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A 7-year-old male child presented with complaints of lagophthalmos and lid retraction of the right eye since birth. Magnetic resonance imaging (MRI) showed diffuse thickening of right superior rectus and levator-palpebrae complex along with a hypointense, irregular, and ill-defined lesion in the adjoining fat abutting the lacrimal gland. Biopsy from the lesion showed diffuse orbital fibrosis. Another 3-year-old female child presented with complaints of her right eye appearing smaller and inability to move the right eye freely since birth. MRI showed thickening of right superior and medial recti with diffuse retrobulbar hypointense fibrotic strands. The findings were suggestive of orbital fibrosis. Congenital orbital fibrosis is an extremely rare orbital pathology with very few cases described in the literature. The most common clinical features are motility restriction, restrictive strabismus, upper lid retraction, enophthalmos, and proptosis. The diagnosis can be made on imaging but requires biopsy for confirmation. Management is mostly conservative in the form of refractive and amblyopia therapy.

Magnesium oxide nanoparticles (MgO NPs) have gained significant importance in biomedicine and variety of nanotechnology-based materials used in the agriculture and biomedical industries. However, the release of different nanowastes in the water ecosystem becomes a serious concern. Therefore, this study was executed to evaluate the toxic impacts of MgO NPs on grass carp. A total of 60 grass carp were randomly divided in three groups (G0, G1, and G2). Fish reared in group G0 were kept as control while fish of groups G1 and G2 were exposed to 0.5 mg/L and 0.7 mg/L MgO NPs, respectively, mixed in water for 21 days. The 96h median lethal concentration (LC 50 ) of MgO NPs was found to be 4.5 mg/L. Evaluation of oxidative stress biomarkers, antioxidant enzymes, DNA damage in different visceral organs and the presence of micronuclei in erythrocytes were determined on days 7, 14, and 21 of the trial. Results revealed dose- and time-dependent significantly increased values of reactive oxygen species, lipid peroxidation product, DNA damage in multiple visceral organs and formation of micronuclei in the erythrocytes of treated fish (0.7 mg/L). The results on antioxidant profile exhibited significantly lower amounts of total proteins, catalase, superoxide dismutase, and peroxidase in visceral organs of the fish exposed to MgO NPs (0.5 and 0.7 mg/L) at day 21 of trial compared to control group. In conclusion, it has been recorded that MgO NPs severely influence the normal physiological functions of the grass carp even at low doses.

Lacrimal canaliculitis is an inflammation of the proximal lacrimal drainage system. It classically presents with symptoms of redness, mucopurulent discharge, medial canthal swelling, epiphora, and pouting punctum. Despite having classical clinical characteristics it is frequently misdiagnosed. The cause can be primarily due to various infectious agents or secondary mostly due to the use of punctal plugs. There are no universally accepted guidelines for the management of canaliculitis but different medical and surgical options have been employed with varying success rates and it is notorious for recurrences and failure to therapy. The present review summarizes the existing literature on lacrimal canaliculitis published over the past 15 years to provide an overview of this uncommon condition. A total of 100 articles published in the literature were anlaysed during this period. The mean age at diagnosis was 57.09 ± 16.91 years with a female preponderance. Misdiagnosis was common with many patients misdiagnosed as conjunctivitis and dacryocystitis. Primary canaliculitis was found to be more frequent than secondary with inferior canaliculus involved more commonly than the superior. Staphylococcus , Streptococcus , and Actinomyces were the most common microbes isolated. Surgical management was employed in 74.25% of cases while medical management was done in 20.82% of cases. The review presents an insight into the complexities of canaliculitis, its diagnosis, and management which will further help to improve the understanding of this uncommon infection of the lacrimal system.

