In all, 67% were nodular BCC and 45.4% located in the lower eyelid. The main outcome measure was the recurrence rate. None of the patients with primary nodular BCC suffered recurrence. The recurrence rate for primary morphoeaform BCC following complete excision is 3.8%. In total, 8.1% of patients had several lesions simultaneously whereas 7.8% patients had BCC in multiple locations subsequently (metachronous). Three patients who had previously recurrent BCC (rBCC) treated elsewhere or not using this method had orbital/lacrimal drainage system involvement requiring exenteration. Conclusion We recommend that patients with a single, completely excised primary solid or nodular BCC can be discharged after one 6-monthly review, although they should be instructed to monitor for the development of further lesions. The incidence of recurrence for primary morphoeaform BCC is 3.8% and for rBCC is 3.6% over 5 years and these patients should stay under review for this period.

A wide range of disease process involve the lacrimal gland/fossa. In this pictorial review, we use histology-proven cases to illustrate conditions that affect the lacrimal gland/fossa. CT and MRI features of neoplastic, inflammatory, infiltrative, and developmental conditions are discussed.

Introduction There is lack of consensus among Primary Health Care Trusts (PCTs) and health insurers on how to reimburse ptosis surgery and upper lid blepharoplasty, as these procedures can be regarded as cosmetic. Standardised photographs are expensive and difficult to achieve, whilst the routine 24-2 visual field lacks the range to detect visually significant superior field defects. Aim To introduce a modified visual field designed to assess the functional disability associated with ptosis and dermatochalasis and to demonstrate the effectiveness of surgery in improving the visual field. Methods Patients who had surgery for ptosis or dermatochalasis between January 2006 and December 2009 were prospectively invited to perform a modified visual field test pre-and post-operatively. Results In total, 97 patients amounting to 194 eyes were included in the study. Ninety five eyes had aponeurotic repair with or without blepharoplasty and 77 eyes had blepharoplasty alone. This modified test has a sensitivity of 98.8% of detecting ptosis. For patients who underwent ptosis surgery with or without blepharoplasty, 84.2% recorded an improvement in points seen with the test and 81% recorded an improvement in visual field height. For those who had blepharoplasty alone, 90.9% recorded an improvement in points seen in the modified visual field test and 80.6% had improvement in visual field height. Conclusion Our modified visual field assessment is a quick and easy way to assess patient disability associated with ptosis and dermatochalasis. Surgery improves the demonstrated defect, confirming that ptosis and dermatochalasis can be considered a functional rather than cosmetic issue.

Background Necrotising fasciitis is an uncommon but life-threatening soft tissue infection characterised by rapidly spreading inflammation and necrosis of skin, subcutaneous fat and fascia. Left untreated, the mortality can be more than 70%. Early surgical intervention can reduce morbidity and mortality. Patients and methods This is a series of 11 patients who presented to our oculoplastic and orbit unit with periocular necrotising fasciitis over a period of five years. We present the modes of presentation, predisposing factors, diagnosis, and the multidisciplinary team management of these patients. Results Of the 11 patients, 1 patient died and 2 patients required intensive care management. Of the 10 surviving patients, 8 patients needed further surgical interventions for correction of complications, like eyelid malposition, ptosis and protective or corrective surgery in the form of ectropion correction, skin grafting and other rehabilitative procedures. Conclusion To the best of our knowledge, this is the largest series of periocular necrotising fasciitis in the literature. Necrotising fasciitis is a potentially fatal condition, resulting in a high rate of mortality and morbidity. Early surgical intervention reduces the mortality. A high index of suspicion is needed to make a prompt diagnosis. These patients need expeditious intervention and may require a long follow-up and subsequent surgery for complications related to scarring and other sequelae.

The hydroxyapatite orbital implant was first released for use as an orbital implant in humans in August 1989. It has been shown to be well tolerated, providing good motility of the artificial eye with a low complication rate when used as a primary implant. This prospective study evaluated the hydroxyapatite orbital implant used as both a primary and a secondary implant. Sixty patients were implanted between October 1992 and November 1994, 28 being implanted as a primary procedure at the time of enucleation or evisceration, and 32 as a secondary procedure. Seven patients underwent second-stage drilling and pegging of the implant. The mean follow-up time was 13 months (range 2-26 months). A standardised operative and post-operative protocol was followed. The patients were evaluated post-operatively for the amount of enophthalmos, degree of upper lid sulcus deformity, motility of the prosthesis, location of the implant in the socket, socket status and the presence or absence of discharge, position of the drill hole and coverage of the implant. Complications and their management were documented. Both patient and surgeon made a subjective assessment of cosmesis and the patient's satisfaction with the overall result was noted. The results of this study show the hydroxyapatite orbital implant to provide excellent motility of the artificial eye and good cosmesis with a low rate of complications when used both as a primary and as a secondary implant.