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Purpose To describe 10 patients with Morbihan syndrome, a rare condition characterized by the slow appearance of erythema and solid edema on the upper portion of the face, and review the literature. Methods Retrospective case series and review. Results The majority of patients were male (80%), and the mean age at presentation was 67 years (range, 48-88 years); 60% had asymmetrical disease (affecting mainly the right side). All subjects underwent a lid biopsy to support the diagnosis of Morbihan syndrome, which showed features of inflammation and vascular dysfunction, highly suggestive of a rosacea histological picture complicated by chronic lymphoedema. A range of medical and surgical treatment were used with variable success. The most effective ones included oral isotretinoin, intralesional triamcinolone injections, and debulking surgery. Conclusions Morbihan syndrome is a rare and chronic condition. It can be difficult to treat and may require a range of interventions.

Purpose To assess whether the use of silicone lacrimal stents affects the long-term success of endonasal dacryocystorhinostomy (EN-DCR). Design Prospective, randomized, controlled, interventional trial. Participants The subjects were adult patients older than 16 years undergoing primary EN-DCR for nasolacrimal duct obstruction who gave fully informed consent and who had no lid malpositions or canalicular pathology. In cases with bilateral surgery, only the right eyes were studied. Participants were randomized to receive stents (control group) or not (study group). Methods Standardized nonendoscopic EN-DCR was performed by the senior author in all cases. When the ostium was completed, the randomization code was revealed as to whether a lacrimal stent was placed or not. Follow-up assessments were made at 3, 6, 9, and 12 months. Stents were removed at 3 months. Main Outcome Measures The primary end point was symptoms of epiphora at 12 months, reported to the surgical booking clerk as (a) resolved, (b) significantly improved, (c) partially improved, or (d) no change or worse. The secondary end point was anatomic patency based on nasolacrimal syringing and categorized as (a) fully patent, minimal, or no reflux; (b) >50% patent but some reflux; (c) some patency but >50% reflux; or (d) nonpatent, 100% reflux. Complete success was defined as having resolved or significantly improved symptoms of watering and minimal or no reflux on nasolacrimal syringing. Partial success was defined as symptoms partially improved with a combination of patency and reflux on syringing. Failure was categorized as no change or worse symptoms of watering and 50% to 100% reflux on syringing. Results A total of 300 patients completed 12 months of follow-up. A total of 152 patients received tubes, and 148 patients did not. Overall success both subjectively and objectively was 94.7% in the stented group and 87.8% in the nonstented group ( P = 0.034, Pearson chi-square 1-tailed test). The most common complications of stents included canalicular cheese-wiring and tube prolapse in approximately 4% each. Conclusions There is a statistically significantly higher success rate in EN-DCR surgery with tubes compared with no tubes. The failure rate in this study was more than twice as high when tubes were not used (12.2% vs. 5.3%).

Background The aetiology of blepharospasm remains unclear. There is evidence that the afferent pathway is important, but this area remains under-researched. Aim To explore the hypothesis that the afferent arm of the blink reflex is abnormal in blepharospasm by assessing a range of measures of corneal sensory function. Methods In this prospective case–control study, 21 patients with blepharospasm and 21 age-matched and gender-matched controls completed the Ocular Surface Disease Index questionnaire and underwent the following assessments: tear osmolarity, Shirmer test, tear-film break up time, corneal and conjunctival vital staining, meibomian gland dysfunction, corneal aesthesiometry and confocal microscopy. Results Corneal sensitivity was significantly lower in patients with blepharospasm than in controls (right eyes p=0.009; left eyes p=0.009, paired t test). The median number of main nerve trunks was lower for patients with blepharospasm than for controls, and this was statistically significant at the 5% level (p=0.04, paired t test). Mean nerve density, median number of nerve branches and median total number of nerves were lower for blepharospasm cases than controls, but this did not reach statistical significance. Tortuosity was greater for blepharospasm cases than controls, but this was not statistically significant. Conclusions Blepharospasm is associated with reduced corneal aesthesiometry and a tendency towards a reduced number of nerves in the sub-basal plexus, implying an impairment in corticosensory processing, possibly a defect of the sensorimotor gating mechanism resulting in a loss of inhibition of the blink reflex.