Aim: To report a case series on canaliculocoele and to review the existing literature., Methods and Materials: A retrospective analysis of the case records of all patients diagnosed with canaliculocoele between January 1 st , 2018, and December 31 st , 2019, was conducted. Only histopathologically proven cases of canaliculocoele with a minimum follow-up of 6 weeks were included., Results: Five cases of canaliculocoele that presented over 2 years were included. The mean age was 58.8 ± 9.63 years, with a female preponderance. The mean duration of symptoms was 22.2 ± 22.71 months. All patients had medial cystic swelling, either at the upper or lower lid. Four patients had gross stenosis of the punctum, while the punctum was absent in one patient. Ultrasound biomicroscopy showed canalicular cystic distension with intra-lesional hyper-reflective echoes. All patients were managed with a complete cystectomy, except for one where a marsupialization was done. Adjunctive mini-Monoka intubation was done in two patients. The histopathological diagnosis of all cases was consistent with canaliculocoele. The mean follow-up was 3.82 ± 2.77 months., Conclusion: Canaliculocoele is mostly unilateral and seen in middle-aged women. A good clinical evaluation supported by diagnostic imaging along with an affirmative histopathology can confirm the diagnosis.

Eccrine spiradenoma is a rare sweat gland tumor and usually presents as a solitary, painful nodule. A solitary spiradenoma involving the eyelid is quite rare. A 39-year-old Indian female presented with a gradually increasing, painless, nodular upper eyelid mass for the past 4 years. On examination, a non-tender approximately 4 × 3 mm cystic mass was noted, which was not adherent to underlying structures. The mass was excised in toto, and the histopathological examination was suggestive of eccrine spiradenoma with a low Ki-67 index. The patient was doing well without any signs of recurrence at 2 months of follow-up.

A 69-year-old female presented with complaints of persistent watering in the left eye for the past 8 years. She underwent a left external dacryocystorhinostomy (DCR) 8 years ago. On examination, left lacrimal passage irrigation showed regurgitation of fluid from opposite punctum. She underwent a revision external DCR with bicanalicular intubation and a portion of fibrosed sac was sent for histopathological examination (HPE). HPE showed a Microfilarial worm with surrounding granulomatous inflammation. Polymerase chain reaction (PCR) on the DNA extracted from the specimen identified the species to be Dirofilaria repens. Dirofilariasis is an accidental zoonotic infection in humans. Due to its migration, the worm can affect ocular and periocular structures. There are two case reports of perilacrimal dirofilariasis. This is the first case to report a filarial worm in the lacrimal sac causing chronic inflammation which probably led to failure of DCR. Treatment of choice is the complete eradication of the worm. PCR aids in the identification of species.

Purpose: To evaluate the efficacy of intermittent manual carotid compression (IMCC) in the management of low-flow carotid cavernous fistulae (CCF)., Materials and Methods: Patients diagnosed with low-flow CCF and treated with IMCC over a period of 13 years were retrospectively analyzed. Data analyzed included demographic details, clinical features, type of CCF, and response to therapy. Outcomes were categorized as complete cure, partial cure, and no cure or worsening. Patients with complete and partial cure were grouped as good outcome whereas those with no cure or worsening as poor outcome., Results: A total of 44 patients were advised IMCC for low-flow CCF, of whom five were lost to follow-up. Results of the remaining 39 patients were analyzed, of whom 21 (53.8%) were males. The mean age at presentation was 54.38 ± 14.54 years. The median duration between the onset of symptoms and presentation was 5.0 ± 4.10 months. The common presenting features were episcleral congestion and proptosis (89.7%), extraocular motility restriction (66.7%), and diplopia (48.7%). Most common CCF type was type D (34, 87.2%). All patients were advised to undergo IMCC. Good outcome was seen in 35 patients (89.7%, 95% CI: 80.2% to 99.2%), whereas poor outcome was seen in four (10.3%) patients. The mean duration of follow-up was 15.91 ± 21.87 months., Conclusion: The present study found a good outcome with IMCC in 89.7% cases of indirect low-flow CCF with no major complications. It should be considered the management of choice in patients who are systemically unfit or cannot afford endovascular embolization.

