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Botulinum Toxin A injected into the levator palpebrae superioris produces a flaccid ptosis of the upper lid and provides a safe and effective protection for the cornea to aid healing in indolent ulceration or as prophylaxis when there is fifth or seventh cranial nerve damage. Fifteen patients have received this treatment. Levator paresis, producing ptosis for a mean of 2-3 weeks and recovering in a mean of 8.1 weeks was successfully produced in all patients and complete corneal healing was produced in 80% of patients. The major side effect was weakness of the superior rectus muscle which occurred in 80% of cases and lasted a mean of 6 weeks.

The results of azathioprine therapy in five patients with chronic progressive or relapsing idiopathic inflammatory polyneuropathy are described. In four patients a sustained improvement followed treatment and in the other patient azathioprine successfully replaced corticosteroid therapy. The improvement was often delayed for up to three months. The literature on the use of azathioprine in chronic polyneuropathy is reviewed. We suggest that there is a place for azathioprine treatment in patients with chronic idiopathic polyneuropathy resistant or intolerant to corticosteroid treatment.

A total of 1666 patients undergoing isolated coronary artery bypass were studied for the occurrence of postoperative atrial fibrillation. Possible associations of this arrhythmia with various preoperative, intraoperative, and postoperative factors were studied by univariate (chi 2 and t tests) and multivariate (logistic regression) analyses. The overall incidence of postoperative atrial fibrillation was 28.4%, with the major occurrence 2 days after the operation. Both univariate and multivariate studies indicated the patient's age to be the dominant factor promoting postoperative atrial fibrillation, with an increasing prevalence in older patients (p = 0.0001). Multivariate analysis showed that postoperative beta-blocker therapy conveyed considerable protection against postoperative atrial fibrillation (p = 0.001) but was less effective in the older patients. Men were more prone to this arrhythmia (p = 0.02). Although these associations appeared significant, the logistic model proved to be a poor predictor of postoperative atrial fibrillation, which suggests that other factors not studied, or mere chance, may also be responsible.

Botulinum toxin A produces a temporary, flaccid ptosis when injected into the levator palpebrae superioris muscle. The resulting protective ptosis was used to aid healing in 21 cases of indolent ulceration, and, prophylactically, in 4 cases of neuroparalytic keratitis. Of the indolent ulcers, 90% healed completely. In all but one case, the cornea was covered completely by the lid and complete ptosis was produced in 75% of cases in an average of 3.6 days, lasting for 16 days on average before recovery began. Recovery of levator function was complete in 8.5 weeks on average. Superior rectus underaction was seen in 68% of cases but this recovered completely in all cases in an average of 6 weeks. Impression cytology showed a trend toward normal conjunctival morphology as healing progressed.

Millipore filters were used to obtain sheets of cells from the ocular surface. Using Periodic Acid Schiff-haematoxylin the intracellular neutral mucus of the goblet cells stains a brilliant, bright pink and the cell nuclei dark blue making it possible to observe the epithelial cells and the goblet cell population. In certain ocular surface diseases the size of the PAS-haematoxylin staining goblet cell population is reduced, returning towards normal as ocular health improves. These observations had previously been interpreted as showing degeneration followed by regeneration of the goblet cells. However, Alcian blue stains an acidic mucus, which does not stain with PAS-haematoxylin. Acidic mucus containing goblet cells have been revealed using Alcian blue staining when added to the PAS stained cells in conditions that have previously been shown to have reduced goblet cell population when assessed by PAS-haematoxylin staining. This suggests that the staining properties of some of the goblet cells have changed. The extra goblet cells revealed by Alcian Blue staining makes the total of goblet cells present close to normal in numbers. Improved clearing methods and cytological preservation has revealed that there is also a population of goblet cells that do not stain with either technique. These observations must cast doubts on previous claims of reduced goblet cell population associated with some extraocular diseases.

The electroretinogram, findings, in response to a flash stimulus, was recorded from a skin electrode placed on the bridge of the nose in 4465 infants and children seen over a 10 year period. The electroretinogram was combined with a flash visual evoked potential. From this total, the electroretinographic findings in 240 patients, aged 1 day to 17 years, without suspected retinal pathology and with a normal visual evoked potential, were used as controls and normal electroretinographic parameters of different age groups defined. There were 332 patients who showed an absent or very reduced amplitude electroretinogram. They were divided into primarily ocular disorders (n = 195), neurodegenerative disorders (n = 94), and various syndromes (n = 43). Fundus examination did not always show any obvious abnormalities. The use of this simple and reliable technique for recording the electroretinogram made it possible to include this investigation as a routine procedure without the need for sedation in infants and uncooperative children. Electroretinographic studies, especially when combined with visual evoked potentials, and in some cases electroencephalography, may aid diagnosis in a wide variety of paediatric conditions, many of which have genetic implications.

A study of 248 patients who underwent operative procedures for trigeminal neuralgia over a nineteen year period is presented, with particular reference to those who developed neuroparalytic keratitis to see if cervical sympathectomy had any protective effect on the cornea. 51 patients underwent cervical sympathectomy, 46 as a prophylactic procedure, and 5 as a treatment for neuroparalytic keratitis. Of these patients 3 (5.9%) developed neuroparalytic keratitis, but 2 of them had had an inadequate sympathectomy. Forty seven patients who did not undergo cervical sympathectomy had either an anaesthetic cornea or a reduced corneal reflex, and of these 11 (23.4%) developed neuroparalytic keratitis. An adequate cervical sympathectomy therefore appears to have a protective effect on the cornea against the development of neuroparalytic keratitis.