Anti-Tuberculosis therapy induced Liver injury in children

Introduction: Tuberculosis has remained and is one of the major issues of the under developed world including Pakistan. About 10-11 percent cases of tuberculosis are from pediatric population. Isoniazid, rifampicin and pyrazinamide constitutes generally used therapeutic regime. Directly observed treatment short course [DOTS] is now much popular strategy. Ant tuberculosis drug-induced liver injury creates obstacles in treatment and also exerts socioeconomic strain on resources

Objective: To determine the frequency, severity and pattern of the Anti-tuberculosis Drug-Induced Liver Injury in children under 14 years of age

Study Design: Case series study

Duration of Study: 02-10-2015 to 03-10-2016

Setting: Department of Pediatric Medicine Unit-1, Allied Hospital, Faisalabad. Sample size: The total sample size is 100 cases. Sampling Technique: Non-probability purposive sampling. Methodology: Total of 100 patients with either sex from 1 to 15 years of age, on anti-tuberculosis therapy due to any variety of tuberculosis having normal liver anatomy and function initially were studied. Patients already having hepatobiliary disease regardless of etiology were not enrolled in study. Initial diagnosis was confirmed using set criteria. All patients underwent detailed medical history and physical examination followed by investigations. Data comprising age, sex, type of tuberculosis, treatment interval, and hepatotoxicity etc. was collected using designed Performa by the researcher. The data was analyzed through SPSS-20 by means of descriptive statistic

Results: In our study, out of 100 children, minimum age was 6 months and maximum age was 156 months and Mean + SD was calculated as 38.07+/-37.368 months, 51 [53.1 percent] were male and 45 [46.9 percent] were females, ventilator associated pneumonia was recorded in 19 [19.8 percent] while 77[80.2 percent] had no findings of the ventilator associated pneumonia

Conclusion: The frequency of TB DILI was 14.0 percent in this study, indicating the importance of keeping index of suspicion high for the development of hepatotoxicity with anti-tuberculosis therapy in children being treated for any variety of tuberculosis

Fatty acid profile and effect of fish fermented silage on digestive enzymes in Labeo rohita / Perfil de ácidos graxos e efeito de peixe fermentado em silagem de enzimas digestivas em Labeo rohita

Due to inconsistency in demand and supply of fishmeal there is immense need of alternate protein sources. Present project was therefore designed to replace costly fishmeal (FM) with low-priced fermented fish silage (FFS) in fish feed. Fermented fish silage was prepared by fermentation process using Lacto bacillus bacteria and its fatty acid profile and effect on digestive system of Labeo rohita was investigated. Lipid contents were isolated by Soxhlet apparatus and recorded as 6.23 ± 1.23 g/100g of fermented fish silage (FFS). Fatty acid profile of extracted Lipids was determined by gas liquid chromatography (GLC), sufficient amount of unsaturated fatty acids were found with pattern mono unsaturated fatty acids (MUFA) > saturated fatty acids (SFA) >poly unsaturated fatty acids (PUFA). Three treatment diets containing 100% silage (T1), 75% silage (T2) and 50% silage (T3) were prepared by mixing it with soybean meal (SBM) and rice bran as co-ingredients while fermented fish silage was replaced by fishmeal in control diet (T0). The experiment was conducted in glass aquaria in triplicate. Fish growth parameters were recorded fortnightly while physicochemical parameters of water were recorded on daily basis. After completion of feeding trial, three fish were randomly dissected to excise out their intestines and determine activity for protease, amylase and lipase enzymes. Non-significant differences (P<0.05) were recorded in growth parameters and enzymatic activity among all diets except lipase enzyme. Deceptively, it can be concluded that FFS has reasonable concentration of nutrients and unsaturated fatty acids so it can successfully replace fishmeal in fish diets.

