Ophthalmic Manifestations of Seborrheic Dermatitis.

Seborrheic dermatitis (SD) is a common, chronic inflammatory skin disease that affects the sebaceous tissues of the body. The meibomian glands of the eyelids are modified sebaceous glands. Involvement of the meibomian glands and their dysfunctioning are significant in SD; however, the ophthalmic features of SD have been poorly described in the literature. The ophthalmic manifestations of SD and the significance of ocular examinations in SD patients are discussed in this review.

Post-COVID-19 endogenous endophthalmitis case series and review of literature.

PURPOSE: To describe a series of post-coronavirus disease 2019 (COVID-19) endogenous endophthalmitis (EE) patients from a multispecialty tertiary hospital in North India. METHODS: A retrospective chart review including all consecutive cases with EE following confirmed COVID-19 disease from July 2020 to June 2021. RESULTS: Seven eyes of four patients (three female and one male) were included. Two patients had confirmed bilateral fungal (Aspergillus sp.) EE and two patients had presumed fungal EE (one bilateral and one unilateral). Three of these four patients received systemic steroids as part of COVID-19 treatment previously. Five eyes were managed with initial intravitreal injection (IVI), followed by pars plana vitrectomy (PPV), and two eyes were managed with only IVI. All patients received systemic antifungal agents. Intraocular inflammation resolved in all eyes with treatment. One patient of EE also developed voriconazole-induced transient visual hallucination, which resolved on discontinuing the medication. CONCLUSION: This case series represents a series of EE cases following COVID-19 disease or its sequelae or as a result of prior treatment for COVID-19. Ophthalmologists and physicians must be vigilant about these complications and initiate prompt management at the earliest.

Retinal Nerve Fiber Layer Thickness in Patients With Obstructive Sleep Apnea.

PRCIS: Average and superior quadrant retinal nerve fiber layer thickness (RNFLT) was lower in the more severe obstructive sleep apnea (OSA) group and inversely associated with apnea-hypopnea index (AHI). OSA may have an impact on RNFLT. PURPOSE: The purpose of this study was to study the RNFLT using optical coherence tomography (OCT) in patients with different severities of OSA. PATIENTS AND METHODS: In this hospital-based prospective cross-sectional study, 90 (90 eyes) newly diagnosed OSA patients aged 18 years or above were enrolled. Based on the AHI, there were 38.8%, 30%, and 31.1% cases of mild (AHI≥5 to <15), moderate (AHI≥15 to <30), and severe (AHI≥30) OSA, respectively. All the participants underwent a comprehensive ocular examination. OCT was done using CIRRUS HD-OCT 500 to measure the RNFLT. RESULTS: The average RNFLT among the 3 OSA groups was significantly different ( P =0.002) and inversely associated with AHI ( P =0.02, rs =-0.16). Severe OSA had thinner average RNFLT than those with mild and moderate OSA ( P =0.01 and 0.003, respectively). Among the 4 quadrants observed, only the superior quadrant RNFLT among the 3 OSA groups was significantly different ( P <0.00001) and inversely associated with AHI ( P =0.01, rs =-0.17). Severe OSA had thinner superior quadrant RNFLT than those with moderate OSA ( P <0.01). The differences in the intraocular pressure among the 3 OSA groups were statistically significant ( P <0.0008). Patients with moderate and severe OSA had higher intraocular pressure than patients with mild OSA ( P =0.002 and 0.001, respectively). CONCLUSIONS: Attention should be paid to the patients with OSA as it may have an impact on RNFLT. OSA patients should be screened for glaucoma as early detection of glaucoma can reduce vision loss in these patients.

Orbital Venolymphatic Malformation Treated With Sodium Tetradecyl Sulfate: A Case Report.

Orbital and periorbital venolymphatic malformations (VLMs) are benign congenital vascular lesions and constitute 1%-3% of all orbital masses. Widespread facial venous malformations have a high incidence of associated intracranial developmental venous anomalies (DVAs). In such cases, there can be a sudden increase in proptosis following upper respiratory infection or minor trauma. Numerous percutaneous intralesional sclerosing agents like sodium tetradecyl sulfate (STS), bleomycin, doxycycline, ethanol, and OK-432 (Picibanil) have been used for treating VLMs. We hereby report a rare case of retro-orbital VLM treated successfully with STS injection and an isolated dural arterio-venous (AV) fistula in the same patient.

