Cataracts.

94 million people are blind or visually impaired globally, and cataract is the most common cause of blindness worldwide. However, most cases of blindness are avoidable. Cataract is associated with decreased quality of life and reduced life expectancy. Most cases of cataract occur after birth and share ageing and oxidative stress as primary causes, although several non-modifiable and modifiable risk factors can accelerate cataract formation. In most patients, phacoemulsification with intraocular lens implantation is the preferred treatment and is highly cost-effective. There has been an increase in the use of comprehensive cataract surgical services, including diagnoses, treatment referrals, and rehabilitation. However, global inequity in surgical service quality is still a limitation. Implementation of preoperative risk assessment, risk reduction strategies, and new surgical technologies have made cataract surgery possible at an earlier stage of cataract severity with the expectation of good refractive outcomes. The main challenge is making the service that is currently available to some patients accessible to all by use of universal health coverage.

[INTERVENTIONAL GLAUCOMA - A SHIFT IN THE TREATMENT PARADIGM].

INTRODUCTION: Glaucoma is a progressive optic neuropathy and is the leading cause of preventable irreversible blindness worldwide. Glaucoma causes progressive visual field loss and can have significant implications on the patient's quality of life. Lowering intraocular pressure (IOP) is the only treatment proven to prevent vision loss from glaucoma. It is achieved using medication, laser treatment and surgery. The treatment paradigm of glaucoma has been one whereby surgical intervention has been left for advanced cases due to a variety of reasons, mainly concerning safety and long term success. The past two decades have seen a paradigm shift towards earlier IOP lowering interventions using a wide array of different technologies in the laser and surgical spaces. This review aims to understand the background to this paradigm shift, its necessity, and its potential impact on the vision and life of glaucoma patients.

Identifying new drugs and targets to treat rapidly elevated intraocular pressure for angle closure and secondary glaucomas to curb visual impairment and prevent blindness.

A multitude of pharmacological compounds have been shown to lower and control intraocular pressure (IOP) in numerous species of animals and human subjects after topical ocular dosing or via other routes of administration. Most researchers have been interested in finding drug candidates that exhibit a relatively long duration of action from a chronic therapeutic use perspective, for example to treat ocular hypertension (OHT), primary open-angle glaucoma and even normotensive glaucoma. However, it is equally important to seek and characterize treatment modalities which offer a rapid onset of action to help provide fast relief from quickly rising IOP that occurs in certain eye diseases. These include acute angle-closure glaucoma, primary angle-closure glaucoma, uveitic and inflammatory glaucoma, medication-induced OHT, and other secondary glaucomas induced by eye injury or infection which can cause partial or complete loss of eyesight. Such fast-acting agents can delay or prevent the need for ocular surgery which is often used to lower the dangerously raised IOP. This research survey was therefore directed at identifying agents from the literature that demonstrated ocular hypotensive activity, normalizing and unifying the data, determining their onset of action and rank ordering them on the basis of rapidity of action starting within 30-60 min and lasting up to at least 3-4 h post topical ocular dosing in different animal species. This research revealed a few health authority-approved drugs and some investigational compounds that appear to meet the necessary criteria of fast onset of action coupled with significant efficacy to reduce elevated IOP (by ≥ 20%, preferably by >30%). However, translation of the novel animal-based findings to the human conditions remains to be demonstrated but represent viable targets, especially EP2-receptor agonists (e.g. omidenepag isopropyl; AL-6598; butaprost), mixed activity serotonin/dopamine receptor agonists (e.g. cabergoline), rho kinase inhibitors (e.g. AMA0076, Y39983), CACNA2D1-gene product inhibitors (e.g. pregabalin), melatonin receptor agonists, and certain K+-channel openers (e.g. nicorandil, pinacidil). Other drug candidates and targets were also identified and will be discussed.