Devido à diferença na procura e na oferta de farinha de peixe há imensa necessidade de qualquer membro suplente da fonte de proteína. Tão presente projeto foi projetada para substituir a dispendiosa farinha de peixe (FM) com barato peixe fermentado de ensilagem (FFS) em alimentos para peixes. FFS foi preparado pelo processo de fermentação usando Lactobacillus bactérias e seu perfil de ácidos graxos e efeito sobre o sistema digestivo de Labeo rohita foi investigado. Conteúdo lipídico foram isoladas pelo aparelho de Soxhlet e registadas como 6,23 ± 1,23 g/100g de FFS. Perfil de ácidos graxos extraídos de lipídios foi determinada por cromatografia líquida de gás (GLC). Quantidade suficiente de ácidos graxos insaturados foram encontrados com padrão MUFA > SFA > AGPI. Tratamento de três dietas contendo silagem de 100% (T1), 75% silagem (T2) e 50% silagem (T3) foram preparados misturando com farinha de soja (SBM) e farelo de arroz como co ingredientes enquanto FFS foi substituído pela FM na dieta controle (T0). O experimento foi conduzido em aquários de vidro em triplicado. O Crescimento dos peixes foram anotados os parâmetros quinzenal enquanto parâmetros físico-químicos de água foram registradas diariamente. Após a conclusão do teste de alimentação, três peixes foram aleatoriamente dissecada a impostos especiais de consumo os seus intestinos e determinar a atividade de protease, enzimas amilase e lipase. As variações não significativas (P<0,05) foi registrada em parâmetros de crescimento e atividade enzimática entre as dietas exceto enzima lipase mostrou diferença significativa entre as dietas de tratamento. Aparentemente, é possível concluir que a concentração razoável de FFS tem nutrientes e ácidos graxos insaturados de modo que ela possa substituir com êxito a farinha de peixe na dieta de peixes.

Efficacy of intra-vitreal bevacizumab combined with phaco-emulsification in the prophylaxis of macular edema in patients with non-proliferative diabetic retinopathy

Objective: This study was designed to evaluate the prophylactic efficiency of intra-vitreal Bevacizumab combined with cataract surgery in patients of non-proliferative diabetic retinopathy without macular edema for the prevention of macular edema by assessing the visual outcome

Methodology: This was interventional, randomized, open-label and control study of two parallel groups of already diagnosed patients with pre-proliferative diabetic retinopathy without macular edema. The study included sixty eyes of sixty patients, having non-proliferative diabetic retinopathy without macular edema and lens opacity [grade 1 to 3]. One group [n=30] received intra-vitreal injection of Bevacizumab and the control group [n= 30] did not received intra-vitreal injection of Bevacizumab at the time of standard phaco-emulsification. Main outcome measure was best-corrected visual acuity [BCVA] at the end of two months compared with the baseline visual acuity recorded along with central macular thickness [CMT] measured on optical coherence tomography [OCT] as required

Results: The outcome was an improvement of BCVA at the end of 8[th] week compared with that at baseline in the Bevacizumab group and a worsening of visual acuity in the control group [p = 0.005]

Conclusions: Prophylactic use of intravitreal Bevacizumab combined with phacoemulsification appears to be beneficial in preventing post-surgical visual loss in eyes with NPDR by preventing the chance of macular edema

Comparison of sensitivity and specificity of blue yellow primetry versus standard automated primetry in early / glaucoma suspect patients

Purpose: To compare the sensitivity and specificity of short wavelength automated Perimetry [SWAP] with standard automated perimetry [SAP] using the SITA program to detect early or glaucoma suspect patients

Study Design: Cross sectional prospective and comperitative study of perimetric diagnostic sensitivity and specificity of two perimetric methods in early or glaucoma suspect patients

Study Duration: June 2010 - May 2012

Materials and Methods: Fifty patients with ocular hypertension, early glaucoma or suspect patients were enrolled for the perimetric tests. After complete ophthalmic examination, each patient was tested with the standard automated perimetry [SAP], 30-2 thrice and then on short wavelength automated perimetry [SWAP; 24-2] once

Results: The average MD in the SWAP group was significantly higher than in the SAP Group [SWAP - 6.55ds SAP- 2.60db P<0.001]. A significant difference also existed in PSD between the two groups [SWAP: 3.50db, SAP 2.50db, P<0.001]. The test time was longer in the SWAP group than in the SAP group [SWAP: 15min, SAP 13min P<0.001]. However the sensitivity indices were in normal limits. There were significant differences in number of depressed test point locations between two tests strategies. The number of eyes showing cluster of significantly depressed points were more with the SWAP test strategy than with SAP

Conclusion: The SITA, SWAP identified at least much earlier glaucomatous visual field defects than SITA, SAP. The study showed that greater MD and PSD with SWAP

Yield of cervical mediastinoscopy in diagnosis of indeterminate mediastinal lymphadenopathy/masses and staging of lung cancer

