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A 3-year-old girl presented with sudden onset of bilateral vision loss on waking up from sleep. There had been no associated eye pain, eye redness, fever or history of trauma in the days leading up to the presentation. She had been diagnosed with Evans syndrome at the age of 18 months and started on a regular dose of oral prednisolone under regular follow-up at the paediatric clinic. Upon presentation, her visual acuity was light perception bilaterally, with relative afferent pupillary defect in the right eye and sluggish pupils bilaterally. Bilateral fundus examination showed normal macula and pink optic discs without papilloedema. Other systemic examinations were unremarkable. The provisional diagnosis was severe bilateral retrobulbar optic neuritis, prompting further investigations to rule out infectious or vasculitic causes. Extensive investigations were carried out during admission including infective screenings of blood and urine, all of which were negative. A contrasted magnetic resonance image of the brain showed both orbital segments were swollen and appeared hyperintense, with involvement of the intracanalicular and intracranial segments, suggesting an inflammatory or demyelinating aetiology. A visual evoked potential test to rule out demyelination disease was also normal. As intravenous methylprednisolone treatment appeared to have a slow effect, the treatment was switched to intravenous gammaglobulin. The patient responded well to treatment, and her latest visual acuity assessment 1 month after presentation showed bilateral vision of 6/24. This is the first-ever Evans syndrome patient to be reported worldwide with bilateral optic nerve sterile inflammation.

Background: Over past few months due to COVID-19 lockdown, our society has been in indoor settings where the education, work and entertainment are through digital platform. This created an increase in rate of digital eye strain. Method & materials: An epidemiological observational study conducted during lockdown period among people of Kerala with a structured and validated questionnaire using Google form. People with age ≥ 18 years, using digital screen on continuous basis were included in the study.Inform consent were collected from the participants before the survey.The statistical analysis were done using SPSS software. Results and Discussions: A total of 584 were participated in the study where more than 86% reported at least one symptom. Smart phone and computer were the major platform used by participants mainly for learning and entertainment.31% of participants were continuously using digital screen for >2hours.One fourth of participants were using the screen for >9 hours and a 20% uses the screen in dark room or dim light for >5 hours. 66% had mild and 2.2% had severe symptoms.Headache was the common symptom found followed by eye pain and neck/shoulder/joint pain. Females were found to be more prone to develop CVS. Headache, eye redness, burning, etc. were correlated with duration of use. Conclusion: The digital screens demands high visual strain, much attention and care should be taken for vision problems and related issues.Since we are depending on digital screens for many of the daily activities, the information related to CVS and associated discomfort along with the prevention strategies should be explained by health professionals. Keywords: Digital Eye Strain, Computer vision syndrome, Lockdown, COVID-19

Rationale: Diffuse unilateral subacute neuroretinitis is a form of posterior uveitis and has a few clinical presentations according to the onset of presentation. Patients’ concern: A girl (5-year-old) and 2 boys (both 12-year-old) were included in this report. Upon presentation, the visual acuity ranges from 6/12 to 6/60. All three cases had different symptoms (case 1: floaters; case 2: eye redness and pain; case 3: central scotoma). All of them had variable posterior uveitis features (case 1: vitritis and focal retinitis; case 2: subretinal larva track; case 3: choroiditis). Diagnosis: Diffuse unilateral subacute neuroretinitis. Intervention: All 3 patients were treated with oral albendazole. Outcome: All patients showed remarkable resolution of inflammatory reactions of the eye and also improvement of vision. Lesson: High index of suspicion should be made for children and young adults who are previously healthy but presented with suddenly onset of reduced vision with clinical features of posterior uveitis of variable degree. Clinical features together with a full blood picture can help to diagnose the problem when other parameters are negative.

The case presented is a 66-year-old woman who attended the emergency department due to skin lesions on the limbs, facial oedema, and eye redness accompanied by haemorrhagic conjunctivitis. The symptoms resolved after one week of systemic steroid treatment. Skin biopsy confirmed Sweet syndrome. Sweet syndrome is rare disorder and unknown by most ophthalmologists despite its frequent ophthalmological manifestations. Ocular involvement is present in one third of patients, with episcleritis and conjunctivitis being the most repeated. Pathology findings confirm the diagnosis which is also characterised by a rapid response to systemic corticosteroids.

