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Purpose : Psychological distress is reasonably well documented in people with facial disfigurement; however, in patients following eye removal surgery this has not been studied adequately. We hypothesised that lower distress levels would be associated with age and more adaptive coping strategies and that women would be more likely to report higher levels of distress and, therefore, use maladaptive coping strategies. Methods : This exploratory, cross-sectional study measured distress and coping in a sample of 56 post enucleation or evisceration patients. The Hospital Anxiety and Depression Scale and the Brief COPE measured distress and coping strategies. Results : In all, 25.5% and 10.9% of the sample had high levels of anxiety and depression, respectively. Significant associations were found between levels of distress, coping strategies and demographic variables ( p < .05). There were significant differences in coping strategies between those with higher and lower levels of distress ( p < .05). Females reported higher levels of anxiety ( U = 202.5, p < .01) and depression ( U = 229, p < .05) than males. Those who experienced enucleation or evisceration aged between 20 and 39 years reported significantly higher levels of depression compared with other age groups ( U = 68.5, p < .01). Conclusions : There was a relatively low level of distress across the whole sample, but we found high levels of distress in a considerable proportion (18.18%) of participants. Participants' coping strategies and levels of distress were correlated. Females and participants aged between 20 and 39 years at time of eye removal were particularly vulnerable to distress.

Background: Botulinum toxin A (BTXA) injection to the levator palpebrae superioris muscle to induce a protective ptosis can adversely cause reduced upgaze due to diffusion of BTXA to the superior rectus muscle., Purpose: To compare the incidence of reduced upgaze in trascutaneous versus transconjunctival administration of BTXA to induce protective ptosis in patients with exposure keratopathy due to facial nerve palsy., Methods: All patients included in this study suffered from acute exposure keratopathy and they all required chemodenervation of the levator muscle to induce a protective ptosis. Patients in group A received BTXA (Dysport) transcutaneously though the upper eyelid skin crease. Patients in group B received BTXA (Dysport) into the subconjunctival space at the superior border of the tarsal plate of the upper eyelid transconjunctivally. All subjects were closely monitored after BTXA injection and during each follow-up assessment the upper eyelid was lifted in order to uncover the effects on ocular motility. All patients had a follow-up of at least 1 year following injection of BTXA for their facial nerve palsy and its complications., Results: In group A, 20 patients were included. Reduced upgaze occurred in 9 patients (45%). Five required treatment with a Fresnel prism or ocular occlusion to avoid intractable diplopia. There were 15 patients in Group B, and only 2 of them developed post-treatment superior rectus underaction. One of these patients resolved spontaneously and the other patient required treatment with a spectacle-mounted Fresnel prism for diplopia. The difference in incidence of reduced upgaze between the 2 techniques was statistically significant (Fisher's exact test, P=0.0493)., Conclusion: Injecting BTXA to induce protective ptosis via a transconjunctival supratarsal route was significantly less likely to induce superior rectus underaction than when given via the transcutaneous route.

Purpose: A retrospective case note review was undertaken to elucidate any differences in the cosmetic results and rate of serious complications between hydroxyapatite (HA) and porous polyethylene (PP) orbital implants., Methods: Patients who had undergone orbital implant surgery during the period 1993 to 1997 by a single surgeon were identified. Twenty-six patients had an HA implant and twenty-six had received a PP implant. All patients were reviewed in the ocular prosthetics department in a masked manner. The orbits were scored for post-enucleation socket syndrome (PESS) score, and quantification of implant mobility was done. Data analysis was conducted using Mann-Whitney U test for two independent samples., Results: There was no significant difference in PESS scores in patients with an HA or a PP implant. Implant elevation was better in patients with secondary (p = 0.029) and exchange (p = 0.042) PP implants. Only one patient in each of the HA and PP groups suffered significant implant exposure that required dermis fat and mucous membrane graft cover., Conclusions: The complication rates and PESS scores were identical between the HA and PP implant groups. The implant mobility was better in the PP group. In clinical practice, the choice of the type of orbital implant inserted may also be governed by other factors such as surgeon experience, ease of use, and cost.

AIM. To investigate whether the extent of ocular morbidity had de-creased as a result of improved diagnosis, awareness and treatment of Wegener 's granulomatosis (WG). MATERIALS AND METHODS. A retrospective study of all patients with ophthalmic involvement due to WG over an 8-year period. RESULTS. Forty-nine patients were diagnosed to have WG. Of these, 28 had ocular involvement: 21 patients had focal ocular involvement (conjunctivitis, episcleritis, scleritis, keratitis, iritis, retinitis)and 7 had orbital involvement. Permanent visual loss occurred in three patients with orbital involvement, but in no patients with focal ocular disease. Up to 90% of patients had systemic involvement. Three deaths oc- curred among those with ocular involvement. CONCLUSIONS. Patients with WG have a much improved visual prog- nosis as a result of early diagnosis and intervention with systemic im- munosuppression. A combination of assays for ANCA and tissue biop-sies were needed to establish the diagnosis of WG. Treatment with immunosuppressive agents (usually prednisolone and cyclophospha- mide)led to a good response in the majority of cases.

The use of porous spherical orbital implants enables ocular prosthesis motility to be improved if necessary by subsequent drilling of the implant and coupling it to the prosthesis with a peg. We compared the effect of drilling at different speeds on hydroxyapatite and porous polyethylene (Medpor) spherical implants. The implants were drilled at fixed speeds of between 15 and 2000 revolutions per minute. The samples were then viewed in an electron microscope and photographed. When hydroxyapatite is drilled the porous structure of the implant is maintained although a precise hole with well-defined walls was not produced. This contrasts with porous polyethylene where the porous structure is lost although a precise drill hole is created. This drilling technique has been used successfully in patients with hydroxyapatite implants, thus making possible stable epithelialisation of the drill hole. Our results confirm that the drilling of porous polyethylene using this technique is unlikely to be successful, as loss of the porous structure would prevent stable epithelialisation of the drill hole, resulting in exposure of the implant.