Reiter's disease, also known as reactive arthritis, is a seronegative HLA‐B27‐associated autoimmune disease, characterised by oligoarthritis of large joints with additional ophthalmic and urological manifestations. Many will recall the aide‐mémoire ‘can't see, can't pee, can't climb a tree’ from their medical school days. This article describes the history and aetiology of Reiter's disease, along with its treatment and prognosis, and reminds readers to be vigilant for its characteristic signs and symptoms.
The potential ophthalmic side-effects of commonly prescribed urological drugs have been discussed in the literature and emphasised in surgical and ophthalmological training for some time, although no clear guidelines have been established. In this article the authors provide some practical advice to assist prescribers.
Marfan’s syndrome (MFS) is an autosomal dominant connective tissue disorder where ophthalmic problems are often the presenting symptom in childhood. Diagnosis is based on established criteria outlined by expert opinion in 1996, known as the Ghent criteria. These criteria have recently been revised, and place more weight on two cardinal features of MFS: ophthalmological and cardiovascular pathology. Ophthalmologists thus have a prominent role to play in both diagnosis and lifelong care for MFS patients. This article aims to outline the presentations of ocular pathology and diagnostic challenges for aspiring ophthalmologists who will be key members of the multi-disciplinary team in future. In light of the revised Ghent classification, ophthalmology trainees must have a low threshold for investigation of a suspected MFS patient with a working knowledge of the diagnostic criteria. This will allow prompt correction of the sight threatening complications of MFS and early initiation of long- term monitoring of the life-threatening cardiovascular complications.
To report the results of skin crease preservation with a modified technique of open-sky Muller's muscle-conjunctival resection that precludes the need to reconstruct the upper eyelid skin crease with full thickness sutures.A nonrandomized, retrospective audit of 45 eyelids of 37 consecutive patients with acquired blepharoptosis, undergoing surgical correction by a single surgeon, between November 2011 and July 2014. Surgical technique involved subtotal resection of Muller's muscle plus underlying conjunctiva, under direct visualization. The stump of Muller's muscle was then reattached to the superior tarsus with buried 7-0 Vicryl. Wound closure was achieved using interrupted buried 7-0 Vicryl, without full thickness skin crease reformation. Outcomes were evaluated according to standards recommended by the British Oculoplastic Surgery Society National Ptosis survey. These included assessment of upper margin reflex distance (MRD1), skin crease, eyelid contour and symmetry and surgical complications.In total, all 45 eyelids met the outcome criteria for success. The median MRD1 increased from 0 mm preoperatively (range: -2 to 2) to 3.1 mm (range: 3-5 mm) following surgery, p value < 0.01. For patients with unilateral blepharoptosis, the average postoperative eyelid height difference between right and left was 0.17 mm (range: 0-1 mm). All patients achieved good eyelid contour and symmetry and none required reoperation as assessed at final follow up following surgery (mean 77 days, range: 24-366). Skin crease was lowered and normalized in all patients with median preoperative and postoperative measurements of 12 mm and 10 mm, respectively, p value < 0.01. Two cases (4.4%) developed early asymptomatic superficial punctate keratopathy, which resolved spontaneously by 4 weeks. Nonstandardized patient experience survey achieved high scores for overall satisfaction and likelihood to recommend treatment to friends and family, with low scores for postoperative pain and swelling.Skin Crease Preserving modified open-sky Muller's muscle-conjunctival resection is an effective technique for correcting blepharoptosis, while normalizing the skin crease.
In a world where health care specialists are increasingly aware of the need for globalised health care, and with specialists from the UK participating in charitable work in some of the most challenging environments abroad, understanding how to provide effective care in the developing world is key. In July 2014, Sonia Szamocki, a junior doctor with an interest in ophthalmology, was given the opportunity to join the Orbis Flying Eye Hospital (FEH) to the Phillippines. The FEH is a mobile teaching hospital that plays host to a fully equipped operating theatre, complete with preoperative and recovery rooms and a clinic room with slit lamps, surgical stimulators and laser equipment. In this article, Sonia reviews her experience and provides a snapshot of the challenges in the developing world in preventing avoidable sight loss.
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