SUMMARY Histological examination of 99 human lacrimal glands showed a relationship between atrophy of the secretory acini and secretory duct obstruction, ascending periductal fibrosis, and obliteration of the adjacent blood vessels caused by lymphocytic and polymorphonuclear inflammation. Investigation of the subgroups of the B lymphocytic series by immunohistochemistry did not show any statistical change with age, sex, fibrosis, or lymphocytic inflammation. The concept of senile atrophy occurring as a result of senescent involution of the lacrimal gland is challenged on the basis of the histological findings.Keratoconjunctivitis sicca in the elderly population is widely considered to be due to senescent involution of the lacrimal gland. '`This degeneration has been termed 'senile atrophy" to distinguish the condition from atrophy secondary to Sjogren's syndrome, infection, and malignancy. Although arteriosclerosis45 and inflammation"7 were formerly considered to be important causative factors, various clinical reports8" have recently stressed the need for further contemporary histological studies of age related changes in the lacrimal gland.This study of the human lacrimal gland was carried out in order to define the nature and prevalence of fibrosis, acinar atrophy, and duct pathology. The original hypothesis was that, if a low intensity inflammatory process had caused these changes, there might be alterations in the relative frequency and distribution of the subgroups ofthe B lymphocytic series.Accordingly this component of the immune system was investigated by means of immunohistochemistry. Materials and methodsLacrimal gland tissue was obtained from two exenteration specimens and 97 post-mortem examinations of patients in a general hospital. Two-thirds of these specimens were used in a previous study.3 The patients were randomly selected, and cases were excluded from the study only if the quality or quantity of the material did not permit histological grading of the degree of fibrosis.The lacrimal gland was removed from one or both sides within 24 hours post mortem either via the orbit or by the conjunctival route. The tissue was fixed in cacodylate gluteraldehyde 2-5% or buffered formalin and embedded in paraffin. Sections were stained with haematoxylin and eosin, and Unna-Pappenheim technique, and the immunoperoxidase technique for immunoglobulins and macrophages "' (Dakopatts A/S). Without prior knowledge of the age, sex, and cause of death the pathological material was categorised according to the degree of fibrosis, duct pathology, and acinar atrophy. When both glands had been removed, quantitative assessment was carried out on only one specimen, which was chosen at random. This was because prior examination had revealed no significant differences between the two sides.The

Purpose To review recent advances in the diagnosis and treatment of congenital vascular malformations of the retina and choroid. Methods Review of the current literature on retinal haemangioblastoma, racemose haemangiomatosis, retinal cavernous haemangioblastoma, circumscribed choroidal haemangioma, and diffuse choroidal haemangioma. Conclusion The management of patients with congenital vascular lesions of the retina and choroid is advancing rapidly through recent developments in genetic testing, ocular imaging, and treatment. Most are associated with systemic disease, which may be lifethreatening. New therapeutic methods such as Verteporfin photodynamic therapy and antiangiogenic therapy have significantly improved the treatment of retinal and choroidal angiomas and vascular malformations. Ophthalmologists have a major role in detecting and diagnosing these tumours and in providing long-term care in collaboration with a specialist in the field.

SUMMARY S-100 protein is a 21 000 dalton acidic calcium-binding protein present in ocular melanomas and some normal ocular tissues. Ocular fluids and extracts of ocular tumours were examined by a sensitive radioimmunoassay that could detect less than 5 ng of S-100 protein in minute volumes of fluid. Three ocular melanoma biopsy specimens had S-100 protein at levels between 25 and 1300 ng/ml, comparable to that found in a cutaneous melanoma biopsy specimen (1000 ng/ml). (SI conversion: ng/ml= [tg/l.) Six melanoma culture lines had 1000 to 125 000 ng/ml.Four lymphoblastoid cultures had less than 2 ng/ml, and three colon carcinoma cultures had 180 ng/ml. Subretinal fluid from 23 melanoma-containing eyes had 10 to 76 800 ng/ml. Lesser amounts were found in eyes with small, anteriorly located, lightly pigmented tumours. Vitreous from 3 melanoma-containing eyes had 10 000 to 11 000 ng/ml. Vitreous obtained from three eyes during tractional retinal detachment repair had 500 to 1600 ng/ml, and vitreous obtained at necropsy from six normal eyes had 2 to 120 ng/ml. Aqueous from six melanoma-containing eyes had 10 to 30 ng/ml, levels not significantly different from those observed in three normal eyes (80-120 ng/ml

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This case illustrates that deferring the treatment of a choroidal melanoma presenting during pregnancy can be a reasonable treatment plan, if the patient is highly motivated to keep the eye.