Orbital amyloidosis is an uncommon entity. Lacrimal gland, orbital soft tissue and extraocular muscles are the usual sites of involvement. Deposition of amyloid in the extraocular muscle can be either isolated or associated with systemic amyloidosis. We describe a case of a 43-year-old male with isolated amyloid infiltration of the right lateral rectus muscle presenting as a progressive esotropia. The case was initially misdiagnosed as lateral rectus palsy and myositis due to non-specific radiological features of the entity. The diagnosis was confirmed by a biopsy. Intramuscular Botulinum toxin injection, was administered to the right medial rectus to alleviate diplopia temporarily, and strabismus surgery was planned at a later stage. Amyloid deposition is a rare cause of extraocular muscle enlargement. Histopathology is confirmatory. Screening for systemic amyloidosis is mandatory in all cases.

Purpose: To compare the results between tarsofrontalis sling (TFS) and levator palpebrae superioris (LPS) excision with TFS in cases of ptosis with Marcus Gunn jaw winking syndrome (MGJWS)., Method: A retrospective review of records of all patients undergoing either TFS (group A) or LPS excision along with TFS (group B) in cases of ptosis with MGJWS was done over the past 10 years and their results were compared., Results: The study included 73 patients (75 eyes). There were 36 patients (36 eyes) in group A and 37 patients (39 eyes) in group B. There was a significant reduction in the excursion due to MGJWS from 4.7 ± 1.49 to 1.91 ± 1.04 mm in group A (p = .001) and 4.65 ± 1.34 to 1.79 ± 0.98 mm in group B (p < .05). The reduction in excursion due to MGJWS and lagophthalmos were comparable in both groups. The mean follow-up in group A was 5.62 ± 6.94 (Range: 1-24) months and group B was 19.15 ± 29.16 (Range: 1-96) months (p = .01)., Conclusion: Both TFS and LPS excision with TFS is equally effective in dampening the eyelid excursion in MGJWS. Tarsofrontalis sling is a safe, easy and effective technique for MGJWS with lesser complication.

Purpose: To study the risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis (ROCM) during the COVID-19 pandemic in India., Methods: Multi-centric retrospective case-control study conducted from October 2020 to May 2021. Cases comprised of consecutive patients of COVID-19-associated ROCM (CA-ROCM) presenting at the participating ophthalmic institutes. Controls comprised of COVID-19-positive or COVID-19-recovered patients who did not develop ROCM. Comparative analysis of demographic, COVID-19 infection, treatment parameters and vaccination status between cases and controls performed. Clinical and imaging features of CA-ROCM analyzed., Results: There were 179 cases and 361 controls. Mean age of presentation in cases was 52.06 years ( p = .001) with male predominance (69.83%, p = .000011). Active COVID-19 infection at the time of presentation of ROCM (57.54%, p < .0001), moderate to severe COVID-19 ( p < .0001), steroid administration (OR 3.63, p < .00001), uncontrolled diabetes (OR 32.83, p < .00001), random blood sugar >178 mg/dl were associated with development of CA-ROCM. Vaccination showed a protective effect ( p = .0049). In cases with intracranial or cavernous sinus extension there was history of steroid administration (OR 2.89, p = .024) and orbital apex involvement on imaging (OR 6.202, p = .000037) compared to those with only rhino-orbital disease., Conclusion: Male gender, active COVID-19 infection, moderate or severe COVID-19, uncontrolled diabetes, steroid administration during COVID-19 treatment are risk factors for developing rhino-orbital-cerebral mucormycosis. Vaccination is protective. Random blood sugar of >178 mg/dl in COVID-19 positive or recovered patients should warrant close observation and early detection of ROCM. Presence of ophthalmoplegia, blepharoptosis at first clinical presentation and orbital apex involvement on imaging are associated with intracranial extension in ROCM.