Cosimo Mazzotta,1– 4 Ermete Giancipoli5 1Department of Medicine, Surgery and Neurosciences, Post-Graduate Ophthalmology School, University of Siena, Siena, Italy; 2Departmental Ophthalmology Unit, Alta Val d’ Elsa Hospital, Siena, Italy; 3Ophthalmology Operative Unit, Casentino Hospital, Arezzo, Italy; 4Siena Crosslinking Center, Siena, Italy; 5Ophthalmology Unit, Vito Fazzi Hospital, Lecce, ItalyCorrespondence: Cosimo MazzottaSiena Crosslinking Center, Via Sandro Pertini 7, Monteriggioni, Siena, ItalyTel +39 3495550676Email cgmazzotta@libero.itPurpose: To report the clinical-epidemiological association between acute anterior uveitis and acute bilateral follicular conjunctivitis in a 30-year-old female patient who had tested positive for the SARS-CoV-2 RT-PCR.Methods: A 30-year-old female visited emergency ophthalmology care at the Siena Crosslinking Centre, Italy, for a bilateral eye redness lasting two weeks, associated with unilateral photophobia and blurred vision in her right eye. She visited on the 23rd of March 2020 in the full pandemic period and presented chills and fever with a temperature of 39.0°C, associated with complete loss of taste. Since eye examination findings, systemic symptoms and epidemiological criteria correlated with SARS-CoV-2 infection, she was referred to Siena University Hospital, Italy, for the SARS-CoV-2 nasopharyngeal buffer and haematological examinations for uveitis.Results: Eye examination revealed bilateral conjunctival hyperaemia with acute follicular conjunctivitis associated with right eye acute anterior uveitis characterized by diffuse pigmentary and whitish immune precipitates over the anterior capsule of the crystalline lens and initial anterior lens opacity explaining the blurred vision. Adjunctive prophylactic eye topical treatment, included in the acronym SHYPIO (0.02% sodium hypochlorite solution, 0.6% povidone iodine eye-drops and 10.50% ozonized oil eye-drops), was associated with conventional uveitis therapy to prevent the virus spread through the ocular surface route.Conclusion: Our report demonstrates that complicated acute anterior uveitis (iridocyclitis) with blurred vision could be associated with SARS-CoV-2 infection, being potentially sight-threatening for early complicated lens opacity. Ophthalmologists examining suspected or asymptomatic patients should be aware of the risk of 2019-nCoV infection.Keywords: SARS-CoV-2 uveitis, SARS-CoV-2 anterior uveitis, SARS-CoV-2 associated uveitis, SARS-CoV-2 conjunctivitis, COVID-19 uveitis, COVID-19 conjunctivitis

Objective : to assess the effectiveness of tear substitutes in patients suffering from dry eye syndrome (DES). Material and methods . 100 patients with an established diagnosis of mild to moderate DES, averagely aged 42.0 ± 2.1, were divided into three groups: group 1 involving 33 patients (54 eyes, 13 men and 20 women) aged 42.7 ± 2.13 with mild DES, who were treated by low viscosity eye drops, group 2 involving 33 patients (56 eyes, 13 men and 20 women) aged 41.4 ± 2.07 with moderate DES, who were treated by moderate viscosity eye drops and group 3 involving 34 patients (52 eyes, 14 men and 20 women) aged 41.9 ± 2.1 with moderate DES, who were treated by high viscosity eye drops. Treatment results were evaluated after 1 month on the basis of complaints, objective examination data and indicators of the functional tests Results . The complaints (of discomfort, eye strain, fatigue when working with text, eye redness, lacrimation, burning and cramping in the eyes) became less severe, and so did the objective signs of DES. The functional test indicators showed an improvement, too. The best results of the treatment were noted in group 3, where the tear production indicator (Schirmer’s test) increased by 68.1 %. This indicator increased by 66.7 % and 61.5 % in groups 1 and 2, respectively. The LIPCOF test results dropped 3.9 times in group 1 and only 2,3 times in groups 2 and 3. Conclusion . Tear substitutes must be used in DES as the first line of conservative therapy. The improvement of subjective evaluations of the patients and the data of objective research in all three groups is the result of an adequate selection of tear substitutes drugs of a certain degree of viscosity according to the severity of DES.

Aim of the work: This report aims to present the clinical challenge in managing a case of anterior scleritis associated with anti-neutrophil cytoplasmic antibody (ANCA), which was masquerading as recurrent conjunctivitis and the lines of management and disease course. Case report: A 68-year-old Malaysian male presented with bilateral blurring of vision associated with pain and redness for one-week duration. He had prior episodes of eye redness and discomfort, which was temporarily relieved with a course of corticosteroid eye drops, on presumptive diagnosis of conjunctivitis. Visual acuity was 6/18 bilaterally. Anterior segment examination showed diffuse conjunctival and episcleral injection which was tender on palpation. There was no posterior segment involvement in both eyes. Patient was tested positive for ANCA and proteinase 3 (PR3). Urinalysis showed proteinuria and hematuria. Chest X-ray was clear with no evidence of pulmonary infiltrations, nodules, cavitation or pleural effusion. Electrocardiogram showed left ventricular hypertrophy with right bundle branch block. The patient also had sensorineural hearing loss. A diagnosis of ANCA-associated scleritis was made and patient was treated with a combination of oral glucocorticoids and azathioprine. The patient had two episodes of anterior scleritis and developed bilateral peripheral ulcerative keratitis (PUK) which resulted in permanent visual impairment with no further progress. Ongoing rheumatology service work-up for systemic vasculitis could not classify the case. Conclusion: ANCA-associated vasculitis can have atypical ocular presentation and can be clinically misdiagnosed as conjunctivitis. Long term visual and systemic complications can be prevented with early detection and prompt immunosuppressive treatment. Keywords: ANCA, Scleritis, ANCA-associated vasculitis, Conjunctivitis

Background Acute closed-angle glaucoma has an incidence of 2.2-4.1 cases per 100 000 persons per year in Europe. It is an ophthalmological emergency in which markedly elevated intraocular pressure can damage vision permanently. Because the acute symptoms are not always clearly referable to the eyes, patients often present to physicians who are not ophthalmologists. Methods This review is based on pertinent articles retrieved by a selective search in PubMed. Results The diverse symptoms of acute closed-angle glaucoma include eye redness, worsening of vision and other visual disturbances, headache, and nausea. Acute closed-angle glaucoma has multiple causes. Not all predisposing factors have been definitively identified; above all, there are certain anatomical configurations of the eye that make it more likely to arise. The goals of treatment are to reduce the elevated intraocular pressure rapidly, which usually leads to marked symptom relief, as well as to eliminate the situation that led to open-angle glaucoma. For proper treatment, the patient should be seen by an ophthalmologist without delay, on the day of symptom onset if possible. Conclusion Primary prevention of acute closed-angle glaucoma is not always possible. Even physicians who are not ophthalmologists can diagnose markedly elevated intraocular pressure by palpation of the globe. Proper, specific treatment can help patients rapidly and lastingly.