To determine the yield of cervical mediastinoscopy in indeterminate antero-superior mediastinal lymphadenopathy or masses and in staging of non small cell carcinoma lung. Descriptive prospective study. Thoracic Surgical unit of Combined Military Hospital Rawalpindi from Jan 2007 to June 2009. Patients were placed in group I for diagnostically indeterminate antero superior mediastinal lymphadenopathy/masses and in group II for staging of non small cell lung cancer [NSCLC] with enlarged mediastinal lymph nodes on CT scan [greater than 10 mm on short axis]. All patients underwent the procedure under general anaesthesia. A plane anterior to trachea was developed using blunt finger dissection until carina. Biopsies of the mass or lymph nodes were taken and sent for histopathology. In case of staging for Carcinoma lung, lymph node stations 2L, 2R, 4L, 4R and 7 were searched and biopsied and sent in appropriately labelled containers for histopathology. Patients were usually discharged on the same day. Forty eight cases were included in this study during the course of 2 1/2 years of period. Twenty nine cases were included in group I and nineteen in group II. In group I chronic caseating granulomas due to tuberculosis were the most cause in 45% of cases followed by 24% cases of lymphoma. In group II, 4 [21%] cases revealed no evidence of malignancy in any lymph nodes and in 11 [57.9%] cases only ipsilateral mediastinal lymph nodes were involved by tumor making it N2 disease. In 4 [21%] cases contra lateral mediastinal lymph nodes were involved by tumor making it N3 disease. Mortality in this study was only one case [3 4%] Mediastinoscopy is minimally invasive cost effective and simple procedure in trained hands for both diagnosis and staging purpose

Video assisted thoracoscopic surgery [VATS] lung biopsy for non-responsive patients of interstitial lung disease [ILD]

To study the results of VATS [Video Assisted Thoracoscopic Surgery] Lung Biopsy in Interstitial Lung Disease [ILD] case series. Department of Thoracic Surgery, CMH Rawalpindi from Jan 2009 to Mar 2010. All those patients of ILD [Interstitial Lung Disease] were included who failed to improve after a period of observation including those on empiric therapy, all patients in which BAL [Bronchoalveolar Lavage] and TBLB [Transbronchial Lung biopsy] was inconclusive and all those patients fit to undergo thoracoscopic surgery. Patients excluded were elderly patients, those with systemic disorders frequently associated with ILD and those with known neoplasm likely to have lymphangitic dissemination. We used three thoracoscopic ports, all biopsies were sent for histopathology examination, single chest tube was placed in all cases and it was removed once the airleak ceased. All complications encountered were noted. Fourteen patients were registered during study period. Biopsy showed that 9 had ILD, and 5 did not have ILD. Only complication was a prolonged airleak for 2 days in 2 patients. No mortality was encountered. Thoracoscopic surgical biopsy can be accomplished safely in most cases where there is a diagnostic dilema for interstitial lung disease

Tracheal schwannoma: a rare tracheal tumour

Primary tracheal tumours are histologically similar but 100 times less common than main stem tumours. We report a case of primary tracheal schwannoma in a middle aged man. He had chronic cough for 2 years, and developed hemoptysis and stridor in the days preceding to presentation. He was treated by resection of the tumour and primary anatomosis of the trachea. The patient recovered well after surgery and had a near normal PEFR after one and a half year of follow-up and bronchoscopic examination excluded any recurrence

Cataract; corticosteroid induced intraocular pressure elevation after extraction

To observe the tendency of corticosteroids to raise the intraocular pressure after prolonged use of 0.1% dexamethasone eye drops during post operative period of cataract extraction. Observational study. From August 2008 to December 2009. In the study 50 patients were included. These patients had age related cataract in one or both eyes. The IOP of every patient was measured preoperatively with the help of Goldman applanation tonometer. After cataract extraction, every patient received 0.1% dexamethasone eye drops four times a day for one month. The IOP was measured fortnightly. Department of Ophthalmology, Allied Hospital, Faisalabad and the clinics of the authors. Topical administration of 0.1% Dexamethasone Eye Drops ,four times a day for one month after age related cataract extraction caused elevation of intraocular pressure more than 21 mm Hg in 8% of general population

