Purpose: There is no universal consensus on second-line agents for the treatment of moderate/severe to sight-threatening thyroid eye disease (TED) to maintain remission after first-line intravenous methylprednisolone (IVMP). This study investigates the efficacy and safety of mycophenolate mofetil (MMF) in TED patients in a real-world setting and over a longer period than previous randomized controlled trials. Methods: A retrospective cohort study of TED patients with active moderate/severe to sight-threatening TED seen over a 4-year period. Data collected were visual acuity (VA), Clinical Activity Score (CAS), Gorman Diplopia scores, MMF dosing and side effects at 24, 52 and 78 weeks. Clinical efficacy was defined as an absence of relapse: no decline in best corrected LogMAR VA, no need for further steroids, no increase in CAS of ≥2. Results: Out of 23 patients, 20 patients were included in this study. 10% (2/20) stopped MMF before 24 weeks. Median duration of MMF treatment was 76 weeks (1-140 weeks). 55% (11/20) had dysthyroid optic neuropathy (DON). In those with active moderate-severe TED without DON, clinical efficacy was seen in 100% (8/8) at 24 weeks, 87.5% (7/8) at 52 weeks, and 83.3% (5/6) at 78 weeks, with CAS decreasing from a baseline of 2.78±1.99 to 0.50±0.58 at 24 weeks, 0.50±0.82 at 52 weeks and 1.00±1.30 at 78 weeks. In DON, improvements were seen in 90% (9/10) at 24 weeks, 100% (7/7) at 52 weeks and 100% (4/4) at 78 weeks, with significantly reduced CAS scores from 2.55±1.54 to 0.83±1.27, 1.00 ±1.17 and 0.63±0.95 at 24, 52 and 78 weeks, respectively. Gorman score, VA and soft tissue inflammation parameters also improved throughout. There were two significant side effects over the treatment period. Conclusion: MMF appears to be an effective and safe second-line immunosuppressive agent. Further studies aimed at elucidating optimal dosing regimens and ideal treatment duration will prove helpful.

Aim: To prospectively study the quality of care for chalazion surgery between nursing and medical staff. Methods: Patients who underwent chalazion removal surgery in the minor operations department at Western Eye Hospital between January 2010 to March 2010 by nursing staff and November 2010 to March 2011 by medical staff. Results: The service provided for chalazion removal was well received. Overall there was no difference between quality of care between the nursing and medical staff. There were some points highlighted by patients regarding the general practice referral and pre appointment information. Conclusion: Nurse led chalazion removal has shown to a safe effective solution to future economic rationalisation for elective minor procedures. A high level of quality of care for the service has been shown.

Purpose: Congenital nasolacrimal duct obstruction is a common condition that is treated conservatively. There are varying reports on when to consider intervention. The aim of this study is assess when intervention is performed in England on the National Health Service and to review the opinions of Oculoplastic surgeons in the United Kingdom.