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.

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.

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.