Aims/background-The aim of this study was to assess the morbidity associated with harvesting autogenous fascia lata for brow suspension ptosis surgery. Methods-A retrospective study by postal questionnaire of 24 consecutive patients. Results-Early postoperative problems with pain on walking (67%), limping (38%), and wound pain (57%) occurred mostly for less than 1 week. The final cosmetic appearance of the scar caused minor concern in 38% of patients. Conclusion-Fascia lata is the preferred material for permanent ptosis correction when a brow suspension is required. Most of the patients, following fascia lata harvest, experienced some symptoms of leg pain and limping for less than 1 week. The only long term problem was the scar. 38% of patients found the final cosmetic appearance caused minor concern. (Br J Ophthalmol 1997;81:581-583)

The treatment ofacute angle closure glaucoma has been influenced by the development of the YAG laser and its ability to perform iridotomies as an outpatient procedure. In this retrospective study the results of YAG iridotomy were compared with surgical peripheral iridectomy. When compared with surgical peripheral iridectomy patients, YAG iridotomy patients were at greater risk of proceeding to further surgery, with this risk being significantly associated with increasing duration of attack. The authors suggest that in selected cases, surgical iridectomy should be given consideration as a primary procedure.

In a prospective study of 26 premature infants, 5 ,l microdrops were compared with standard 26 ul eye drops of cyclopentolate 0-5% and phenylephrine 2 5%. There was no statistical difference in pupil dilatation. The 5 gl microdrops have potentially fewer adverse effects in premature infants. (BrJf Ophthalmol 1993; 77: 364-365) Systemic toxicity from DiscussionThe volume of an eye drop from a minim is 26 /u16 which is greatly in excess of the adult precorneal tear film volume of 7 ul.7 Eighty per cent of standard drops may be lost in the first 15-30 seconds via the nasolacrimal duct, conjunctival blood vessels, or spillage onto the skin. Systemic absorption is directly into the circulation from the conjunctival and nasal mucosa without first pass metabolism in the liver. Therefore systemically absorbed eye drops are more like intravenous agents than oral ones.7There was no statistically significant difference in pupil dilatation in this study between the smaller 5 ul drop size and the conventional 26 ul drop size. Equal pupil dilatation has been demonstrated with 8 ,ul and 30 ul drops of phenylephrine in neonates but the pupil size was only 4-86 mm and 4-57 mm respectively.8 The pupil diameter was larger in this study which is compatible with the results of Carpel and Kalina who showed there was an additional effect in premature infants when cyclopentolate was added.9 In adults reduction in drop size of phenylephrine 10% and tropicamide 1% produces adequate mydriasis.6Brown et al have shown that drop size can be reduced by designing a bottle with a narrower outlet.'0 The systemic absorption is less with a smaller than a larger drop volume.8 Infants in particular may be more likely to absorb eye drops systemically as the tear volume is small and the drops are instilled supine so that spillage onto the skin may be less. " The risk oftoxicity may also be increased because of low body mass and the immaturity of the cardiovascular and nervous systems.4 Cyclopentolate in adults and children may cause psychosis, behavioural disturbance, ataxia, agitation, fits, and gastrointestinal upset.'2 Preterm twins developed gastrointestinal side effects from cyclopentolate 1%, and abdominal distension and increased gastric aspirate was reported in 50 preterm infants examined for retinopathy of prematurity.512 There are many reports of cardiovascular adverse effects from phenylephrine.' 2 Raised blood pressure has been observed in preterm infants after dilatation with 2 5% phenylephrine and this potentially increases the risk of intraventricular haemorrhage.4The risk of adverse systemic effects from eye drops is well recognised and as more and more premature babies are being examined it would be better medical practice not to use over five times more medication than is required.

We report a case ofpartial avulsion ofthe optic nerve caused by sudden rotation of the globe due to a snooker cue injury. Minimal direct ocular trauma occurred. This case supports the belief that sudden rotation of the globe is the major mechanism of optic nerve avulsion. We include the first results of ultrasound examination that demonstrate optic nerve injury in such a case and believe that, in conjunction with fluorescein angiography and computerised tomography, it is important in the full evaluation of such cases.

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