Resolution of diplopia after repair of the deep orbit

The degree of resolution of diplopia after repair of a blow-out fracture of the orbital floor varies and depends on many factors. We present six patients, each of whom had extensive fractures of the floor of the orbit that extended posteriorly to its anatomical limit. The mean (range) time for the resolution of diplopia after reconstruction was 4.4 (1-7) months. We think that its slow resolution in these patients may require preoperative counselling, and also the postoperative management of patients with extensive disruptions of the floor of the orbit posterior to the anterior limit of the inferior orbital fissure (within the deep orbit) must be carefully planned.

A randomised, double-blind trial of topical ketorolac vs artificial tears for the treatment of episcleritis

PURPOSE

To determine whether topical ketorolac (Acular) is more effective than artificial tears in treating the signs and symptoms of idiopathic episcleritis.

METHODS

In this prospective, randomised, double-blind study, 38 eyes of 37 patients presenting with idiopathic episcleritis were allocated to receive either topical ketorolac (0.5%) or artificial tears three times a day for 3 weeks. The severity of patients' signs (episcleral injection and the number of clock hours affected) were recorded at weekly intervals. Patients' symptoms (perceived redness and pain scores) were recorded using a daily diary.

RESULTS

There was no significant difference in the ophthalmic signs between the two groups at each assessment, including intensity of episcleral injection and the number of clock hours affected. No significant difference was found in the time to halve the baseline redness intensity scores (4.4 vs 6.1 days, P=0.2) or pain scores (3.6 vs 4.3 days, P=0.55). Significantly more patients on ketorolac reported stinging at the first follow-up visit (P<0.001).

CONCLUSION

Topical ketorolac is not significantly better than artificial tears in treating the signs or symptoms of idiopathic episcleritis.

Visual function following neurosurgical optic nerve decompression for compressive optic neuropathy

AIMS

To assess the course of visual function after neurosurgical decompression of the optic nerve during resection of intracranial tumours. To obtain information that may be used to counsel patients.

METHODS

A retrospective review of the acuity and visual fields of 27 patients undergoing neurosurgical decompression of 36 optic nerves in a regional neurosurgical centre. Two groups were considered, those undergoing craniotomy for sphenoid wing meningioma en plaque, and those undergoing an extended transbasal approach to intracranial tumours.

RESULTS

At the last follow-up (1-97 months), improvement in acuity was seen in 47% of eyes with decompressed nerves. One-third of these showed late improvement, and two-thirds showed immediate improvement. In total, 20% of eyes had worse acuity at the last follow-up compared with preoperative values, just under one-third of these showed late deterioration, and the remainder showed immediate deterioration. In total, 33% of eyes achieved acuities equal to those recorded preoperatively, 6% improving to this level postoperatively.

CONCLUSIONS

The majority of eyes in this study maintained or improved acuity after decompression. A proportion of eyes continue to improve after surgery, and a proportion deteriorate. There is no relation between duration of preoperative symptoms or the level of preoperative acuity and the change in acuity achieved.

Doppler ultrasonography to aid diagnosis of orbital capillary haemangioma in neonates

PURPOSE

To illustrate the use of Colour Doppler Ultrasonography to aid the differential diagnosis of orbital masses in neonates.

METHODS

Three cases are reported of neonates presenting with undiagnosed orbital masses as isolated findings, causing lid swelling and proptosis and prompting a differential diagnosis of an orbital vascular lesion, rhabdomyosarcoma or other tumour. Colour Doppler Ultrasonography in expert hands using a small footprint linear 10-5 transducer proved an atraumatic, rapid and accurate way of confirming a vascular lesion at the first clinic visit. This reassured the family and ophthalmologist alike, and obviated the need for biopsy or cross sectional imaging requiring anaesthetic. All three lesions were orbital capillary haemangiomas with characteristic ultrasonographic findings.

RESULTS

Illustrations are provided to illustrate the features of the capillary haemangiomas when visualised with Colour Doppler Ultrasonography.

CONCLUSIONS

The use of ultrasonography in very young infants can help exclude malignancy, without the need for cross sectional imaging or biopsy under anaesthetic. However, close observation remains mandatory. Repeat scanning is easily performed with no adverse effects, in potential contrast to other imaging modalities.

Can patients safely read their psychiatric records? Implications of freedom of information legislation

OBJECTIVE

To assess how suitable psychiatric medical records are for access by patients.

DESIGN

We examined a random selection of psychiatric records to identify features which we thought might be confusing or injurious to a patient reading his or her own record.

RESULTS

Potentially offensive, alarming or upsetting entries were found in most records.

CONCLUSION

Clinicians need to take care in recording information in medical records lest patients be adversely affected by the experience of reading their notes. Access should always be arranged in conjunction with a medical supervisor.