The problem of ophthalmic emergencies and their management has been the subject of three recent papers,'`all of which have been based on data collected from specialist eye emergency units. Opinion as to the role of the doctor and the nurse has varied. This study aims to assess the ophthalmic workload of an accident and emergency (A and E) department in a district general hospital (DGH) where all patients attending are seen in the first instance by A and E medical staff with basic ophthalmic training and then referred where necessary to the ophthalmic resident or to the eye clinic.The results are presented to give an insight into the handling of eye emergencies in the A and E department, the variety and frequency of the presenting conditions, and their seasonal variation. The benefits and pitfalls of an ophthalmic emergency service run in conjunction with a general emergency service are discussed.Material and methods

SUMMARY A retrospective study of 245 fellow eyes of patients admitted in primary acute angleclosure glaucoma (ACG) is presented. Twenty-five (10-2%) had acute ACG in the fellow eye on presentation. Of the remaining 220, 33 (15%) subsequently developed acute ACG before prophylactic surgery was performed. Possible predisposing factors were analysed. The main findings were that acute ACG in the fellow eye occurred most frequently in hospital, or during the first month after discharge if prophylactic surgery was not performed. The instillation of mydriatics in the operated eye increased the risk to the fellow eye. Pilocarpine and carbonic anhydrase inhibitors confer the best protection on the fellow eye, but no medical regimen entirely prevented an attack of acute ACG in the fellow eye.

The aim of this retrospective study was to assess the outcome of combined cataract extraction and trabeculectomy, and to determine whether it is a safe, effective procedure for patients in whom cataract and glaucoma coexist.Trabeculectomy has been shown to be a safe, effective operation in both open-and closed-angle glaucoma1 2 and to a lesser extent in secondary glaucoma.3 A small study by Thyer and Wilson4 reported encouraging results when trabeculectomy was combined with cataract extraction for glaucoma patients with lens opacities. Further follow-up studies56 confirmed the efficacy of this procedure, but numbers were small in the first study, and the period of follow-up was only 3 months in the second. Midland Eye Hospital by consultant staff and junior staff in training. The 59 eyes have been followed up for a minimum of 6 months; of these, 51 have been followed up for 12 months and 28 for 2 years. Most of the patients were over the age of 60 years (age range 23-87 years; mean age 69 years).

Acetazolamide and pilocarpine have a central role in the initial management of primary acute angle closure glaucoma (PACG), but there is no consensus concerning their mode of delivery, as borne out by a recent survey of senior UK ophthalmologists reported below. Ocusert Pilo 40 was developed to remain in situ releasing pilocarpine for up to one week. In view of its potential advantages, a trial of Ocusert Pilo 40's efficacy in PACG was conducted. In two separate controlled studies, eyes diagnosed with PACG were randomised to receive Ocusert Pilo 40, and either an intensive pilocarpine regimen or a low-dose pilocarpine treatment. All patients also received Diamox 500 mg i.v. Two hours after starting topical treatment, the study was terminated and ocular and systemic response to treatment and the eventual outcome were assessed. In both studies, intravenous Diamox caused a fall of intraocular pressure (IOP) within 30 min. Over the treatment period, a comparable reduction in IOP was seen in the Ocusert-treated, the intensive-pilocarpine-treated, and the low-dose-pilocarpine-treated groups. No damage to the corneas were observed.

Aim: To describe a case of a 14-month-old girl who presented to the eye clinic with unusual bouts of horizontal nystagmoid movements. Methods: The orthoptic findings are presented, along with the investigation results, underlying pathology, treatment and long-term prognosis. Results: A thoracic neuroblastoma was identified on chest X-ray and subsequent CT scan. After resection of the tumour the initial presenting sign of intermittent opsoclonus persisted. Conclusions: This case shows the presentation of an infant with dancing eye syndrome (DES), secondary to a thoracic neuroblastoma. Following the surgical resection of the primary tumour the intermittent opsoclonus remained. The ocular motility slowly returned to normal but some neurological sequelae persisted.