Purpose: To study the clinical, microbiological profile and management outcomes of orbital abscess at a tertiary care center in South India., Material and Method: In a retrospective interventional case series, we reviewed all patients diagnosed with orbital cellulitis from 2000-2020. The data analyzed included demographic profile, clinical and radiological features, microbiological profile, and management outcome., Results: A total of 921 cases of orbital and periorbital infections were reviewed. Seventy-two cases were diagnosed as orbital cellulitis. Thirty-four cases (47.22%) had radiological evidence of orbital abscess. The median age was 20.63 years. Three patients (8.82%) were neonates. A male preponderance was noted (23, 67.65%). Sinusitis (10, 29.41%) and diabetes (5, 14.7%), were the most common predisposing factors. Optic neuropathy was seen in 15 (44.11%) patients, cavernous sinus thrombosis in two patients (5.88%), and septicemia in one patient (2.94%) Multiple orbital abscesses were noted in 7 (20.59%) cases. All patients underwent surgical drainage. Methicillin-sensitive Staphylococcus aureus was the most common organism isolated in 14 patients (41.18%). Vision improvement or stabilization was seen in all except 3 (8.82%)., Conclusion: Orbital abscess is a potential sight-threatening orbital infection. The infective process can spread and ascend up to involve cavernous sinus thereby becoming life-threatening. A timely diagnosis and intervention can halt the disease process and help restore vision in many cases.

A 28-year-old male presented with gradually progressive swelling of the right lower eyelid along with a prominence of the eye for 6 months. He had received oral steroids and intraorbital triamcinolone acetonide injection in the inferior quadrant for active thyroid eye disease. External examination revealed right eye proptosis and swelling along the inferior orbital region. Magnetic resonance imaging showed an ill-defined soft tissue lesion in the inferior extraconal space and a bulky right inferior rectus. Histopathology of the biopsied material revealed inflammation with septate fungal filaments, identified as Aspergillus flavus on culture. He responded well to oral voriconazole despite a recurrence during the course of treatment. Intraorbital steroids are given for idiopathic and thyroid-associated orbital inflammation. This is a report of a rare complication of fungal orbital abscess following intraorbital corticosteroid injection in an immunocompetent young patient.

The National Premarital Screening Program, which includes sickle cell disease and thalassemia, was made mandatory in 2004 by the Kingdom of Saudi Arabia (KSA), and the earlier studies have shown a poor knowledge and negative attitude toward this program in the different study groups. This study was conducted to assess the knowledge and attitudes toward premarital screening (PMS) in a randomly selected national sample of the Saudi population, 18 years and above. This was a cross-sectional study conducted in the Saudi population in the western region between July and December 2021. Valid and reliable questionnaire and data were collected from 893 participants aged ≥18 years. The χ 2 test was used to ascertain if there is an association between categorical variables. Multivariate logistic regression was used to determine factors predicting satisfactory knowledge. All 893 study participants had heard about PMS with 625 (70.0%), 244 (27.3%) and 24 (2.7%) having satisfactory, fair and poor knowledge, respectively. Participants aged 26-35 years ( p  =0  . 038), females ( p  < 0.001), those with higher education ( p  = 0.003) and employed ( p  = 0.004), had a better knowledge compared to other groups. Most of the participants had a positive attitude toward PMS. There is a changing trend in the knowledge and attitude toward PMS with a greater number of people wanting to go for PMS. There is also an improvement in the number of participants opting out of marriage in case of incompatibility with their future partner. However, the health education programs need to be improved regarding the hemoglobinopathies.

Purpose: To report the clinical profile and management outcomes of a series of cases of malignant tumors of the lacrimal drainage system (LDS)., Materials and Methods: A retrospective analysis of all cases diagnosed with LDS malignancy over the past 24 years (1995-2019) was done. Patient characteristics, tumor types, management, and outcomes were analyzed., Results: A total of 14 patients were included. Thirteen cases were of primary malignancy, while one was a secondary lesion. The mean age was 42.5 years, with males and females being equally affected. A medial canthal mass was the most common (9, 64.2%) presentation. Six patients (42.8%) had undergone one or more dacryocystorhinostomy surgeries for nasolacrimal duct obstruction before presentation. Seven patients underwent wide local excision (50%) while 3 (21.4%) each underwent dacryocystectomy and exenteration. Adjuvant radiation was administered to 4 (28.5%) patients. Thirteen (92.8%) patients were diagnosed with epithelial malignancy while one (7.1%) was a case of small B cell lymphoma. Transitional cell carcinoma was the most common epithelial malignancy (4, 28.5%). Three (21.4%) patients had metastatic disease (2 lymph nodes and one angle of jaw). There was no mortality after a mean follow up of 40.7+&#95;25.1 months (Median 26; Range 4-131)., Conclusion: LDS malignancy is rare, with the epithelial variant being far more common than non-epithelial. Wide local excision with adjuvant radiotherapy is the preferred management. Long-term follow-up is essential to manage recurrences and to increase survival.

