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Purpose: To report the prevalence of amblyopia risk factors in children with congenital nasolacrimal duct obstruction.Methods: A retrospective review of records of children with the diagnosis of congenital nasolacrimal duct obstruction (NLDO), who underwent probing from January 2009 to October 2011, was done. All of them underwent a complete ophthalmic evaluation including cycloplegic refraction and strabismus evaluation before probing.Results: A total of 142 children were included in this study. The mean age at presentation was 22.38 months (sample standard deviation (SSD) - 15.88). Amblyopia risk factors were defined according to two sets of guidelines: The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) referral criteria guidelines and the new AAPOS Vision Screening Committee guidelines. Twenty-eight (20%) children were found to have some form of amblyopia risk factor based on the referral criteria prescribed by AAPOS. However, on applying modified guidelines described by Donahue et al., to analyze the same cohort, 21 children were found to have amblyogenic risk factors. Of these 28 children, 13 had significant astigmatism (>1.50 D), 8 children had hypermetropia (>3.50 D), and six children had anisometropia (>1.50 D). One child had significant cataract (media opacity >1 mm). None of the children in this series had either myopia or strabismus.Conclusion: Prevalence of amblyopia risk factor was found to be 20% in our study based on the older guidelines; however, it reduces to 14.78% by applying the modified guidelines. Despite this reduction, importance of a comprehensive ophthalmic examination including cycloplegic refraction in all children presenting with NLDO cannot be overstated. A close follow-up of these children is also essential to prevent the development of amblyopia. [ABSTRACT FROM AUTHOR]

A 25-year-old young male patient presented in casualty department with severe respiratory distress on the fourth day from onset of symptoms. The patient was nonsmoker and had no antecedent medical or drug history. Prior to admission, patient had dry cough and bilateral pleuritic chest pain for the last three days. He was in severe respiratory distress with use of accessory muscles of respiration. On examination, he had heart rate of 120 beats/min, blood pressure (BP) of 150/80, respiratory rate of 48-52/min and central cyanosis present. On systemic examination, reduced intensity of breath sounds with extensive rhonchi and crepitation was found in both lung fields, with other examination being within normal limits. On pulse oximetry, oxygen saturation was 28% on room air, which increased up to 36% with the help of 4 L oxygen via nasal prongs. PaO2/ FiO2 ratio was 100. Chest X-ray analysis was suggestive of non-cardiac pulmonary edema in view of bilateral fluffy opacity without cardiomegaly. In view of 2/3 positive criteria, his provisional diagnosis was Acute Respiratory Distress Syndrome (ARDS). He required mechanical ventilatory support and was gradually weaned over a period of 10 days. The patient was treated with broad spectrum antibiotics and other supportive measures. On re-evaluation of history, we found that he was a goldsmith by occupation, smelting silver and gold for the past 8-10 years. On the day of onset of symptoms, while smelting silver he was exposed to golden yellow fumes for around 15 minutes, with the quantum of exposure more than any other day earlier. From previous experience and analysis of similar silver metals, he was able to tell us that the silver was adulterated with large amount of cadmium on that day than before. Serum level of cadmium was 2.9 μg/L 6 days after initial exposure. At the time of discharge, he had residual opacities in the chest radiograph and resting oxygen saturation was 94% on room air. [ABSTRACT FROM AUTHOR]