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Introduction: The standard treatment protocol of orbital cellulitis includes the use of broad-spectrum intravenous antibiotics. This study was done to evaluate the role of oral corticosteroids in the treatment of orbital cellulitis in order to address the inflammatory component. Methods: A prospective comparative interventional study was carried out on 17 cases of orbital cellulitis over 16 months. All the patients were treated with intravenous antibiotics and were allotted to Group A or B. The former consisted of eight cases (intravenous antibiotics) while group B consisted of nine cases (intravenous antibiotics and oral corticosteroids). The oral corticosteroids were started after 24 to 48 hours of initiation of antibiotics. The outcomes compared between the two groups were hospital stay, visual analogue score, temperature, peri-orbital edema, proptosis, visual acuity, extra-ocular movement and conjunctival chemosis. Results: The age of the participants ranged from 7 to 77 years with M:F = 6:11. The mean duration of hospital stay was 7.75±2.7 and 8.22± 2.53 days in group A and B. The result showed that the changes in the other parameters were significant on the 3rd day after starting treatment in both groups but insignificant between the groups at the end of 7th and 14th day. Conclusions: In our study, addition of oral corticosteroids to intravenous antibiotics showed no added beneficial effect over the use of intravenous antibiotics alone in the treatment of orbital cellulitis. However, it was noted that there was no further deterioration of the disease with the use of steroids.

Abstract Though rare, a pediatric dentist should have background knowledge of this kind of presentation which can greatly affect their patient's quality of life and leave them with a significant deficit at a very young age.

Background: Age-related cataract is one of the most important causes of preventable blindness among elderly population in the world. Among various causes of cataract, the level of ascorbic acid in the plasma and aqueous humor is an important parameter that can prevent cataract formation. The level of ascorbic acid in the plasma and aqueous humor is also an indicator of various morphological pattern of cataract. Materials and Methods: A hospital-based cross-sectional study was conducted among 136 patients with immature age-related cataract (≥50 years) who underwent Manual Small Incision Cataract Surgery in the Ophthalmology Department of BPKIHS for the duration of 1 year. Plasma and aqueous humor ascorbic acid levels were determined by standard competitive ELISA test. Results: Ascorbic acid concentrations in aqueous humor as well as plasma were statistically significant with the nuclear type of cataract (p

Background. Orbital lymphomas are primarily non-Hodgkin type and can originate from the eyelids, extraocular muscles, soft tissue orbital adnexa, conjunctiva, or lacrimal glands. Orbital malignancies often represent a diagnostic dilemma for clinicians given their varying and atypical presentations. Objective. To report a case of orbital lymphoma mimicking orbital cellulitis. Case. A 66-year-old male patient presented with sudden onset of painful proptosis with visual impairment in the left eye for 15 days. On ocular examination, best-corrected visual acuity was 6/12 in the right eye and 2/60 in the left eye, abaxial proptosis with hypertropia, swollen and erythematous eyelids, restricted extraocular movement in all cardinal position of gaze, conjunctival congestion with chemosis and tortuous vessels, sluggish pupillary reaction, and chorioretinal folds in the inferior quadrants. The case was diagnosed as left eye orbital cellulitis, and the patient was treated with broad-spectrum intravenous antibiotics and oral steroids. No clinically discernible response was noted despite 7 days of antibiotics and steroids. Contrast-enhanced computed tomography (CECT) orbit showed features suggestive of orbital lymphoma involving the ipsilateral maxillary and ethmoid sinuses. ENT consultation with diagnostic nasal endoscopy and biopsy was done. Histopathological reports showed features of non-Hodgkin lymphoma. Conclusion. Orbital malignancies masquerading as orbital cellulitis can pose a diagnostic dilemma. A multidisciplinary approach involving ENT consultation, radiological investigation, and pathological sampling can help achieve a timely diagnosis and appropriate management.

