Primary Orbital Tuberculosis with Cold Abscess: A Case Report.

Orbital tuberculosis is a rare form of extrapulmonary tuberculosis involving orbital soft tissue, periosteum, bones and lacrimal glands. This is a case report of a 6-year-old male child who presented with swelling of the right upper eyelid. He had normal visual acuity without signs of diplopia or ophthalmoplegia. The tuberculin skin test was reactive and the computed tomography scan showed peripherally enhancing collection with bony erosion and intracranial extension in the extraconal space of the superolateral right orbit. Orbital exploration was done which showed caseous material. The histological examination revealed necrotizing granulomatous tissue. The caseous material on Ziehl Neelsen staining confirmed acid-fast bacilli causing a tubercular abscess. The child is currently on anti-tubercular therapy planned for 12 months. Orbital tuberculosis might or might not be in association with pulmonary tuberculosis and should always be taken into consideration while dealing with chronic inflammatory orbital disease and an orbital mass. Keywords: case reports; orbit; tuberculosis.

Vernal Keratoconjunctivitis among Patients Presenting to the Outpatient Department of Ophthalmology of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Vernal keratoconjunctivitis is a seasonally recurring, bilateral inflammation of the conjunctiva, that occurs in male children with invariable personal or family history of atopy. It is characterized by interstitial inflammation of the cornea and can have sight-threatening complications if not treated in time. The aim of this study was to find out the prevalence of vernal keratoconjunctivitis among patients presenting to the outpatient department of ophthalmology of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among patients presenting to the outpatient department of ophthalmology from June 2020 to May 2021. Ethical approval was taken from the Institutional Review Committee (Reference number: IRC-PA-076). The relevant details of the history and clinical examination of the patients were recorded on a specifically designed proforma. A simple random sampling technique was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 2400 patients with conjunctivitis visiting the outpatient department of ophthalmology, vernal keratoconjunctivitis was seen in 80 (3.33%) (2.61- 4.05, 95% Confidence Interval). Conclusions: The prevalence of vernal keratoconjunctivitis in our study was found to be similar to the other studies done in similar settings. Keywords: conjunctivitis; refractive error; vernal keratoconjunctivitis.

The Retinal Nerve Fiber Layer and Macular Thickness in Patients with Type 2 Diabetes Mellitus without Retinopathy Using Optical Coherence Tomography: A Comparative Study.

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.

Profile of Destructive Ocular Surgery and its Indications: A Twelve-Year Review from Eastern Nepal.

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.

Managing Recurrent Orbital Lymphangioma in a Pubertal Female with Negative Pressure Aspiration and Intralesional Bleomycin Injection: A Case Report.

INTRODUCTION: Management of orbital lymphangioma is challenging. Complete surgical excision is often impossible due to its infiltrative nature. Sclerosing agents have been used in its management with variable outcomes. We report a case of recurrent orbital lymphangioma managed with intralesional bleomycin. CASE: A 14-year-old female presented with proptosis of the right eye for two weeks. She had a similar history at five years of age for which she underwent surgical excision. We performed negative pressure aspiration using a 20-gauge angiocatheter, injected bleomycin, and left the cannula in situ for repeat aspiration to maintain cyst collapse. OBSERVATION: The lymphangioma regressed, and there was no recurrence at six months of follow-up. CONCLUSION: This report highlights the use of negative pressure aspiration and intralesional bleomycin injection by minimal intervention using angiocatheter in the successful management of orbital lymphangioma.

Central corneal thickness and intraocular pressure in patients of primary open angle glaucoma and normal population in Nepalese population: A hospital based study.

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.

Visual Evoked Potentials in Primary Open Angle Glaucoma.

BACKGROUND AND AIMS: Visual evoked potentials (VEPs) assess the integrity of the visual pathways from the optic nerve to the occipital cortex. Optic disc cupping and visual field loss have been associated with prolongation of latency of VEP in primary open angle glaucoma (POAG). METHODS: Pattern reversal and flash VEP tests were done in consenting 20 primary open angle glaucoma eyes and 40 normal control eyes. RESULTS: In POAG cases, the refractive error [3.51 ± 1.88 versus 1.88 ± 1.11, D, p = 0.001], cup-disc ratio in percent [66.00 ± 16.98 versus 28.50 ± 5.80, p = 0.001], intraocular pressure [19.55 ± 2.08 versus 11.65 ± 1.64, mmHg, p = 0.001], and automated visual field pattern standard deviation [4.13 ± 6.96 versus 1.64 ± 0.45, dB, p = 0.001] were significantly more than in control. The visual acuity [0.41 ± 0.29 versus 1.00 ± 0.00, p = 0.001], foveal visual sensitivity [25.92 ± 6.88 versus 33.48 ± 1.75, dB, p = 0.001], and automated visual field mean deviation [-9.63 ± 10.58 versus 0.07 ± 1.54, dB, p = 0.001] were significantly less in cases than in control. Among VEP variables, pattern reversal latency N145 [149.00 ± 15.75 versus 137.52 ± 15.20, ms, p = 0.011], flash amplitude N75 [2.18 ± .57 versus 1.47 ± .38, µV, p = 0.001], and flash amplitude N145 [1.99 ± .39 versus 1.43 ± .38, µV, p = 0.001] were increased in cases. The pattern reversal amplitude N75 [1.97 ± .35 versus 2.47 ± .58, µV, p = 0.001], amplitude P100 [3.09 ± .46 versus 6.07 ± 1.44, µV, p = 0.001], and amplitude N145 [2.21 ± .58 versus 4.45 ± 1.99, µV, p = 0.001] were decreased in cases. CONCLUSIONS: POAG caused glaucomatous damage to optic pathway.

Herpes zoster ophthalmicus presenting as orbital abscess along with superior orbital fissure syndrome: A case report.

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.

Ocular Inflammatory Myofibroblastic Tumor in the Left Eye with Phthisis Right Eye: A Rare Occurrence in a Child.

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.

Orbital cellulitis in a neonate of the tooth bud origin: a case report.

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.

Primary malignant tumours of eye and adnexa in Eastern Nepal.

BACKGROUND: The purpose of the present paper was to report the spectrum of primary malignant tumours of eye and adnexa at BP Koirala Institute of Health Sciences, Nepal, from 1995 to 2000. METHODS: A retrospective study of medical records with histopathological confirmation of malignant tumours of the eye and adnexa was done for the years 1995-2000. A total of 116 consecutive medical records from the Department of Pathology at BP Koirala Institute of Health Sciences were retrieved. All those patients with primary ophthalmic malignancies were included and non-malignant cases were excluded. RESULTS: There were 80 patients of which 39 (48.8%) were male and 41 (51.2%) were female. Four patients had bilateral involvement. The most common malignancy was retinoblastoma (45.2%), followed by basal cell carcinoma (22.6%). CONCLUSION: Retinoblastoma is the most common eye cancer. The incidence of melanomas is correspondingly lower than that reported in the West. The present pilot study, the first of its kind, will lay the foundation for the monitoring of the future pattern of ophthalmic malignancies in Nepal and provide a basis for comparison elsewhere.

Oculosporidiosis in eastern Nepal: a report of five cases.

Rhinosporidiosis is endemic in India, Sri Lanka, and parts of East Africa and South America; sporadic cases are reported in other countries. We report on five patients from eastern Nepal with oculosporidiosis. The conjunctiva was involved in two patients and the lacrimal sac was involved in three patients; treatment was by simple total excision of the conjunctivalgrowth (patients with conjunctival involvement) and by dacryocystectomy (patients with lacrimal sac involvement). This is the second case report from Nepal.