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BACKGROUND Corneal ulcer is an open sore on cornea causing significant morbidity especially in developing countries. It is associated with redness, watering, photophobia, pain and decreased vision of that eye. It is a vision threatening emergency and may lead to corneal scarring and perforation. If left untreated it may progress to endophthalmitis. So, an early diagnosis with recognition of the causative agent is very much essential to preserve vision. We conducted this study to evaluate the risk factors, causative organisms, and patient demographics of microbial keratitis. METHODS All new patients with suspected suppurative keratitis presenting at the ophthalmology OPD of Calcutta National Medical College and Hospital for a period of 1 year were evaluated. Sociodemographic data, visual acuity at presentation, and information pertaining to the risk factors were recorded. After diagnosing infective corneal ulcer clinically, corneal scraping was performed. Microscopy and culture were performed on all corneal specimens obtained. From this data we tried to find out the epidemiological pattern and factors involved in suppurative corneal ulcer. RESULTS One hundred and fifty cases of suppurative keratitis were studied clinically and microbiologically. Study showed a male preponderance (73.33%) with cultivators constituting the major occupational group (29.33%). Trauma was the commonest pre-disposing factor (64%). Among the 114 (76%) culture positive cases, 62 (41.33%) patients had pure fungal infection, 33 (22%) patients had pure bacterial infections and 19 cases (12.67%) had mixed fungal and bacterial infections. Aspergillus spp. were the most common fungal isolate, while among the bacteria positive cases, the main isolates were Staphylococcus aureus, Pseudomonas sp. and Pneumococcus. CONCLUSIONS Suppurative corneal ulcer is an important cause of preventable blindness. Smear and culture is an essential tool in the diagnosis of these infections. Region based information about the causative organisms and risk factors helps in empirical management, and to formulate guidelines for prevention of suppurative keratitis in the population at risk.

BACKGROUND Destructive Eye Surgeries (DES) are performed for some ocular conditions where there is no hope for vision and the diseased eye is a threat for the healthy eye or various systemic complications. This terminal mode of treatment has a huge impact on psychological aspect and cosmetic concerns for the patients and their relatives. This retrospective study was done to determine various indications for performing DES and their rate as well as pattern of distribution among patients attending Regional Institute of Ophthalmology (RIO) in West Bengal (WB). METHODS This retrospective study included 286 cases of destructive eye surgery performed at RIO, Kolkata for a period of 2 years (1st April 2017- 31st March 2019). Data collection was done by review of operation theatre register and indoor records of patients having panophthalmitis, endophthalmitis, staphylomas, traumatic eye injury, and painful blind eyes. Information collected included age, sex, indication for surgery with the side of the eye involved, visual status of the affected eye at presentation and radiology report. RESULTS Two hundred and eighty-six (286) patients had undergone destructive eye surgery during the study period. The commonest age group was above 60 yrs. (29.37%). The least common age group was 15-40 yrs., about 21.68% of the total. Evisceration was the most commonly performed DES (74.83%) followed by enucleation (24.48%). Orbital exenteration was noted in only 2 cases. Most common causes of DES were infective or inflammatory conditions. Others included ocular trauma, painful blind eye, staphyloma, and neoplasms like retinoblastoma, orbital metastasis etc. CONCLUSIONS Most of the ocular conditions leading to destructive surgery were preventable. Hence proper care, public awareness, and protective measures for maintaining ocular health can reduce the burden of such destructive surgeries.

Background: Ocular trauma and its complications are a significant contributor to global visual impairment and often present as an ophthalmic emergency in medical care facilities. Timely intervention is crucial for final visual outcome. Aims and Objectives: This study aimed to identify the factors that are correlated with the final visual outcome in cases of traumatic hyphema in a closed globe injury (CGI). Materials and Methods: A single-centric, prospective, interventional study was conducted in a tertiary care hospital. Fifty-three consecutive patients were enrolled in the study over a period of 1 year 5 months who presented with traumatic hyphema due to blunt trauma. Patients with a head injury, any blood dyscrasia, on blood thinners, associated with eye injury other than traumatic and unwilling patients were excluded from the study. Data analysis was done using statistical package for the social sciences software. Results: There was male preponderance. Majority of the study population were in the second decade. Best-corrected visual acuity (BCVA) was affected more among those who had hyphema of Grade-II or higher (P = 0.017). BCVA on presentation, posterior segment injury (P = 0.001) was found to be major determinant. Conclusion: We conclude traumatic cataract, corneal blood staining, secondary hemorrhage, time interval between the injury and presentation, BCVA at presentation, posterior segment injuries such as retinal detachment, berlin’s edema, optic atrophy, glaucoma are the major factors that determine the visual outcome. A handful of studies are available in literature regarding the visual outcome in patients with hyphema in CGI due to blunt trauma, but no such study is available from this part of the country.

