Grease gun injury of the orbit: A rare case report.

We report a case of intraconal grease gun injury along with traumatic optic neuropathy in a 20-year-old male. He presented with dimness of vision and proptosis of the left eye (LE) following an accidental injury at work place. The computer tomography of orbit revealed hypodense grease orbit. Cream colored grease was continually exuding from the conjunctival wound. Patient improved rapidly after the surgical removal of the grease by anterior orbitotomy. Grease gun injuries to the orbit have rarely been reported. The present case is the eighth report throughout the world, and the first in India as per our knowledge.

Kimura's disease involving bilateral lacrimal glands and extraocular muscles along with ipsilateral face: A unique case report.

A 23 year female presented with bilateral recurrent swelling of eyelids along with ptosis and proptosis for last 3 years. She also had swellings over the right cheek, parotid gland, and retro auricular area along with regional lymphadenopathy. Systemic laboratory workup revealed raised serum IgE and a high peripheral eosinophil count. Computed tomography and magnetic resonance imaging showed bilateral enlargement of extraocular muscles, lacrimal glands, and ipsilateral parotid gland. Excision biopsy of the retro-auricular lymph node was suggestive of Kimura's disease (KD). The patient responded well to systemic corticosteroid. KD rarely affects orbit, but it should be included in the differential diagnosis of inflammatory diseases of the orbit. To our knowledge, this is the first reported case of KD from India involving the orbit, lacrimal gland, extraocular muscles, parotid gland and buccal area.

An unusual journey of a periocular date palm thorn.

An 8-year-old boy presented with a left lower lid swelling of one month duration. His parents gave a history of date palm thorn injury on left side of the forehead three months back which was removed partially by a local doctor. On examination, there was a left infraorbital swelling with diffuse oedema of the left sided cheek and temporal fossa. A scar mark (entry wound) was detected over the left eyebrow. Three-D configuration of contrast enhanced computed tomography (CECT) of the orbit showed a linear foreign body behind the zygomatic bone. The lower lid mass was excised, the date palm thorn was recovered from a pocket behind the zygomatic bone. Histopathology of the excised mass showed presence of granulation tissue. We describe the management of such a rare case along with review of literature.

Closure of sino-orbital fistula using glabellar rotation flap: A case report.

BACKGROUND: Sino-orbital fistulas (SOF) are a well-reported complication of orbitalexenteration and sinonasal carcinoma resection. Despite repair, however, complete fistula closure may be difficult. CASE: A 79 -years-old man had undergone total exenteration of right orbit for spreading sqamous cell carcinoma of conjunctiva. Subsequently he developed two large sinoorbitalfistulae medially to the ethmoid sinus wall of the orbit. Post- operatively good socket hygiene was maintained but the fistulae increased in size. At 3 month follow-up, closure of the fistulae using glabellar rotation advancement flap was done. The defects have remained closed at follow-up with excellent cosmetic results. There is no recurrence of fistula or malignancy till date. Patient was cosmetically rehabilitated with spectacle prosthesis. CONCLUSION: Glabellar rotation flap for closure of medially situated sino- orbital fistulae is a good option with excellent cosmetic result.

Tuberculous Osteomyelitis of Orbit- A Case Report.

BACKGROUND: Orbital tuberculosis is a rare manifestation of extrapulmonary tuberculosis. We report an interesting case of osteomyelitis of orbital bone in an Indian child. CASE REPORT: A 9- year old girl presented with a gradually increasing painless swelling of left upper lid and blepharoptosis along with swelling of left side of forehead for last two months. The swelling was soft, fluctuating and non-tender. Diagnostic tap revealed thick pus which prompted us to do an incisional drainage of the abscess. The pus was sterile on microbiological examination. A diagnosis of osteomyelitis of orbit along with cold abscess of infratemporal fossa was made on the basis of clinical examination, positive Mantoux (MX) test, high erythrocyte sedimentation rate (ESR) and bony erosion of frontal and zygomatic bones in contrast enhanced computerized tomography (CECT). Patient showed marked improvement with antitubercular drug (ATD) but a sinus developed at the incision site. Six months later patient presented with occasional serous discharge from the sinus.The patient underwent excision of the sinus along with curettage and debridement of the left frontal bone and the tissue was sent for histopathological and microbiological examination. ATD was continued for 15 months. Her post-treatment three year follow up was without any recurrence. CONCLUSION: High index of suspicion should be kept for early diagnosis and timely treatment of the orbital tuberculosis. We want to report the case because of its rarity and clinical interest.