Alteration in pattern reversal visual evoked potential in pediatric population with amblyopia and spherical refractive errors.

Purpose: To study the effect of refractive errors on pattern visual evoked potential (VEP) recordings in the pediatric population. Methods: This cross-sectional observational study assessed 240 eyes of 120 participants attending the outpatient department of a tertiary care center in North India. Participants were between 8 and 18 years of age; 30 participants each were recruited into four groups, namely emmetropia, myopia, hypermetropia, and amblyopia. They were then subjected to pattern reversal VEP, with P-100 amplitude and latency recorded for each participant. Results: The emmetropic group in this study provided normal values of P-100 parameters, namely P-100 latency and P-100 amplitude with readings of 115.78 ± 10.19 ms and 11.11 ± 4.08 µV, respectively. P-100 amplitude was significant compared to P-100 latency in detecting the presence or absence of a specific type of refractive error. It was found that there was a significant association between severity of myopia and P-100 latency (both unaided and aided) with P < 0.05. The severity of hypermetropia showed a significant association with P-100 amplitude (unaided) (P < 0.05). Receiver operating characteristics analysis revealed P-100 amplitude to be a good predictor of refractive error and the cut-offs were calculated. Conclusion: The P-100 parameters of the pediatric Indian population were comparatively higher than conventional values. P-100 latency seemed to better correlate with myopia, while hypermetropia correlated with P-100 amplitude. P-100 amplitude appears to be the most significant predictor of the presence of refractive error in an individual.

Post-traumatic posterior giant retinal tear and macular hole associated retinal detachment.

Background: Blunt trauma to the eye can present with varied manifestations involving both the anterior and posterior segments of the eye. Giant retinal tear (GRT) following trauma occurs most commonly at the equatorial region or anterior to the equator. GRT posterior to the equator is rare. Purpose: To demonstrate the successful management of a post-traumatic posterior GRT and full-thickness macular hole (MH) associated retinal detachment (RD). Synposis: A 21-year-old-male presented with sudden diminution of vision in the right eye (RE) following blunt-trauma with cricket ball. RE vision at presentation was hand movement close to face. Anterior segment of RE revealed pupillary sphincter tear, posterior synechiae and posterior subcapsular cataract (PSC). RE fundus revealed a posterior-GRT, full thickness MH, mild vitreous haemorrhage and rhegmatogenous RD. He was managed with pars plana vitrectomy, encircling scleral band, perfluorocarbon liquid-assisted flattening of GRT, internal limiting membrane peeling, and endotamponade. Post-operatively the retina was attached, MH was closed and the patient achieved an ambulatory vision of 1/60. Highlights: This video demonstrates the successful management of a posterior-GRT and MH associated RD. Removal of adherent hyaloid from the long anterior flap of posterior GRT, peeling of ILM from temporal narrow mobile strip of retina (which has a risk of radial extension of GRT edges) and manoeuvring in suboptimally dilated pupil are illustrated in this video. Video Link: https://youtu.be/p04-_t0Wuuc.

Pattern of uveitis from a tertiary eye care center in Himalayan belt of North India.

Purpose: To study the clinical characteristics of uveitis in patients presenting to a tertiary care institute in the northern part of India, predominantly serving the population of Himalayan belt. Methods: In this retrospective descriptive case series, data of 141 eyes of 102 patients diagnosed between January 2019 and January 2021 were analyzed. Patients were diagnosed, named, and meshed as per the Standardization of Uveitis Nomenclature. A panel of investigations (systemic and ocular ancillary investigations) were done, which was individualized according to the clinical picture. Results: The mean age of presentation was 39.1 ± 14.62 years. A male predominance (62.7%) was noted. Unilateral presentation was seen in 61.8% of patients. Specific etiological diagnosis was not reached in 56.7% of cases. The incidence of infectious and noninfectious uveitis was 23.4% and 19.9%, respectively. The frequency of anterior, intermediate, posterior, and panuveitis was 23.4%, 11.3%, 46.8%, and 18.5%, respectively. Posterior uveitis was the most frequent anatomical location (46.8%). Tuberculous uveitis was the most common definitive etiology irrespective of location (18.5%). Anterior, intermediate, and posterior uveitis were more frequently idiopathic in origin. Sympathetic ophthalmitis was the most common cause for panuveitis. Conclusion: Uveitis significantly affected the working age group population. Despite the evolution of diagnostic investigations, etiology remained unknown in many cases of uveitis. Infectious etiology was more common. Posterior uveitis as the most frequent anatomical location in our study may be attributed to the tertiary care referral bias.

