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(BrJ Ophthalmol 1995; 79: 150-152)

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.

We examined prospectively 8,726 patients in outpatient eye clinics. A total of 225 (2.9%) patients had subconjunctival hemorrhage. No sexual or age predilection was found. The most common causes for the condition were minor local trauma, systemic hypertension, and acute conjunctivitis. Subconjunctival hemorrhages resulting from local trauma were frequent in the summer, and those associated with systemic hypertension were noted most often in older patients. Blood pressures should be examined in patients with subconjunctival hemorrhages, particularly in older patients.

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Aims-To determine whether the short wavelength sensitive (S) cone electroretinogram (ERG) is selectively altered in diabetic patients with and without retinopathy. Methods-Ganzfeld spectral flashes in the presence of bright white background illumination were used to elicit S cone ERGs in 15 non-retinopathic diabetics, 16 The intensities of the flashes were changed by neutral density filters. The flash duration was 10 microseconds and the stimulus frequency was 5 Hz. Responses were averaged with use of the Neuropack 2 averager (Nihon Kohden, Tokyo, Japan). To determine the difference in relative light intensity required to match the long wavelength sensitive (L) and middle wavelength sensitive (M) cone b-wave produced by the blue (450 nm) flash and that produced by the red (633 nm) flash, we determined the relation between L, M cone b-wave amplitude and light intensity that produced an equal amplitude L, M cone b-wave for the blue (450 nm) flash. To compare the lens yellowing, we obtained the L, M cone balance-namely, the log density units of the neutral density filter required to produce the L, M cone b-wave elicited with red stimuli, which is identical to that with blue stimuli. The lens yellowing reduces short wavelength transmissivity and reduces the L, M cone b-wave amplitude as well as the S cone amplitude. Thus, the L, M cone balance increases with the lens yellowing because long wavelength transmissivity is not greatly affected.9 We obtained permanent recordings using the maximum flash intensity available at 450 nm and dimming the other stimuli with neutral density filters to produce approximately equal long wavelength sensitive (L) and middle wavelength sensitive (M) cone ERGs, because all longer wavelength stimuli had more effective energy for the L and M cones. To obtain action spectra based on equal 973 on 10 May 2018 by guest. Protected by copyright.

No abstract

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.