Gastropleural fistula: an unusual sequel of blunt chest trauma

In the October 2005 Earthquake in mountainous Azad Kashmir and adjacent areas in Pakistan, a young female sustained crush injury chest and upper abdomen. She remained hospitalized with lower chest pain. All initial investigations were normal and she was discharged symptom-free on conservative management. Six months later, she developed acute left sided chest pain and dyspnoea. Provisional diagnosis of empyema was made on X-ray, and tube thoracostomy was done. Diagnostic VATS revealed gastropleural fistula secondary to necrosis of herniated stomach. Resection of necrosed stomach, repair of diaphragm and decortication and transthoracic repair with lower thoracoplasty two months later was performed but both were unsuccessful. After another 02 months, a Roux-en-Y gastrojejunostomy at fistula site was fashioned which proved curative

Screening in a school for visual acuity and amblyopia

To detect the visual acuity by Snellen visual acuity chart and then to find out the incidence of amblyopia. A descriptive and observational study. School health section of Divisional public school and eye department of Allied Hospital, PMC, Faisalabad. 15 December, 2008 to 31 March, 2009. A total of 2600 school children between age 8 to 16 years were included in the study. The visual acuity at 6 meters was checked. The pin hole vision and vision with glasses was done of each student for each eye [right and left]. The cover, uncover, alternate cover-uncover tests, Hirschberg test [to observe the deviation] and ocular movements were done for each child. Distance direct ophthalmoscopy, and Bruckner's test[to confirm the deviation] were performed at the same setting. Children having defective vision were checked further at Eye department of Allied Hospital, PMC, Faisalabad. Here slit lamp examination was done to role out corneal, lens or vitreous opacities. The anterior chamber activity was noted Cycloplegic refraction and fundus examination of the selected subjects was done. All the findings were entered in the Proforma. Out of 2600 children, 383 [14.73%] had glasses and normal 6/6, 6/6 vision. Seven children [0.27%] had defective vision. 13 children [0.50%] without glasses had vision less than normal. A total of 20 children [0.77%] were found to be having amblyopia. The total children with glasses were 390[15%] while 2210 children [85%] were without glasses and having normal 6/6, 6/6 vision. Anisometropic amblyopia was found in 8 children [0.31%], isoametropia in 6 children [0.23%], strabismic amblyopia in 3 children [0.12%] and stimulus deprivation amblyopia in 3 children [0.12%]. The study showed that amblyopia is found about 1% in the educated families. This can be further eliminated or decreased with routine or periodical check up of the children not only in school but also at the pre school age

Syringing and probing results for congenital nasolacrimal duct obstruction

The study was conducted to study the results of syringing and probing technique for treatment of congenital nasolacrimal duct obstruction from the data collection, recorded at Eye Operation Theater and clinics for the patients treated by the said technique. Retrospective Cross-sectional study technique was used. From January 2003 to December 2005. In the study 90 respondents were included with age from six months to five years of both sexes, observed at DHQ Hospital Faisalabad and authors clinics and the data were analyzed by using SPSS package, version 12. Almost 93% of the cases were found to be symptom free at the end of follow up, showing the technique used was one of the best techniques for the said clinical problem

Coupling agents; comparison of efficacy of 0.3% artificial tear gel with 2.5% methylcellulose in various procedures

To find out the uses of commercially available clear lubricant eye gel as coupling agent and compare it with 2.5% methylcellulose in various procedures as 1. In Goldmann triple mirror for gonioscopy 2. In Abraham lens for Nd-YAG laser capsulotomy and iridotomy 3. In Area centralis lens for Grid laser photocoagulation 4. In Wide field lens for scatter or panretinal photocoagulation. Prospective Comparative Study. Diagnostic and research Department of Ophthalmology, Allied Hospital, PMC Faisalabad. From 1[st] July 2008 to 31[st] December 2008. Eighty patients, divided into two groups as each group having forty patients [40 eyes] One drop of topical anesthetic "Alcaine" proparacain hydrochloride was instilled twice in the eye, 5 minutes before starting the procedure. We used hydroxyprophyl methylcellulose 0.3% gel in the half of the patients eyes and used traditionally formulated hydroxypropyl methylcellulose 2.5% in the other half of the patients eyes and the findings were compared with each other. 2.5% methylcellulose was used in 40 eyes during Gonioscopy, Yag-laser iridotomy, Yag-laser capsulotomy and photocoagulation and was compared with 0.3% hydroxypropyl methylcellulose gel in the same procedures in 40 other eyes. Post procedures clarity of view comfort irrigation of solution remants, redness and stinging sensation were compared with the both coupling agents. The 0.3% gel showed good results