Understanding the behavioral determinants that predict barriers and enablers of screening and treatment behaviors for diabetic retinopathy among Bangladeshi women: findings from a barrier analysis.

BACKGROUND AND AIM: While early detection and timely treatments can prevent diabetic retinopathy (DR) related blindness, barriers to receiving these DR services may cause permanent sight loss. Despite having similar prevalence to diabetes and DR, women are less likely than men to perform these behaviors due to multi-faced barriers in screening and receiving follow-up treatments for DR. This study, therefore, aimed at identifying the barriers to - and enablers of - screening and follow-up treatments behaviors for DR among women aged more than 40 years with diabetes from the behavioral perspectives in Bangladesh. METHODS: This Barrier Analysis study interviewed 360 women (180 "Doers" and 180 "Non-doers") to explore twelve behavioral determinants of four DR behaviors including screening, injection of anti-vascular endothelial growth factor (anti-VEGF medication), laser therapy and vitro-retinal surgery. The data analysis was performed to calculate estimated relative risk to identify the degree of association between the determinants and behaviors, and to find statistically significant differences (at p < 0.05) in the responses between the Doers and Non-doers. RESULTS: Access to healthcare facilities was the major barrier impeding women from performing DR behaviors. Difficulty in locating DR service centers, the need to travel long distances, the inability to travel alone and during illness, challenges of paying for transportation and managing workload significantly affected women's ability to perform the behaviors. Other determinants included women's perceived self-efficacy, perceived negative consequences (e.g. fear and discomfort associated with injections or laser treatment), and cues for action. Significant perceived enablers included low cost of DR treatments, supportive attitudes by healthcare providers, government policy, and perceived social norms. CONCLUSION: The study found a host of determinants related to the barriers to and enablers of DR screening and treatment behaviors. These determinants included perceived self-efficacy (and agency), positive and negative consequences, perceived access, perceived social norms, culture, and perceived risk. Further investments are required to enhance the availability of DR services within primary and secondary health institutions along with health behavior promotion to dispel misconceptions and fears related to DR treatments.

Case Series: Avoidable Blindness after Inappropriate Ophthalmic Self-medication in Ghana.

SIGNIFICANCE: Inappropriate ophthalmic self-medication continues to plague Sub-Saharan Africa because of lack of public health education and inaccessibility to eye care services. This case series describes three cases of blindness (two monocular, one binocular) in Ghana, because of self-treatment of ocular conditions using improper drugs or homemade herbal mixtures. The article highlights the consequences of misinterpretation of symptoms and use of traditional home remedies, leading to delayed professional eye care and avoidable blindness. PURPOSE: This case series aims to report three separate cases of avoidable blindness after inappropriate ophthalmic self-medication to draw attention to the need for intense public health education in Ghana. CASE REPORTS: Three men aged 25, 79, and 35 years, respectively, reported severe reduction in visual acuity in one eye for two cases and both eyes for one case. All patients reported ophthalmic self-medication either with an inappropriate drug bought from the drug store or a homemade herbal mixture made from leaves assumed to treat eye infections. Professional care did not yield any improvement in visual acuity because their corneas were already decompensated at the onset of management. The eye of one patient had to be enucleated. CONCLUSIONS: These cases highlight the importance of eye health promotion and education. It is recommended that intense sensitization is carried out at all levels.

Creation of a neovascular age-related macular degeneration national database using a web-based platform: Fight Retinal Blindness Spain. Report 1: Visual outcomes.

