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Reconstruction of full thickness, total upper eyelid defects represents a significant challenge in terms of recreating an upper eyelid which has acceptable cosmesis and a degree of dynamic function. Options include bridging, eyelid-sharing techniques (e.g., Cutler-Beard), or nonbridging techniques such as an anterior lamella-based flap combined with a posterior lamella free graft or a "sandwich flap." The success of these techniques depends on the size of the defect, postoperative cosmesis and whether or not the upper eyelid still has a degree of dynamic function to avoid ptosis and exposure keratopathy. The authors present an innervated frontalis turnover flap supporting anterior and posterior lamella grafts as a reconstructive solution for an extensive upper eyelid defect. This technique is cosmetically acceptable, preserves local tissues, and maintains a degree of dynamic function, which keeps the patient's eye comfortable and does not adversely affect visual acuity.

Primary intraorbital ectopic meningiomas are rare and their existence remains controversial. We present a 30-year-old female with painless, non-axial proptosis and a palpable superomedial mass. The MRI demonstrated that the mass had no optic nerve sheath or sphenoid wing involvement and was initially reported to have no intracranial extension. The patient was initially thought to have an ectopic orbital meningioma. Subsequent multidisciplinary team (MDT) consultation and further specialist review of the MRI revealed a subtle dural tail connecting to an enhancing mass in the olfactory groove. Biopsy revealed a WHO Grade 1 transitional meningioma with an infiltrative pattern. We argue that some previously reported cases of ectopic meningioma may lack the requisite imaging to discover the primary disease. Our report highlights the importance of MRI in this group of patients and the role of a skull-base MDT with specialist neuroradiology input to determine the true origin and extent of these extradural orbital meningiomas.

Purpose:To ascertain the level of information relating to specifi c risks desired by patients prior to cataract surgery. Setting: Dedicated cataract surgery pre-assessment clinics of 2 hospitals in South West Wales, UK. Methods: Consecutive patients (106) were recruited prospectively. Of these, 6 were formally excluded due to deafness or disorientation. Eligible patients (100) were asked a set of preliminary questions to determine their understanding of the nature of cataract, risk perception, and level of information felt necessary prior to giving consent. Those who desired further information were guided through a standardized questionnaire, which included an audio-visual presentation giving information relating to each potential surgical complication, allowing patients to rate them for relevance to their giving of informed consent. Results: Of the entire group of 100, 32 did not wish to know "anything at all" about risks and would prefer to leave decision making to their ophthalmologist; 22 were interested only in knowing their overall chance of visual improvement; and 46 welcomed a general discussion of possible complications, of whom 25 went on to enquire about specifi c complications. Of these 25, 18 wished to be informed of posterior capsular (PC) tearing, 17 of endophthalmitis, 16 each of dropped lens, retinal detachment and corneal clouding, and 15 of bleeding, sympathetic ophthalmia, and PC opacifi cation. Conclusion: Patients differ in their desire for information prior to cataract surgery, with one signifi cant minority favoring little or no discussion of risk and another wishing detailed consideration of specifi c risks. A system of consent where patients have a choice as to the level of discussion undertaken may better suit patients' wishes than a doctor-specifi ed agenda.

Some ophthalmology practices continue to spend the time and cost necessary to fully drape the operative microscope despite the lack of studies in the literature to support this action. Our findings are the first to suggest that ophthalmic operating microscopes do not pose a significant risk for bacterial or fungal contamination of the surgical field and hence routine microscope draping may not be necessary. References

histology. 1 Steroid-induced myopathy has been documented elsewhere but is typically chronic and degenerative. However, two studies involving intracameral triamcinolone and dexamethasone (Decadron) injection have implicated the vehicle used in steroid preparations in causing mild myopathic ptosis. 2,3 Furthermore, specimens taken of orbital fat, prolapsed after PST triamcinolone injection, have demonstrated histiocytes containing phagocytosed particulate material. 4 We, therefore, hypothesize that in our patient, inadvertent delivery of triamcinolone directly into the levator muscle induced a fibrotic foreign body response, possibly to the vehicle. This is an unusual complication of a common procedure and cautions us regarding the contentious 'off-label' use of triamcinolone acetonide. 5