SUMMARY Seventy-one patients presenting with acute herpes zoster ophthalmicus were followed up for six months for a prospective analysis of the natural history of the disease. Acute and chronic ocular complications, nasociliary nerve Standardised assessment forms were completed at presentation and at subsequent visits. Pain was assessed by visual analogue scale (VAS). The patient was asked to look at a 100 mm horizontal line with a zero at one end and three pluses at the other, with the instruction that the latter represented the worst pain he could possibly imagine. He was then asked to indicate with a mark along the line the severity of any pain being experienced at the time of the interview, and a measurement was taken in millimeters. At subsequent interviews a fresh line was presented. Ocular involvement, nasociliary nerve (NCN) involvement at presentation, rash severity, and duration were also assessed.Assessment of pain by a VAS has been shown to be reproducible for the same individual and a method that allows reliable statistical analysis.6 Like all pain assessment it is subjective, and hence direct comparisons between patients cannot be made. However, 353
SHORT REPORTS Relief of acute pain in herpes zoster ophthalmicus by steliate ganglion block Stellate ganglion block has been suggested as a useful treatment for trigeminal herpes zoster,'4 being most effective if started within two weeks of the onset of the disease.' We evaluated the efficacy of this treatment in a randomised prospective controlled study for the first time and assessed its complications.
SummaryDiplopia in the inferior field due to orbital trauma is a notoriously difficult and dis abling problem. Even if a blow-out fracture is repaired by current methods, patients may still have diplopia. There also exists another group in whom no demonstrable radiological fracture can be found, and yet there is a severe down gaze deficit.The possible mechanisms of this phenomenon are discussed and the results of hori zontal muscle transpositon surgery in a series of nine patients is reported.The authors conclude that this procedure is a valuable method of increasing the useful field of binocular single version in these patients.
Eight centres throughout the United Kingdom cooperated with a prospective evaluation of the accuracy of surgery for horizontal strabismus. The eight centres were divided into four with a specialist interest in strabismus and four offering a general ophthalmic service. Each participating surgeon was asked to indicate the anticipated outcome of surgery and, thereafter, orthoptic examinations were made postoperatively to determine the actual outcome. Two hundred and five cases were included in the study and it is hoped the results will serve as useful guidelines for those departments wishing to undertake audit oftheir own strabismus surgery. There was no statistically significant difference in the accuracy of surgical alignment achieved by strabismus specialists and general ophthalmologists. (BrJ Ophthalmol 1995; 79: 10-11)
SummaryThirty-one consecutive patients were treated with injections of Botulinum Neu rotoxin A to rectus muscles for strabismus following retinal detachment surgery. In 14 cases the presenting problem was diplopia and in 17 cases the presenting problem was cosmetic appearance. A total of 67 injections was given. Twenty-seven cases had nine months or more follow-up. Of these, four of 11 cases with diplopia had fusion restored, four were shown to have no fusion potential, and three had temporary improvement only. In 16 cases with a primary cosmetic problem there was no useful effect in two, three had surgery as an alternative, three were realigned long-term, and eight had continuing maintenance therapy with toxin. Over half the series had undergone multiple detachment surgery, often for giant tears and other complex pathology.Ocular motility problems following retinal detachment surgery are not uncommon.Retrospective studies1--l have shown an inci dence of up to 14% of post -operative motility dysfunction, while prospective studies have shown an even higher incidence with up to
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