Crab louse infestation of eyelashes

To present clinical features and management of ten patients of crab louse infestation of eyelashes Present study includes ten cases of crab louse infestation of eyelashes seen during last few years in eye OPD of Services Hospital and Jinnah Hospital Lahore. Patients visiting eye out-patients department who were reported to have crab louse infestation of eyelashes were examined in detail including systemic examination. Infested parts of the body were photographed as well. The adult patients were asked about similar problem in their sexual partners and the parents of children were inquired similarly. All patients were treated with adequate washing of eyelashes and other involved parts with soap and water and application of any ophthalmic preparation having petroleum base e.g. Polyfax eye ointment in the conjunctival sac and eyelashes and anti-lice dermal preparation e.g. Lotrix [Permethrin] skin preparation to other parts. All patients were followed for a period of three months performing examination of eyelashes with slitlamp and systemic examination every two weeks. Seven out of ten patien ts were adults [70%], five males and two females, and remaining three patients were children [30%]. Forty percent of patients [4/10 patients] had related systemic lesions, including blue gray macules [Maculae caeruleae] and the bullous lesions. In addition to systemic dermatological manifestations, ocular symptoms included deposits in the roots of eyelashes, irritation or feeling of some thing moving in lid margins, mild lacrimation and redness. Ocular examination revealed multiple lice anchoring themselves in the roots of eyelashes sucking blood, along with hundreds of nits cemented with eyelashes. There was a mild conjunctival congestion. Removal of lice resulted in formation of small ulcers of margin of lid. Adequate washing with soap and water, followed by application of Polyfax eye ointment for two to three weeks, resulted in complete cure of the palpebral disease. This study emphasizes the significance of an infrequently seen clinical condition of crab louse infestation of eyelashes, not only as a venereal disease expecting much higher number of infections but also as an important cause of refractory cases of chronic irritation of eyes with blepharitis. Careful examination of eyelids with slitlamp microscope may establish the diagnosis. All the sexual partners should be treated simultaneously. Other parts of the body having less dense population of hair should be examined and adequate measures should be taken for the management, including application of anti-lice dermal ointment e.g. Lotrix [Permethrin] skin ointment

effects of reducing the exposure time of mitomycin C in glaucoma surgery

Topical application of mitomycin C has significantly increased the success rate of trabeculectomy. However the optimum exposure time of mitomycin C to the filtration site is not known. The purpose of this study was to determine whether adequate post-operative control of IOP and a lower incidence of post operative complications can be achieved by using mitomycin-C for a shorter period of time during trabeculectomy, performed in high risk glaucoma patients. Twenty eyes of patients of glaucoma, who were considered to be at high risk for failure because of their young age, previous ocular surgery like cataract extraction and trabeculectomy, inflammatory glaucoma, high myopia and prolonged anti-glaucoma medication, underwent trabeculectomy with topical application of 0.2 mg/ml concentration of mitomycin C for three minutes. They were case matched with a group of same number of eyes of high risk glaucoma patients who received same concentration of drug for 5 minutes. Twelve months after surg ery, the mean pre-operative IOP decreased from 29.9 mmHg to a post-operative level of 16.05 mmHg in 3 minutes group, with a success rate of 85%, and from 29.35 mmHg to 16.55 mmHg in 5 minutes group, with the same success rate of 85%. The incidence of complications was higher in 5 minutes group, when total number of complications was compared. [p value< 0.05] Ocular hypotony developed in 3 [15%] eyes in 5 minutes group, and none in 3 minutes group. No patient developed hypotony related maculopathy in either group. Other complications like hyphema, post-operative uveitis, and conjunctival wound leakage were managed conservatively. The present study supports the conclusion of previous studies that mitomycin C is highly effective drug when used in association with trabeculectomy, and when used in concentration of 0.2 mg/ml for three minutes is as effective in controlling post-operative IOP as is five minutes exposure time of the same concentration. Further, emphasizing that the shorter exposure of the drug is associated with lesser incidence of vision threatening complications