Viral mononeurities causing partial oculomotor nerve palsy in an 8 month old child.

BACKGROUND: Palsy of the oculomotor nerve is rarely seen in children, and comprehensive guidelines for management and outcome are difficult to find. CASE: Here we describe a 8 month old boy with left sided ptosis and infero-leteral deviation of left eye and normally reacting pupil and CSF antimeasles antibody titre negative. OUTCOME: The ptosis improved within 3 weeks with no residual neurodeficit. MESSAGE: Viral mononeuritis leading to partial 3rd nerve palsy is a rare entity in children till date.

Comparison of diagnostic capability of macular ganglion cell complex and retinal nerve fiber layer among primary open angle glaucoma, ocular hypertension, and normal population using Fourier-domain optical coherence tomography and determining their functional correlation in Indian population.

CONTEXT: Analysis of diagnostic ability of macular ganglionic cell complex and retinal nerve fiber layer (RNFL) in glaucoma. AIM: To correlate functional and structural parameters and comparing predictive value of each of the structural parameters using Fourier-domain (FD) optical coherence tomography (OCT) among primary open angle glaucoma (POAG) and ocular hypertension (OHT) versus normal population. SETTING AND DESIGN: Single centric, cross-sectional study done in 234 eyes. MATERIALS AND METHODS: Patients were enrolled in three groups: POAG, ocular hypertensive and normal (40 patients in each group). After comprehensive ophthalmological examination, patients underwent standard automated perimetry and FD-OCT scan in optic nerve head and ganglion cell mode. The relationship was assessed by correlating ganglion cell complex (GCC) parameters with mean deviation. Results were compared with RNFL parameters. STATISTICAL ANALYSIS: Data were analyzed with SPSS, analysis of variance, t-test, Pearson's coefficient, and receiver operating curve. RESULTS: All parameters showed strong correlation with visual field (P < 0.001). Inferior GCC had highest area under curve (AUC) for detecting glaucoma (0.827) in POAG from normal population. However, the difference was not statistically significant (P > 0.5) when compared with other parameters. None of the parameters showed significant diagnostic capability to detect OHT from normal population. In diagnosing early glaucoma from OHT and normal population, only inferior GCC had statistically significant AUC value (0.715). CONCLUSION: In this study, GCC and RNFL parameters showed equal predictive capability in perimetric versus normal group. In early stage, inferior GCC was the best parameter. In OHT population, single day cross-sectional imaging was not valuable.

Penetrating ocular fish hook injury: a case report.

BACKGROUND: Fishing is a popular rural recreational activity. Fortunately, penetrating ocular injuries with fish hooks are rare. These injuries are usually caused by fish hook prongs penetrating the ocular tissues. We report a rare case of penetrating fish hook injury to the globe and its successful surgical management. CASE: A 12- year-old female child was referred to the causality with a fish hook embedded in her right eye. She sustained the injury while fishing with her father. The fish hook had penetrated the globe obliquely. The hook was removed via its entrance wound under general anesthesia. Subsequently the child developed traumatic cataract which was operated with a final visual outcome of 6/12. CONCLUSION: Visual prognosis can be profoundly affected by the initial management. Prompt surgical intervention as done in our case is recommended to prevent significant visual loss. Keywords Fishhook; penetrating ocular injury; traumatic cataract.

Paediatric ocular trauma in a tertiary eye care center in Eastern India.

A retrospective study was performed to assess the pattern of pediatric ocular trauma in a tertiary eye center in eastern India. Records of 672 patients aged 16 years or less with ocular trauma who attended the outpatient department or emergency or treated as inpatients at a tertiary referral center between April 2009 and March 2010 were reviewed. Boys accounted for 70% cases. Most children were of the 5-10 years age group. Closed globe injury was the commonest (418 patients, 62.19%), followed by open globe injuries (127 patients, 19%), orbital injuries (52 patients, 7.67%), superficial foreign bodies (7.14%) and burn (4.01%). Home was found to be the commonest place of injury (44%), and only 51.9% attended the health facility within 24 h. Conservative management was done in 497 (74%) cases, whereas 175 (26%) cases were treated surgically. Final visual outcome of 443 (66%) patients were between 20/20 and 20/50. Sixty-eight patients had worst visual outcome with monocular blindness of the injured eye. Strategies to reduce the incidence of ocular trauma at home should be directed towards raising the parental education and public awareness.