Clinical profile and retinal nerve fibre layer thickness of optic disc oedema patients at a tertiary care institute in North India.

BACKGROUND: Optic disc oedema (ODE) is an important manifestation in various ocular as well as systemic disorders. Measurement of retinal nerve fibre layer (RNFL) thickness in ODE patients may help in monitoring the progress of the disease and treatment response. OBJECTIVE: To assess the clinical characteristics, aetiology and retinal nerve fibre layer (RNFL) imaging features of optic disc oedema (ODE) patients. DESIGN: A retrospective observational study. METHODS: This hospital-based study included performed for patients presenting with unilateral or bilateral ODE at the ophthalmology outpatient department of a tertiary institute between January 2019 and December 2019. Clinical features of all ODE patients were noted. RNFL thickness was measured by spectral-domain optical coherence tomography (Cirrus 500, Carl Zeiss Meditec, Dublin, CA, USA). RESULTS: Sixty-four patients with ODE were seen with female preponderance (56.2%). The mean age of presentation was 36.8 ± 13.8 years. Bilateral ODE was seen in 57.8% patients. The most common cause of bilateral ODE was idiopathic intracranial hypertension (IIH) and vascular papillopathy. Retinal vein occlusion (RVO)-associated ODE was the most common unilateral presentation. Presenting visual acuity was best with IIH and worst with anterior ischaemic optic neuropathy (AION). The mean duration of symptoms was maximum with intracranial space-occupying lesion associated papilloedema and minimum with AION. The mean RNFL thickness was highest in uveitis-associated ODE, followed by compressive ON, and IIH. A positive correlation was noted between clinical ODE severity and RNFL thickness. All aetiological categories (except uveitic and compressive) had maximum RNFL thickening in the inferior quadrant and minimum in the temporal quadrant. CONCLUSION: The current study provides a clinical profile and RNFL measurements of ODE patients at this locality. The clinical severity of ODE correlated positively with RNFL thickness and most of the categories of ODE followed the normative pattern of RNFL thickness (inferior > superior > nasal > temporal) despite thickening.

Burden of ocular morbidities and color blindness among school-attending children in a foothill town of Uttarakhand State.

PURPOSE: To estimate prevalence of common ocular morbidities including color blindness among school-attending children of an urban foothill town of Uttarakhand State in Northern India. METHODS: A cross-sectional study was conducted among school-going children of age group 6-16 years of standard I-XII. Schools were selected using population proportionate to the size sampling technique. Detailed ocular examination including color vision and unaided or aided visual acuity for various ocular morbidities was done. Data was entered into MS excel with statistical analysis using SPSS version 23 with significant P value <0.05. RESULTS: In total, 13,492 students (mean age 10.9 ± 2.7 years) with almost equal male to female ratio were screened. Overall prevalence of ocular morbidity was 23.2%, with refractive error (18.5%) on top, followed by color blindness (2.2%). The later was observed more among males (3.0%) as compared to females (1.4%) with significantly higher odds, OR = 2.3 (1.7-2.9) (P < 0.001). CONCLUSION: Refractive error has been the most common ocular morbidity, followed by color blindness. Earliest detection can prevent permanent disability and disappointment among youngsters when rejected from entering certain professions due to color vision defect.

Microspherophakia: A clinical approach and mini review with a case report.