Background: This article aims to describe histopathologic high risk tumor characteristics in our patient population of retinoblastoma. It is based on consensus criteria for definitions of choroidal and optic nerve invasion as outlined in The International RetinoblastomaStaging Working Group (IRSWG) 2009.Materials and Methods: Fifty histopathologically diagnosed cases of retinoblastoma were archived from records of Pathology department during years 2004 to 2014. Re-evaluation of slides to identify choroidal and optic nerve invasion as per IRSWG along with Pathologic tumor staging was done. Data were entered into Microsoft excel sheets and results expressed in percentages. Department of Ophthalmology was consulted for recurrence of Retinoblastoma.Results: Among fifty cases, Choroidal invasion was absent in 62% cases. Minimal invasion (3mm) in 14% cases and extra ocular involvement in 6% cases. The optic nerve was free of tumor in more than three forth of the cases (78%). Prelaminar and retro laminar involvement of optic nerve was observed in 6% and 10% cases respectively. Intraocular spread of tumor was observed in 6% of cases. The cut margin of optic nerve was involved in 42% while it was free of tumor in 58% of cases. Significant number of tumours were pathologically classified as pT1 (58%) followed by pT2a (22%). pT3a and pT4b were found in 6% each and pT3b and pT4a were found in 4% each. Recurrence was observed in two cases of PT3a and one of pT4b.Conclusion: We conclude identifying low percentages of high risk charateristics in a retrospective histologic experience with Retinoblastoma. Recurrence observed in two tumours staged pT3a sheds light on prognostic significance of reporting massive choroidal invasion despite free cut margin. These observations call for routine practice of standardized histopathologic reporting and processing of enucleated eye samples at our tertiary care centre.Journal of Pathology of Nepal (2015) Vol. 5, 723-726

Context: The coexistence of diabetes mellitus (DM) with hypothyroidism is a known clinical observation. Aims: To estimate prevalence and co-relate that of hypothyroidism in patients with DM in relation to the age and sex, the lipid profile, body mass index visiting diabetes clinic and inpatients in B. P. Koirala Institute of Health Sciences. Settings and Design: The hospital-based descriptive study. Materials and Methods: Two hundred and seventy-one known or newly detected cases of DM aged more than 15 years were selected randomly from September 2012 to September 2013 and subjected to evaluation for thyroid function - clinically and biochemically and other relevant investigations were done. Statistical Analysis Used: For descriptive statistics mean, standard deviation, percentage, proportion were calculated. For inferential statistics following test were carried out at the level of significant 0.05 where confidence interval is 95%. The statistical operations were done through Statistical Package for the Social Sciences version 10. Results: Of 271 subjects, the prevalence of hypothyroidism (clinical and subclinical) in diabetics was, 4.05% (11/271) with females preponderance, of which 7 (30.4%) were clinically hypothyroid and 4 (17.4%) were subclinical hypothyroid. One (4.3%) patient had subclinical hyperthyroidism. The mean age at diagnosis of type 2 DM was 51-60 years. 8.69% of diabetics with primary hypothyroids were having morbid obesity. High-density lipoprotein among different thyroid status were statistically significant (P = 0.042). Conclusions: Hypothyroidism is not uncommon in diabetes, and we found body mass index, mean triglyceride and cholesterol levels were more in those diabetic patients having coexisting hypothyroidism.

Context: Dry eyes has been associated with inflammation and apoptosis of the ocular surface which is responsible for conjunctival goblet cell loss in long term. Aim: To study the efficacy of carboxymethylcellulose and topical cyclosporine A 0.05% in the treatment of dry eyes and their effect on the density of conjunctival goblet cells (GCD). Settings and design: Hospital based, Randomized clinical trial. Methods and material: A total of 90 patients of dry eyes were enrolled and were randomly divided into two groups of 45 each. Group A was treated with topical cyclosporine A 0.05% twice daily and group B with preservative free carboxymethyl cellulose 0.5% (CMC) four times daily for 6 weeks. Different parameters like dry eye symptoms through visual analogue score (VAS), tear break up time (TBUT), Schirmer’s tests (SCH), fluorescein stain (FLU) and goblet cell density (GCD) were obtained prior to treatment and compared with the results after 6 weeks of treatment. Statistical analysis used: SPSS software, version 12.0. Results: After 6 weeks of treatment both the groups showed significant improvement from baseline values of all the parameters (p