A 2-year-old girl with a 1-year history of photophobia presented with bilateral eye redness and was found to have dendriform corneal ulcers, which were initially managed with acyclovir ointment, without improvement. Clinical inspection revealed small cutaneous lesions on the fingers and toes. The association of pseudodendritic keratitis with palmo-plantar hyperkeratotic lesions was suspicious for tyrosinemia type 2, which was confirmed by high levels of plasmatic tyrosine (2134 μmol/L). A protein-restricted diet led to the complete resolution of the corneal and cutaneous lesions and avoided the potential toxicity of tyrosine on central nervous system.

The structure of the primary ophthalmologist appoint¬ment at the outpatient department has changed over the last 10-20 years. Universal computerization, the use of tablets and smartphones, being in air-conditioned rooms are accompanied by an increase in the number of patients with complaints of eye redness, dryness and discomfort. The use of vital dyes for biomicroscopy of the eye anterior segment is a simple and informative method for the early detection of diseases of conjunctiva and cornea. Practical recommendations regarding the use of fluorescein in the daily ophthalmic practice, diagnostic features of obtained patterns in diseases of the eye anterior segment as well features that help to assess the fit of contact lenses are giv¬en in the article.

An elderly diabetic lady presented with a painful swollen right eye and blurred vision for one week, preceded by right eye redness for six months. Her right eye best-corrected visual acuity was finger counting at 1 m. There was right eye proptosis, limited extraocular muscle movements, corkscrew vessels, chemosis and elevated intraocular pressure, but no bruit. Fever was absent. Computed tomography of the brain and orbit showed thickened extraocular muscles and intraconal fat streakiness, with normal superior ophthalmic vein and concavity of the cavernous sinus. Intravenous antibiotics resulted in limited clinical improvement. The subsequent response to oral prednisolone was dramatic, with the improvement of visual acuity to 20/60 after three doses. In cases of atypical orbital cellulitis where antibiotics fail, one should consider differential diagnoses such as orbital inflammatory disease, vascular anomalies and masqueraders. We discuss the approach to the diagnosis of acute proptosis in a diabetic patient and highlight the role of corticosteroids in idiopathic orbital inflammatory disease.

Purpose: We report the case of a 33-year-old male who presented with unilateral central serous retinopathy three days after the injection of a COVID-19 vaccine. Observations: A 33-year-old healthy Hispanic male referred to the ophthalmology service due to blurry vision and metamorphopsia in the right eye without any flashes, floaters, eye redness or pain. The patient reported that 69 hours prior to presentation he received the first dose of the Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine. He denied any past ocular history or pertinent medical history. He does not take any medicines and denies stressful factors in his life. The clinical examination and imaging tests were consistent with central serous retinopathy that resolved in three months. Conclusions and importance: This is the first report of an ocular complication potentially associated with a COVID-19 vaccination. Our case contributes information of a side effect potentially related to this new vaccine.

Background Frosted branch angiitis (FBA) is an uncommon ocular sign with multiple causes. With the recent outbreak of coronavirus disease 2019 (COVID-19), many cases of ocular manifestation in association with this disease have been reported. However, as yet we have no complete understanding of this condition. We report here the first case of FBA in a human immunodeficiency virus-infected patient with coexisting cytomegalovirus (CMV) and COVID-19 infection. Case presentation A 33-year-old Malay man with underlying acquired immunodeficiency syndrome receiving highly active antiretroviral therapy was referred to the Opthalmology Department with complaints of blurry vision for the past 2 months. He had tested positive for and been diagnosed with COVID-19 1 month previously. Clinical examination of the fundus revealed extensive perivascular sheathing of both the artery and vein suggestive of FBA in the right eye. Laboratory testing of nasal swabs for COVID-19 polymerase chain reaction (PCR) and serum CMV antibody were positive. The patient was then admitted to the COVID-19 ward and treated with intravenous ganciclovir. Conclusion Clinicians should be aware of and take the necessary standard precautions for possible coexistence of COVID-19 in an immunocompromised patient presenting with blurred vision, eye redness, dry eye and foreign body sensation despite the absence of clinical features suggestive of COVID-19. Whether FBA is one of the ocular signs of co-infection of COVID-19 and CMV remains unknown. Further studies are needed to provide more information on ocular signs presented in patients with concurrent COVID-19 and CMV infections.