Microspherophakia refers to a spherophakic lens with a decreased equatorial diameter. Microspherophakia can be found in systemic or ocular conditions, such as Marfan's syndrome, Weill-Marchesani syndrome, iridocorneal endothelial syndrome, and Axenfeld-Rieger syndrome. A 3-year-old girl was brought with complaints of eyes appearing larger, watering and inability to see bright light for 1 year. On examination, she had megalocornea; the cornea was clear with a shallow anterior chamber, and microspherophakic lens. Her intraocular pressure (IOP) was recorded as 43 and 32 mmHg in the right and left eyes, respectively. This article guides in classifying, categorizing, and managing a case with microspherophakia.

A rare case of type 3 usher syndrome with bilateral cystoid macular edema treated with topical dorzolamide.

A 30-year-old female presented with gradually progressive diminution of vision for 1 month, with night blindness for the past 5 years and difficulty in hearing for the past 10 years. Her developmental history and family history were unremarkable. Ocular examination revealed visual acuity of 6/36 in both eyes. Fundus showed features of retinitis pigmentosa with bilateral macular edema. Audiometry revealed bilateral sensorineural hearing loss; although, her vestibular functions were preserved. Clinical diagnosis of Usher syndrome type 3 was made based on normal hearing at birth, delayed presentation of progressive visual and auditory impairment with normal vestibular function, and developmental milestones. Her macular edema resolved after 3 months of treatment with topical dorzolamide therapy. The unique feature of this case is the presence of bilateral macular edema in type 3 Usher syndrome, which is rarely reported in literature.

Yogic Pranayama and Diaphragmatic Breathing: Adjunct Therapy for Intraocular Pressure in Patients With Primary Open-angle Glaucoma: A Randomized Controlled Trial.

PRCIS: Yogic pranayama and diaphragmatic breathing are potential adjunctive therapies for patients with glaucoma; however, they are not substitutes for medicine or eye drops. PURPOSE: Currently, medical or surgical lowering of intraocular pressure is the only therapeutic approach for treating primary open-angle glaucoma. Intraocular pressure maintenance is influenced by autonomic activity (sympathetic and parasympathetic). "Yogic pranayama" and "diaphragmatic breathing" are exercises that can affect autonomic activity by stimulating a wakeful hypometabolic state of parasympathetic dominance. We aimed to assess the effect of yogic pranayama and diaphragmatic breathing on intraocular pressure to determine whether it can be recommended for individuals with established glaucoma in combination with glaucoma medication as an adjuvant therapy. MATERIALS AND METHODS: In this prospective, randomized trial, 90 patients with primary open-angle glaucoma (180 eyes, age: above 40 y) were assigned to either the control or yogic pranayama and diaphragmatic breathing exercise group. In the latter group, yogic pranayama and diaphragmatic breathing were practiced daily for 6 months. We measured the intraocular pressure at presentation and subsequently after 1, 3, and 6 months. RESULTS: Compared with the wait-list group, the yogic pranayama and diaphragmatic breathing exercise group had significantly lowered intraocular pressure (right eye: 20.85±3.39 to 14.90±2.86 mm Hg; left eye: 20.30±4.12 to 14.25±3.85 mm Hg; P<0.001). CONCLUSION: Yogic pranayama and diaphragmatic breathing exercises can reduce intraocular pressure in patients with primary open-angle glaucoma and can therefore be recommended as an adjuvant therapy.

Comparison of home-based pencil push-up therapy and office-based orthoptic therapy in symptomatic patients of convergence insufficiency: a randomized controlled trial.

