The not-so-lazy-T: a modification of medial ectropion repair.

Medial involutional ectropion without excessive lateral canthal tendon laxity is often corrected using the lazy-T procedure. This procedure however carries a potential risk of canalicular damage, and locating the lower lid retractors can be difficult. We have developed a modification. Replacing the tarso-conjunctival diamond with a subconjuctival pocket posterior and inferior to the punctum, into which the lower lid retractors are advanced from the base of the wedge excision, which effectively ensures plication of the lower lid retractors while maintaining a straightforward procedure. The follow-up data on five procedures showed surgical and symptomatic success in all patients, without complications. These results confirm the efficacy of this modification of the lazy-T procedure in the correction of medial lower lid ectropion.

Fucithalmic, chloramphenicol or no treatment after squint surgery in children. A single blind randomised study.

One hundred and four children undergoing strabismus surgery were randomised post-operatively to one of three treatment groups; 1) fucithalmic drops twice daily; 2) chloramphenicol (chlormycetin) ointment twice daily; 3) no treatment. Allocation to the 'no treatment' group had to be stopped after 3 of the first 8 patients in the group developed severe mucopurulent conjunctivitis. A parental questionnaire and clinical assessment, carried out in a single blind fashion revealed that nearly all parents were able to apply the prescribed treatment and that both treatments were effective in preventing bacterial conjunctivitis. Post-operative antibiotics seem to be necessary following squint surgery in children, and fucithalmic viscous drops are a useful alternative to chlormycetin ointment.

Angle closure glaucoma precipitated by labour.

Acute angle closure glaucoma generally occurs in older hypermetropic individuals, precipitated by pupillary dilation. However it is often forgotten that it can occur in younger people and that it does not occur solely as a result of the use of mydriatics or normal pupillary dilation in response to darkness. It is recognised that it can occur during or shortly after a surgical procedure done under either spinal or general anaesthetic. We describe a case of acute angle closure occurring in a 37-year-old woman, precipitated by labour. To our knowledge no such case has been described in the literature.

Domiciliary post-operative assessment following cataract surgery carried out by specialist nurses.

PURPOSE: To establish whether first day postoperative review by ophthalmic trained nurses following day case cataract surgery is a safe and effective practice. METHODS: A prospective study was undertaken of all patients undergoing day case cataract surgery followed by a domiciliary visit in 1996. Principal outcome measures were: (1) incidence of problems diagnosed by the nurses at the first visit, (2) the rate of referral to the hospital for medical review, (3) incidence of problems identified at the first clinic review (10-14 days later), with particular attention paid to any that might be attributed to an event 'missed' by the nurse at the first day, and (4) visual acuity at 3 months, to allow comparison with previously published national outcome measures. RESULTS: From 281 cases, although nurses identified a problem in 11%, only 4.2% required referral back to medical staff from the domiciliary visit; 2.1% required re-admission over the first 2 weeks. Only one case (0.35%) was found to have a missed pathology; this patient had no long-term adverse outcome. Visual acuity outcomes at 3 months compared favourably with results from the National Cataract Surgery Survey. CONCLUSIONS: Domiciliary visits by ophthalmic trained nurses are a safe alternative to routine hospital review by medical staff.