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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%).

We tested the sensitivity and responsiveness of the TED-QOL to rehabilitative surgery in thyroid eye disease (TED). The 3-item TED-QOL and 16-item GO-QOL, which assess quality of life (QoL) in TED, were administered to consecutive patients undergoing rehabilitative surgery. The questionnaires were completed pre-and post-operatively to assess sensitivity (ability to discriminate between different surgical groups) and responsiveness (ability to detect within patient changes over time).56 patients underwent 69 procedures for TED (29 orbital decompressions, 15 strabismus operations, 25 eyelid procedures). The differences in scores between the three types of surgery (a measure of sensitivity) were statistically significant at the 5% level pre-operatively and post-operatively for all 3 TED-QOL scales and for both GO-QOL scales, but much more so for the TED-QOL scales in each case. The within-patient changes between the pre- and post-operative scores for the same subjects (a measure of responsiveness) were statistically very highly significant for the TED-QOL overall and appearance scales for each of the surgeries. The pre- and post-operative difference for the TED-QOL functioning scale was highly statistically significant for strabismus surgery but not for decompression or lid surgery. The change between the pre- and post-operative scores for the GO-QOL was significant for the functioning scale with strabismus and lid surgery, and was highly significant for the appearance scale with lid surgery but not for strabismus surgery or decompression. The 3-item TED-QOL is sensitive and responsive to rehabilitative surgery in TED and compares favorably with the lengthier GO-QOL for these parameters.

A 53-year-old man with rheumatoid arthritis presented with 1 week of progressive right-sided proptosis, diplopia and pain on eye movement, particularly when looking to the left. Examination demonstrated marked lid swelling, limited right elevation and dextroelevation with pain on adduction (figure 1A). The affected eye was injected and chemosed. There was no evidence of optic nerve compromise. Figure 1 (A) Colour photographs demonstrating the eye in the cardinal positions of gaze. Central image showing the eyes in primary position. There is moderate limitation of right eye dextroelevation and elevation, indicating impairment of the right lateral and superior recti muscles. Note: pain was maximal with eye movement in …

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.

Purpose To assess the incidence, duration, and severity of oscillopsia after lateral wall orbital decompression for thyroid eye disease. Design Retrospective telephone interview. Participants A consecutive group of patients who had undergone lateral wall orbital decompression for thyroid eye disease performed by 2 consultants at Moorfields Eye Hospital between January 2008 and December 2010. Methods Patients were telephoned and a standardized interview related to postoperative oscillopsia was performed. The degree of preoperative and late postoperative exophthalmometry was assessed from clinical records. Main Outcome Measures The presence, severity, and duration of postoperative oscillopsia and its impact on daily activities. Results Ninety-eight patients were interviewed successfully, of which 34 (35%) had noted postoperative oscillopsia that occurred upon chewing in 29 of 34 patients (85%) and upon walking in 8 of 34 patients (24%). The oscillopsia resolved within 1 year in 15 of 34 patients (44%), and 16 of 34 (47%) still had mild symptoms at 2 years or more after surgery. Fourteen patients (41% of affected patients; 14% of the entire group) initially were troubled by the symptom, but at the time of interview, only 1 person found it troublesome and 7 reported it as a minimal problem. The reduction in proptosis was similar among those with and without oscillopsia. Conclusions The incidence of oscillopsia after lateral wall orbital decompression was 35% when patients were questioned directly, and was much higher than anticipated from extensive clinical experience (where very few patients mention the symptom). In almost all cases, the oscillopsia resolved or was not troublesome, and only 1 patient found it bothersome more than 2 years after surgery. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

We read the October issue of the British Journal of Ophthalmology and in particular the safety review of bevacizumab (Avastin) versus ranibizumab (Lucentis) by Schmucker et al with great interest.[1][1] NICE approved the use of Lucentis for the treatment of macular degeneration in February 2007. We

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.