BACKGROUND: To study the visual outcomes of neovascular AMD (nAMD) treated with anti-vascular endothelial growth factor (VEGF) drugs at national level. METHODS: Multicenter national database of nAMD eyes treated with anti-VEGF intravitreal injections (ranibizumab, aflibercept, bevacizumab) in fixed bimonthly (FB) or treat-and-extend (TAE) regimens. Demographics, visual acuity (VA) in logarithm of the minimum angle of resolution (logMAR) ETDRS letters at baseline and subsequent visits, number of injections and visits data were collected using a validated web-based tool (Fight Retinal Blindness!). RESULTS: 1273 eyes (1014 patients) were included, 971 treatment naïve (TN) and 302 previously treated (PT). Baseline VA (mean ± SD) was 57.5 (±19.5) and 62.2 (±17) (p > 0.001), and 24 months final VA was 60.4 (±21.2) and 58.8 (±21.1) (p = 0.326), respectively. Mean VA change at 12/24 months was +4.2/+2.9 letters in TN eyes and +0.1/-3.4 letters in PT eyes (p < 0.001/p < 0.001). The percentage of ≥15 letters gainers/losers at 24 months was 24.8%/14.5% in TN, and 10.3%/15.7% in PT eyes. The median number of injections/visits at 12 months was 7/9 in TN and 6/8 in PT (p = 0.002/p < 0.001) and at 24 months was 11/16 in TN and 11/14 in PT (p = 0.329/p < 0.001). Study drugs included ranibizumab (39.5%), aflibercept (41.2%) and bevacizumab (19.3%). CONCLUSION: Independent, large-scale national audits are feasible if committed health care professionals are provided with efficient information technology systems to do them. The results described here represent an adequate measurement of the quality of care delivered nationwide and benchmark the clinical management of nAMD at a country level compared to other real-world international cohorts.

Roll Back Stroke: The Way Forward for Physicians and Patients.

The 6-lettered word "Stroke" is an ancient disease, likened Biblically to "666" in Revelation 13 verse 18. Globally, it is the commonest cause of acquired long-term disability. While its incidence has been declining in high-income countries, low/middle-income countries (LMICs) have witnessed an increase. This increase is driven by epidemiologic-transition/modernization-complex, healthcare disparities, and increasing prevalence of vascular risk-factors. Despite the disproportionate burden of stroke in LMICs, these countries have the lowest rate of access to acute reperfusion-interventions leading to greater stroke-related morbidity/mortality. Effective primordial, primary, secondary, tertiary, and quaternary prevention-strategies coordinated at all levels of care are needed to reduce stroke incidence and poor outcomes. The World Stroke Organization (WSO) has proposed achieving global primary prevention through 1) Populationwide approach to limiting stroke risk-factors exposure, 2) App-based motivational population-wide approach to mitigating stroke riskfactors, 3) use of low-cost combination/poly-pill to treat hypertension/dyslipidemia and 4) addressing behavioural risk-factors through interventions by community health-workers. The need to set-up stroke-units, post-hospitalisation rehabilitationcentres, stroke-registers/registries, stroke-clubs, and encourage community health-education, must be emphasised for optimal care in LMIC.13 Community Health Empowerment (CHE) with the Acronym BE FAST / STRoke as warning signs of stroke must be emphasised (B: Balance-loss; E: Eye vision-loss; F: Facial Asymmetry; A: Arm weakness; S: Speech difficulties; T: Time is brain; Or first 3-letters of STRoke - Can Patient Smile? Talk? Or Raise-arm?). Stroke hemorheology/blood-flow and treatment involve 3Ps' of pathogenic principles/strategies (Passenger, Passage, Power). Its complications include the 10D's: Death, Disability, Depression, Dementia, Delirium, Dysphagia, Dehydration, Deep-Venous Thrombosis, Decubitusulcers, Dysphasia, Seizures.

