An unusual form of blink reflex induced by pressing on a frontal burr hole.

glaucoma. It is now recognised to comprise the diagnostic triad of a diffusely flat anterior chamber, high intraocular pressure, and aqueous pooling that is sometimes visible in or in front of the anterior vitreous. Malignant glaucoma is notoriously difficult to treat and carries a generally poor prognosis for long term control of intraocular pressure. It is thought to involve the mechanisms of ciliolenticular block of aqueQus flow leading to the misdirection of aqueous posteriorly into, or in front of, the vitreous gel leading to the characteristic diffuse shallowing of the anterior chamber accompanied by an often precipitous rise in intraocular pressure. Medical treatment alone is rarely successful in establishing control of the IOP.23 Pars plana vitrectomy has been used in the surgical management of malignant glaucoma with some definite but limited success in phakic as well as pseudophakic eyes.45 However, when malignant glaucoma develops in pseudophakic eyes (with posterior chamber IOLs) there exists an additional treatment option of Nd:YAG laser capsulotomy and/or vitreolysis26 which can be effective in arresting the spiralling rise in IOP by redirecting aqueous flow anteriorly thereby avoiding the need for acute surgical intervention with its inevitably higher morbidity. The same reasoning can be applied to aphakic eyes that have an intact posterior capsule, with similar chances of a successful outcome.