A 52-year-old male presented with right eye prominence of 1-year duration. Right eye examination revealed proptosis and limitation of extraocular movements. Magnetic resonance imaging (MRI) of the orbit showed soft tissue mass in the inferomedial orbit with medial rectus involvement and involving lacrimal sac. The patient underwent an incisional biopsy. Histopathology confirmed a diagnosis of primary orbital adenocarcinoma. Positron emission tomography computed tomography (PET CT) did not show the involvement of any other organ. Right orbital exenteration was done for disease control. On histopathology the mass was found to be arising from the lacrimal sac and was reported as apocrine adenocarcinoma. The diagnosis was further confirmed by immunohistochemistry with the tumor staining positive for gross cystic disease fluid protein 15 (GCDFP 15). The patient received adjuvant radiotherapy and is alive without any recurrence at 1 year of follow up. Apocrine adenocarcinomas are rare malignant skin adnexal tumors. Involvement of lacrimal sac is extremely rare with only one case reported in the literature till date. Immunohistochemistry utilizing GCDFP 15 stain can confirm the diagnosis.

Obesity is a global health concern associated with the dysbiosis of intestinal microbial composition. In this study, we investigated the potentials of urolithin A (Uro-A) and urolithin B (Uro-B), two gut microbiota-derived metabolites of ellagitannins, in reducing body weight gain through the modulation of the gut microbiota. We established a high-fat diet (HFD)-induced obesity model in rats that were later administered with either 2.5 mg/kg of Uro-A or Uro-B. Serum biochemical parameters were quantified, and changes in the composition of the gut microbial community were analysed using 16S rDNA gene sequencing. Our results showed that the urolithins significantly decreased the body weight in HFD-fed rats and restored serum lipid profile. The taxonomic analysis showed that both Uro-A and Uro-modulated gut microbes related to body weight, dysfunctional lipid metabolism and inflammation. Overall, our results suggest that Uro-A and Uro-B possess anti-obesity properties, which may be related to the modulation of the gut microbial composition.

Aim: To describe the clinical and radiological features of orbital cysticercosis and its management outcome., Material and Method: A retrospective analysis of consecutive cases of orbital cysticercosis between January 2008 and January 2018. The management outcome was classified into good, fair, and poor depending upon the resolution of the clinical features and status of the cyst and scolex in the imaging studies., Results: A total of 61 patients with a mean age of 24.33± 31.04 years were included. The male: female ratio was 1.9:1. Pain, with or without prominence of the eye was the most common presenting symptom (n = 35, 57.4%). The mean duration of symptoms was 3.65 +/-8.56 months. Ocular motility restriction was the most common sign (n = 52, 85.2%). Fifty-five (90.16%) patients had myocysticercosis with inferior rectus being most commonly involved (n = 17, 27.9%), while 6 (9.83%) cases had orbital cysticercosis without any ocular muscle involvement. Four patients had compressive optic neuropathy. Subjectively, good clinical outcome was documented in 37 (60.65%), fair in 17 (27.87%) and poor in 7 (11.47%) patients. Objectively, imaging studies showed complete resolution of the cysticercosis lesion in 18 (45%), partial in 19 (47.5%), and no change in 3 (7.5%) patients., Conclusion: A high index of suspicion and a thorough knowledge of the clinical and radiological features are necessary for the proper diagnosis and management of orbital cysticercosis. Medical management with oral albendazole combined with oral steroids leads to desired outcome in the majority.

