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.

The effects of paraquat on rat brain were studied. Activities of complex I (NADH: ubiquinone oxidoreductase) in mitochondrial electron transport system, lipid peroxidation and the amount of catecholamines in rat brain were measured after acute paraquat exposure. Complex I activities were significantly lower and lipid peroxides were higher in the brains of a paraquat-treated group than in those of a control group. Lipid peroxide in rat serum, however, did not increase after paraquat exposure. A study of the time dependency of paraquat effects disclosed that mitochondrial complex I activities in rat brain as well as those in rat lung and liver gradually decreased prior to the appearance of respiratory dysfunction. As compared to controls, the dopamine in rat striatum was significantly lower in the paraquat-treated group. These results suggest that paraquat after crossing the blood-brain barrier might be reduced to the radical in rat brain, which may damage the brain tissue, especially dopaminergic neurons in striatum. We therefore propose that cerebral damage should be taken into consideration on paraquat exposure. Patients may therefore need to be followed up after exposure to high doses of paraquat.

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Sex differences were observed in host resistance to Mycobacterium marinum infection in mice. Males were found to be more susceptible than females in terms of mortality, incidence of gross skin lesions, and bacterial load in the lungs and spleen. The degree of sex differences varied from strain to strain of test mice, in the order C3H1/I1e, A/J, and BALB/c > DBA/2, B10.A, and C57BL/6, on the basis of survival time and multiplication of organisms in the visceral organs. Although this ordering corresponded to the susceptibilities of both male and female mice to the organisms, much greater strain dependency was seen in males than in females. Castration caused an increase in the host resistance of males, but this effect was substantially reversed by continuous testosterone treatment. Testosterone also increased the susceptibility of female mice to this infection. These findings imply that the male sex hormone is involved in the lowered anti-M. marinum resistance of males. Although athymic mice were more susceptible than euthymic mice, a substantial degree of sex difference was also observed in the T-cell-depleted animals, indicating that natural host resistance to this infection is sex dependent. Indeed, more efficient macrophage mobilization at the site of infection was seen in females than in males. Although female T-cell transplantation improved the lowered resistance of athymic mice, there was a sex difference in bacterial growth in the lungs. This implies that sex hormones affect T-cell functions. Sex differences in host resistance have been reported in mycobacterial infections, such as those due to Mycobacterium lepraemurium (6) and the M. avium complex (33), in mice. Males are more susceptible to these infections than are females; hence, participation of sex hormones in this phenomenon has been suggested. In humans, males predominate in the incidence of M. avium complex and M. kansasii infections (1, 21, 27, 34). Estrogens increase the resistance of host animals to infections such as those caused by Salmonella (20), Streptococcus (20), Pasteurella (20), and Trypanosoma (17) species. However, it has been reported that resistance to listerial (24, 25), staphylococcal (32), gonococcal (15), and chlamydial (26) infections is conversely reduced by the same sex hormone. In Leishmania major infection, orchidectomy causes increased resistance in male mice and administration of testosterone decreases anti-L. major resistance in female mice (18). We previously reported that sex differences in host resistance to M. avium complex infection in BALB/c mice are partly attributable to the antimicrobial activity of host macrophages (M@). Specifically, peritoneal M4) from female mice show more potent anti-M. avium complex activity than do M4 from male mice (33). However, detailed mechanisms of the sex differences in host resistance to mycobacterial infections still await elucidation. M. marinum is the causative agent of swimming pool granuloma or fish tank granuloma in humans, and a similar disease is produced in experimental an...

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.

We examined fundus photographs of 5,789 patients (11,578 eyes) and found 39 patches of myelinated nerve fibers in 35 eyes of 33 patients. The prevalence was 0.57%. The lesion was more frequent in females than in males. The patch occurred more often at the superior sectors of the nerve head and in the inferotemporal retina than in other areas. No myelinated nerve fibers were discovered in the macula. One patient (case 1) had 3 patches in 1 eye. Two patients (cases 2 and 3) had unilateral myelinated nerve fibers, bilateral myopia and ipsilateral amblyopia. In case 3, the patch was associated with an epiretinal membrane. Another patient (case 4) had branch vein occlusion and neovascularization from the patch of myelinated nerve fibers. The fundus conditions observed in our cases 1–4 may be uncommon.

We reviewed the clinical records, color photographs and fluorescein angiograms of 106 eyes of 53 patients (44 men and 9 women) with central serous chorioretinopathy who had been followed up for 1 year or more. Their ages ranged from 20 to 59 years. One eye in each patient was involved at the initial visit. According to fluorescein-angiographic findings, the lesions were divided into smokestack pattern (13 eyes), ink blot appearance (33 eyes) and minimally enlarging spot (7 eyes). Most patients complained of central scotoma, and most patients had moderately decreased visual acuities at the initial visit, which improved after recovery. In particular, all 7 eyes with a minimally enlarging spot had a visual acuity of 0.8 or more at the initial visit; of these 6 eyes had 1.0 or more several weeks later. On fluorescein angiography, 49 eyes demonstrated 1 leaking spot and 4 eyes showed 2 spots. Of 57 leaking spots, 10 were observed in the foveola, 31 were noted in the fovea and 16 were found in the para- or perifovea. Of 13 smokestack patterns, 5 were found in the inferonasal area. The ink blot appearance and minimally enlarging spots were frequently found in the superonasal and superotemporal areas.