Introduction: Diabetes ketoacidoisis (DKA) is characterized by hyperketonaemia, metabolic acidosis, and hyperglycemia. Aims: The aim of this study was to describe the demographic profile, clinical characterstics of patients admitted with diabetic ketoacidosis in BPKIHS, medical ward. Settings and Design: The hospital based descriptive study. Materials and Methods: We took all the patients admitted with a diagnosis of diabetic ketoacidosis (DKA) as defined ADA 2006 consensus statement in medical ward from January 2010 to December 2010. The statistical operations was done through Manufactured by IBM Corp. Results: Only sixteen patients (7 type 1 and 9 type 2DM) were with DKA. When compared to the 16 subjects with type 1 DM ,the type 2 were older (56.8 s 25.7 years) and had a significantly higher PH levels (7.11 s 7.28 P = 0.04). The mean body mass index was 20.5±2.44 in both Type 1 and type 2 DM. Four were on diet control and Insulin respectively. Five were on oral hypoglycemic agents (OHA) and three on both (insulin and OHA). Infection was most common precipitating factor (56.25%) followed by poor drug compliance (37.5%) and first presentation (6.25%). Conclusions: We found majority of patients were type 2 DM. Metabolic acidosis has significant association in both type of diabetic. We found infection was the most common precipitating factor for DKA.

Orbital abscess and superior orbital fissure syndrome (SOFS) are rare manifestations of herpes zoster ophthalmicus. Herein, we report a case of orbital abscess along with SOFS in a 2.5-year-old-male child secondary to herpes zoster infection. He presented with a 5-day history of proptosis and ptosis of the right eye that had been preceded by vesicular eruptions on the right forehead and scalp. Computed tomography scan of the head and orbit showed orbital abscess and right cavernous sinus thrombosis. A diagnosis of orbital abscess with SOFS secondary to herpes infection was made. The condition subsequently improved following antiviral therapy, intravenous vancomycin and amikacin, and oral corticosteroids.

Orbital cellulitis is a serious, yet uncommon infection in neonates. It can result in significant sight and life threatening complications. Most commonly, it occurs secondarily as the result of a spread of infection from the sinuses. Orbital cellulitis, secondary to dental infection is rare. We hereby report a case of orbital cellulitis secondary to dental infection in a 15-day-old neonate without any systemic features.

Inflammatory myofibroblastic tumor (IMT) is a benign pseudoneoplastic inflammatory condition with the potential for persistent local growth and recurrence that rarely affects the orbit. We report a very rare case of anterior orbital IMT in a child who presented with gradually progressive mass in left eye for 16 months. Ocular examination showed a cauliflower like exophytic mass at 360 degrees of the perilimbal area covering the entire cornea and obscuring the visualization of anterior and posterior segments. The right eye was phthisical. CT scan showed a lobulated exophytic soft tissue mass in the preseptal region and along the anterior portion of the left globe extending from medial canthus to the lateral canthus. Enucleation of the left eye was performed and the histopathological examination confirmed the diagnosis of IMT. This report aims to raise awareness about this rare ocular entity and emphasizes its early treatment as delay can result in loss of the eye.

Diabetes Mellitus (DM) and psychiatric illness are related in many ways by prevalence, burden, course, and outcome. Co-morbid mental illness may play a role in determining the complication in diabetic patients. This study was conducted in 2010 among consecutive diabetic out-patients diagnosed as per American Diabetes Association (ADA) guidelines 2009, of age above 14 years, to compare the complications in diabetic patients with or without mental illness. Diabetic neuropathies, cardiovascular complications, and morbid obesity were among the complications significantly more among diabetic patients with mental illness (GHQ-12 ≥ 2) than without mental illness (GHQ-12 ≤ 2).

The pleomorphic adenoma of lacrimal gland presents as a painless, progressive, slowly growing supero-temporal swelling with variable proptosis. This tumor is usually found in adults and extremely rare in teenage. We report a case of a 15-year-old boy with pleomorphic adenoma of lacrimal gland which mimicked pseudotumor of orbit due to its presentation as an orbital inflammatory disease and the age distribution. Neuroimaging also suggested pseudotumor and oral steroid was started. But, there was no improvement on steroids and ultrasound guided Fine Needle Aspiration Cytology (FNAC) was performed which suggested Pleomorphic adenoma of the lacrimal gland. En-bloc excision of the mass through antero-lateral orbitotomy was done with satisfactory final outcome The histopathological evaluation was consistent with pleomorphic adenoma of the lacrimal gland. Keywords: lacrimal gland pleomorphic adenoma; orbitotomy; proptosis; pseudotumor.