A 29-year-old man with a medical and social history notable for smoking presented with progressive orbital congestion, conjunctival injection, and extraocular muscle enlargement consistent with thyroid eye disease (TED). On ophthalmologic examination, tortuous episcleral vessels and blood in Schlemm’s canal on gonioscopy clued an alternative diagnosis. Cavernous sinus enhancement on computed tomography also suggested a retro-orbital process. Digital subtraction angiography confirmed a low-flow indirect carotid-cavernous fistula (CCF). He subsequently underwent endovascular embolization treatment. Ocular symptoms resolved by seven weeks, and he remained ocular symptom free at six months. Eye redness and proptosis frequently cause patients to seek medical attention. In the absence of a mass or signs of infection, TED is high on the differential, especially with a smoking history and even with normal thyroid parameters. However, CCF may lurk; the authors describe key diagnostic features and management.

The spread of the new SARS-CoV-2 is marked by a short timeline. In this scenario, explaining or excluding the possible transmission routes is mandatory to contain and manage the spread of the disease in the community. In the recent pandemic, it is still unclear how coronavirus can end up in ocular fluids. Nevertheless, eye redness and irritation in COVID-19 patients have been reported, suggesting that a possible ocular manifestation of SARS-CoV-2 infection may be conjunctivitis. On the basis of epidemiological data provided by previous SARS-Cove infection, numerous theories have been proposed: (1) conjunctiva as the site of direct inoculation by infected droplets; (2) the nasolacrimal duct as a migration route of the virus to the upper respiratory tract, or (3) haematogenic infection of the tear gland. The demand for further investigations to verify ocular involvement in COVID-19 infection came out from the results of recent meta-analysis studies, so the eye cannot be completely excluded as a transmission route of the infection. Thus, healthcare personnel and all the people that enter in contact with infected or suspected patients must always use the prescribed protective equipment.

A 46-year-old female patient, who presented with a black, crusty lesion on the upper eyelid, was diagnosed with cutaneous anthrax after the detection of Bacillus anthracis in the skin culture. It was determined that the symptoms started after she cooked the meat she bought from a butcher. Anthrax is a disease that should be kept in mind in cutaneous infections even in isolated lesions, especially in endemic areas. (C) 2021 The Author(s). Published by S. Karger AG, Basel

To report the case of a surgical-induced necrotizing scleritis (SINS) following vitreoretinal surgery for rhegmatogenous retinal detachment, successfully managed by superficial muscle temporal fascia grafting. An 18-year-old teenager, with a history of a 23G vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment of the left eye, presented with intense left ocular pain, decreased visual acuity to counting fingers and eye redness. Split lamp examination showed: Conjunctival infiltration with silicone oil, circumferential sclera thinning with ectasia of the underling uvea. The fundus examination showed an attached retina. Necrotizing scleritis was the retained diagnosis. SINS was the final diagnosis. An immunosuppressive therapy was started. Superficial muscle temporal fascia grafting was performed to cover the necrotizing sclera. The patient did well postoperatively without sclera thinning or ectasia and the fascia grafting still intact without retraction after 6 months of follow-up. This is the first case in the literature that used the superficial temporal muscle fascia as a graft for sclera reinforcement in SINS. We propose new support to reinforce the deficient sclera. This graft must be associated with prompt immunosuppressive therapy at high doses.

Background: Eye stye is a local infection in the form of a red bump (a boil) caused by a blockage andinflammation of the sebaceous glands whose secretions help to form tears. Approximately 90-95% of thecauses of “stye” is an infection with Staphylococcus aureus, and it is possible that malnutrition and lack ofsleep contribute to the infection as well.Method:The study was done at Institute of Medical Technology/al–Mansour/Baghdad from January 2018till January of 2019. 100 conjunctiva eyes swab and Stye swab samples were collected from students sufferedfrom eye redness and conjunctiva, which include 50 male and 50 female. The diagnoses of specimens weredone by using the Analytical Profile Index System (API) for chemical tests and by culturing on enriched andselective culture media to isolate and diagnose the bacteria.Results: The results showed that 57(57%) samples were positive for bacterial eye infections. The studyshowed high percentage of eye infection among students was due to Staphylococcus aureus bacteria, followedby Staphylococcus epidermides and Pseudomonas aeruginosa (61.40%, 35.08% and 3.50%respectively).Most of bacterial isolates were resistance to antibiotics.Conclusion: One of the most important conclusions is to go to the doctor or pharmacist to treat eyeinflammation to avoid the occurrence of eye pain, burning and redness, and not to repeat the infection.Personal and general hygiene must also be taken care of to reduce the spread of bacteria that cause eyeinfections among people.

Ocular complications of coronavirus disease 2019 (COVID-19) do not essentially cause serious visual loss. However, due to the characteristics of this disease, delays in diagnosis and treatment in hospitalized patients may leave them with serious visual impairment. If conjunctivitis is suspected, ophthalmological follow-up is needless because it is expected spontaneous healing. Diplopia is often complicated for extra-ocular neurological findings and need neurological consults. Ophthalmologists should be consulted for ocular surface disease, high intraocular pressure, and ocular inflammation that may cause visual loss if patients complain of blurred vision, visual loss, and ocular pain. The problem is unconscious patients with risk of developing high intraocular pressure or keratitis. An ophthalmologist should be consulted as soon as possible if eye redness or pupil abnormalities appear in these patients. We developed a flowchart for ophthalmic consultations in hospitalized patients with COVID-19, for facilities where an ophthalmologist is not always present, and for third or fourth waves or, a pandemic of another infectious disease.