To assess whether the use of silicone lacrimal stents affects the long-term success of endonasal dacryocystorhinostomy (EN-DCR).Prospective, randomized, controlled, interventional trial.The subjects were adult patients older than 16 years undergoing primary EN-DCR for nasolacrimal duct obstruction who gave fully informed consent and who had no lid malpositions or canalicular pathology. In cases with bilateral surgery, only the right eyes were studied. Participants were randomized to receive stents (control group) or not (study group).Standardized nonendoscopic EN-DCR was performed by the senior author in all cases. When the ostium was completed, the randomization code was revealed as to whether a lacrimal stent was placed or not. Follow-up assessments were made at 3, 6, 9, and 12 months. Stents were removed at 3 months.The primary end point was symptoms of epiphora at 12 months, reported to the surgical booking clerk as (a) resolved, (b) significantly improved, (c) partially improved, or (d) no change or worse. The secondary end point was anatomic patency based on nasolacrimal syringing and categorized as (a) fully patent, minimal, or no reflux; (b)50% patent but some reflux; (c) some patency but50% reflux; or (d) nonpatent, 100% reflux. Complete success was defined as having resolved or significantly improved symptoms of watering and minimal or no reflux on nasolacrimal syringing. Partial success was defined as symptoms partially improved with a combination of patency and reflux on syringing. Failure was categorized as no change or worse symptoms of watering and 50% to 100% reflux on syringing.A total of 300 patients completed 12 months of follow-up. A total of 152 patients received tubes, and 148 patients did not. Overall success both subjectively and objectively was 94.7% in the stented group and 87.8% in the nonstented group (P = 0.034, Pearson chi-square 1-tailed test). The most common complications of stents included canalicular cheese-wiring and tube prolapse in approximately 4% each.There is a statistically significantly higher success rate in EN-DCR surgery with tubes compared with no tubes. The failure rate in this study was more than twice as high when tubes were not used (12.2% vs. 5.3%).

To develop and test a user-friendly questionnaire for rapidly assessing quality of life (QOL) in thyroid eye disease (TED).A three-item questionnaire, the TED-QOL, was designed and compared to the 16-item Graves Ophthalmopathy (GO)-QOL and the nine-item GO-Quality of Life Scale (QLS). 100 patients with TED were administered all three questionnaires on two occasions. Results were compared to clinical severity scores (Vision, Inflammation, Strabismus, Appearance (VISA) classification). Main outcomes were construct and criterion validity, test-retest reliability, duration, comprehension and completion rates. TED-QOL correlated strongly with the other questionnaires for corresponding items (Pearson correlation: appearance 0.71, 0.62; functioning 0.69, 0.66; overall QOL 0.53). Test-retest analysis demonstrated good reliability for all three questionnaires (intraclass correlations: TED-QOL 0.81, 0.74, 0.87; GO-QOL 0.81, 0.82; GO-QLS 0.74, 0.86, 0.67). TED-QOL was significantly faster to complete (1.6 min vs GO-QOL 3.1 min, GO-QLS 2.7 min, p0.0001) and had a higher completion rate (100% vs GO-QOL 78%, GO-QLS 94%). There was only moderate correlation between items on all three questionnaires and VISA scores.The TED-QOL is rapid and easy to complete and analyse and has similar validity and reliability to longer questionnaires. All questionnaires showed only moderate correlation with disease severity, emphasising the discrepancy between objective and subjective assessments and the importance of measuring both.

Purpose To investigate whether a vibrating device applied in a circular motion to the forehead reduces the pain of local anesthetic injection in upper eyelid surgery. Design Prospective, interventional, cross-over, randomized, controlled clinical trial. Participants Eighty patients undergoing bilateral upper eyelid surgery under local anesthesia. Intervention A vibrating device was applied in a circular motion to participants' foreheads while local anesthetic was injected into 1 eyelid. During injection of anesthetic on the contralateral lid, the device was applied to the forehead in static fashion with the vibration switched off (placebo). The order of intervention was randomized. Main Outcome Measures After both injections had been given, participants were asked to specify their pain ratings for each injection on a scale of 0 to 10, with 0 representing no pain and 10 indicating the worst pain imaginable. Participants were also asked to qualitatively compare the 2 sides. Results The mean pain scores were 3.3 for the vibration-assisted side and 4.5 for the placebo. This difference was statistically significant ( P =0.0003); 73% of participants found the vibrated side to be better than the placebo, with 35% finding it a lot or quite a bit better. Conclusions Vibration-assisted anesthesia during upper eyelid surgery has a beneficial effect that is highly statistically significant and is clinically significant in terms of patients' qualitative assessment of pain. Further research is needed to determine whether this constitutes a quantitatively clinically significant improvement in pain management. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