Introduction: Diabetes leads to an alteration in retinal nerve fiber layer (RNFL) thickness and macular thickness which can easily be detected with optical coherence tomography (OCT)., Objectives: This study was done to compare the RNFL and macular thickness between diabetic patients without retinopathy and non-diabetic patients so that it would be useful in the early detection of retinal changes if present. The correlation between the RNFL and macular thickness with metabolic blood parameters of diabetic subjects was also studied., Materials and Methods: This is an observational, cross-sectional, hospital-based study including 120 subjects who were further divided into two groups. Group A consisted of 60 diabetic patients without retinopathy and group B consisted of 60 non-diabetic patients. The blood parameters were recorded and the RNFL thickness and macular thickness were compared between the two groups after evaluation by OCT., Results: The average central macular thickness was found to be more in group A but was statistically insignificant (p=0.29). Macular thickness in the superior quadrant was significantly higher among group A when compared with group B (p=0.01). Whereas RNFL thickness difference between the two groups was statistically insignificant (p=0.53). Blood urea showed significant positive correlation (r=0.269) with central macular thickness (p=0.03)., Conclusion: Our study showed that diabetic patients without retinopathy could have increased macular thickness in the superior quadrant when compared with normal people whereas RNFL thickness may not alter. The blood urea levels of the diabetic patients can provide us clues regarding possible retinal changes., (© NEPjOPH.)

Background: Destructive ocular surgeries are performed for many conditions ranging from trauma to tumours, where the eyes cannot be salvaged. The objective of our research was to study the profile of destructive ocular surgery and their indications., Methods: This retrospective study reviewed all patients who underwent evisceration, enucleation, and exenteration at B.P. Koirala Institute of Health Sciences, a tertiary eye hospital in Eastern Nepal, between January 2008 and December 2019. Medical records on patient demographics, type of surgery performed, and an indication of surgery during the study period were reviewed., Results: One hundred thirty-four patients underwent destructive ocular surgeries. The median age of patients undergoing surgery was 14.5 (3-50) years. Children aged ten years or less accounted for 46.3% of the total patients. Fifty-two percent were male. The left eye was affected in more than half of the cases (56.7%). Enucleation was the most performed destructive ocular surgery (76 cases, 56.7%). Intraocular and ocular adnexal malignancy was the most common overall indication (62 cases, 46.3%). Ocular infection (19 cases, 41.3%) and trauma (15 cases, 32.6%) were the most common indication of evisceration. Retinoblastoma accounted for most cases of enucleation (43 cases, 56.6%). Malignancy was the only indication of exenteration (12 cases, 100%)., Conclusions: Enucleation was the most common destructive ocular surgery. Malignancy accounted for most of the cases of destructive eye surgery, followed by ocular infection. Ocular infection and trauma were the most common indication of evisceration, whereas retinoblastoma and eyelid malignancy were responsible for most of the cases of enucleation and exenteration, respectively.

Introduction: Central corneal thickness (CCT) is a powerful predictor of primary open angle glaucoma. Individualized risk assessment is critical for early diagnosis and management of glaucoma., Objectives: To compare CCT and intraocular pressure in patients of primary openangle glaucoma (POAG) with those of normal population., Materials and Methods: A Comparative Cross-Sectional Study was performed in Ophthalmology department of B. P. Koirala Institute of Health Sciences, Nepal. Newly diagnosed cases of primary glaucoma (open angle, normal tension) of 18 years and above, without known systemic diseases were included., Results: Out of a total of 291 subjects (582 eyes), 105 subjects (210 eyes) were with primary glaucoma and 186 (382 eyes) were normal subjects. There was no significant difference in CCT between glaucomatous (533.57 μm) and normal (530.06 μm) eyes (p=0.1). Cornea was thinner (518.±18.03 μm) in eyes with severe glaucomatous damage (cup:disc ratio > 0.8) than in moderate glaucomatous damage (cup:disc ratio=0.5-0.8)(p=0.003). There was a statistically significant difference of 22.05 μm in CCT between POAG and NTG (p<0.001). A positive correlation was found between IOP & CCT in both cases and control group (p=0.000; r = 0.355, 0.254; r2 =0.126, 0.064 respectively)., Conclusion: Majority of studied Nepalese population have CCT less than 550 μm, thus increasing the risk of POAG. CCT decreases with age, and females with glaucoma have significantly thicker cornea than men. There is a significant positive correlation between CCT and IOP, and IOP will have to be adjusted for CCT for proper diagnosis and monitoring of glaucomatous damage in Nepalese population too., (© NEPjOPH.)