PURPOSE: To assess and compare the effectiveness of home-based pencil push-up therapy (PPT) and office-based orthoptic therapy (OBOT) in patients with convergence insufficiency. METHODS: In this randomized clinical trial, 176 symptomatic patients with convergence insufficiency, aged between 9 to 30 years, were randomly assigned to receive 6 weeks of home-based PPT (Group I) or OBOT (Group II) after determining refractive error, near point of convergence (NPC), convergence insufficiency symptom survey (CISS) score, near phoria and positive fusional vergences (PFV) at near. The participants of Group I underwent home-based PPT (pencil push-ups exercises15 minutes per day, daily for 6 weeks) and those of Group II OBOT (convergence fusional exercises on synoptophore for 20 min per day, 3 days a week, for 6 weeks) without home reinforcement. Patients were re-examined at 3 and 6 weeks after initiation of treatment. NPC and CISS score were the primary and secondary outcome measures, respectively. Statistical analysis was performed with the independent samples t-test, Friedman test and the analysis of variance (ANOVA). Statistical significance was indicated by p-value < 0.05. RESULTS: Participants of both the groups had statistically significant improvement in NPC, CISS score, PFV and near phoria (p < 0.001), but there was no statistically significant difference between the two groups (p > 0.05). However, patients of Group II had significantly better PFV after final visit than those of Group I (p < 0.001). CONCLUSION: Home-based PPT with good suppression control and with compliance ensured by log book entries, is a simple, cheap, less time consuming and comparably effective alternative to more expensive OBOT for patients suffering from CI. CTRI registration number: REF/2016/11/012,732, Date of registration 25/04/ 2016, Retrospectively Registered.

Case Report: Foveolitis as an Indicator of Underlying Undiagnosed Dengue Fever.

We describe a case of dengue fever-associated foveolitis that presented initially to the ophthalmologists with complaints of unilateral diminution of vision. A 30-year-old Indian woman had presented with sudden onset diminution of vision in the left eye (LE) for the past 2 days. It was also associated with low-grade fever and myalgia, which started few days before visual deterioration. Fundus showed few retinal hemorrhages and tiny subretinal yellowish lesions at the fovea in the LE. Optical coherence tomography and fluorescein angiography were indicative of foveolitis. Amsler charting showed a central scotoma in the LE. She was treated with oral steroids along with supportive treatments. A near-complete anatomical and functional recovery was noted. Our case depicts the significance of awareness of the ophthalmic complications of dengue fever among both ophthalmologists and physicians, and also highlights the key clinical and multimodal imaging findings in a case of dengue foveolitis.

Accuracy of anterior segment optical coherence tomography for pre-operative localization of insertions of extraocular recti muscles.

INTRODUCTION: To study the accuracy of anterior segment optical coherence tomography (AS-OCT) function of Cirrus HD-OCT 500 (Carl Zeiss Meditec, Dublin, CA) in calculating the insertion of rectus muscles from the limbus in patients undergoing primary squint surgery. METHODOLOGY: A prospective, double-masked, observational study was conducted on 128 muscles of 46 patients with strabismus who were planned for strabismus surgery between January 2019 and December 2019. Insertion distance from limbus was measured using AS-OCT function of Cirrus HD-OCT 500 preoperatively. Intraoperative measurements were taken using Castroviejo caliper. A Bland-Altman analysis was performed to determine the agreement between the readings. RESULTS: A total of 128 muscles were successfully imaged and evaluated, including 13 superior recti (10.15%), 23 inferior recti (17.96%), 35 medial recti (27.34%) and 57 lateral recti (44.53%). 124 muscles (96.9%) were within 1mm difference, which was considered clinically acceptable. Bland-Altman plots showed the level of agreement between the two methods was good. CONCLUSION: Anterior segment scan function of Cirrus HD-OCT 500 is an accurate method to detect the insertion of extraocular recti muscles in patients of primary strabismus surgery.

Intraocular pressure and tear production changes in pregnant women at term pregnancy and immediate post-partum: A pilot study.

AIM: To study the intraocular pressure (IOP) and tear production changes in uncomplicated pregnant women at term pregnancy and immediate postpartum. MATERIALS AND METHODS: The patients admitted in the Department of Obstetrics and Gynaecology for delivery were included in the study. A total of 106 participants who were at term uncomplicated pregnancy were selected according to the inclusion and exclusion criteria. They were subjected to type 1 Schirmer's testing and intraocular pressure measurement by Perkin's tonometer before and after delivery. RESULT: There was no significant pre- and postdelivery IOP difference between the different age groups (<30 and ≥30 years), mode of delivery, and parity. There was a statistically significant (P < 0.001) increase in mean tear production (Schirmer's test) after delivery, irrespective of age group, mode of delivery, and gravida status. However, no significant intergroup difference was observed. CONCLUSION: There was no significant change in IOP before and after delivery in uncomplicated pregnancies. However, a statistically significant increase in tear production was observed in the immediate postpartum period.