Lagophthalmos: An etiological lookout to frame the decision for management

Purpose: To describe the etiology, clinical profile, duration of lagophthalmos cases and thereby, framing a decision for the management based on the severity of Exposure keratitis (EK), Facial palsy (FP) with each etiology and to describe the outcome of the management options. Methods: The method was a prospective review of 120 lagophthalmos cases treated at a single tertiary center from January 2018 to January 2019. The main outcome measures were analysing the association between age, etiology, duration and management of lagophthalmos. Results: Of the 120 patients studied, paralytic etiology was noted in 86 and eyelid etiology in 34 patients. The percentage of various lagophthalmos etiology documented were Bell’s palsy (35.83%), lagophthalmos in ICU patients (15%), traumatic facial palsy(FP) (10.80%), stroke associated FP (6.67%), infection associated FP (6.67%), iatrogenic FP, cicatricial lagophthalmos (5%), lagophthalmos post eyelid surgeries (5%), neoplastic FP(3.33%), congenital FP (1.67%), proptosis induced lagophthalmos (1.67%), floppy eyelid syndrome induced lagophthalmos (0.83%) and lid coloboma associated lagophthalmos (0.83%). A statistically significant correlation was noted between exposure keratitis and age, with an increased prevalence age advances. The management showed significant variation with individual etiology, with some etiologies unquestionably requiring surgical management. Surgical management is crucial as the duration of lagophthalmos increases more than 6 weeks, EK involving pupillary axis and poor FP recovery. Conclusion: This study concludes that the conservative management was sufficient in all cases when the duration is less than 1 week, Exposure keratitis not involving the pupillary axis (EK< Grade II) and FP with good functional recovery ( FP < Grade III). The predominant causes being Bell’s palsy, lagophthalmos in ICU patients and vascular FP. Whereas, cases with poor functional recovery of facial palsy(FP) and permanent eyelid deformation require definitive surgical management like Traumatic FP & cicatricial lagophthalmos

Evaluation of in vitro antioxidant potential of methanolic extracts of the Ferns, actiniopteris radiata (SW) link. and equisetum ramosissimum desf.

Present study reports the antioxidant activities of methanolic extracts of Actiniopteris radiata and Equisetum ramosissimum. The analyses carried out were DPPH radical scavenging, ABTS·+, reducing power, and ferrous ion chelating tests. From the analyses, Actiniopteris radiata and Equisetum ramosissimum, were found to have potent antioxidant activity against DPPH with the IC50 value of 93.48 and 78.58 respectively. Actiniopteris radiata had the highest values for ABTS·+ radical scavenging activity (2523.11μ TE/g) and reducing power assay (0.853 absorbance at 700μg/ml). However, the fern, Equisetum ramosissimum exhibited higher ferrous iron chelating activity (41.18% at 5000μg/ml) than Actiniopteris radiata. Thus the results obtained in the present study indicate that these plants have the potential as natural source of antioxidants, capable of protecting against free radical mediated damage and may have applications in preventing and curing various diseases.