Spontaneous dislocation of a crystalline lens to the anterior chamber with pupillary block glaucoma in Noonan Syndrome: a case report.

We report a 13-year-old child with Noonan Syndrome who developed spontaneous dislocation of the crystalline lens in anterior chamber leading to pupillary block glaucoma in the left eye and subluxation of lens in right eye. Intracapsular extraction of the dislocated lens was done in the left eye. Prompt diagnosis and management is needed in such cases to avoid glaucoma and corneal endothelial cell damage. We could not find any such case after thorough Medline search.

Ankyloblepharon filiforme adnatum: report of two cases.

Ankyloblepharon filiforme adnatum (AFA) is a rare congenital anomaly characterized by partial or complete adhesion of upper and lower eyelids, usually seen as an isolated finding but often associated with other anomalies or a well-defined syndrome. We report two cases of AFA who presented at a tertiary eye care center of West Bengal. Family history of consanguinity was absent. One baby had abnormal tuft of hair over the small of the back. No other congenital abnormalities were detected in any of them. The adhesions of the eyelids were divided by a number 15 blade after crushing with mosquito forceps in both cases without any anesthesia. Subsequent ocular examinations following separation and during follow-up revealed normal eyelid function, ocular motility, and fundus. In a case of AFA, timely separation of the eyelids is crucial to avoid the development of occlusion amblyopia. Cases of AFA reported in the literature are reviewed.

Primary conjunctival amyloidosis.

A 19-year-old previously healthy male presented with a 4 year history of painless drooping of right upper eyelid. On eversion of the right upper eyelid, a yellowish pink mass was seen in the tarsal region. Rest of the ocular examination was normal in both the eyes. Initial biopsy showed chronic inflammation. Subsequently, the entire mass was excised and histopathological examination showed the presence of amyloid in the subconjunctival stroma. At 3 months follow-up, similar lesion was detected in the right lower, left upper, and lower lid, which were treated with cryotherapy, with partial resolution. Patient has been followed up for more than 2 years without any complaints. To our knowledge, this is the first case report of an isolated primary conjunctival amyloidosis with involvement of both the upper and lower palpebral conjunctiva of either eye. It was treated successfully by excision and cryotherapy.

Bilateral central serous chorio-retinopathy in pregnancy presenting with severe visual loss.

INTRODUCTION: Bilateral central serous chorio-retinopathy is an unusual presentation. OBJECTIVE: To report a case of pregnancy-induced bilateral central serous chorio-retinopathy. CASE: A thirty-year-old woman complaining of reduced vision in both the eyes was referred for ophthalmoscopic evaluation in her third trimester of pregnancy. The best-corrected visual acuity was 6/60 in the right eye and finger counting at four meters in the left. The funduscopic examination revealed serous macular detachment with white sub-retinal exudates in both the eyes. Optical coherence tomography sections through the macula demonstrated serous elevation of the retina and retinal pigment epithelial detachment in both the eyes. The serous macular detachment resolved and the patient recovered to the visual acuity of 6/6 in both the eyes after twelve weeks of delivery. The OCT showed resolution of the sub-retinal fluid and disappearance of the sub-macular exudate in the right eye, but the resolution was partial in the left eye. CONCLUSION: Pregnancy is a risk factor for CSCR and it can present with severe bilateral visual diminution.

Ophthalmomyiasis externa -- report of two cases.

Ocular myiasis in humans is a rare phenomenon. Here two cases are reported who came to a tertiary care centre with features of unilateral acute catarrhal conjunctivitis. Fly larvae were detected on slit lamp examination and removed after immobilising it with topical 4% lignocaine. Topical antibiotics and steroid drops were prescribed for 2 weeks. The samples were identified as Oestrous ovis by the entomology department of the Institute of Tropical Medicine, Kolkata. The signs and symptoms regressed within 48 hours. The cases are being reported to create awareness among the ophthalmologists regarding larval conjunctivitis especially in developing countries like India, where the general standard of hygiene is low and fly infestation is common.