Aim: The aim of the study is to describe intracanalicular antibiotic ointment loading as a treatment option for canaliculitis., Material and Methods: It was an interventional prospective study. The study was conducted over a 3 year period from June 2015 to June 2018. All patients of canaliculitis managed with intracanalicular antibiotic ointment loading and with a minimum follow up of 3 months were included in the study. The antibiotic ointment was loaded into the canaliculus based on the antibiotic sensitivity of the material expressed out from the canaliculus. Patients' demographics, clinical details, microbiological profile and management outcomes were evaluated., Results: A total of 24 patients were included in the study. Mean age at presentation was 58.41 ± 9.4 years. The right eye was involved in 15 (62.5%, p = .0424) cases. The incidence of lower canaliculus involvement (14, 58.33%, p = .022) was significantly higher as compared to the upper canaliculus (8, 33.33%). Staphylococcus epidermidis and Actinomyces israelii (6, 25%) were the most commonly isolated organisms. Mean number of intracanalicular antibiotic loading sessions required was 4.21 ± 1.69 (range 2-8). Complete resolution of canaliculitis was seen in all (100%) cases., Conclusion: Canalicular antibiotic ointment loading is a minimally invasive, safe, and effective procedure. It preserves the anatomy and function of the punctum and canaliculus and can be considered as one of the management options for canaliculitis.

Purpose: To describe the magnetic resonance imaging (MRI) features of the medial canthal tendon (MCT) insertion in a series of patients of the Centurion syndrome., Methods: This was a prospective study carried out over a period of 1 year. All patients clinically diagnosed with Centurion syndrome underwent MRI with surface coils. The insertion of both the limbs (anterior and posterior) of the MCT was studied radio-logically and correlated clinically., Results: We recruited six patients, of whom four were males. The anterior limb of the MCT was found to insert anterior to the anterior lacrimal crest in three, normally inserted in two, and thinned out and mal-developed in one. None of the patients with normal insertion had the classical beak sign or prominent nasal bridge., Conclusion: The anterior limb of the MCT may not always be inserted anteriorly in cases of Centurion syndrome; it can be normal or mal-developed. Disinsertion of the MCT, which is the most common procedure done for Centurion syndrome, might not be helpful in cases where the MCT is normally inserted or mal-developed.

Plasma cell granuloma is a rare non-neoplastic inflammatory condition of unknown etiology commonly involving lung and gastrointestinal tract. Conjunctival disease per se is very rare and usually associated with involvement of other organs. We report a case of conjunctival plasma cell granuloma without any systemic involvement in a 9-year-old girl who presented with bilateral reddish vascularised subconjunctival episcleral mass. An excision biopsy of the mass in the left eye followed by histopathologic examination and Immunohistochemistry confirmed the diagnosis. At 1 year follow-up, the child had no recurrence in the operated eye whereas the lesion remained the same in the other eye despite systemic treatment with immunosuppressants. This case is being reported for its rarity and to insist on the mandatory need for a thorough systemic workup to identify multiorgan involvement as well as to rule out other systemic disorders.

Chitosan, obtained as a result of the deacetylation of chitin, one of the most important naturally occurring polymers, has antimicrobial properties against fungi, and bacteria. It is also useful in other fields, including: food, biomedicine, biotechnology, agriculture, and the pharmaceutical industries. A literature survey shows that its antimicrobial activity depends upon several factors such as: the pH, temperature, molecular weight, ability to chelate metals, degree of deacetylation, source of chitosan, and the type of microorganism involved. This review will focus on the in vitro and in vivo antimicrobial properties of chitosan and its derivatives, along with a discussion on its mechanism of action during the treatment of infectious animal diseases, as well as its importance in food safety. We conclude with a summary of the challenges associated with the uses of chitosan and its derivatives.

Background: Medical education has a longstanding tradition of using logbooks to record activities. The portfolio is an alternative tool to document competence and promote reflective practice. This study assessed the acceptance of portfolio use among Saudi undergraduate medical students., Methods: Portfolios were introduced in the 2nd through 5th years at King Abdulaziz University over a two-year period (2013-2015). At the end of each academic year, students completed a mixed questionnaire that included a self-assessment of skills learned through the use of portfolio., Results: The results showed a difference in focus between basic and clinical years: in basic years students' focus was on acquiring practical skills, but in clinical years they focused more on acquiring complex skills, including identifying and managing problems. The questionnaire responses nonetheless revealed a positive trend in acceptance (belief in the educational value) of portfolios among students and their mentors, across the years of the program., Conclusions: Using portfolios as a developmental learning and formative assessment tool in the early undergraduate years was found to contribute to students' ability to create their own clinical skills guidelines in later years, as well as to engage in and appreciate reflective learning.