Background: Sino-orbital fistulas (SOF) are a well-reported complication of orbitalexenteration and sinonasal carcinoma resection. Despite repair, however, complete fistula closure may be difficult. Case: A 79 –years-old man had undergone total exenteration of right orbit for spreading sqamous cell carcinoma of conjunctiva. Subsequently he developed two large sinoorbitalfistulae medially to the ethmoid sinus wall of the orbit. Post- operatively good socket hygiene was maintained but the fistulae increased in size. At 3 month follow-up, closure of the fistulae using glabellar rotation advancement flap was done. The defects have remained closed at follow-up with excellent cosmetic results. There is no recurrence of fistula or malignancy till date. Patient was cosmetically rehabilitated with spectacle prosthesis. Conclusion: Glabellar rotation flap for closure of medially situated sino- orbital fistulae is a good option with excellent cosmetic result.

Aims and Objectives: The aim was to study the demographic pattern, clinical features, management, and prognosis of the patients with firecracker-related ocular injuries during Diwali. Materials and Methods: This institution-based prospective study was done in 30 patients who attended eye emergency and outpatient department (OPD) of Calcutta National Medical College and Hospital, West Bengal, during the period of 1 week of Diwali in 2016 and 2017. The parameters studied were the age and sex of the patients, type of firework (crackers and sparklers), eye involved, severity of injury with respect to active and passive participants, management, severity of injury, and visual outcome with respect to type of firecrackers. Results: A total of 30 patients attended eye OPD and emergency during our study period, of which 23 (76.7%) were male and 7 (23.3%) were female. All of them were in the pediatric age group (1–15). All patients were examined on the day of injury. Patients between 6 and 10 years of age were most commonly affected. Four cases (13.3%) were open-globe injuries and 26 (86.7%) cases were closed-globe injuries. Visual acuity varied from 6/9 to no perception of light. The most common firework involved was the crackers. Conclusions: Careless and indiscriminate use of firecrackers may sometimes lead to serious ocular damage. In India, use of fireworks is quite common during various festivals, particularly during Diwali, thus fireworks-related ocular injuries are important causes of blindness. This prospective study revealed the presentation and outcome of ocular injuries due to firecrackers in this area of mixed culture during this festive week.

An 8-year-old boy presented with a left lower lid swelling of one month duration. His parents gave a history of date palm thorn injury on left side of the forehead three months back which was removed partially by a local doctor. On examination, there was a left infraorbital swelling with diffuse oedema of the left sided cheek and temporal fossa. A scar mark (entry wound) was detected over the left eyebrow. Three-D configuration of contrast enhanced computed tomography (CECT) of the orbit showed a linear foreign body behind the zygomatic bone. The lower lid mass was excised, the date palm thorn was recovered from a pocket behind the zygomatic bone. Histopathology of the excised mass showed presence of granulation tissue. We describe the management of such a rare case along with review of literature. Keywords: Periorbital injury, Date palm thorn, 3D imaging

Background: Orbital tuberculosis is a rare manifestation of extrapulmonary tuberculosis. We report an interesting case of osteomyelitis of orbital bone in an Indian child. Case Report: A 9- year old girl presented with a gradually increasing painless swelling of left upper lid and blepharoptosis along with swelling of left side of forehead for last two months. The swelling was soft, fluctuating and non-tender. Diagnostic tap revealed thick pus which prompted us to do an incisional drainage of the abscess. The pus was sterile on microbiological examination. A diagnosis of osteomyelitis of orbit along with cold abscess of infratemporal fossa was made on the basis of clinical examination, positive Mantoux (MX) test, high erythrocyte sedimentation rate (ESR) and bony erosion of frontal and zygomatic bones in contrast enhanced computerized tomography (CECT). Patient showed marked improvement with antitubercular drug (ATD) but a sinus developed at the incision site. Six months later patient presented with occasional serous discharge from the sinus.The patient underwent excision of the sinus along with curettage and debridement of the left frontal bone and the tissue was sent for histopathological and microbiological examination. ATD was continued for 15 months. Her post-treatment three year follow up was without any recurrence. Conclusion: High index of suspicion should be kept for early diagnosis and timely treatment of the orbital tuberculosis. We want to report the case because of its rarity and clinical interest.