Normal conjunctival flora

To determine the prevalence of normal conjunctival flora and its types. An observational study. At Ophtha-lmological Department, DHQ/Allied Hospital, PMC, Faisalabad, from November 2006 to February 2007. This study was performed on 500 patients, aged form 20 years to 70 years with normal looking eyes. The samples of sterile stuart's swab were made on conjunctiva of patients, without touching eyelashes or lid margins. The swabs were touched with conjunctiva of both eyes and placed in stuart's transparent media to shift to microbiological laboratory. Out of 500 swabs 412 [82.4%] showed no growth while 78 [15.6%] showed microbial growth. Out of these 78 swabs, there were 44 [56.41%] having normal flora, while 34 [43.59%] had other pathogens. The normal looking eyes harbour different types of the organisms. Any trauma, accidental hurt or elective surgical procedure is not free from risk of conjunctival infection, keratits or endophthalmitis etc

Dacryocystorhinostomy; a comparative study of the results with and without silicon intubation in Pakistani patients of chronic dacryocystitis

To compare the results of standard dacryocystorhinostomy with the results of dacryocystorhinostomy done with silicon tube stentting of the lacrimal canaliculi. This is a hospital based, prospective, comparative and interventional study. Department of Ophthalmology, Allied Hospital Punjab Medical College Faisalabad. January 2006 to December 2006. Twenty seven patients of chronic dacryocystitis fulfilling the inclusion criteria were selected and divided in two groups. Group A consisted of 15 patients who underwent standard dacryocystorhinostomy and Group B consisted of 12 patients who underwent dacryocystorhinostomy along with intubation of the lacrimal canaliculi with silastic tubes. All the patients were followed up for at least six months post-operatively. Success of the procedure, defined as the symptomatic relief of epiphora and infection was assessed at the end of follow-up period. Of the total 27 patients of chronic dacryocystitis 23 [85%] were female and 4[15%] were male. The mean age of the patients was 45 years. The success of the procedure was recorded in 14 [93.33%] patients in group-A and in 10 [83.33%] patients in group B. Quite a few and simple complications were recorded during the study period. 1. Standard external dacryocystorhinostomy is a simple and cost effective procedure for the management of chronic dacryocystitis. 2. Silicon tube stentting of the lacrimal canaliculi does not have any extra advantage in the management of chronic dacryocystitis without canalicular obstruction

Cataract surgery; Axial length variation

eajaved@hotmail.com. To describe the variation of axial length in patients undergoing cataract surgery. A retrospective case series. At Opthalmological Department, Allied Hospital, PMC, Faisalabad from May 2006 to June 2007. The axial length of 566 patients who were admitted for cataract surgery were measured with A. scan [Axis II, Quantel]. The eleven patients with age below 15 years and above 90 years and with history of trauma, corneal scarring were excluded. So there were 555 patients for this study. A careful history of diabetes mellitus, hypertension, trauma, previous history of surgery, glaucoma and uveitis was taken, and slit lamp examination, tonometry, pupillary reactions, perception and projection of light was done. The data collected was entered in specially designed Performa. An average of ten readings of axial lengths with A-Scan for each patient was taken. Out of 555 patients, there were 350 male [63.06%] and 205 female [36.94%] patients. There were 250[45.05%] patients having age between 46 to 60 years. There were 27[4.86%] patients having age between 15 to 30 years and the same number 27[4.86%] of patients was seem having age between 76 to 90 years. The most of the patients 273[49.18%] had axial length between 23 mm to 25 mm. There were only 3 patients with axial length between 29.01 to 31 mm. There were a significant number of patients, 230[41.45%] having axial length between 21.01 to 23mm. The biometry depends upon axial length, kratometry and anterior chamber depth. Most of the formulae supposed for IOL calculations depend upon only two factors, the axial length and the keratometry. In our community, short and long eyes are very rare and so SRK-T formula for IOL calculations provides satisfactory postoperative results. The axial length carries more importance as its variation causes a gross change in IOL power and postoperative refractive errors

