented with advanced unilateral chronic angle closure glaucoma and myopia with gross cupping and field loss in a previously hyperopic eye with a marked increase in corneal curvature. This emphasises that a marked myopic shift may be an important sign of glaucoma in a young patient.

Retained cilia in the eye following injury are rare. There are reports of long term tolerance to cilia in the anterior chamber but no information about the effect on the corneal endothelium. A 31-year-old man was seen with a 19-year history of a retained eyelash embedded in a corneal scar and extending across the anterior chamber to the chamber angle. The follicle was absent. There was no cellular inflammatory reaction, and the eye otherwise appeared normal on slit-lamp examination with normal vision. However, there was the appearance of an encrusted deposit on the surface of the lash and a markedly lowered endothelial cell count of 750 cells/mm2 compared with the fellow eye. The lash was not removed.

A series of 22 patients with crystals in the anterior segment of the eye was examined by specular microscopy. Of 10 patients with hypermature cataract and hyperrefringent bodies in the anterior chamber cholesterol crystals were identified in four patients and in six of the 10 in whom aspirate was obtained cholesterol crystals were demonstrated in three, two of these having shown crystals on specular microscopy. In 10 patients with intracorneal crystalline deposits, cholesterol crystals were found on specular microscopy, including one case of Schnyder's crystalline corneal dystrophy. Of two patients with multiple myeloma, corneal crystals were demonstrated in one. Crystals of the anterior segment of the eye are most likely to be cholesterol, and identification is important for future treatment.

A 57-year-old housewife, with controlled hypertension, presented with acute right proptosis and visual loss with external ophthalmoplegia due to spontaneous orbital haemorrhage. Vision and ocular motility were returned to normal by the rapid surgical evacuation of the blood. Acute orbital haemorrhage is an ocular emergency requiring urgent treatment to prevent the usual previously reported outcome of permanent visual loss.

A series of 17 patients with stromal atrophy, hypoperfusion, and microneovascularisation of the iris investigated in the Glaucoma Investigation and Research Unit are described, and their iris angiograms were compared with those of normal irides of patients in the same age group seen in general clinics. In all but one of the 17 cases this iris atrophy was associated with glaucoma or ocular hypertension, which appeared to be secondary to the iris changes. The condition was bilateral and presented a typical slit-lamp appearance, with subtle evidence of microneovascularisation. There was neither history nor clinical evidence of previous trauma, heterochromia, or intraocular inflammation. The commonest form of iris atrophy affected the inner third of the iris stroma in a patchy manner, often with sparing above. However, diffuse atrophy occurred in two cases, and there were two cases of 'senile tears' of the iris. Some accompanying atrophy of the pigment epithelium was usual but less prominent. The changes on fluorescein angiography of the iris included the late appearance of dye with a long arteriovenous circulation time, fewer arteries than normal with sectorial hypoperfusion, leakage of dye from the pupil margin and peripupillary neovascularisation, stromal tufts, and sometimes more complex stromal microneovascularisation. An expanded prominent lesser vascular circle was a common feature of the condition. The condition is bilateral and distinct from other forms of iris atrophy. In all cases the iris changes appeared to be secondary to the vascular hypoperfusion and were not consistently associated with evidence of gross vascular disease. All patients had grey (blue) irides, and this may be an aetiological factor. The condition appears common enough to form a significant group of glaucoma patients and to be a separate clinical entity.

A case is described of malignant glaucoma with extreme shallowing of the anterior chamber (AC) and an abnormally high intraocular pressure (IOP) following laser iridotomy for acute angle closure glaucoma. The episode followed the use of strong miotic (pilocarpine hydrochloride 4%) and was reversed by mydriatics including phenylephrine hydrochloride. Serial estimation of anterior chamber depth is important in the management of angle closure glaucoma.

Fluorescein iris angiography and fluorophotometry were performed on a series of 9 patients with bilateral and 11 with unilateral pseudoexfoliation, 12 bilateral aphakes with pseudoexfoliation, and 7 unilateral aphakes with bilateral pseudoexfoliation. Angiography showed a loss of radial iris vessels, a heavy leak of fluorescein from the pupil margin, progressive neovascularisation of the outer 2/3 of the iris, and less constantly a network of fine new vessels in the inner 1/3 of the iris stroma. These changes were absent in unaffected eyes. After cataract extraction there seemed to be a definite lessening of fluorescein leak from the pupil margin. Fluorophotometry showed a much higher fluorescein concentration at the anterior focus in eyes with pseudoexfoliation than in normal controls or in fellow unaffected eyes. There was a much smaller rise in fluorescein concentration at the posterior focus in a minority of affected eyes. The ranges of fluorescein concentrations at the anterior focus in both phakic and aphakic patients with bilateral pseudoexfoliation did not differ significantly. The concentration at the anterior focus of unilateral aphakes with bilateral pseudoexfoliation was lower than in the fellow phakic eye. These findings suggest that the neovascular reaction seen in pseudoexfoliation is associated with patchy occlusion of the normal iris vasculature, occurs in the anterior segment of the eye, and does not continue to progress after removal of the lens.

The occurrence of haemolytic glaucoma in phakic eyes due to ghost cells has not previously been reported. Three cases of haemolytic glaucoma occurring over two years after massive vitreous haemorrhage in patients with an intact lens iris diaphragm are described. In one case there was histological confirmation of the presence of ghost cells in the anterior chamber. The mechanism proposed for the passage of ghost cells to the anterior chamber is through a defect in the anterior hyaloid face, created as the vitreous liquefies and degenerates. The reported cases were satisfactorily treated by trabeculectomy with anterior chamber washout, which management has not previously been reported in haemolytic glaucoma.

A series of 474 mixed cases of glaucoma was assessed to determine whether there were any genetic differences between different types of glaucoma. A careful distinction was made between chronic open angle glaucoma (COAG), acute and chronic angle closure glaucoma, ocular hypertension, low tension glaucoma, patients with large cup disc ratios, and various types of secondary glaucoma including pseudoexfoliation of the lens capsule, uveitic and traumatic glaucoma. Using ABO blood groups, Rhesus groups, ABH secretion or non-secretion, and phenylthiourea tasting we identified certain differences. The differences from normal were significant decrease in Rh-negative patients in chronic closed angle glaucoma (p less than 0.05), a decrease in ABH secretors in ocular hypertension (p less than 0.01), and fewer HB secretors in patients with COAG (p less than 0.02). There was a significant decrease in AH secretors and increase in HB secretors in both pseudoexfoliation with raised intraocular pressure compared with COAG (p less than 0.01) and in secondary glaucomas as a group compared with COAG (p less than 0.01). Tasters of phenylthiourea were more common in traumatic and uveitic glaucoma than in normal controls (p less than 0.05). These results suggest that secondary glaucoma develops in different subjects from COAG, while patients who develop a rise in intraocular pressure proceed to cupping and field loss if they have a certain genetic constitution. The groups of patients are too small for the differences to be of great prognostic value.