Orbital involvement by plasma cell tumours is rare. Orbital tumours do not generally present as an acute orbital inflammatory disease in adults, though tumours such as rhabdomyosarcoma may cause clinical signs similar to an acute orbital cellulitis in children. We describe a patient with bacterial orbital cellulitis and sinusitis who was found to have an extramedullary plasmacytoma of the maxillary antrum and orbit and coexisting testicular seminoma.

A case is reported ofsecondary syphilis with ocular signs in a patient who had antibodies to human immunodeficiency virus (HIV) and hepatitis B infections and from whose urine cytomegalovirus was cultivated. Treatment with penicillin resulted in rapid recovery from his retinitis and uveitis. The case highlights the importance of testing for syphilis in all patients with HIV infection.

This unusual presentation of simultaneous bilateral involvement in a patient with herpes zoster suffering agonizing pain focuses our attention on another possible precipitating factor. Pain, possibly through increased sympathetic tone, and subsequent mydriasis might initiate a resonse resulting in angle closure in predisposed individuals.

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3 Thirty-five patients were recruited, but eleven were withdrawn during the run in period largely because of adverse effects; these became less troublesome when it was decided to give the once daily dose at 22.00 h. Four were withdrawn during the cross over, two because of inadequate IOP control. Twenty completed the trial. 4 The morning plasma concentration of acetazolamide measured each week showed no tendency to accumulation during the study. The mean swing (maximum minus minimum) in plasma acetazolamide concentration during the 24 h profile was less (P < 0.005) with the SR formulation (11.6 ± 4.9; mg I-1 + s.d.) than with the conventional (15.5 ± 4.7) but the mean concentrations over the 24 h profile were indistinguishable (P > 0.05; 9.7 ± 3.8 and 8.6 ± 2.8 respectively). 5 Satisfactory control of IOP (no more than one reading above 22 mmHg) was maintained despite the changes in formulation in all but two of the patients who entered the cross over study. No close relationship between IOP and plasma concentration of acetazolamide was found. The 24 h IOP profiles whilst receiving each of the formulations were indistinguishable; thus the smoothing of the plasma drug concentration profile achieved by the SR formulation did not reduce the amplitude of swings in IOP. Similarly, no difference was observed between the formulations with respect to adverse effects. 6 It is concluded that the SR and conventional formulations were equivalent with respect to mean plasma acetazolamide concentration, IOP control and adverse effects. The SR formulation did not show practical advantages over the conventional formulation which was equally effective even with dosage intervals of 12 or 24 h.