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Monosymptomatic patients with MRS require a high index of suspicion. Histopathological confirmation is vital for the diagnosis.

Orbital floor blowout fractures in the pediatric population have a high incidence of muscle entrapment that must be recognized and treated early to avoid muscle necrosis and permanent ocular restriction from fibrosis. Medial orbital wall fractures with entrapment are rare, but early recognition and operative release of the entrapped muscles result in better outcomes.

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Four patients with malignant melanoma of the eyelid skin and 14 patients with conjunctival malignant melanoma are presented. Surgery was recommended for eyelid lesions and local excision followed by cryotherapy for conjunctival lesions. One patient with an eyelid skin malignant melanoma died and two patients with extensive malignant melanoma of the conjunctiva died. Nodular lesions involving the lid margin have the worst prognosis of eyelid skin malignant melanomas, and the greater the extent of conjunctival involvement the worse the prognosis for conjunctival malignant melanomas. The complications of cryotherapy are minor, but the follow-up period in this series is too short to comment on survival times.

Twenty two patients with primary congenital lid retraction affecting either the upper or lower eyelids or both are presented. The clinical features and management are discussed in the hope that recognition of this clinical entity will prevent unnecessary investigation. Eyelid retraction is usually secondary to thyroid disorders, trauma, proptosis, seventh nerve palsy, or neurological abnormalities affecting the third nerve. Primary congenital lid retraction has been described only relatively rarely as individual case reports.'-It is not well recognised as a clinical entity, and so individual patients may be investigated unnecessarily and the diagnosis not considered.7 This report reviews the findings in 22 patients with congenital lid retraction affecting either the upper or lower eyelid.

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