Infectious keratitis – a review.

Infectious keratitis is an important problem in the Indian context, and epidemiological studies suggest a higher prevalence of disease as compared to the developed world. Various aspects of the problem, including the host defence, ocular and systemic risk factors and microbial mechanisms that enhance pathogenesis have been discussed. The clinical and microbiological approach to the infected eye and patient and the relevant tests have been outlined. The major classes of medications that are used the methods of delivery are specified. Finally, the approach to patients with non-responsive keratitis that requires surgical manoeuvres is also highlighted. Clinical experience is important in distinguishing an infective from an inflammatory corneal pathology. The role of an experienced microbiologist is inevitable, for good clinical outcome. Therapeutic keratoplasty has to be done at the right time for better clinical outcomes.

Conjuctivochalasis - a review.

Conjunctivochalasis is an ocular condition that is usually missed, unless specifically looked for. It is defined as a redundant loose non edematous inferior bulbar conjunctiva. Though generally asymptomatic, It may also present as dryness and foreign body sensation. Various grading systems like Mirmura ((based on Lid-parallel conjunctival folds), Mellers (based on lid-parallel conjunctival folds, punctual occlusion and conjunctival fold changes during down gaze and digital pressure) and Zhang’s based on conjunctival folds, dryness, foreign body sensations, epiphora symptoms, punctual occlusion, tear meniscus height, tear film break-up time (BUT), and conjunctival fold changes during down gaze) system has been outlined. Various etiological aspects like dissolution of the Tenon’s Capsule and role of expression of matrix metalloproteinase-1 (MMP-1) and matrix metalloproteinase-3 (MMP-3) has been dealt in detail. Different surgical approaches like pastepinch- cut conjunctivoplasty and their steps are specified. Conjunctivochalasis has to be understood in a wider depth and more research work is required to understand CCh in better detail so that preventive steps can be implemented with regard to secondary causes.

Dry eye - a review.

Of the myriad reasons for visits to an ophthalmologist, one of the most common maladies afflicting patients is Dry Eye Disease (DED), which can cause mild discomfort in the early stages and endstage ocular surface damage in its more severe forms. Dry eye is a problem of utmost importance, more in the developed rather than developing nations. Various aspects of the manifestation, including the tear osmolarity, ocular surface homeostasis and the role of ocular surface epithelial stem cells in maintaining the ocular surface homeostasis have been discussed. The objective tests to assess and grade dry eye have been noted. A systematic approach to the affected eye and the patient has also been outlined. The major categories of medications used along with the methods of delivery are specified in this review. A systematic approach in understanding the type and grade of Dry Eye Disease is mandatory for good clinical response. Along with clinical management the doctor should also stress on environmental changes that exaggerates dryness.