L'accident vasculaire cérébral (AVC) est une maladie ancienne, assimilée bibliquement à "666" dans l'Apocalypse 13 verset 18. Dans le monde, c'est la cause la plus fréquente d'invalidité acquise à long terme. Alors que son incidence a diminué dans les pays à revenu élevé, les pays à revenu faible ou intermédiaire (PRFM) ont connu une augmentation. Cette augmentation est due au complexe épidémiologie-transition/ modernisation, aux disparités en matière de soins de santé et à la prévalence croissante des facteurs de risque vasculaire. Malgré le fardeau disproportionné de l'AVC dans les PRFM, ces pays ont le plus faible taux d'accès aux interventions de reperfusion aiguë, ce qui entraîne une morbidité/mortalité plus importante liée à l'AVC. Des stratégies de prévention primordiales, primaires, secondaires, tertiaires et quaternaires efficaces et coordonnées à tous les niveaux de soins sont nécessaires pour réduire l'incidence des AVC et les mauvais résultats. La World Stroke Organization (WSO) a proposé de réaliser une prévention primaire globale par 1) une approche à l'échelle de la population pour limiter l'exposition aux facteurs de risque d'AVC, 2) Basé sur une application approche motivationnelle à l'échelle de la population pour atténuer les facteurs de risque d'AVC , 3) l'utilisation d'une combinaison de pilules à faible coût pour traiter l'hypertension et la dyslipidémie et 4) la prise en compte des facteurs de risque comportementaux par des interventions des agents de santé communautaires. La nécessité de créer des unités d'AVC, des centres de réadaptation posthospitalisation, des registres/registres d'AVC, des clubs d'AVC, et d'encourager l'éducation sanitaire communautaire, doit être soulignée pour des soins optimaux dans les PRFM.13 L'autonomisation de la santé communautaire (CHE) avec l'acronyme BE FAST / STRoke comme signes d'alerte de l'AVC doit être soulignée (B : Perte d'équilibre ; E : Perte de la vision oculaire ; F : Asymétrie faciale ; A : Faiblesse du bras ; S : Difficultés d'élocution ; T : Le temps, c'est le cerveau; ou les 3 premières lettres de STRoke - Le patient peut-il sourire? Parler ? Ou lever le bras ?). L'hémorhéologie/la circulation sanguine et le traitement de l'AVC impliquent des 3P de principes/stratégies pathogènes (Passager, Passage, Puissance). Ses complications comprennent les 10D: Décès, invalidité, Dépression, Démence, Délire, Dysphagie, Déshydratation, thrombose veineuse profonde, ulcères de décacubitude, Dysphasie, convulsions. Mots-clés: Épidémiologie, Éducation sanitaire, Prévention, Accident vasculaire cérébral, Handicap.

Anti-VEGF therapies for age-related macular degeneration: a powerful tactical gear or a blunt weapon? The choice is ours.

PURPOSE: Blindness and vision loss are still frequent disabilities associated with a relevant impact on health care and quality of life, and a high economic burden. Supranational programs established by the World Health Organization (WHO), International Agency for the Prevention of Blindness (IAPB), and World Health Assembly (WHA) aim at reducing avoidable visual impairment. Age-related macular degeneration (AMD), diabetic retinopathy (DR), and other retinal diseases are well known causes of visual disability. Since more than a decade, intravitreal agents are available for the treatment of these diseases. The aim of this study is to review whether pharmacotherapy with anti-vascular endothelial growth factor (VEGF) drugs has led to a decrease in the prevalence of blindness with emphasis on AMD and different countries. A brief analysis of other factors correlated to changes in the rate of blindness is also presented. METHODS: PubMed and Scopus web platforms were used to identify relevant studies on epidemiology of blindness and vision impairment, the influence of intravitreal therapies, and the existence of different vision care models. Additional data and material was searched in web internet accessed by the web browser Firefox. RESULTS: Age-standardized prevalence of blindness secondary to AMD has started to decline as testified by a number of studies in different countries. This is due to the adoption of anti-VEGF therapy and its adequate management. The frequency of treatment and regimens applied are indirect signs of successful treatment. Local rules and regulations may represent an obstacle. CONCLUSIONS: This review shows that by implementing existing health care systems and dispensing adequate therapies in the field of retinal diseases, the prevalence of blindness due to these conditions can decline.

Generation of Filler Emboli as a Mechanism for Filler-Related Blindness.