Introduction: A large number of hormonal, metabolic, immunologic and haematological changes occur in all organ system of female body during pregnancy. Human eye and its function are no exception to these changes., Purpose: To evaluate physiological ocular changes in various trimesters of pregnancy and to compare them amongst the three trimesters., Patients and Methods: A hospital based cross sectional study, using judgmental convenient sampling method, was done in both eyes of 120 pregnant females (40 in each trimester), with known last menstrual period, attending antenatal clinic of BPKIHS, Dharan. Women with known systemic or ocular diseases like conjunctivitis, keratitis, iridocyclitis, glaucoma, refractive error, were excluded. Demographic details of all patients were recorded and detailed ocular examination, including best corrected visual acuity, slit lamp examination, vertical and horizontal keratometry, central corneal thickness and intraocular pressure were performed and recorded. A comparison of these parameters was made amongst three trimesters., Results: Visual acuity of all the subjects was 0 logMAR. Corneal curvature, both vertical and horizontal, significantly increased towards third trimester. Central corneal thickness progressively increased from first to third trimester (p= 0.019 Right eye, 0.016 Left eye). In contrary to this, intraocular pressure significantly decreased during successive stages of pregnancy (P=0.000 both eye)., Conclusion: Significant increase in corneal curvature and central corneal thickness along with, decrease in intraocular pressure occur during successive trimesters of pregnancy. All pregnant women should have routine ocular examination; changes noted, if any, should receive attention and period of gestation should be considered prior to making a diagnosis., (© NEPjOPH.)

The World Health Organization's (WHO) global initiative for the elimination of avoidable blindness by the year 2020 (Thylefors et al., 1995) has prioritized the control of childhood blindness. Currently cataract remains one of the most important causes of treatable blindness in children (Giles et al., 2016). In Nepal, as in other developing countries, cataract is believed to be a leading cause of blindness in children. According to The Nepal Blindness Survey from 1978 to 1980, congenital cataract accounted for 16.3% of blindness detected in children under the age of 15 years (Brilliant et al., 1985). Epidemiology of Blindness in Nepal 2012 survey has suggested that the prevalence of childhood blindness has reduced from 0.68% in 1981 to 0.4% in 2011 (Sapkota, 2012)., (© NEPjOPH.)

Ocular involvement of rhinosporidiosis is seen in about 15% of cases and clinically appears as a freely mobile, granular, pink, fleshy sessile or pedunculated mass. The conjunctiva is the most common site of origin. A 25-year-old male presented with a painless mass in the lower part of the left eye for 6 months which was gradually progressive. Examination revealed a pedunculated mass of 15 mm x 15 mm arising from the lower palpebrae of the left eye retracting the lower lid. It appeared to be vascular with few white spots at the apex. Rest of the ocular examinations was within the normal limit. The presentations of ocular rhinosporidiosis vary. Though the conjunctival origin is very common, it may not have a classic pink fleshy appearance at all times. A vascular/cystic painless conjunctival mass should also be considered as a case of rhinosporidiosis in prone areas.

Orbital abscess and superior orbital fissure syndrome (SOFS) are rare manifestations of herpes zoster ophthalmicus. Herein, we report a case of orbital abscess along with SOFS in a 2.5-year-old-male child secondary to herpes zoster infection. He presented with a 5-day history of proptosis and ptosis of the right eye that had been preceded by vesicular eruptions on the right forehead and scalp. Computed tomography scan of the head and orbit showed orbital abscess and right cavernous sinus thrombosis. A diagnosis of orbital abscess with SOFS secondary to herpes infection was made. The condition subsequently improved following antiviral therapy, intravenous vancomycin and amikacin, and oral corticosteroids.

