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Orbital cellulitis following sub-Tenon's anaesthesia H Dahlmann et al 200Eye TGF-␤, which are known to induce expression of ␣E␤7 on IELs. 9 This may be another reason why IELs are present throughout all the layers of the dysplastic epithelium but only along the basal cells of normal conjunctival epithelium.We did not notice any definite relationship between the degree of dysplasia and E-cadherin expression. These findings contrast to observations made with cervical intraepithelial neoplasia where reduced Ecadherin expression related to an increasing loss of cell differentiation. 10 The observations made in this study with regard to E-cadherin suggest that the distribution of IELs in normal conjunctiva and CIN cannot be explained by the distribution of E-cadherin alone.

SUMMARYThree cases are reported which had features similar to, and evolved in a pattern consistent with central retinal vein occlusions and a fourth case is reported which behaved as a hemispheric vein occlusion. However, they differed from classic retinal vein occlusions by having prominent sheathing of the retinal venous vasculature at presentation, which in all four cases resolved within three weeks. There was no evidence for any of these cases having an inflammatory vasculitis. The significance of this transient sheathing is uncertain.Three cases are reported of a condition that behaved like ischaemic central retinal vein occlusion (CRVO) and a fourth with a similar appearance, but with the features of a hemispheric vein occlusion. They all differed from classic retinal vein occlusions by their striking fundal appearance at presentation, with sheathing of the walls of the involved retinal venous system. Sheathing of retinal vessels is a recognised late phenomenon in both central and branch retinal vein occlusions, but is not a recognised feature at presentation in the absence of inflammation.Such a fundal appearance at presentation suggests a dif ferential diagnosis of retinal vasculitis, reticulum cell sar coma, frosted branch angiitis or papillophlebitis. However, the sheathing resolved within three weeks and otherwise the features and clinical course were similar to retinal vein occlusions. PATIENTS Case OneA 23-year-old man presented to casualty with a one-day history of blurring of vision in his left eye. Two months previously he had had a vesicular rash of uncertain cause that affected his back, arm and legs. This had cleared within a week without obvious sequelae. Two weeks Eye (1992) 6, 313-316 before presentation he had noted a blind spot in the tem poral field of his left eye, which had lasted for one day and had resolved.The vision was 6/5 in the right eye and 6/60 in the left eye with a afferent pupillary defect. There were cells+ in the anterior chamber and fine keratic precipitates were noted. There were no cells in the vitreous. The intraocular pressures were normal in both eyes. The dramatic findings were on fundal examination (see Fig. la). All the retinal veins showed sheathing with the tributary venules termi nating in retinal haemorrhages. The optic disc was swol len and there was pronounced cystoid macular oedema. There were also widespread scattered retinal haemor rhages. A few cells only were noted in the anterior vitreous.Fluorescein angiography at this stage showed diffuse venous leakage and macular oedema (Fig. lb).Full assessment was performed by a general physician and no evidence of a systemic disorder, particularly Beh get'S disease or sarcoidosis, could be found on history, full physical examination or investigation, which included full blood count, biochemistry profile, autoantibody screen (including ANA and ANCA) , immunology, virology (including herpes viruses), SACE, VDRL, chest radio graph and urine analysis. A CT scan of his sinuses and orbits showed normal enhancement an...

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