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Overtraining syndrome is common in athletes. It manifests itself with both physiological and psychological symptoms, and can adversely affect an athlete's performance. This article reviews the physiological and psychological signs and symptoms of overtraining syndrome in order to help the athletic trainer recognize the condition. With an understanding of overtraining syndrome, the athletic trainer can better aid coaches and athletes in preventing and treating this phenomenon, and thus maintain the athlete's optimal performance level.

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Movement disorders, or dyskinesias, in the facial region may be categorized in several ways. Dystonic movement disorders in the cranial-cervical region, including essential blepharospasm, Meige syndrome and spasmodic torticollis, are characterized by uncontrollable squeezing movements in the face and neck. These disorders typically present in the fifth and sixth decades of life. Essential blepharospasm is particularly debilitating, as the involuntary eyelid closure that accompanies this condition may result in functional blindness with an otherwise normal visual pathway. Hemifacial spasm is an intermittent, unilateral, spasmodic contraction of the muscles innervated by the facial nerve. This disorder usually presents in the third or fourth decade and has a different underlying pathophysiology than the dystonias. Botulinum A toxin therapy has largely supplanted surgical intervention in the treatment of essential blepharospasm and hemifacial spasm.

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Disposable soft contact lenses are an alternative to conventional extended-wear lenses and provide an acceptable margin of safety and convenience for the wearer. The lenses are worn for one to two weeks and then discarded. Buildup of tear film deposits is minimized, and the need for cleaning and disinfecting solutions is eliminated. The long-term safety of disposable contact lenses is unknown.

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Educating personnel regarding issues related to health and foreign travel has always been an important deployment concern. This article provides general health education guidelines pertinent to any deployment, but especially foreign deployment. The report is intended as a vehicle for initiating the health education process of nonmedical personnel prior to deployment.

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Lower eyelid retraction associated with prior blepharoplasty, trauma, or other conditions is a challenging problem for the ophthalmic surgeon. We describe a procedure involving tightening the lower eyelid and supraplacing the lateral canthus in combination with in-glove lysis of the lower eyelid retractors and scar tissue. This is accomplished through a small lateral incision. To date, we have treated over 200 eyelids using this technique with excellent results. We recommend this technique for the treatment of mild to moderate degrees of lower eyelid retraction.

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Medial canthal malpositions and marked medial ectropion due to laxity, scarring, or trauma can be difficult to correct. Medial canthal tendon publications have been advocated but they do not achieve adequate posterior and medial placement of the medial canthal angle and they lack permanence. One of us (R.L.A.) has developed a surgical technique for correcting these problems that is a modification of the lateral tarsal strip procedure used to correct lateral canthal tendon laxity and malposition. The medial tarsal strip procedure repositions and tightens the medial lower or upper eyelid, establishing a normal anatomic appearance. Its use is indicated in cases of medial canthal malposition or marked medial ectropion associated with a nonfunctioning canalicular system or in those cases in which loss of function of a patent canaliculus is acceptable or desirable. The advantages of the medial tarsal strip are as follows: (1) surgery is directed at the site of the defect; (2) recurrence of canthal tendon laxity and elongation is avoided; (3) a more medial and posterior positioning of the medial eyelid can be obtained; (4) any amount of eyelid laxity can be corrected simultaneously; (5) the almond-shaped canthal angle is preserved or reestablished; and (6) the procedure is fast and easily performed.

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Major criticisms of quasi-integrated implants, such as the Iowa Implant, have been the time-consuming surgical technique needed to implant the prosthesis, and the high rate of extrusion. The Universal Implant (Oculo-Plastik, Montreal) is designed with these concerns in mind. In addition, those qualities that produce the motility advantages of a quasi-integrated implant and the ease of placement of a sphere have been incorporated into the design of the Universal Implant. The Universal Implant also (1) uses a faster implantation technique at surgery, (2) avoids cleaning the muscles, (3) has smaller mounds that are lower and more rounded, and should decrease the late extrusion rate, (4) can be used as an evisceration implant, enucleation implant, or secondary implant, and (5) has a larger girth and radius on the posterior surface that, in turn, helps support orbital fat and tissues and results in a more natural superior sulcus. It is recommended that the Universal Implant be used by surgeons who were pleased with the Iowa Implant, as the Universal implant represents an excellent alternative with major advantages over most other enucleation implants.

