BackgroundSeveral recent studies have recommended that ophthalmologists must be aware of the visual sensations (and their associated anxiety/fear) experienced by patients undergoing cataract surgery. We assessed the knowledge of a group of eye doctors in Pakistan regarding these phenomena.MethodsThis was a cross-sectional survey. Eye doctors (ophthalmologists, residents and medical officers) attending the Ophthalmological Society of Pakistan Annual Conference 2011, in Karachi were invited to participate in the study. A self-administered structured questionnaire was used to examine their knowledge of visual sensations and their associated anxiety/fear experienced by patients during cataract surgery. Simple frequencies and proportions were calculated to describe the data.ResultsA total of 150 ophthalmologists, residents and medical officers were invited to participate in the study. Of these, 68 (45.3%) responded. The mean age (±SD) of the participants was 42.9 (13.2) years. The proportion of participants who thought that patients could experience visual sensations during cataract surgery under regional anaesthesia was 89.7% and that under topical anaesthesia was 73.5%. The most frequently cited sensations included: light perception, changes in light brightness, movements, instruments and surgeon’s hands or fingers.The eye doctors estimated that 38.9% and 64.3% patients would see at least something during cataract surgery under regional anaesthesia and topical anaesthesia, respectively. They also believed that 24.2%-36.9% of patients may experience anxiety/fear as a result of visual sensations during such surgery. Approximately half of the eye doctors did not think that retained vision was a source of fear or anxiety for the patients. While most of them acknowledged the importance of preoperative counselling in helping to alleviate such fear/anxiety, the majority of them did not regularly counsel their patients on what to expect during the surgery.ConclusionOur study reveals that a significant proportion of eye doctors do not have adequate knowledge of the visual phenomenon and their associated anxiety or fear, that patients can experience during cataract surgery. Targeted educational interventions are needed to increase awareness of this phenomenon among eye care professionals.

A young women developed unilateral facial neuropathy 2 weeks after a motor vehicle collision involving fractures of the skull and mandible. MRI showed contrast enhancement of the facial nerve. We review the literature describing facial neuropathy after trauma and facial nerve enhancement patterns with different causes of facial neuropathy.

Knife crimes and facial injuries Sir, knife crimes are on a steady rise in the UK producing deleterious effects on the victim, family and community. More than 5,000 recorded hospital consultations in England were noted in 2017-18 related to assault by sharp weapons (14% rise compared to 2016-17). Disturbingly, 10-17-year-olds accounted for 21% of all offensive weapon possessions. 1 The increase in the number of female offenders involved in Offensive Weapons Related Crimes (OWC) in recent years is alarming. A 23-year-old Asian female was brought in via ambulance after being stabbed with a knife on the left side of her face by another female assailant after an argument. She had also been hit with a bottle on her head during the same episode. On examination, she had a large variably deep wound of the left cheek with ragged edges measuring approximately 12 cm in length (Fig. 1). The facial nerve appeared to be intact with no global neurological deficit. The patient was admitted for a formal exploration of the facial wounds including assessment of the parotid duct. The wound was found to be just short of the duct. The area was thoroughly debrided and closed primarily. Facial injuries are a common presentation in the emergency department and quite often COMMENT