Introduction: Diabetes ketoacidoisis (DKA) is characterized by hyperketonaemia, metabolic acidosis, and hyperglycemia., Aims: The aim of this study was to describe the demographic profile, clinical characterstics of patients admitted with diabetic ketoacidosis in BPKIHS, medical ward., Settings and Design: The hospital based descriptive study., Materials and Methods: We took all the patients admitted with a diagnosis of diabetic ketoacidosis (DKA) as defined ADA 2006 consensus statement in medical ward from January 2010 to December 2010. The statistical operations was done through Manufactured by IBM Corp., Results: Only sixteen patients (7 type 1 and 9 type 2DM) were with DKA. When compared to the 16 subjects with type 1 DM, the type 2 were older (56.8 s 25.7 years) and had a significantly higher PH levels (7.11 s 7.28 P = 0.04). The mean body mass index was 20.5±2.44 in both Type 1 and type 2 DM. Four were on diet control and Insulin respectively. Five were on oral hypoglycemic agents (OHA) and three on both (insulin and OHA). Infection was most common precipitating factor (56.25%) followed by poor drug compliance (37.5%) and first presentation (6.25%)., Conclusions: We found majority of patients were type 2 DM. Metabolic acidosis has significant association in both type of diabetic. We found infection was the most common precipitating factor for DKA.

Background: Sturge-Weber syndrome (SWS) is a rare congenital neuro- oculo- cutaneous disorder. Glaucoma is one of the ocular abnormalities associated with it. Management of glaucoma in SWS is challenging., Objective: To report surgical and visual outcome of trabeculectomy in bilateral glaucoma in Sturge-Weber syndrome and the challenges encountered in its management., Case Description: A six-year-old girl presented with gradually progressive increase in size of both the eyes associated with watering, photophobia and diminution of vision since birth. On examination she was diagnosed to have bilateral SWS with glaucoma, refractive to antiglaucoma medications. She underwent trabeculectomy with intraoperative use of 5- FU. The post operative period was complicated with choroidal effusion in both the eyes with shallow anterior chamber. In the second post operative day, the right eye anterior chamber re- formation was done with ringer lactate solution. There was spontaneous resolution of choroidal effusion with normalization of intraocular pressure with no adverse effect on visual acuity within one week., Conclusion: Treatment of glaucoma associated with Sturge-Weber syndrome is challenging. When planning surgical intervention an increased risk of choroidal effusion associated with it, should be kept in mind., (© NEPjOPH.)

Context: The coexistence of diabetes mellitus (DM) with hypothyroidism is a known clinical observation., Aims: To estimate prevalence and co-relate that of hypothyroidism in patients with DM in relation to the age and sex, the lipid profile, body mass index visiting diabetes clinic and inpatients in B. P. Koirala Institute of Health Sciences., Settings and Design: The hospital-based descriptive study., Materials and Methods: Two hundred and seventy-one known or newly detected cases of DM aged more than 15 years were selected randomly from September 2012 to September 2013 and subjected to evaluation for thyroid function - clinically and biochemically and other relevant investigations were done., Statistical Analysis Used: For descriptive statistics mean, standard deviation, percentage, proportion were calculated. For inferential statistics following test were carried out at the level of significant 0.05 where confidence interval is 95%. The statistical operations were done through Statistical Package for the Social Sciences version 10., Results: Of 271 subjects, the prevalence of hypothyroidism (clinical and subclinical) in diabetics was, 4.05% (11/271) with females preponderance, of which 7 (30.4%) were clinically hypothyroid and 4 (17.4%) were subclinical hypothyroid. One (4.3%) patient had subclinical hyperthyroidism. The mean age at diagnosis of type 2 DM was 51-60 years. 8.69% of diabetics with primary hypothyroids were having morbid obesity. High-density lipoprotein among different thyroid status were statistically significant (P = 0.042)., Conclusions: Hypothyroidism is not uncommon in diabetes, and we found body mass index, mean triglyceride and cholesterol levels were more in those diabetic patients having coexisting hypothyroidism.

Orbital cellulitis is a serious, yet uncommon infection in neonates. It can result in significant sight and life threatening complications. Most commonly, it occurs secondarily as the result of a spread of infection from the sinuses. Orbital cellulitis, secondary to dental infection is rare. We hereby report a case of orbital cellulitis secondary to dental infection in a 15-day-old neonate without any systemic features.