A rare case report of bilateral Purtscher-like retinopathy in juvenile dermatomyositis.

Purpose: To report a rare case of bilateral Purtscher-like retinopathy (PLR) in a young adult diagnosed with dermatomyositis. Method: A case report with multi-modal imaging. Result: A 17-year-old male presented with subacute marked diminution of vision along with arthralgia, weakness of all four limbs and development of multiple rashes around body. Fundus examination revealed bilateral multiple Purtscher flecken, pseudo-cherry red spot, and intra-retinal haemorrhages with cotton wool spots. Systemic and laboratory examinations, magnetic resonance imaging (MRI) and biopsy of tissue confirmed the diagnosis of juvenile dermatomyositis with PLR. Conclusion: Dermatomyositis, being a rare cause of PLR, should essentially be considered as one of the differentials as timely intervention can alter the course of disease and prove life-saving for the patient.

Comparative Clinicopathological Evaluation of the Ocular Surface in Newly Diagnosed Patients of Hyperthyroidism and Hypothyroidism Compared to Healthy Subjects.

Introduction Thyroid eye disease is a multifactorial disorder affecting the tear film and ocular surface, which leads to dry eye. The aim of the study is to evaluate the tear function test and ocular surface changes clinically and to correlate pathologically using impression cytology in recently diagnosed cases of thyroid dysfunction, including both hyperthyroid and hypothyroid patients, and to compare the results with healthy subjects. Methods This was a cross-sectional analytical study. Thirty diagnosed patients with hyperthyroidism and hypothyroidism, each within three months, and 30 healthy age-matched controls were included. All patients and controls underwent an assessment of proptosis, palpebral fissure height (PFH), tear function test, Ocular Surface Disease Index (OSDI) questionnaire, Schirmer's test, tear break-up time (TBUT), and impression cytology for ocular surface assessment. These parameters were compared between cases and controls. Standard statistical analysis was used. Results Mean proptosis and PFH showed no significant difference among groups (P-value = .071). The mean value of OSDI was 42.33+22.67, 41.15+16.03, and 29.33+6.84 in the hyperthyroid, hypothyroid, and controls groups, respectively; the difference being statistically significant (p=0.001). Mean TBUT was 7.13+3.28 sec, 6.38+2.46 sec, and 11.15+2.39 sec in hyperthyroidism, hypothyroidism, and controls, respectively (p=0.001). The mean value of the Schirmer tear test was 12.93+5.81 mm, 13.30+4.44 mm, and 17.55+7.35 mm in hyperthyroidism, hypothyroidism, and controls, respectively (p=0.001). Eighty percent (80%) of patients in the hyperthyroidism group had grade 2-3 squamous metaplasia as compared to 70% in hypothyroidism patients and 24.4% in controls, signifying ocular surface damage (p<0.05). Conclusions The mean PFH and proptosis did not differ between the three groups. However, increased OSDI score, decreased Schirmer's test value, decreased TBUT, and grades 2-3 squamous metaplasia in patients with thyroid dysfunction suggest the presence of dry eyes. Despite no clinically visible signs of thyroid ophthalmopathy, there is ocular surface damage right from the early stages of thyroid dysfunction, possibly attributable to the evaporative mechanism as well as ocular surface inflammation and instability of the tear film.

Massive corneal-epibulbar dermoid managed with pre-descemetic DALK and SLET.

Management of large corneal-epibulbar dermoids always poses a challenge to the surgeons due to deeper corneal involvement. Also, there is a risk of limbal stem cell deficiency and formation of pseudopterygium with larger areas of limbal involvement. We report a novel surgical technique for the management of giant corneal-epibulbar dermoid with pre-descemetic deep anterior lamellar keratoplasty (DALK) and simple limbal epithelial transfer (SLET).