We assessed the feasibility of an epidemiological study on the risk of radiation-related lens opacities among interventional physicians in Germany. In a regional multi-centre pilot study associated with a European project, we tested the recruitment strategy, a European questionnaire on work history for the latter dosimetry calculation and the endpoint assessment. 263 interventional physicians and 129 non-exposed colleagues were invited. Questionnaires assessed eligibility criteria, risk factors for cataract, and work history relating to occupational exposure to ionising radiation, including details on type and amount of procedures performed, radiation sources, and use of protective equipment. Eye examinations included regular inspection by an ophthalmologist, digital slit lamp images graded according to the lens opacities classification system, and Scheimpflug camera measurements. 46 interventional (17.5%) and 30 non-exposed physicians (23.3%) agreed to participate, of which 42 and 19, respectively, met the inclusion criteria. Table shields and ceiling suspended shields were used as protective equipment by 85% and 78% of the interventional cardiologists, respectively. However, 68% of them never used lead glasses. More, although minor, opacifications were diagnosed among the 17 interventional cardiologists participating in the eye examinations than among the 18 non-exposed (59% versus 28%), mainly nuclear cataracts in interventional cardiologists and cortical cataracts in the non-exposed. Opacification scores calculated from Scheimpflug measurements were higher among the interventional cardiologists, especially in the left eye (56% versus 28%). Challenges of the approach studied include the dissuading time investment related to pupil dilatation for the eye examinations, the reliance on a retrospective work history questionnaire to gather exposure-relevant information for dose reconstructions and its length, resulting in a low participation rate. Dosimetry data are bound to get better when the prospective lens dose monitoring as foreseen by 2013 European Directives is implemented and doses are recorded.

In long-standing keratoconjunctivitis refractory to treatment, special attention should be paid to the possible presence of molluscum contagiosum, particularly in children and the lesions should be promptly removed.

A healthy 13 year old boy presented with swelling of the left eyelid that had been gradually enlarging over the previous 2 days. After raising the upper eyelid visual acuity was 0.8, and ocular motility was unremarkable. On the following day-after initiation of an oral antibiotic treatment-visual acuity decreased to 0.63, and there was a restriction in upward gaze of the left eye, indicating the presence of an inflammatory orbital complication (orbital cellulitis). This can occur in 3 to 4% of children with acute rhinosinusitis and is an emergency that is potentially fatal (sinus vein thrombosis, meningitis). Initially it is important to differentiate between pre-and postseptal disease by means of imaging, motility testing, and pupillary reaction. Eyelid swelling without elevated temperature can also be a sign of an orbital complication, and in cases of functional monovision, diplopia may not be noticed. Orbital cellulitis can be caused by dacryocystitis, sinusitis, or trauma. The diagnosis has to be confirmed by checking for inflammatory parameters, performing magnetic resonance imaging/computed tomography, and-in case of elevated temperature-blood culture for a specific intravenous antibiotic therapy. Interdisciplinary collaboration between the departments of pediatrics, otorhinolaryngology, and ophthalmology is of utmost importance in these patients.

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