Purpose: This paper aims to summarize recent developments regarding the synthesis, application and challenges of fungal AgNPs. Possible methods to overcome the challenge of synthesis and reduce the toxicity of AgNPs have been discussed., Materials and Methods: This review consults and summary a large number of papers., Results: Silver nanoparticles (AgNPs) have great potential in many areas, as they possess multiple novel characteristics. Conventional methods for AgNPs biosynthesis involve chemical agents, causing environmental toxicity and high energy consumption. Fungal bioconversion is a simple, low-cost and energy-efficient biological method, which could successfully be used for AgNPs synthesis. Fungi can produce enzymes that act as both reducing and capping agents, to form stable and shape-controlled AgNPs., Conclusions: AgNPs have great potential in the medical and food industries, due to their antimicrobial, anticancer, anti-HIV, and catalytic activities. However, the observed in vitro and in vivo toxicity poses considerable challenges in the synthesis and application of AgNPs.

Purpose: Hyaluronidase enzyme is a common additive with local anesthetic agent to facilitate faster permeation of the anesthetic in periocular tissues during ophthalmic surgery. We report a series of five subjects presenting with clinical features mimicking orbital cellulitis following peribulbar anesthesia and consequently diagnosed with hyaluronidase hypersensitivity., Setting: The study was conducted at a tertiary eye care center in Southern India., Design: It was a retrospective interventional case series., Methods: We retrospectively reviewed the case records of patients diagnosed as and treated for hyaluronidase allergy from 2011 to 2015. The presenting features included periocular edema, proptosis, and restriction of ocular movements. The symptoms appeared immediately after the injection to as late as 6 days after the surgery. All patients underwent comprehensive ophthalmic evaluation, relevant investigations, and dermal allergy tests. All five patients tested positive for hyaluronidase. Patients were treated with antihistaminics, systemic steroids, and emergency orbital decompression, when required. In majority of the patients, symptoms resolved in 3-5 days. Clinically, hyaluronidase allergy may mimic orbital cellulitis, which in the context of a recent intraocular surgery may be alarming for both the patient and the surgeon. However, with prompt intervention, the prognosis is extremely favorable in cases of hyaluronidase allergy. It is important for ophthalmic surgeons and anesthetists to recognize and differentiate this entity from the more serious vision threatening conditions.

Pleomorphic adenoma is the most common epithelial neoplasm of the lacrimal gland. The tumor typically presents with a superotemporal mass with inferonasal displacement of the globe. They generally measure less than 3 cm in size and can be removed comfortably via a lateral orbitotomy approach. Pleomorphic adenoma left unattended for a long period grows up to humongous proportions and poses a surgical challenge both for its complete removal and globe salvage. We report a rare case of pleomoprphic adenoma of the lacrimal gland in an adult male, who did not seek any medical advice for 20 years allowing the tumor to expand enormously in all dimensions, with complete obscuration of the globe. The tumor was excised completely and globe could be salvaged.

Mesenchymal chondrosarcoma is a rare orbital tumor. Several case reports of this rare tumor have been published in the literature but only 6 cases have documented a follow up of 5 years or more. We report a case of 28 year-old female who presented with left orbital mass. Computed Tomography (CT) revealed a lobulated mass in the superior extraconal space with dense intralesional calcification. Patient underwent complete resection of the mass and histopathology was suggestive of mesenchymal chondrosarcoma. He was given adjuvant radiotherapy and there was no recurrence or metastasis at 5 years of follow-up. The case highlights that a complete resection with adjuvant radiotherapy in cases of orbital mesenchymal chondrosarcoma offers excellent prognosis.