1. Eleanor A. Sharp, MD* 2. Jessica L. Garrison, MD* 1. *Paul C. Gaffney Division of Pediatric Hospital Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA A 9-day-old infant boy presents to the emergency department with a 1-day history of bilateral eye redness and yellow discharge. The morning before presentation, his mother noted his right eye to be crusted shut with dried yellow discharge. She applied a warm compress that removed the discharge and allowed him to open his eye normally. However, over the next several hours he developed bilateral eyelid swelling and yellow drainage from both eyes. He seemed to be trying to rub his eyes and was fussier than usual. The day of presentation, his mother noted both his eyes were red, swollen, and draining yellow fluid, so she brought him to the emergency department for evaluation. The patient has not been breastfeeding as long or as frequently as usual over the past day but has still had normal stool and urine output. The patient has not had fever, nasal congestion, rhinorrhea, rash, or sick contacts. His twin sister is asymptomatic. The patient was born full term via spontaneous vaginal delivery. He was the firstborn twin. The mother received routine prenatal care, and both the pregnancy and delivery were uncomplicated. Maternal screening for gonorrhea and chlamydia at the first prenatal visit was negative, and the patient received ophthalmic erythromycin after delivery. In the emergency department, the infant is afebrile with normal vital signs for age. He is fussy but consolable. He has periorbital swelling with overlying erythema, conjunctival injection, and mucopurulent discharge from both eyes, right worse than left. The reminder of his examination is unremarkable. Due to his age, evaluation for possible serious bacterial infection is completed. His white blood cell count is …

Driver fatigue causes tragic events and hazardous consequences in transportation systems. Especially, in developing countries, drivers have longer working hours and drive longer distances with short breaks to gain more money. This paper develops a new real time, low cost, and non-intrusive system that detects the features of fatigue drivers. It detects cues from the face of people who didn’t sleep the right hours or who have over worked. It identifies eye-related cues such as red eyes and skin-related cues who have like dark areas under the eye. This work uses CascadeObjectDetector that supports the Haar Cascade Classifier, Local Binary Patterns (LBP) and Histograms of Oriented Gradients (HOG) to develop a new algorithm, and locates the areas under the eye and reference areas on the face to compare the skin color tone. It uses the semi-supervised anomaly detection algorithm to recognize abnormality of the area under the eyes and eye redness. The system was evaluated with 7 participants with different skin colors and various light conditions. The results are very promising. The accuracy is quite high. All cues are detected correctly.

A Man with Joint Pain and Eye Redness A 37-year-old man presented with arthralgias, rash, calf pain, and redness in both eyes. The C-reactive protein level was elevated, and the erythrocyte sedimen...

Background and importance PRGF-Endoret is an autologous preparation obtained from the patient‘s own blood containing a set of proteins specifically addressing wound healing and tissue regeneration of the ocular surface. It is used to treat dry eye, often displacing other therapies such as autologous serum. Aim and objectives To evaluate the efficacy and safety of PRGF-Endoret eye drops, as well as patient satisfaction, in patients with dry eyes. Material and methods This was a retrospective observational study of all patients for whom PRGF-Endoret was requested between February 2019 and October 2019 for the treatment of several disorders with ocular dryness as a symptom. The following demographic and clinical data were obtained from the electronic medical history: age, gender, treatment start date, indication, dosage, treatment duration, previous treatment with autologous serum and clinical evolution. In addition, two anonymous surveys were conducted based on the dry eye questionnaire (DEQ). The first survey was conducted in patients who started treatment, evaluating the frequency of several symptoms (eye dryness, foreign body sensation, eye stinging, pain, eye tingling, blurred vision, eye redness, discomfort to light) and a second survey was conducted when renewing the treatment, in which efficacy and safety (taking as a measure the appearance of adverse effects) was evaluated, and also satisfaction with the treatment. Results Twenty-two patients were studied, 14 women (64%), with a median age of 64 (24–95) years. Most patients (70%) had been diagnosed with keratitis and/or corneal ulcer. According to the electronic medical history, in 73% of cases the clinical evolution was favourable after at least 3 months, requesting treatment renewal in 68%. Only one case reported insomnia as a possible adverse effect. Three patients (14%) have not yet completed 3 months of treatment. The results of the surveys indicated that 100% of patients were satisfied and noticed improvement in several symptoms: 50% of patients had previously received autologous serum, 82% of them had a favourable evolution (two without evaluation). Conclusion and relevance The results indicated that PRGF-Endoret improved dry eye symptoms in our patients, was safe and patients were satisfied. Patients previously treated with autologous serum had favourable evolution with PRGF-Endoret. Although it is thought to be more expensive, patients were satisfied with the change. References and/or acknowledgements No conflict of interest.