BACKGROUND: Intra-arterial injection of fillers can lead to occlusion of the ophthalmic artery or its branches supplying the retina or the optic nerve. The mechanism through which this occurs is incompletely understood. We investigated the possibility of generating microparticles after injecting commercially available fillers into a flowing system in vitro. METHODS: Three hyaluronic acid fillers and one calcium hydroxylapatite filler were injected into an artificial saline flow system mimicking arterial systolic blood pressure and corresponding to the diameter of the facial artery. All the saline at the end of the tube was collected, centrifuged, and inspected for filler particles. RESULTS: After injection into the system, all fillers immediately disintegrated into small particles that were carried downstream with the flow of the saline. The saline at the end of the tube contained collections of filler. CONCLUSION: Hyaluronic acid and hydroxylapatite fillers break up into small particles immediately after injection into a flowing system, generating emboli rather than a column of filler. The results of this study lead us to hypothesize another potential mechanism leading to filler-related blindness.

How I do it: total resection of a giant sphenoclinoidal meningioma with normalization of near blind vision.

BACKGROUND: Resection of giant sphenoclinoidal meningiomas (SCLM) remains difficult. We discuss a patient presenting with right eye near blindness who underwent total removal of a giant SCLM, resulting in normal vision and no recurrence. METHOD: Utilizing frontotemporal craniotomy, devascularization, debulking, and detachment was achieved. Microdissection of tumor off the optic nerve and carotid perforators was accomplished, resulting in total resection, visual normalization, and no deficits using efficient face-to-face microscope set-up, 2-surgeon 4-hand technique, and double bipolar-suction arrangement. CONCLUSION: Frontotemporal craniotomy was adequate. Preservation of the optic nerve and carotid artery is key. Meticulous microsurgical techniques and refined instruments are important for success.

Prevention and Management of Filler Induced Iatrogenic Stroke of the Eye [Formula: see text].

In the past few decades, minimally-invasive esthetic treatments and the use of injectable Hyaluronic Acid Gels and other filling agents to treat facial esthetics have increased dramatically. Although extremely rare, a filler can cause ocular and orbital ischemia by retrograde flow from the ophthalmic artery when injected in any of the anastomosis of the face. Once filler reaches the central retinal artery, blindness is inevitable, and no treatment is effective. While the risk of blindness happening with any filler injection is rare, the life-altering irreversible consequence of a procedure that was anticipated to be simple and beautifying is a reality that each injector must be prepared for with every injection. The parameters associated with an iatrogenic stroke of the eye are the site of injection, the injection technique, patient characteristics, and the material injected. Understanding the interplay of each of these variables might help us reduce the possibility of blindness during the injection of a soft-tissue cosmetic filler. Here, we explore the causes of Hyaluronic Acid Gels Filler embolic phenomena, review the natural course of the process, and discuss appropriate immediate interventions. We also (1) propose an education plan for injectors and describe how to carry out a focused ophthalmologic examination and procedural activities for a referral to an ophthalmologist, (2) outline steps to prevent emboli during filler injection, and (3) how to manage and support a patient with a sudden loss of vision during or immediately after a Hyaluronic Acid Gels filler treatment.

Treatment outcomes on neovascularization after CRAO treated with hyperbaric oxygen.

Central retinal artery occlusion (CRAO) is a condition that causes sudden vision loss due to obstruction of the retinal artery, typically from a thrombotic or embolic source. It is often associated with atherosclerotic risk factors, including cardiovascular disease, diabetes, hyperlipidemia, and a history of cerebrovascular disease. CRAO often leads to a poor visual outcome as well as neovascularization of the iris, retina, and optic disc, which can exacerbate vision loss and cause pain. While there are several treatment modalities for CRAO, few have been proven to be effective in decreasing the effects of neovascularization. The use of hyperbaric oxygen (HBO2) therapy is often used in the treatment of CRAO due to its ease of use and relatively benign side effect profile. This study aims to assess the degree of improvement in visual acuity (VA) and neovascularization following HBO2. Our data ultimately shows that 20% of patients developed neovascularization after HBO2 compared to 29.8% of those who did not undergo HBO2 (p<.05). Our findings suggest that HBO2 has a statistically significant protective effect against neovascularization and may improve long-term visual acuity.

