AIM: To study the frequency of amblyogenic factors in patients with congenital ptosis.congenital ptosis more than 1 year old were included. Amblyopia was defined as best-corrected visual acuity (BCVA) less than 10/10 or a difference between the two eyes of at least 2/10. In patients too young to be measured by the linear Snellen E test, fixation behavior was observed. Different types of amblyopia were assessed for each patient as: 1) anisometropic amblyopia: astigmatic anisometropia≥ 1dpt, hyperopic spherical anisometropia≥ 1dpt, myopic spherical anisometropia≥ -3dpt (with cycloplegia);2) strabismic amblyopia, and 3) stimulus deprivation amblyopia (SDA). Then the total incidence of amblyopia and each type of it were obtained. Patients with uni-and bi-lateral ptosis were also compared. Each specific cause was refractive amblyopia in 29.8%, SDA in 10.5%, strabismic amblyopia in 4.3%. Amblyopia was more frequent in severe ptosis, 76% in patients with covered optical axes (OA), compared to non-covered OA (22.5%). In unilateral ptosis with covered OA, astigmatic anisometropic amblyopia was more frequent, and in bilateral ptosis with at least one eye covered OA, spherical anisometropic amblyopia was more frequent. In both unilateral and bilateral ptosis, SDA was more common if the OA was covered. Paying attention to all causes of amblyopia may be important in preventing amblyopia in a child with a ptotic eye.

BACKGROUNDXerostomia is one of the most common side effects of radiation therapy among patients with head and neck cancers (HNC). However, conventional medicine lacks an effective treatment for radiation-induced xerostomia.

OBJECTIVESynthesizing the traditional use of Alcea digitata and Malva sylvestris with their known beneficial effects from recent studies, we evaluated the efficacy of the herbs in the quality of life (QOL) of HNC patients with radiation-induced xerostomia.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONSThis study is a randomized, double-arm, open-label active-controlled clinical trial. We evaluated the effect of A. digitata and M. sylvestris on QOL of HNC patients with radiation-induced xerostomia compared with Hypozalix (artificial saliva). Patients were enrolled from the Imam Hossein Hospital's oncology clinic in Shahid Beheshti University of Medical Sciences, Tehran, Iran.

MAIN OUTCOME MEASURESPrimary outcome measures in this trial were changes in patients' QOL assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Head and Neck Module (EORTC QLQ-H&N 35).

RESULTSBetween-group analysis showed that the intervention group patients obtained significantly lower (better) total EORTC QLQ-H&N 35 scores as compared to the control group at the end of the intervention period (P = 0.007). Mean scores of dry mouth of EORTC QLQ-H&N 35 was also significantly lower (better) in the intervention group as compared to the control group (P = 0.017).

CONCLUSIONTraditional Persian medicine preparation of hollyhocks and common mallow should be considered as a suitable treatment for xerostomia and improving QOL in HNC patients with radiation-induced xerostomia.

TRIAL REGISTRATIONThe trial was registered in ClinicalTrials.gov with Identifier: NCT02854358.