Exotropia as a sign of myasthenia gravis in dysthyroid ophthalmopathy.

In cases 1-4 it was difficult to measure the visual function due to the patients' mental retar- dation and/or behavioural disturbance. Case 6 gives an indication ofthe degree ofunaided visual improvement that can be expected in epikerato- plasty for keratoconus.5 Where there is significant corneal scarring deep lamellar keratoplasty with lyophilised tissue can be used,6 and this latter technique could perhaps also benefit from botulinum toxin induced ptosis as part of the early postoperative management.