Gender blindness: On health and welfare technology, AI and gender equality in community care.

Digital health and welfare technologies and artificial intelligence are proposed to revolutionise healthcare systems around the world by enabling new models of care. Digital health and welfare technologies enable remote monitoring and treatments, and artificial intelligence is proposed as a means of prediction instead of reaction to individuals' health and as an enabler of proactive care and rehabilitation. The digital transformation not only affects hospital and primary care but also how the community meets older people's needs. Community care is often provided by informal and formal care-givers, most of whom are women. Gender equality is at the heart of many national strategies, but do all genders have equal rights, responsibilities and opportunities when it comes to community care and its digital transformation? The digital transformation of community care is entangled with how care is provided to older people and the working conditions of community-care professionals. Current and, even more so, future community-care systems are and will be partly constituted by networks of technological artefacts. These health and welfare technological artefacts and the discourse surrounding them mediate and constitute social relations and community care. This article looks into how health and welfare technology and artificial intelligence-based devices and systems mediate and constitute gender relations in community care and presents an argument for reflexivity, embodiment, pluralism, participation and ecology as an alternative strategy to treating community care as one-size-fit-all and being blind to gender-related issues.

Ethambutol Optic Neuropathy: Vigilance and Screening, the Keys to Prevent Blindness with the Revised Anti-tuberculous Therapy Regimen.

There has been change in the guidelines for the management of tuberculosis in India. The new guidelines advocate the daily use of Ethambutol for both intensive and continuation phase of the treatment. This may be a matter of concern as increased cumulative dose may lead to increase in incidence of toxic optic neuropathy due to ethambutol. Indian Neuro-Ophthalmology Society has taken cognizance of the issue and has come-up with guidelines for prevention and early detection of the toxic optic neuropathy.

Cataract surgery and Indigenous eye care: A review.

Cataract remains the leading cause of blindness in Aboriginal and Torres Strait Islander peoples and is still a major cause of vision loss. The pathway of care to cataract surgery has many potential gaps and barriers. Although there has been a significant increase in services over the last few years, there is still the urgent need to facilitate timely and affordable cataract surgery. Particularly for public surgery there needs to be a significant decrease in waiting times for the clinical assessment of those needing surgery and for those on a surgical waiting list.

[Laboratory predictors of glaucoma in patients with middle and old age - a tool to improve the quality of life (literature review).]

There are about 1,3 billion people worldwide with visual disorders such as cataract and glaucoma, the prevalence of which is significantly higher in elder persons. Eye diseases remain a global medical, social and economic problem, associated with both the progression of the disease up to blindness and the lack of pathogenetic therapy methods. Timely detection of pathology is secondary prevention of glaucoma. At present, a number of diagnostic techniques have been developed, including mainly instrumental techniques. Undoubtedly, laboratory indicators should be used as screening methods of early diagnosis. Today, a group of biomarkers with different degrees of sensitivity and specificity has been identified. However, these markers have some difficulty in indicating. Finding signs of glaucoma in complete blood count is an important task. Glaucoma is recognized as a systemic disease, which should be reflected in the change in morphofunctional properties of blood elements.

A Consensus on Minimizing the Risk of Hyaluronic Acid Embolic Visual Loss and Suggestions for Immediate Bedside Management.

