Timing of probing for nasolacrimal duct obstruction in infants and children

We report the results of management of congenital nasolacrimal duct impotency in infants and children, with a special reference to a comparison of conservative therapy and surgical probing-irrigation. The incidence of nasolacrimal stenosis was 53 patients [1.7%] out of a total of 3,108 patients we examined. During the period from December 1990 to December 1991, 53 patients with epiphora and discharge received treatment. Spontaneous recovery ensued conservative treatment and massage in 33 [62.4%] of the patients. One probing-irrigation procedure relieved tearing in 15 [28.3%] of the patients in whom conservative approach had failed. The second probing-irrigation succeeded in another four [7.5%] patients. On patient [1.8%] did not respond even to the third probing-irrigation. Therefore, probing-irrigation succeeded 75% of the time on the first attempt and 20% of the time on the second attempt, and failed even on the third attempt 5% of the time in patients who did not respond to conservative therapy [15 or 38%]. Probing was tried only in patients who were older than six months. [Pakistan Journal of Ophthalmology 10:82-84, October, 1994.]

Incidence of ocular complications of diabetes mellitus in Pakistan

We studied 150 patients, 122 with non-insulin-dependent diabetes mellitus [NIDDM] and 28 with insulin-dependent diabetes mellitus [IDDM], to determine the incidence of retinal and non-retinal ocular manifestations of diabetes mellitus in population visiting the Department of Ophthalmology, Lady Reading Hospital, Postgraduate Medical Institute, Peshawar. Corneal sensitivity was reduced in 62.3% of the NIDDM patients and in 35.7% of IDDM patients. Mature cataract of aphakia was present in 25.4% of the NIDDM and 14.2% of the IDDM patients. We found true diabetic cataract in only one patients, an 11-year old girl with IDDM in diabetic coma. Chronic open-angle glaucoma or ocular hypertension was present in 9% of the NIDDM patients but in none of the IDDM patients. Background diabetic retinopathy [BDR] occurred in 15% of the NIDDM and 11% of the IDDM patients with a diabetes duration of less than 5 years. With a duration of 5-10 years, this figure rose to 18% in the NIDDM group and to 28.5% in the IDDM group. The frequency increased to 66.6% in the NIDDM group and to 33.3% in IDDM group beyond 10 years of disease duration. Proliferative diabetic retinopathy [PDR] or preproliferative diabetic retinopathy [PPDR] was present in 5% of the NIDDM patients and in none of the IDDM patients with disease duration of less than 5 years. In the group with disease duration of 5-10 years, PDR or PPDR was present in 26% of the NIDDM patients, 14.2% of the IDDM patients. When duration of diabetes went beyond 10 years, this figure rose to 33.3% in both NIDDM and IDDM groups. Diabetic maculopathy was present in 11.6% of the patients with NIDDM and in no patient with IDDM with diabetes duration of less than 5 years. This figure increased to 20% in the NIDDM group and to 28% in IDDM group with a duration of 5-10 years. In patients with diabetes of more than 10-years duration, maculopathy was present in 25% of the patients in the NIDDM group and none in the IDDM group. [Pakistan Journal of Ophthalmology 8: 7-11, January, 1992]

Presumed cutaneous ocular anthrax with signs of orbital cellulitis

We saw eight patients, four male and four female, ranging from 10- to 40-year in age, who had unilateral redness, itching, and marked swelling of the eyelids and periorbital area. The edema also extended to the entire face, the opposite eye, the forehead, and the postauricular region. All patients had severe constitutional symptoms and intense headache. The inflammation extended posteriorly into the orbit, with restriction of globe motility to a varying degree in all patients and signs of optic disc involvement in some of them, mimicking a cavernous sinus thrombosis. These patients recovered only when heavy doses of intravenous penicillin [2.4 million units daily in continuous drip], alongwith oral ibuprofen 400 mg t.i.d., were added to their management. The swelling gradually subsided over a period of several days with formation of a black eschar on the involved area of the affected eyelid. Weeks later, the eschar fell off, leaving behind a badly scarred eyelid with severe ectropion which needed extensive plastic repair. Although cultures in our laboratory did not confirm it, we strongly suspect these to be the cases of cutaneous anthrax of the eyelid. Further study is in progress to learn the source of Bacillus anthracis in the area to which these patients belong