We report a case of a 16-year-old-child, with no pathological history, who presented to the ophthalmic emergencies for the appearance of skin lesions on his right lower eyelid, with burning sensation, evolving in the last 3 days. With no additional ocular manifestations. Otherwise, the patient denied having a history of recurrent skin eyelid rushes, eye redness, or eye pain. The clinical examination revealed an area of ulceration, and found multiple small vesicles centrally along of the right lower eyelid, that attends the lid margin. While the slit lamp examination didn´t find any ocular surface involvement, and posterior segment examination was normal in both eyes. In our case, the patient diagnosed as herpes eyelid infection. He was treated topically with antiviral treatment (acyclovir). The eyelid lesions resolved without scarring. Herpes simplex virus (HSV) eye infection was reported by several authors as one of the causes of corneal blidness in the developed world. There are two herpes virus simplex that belongs to herpesviridae family: HSV that affects the oral and ocular regions which is type 1, and HSV that affects the genital area which is type 2. Various studies reports that primary infections are usually acquired during childhood. But recently, several authors reported that these infections are acquired during adolescence and adulthood. It is often asymptomatic, and in some cases it can presented as a blepharoconjunctivitis. After this initial infection when the virus reactivates, herpetic eye disease can manifest by severe eye infections, which can lead to blindness in some cases.

Silvia Tavazzi,1,2 Riccardo Origgi,1 Martina Anselmi,1 Andrea Corvino,1 Sara Colciago,1 Matteo Fagnola,2 Silvia Bracco,1 Fabrizio Zeri1– 3 1Department of Materials Science, University of Milano-Bicocca, Milan, Italy; 2Research Centre in Optics and Optometry (COMiB), University of Milano-Bicocca, Milan, Italy; 3Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, UKCorrespondence: Silvia Tavazzi Email silvia.tavazzi@unimib.itPurpose: To compare the effects of artificial tears (ATs) in wearers of biweekly replacement silicone hydrogel contact lenses (BW-Ws) and wearers of daily disposable contact lenses (DD-Ws) of the same material.Materials and Methods: The aqueous-supplementing ATs, OPTOyalA and OPTOidro, were assigned to be used for 2 weeks to healthy and young subjects: 1) 20 (8 and 12, respectively) BW-Ws wearing silicone hydrogel somofilcon A CLs (Clariti Elite), 2) 18 (9 and 9, respectively) DD-Ws wearing silicone hydrogel somofilcon A CLs (Clarity 1 Day), and 3) a control group of 33 (16 and 17, respectively) N-Ws. Ocular symptoms and comfort, tear volume and stability, and ocular surface condition were assessed by Ocular Surface Disease Index (OSDI), 5-Item Dry Eye Questionnaire (DEQ5), tear meniscus height (TMH), non-invasive tear break-up time (NIBUT), and evaluation of ocular redness (OR). The assessment was performed before and after 15 days of use of the ATs in the 3 groups (BW-Ws, DD-Ws, and N-Ws).Results: No clear significant difference was noted in symptoms and signs between OPTOyalA and OPTOidro irrespectively of the group of people studied. ATs use for 15 days produced a significant improvement in DEQ5 and OR in DD-Ws (Δ=− 34%, p=0.006; Δ=− 23%, p< 0.001) and in N-Ws (Δ=− 21%, p=0.001; Δ=− 10%, p=0.006) but not in BW-Ws (Δ=− 5%, p=0.072; Δ=− 2%, p=0.257). No significant change was noted for TMH.Conclusion: In young and healthy subjects, the aqueous-supplementing effect of the ATs under consideration is more a rinsing and tear replacem ent effect than an increase in tear volume, and it produces an improvement of the eye redness and ocular symptoms. Contact lens wear influenced the effectiveness of ATs in a way which is correlated with the CL replacement schedule.Keywords: artificial tears, contact lenses, somofilcon A

Background To report a case of a carotid-cavernous fistula (CCF) that occurred after a motor vehicle accident and review the uniqueness of this case and the main confusing points for the diagnosis of such cases. Case presentation A 22-year-old man complained of left eyelid swelling, eye redness, visual decrease and occasional headache after motor vehicle accident 4 months prior during which he experienced a head injury. He was initially thought to have glaucoma, but he was finally diagnosed with a right CCF based on magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). Timely embolization surgery resulted in obvious relief of the ocular symptoms and an improved prognosis. Conclusion This is the first reported case of a post-traumatic unilateral CCF with contralateral symptoms in direct CCF, it is very infrequent and deserves our attention. We should maintain high suspicion of CCF and confirm the diagnosis by DSA when managing such patients to prevent serious consequences. Early diagnosis and treatment can improve the prognosis of patients.

Uncorrected proof, Purpose To report the on-eye breakage of a mini-scleral contact lens in a healthy cornea after being hit by a speeding object, without causing any severe corneal damage. Case report A 24-year-old Caucasian male involved in a clinical study reported the in situ breakage of a mini-scleral contact lens during motorbike maintenance. The patient reported eye redness and irritation that significantly decreased after all the pieces of the lens were recovered from the eye. Ocular examinations within 48 h showed absence of corneal damage other than superficial punctate keratitis inferiorly and no fragments of the lens were found in the conjunctival sac. The patient was wearing a 15.2 mm mini-scleral lens in a high Dk material. The evolution of rigid materials towards higher Dk values has resulted in a decreased hardness and modulus values, so these materials are more elastic when subjected to mechanical stress, which could be a beneficial aspect in absorbing the energy of an impact before breaking in pieces. Conclusion This case report shows that ScCL could have a protective effect to the corneal surface from the direct impact of a high-speed object. Mechanical material properties, wide supporting area and post-lens tear volume acted as protective factors helping to absorb and distribute the kinetic energy of the impacting object, This project was supported in part by an unrestricted grant from Bausch & Lomb (Rochester, USA) and projects PTDC/SAU-BEB/098391/2008, PTDC/SAU-BEB/098392/2008 and the Strategic FundingUID/FIS/04650/2013. Authors declare that they do not have any proprietary or financial interest in any of the materials mentioned in this article., info:eu-repo/semantics/publishedVersion