Ocular prosthesis is either a readymade stock shell or custom made prosthesis (CMP). Presently, there is no other technology available, which is either superior or even comparable to the conventional CMP. The present study was designed to fabricate ocular prosthesis using computer aided design (CAD) and rapid manufacturing (RM) technology and to compare it with custom made prosthesis (CMP). The ocular prosthesis prepared by CAD was compared with conventional CMP in terms of time taken for fabrication, weight, cosmesis, comfort, and motility. Two eyes of two patients were included. Computerized tomography scan of wax model of socket was converted into three dimensional format using Materialize Interactive Medical Image Control System (MIMICS)software and further refined. This was given as an input to rapid manufacturing machine (Polyjet 3-D printer). The final painting on prototype was done by an ocularist. The average effective time required for fabrication of CAD prosthesis was 2.5 hours; and weight 2.9 grams. The same for CMP were 10 hours; and 4.4 grams. CAD prosthesis was more comfortable for both the patients. The study demonstrates the first ever attempt of fabricating a complete ocular prosthesis using CAD and rapid manufacturing and comparing it with conventional CMP. This prosthesis takes lesser time for fabrication, and is more comfortable. Studies with larger sample size will be required to further validate this technique.

A 44-year-old male patient presented with painless progressive proptosis of left eye for the last 20 years. Examination revealed a purplish vascular mass extending from the medial orbital region to the surface of the globe. He underwent complete excision of the mass via an anterior orbitotomy approach. Histopathology and immunohistochemistry revealed a diagnosis of angioleiomyoma. No recurrence was noted at 1 year of follow-up. Angioleiomyomas are benign smooth muscle tumors with an additional vascular component. Their occurrence in the orbit is extremely rare with only three cases reported in literature till date. We report a fourth case of angioleiomyoma of the orbit with the longest duration of presentation of 20 years.

Objective: Increased extent of lipid peroxidation and decreased antioxidant defense has been postulated as a major contributor to the development of preeclampsia. The present study was conducted to determine the serum level of malondialdehyde (MDA) and vitamin C in these patients., Methods: This research was conducted as a case-control study to assess the extent of lipid peroxidation and antioxidant status in 150 preeclampsia patients and 174 healthy pregnant women. Lipid peroxidation was assessed by measuring serum MDA level, and antioxidant defense was evaluated for serum vitamin C by UV spectrophotometric method. Independent sample t test and Pearson's correlation test were used for the statistical analysis with statistical software package SPSS, version 16.0 (SPSS, Inc., Chicago, IL)., Results: Our study found significantly higher level of MDA (p < 0.05) and significantly lower level of vitamin C (p < 0.05) in preeclampsia patients in comparison to the control subjects. Pearson's correlation analysis revealed that there was negative correlation between the serum level of MDA and vitamin C for both patient (r = -0.057, p = 0.669) and control groups (r = -0.128, p = 0.487). Analysis of socio-economic data revealed that preeclampsia was more prevalent among the rural pregnant than the urban pregnant women (OR 1.44, 95% CI 0.665-3.14, p = 0.352). It was also observed that primigravida pregnant were at higher risk for the development of preeclampsia than the multigravida pregnant women (OR 1.87, 95% CI 0.868-4.04, p = 0.108)., Conclusions: Elevated serum MDA and depleted serum vitamin C may be associated with the development of preeclampsia.

Castleman disease is a non-neoplastic cause of lymphadenopathy, first described in 1956 by Dr. Benjamin Castleman. Orbital involvement in Castleman disease is extremely rare. We report a case of bilateral orbital Castleman disease in a 48-year-old Asian male who presented with bilateral inferior dystopia. MRI revealed bilateral extraconal superior orbital mass. Histopathology and immunohistochemistry of the mass revealed features of Castleman disease of hyaline vascular type. Castleman disease should be a differential in suspected idiopathic orbital inflammatory disease and lymphoproliferative disorders.

Purpose: Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is an autosomal dominant disorder characterized by bilateral ptosis with poor levator function, epicanthus inversus and shortened horizontal palpebral fissures., Method: Eighteen -month -old twin sisters presented with history of watering from their left eyes since birth. Examination revealed features of BPES with left congenital nasolacrimal duct obstruction in both., Result: the twins underwent therapeutic probing, which was successful in one and failed in the other. the second child was subsequently managed by external dacryocystorhinostomy., Conclusion: To our knowledge, this is the first report of Blepharophimosis syndrome with congenital nasolacrimal duct obstruction occurring in twin sisters.