Cerebrospinal fluid (CSF) leakage is an uncommon but significant complication of orbital and rarely lacrimal surgery. We report a rare case of CSF rhinorrhea following external dacryocystorhinostomy (DCR) surgery. A 38-year-old healthy lady was diagnosed to have chronic dacryocystitis for which right side external DCR was done. At the evening of first postoperative day, the patient noticed a discharge of clear fluid coming through the right nostril, in sitting posture. The fluid was sent for biochemical analysis. Based on clinical and biochemical tests of fluid, a diagnosis of iatrogenic CSF rhinorrhea was made. Contrast enhanced computed tomography and computed tomography cisternography failed to reveal any site of active leakage. However, the patient improved with conservative management only. CSF leakage occurs very rarely in external dacryocystorhinostomies with only a few case reports found in the literature. Knowledge of anatomy and thorough preoperative assessment may predict areas at high-risk for encountering this problem.

Introduction: Benign intracranial hypertension (BIH) is a disorder defined by symptoms and signs suggestive of increased intracranial pressure (ICP) in the absence of any cause evident on neuroimaging or other evaluations. Usually the disease has a variable outcome but chances of severe visual loss are only 6%. Methods: We report a case of 50 year old lady who presented to us with severe headache. Visual acuity was 20/20 both eyes. Anterior segment was within normal limit. Post segment evaluation revealed bilateral disc oedema. Thorough radiological and neurological examination confirmed diagnosis of Benign intracranial hypertension (BIH). We advised medical treatment and referred the patient to Neurology OPD for further management. She was lost to follow up to us for 4 months. She discontinued medicines in between. Her vision was 20/200 and fundus showed atrophic disc edema. We restarted previous medicines and referred to Neurology where she was admitted and managed conservatively. Finally she presented after 2 months with no perception of light both eyes. Examination revealed bilateral afferent pupillary defect and sixth nerve paresis. Fundus showed bilateral disc pallor.

Fishing is a popular rural recreational activity. Fortunately, penetrating ocular injuries with fish hooks are rare. These injuries are usually caused by fish hook prongs penetrating the ocular tissues. We report a rare case of penetrating fish hook injury to the globe and its successful surgical management.A 12- year-old female child was referred to the causality with a fish hook embedded in her right eye. She sustained the injury while fishing with her father. The fish hook had penetrated the globe obliquely. The hook was removed via its entrance wound under general anesthesia. Subsequently the child developed traumatic cataract which was operated with a final visual outcome of 6/12.Visual prognosis can be profoundly affected by the initial management. Prompt surgical intervention as done in our case is recommended to prevent significant visual loss. Keywords Fishhook; penetrating ocular injury; traumatic cataract.

A 23 year female presented with bilateral recurrent swelling of eyelids along with ptosis and proptosis for last 3 years. She also had swellings over the right cheek, parotid gland, and retro auricular area along with regional lymphadenopathy. Systemic laboratory workup revealed raised serum IgE and a high peripheral eosinophil count. Computed tomography and magnetic resonance imaging showed bilateral enlargement of extraocular muscles, lacrimal glands, and ipsilateral parotid gland. Excision biopsy of the retro-auricular lymph node was suggestive of Kimura's disease (KD). The patient responded well to systemic corticosteroid. KD rarely affects orbit, but it should be included in the differential diagnosis of inflammatory diseases of the orbit. To our knowledge, this is the first reported case of KD from India involving the orbit, lacrimal gland, extraocular muscles, parotid gland and buccal area.

A 19-year-old previously healthy male presented with a 4 year history of painless drooping of right upper eyelid. On eversion of the right upper eyelid, a yellowish pink mass was seen in the tarsal region. Rest of the ocular examination was normal in both the eyes. Initial biopsy showed chronic inflammation. Subsequently, the entire mass was excised and histopathological examination showed the presence of amyloid in the subconjunctival stroma. At 3 months follow-up, similar lesion was detected in the right lower, left upper, and lower lid, which were treated with cryotherapy, with partial resolution. Patient has been followed up for more than 2 years without any complaints. To our knowledge, this is the first case report of an isolated primary conjunctival amyloidosis with involvement of both the upper and lower palpebral conjunctiva of either eye. It was treated successfully by excision and cryotherapy.