Self-inflicted eye trauma is a serious form of self-harm as it may lead to irreversible visual disability. Diagnosing self-inflicted ocular injuries, in all its forms, can be quite challenging. In this report, we are presenting a 5-year- old girl presented to Sohag University Outpatient Clinic with a history of repeated attacks of bilateral eye redness with blood-tinged strands removed from her eyes. After ocular examination, inferior bulbar conjunctival injection with blood-tinged strands were found. After careful examination of the strands, it was discovered that they were actual threads of cloth due to self-inflicted eye injury. Following psychiatric consultation, the patient was diagnosed as having a major depressive disorder. The case was subject to pharmacological and psychotherapeutic treatment, and showed significant improvement within two months of starting treatment as regard to depressive symptoms and self-injury behaviors. Although self-inflicted ocular injuries due to pediatric mood disorders are rare, it should be suspected in any case of unexplained chronic conjunctivitis.

Background Currently, there is no formally accepted pharmacological treatment for COVID-19. Materials and methods We included COVID-19 outpatients of a Peruvian primary care center from Lima, Peru, who were treated between April 30 - September 30, 2020, with hydroxychloroquine and azithromycin. Logistic regression was applied to determine factors associated with case-fatality rate. Results A total of 1265 COVID-19 patients with an average age of 44.5 years were studied. Women represented 50.1% of patients, with an overall 5.9 symptom days, SpO2 97%, temperature of 37.3 °C, 41% with at least one comorbidity and 96.1% one symptom or sign. No patient treated within the first 72 h of illness died. The factors associated with higher case fatality rate were age (OR = 1.06; 95% CI 1.01–1.11, p = 0.021), SpO2 (OR = 0.87; 95% CI 0.79–0.96, p = 0.005) and treatment onset (OR = 1.16; 95% CI 1.06–1.27, p = 0.002), being the latter the only associated in the multivariate analysis (OR = 1.18; 95% CI 1.05–1.32, p = 0.005). 0.6% of our patients died. Conclusions The case fatality rate in COVID-19 outpatients treated with hydroxychloroquine/azithromycin was associated with the number of days of illness on which treatment was started.

Purpose To report a case of retained anterior chamber graphite foreign body with subsequent inflammation 20 years later. Observations A 29-year-old female who presented with first episode of acute blurring of vision and eye redness was noted to have a retained intraocular graphite foreign body in her anterior chamber. She recalled being accidently hit by a mechanical pencil 20 years ago. Conclusions and importance Retained intraocular graphite foreign bodies are inert and generally do not cause inflammation. This is the longest reported duration of retained anterior chamber graphite foreign body that developed subsequent inflammation and corneal endothelial damage only 20 years later.

Introduction: Poor healing is one of the main causes of impaired vision and even blindness. Objective: To determine the effectiveness of autologous serum rich in Growth Factors in the repair of lesions on the ocular surface of uncertain evolution to conventional treatment. Method: Quasi-experimental clinical study. 46 ocular units were treated with neurotrophic keratopathy, exposure keratopathy and direct ocular trauma, which affected the conjunctiva, - the corneal epithelium and stroma - and the sclera. It was evaluated anatomically and functionally using the Schirmer test, Fluorescein stain and ocular CT between March 2020 and December 2020. Result:. Pain was the first symptom to improve, followed by foreign body sensation, blepharospasm, eye redness, and epiphora. The lesions that evolved in a short time were those that affected the epithelium, followed by those of the corneal stroma and finally the lesions that affected sclera. An average of 15 days was obtained for immediate surface recovery and 21 days for late recovery. Lesions with total thinning of the sclera took about 2 months. Conclusion The findings related to pain threshold, recovery time, scar remodeling of the affected tissue and recovery of visual acuity are promising and important. The use of autologous serum rich in growth factors can be a therapeutic alternative for those lesions that are difficult to resolve with conventional treatment.

A66-year-old man presented with burning pain and erythema over the left axilla, and pustules that had ruptured and crusted over. The rash also involved the right axilla, trunk, abdomen, and face. He said the symptoms had developed 3 days after starting to use ciprofloxacin eye drops for eye redness

Background: To report a case of a cerebral Arteriovenous Malformation(AVM) with eye symptoms firstly and review the characteristic of this case and the main confusing point for diagnosis of such case. Case presentation: A 58-year-old women presented to the ophthalmology clinic with 1 and an half year of right eye redness, Ocular hypertension and recurrent headache. One and a half year ago she was diagnosed as right eye dry eye and glaucoma and had received treatment according to diagnosis, however all the treatment did not lead to any improvement of redness and headache. On physical examination, it revealed dry eye and severe corkscrew hyperemia with dilated vessels in the right eye. After we consider that the symptom may be related to intracranial abnormal vessels, Computed tomography angiography and venography (CTA+CTV) were performed and the results showed an arteriovenous malformation (AVM) of right parietal-occipital area in the brain. The AVM was definitely located by the further examination of Digital subtraction angiography (DSA). After the AVM endovascular embolism treatment, the conjunctival congestion of the right eye was significantly relieved and the intraocular pressure was decreased to normal. Conclusion: In clinical practice, when found corkscrew hyperemia accompanied by neurological symptoms, it might be considered as a result from cerebral vessels diseases, so in this case ophthalmologists diagnosis should combine disease history and imaging examination. Key word: cAVM, DSA, hyperemia, glaucoma