PURPOSE To present the results of external dacryocystorhinostomy (ext-DCR) for epiphora using strict outcome criteria and provide an accurate baseline and evidence from which to compare the results of endonasal dacryocystorhinostomy. METHODS Retrospective case notes review of 158 consecutive adult patients who underwent primary ext-DCR. Functional success was assessed according to the patients' symptoms and anatomical success was measured using objective tests of lacrimal system patency: 1) the functional endoscopic dye test and/or endoscopic endonasal inspection of the ostium; 2) syringing of the lacrimal system; and 3) the fluorescein dye retention test. Patients without complete follow-up data were recalled for clinical reevaluation. A minimum follow-up of 6 months was required. Comparison of overall functional and anatomical success was further analyzed according to etiology using logistic regression and for different grades of surgeon using the chi-squared test. RESULTS The results for 124 of 158 ext-DCRs showed an overall functional success of 69% and anatomical success of 74%. Patients with primary acquired nasolacrimal duct obstruction (PANDO) who had surgery by the specialist lacrimal surgeon had high success: 83% functional success and 100% anatomical success. Patients with watering eyes from non-PANDO aetiology including canalicular disease who had surgery by the specialist lacrimal surgeon had moderate success: 78% functional success and 70% anatomical success. The results of all surgery by trainees were lower but only significantly so for PANDO. The mean duration of follow-up was 2.6 years (range, 6 months to 8.3 years); median follow-up was 1.9 years. CONCLUSION This study used strict criteria to assess functional and anatomical outcomes of primary ext-DCR and thus provide baseline measures of success with a minimal follow-up of 6 months. When canalicular disease was excluded, results for PANDO were higher. Surgery performed by the specialist lacrimal surgeon had higher success rates than when performed by trainee.

The aim of the study was to assess sexual health knowledge of medical students. Participants from the student population of an English Medical School (University of Bristol) were asked to fill in a questionnaire on the Internet about sexual health issues. The number of correct responses to each question was analysed according to participants' gender and medical school year. While certain issues relating to sexually transmitted infections, contraception and confidentiality in HIV testing were well understood, there was poor knowledge about the failure rate of condoms, abortion rates and prevalence of chlamydia. Women knew more about the contraceptive pill than men. Although increased years of medical training had some benefit in improving the accuracy of knowledge, this effect was surprisingly small. Most medical students have inaccurate factual knowledge about certain important sexual health issues. We consider this to reflect poorly on sexual health awareness in young people in general. There is need for greater sexual health education for future doctors and for the general public.

We present a case of benign mature orbital teratoma in a neonatal boy that involved the chiasmal area and cavernous sinus and displaced the nasopharynx. Visual potential was deemed to be good. Because of the chiasmal involvement, complete surgical resection, which would have compromised his visual function, was considered inadvisable. A debulking procedure, mainly of the cystic parts of the tumor, was performed. The patient remains stable at 3 years of age, with no further growth of the tumor and good vision in the affected eye.

Capsules containing liquid laundry detergent have recently become popular. We describe six children who presented with ocular surface injuries due to the bursting of such capsules. J Pediatr Ophthalmol Strabismus 2006;43:250-251. AUTHORS Drs. Fayers and Munneke are from the Department of Ophthalmology, Royal Bournemouth Hospital, Dorset, United Kingdom. Dr. Strouthidis is from the Department of Ophthalmology, Chelsea and Westminster Hospital, London, United Kingdom. Originally submitted April 6, 2005. Accepted for publication May 2, 2005. Address reprint requests to Dr. Tessa Fayers, Western Eye Hospital, London NW1 5YE, United Kingdom.