To assess the need for eye care in children and adolescents with severe mental deficiency, a cross-sectional study of the prevalence and causes of ocular defects amongst these individuals was conducted. Two hundred and sixty residents in a mental handicap unit were examined from January 1992 to June 1993. It was found that there was an unusually high prevalence of severe visual impairment (25%), refractive errors (24%), squint (8%) and a number of organic ocular diseases (8%). All the patients studied were non-verbal and 18% of them were deaf. Only 23 patients could walk. The results emphasize the need for establishing an efficient system to provide regular ophthalmic care for children with severe mental deficiency.

Ten consecutive cases of severe unilateral congenital ptosis were surgically corrected before 1 year of age (range 3-11 months) in an attempt to achieve early functional and cosmetic improvement. In all cases, a frontalis suspension using Mersilene mesh was performed. With a mean follow-up of 40.3 months (range 33-54 months), all patients achieved normal or near normal eyelid position and all had their chin-up head posture resolved. One patient developed a mild exposure keratitis that was treated successfully with topical antibiotics and lubricants. Our findings suggest that the Mersilene mesh sling has good potential for ptosis management in infants who are too young for fascial harvesting. However, a larger series with a longer follow-up period is required before the eventual safety and efficacy of the Mersilene mesh sling can be properly ascertained.

We performed a prospective study using the palmaris longus tendon as the sling material to correct 8 consecutive ptotic eyelids in 7 adults. All operations were done with the patient under local anaesthesia by a single surgeon (D.S.C.L.). With a mean follow-up period of 14 months (range 2-20 months), all the ptotic eyelids were well corrected with no recurrence, intraoperative or post-operative complications. Use of the palmaris longus tendon as an alternative to fascia lata for sling surgery in adults is recommended.

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