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We describe the surgical approach of two patients with myogenic blepharoptosis. The ptosis is caused by a glycogenosis type II (Pompe disease) in the first case and is due to a juvenile, chronic progressive external ophthalmoplegia (Kearns-Sayre syndrome) in the second case. The first patient presented a unilateral ptosis. The ptosis in the second patient was bilateral and manifest. The eyelids could only be opened manually. A resection of the palpebral levator muscle was carried out under local anesthesia. The choice of the technique will be explained. The amount of levator resection was calculated considering the residual eyelid motility and Bell's phenomenon. Electronmicroscopy of the resected levator muscle will be discussed.

A frontalis suspension was carried out in a patient with an essential type of blepharospasm, characterized by difficulties in initiating the act of lid elevation, often referred to as the apractic form of blepharospasm or, as J. Elston proposed, the pretarsal blepharospasm. The patient tries to open the eyes by using the frontalis muscle or by manual traction. It is known than in this form of blepharospasm, insufficient results are seen after botulinum toxin infection. Proper examination of the skin crease of the upper eyelid and of the eyelid gives an idea of the insertion of the levator aponeurosis and of the levator muscle function. A desinsertion, due to frequent manual traction, may be found. In this case, reinsertion of the aponeurosis may relieve the symptoms. If no desinsertion is present a frontalis suspension, similar to those used in ptosis surgery, may give good results.

A 63 years old woman presented with bilateral blepharospasms and eyelid apraxia which was treated with Botulinum toxin injections. A post-treatment ptosis was seen with preserved levator function. It was then suggested that manual eyelid traction could have caused aponeurotic dehiscence of the levator muscles. Surgical exploration confirmed this diagnosis. One must be aware that eyelid apraxia can mask an aponeurotic dehiscence of the levator muscle induced by chronic manual traction exerted on the apractic eyelids.

Experimental study of the intraocular penetration of six drugs with therapeutic effect on toxoplasma. A direct and an indirect method are used. The penetration of six drugs administered sub-conjunctival, retrobulbar and intramuscular in one shot is measured in the anterior chamber, the vitreous and the retina-choroid of a healthy rabbit eye. The best results are obtained for: spiramycin, trimethoprim-sulfamethoxazole and clindamycin. The therapeutic efficiency of four drugs on infected rabbit eyes with toxoplasma are studied using an indirect method: pyrimethamine and especially doxycycline have a positive effect.

The value of a carotid endarterectomy in patients with ocular symptoms such as amaurosis fugax, scotoma, loss of visual acuity or diplopia is considered from an ophthalmological point of view. The concurrent fundus lesions are discussed and the ocular results of two different groups of patients are presented. A first group of 12 patients underwent an endarterectomy for their specific ocular complaints, while a second group of 15 patients with ocular symptoms associated with carotid lesions were treated conservatively. The usefulness of the retro-ocular doppler sonography in the vascular check-up is stressed. A good visual prognosis after carotid endarterectomy can be predicted when the blood velocity in the ophthalmic artery is 0.2 to 0.4 m/sec.