Nd: yag laser capsulotomy and complications

To evaluate the complications of Nd: Yag laser when applied on postoperative posterior capsule opacification [PCO], following extra capsular cataract extraction [ECCE] with intraocular lens [IOL]. Analytical and descriptive study. Eye OPD of DHQ Hospital, PMC and Clinic of Professor Zia ud Din Ahmad, Faisalabad. From Jan 2006 to Jan 2007. There were 120 patients; age ranged from 15 years to 80 years with post operated extra capsular cataract extraction with posterior capsular opacification. A Proforma was made which included detailed history of diabetes, hypertension, time period of cataract extraction, other relevant surgical or medical history, and examination e.g. Visual acuity, slit lamp examination, intraocular pressure measurement [applanation tonometry] dilated posterior capsule examination and slit lamp biomicroscopy etc. The patients were kept under observation for 5 hour and called for follow up after one week. Out of 120 patient s 70 eyes showed visual improvement from 6/18 to 6/6 [58.34%], while 30 Shown visual acuity improvement from count figures to 6/24 [25%], mild anterior uveitis occurred in 8 cases [6.67%], corneal damage in 2 cases [1.6%] while transient raised Intraocular Pressure [IOP] in 7 cases [5.83%]. The damage to IOL observed in 3 [2.5%], the corneal damage was seen in 2 cases [1.67%]. The Nd; Yag Laser is very effective, cheap and easy mode of treatment for PCO with minimal post laser complications

audit of electroencephalography [EEG] referral in tertiary care teaching hospital

The aim of the study is to describe the various findings of electroencephalography in assessing diseases encountered in clinical practice, to audit the use of EEG in a tertiary teaching hospital, and to describe the diagnostic categories in which EEG can be helpful as diagnostic tool. Descriptive study This study has been carried out at Department of Psychiatry Khyber Teaching Hospital, Peshawar. Cases were examined retrospectively over a period of one year from January to December 1998. All the record of the patients who had EEG during one year period i.e. from January to December 1998 was examined. Relevant informations were recorded on a performa prepared for this study. The total number of request during year 1998 were 971, out of which 570 [59%] were male and 401 [41%] were female. In 588 [61%] cases result was positive and in 383 [39%] was negative. Electroencephalography was helpful in assessing the diagnosis of epilepsy in 344 cases [58%] and delirium in 181 cases [31%]. This paper highlights the importance of EEG is an important electrophysiological investigation especially in cases of delirium and epilepsy. It is recommended that it should be available in every tertiary teaching hospital

Role of video assisted thoracoscopy in management of empyema thoracis

The hospital based Cohort study was carried out over a period of 21 months to analyze and evaluate the out come of patients who had presented with acute stage of empyema thoracis and were treated by video assisted thoracoscopy. 30 patients with acute empyema thoracis received treatment by video assisted thoracoscopy in Combined Military Hospital Rawalpindi from March 2000 to December 2001. Both civilians as well as military personnel were included in the study out of which 22 were males and 8 were females. Majority of the patients were of 30 years and above age group. The most common etiology was respiratory tract infection with pneumonia and tuberculosis making the largest proportion. The leading presenting symptoms included low grade pyrexia, breathlessness, loss of weight and chest pain. One third of patients had some other associated systemic illness. Video assisted thoracoscopy was used in all 30 patients with only 2 patients requiring open thoracotomy. Post operative wound infection was the most commonly encountered complication. In most of the cases the procedure was over within an hour and in majority of patients hospital stay was upto 2 weeks. There was one death, which was not due to procedure but due to septicemia. These results are similar to those found elsewhere in the world

Ocular complications of herpes zoster ophthalmicus

The purpose of this prospective study was to determine the incidence of Ocular involvement in HZO and to describe the clinical presentation and course of HZO in the eye [both intra and extra ocular structures] DESIGN: Prospective study. SETTING: Ophthalmology Department of Punjab Medical College, Faisalabad. PERIOD: 2 Years from Sep 96 to Sep 98. PATIENTS AND METHODS: Total fifteen patients; thirteen male and two female. Out of 15 patients of HZO 73.33% developed ocular involvement while 26.67% spared the eye involvement. All patients 100% had lesions on forehead and upper lid while Hutchinson sign remained positive only in 66.67%. Blepherotosis and trichiasis was developed in 26.67% and 6.67% respectively while 73.33% cases developed conjunctivitis and punctate epithelial keratitis with ultimate corneal scarring in 66.67%. Corneal hyposensitivity was detected in 66.67%. AC reaction in 73.33%. Pupillary abnormalities in 53.33%. 6th nerve palsy in 6.67%. Glaucoma in 20%. Post herpatic neuralgia in 26.67% cases. One patient developed contra lateral haemiplegia and orbital apex syndrome while none of the patient developed optic neuritis, necrotizing retinitis, chorioretinitis, Horner's syndrome and progressive outer retinal necrosis. Deterioration of vision was detected in 73.33% cases