Purpose To describe the clinical, immunohistochemical and prognostic features, as well as outcomes of a large series of patients with orbital and periorbital diffuse large B-cell lymphoma (DLBCL). Design This study is a multicentre, retrospective non-comparative consecutive case series. Methods The setting for this study was institutional. A total of 37 consecutive patients identified from the institutions' databases with periorbital and orbital DLBCL were enrolled in the study. A retrospective chart review was used for observation. The main outcome measures were patient demographics, clinical features, imaging, immunohistochemical and histopathological data, treatments administered, and survival. Results A total of 20 out of 37 cases (54.1%) represented localised periorbital disease (group L), 11 of 37 (29.7%) had systemic disease at presentation with periorbital disease (group S1), and 6 of 37 (16.2%) had previous history of systemic lymphoma (group S2). In all, 28 out of 30 (93.3%) patients were CD20 þ , 5 of 25 (20%) were CD3 þ , and 11 of 11 (100%) were CD79a þ (varying denominators reflect the different numbers of patients tested). A total of 25 out of 32 patients (78.1%) received chemotherapy, 14 (43.8%) received rituxmab plus chemotherapy, and 19 (59.3%) received radiotherapy. Nine deaths occurred, one in group L (not lymphoma related), six in group S1, and two in group S2. Five-year Kaplan-Meier survival estimates were 55.9% for all cases, 90.9% for group L, 36.0% for group S1, and 0% for group S2. One-year progression-free survival estimates in groups S1 and S2 combined were 58.3% for patients treated with rituximab and 28.6% for those who were not. Conclusions To our knowledge, this report represents the largest series of patients with periorbital and orbital DLBCL in the literature. The difference in survival between groups L, S1 and S2 was striking, reflecting the grave prognosis of systemic DLBCL, but conversely the relatively optimistic outlook for patients with localised disease. Rituximab plus chemotherapy may be associated with increased survival.

As in other studies women had narrower canals than men. Surprisingly we found no difference between New Zealand Maori and Caucasian. Unexpected was the larger diameter in Pacific People, as they have a higher incidence of dacryocystorhinostomy surgery. PANDO is likely to be of multifactorial aetiology and nasolacrimal canal diameter may not be a significant factor. Our described method of measuring canal diameter by CT scan is comparable to a cadaver study.

Application of sunscreen is a widely used mechanism for protecting skin from the harmful effects of UV light. However, protection can only be achieved through effective application, and areas that are routinely missed are likely at increased risk of UV damage. Here we sought to determine if specific areas of the face are missed during routine sunscreen application, and whether provision of public health information is sufficient to improve coverage. To investigate this, 57 participants were imaged with a UV sensitive camera before and after sunscreen application: first visit; minimal pre-instruction, second visit; provided with a public health information statement. Images were scored using a custom automated image analysis process designed to identify areas of high UV reflectance, i.e. missed during sunscreen application, and analysed for 5% significance. Analyses revealed eyelid and periorbital regions to be disproportionately missed during routine sunscreen application (median 14% missed in eyelid region vs 7% in rest of face, p<0.01). Provision of health information caused a significant improvement in coverage to eyelid areas in general however, the medial canthal area was still frequently missed. These data reveal that a public health announcement-type intervention could be effective at improving coverage of high risk areas of the face, however high risk areas are likely to remain unprotected therefore other mechanisms of sun protection should be widely promoted such as UV blocking sunglasses.

Trans-scleral contact diode laser cyclophotocoagulation (TCDLC) appears to be a relatively safe and effective method of Eye (2001) 15, 453-457

The use of a pledget cellulose sponge to deliver mydriatics prior to cataract surgery is as effective as the conventional method of repeated drop administration and was not associated with any adverse effects.

Background: Lymphomas of the lacrimal sac are rare, accounting for less than 10% of lacrimal sac malignant tumours. They may present with symptoms typical of secondary acquired nasolacrimal duct obstruction and are thus often misdiagnosed. Methods: Case series and literature review. Results: Herein we describe 3 cases of chronic lymphocytic leukaemia (CLL)/small-cell lymphocytic lymphoma (SLL) of the lacrimal sac with immunohistochemical and in 1 case molecular confirmation. Conclusion: Lymphomas of the lacrimal sac should be suspected in patients with known CLL presenting with epiphora and dacryocystitis. During dacryocystorhinostomy, an incisional biopsy of the lacrimal sac is essential for confirming CLL/SLL involvement and may guide treatment.

Many moisturisers contain sun protection factors (SPF) equivalent to those found in sunscreens. However, there is a lack of research into how SPF moisturiser application compares to sunscreens in terms of coverage achieved and protection afforded. Previously we demonstrated that users incompletely covered their eyelid regions during routine sunscreen application. Here, we aimed to determine if SPF moisturiser users also displayed these tendencies. A study population of 84 participants (22 males, 62 females, age 18–57) were exposed to UV radiation and photographed using a tripod mounted UV sensitive DSLR camera on two separate visits. At visit one, images were acquired before and after applying either SPF30 sunscreen or moisturiser, then at visit two the study was repeated with the other formulation. Images were processed for facial landmark identification followed by segmentation mapping of hue saturation values to identify areas of the face that were/were not covered. Analyses revealed that application of moisturiser was significantly worse than sunscreen in terms area of the whole face missed (11.1% missed with sunscreen compared to 16.6% for SPF moisturiser p<0.001 paired t-test). This difference was primarily due to decreased coverage of the eyelid regions (14.0% missed with sunscreen, 20.9% moisturiser, p<0.001). Analysis of a post-study questionnaire revealed participants to be unaware of their incomplete coverage. Secondary analyses revealed improved coverage in males (p = 0.05), and, with moisturiser only, in participants with darker skin tones (p = 0.02). Together these data indicate that, despite potential advantages in terms of increased frequency of application of moisturiser, the areas of the face that are at higher cancer risk are likely not being protected, and that participants are unaware that they are at risk. As such, alternative sun-protection strategies should be promoted.

Aim: To compare the Sbisa bar (Bagolini filter bar) with neutral density filters (NDF) in quantifying relative afferent pupillary defects (RAPD). Methods: 11 patients with a RAPD were graded and a neutral density filter bar was used to quantify the RAPD. This was repeated using the Sbisa bar. The Sbisa bar (Bagolini filter bar) is used by orthoptists to quantify density of suppression in amblyopia and is of a similar construct to NDFs. Before this clinical part of the study the luminance for each filter was measured, which enabled a direct comparison to be made. Results: In the analysis of patients with RAPD a high correlation was found when comparing the Sbisa and NDF bars r = 0.95. This was statistically significant (p = <0.001). Correlation was also high when the luminance values for the filters were substituted for the clinical readings (r = 0.92; p=<0.001). Conclusion:The Sbisa bar is a comparable instrument to the NDF bar in measuring RAPD. Its availability in the clinical situation makes it a practical choice.