A conservative approach to the management of tear duct obstruction in babies does not lead to an excess of epiphora at the age of seven. A cohort study in Dundee (Eye1998;12:669–71) showed no relation between congenital nasolacrimal duct obstruction and excess tearing in 7 year olds. Almost 8% of 7 year olds were said by their parents to have excess tearing but at that age it seemed to be related either to atopy or to viral upper respiratory infections.

Improved hearing is only one outcome to be considered after insertion of grommets for glue ear. A parent questionnaire survey in Liverpool and Southport (Journal of Laryngology and Otology1998;112:732–41) showed that after the operation 67% of parents thought their child could hear the television better, 63% thought the child’s general health was improved, reported behaviour problems at school or nursery fell from 49% to 7%, and speech difficulties from 37% to 21%. The parents also reported postoperative reductions in earache and in prescriptions for antibiotics. These parental perceptions may explain why parents who have experience of grommet insertion in one child are often keen for subsequent children to have the same operation.

Thickened, whitened, broken finger nails …