Purpose: To report a case of contact lens-related infectious keratitis caused by the Gram-negative plant pathogen Rhizobium radiobacter. Observations: A 26-year old lady with history of contact lens use presented with three weeks history of right eye redness and pain, with the left eye also being involved in the past week. Slit lamp examination of the right eye demonstrated multiple faint subepithelial and stromal infiltrates with no overlying epithelial defect, and no anterior chamber activity. Anterior segment optical coherence tomography demonstrated multiple hyper-reflective foci scattered at various depths of the corneal stroma. Corneal scrapings grew Rhizobium radiobacter, and culture-directed antibiotic therapy with topical gentamicin and levofloxacin resulted in slow clinical improvement of the R. radiobacter keratitis without visual sequelae. Conclusions and importance: We have described the clinical features, microbial susceptibilities, and response to treatment in a case of R. radiobacter infectious keratitis.R. radiobacter has recently emerged as a source for several ocular and systemic infections and was identified in a series of polymicrobial keratitis cases. Our case report of monomicrobial R. radiobacter keratitis adds to the sparse literature on this uncommon but potentially sight-threatening infection. Keywords: Rhizobium radiobacter, Infectious keratitis, Contact lens, Atypical bacterial keratitis

Background Of the 10 patients with adenoviral type 54 keratoconjunctivitis examined at Nojima Hospital, 2 developed stellate keratitis and mutton-fat keratic precipitates (KPs) following acute symptoms. Case presentation We encountered 10 cases of epidemic keratoconjunctivitis from August to October 2017. All patients were adults with a mean age of 60.9 ± 10.0 years. The species D human adenovirus (HAdV)-54 was detected in the conjunctival scrapings of these patients. Fluorometholone instillation was administered during the first week for acute symptomatic relief. Case 1: A 64-year-old female was prescribed with fluorometholone instillation, which was discontinued after 1 week when her symptoms alleviated. One week after discontinuation of the instillation, she presented with blurred vision in her left eye with KPs and multiple stellate keratitis. The anterior chamber had no apparent cells. Her symptoms disappeared after 1 week of betamethasone instillation. Case 2: A 66-year-old female was prescribed with 0.1% fluorometholone instillation, which was discontinued within10 days. Three months after the appearance of initial symptoms, multiple subepithelial corneal infiltrates (MSI) appeared in her eyes. Stellate keratitis and dark-brown pigmentation were observed in the centres of MSI, with several cells in the anterior chamber. Betamethasone was prescribed, and MSI and stellate keratitis improved within 1 week. However, KPs were observed in the left eye. The instillation was continued for 3 more weeks until symptoms improved. Conclusions MSI is an immune reaction that occurs after the disappearance of acute symptoms. Here, corneal findings and KPs were observed after improvement in eye redness and discontinuation of steroids. These symptoms were presumed to be secondary inflammation due to immune response to the adenoviral antigen. The clinical features of HAdV-54 keratoconjunctivitis on the ocular surface are initially moderate, but become active in the subacute to chronic phases. This may develop atypical findings, including stellate keratitis with KPs. Although early steroid administration can relieve acute symptoms, it may facilitate chronic corneal immunological reaction.

Purpose.Epithelial ingrowth occurring many years after primary Laser in Situ Keratomileusis (LASIK) without a preceding traumatic event is very rare.Case Report.We describe the case of a 61-year-old woman with epithelial ingrowth in her right eye 15 years after primary LASIK. She presented with right eye redness, pain, and decreased vision and denied any preceding trauma. An epithelial cells’ tract was visible on Optical Coherence Tomography. Conservative treatment lead to the stabilization of the epithelial nests.Discussion.Epithelial ingrowth can occur many years after LASIK and may be due to a microtrauma to the edge of the flap.

Purpose: To assess digital eye strain (DES) among schoolchildren during lockdown. Methods: An online questionnaire-based, cross-sectional study was conducted. A validated, self-administered, electronic questionnaire was circulated among students of 5–18 years of age. The duration of data collection was from May 18, 2020 to May 24, 2020. Rasch-based Computer-Vision Symptom Scale was deployed to measure the DES. Results: A total of 654 students (mean age: 12.02 ± 3.9 years) completed the survey. The average per day digital device exposure was 5.2 ± 2.2 h. A total of 507 (92.8%) children reported experiencing at least one asthenopic/dry eye symptom (AS/DS). The most prevalent symptoms were eye redness (69.1%) and heaviness of eyelids (79.7%). Significant positive correlation was reported between age and per day duration of digital device exposure (Pearson correlation 0.25; P < 0.001). Computer vision syndrome (CVS) score for spectacle users was significantly higher (P < 0.001). CVS score was found to correlate significantly with age and duration of digital device exposure (P < 0.001). Conclusion: Most of the students surveyed, experienced at least one symptom of DS or AS, indicating a need to educate them about the possible deleterious effects and help them adapt to the currently evolving education system.