In this first ever longitudinal study it was found that assessment of lid position in ICU patients is the single most important observation to be carried out. A management algorithm derived from this evidence is based on daily observation and selective lid taping and shows encouraging early results.

Data relating to 3313 adenovirus isolates from patients in Greater Manchester, UK between 1982 and 1996 were analysed using chi2 tests and 95% confidence intervals. Of the 3098 isolates that were typed, 18.6% were serotype 2, 14.9% serotype 3, 12.1% serotype 1 and 10.9% serotype 41. There was evidence of a seasonal occurrence of serotype 7 (March-August), serotype 2 (January-April), serotype 4 (June-August) and subgenus F (September-November). Children less than 5 years old were the most common group of patients with adenovirus infection (61.3%) compared to 24.2% for adults and only 5.6% for school children (5-15 years). Gastric symptoms were the most common amongst infants (47.6%) followed by respiratory (27.5%) and general symptoms (12.9%). In adults, the overwhelming clinical condition was conjunctivitis (88.9%). Despite the traditional association with adenoviruses, remarkably few cases of pharyngoconjunctival fever were recorded (1.7%).

The proposed eye care algorithm appears to be effective in preventing ocular surface abnormalities in the sedated and unconscious patients in the ICU, and efficient in that it may reduce the workload required for critically ill patients.

We present 7 cases of canalicular involvement with Actinomyces collected over a 5-year period. All patients had involvement of one canaliculus, upper or lower, with lacrimal drainage patent to syringing. Curettings obtained by incising the involved canaliculi yielded Actinomyces species (5 cases) and Arachnia propionica (2 cases), typically in association with a mixed bacterial growth. Our results show that these patients often remain undiagnosed for months or even years, and are treated inappropriately for their recurrent symptoms. Despite sensitivity of Actinomyces to a broad spectrum of antibiotics, medical therapy alone does not eradicate the disease, and surgical evacuation of all concretions is essential to achieve a cure.

We report five cases of severe eye injury sustained in cricket, including retinal detachment and rupture of the globe. The eye is at particular risk from a rising ball. We comment on the need for appropriate facial protection for batsmen and close fielders.

The outcome of 50 surgical procedures in 41 patients who were anticoagulated at the time of surgery were reviewed to determine whether anticoagulation was associated with an increase in ophthalmic morbidity. Twenty-seven patients were receiving warfarin and 14 patients nicoumalone. The International Normalised Ratio (INR) was determined immediately prior to surgery and ranged from 1.1 to 4.9. Thirty-nine operations were performed under local anaesthetic and 11 under general anaesthetic. Thirty-three patients had extracapsular cataract extractions with posterior chamber lens implantation. No major haemorrhagic complications were associated with the local anaesthetic or the surgical procedure. Patients on anticoagulation therapy are at risk of life-threatening complications if their anticoagulation is stopped or reduced. This study demonstrates that most ophthalmic surgical procedures can be safely performed whilst the patient is therapeutically anticoagulated.

SUMMARYSerum antibodies to the cornea were investigated in patients with peripheral ulcerative keratitis (PUK) in iso lation or in association with a systemic disease (rheu matoid arthritis or Wegener's granulomatosis). Indirect immunofluorescence on bovine corneal sections demon strated that antibodies bound to epithelial antigens in two distinct patterns: a lattice-like pattern, probably staining intercellular membrane antigens, and a diffuse pattern covering the entire surface of the epithelium. Both pat terns were associated with PUK rather than systemic disease whilst the presence of the lattice pattern was more associated with the onset of the PUK. Immunoblotting of sera to corneal epithelial protein extracts demonstrated that a number of corneal antigens were targeted by anti bodies. 1\vo antigens, 54 kDa and 70 kDa, were of par ticular interest. Antibodies to the 54 kDa antigen, the major corneal-specific antigen, were also detected by enzyme-linked immunosorbent assay (ELISA). Longi tudinal studies showed that these antibodies often first occurred after an episode of PUK. Antibodies to the 70 kDa antigen were related to the Wegener's granu lomatosis rather than the PUK.Peripheral ulcerative keratitis (PUK) or corneal melt is a rare but sight-threatening condition which may occur either in isolation or in association with a systemic disease, which is usually an immunologically mediated disorder.l-4 The pathogenesis of PUK remains poorly understood but there is evidence for an autoimmune aetiology both in this condition and in other types of per ipheral corneal destructive disease. Circulating antibodies to both corneal and conjunctival epithelium have been

SUMMARYPoor systemic absorption has limited the, efficacy of early oral acyclovir in herpes zoster ophthalmic us (HZO).Aqueous humour levels are substantially higher if the drug is administered topically to the eye. A multicentre open randomised study was performed to compare the ocular prophylactic effects of topical and oral acyclovir.Fifty-seven patients with HZO within 72 hours of the onset of rash received either topical acyclovir ointment or 800 mg oral acyclovir, both 5 times daily for 7 days, and were followed for 12 months. Patients receiving ointment were significantly more likely to have ocular complica tions (p<0.02) and anterior uveitis was significantly more frequent (p<0.01) and severe (p<0.0l). Corneal hypo aesthesia was significantly more frequently (p<0.05) and severe (p<0.02) at 1 month. From 2 weeks patients receiv ing ointment were more likely to have pain and at all times their pain was more severe, but these differences wer� not statistically significant. In spite of its apparently better penetration topical acyclovir appears to have no prophylactic value in the management of early HZO.Herpes zoster is the commonest disease of the nervous system. Prevalence increases with age and it has been esti mated that each individual has a 50% risk of being affected by age 85 years and a I % chance of being affected twice. 1 Of affected cases 10-17% are ophthalmic, and this is the second commonest site after thoracic dermatomes.1,3Ocular complications at some time after the onset of rash occur with a frequency of around 50% in herpes zoster Qphthalmicus (HZO), with activity persisting for 6 months or more in up to 28% of initially affected eyes.4 Incidence and severity of ocular complications are not related to age, sex or severity of rash, but involvement of the external division of the nasociliary nerve is signifi cantly associated with the development of ocular compli cations. Complications in HZO are varied,4-R with anterior uveitis being the commonest followed by varieties of kera- Eye (1994) 8, 688-691 © 1994 Royal College of Ophthalmologists titis. Onset of acute ocular complications ranges between 7 and 28 days. Up to 93% of patients with HZO experience acute pain.4 Chronic pain occurs in up to 34%,1,1,4,9,10 becoming more frequent with age and rising to 71 % in those aged 80 years and over.4Management of HZO remains controversial. Recent attention has centred on the role of antivirals and in par ticular acyclovir in management and prophylaxis. There is also a role for topical steroids but the precise relationship between these two therapeutic options remains unclear. 1 1, [ 1 Two studies have reported prophylactic effects in the eye of oral acyclovir in HZO provided it is commenced within 72 hours of the onset of rash.13.14 Results were somewhat conflicting, with one study show ing an early [ J and one a late effect. [4 A retrospective case control investigation failed to detect a significant thera peutic effect. [5 Double-masked placebo-controlled studies on the effect of acyclovir on pain ...