The deposition of calcium salts in the cornea and conjunctiva of patients with hypercalcaemia has been noted for some time, especially in the conditions of hyperparathyroidism (Cogan, Albright, and Bartter, 1948;Walsh and Murray, 1953), sarcoidosis (Cogan and others, 1948; Walsh and Murray, I953; Crick, Hoyle, and Smellie, I961;Cogan and Henneman, 1957), and vitamin D intoxication (Walsh and Murray, I953;Howard and Meyer, 1948; Leira, 1954; Smith, 1957). More recently Berlyne and Shaw (I967, I968) reported similar deposits in patients with acute and chronic renal failure in whom by contrast there was hypocalcaemia and marked hyperphosphataemia. They also found that the calcium and inorganic phosphate product was usually greater than 70 in these patients, and further suggested that these deposits were responsible for the red eye of renal failure. Other workers have confirmed the presence of these deposits in uraemic patients but have questioned the aetiology of the red eye (Harris, Cohn, Toyofuku, Lonergan, and Galin, I97I; Caldeira, Sabbaga, and Ianhez, I970).The purpose of this paper was to assess ocular calcium deposits in a moderately large group of patients with chronic renal failure, and to find if there is any correlation between these deposits, the red eye of renal failure, reduced tear production, and the bony rarefaction which often occurs in such patients. Finally, the effect of regular haemodialysis and renal transplantation on such deposits was observed over periods of from I to 4 years. Patients and methods38 patients on haemodialysis were examined over a period of from I to 4 years. There were seventeen male and twenty-one female patients, the average age in both groups being 33 years. Of those who received a donor kidney during this period, eleven have been observed to date. An additional group of eight patients who were seen for the first time after renal transplantation was also observed. All patients had a full ocular examination and in particular the calcium deposits were examined and graded, depending on their position and extent (Figure, overleaf). Tear secretion was estimated by Schirmer's method (Duke-Elder, I965), and any patient with a red eye was further investigated to ensure that no other pathology was present. X-ray reports ofroutine skeletal surveys were collected and attempts were made to correlate the extent of the bony changes found with the degree of corneal and conjunctival calcification. Finally, levels of serum calcium and inorganic phosphate were measured in each patient.

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SummaryThe eyes of 39 patients who had received allogenic renal transplants were examined for signs of disease. Nine (23 %) had early posterior subcapsular cataracts, two (5% ) developed acute cytomegalovirus retinitis, and one developed steroid-induced glaucoma. The lesions which were found were all attributable to the immunosuppressive drug therapy. Thirty-five (870%) had detectable complement-fixing antibodies to cytomegalovirus.

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In view of these conflicting reports, and the persistent similarities between the latest theories concerning the aetiologies of both uveitis and multiple sclerosis, it was considered worthwhile to carry out a new ocular survey of patients with multiple sclerosis. MethodA total of sixty patients was examined, 25 male and 35 female, varying in age from i8 to 65 years with an average age of 40 years. They had all had the diagnosis of multiple sclerosis confirmed by a neurologist.The anterior segment and anterior vitreous were examined by slit-lamp microscopy and the posterior segment of all eyes was examined, after pupillary dilatation, by direct and indirect ophthalmoscopy. ResultsIn the sixty patients examined, nine (I 5 per cent.) had signs of a uveitis, and seven of these (I I .7 per cent.) had sheathing of the retinal veins (Table). Only four patients complained of an inflamed eye and in only one (Case 40) was it the presenting symptom. Fifteen (25 per cent.) of the patients had had a retrobulbar neuritis as the presenting symptom and these included four of the patients with uveitis. Two of the patients had signs worthy of note in the posterior segment, but were not included in the I5 per cent. One patient had a fibrous plaque overlying a retinal vein similar to that described by Rucker in his original report (Rucker, I944) but without other ocular involvement, and the other