SUMMARY Epiblepharon commonly occurs in Japanese infants and tends to disappear spontaneously with age. We examined 4449 Japanese children aged 3 months to 18 years for epiblepharon associated with inverted eyelashes touching the cornea. The condition was evident in 441 cases. We found that the incidence of epiblepharon decreased with age, but about 2% of high school students still had the condition. No sexual predilection was found. Lower eyelids were commonly involved bilaterally. Most cases of epiblepharon produced no or mild symptoms.Epiblepharon is characterised by a fold of skin that stretches horizontally across the upper or lower eyelid, usually associated with inversion of eyelashes.' It is reported to be common in infants of Oriental races.' To our knowledge no report details the incidence of this condition in recent Japanese literature. We therefore examined the incidence and symptoms of epiblepharon in Japanese children. Subjects and methodsA total of 4449 Japanese children in Shimane Prefecture were examined. Infants were seen on routine 3-month or 6-month screening tests at health centres. Children aged 1 to 6, 7 to 12, and 13 to 18 years were examined on routine ophthalmic screening at nurseries, elementary schools, and high schools, respectively.Epiblepharon was diagnosed as an extra fold of eyelid skin associated with inverted eyelashes touching the corneal surface. The condition was observed with a binocular loup. Corneal touch was confirmed by topical staining with fluorescein and was inspected in forward, upward, downward, nasal, and temporal eye positions. Epicanthus-like conditions were included in the diagnosis when inverted eyelashes produced corneal touch, because the condition was too difficult to differentiate from epiblepharon. Children who had undergone surgery for epiblepharon were also included, even though the condition had been resolved.

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We have shown' that epiblepharon occurred commonly in Japanese infants but tended to disappear spontaneously with age. Only 2% of high school students in our series still had the condition.' Although most children with epiblepharon had no or mild symptoms, some patients experiencing ocular pain needed treatment. These patients were treated initially with lid bracing sutures. If symptoms recurred, the patients underwent a second procedure, either with buried sutures or skin resection. Subjects and methodsWe selected for this study children who (1) Simple lid bracing sutures were used to treat inferior epiblepharon. Double-armed sutures of 3-0 silk were brought from the inferior cul de sac, through the pretarsal orbicularis and out 3 mm below the eyelid margin. The arms of each suture were about 3 mm apart. Usually two sutures were placed at the medial and central portions of the lower eyelids and were tied tightly, with the beads forming a bolster to rotate the eyelashes outward. One week later the suture threads were removed.For superior epiblepharon sutures were similarly passed from the superior cul de sac and out 3 to 4 mm above the eyelid margin. Most often three sutures were placed at the medial, central, and lateral parts of the upper eyelids. The suture threads were removed after one week.Buried sutures were used as a second procedure. A double-armed 5-0 polyglycolic acid suture was passed in a similar way as the lid bracing suture. The conjunctival side of the entry site and the skin at the 128 copyright.

A 78-year-old woman complained of ocular pain in the right eye. Thirty-three months before, the patient had a pterygium excised and mitomycin C, 0.04%, was instilled 3 times a day postoperatively for 10 days in the right eye. The same surgery was performed and the same drug was used for a course of 5 days in the left eye. Corneoscleral ulceration and corneal perforation occurred in the right eye. The lesions were successfully treated with a lamellar patch graft with reserved corneosclera. We believe that it may not be safe to instill 0.04% mitomycin C 3 times a day postoperatively for 10 days.

BackgroundThe dominant diagnostic model of the classification of depression today is unitarian; however, since Kurt Schneider (1920) introduced the concept of endogenous depression and reactive depression, the binary model has still often been used on a clinical basis. Notwithstanding this, to our knowledge, there have been no collective data on how psychiatrists differentiate these two conditions. We therefore conducted a survey to examine how psychiatrists in Japan differentiate patients with major depressive disorder who present mainly with melancholic features and those with reactive features.MethodsThree case scenarios of melancholic and reactive depression, and one-in-between were prepared. These cases were designed to present with at least 5 symptoms listed in the DSM-IV-TR with severity being mild. We have sent the questionnaires regarding treatment options and diagnosis for those three cases on a 7-point Likert scale (1 = “not appropriate”, 4 = “cannot tell”, and 7 = “appropriate”). Five hundred and two psychiatrists from over one hundred hospitals and community clinics throughout Japan have participated in this survey.ResultsThe melancholic case resulted significantly higher than the reactive case on either antidepressants (mean ± SD: 5.9 ± 1.2 vs. 3.6 ± 1.7, p < 0.001), hypnotics (mean ± SD: 5.5 ± 1.1 vs. 5.0 ± 1.3, p < 0.001), and electroconvulsive therapy (mean ± SD: 1.5 ± 0.9 vs. 1.2 ± 0.6, p < 0.001). On the other hand, the reactive case resulted in significantly higher scores compared to the melancholic case and the one- in-between cases in regards to psychotherapy (mean ± SD: 4.9 ± 1.4 vs. 4.3 ± 1.4 vs. 4.7 ± 1.5, p < 0.001, respectively). Scores for informing patients that they suffered from “depression” were significantly higher in the melancholic case, compared to the reactive case (mean ± SD: 4.7 ± 1.7 vs. 2.2 ± 1.4, p < 0.001).ConclusionsJapanese psychiatrists distinguish between major depressive disorder with melancholic and reactive features, and thus choose different treatment strategies regarding pharmacological treatment and psychotherapy.

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We reviewed retrospectively the charts of 36 patients (72 eyes) with BehÇet’s disease. The visual acuities in 21 patients receiving colchicine (group A) gradually decreased with time. The visual acuities in 9 patients receiving colchicine and systemic corticosteroid (group B) gradually decreased after the onset of the disease and were significantly worse than those in group A 10 and 15 years after onset. The visual acuities in 6 patients receiving colchicine and cyclosporin (group C) gradually decreased, and their visual acuity scores were similar to those in group A.

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