Background : Ophthalmomyiasis in humans is a rare phenomenon. Objectives : To create awareness among the ophthalmologists regarding larval conjunctivitis. Cases : We report two cases of ophthalmomyiasis, which came to a tertiary care centre with features of unilateral acute catarrhal conjunctivitis. Observations : Fly larvae were detected on slit-lamp examination and removed after immobilizing them with topical 4 % lignocaine. Topical antibiotics and steroid drops were prescribed for 2 weeks. The samples were identified as Oestrous ovis by the entomology department of the Institute of Tropical Medicine, Kolkata. The signs and symptoms regressed within 48 hours. Conclusion : The ocular myiasis can manifest as a unilateral catarrhal conjunctivitis. Key words: Ophthalmomyiasis, Oestrous ovis, conjunctivitis DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5277 Ne pal J Ophthalmol 2011; 3(2): 193-195

Serous retinal detachment (RD) is a rare complication of pre-eclampsia in pregnancy. We report a case of a 23-year-old primigravida with pre-eclampsia in her third trimester of pregnancy developing bilateral RD at term. After delivery, there was spontaneous resolution of the serous RD. Her best-corrected visual acuity was 6/6 in the right eye and 6/9 in the left eye on 1-year follow-up. Management of pre-eclampsia-induced serous RD is conservative, and the prognosis is good.

We report a case of posttraumatic corneal rupture with massive hyphema followed by extrusion of intraocular lens (IOL) and complete aniridia in a patient who underwent small incision cataract surgery with IOL implantation 2 years back. Repair of the corneal wound with removal of blood from anterior chamber was done. Once the media became sufficiently clear, iris ball was discovered floating in the vitreous cavity mixed with vitreous hemorrhage. Two months after the primary repair, vitrectomy with scleral fixation lens implantation was done. Best-corrected visual acuity in the right eye was 6/12 at 1-month follow-up. In pseudophakic eyes, extrusion of IOL with total aniridia after blunt trauma has rarely been reported in literature.

Ankyloblepharon filiforme adnatum (AFA) is a rare congenital anomaly characterized by partial or complete adhesion of upper and lower eyelids, usually seen as an isolated finding but often associated with other anomalies or a well-defined syndrome. We report two cases of AFA who presented at a tertiary eye care center of West Bengal. Family history of consanguinity was absent. One baby had abnormal tuft of hair over the small of the back. No other congenital abnormalities were detected in any of them. The adhesions of the eyelids were divided by a number 15 blade after crushing with mosquito forceps in both cases without any anesthesia. Subsequent ocular examinations following separation and during follow-up revealed normal eyelid function, ocular motility, and fundus. In a case of AFA, timely separation of the eyelids is crucial to avoid the development of occlusion amblyopia. Cases of AFA reported in the literature are reviewed.

A retrospective study was performed to assess the pattern of pediatric ocular trauma in a tertiary eye center in eastern India. Records of 672 patients aged 16 years or less with ocular trauma who attended the outpatient department or emergency or treated as inpatients at a tertiary referral center between April 2009 and March 2010 were reviewed. Boys accounted for 70% cases. Most children were of the 5-10 years age group. Closed globe injury was the commonest (418 patients, 62.19%), followed by open globe injuries (127 patients, 19%), orbital injuries (52 patients, 7.67%), superficial foreign bodies (7.14%) and burn (4.01%). Home was found to be the commonest place of injury (44%), and only 51.9% attended the health facility within 24 h. Conservative management was done in 497 (74%) cases, whereas 175 (26%) cases were treated surgically. Final visual outcome of 443 (66%) patients were between 20/20 and 20/50. Sixty-eight patients had worst visual outcome with monocular blindness of the injured eye. Strategies to reduce the incidence of ocular trauma at home should be directed towards raising the parental education and public awareness.

Background : Orbital tuberculosis is rare even in endemic areas. The disease may involve soft tissue, lacrimal gland, or the periosteum or bones of the orbital wall. Case : We present an Indian girl, who presented with a slowly growing left-sided superotemporal orbital mass, with no significant previous medical history. The swelling turned to an abscess and burst spontaneously giving rise to a discharging sinus. The discharge was negative for any organism on Gram and Giemsa staining. A tuberculin skin test was strongly positive. Incisional biopsy showed caseating granuloma and Langhan’s giant cells suggestive of tubercular aetiology. The patient responded well to tuberculous chemotherapy. Conclusion : Although tuberculous dacryoadenitis is a very rare manifestation of tuberculosis, still the possibility should be entertained in a slowly growing mass of the lacrimal gland, especially in developing countries where the prevalence of tuberculosis is high. Key words : Tuberculosis, lacrimal gland, histopathology DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5281 Ne pal J Ophthalmol 2011; 3(2): 210-213