Aims To describe the clinical characteristics of patients with eyelid cancers in Taiwan. Methods Between 1980 and 2000, 127 (58 males and 69 females) patients (mean age 62.6; range 10-91 years) with histologically confirmed eyelid cancers were retrospectively evaluated at the National Taiwan University Hospital and Far Eastern Memorial Hospital in Taiwan. Clinical data of all patients were reviewed from medical records. The mean follow-up period was 62.4 months (range 3-240) for 113 patients. Results The 127 eyelid cancers included 79 basal cell carcinomas (62.2%), 30 sebaceous gland carcinomas (23.6%), 11 squamous cell carcinomas (8.7%), five malignant melanomas (3.9%), one Kaposi's sarcoma (0.8%), and one metastatic cancer (0.8%). Tumours developed more commonly in the lower (37.0%) than the upper eyelid (33.9%). The clinical accuracy in predicting eyelid malignancy was 90.5%. Primary treatment modality was mainly surgical excision. The recurrence, metastasis, and mortality rates at 5 years were 15.2, 11.7, and 7.3%, respectively, for all eyelid malignancies. Rates of sebaceous gland carcinoma recurrence, metastasis, and mortality were significantly higher (Po0.05) than those of basal cell carcinoma. The mean interval of recurrence or metastasis after primary treatment was 26.3 months (range 4-112) for all eyelid cancers. Conclusions Although basal cell carcinoma is the most common eyelid cancer in Taiwan, sebaceous gland carcinoma is also common. Of the two, basal cell carcinoma has a better prognosis and sebaceous gland carcinoma has a higher mortality and therefore should be treated much more aggressively. Long-term follow-up is needed after treatment of malignant eyelid tumours.

Background: The objective was to examine the incidence of optic neuritis in Taiwan. A 5-year longitudinal, nationwide, population-based study was conducted. The participants were a random sample of 191,761 subjects, or about 1% of the enrollees in the National Health Insurance program of Taiwan. Methods: We identified subjects who had at least 1 service claim for ambulatory or inpatient care with a principal diagnosis of optic neuritis between 2000 and 2004. We calculated and statistically analyzed the rates of optic neuritis. The main outcome measures were the incidence rates of optic neuritis. Results: From 2000 to 2004, the total cumulative incidence was 1.33 per 1,000 (1.00 vs. 1.67 for male vs. female subjects; p < 0.001, χ² test). The cumulative incidence rates for the age groups of 0–19, 20–39, 40–59 and ≧60 years were 0.33, 1.05, 2.16 and 2.81 cases per 1,000, respectively. Among the subjects aged 40–59 years, the cumulative incidence was higher in women than in men (p < 0.001, χ² test). The incidence density of developing multiple sclerosis after optic neuritis was 0.41% per person-year, and the cumulative incidence of multiple sclerosis after a new diagnosis of optic neuritis was 0.78%. Conclusions: We believe our study is the first nationwide investigation of the incidence rates of optic neuritis in Taiwan. In our investigation, the cumulative incidence peaked among the subjects aged 40–59 years, especially in women. In Taiwan, patients with optic neuritis have a notably low rate of conversion to multiple sclerosis.

Optic neuritis may occur in patients with A. cantonensis meningitis. Treatment with a combination of steroid and larvicidal agents may be beneficial to these patients.

Acute demyelinating optic neuritis is a common optic neuropathy in young adults. There is usually satisfactory visual recovery. However, some patients convert to multiple sclerosis (MS) with potential sequelae of neurological disability. The Optic Neuritis Treatment Trial in the United States was conducted prospectively for 15 years and provided valuable data about clinical course, efficacy of steroid treatment, and risk of conversion to MS. Compared to the many studies in Western countries, research concerning optic neuritis in Asia has so far not been extensive. However, cumulative evidence shows that various features of this disorder differ between patients of Caucasian and Oriental descent. In this article we review up-to-date studies on optic neuritis in Asia and compare the results with prior literature. Prospective and multi-centre studies are currently underway in these regions to increase our understanding of optic neuritis in Asia.

Myasthenia gravis (MG) is an autoimmune disease involving the neuromuscular junction. Autoantibodies to the acetylcholine receptor or, less frequently, to muscle-specific kinase, attack against the postsynaptic junctional proteins, resulting in fluctuating and variable weakness of muscles. Extraocular, levator palpebrae superioris, and orbicularis oculi muscles are particularly susceptible. The majority of patients with MG present with purely ocular symptoms including ptosis and diplopia initially. About half of these patients progress to generalized disease within 2 years. The prevalence of MG in Taiwan is 140 per million with male to female ratio of 0.7. The incidence rate is higher in the elderly. Several immune-related diseases such as lymphoid malignancy, diabetes, and thyroid diseases are associated with MG in the national population-based studies in Taiwan. Ice pack test, rest test, Tensilon/neostigmine test, circulating antibody measurement, and electrophysiological studies are useful diagnostic tools with variable sensitivity and specificity. For the patients with ocular MG, acetylcholinesterase inhibitors are usually the first-line treatment. Corticosteroids and immunosuppressant could provide better disease control and may reduce the risk of conversion to generalized form although there is still some controversy. A thymectomy is also beneficial for ocular MG, especially in refractory cases. The correction of ptosis and strabismus surgery could improve the visual outcome but should be performed only in stable disease.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a condition that mainly affects the peripheral nervous system; however, the central nervous system has also been involved in rare cases. Herein, we describe the case of a 33-year-old man with CIDP who presented with progressively blurred vision and pain with eye movement in both eyes for 1 month. Ocular examination revealed reduced visual acuities of 0.15 (oculus unitas or OU) and unremarkable fundi (OU). Furthermore, bitemporal visual field defects and prolonged visually evoked potentials were evident. Brain magnetic resonance imaging revealed nothing remarkable along the optic nerve and chiasm. These findings were compatible with the diagnosis of bilateral optic neuritis. The patient's symptoms and visual acuity improved after 5 days of intravenous (IV) corticosteroid pulse therapy, which was subsequently replaced by oral prednisolone therapy with a tapering schedule. The patient's visual acuity returned to 1.0 (OU) 6 months after treatment. However, bilateral optic neuritis recurred in 7 months while the patient was on oral prednisolone and azathioprine. IV corticosteroid pulse therapy was subsequently reinitiated and the patient's visual acuity returned gradually to 1.0 (OU). Bilateral optic neuritis is a rare manifestation of CIDP. It responded well to IV corticosteroid therapy in our case.

Visual recovery was observed in most eyes with acute optic neuritis, although disc pale detectable. Patients with recurrent optic neuritis had worse visual outcome. There was a low association of optic neuritis with multiple sclerosis in our patients.

AION may occur in combined treatment of PEG-IFNalpha -2b and ribavirin for chronic hepatitis C. Patients who are candidates for this treatment should be informed about its possible occurrence.