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A retrospective chart review was conducted to determine the impact of recently instituted guidelines on compliance with the standard of care for retinopathy of prematurity (ROP) in the Newborn Intensive Care Unit at the University of Utah Medical Center. In a previous study, it was found that infants eligible for participation in a National Institutes of Health-funded study of ROP were routinely receiving screening eye examinations, whereas infants who qualified for ROP screening according to the standard of care, but not eligible for the study, were seen infrequently. Consequently, a plan to improve the compliance with the standard of care for all infants who fit the standard criteria was implemented. The comparison revealed significant improvement in compliance rates. In one subgrouping of infants, compliance rose from three of 16 (18.75%) infants screened for ROP according to the standard of care, to nine of 11 (82%) infants screened for ROP according to the revised standard. This increase in compliance appears to be due to adherence to guidelines recommended in an earlier study, which included increasing staff awareness of the standard of care, designating a person to schedule and track infants who fit the screening criteria, and including the need for ROP screening on the admission and discharge summary.

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Essential blepharospasm is an idiopathic disorder of progressive involuntary spasms of the orbicularis oculi and upper facial (corrugator, procerus) muscles. Blepharospasm literally means spasm of the eyelids; however, most patients with blepharospasm also have or will develop squeezing in the lower face and neck muscles (Meige's syndrome, orofacial dystonia, or oromandibular dystonia). Some patients develop dystonic, uncontrolled movements in areas outside the facial nerve distribution (segmental cranial dystonia or craniocervical dystonia). Chronic, forceful squeezing by the periocular muscles becomes debilitating for the patient and leads to functional and cosmetic eyelid deformities. Treatment has included a variety of modalities and oral medications that are of limited efficacy. Botulinum-A toxin injections have delivered the best temporary relief from this disorder, while the periorbital myectomy operation has been shown to give the best long-term results.

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We present three atypical cases of dysthyroid optic neuropathy. The unique feature was progressive visual field loss with normal-sized or minimally enlarged extraocular muscles. Other atypical findings included optic nerves that appeared to be linearly on stretch with only moderate proptosis, good ocular motility, and only mildly reduced central visual acuity and color vision despite severe field loss. These cases responded rapidly to decompressive surgery after failing high-dose corticosteroid therapy. While marked enlargement of the extraocular muscles with apical optic nerve compression has been documented to cause dysthyroid optic neuropathy, another etiology such as short optic nerves on stretch appears to be at work in these atypical cases. Although extraocular muscle enlargement is the most important diagnostic feature and indicator of the severity of Graves' ophthalmology, our atypical cases demonstrate that this sign alone is an inadequate basis for diagnosis and visual prognosis.

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Orbicularis myokymia frequently occurs in young, otherwise health individuals. The intermittent muscle fasciculations are transient and generally disappear with time. If the myokymia is persistent or progressive, neurologic assessment and investigation may be necessary. Muscle relaxants, botulinum-A toxin, and surgical myectomy are methods of treatment that only occasionally need to be considered. We present limited orbicularis myectomy and botulinum-A toxin injections as efficacious treatments in five selected intractable cases of orbicularis myokymia.

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A case of visual loss due to orbital emphysema secondary to a blow-out fracture of the orbit is presented. Because vision returned to 20/20 following an optic nerve decompression procedure, we hypothesize that our patient developed a compressive optic neuropathy with ischemia due to the emphysema. Essential instructions concerning the injury that the emergency physician should give the patient suffering an orbital blow-out are also presented.

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In the past 20 years, great strides have been made in contact lens technology, but this progress has been accompanied by a multitude of lens-related problems. Bacterial keratitis may be the most significant problem, but reports of Acanthamoeba keratitis, a parasitic corneal infection, are increasing. Infectious complications may be lessened by proper lens care. Thermal disinfection is recommended for soft lenses with a low water content; chemical decontamination is preferred for soft contact lenses with a high water content.

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We present two unique cases of unilateral blepharochalasis. Blepharochalasis is an idiopathic disorder of young adults manifested by intermittent, recurrent episodes of eyelid edema. After repeated episodes of swelling, the periorbital tissue develops premature aging with thinned, redundant skin and stretching of the eyelid tendons. Blepharochalasis is considered bilateral; unilateral cases are extremely rare. Ptosis surgery in these cases may be unpredictable due to alterations in the levator aponeurosis. Simple reattachment of the apparent edge of the disinserted levator aponeurosis may cause significant overcorrection and variations in postoperative eyelid heights. Our two unilateral cases demonstrated proptosis on the affected side, and prominent vessels in the levator aponeurosis and suborbicularis muscle planes, plus vascular changes in orbital fat in one case. Blepharochalasis therefore may be an orbital rather than a periorbital disease, as suggested previously. Proptosis is probably overlooked in the usual bilateral cases. When all other causes of unilateral swelling have been ruled out and the findings are consistent with blepharochalasis, this diagnosis should be considered.

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