Background/aims: The direct brow lift operation can be used to treat brow ptosis arising from either involutional changes or facial nerve palsy. The authors reviewed their experience with this operation to establish its efficacy and complication rate in the light of concerns over poor scar cosmesis and forehead paraesthesiae in the postoperative period. Methods: A retrospective review of patients undergoing direct brow lifting from 1989 to 2002 was conducted, and information gained on patient satisfaction by questionnaire. Results: The direct brow lift operation was found to give a predictable outcome, with high levels of patient satisfaction. With careful wound closure, postoperative scars are rarely cosmetically unacceptable to the patient. Paraesthesiae are a common but well tolerated sequelae. Conclusions: The direct brow lift was found to be a reliable method for treating brow ptosis arising through involutional change or facial nerve palsy in both men and women. The postoperative scars may be more evident in younger patients so the authors reserve this technique for ''rehabilitative'' rather than cosmetic brow lifts in patients of middle age and beyond.

We present the results of six cases of severe chemical burn of the eye treated by limbal autotransplantation. Three cases were treated in the acute phase, and three in the chronically scarred, healed phase. In five of the six cases, the stability of the ocular surface was markedly improved, resulting in two of the three acute cases in full recovery of normal vision, and in the three chronic cases in improved comfort and reduced corneal opacity and vascularity. In two chronic cases, visual acuity was improved and in one, limbal autotransplantation was followed by successful penetrating keratoplasty. Limbal autotransplantation is a valuable procedure in the rehabilitation of the unilateral, severely chemically burned eye. The indications, techniques, complications and results of this procedure are discussed.

Pigmented paravenous retinochoroidal atrophy (PPRCA) is a rare disorder of unknown origin characterised by bone corpuscle pigmentation accumulation along the distribution of the retinal veins. In

Aims Postoperative lid malpositions are known complications of routine intraocular surgery and were previously attributed to the use of a bridle suture or the myotoxic effect of retrobulbar or peribulbar anaesthetics. However, lid malpositions are still seen under topical anaesthesia. Recent studies have implicated the lid speculum as a factor. Patients with narrower vertical palpebral apertures have been shown to develop postoperative ptosis more frequently, but the reason is unknown. This is the first study to determine the forces exerted by lid speculae over a range of palpebral apertures. Methods Mechanical testing was undertaken using a Bose 3200 materials testing machine. Tests were undertaken on four disposable and four reusable speculae. The force used to compress each speculum was compared over a range of displacements. A two-sample t-test was used to compare the stiffness of the two types of speculum. Results The stiffness of the reusable speculum was significantly greater than the disposable speculum (P ¼ 0.002). The stiffness of each speculum was greatest at the range of displacement corresponding to the narrower palpebral apertures. Conclusions Different speculae exert significantly different forces on patients' eyelids during surgery. The patients who experience the greatest compression from the speculae are those with the smallest palpebral apertures. This may explain why these patients are more likely to develop postoperative lid malpositions.

Complications of intracanalicular plugs can sometimes outweigh their benefits. These plugs can lodge in the lacrimal outflow system and cause pyogenic granuloma formation and canaliculitis. To our knowledge, until now there have been no reports of complications associated with Form Fit hydrogel plugs (OASIS Medical) and its infective complication with Klebsiella oxytoca.