Chronic canaliculitis is an uncommon disease with a protracted course. Its management is prolonged and difficult. An elderly lady was diagnosed to have left lower chronic purulent canaliculitis. Conserva- tive treatment alone did not effect a complete cure. Canaliculotomy with removal of sulphur granules and canalicular curettage also had to be performed to achieve a permanent cure. Unlike many cases of canaliculitis, this patient presented numerous complications confined to the canaliculus. To the best of our knowledge, this is the first report of Actinomyces naeslundii (A. naeslundii) causing chronic puru- lent canaliculitis and associated complications. A. naeslundii canaliculitis should be considered in the differential diagnosis of chronic conjunctivitis with epiphora.

Rheumatoid arthritis is a chronic auto-immune disease that leads to persistent symmetrical polyarthri- tis mainly affecting the hands and feet. Significant extra-articular involvements can occur including the eyes. However, most extra-articular manifestations usually occur in the presence of joints changes or symptoms. We report an interesting case of a 62-year-old Malay lady who was referred severe ocular presentation, peripheral ulcerative keratitis that led to the diagnosis of rheumatoid arthritis. Interest- ingly, she had typical changes of rheumatoid arthritis in the hand but was not troubled by them.

A 55-year-old man presented with a five-day history of blurring of vision, pain and redness in the right eye. He had no significant past ocular or medical history, and gave no history of trauma. Ophthalmologic examination is shown above (Panel). What is the diagnosis? Answer: refer to page 235

(Refer to page 207) Answer: Hypopyon In this case, hypopyon is seen in the anterior chamber and posterior synaechiae can also be seen at the pupil margin. Hypopyon can be defined as layering of white blood cells in the anterior chamber of the eye following acute, subacute and chronic inflammatory reactions involving the aqueous humor and anatomical structures adjacent to it. It appears as a white milky layer at the bottom of the anterior chamber.

We illustrated a case of presumed spontaneously regressed retinoblastoma in a blind eye. The tumour remained stable, with no extraocular spreading, for 20 years. Associating signs included band keratopathy, leukocoria, dislocated lens, calcified retinal masses and tractional retinal detachment.

AIM: To evaluate the visual outcome of LASIK and occlusion therapy for anisometropic amblyopia in adolescents and compare it to the visual outcome of optical correction and occlusion therapy.METHODS: This retrospective case-controlled study included 19 children,aged between 10 and 17 years,with anisometropic amblyopia. Group A included 10 adolescents with anisometropic amblyopia in whom vision did not improve with optical correction and occlusion therapy. These patients were then treated with LASIK and occlusion therapy. Postoperative visual outcomes of this group were analyzed and compared to group B which included 9 age-matched controls who were compliant to treatment of anisometropic amblyopia by optical correction and occlusion therapy.RESULTS: In group A,the mean (SD) spherical refraction was -8.9±5.2D preoperatively and -1.9±2.0D postoperatively,the mean (SD) preoperative best corrected visual acuity (BCVA) was 0.25±0.18,which improved to 0.50±0.26 after treatment. In group B,the mean (SD) pre-treatment BCVA was 0.27±0.18 and improved to 0.50±0.28 after treatment. There was no statistically significant difference between the two groups in terms of post-treatment BCVA.CONCLUSION: LASIK offers a feasible solution for adolescents with anisometropic amblyopia who are not improving in vision with conventional treatment optical correction and occlusion therapy. The outcome in this group was comparable to the outcome in adolescents in whom vision improved with conventional treatment.

· AIM: To present the outcome of anterior single flap external dacryocystorhinostomy (DCR) in Sudanese patients. · METHODS: The data of 200 consecutive patients were retrospectively analyzed, who had anterior single flap external DCR with a minimum of one year follow-up. The surgeries were performed by the same surgeon (the first author) and patients were followed up for one year postoperatively. Presence of epiphora at the end of one year and no response to syringing and probing was considered failure. · RESULTS: The mean age of the study sample was 29.7 years (ranged 4-65 years), The ratio of male to female was 1: 2. The success rate was 98%. Failure was reported in 4 patients, two of them were traumatic cases with preexisting orbital disfigurement. · CONCLUSION: This study adds on to the evidence of the usefulness of anterior single flap DCR. Although it is simpler and easier to master the technique, this procedure showed a success rate comparable to that of the conventional method in literature.