BACKGROUND: Hyaluronic acid fillers have a satisfactory safety profile. However, adverse reactions do occur, and rarely intravascular injection may lead to blindness. Currently there is no internationally recognized consensus on the prevention or management of blindness from hyaluronic acid filler. OBJECTIVES: The authors sought to give guidance on how to minimize the risk and optimize the management of this rare but catastrophic adverse reaction. METHODS: A multinational group of experts in cosmetic injectables from multiple disciplines convened to review current best practice and develop updated consensus recommendations for prevention and bedside intervention if visual loss occurs after cosmetic injection of hyaluronic acid filler. RESULTS: The consensus group provided specific recommendations focusing on the consenting process, prevention, and early management of visual impairment related to intravascular hyaluronic acid filler injection. CONCLUSIONS: Although visual loss due to filler injections is rare, it is important that both patient and physician be aware of this risk. In this paper the authors describe methods and techniques available to reduce the risk and also document suggested initial management should a clinician find themselves in this situation.

Vitriolage (vitriolism) - a medico-socio-legal review.

Vitriolage (acid attack) involves an intentional act of violence in which any corrosive is thrown onto the face and body of a person with the intention of disfiguring them. The most common type of corrosive used in these attacks is sulfuric acid (oil of vitriol) hence the name "vitriolage". Sulfuric acid is a strong acid/corrosive and has a toxic nature that is capable of causing bodily injuries leading to damage to mucous membranes, tissues and skin with blindness, burning, and scars often leading to significant disfigurement with temporary or permanent disability. The main reasons for acid attacks are marriage refusal, rejection of love proposals, dowry issues and male aggression. Acid attacks have horrendous physical, social, psychological and economic effects on victims. This review will delineate the various legal provisions relating to acid attacks with special reference to the recent Indian Criminal Law Amendment Act of 2013 which addressed the issue of these attacks specifically by making it a separate offence in the Indian Penal Code under sections 326 A and B. The Bangladesh Acid Offences Prevention Act 2002 and Acid Crime Control Act, 2002, and legislation and policies combating acid attacks in Cambodia, Nepal and Pakistan will also be mentioned. Additionally, the paper will discuss the role of the judiciary in South Asia by focusing on other landmark judgments and decisions and throw light on the campaign in India namely "Stop Sale Acid" aimed at stopping the unrestricted sale of acid. Finally, further suggestions are proposed to assist in combating this heinous crime.

[Prevention of blindness and ophthalmic epidemiology in China over the past 70 years].

Prevention of blindness is of paramount importance for eye care and health care in China. In the past 70 years, we have embraced a lot of advancements in practice, manpower and landmark studies for the prevention of blindness and development of ophthalmic epidemiology. This summary is dedicated to our predecessors and successors for their contributions to the progress of ophthalmology in China, particularly workers in the field of prevention of blindness and ophthalmic epidemiology. Congratulations on the 70th anniversary of Chinese Journal of Ophthalmology. (Chin J Ophthalmol, 2020, 56: 561-566).

An unusual case of intra orbital foreign body; diagnosis, management, and outcome: a case report.

BACKGROUND: An orbitocranial injury with a penetrating Intraorbital Foreign Body (IOFB) is listed as a rare cause of penetrating trauma. Since this type of trauma is considered a surgical emergency, taking a thorough history along with careful examination to find out the mechanism and cause of the trauma is crucial towards correct diagnosis and management of the disease. CASE PRESENTATION: A 35-year-old male patient was presented to the ER with an occupational craniofacial injury because of an IOFB. The patient underwent an extra-dural orbitocranial craniotomy procedure to remove the foreign body. Interestingly, a plastic foreign body (a piece of a plastic pipe) was removed from the orbital cavity, which was suspected to be a fractured orbital bone, at first place. CONCLUSION: In this study, we demonstrated that plastics could mimic bone structure in a Computerized Tomography (CT) scan leading to possible initial misdiagnosis. Hence high clinical suspicion is necessary for the correct diagnosis of such cases. However, despite the prompt intervention, our patient ended up with permanent vision loss in his injured eye.