A 5-month-old girl with amniotic band syndrome.

A 5-month-old girl presented with bilateral upper and lower eyelid cicatricial ectropion with right eye exposure keratopathy and bilateral lateral canthal defects. Physical examination revealed a constriction band over the temporal area of the head and nasal bridge; she was diagnosed with congenital amniotic band syndrome (ABS). Upper and lower eyelid reconstruction procedures were performed along with lateral canthal reconstruction to salvage the remaining left eye. Congenital ABS is a rare disorder. Most cases of ocular ABS are associated with limb deformities due to constriction defects and blood flow restrictions. Our patient presented solely with ocular and periocular deformities.

Clinical Presentation and Management Strategies in Intraorbital Foreign Bodies.

The authors present a retrospective, observational case study of seven patients, who presented with retained Intra-Orbital Foreign Bodies (IOrbFBs) following penetrating orbital injury at a tertiary eye hospital over a period of one year. Cases were reviewed for epidemiological features, mechanism of injury, nature of foreign body, clinical features, imaging modality, associated complications, management outcomes, and the final prognosis. The mean age of presentation was 27.43 years. Amongst the seven patients, two were children (aged <10 years). The male : female ratio was 4 : 3. Of the seven retained IOrbFBs, two were plastic, two wooden, and three metallic in nature (one gunshot injury, one ball projectile (commonly referred to as BB) injury, and one with knife). Two out of seven had no light perception at presentation. The periocular location of the foreign bodies was inferior in 4 cases and medial in 3 cases. Computed Tomography scan confirmed the diagnosis in five cases and Magnetic Resonance Imaging (MRI) was diagnostic in one. Surgical intervention was done in five cases, and two cases were managed conservatively. The authors conclude that favourable outcome can be achieved even without surgical removal in cases of inert metallic/inorganic IOrbFBs. The properties of plastic FBs can frequently render them invisible on imaging, or they may mimic chronic inflammatory conditions like tuberculosis. Long-standing wooden IOrbFBs evade identification radiologically due to prolonged hydration. The ultimate choice of intervention must be individualised, weighing the risks of retention against the risk of iatrogenic damage.

Unusual Tumours Hidden in Blind Eyes.

INTRODUCTION: This case report describes 3 cases of unsuspected neoplasms in previously blind eyes, with recent onset pain. Cases and observations: Case 1: Female with pain, redness in the non-seeing right eye (R/E) for two months. R/E had total cataract, low intraocular pressure and a well-defined globular mass lesion at the posterior pole, seen on ultrasound. Enucleation with an implant was done. Histopathology clinched the diagnosis of choroidal melanoma. Case 2: A 20-year male, developed pain, redness in left eye (L/E) for two months. L/E was blind since childhood, secondary to trauma. The patient underwent enucleation and detailed histopathological examination and immunohistochemistry supported a diagnosis of ependymoma with vascular malformation. Case 3: A 24-year male with pain, redness in L/E for six months, with decrease in size of eyeball. L/E had low vision since childhood. On examination, L/E was phthisical with diffuse conjunctival congestion, band-shaped keratopathy, cataract, and neovascularization of iris. Imaging revealed a small distorted globe with highly reflective mass along the posterior pole. Histopathology of the enucleated specimen confirmed the diagnosis of choroidal osteoma, with gliosis of the adjacent RPE. CONCLUSION: In the management of a painful blind eye, it is extremely important to rule out an intraocular malignancy, particularly in patients with recent onset of pain.

Comparison of Polypropylene Sling with Combined Transconjunctival Retractor Plication and Lateral Tarsal Strip for Correction of Involutional Lower Eye Lid Ectropion.

PURPOSE: The study aims to compare the effectiveness and complications of transconjunctival retractor plication (TRP) with lateral tarsal strip (LTS) and the polypropylene sling (PS) surgery for treatment of involutional lower lid ectropion. METHOD: A prospective randomised pilot study was conducted on 30 eyes of 30 patients suffering from epiphora having horizontal eyelid laxity >6mm and age >50 years at a tertiary care centre from December 2014 to March 2015. They were randomly divided into two equal groups for TRP with LTS (group A) and PS (group B). Success was defined as relief in epiphora and lid laxity ≤4mm at 12 months post operatively. RESULT: There were 19 male and 11 female patients with age ranging from 55-80 years. The mean grade of ectropion was 2.80±1.32 in group A and 2.87±1.60 in group B. The preoperative horizontal laxity increased with the grade of ectropion (p <0.001) while medial canthal laxity was variable. The average surgical time per procedure in group A was 66 minutes and in group B was 24 minutes. Group A had a success rate of 93.33%, while group B had a success rate of 87%. Post-operative complications occurred in 2 eyes in group B only. CONCLUSION: Both LTS with TRP and PS are effective in the management of involutional ectropion. LTS with TRP though more invasive has higher success rates and a lower incidence of complications as compared to PS. However, PS is an easy to perform out- patient procedure that is faster and better tolerated in old patients.

Results of a new "mirror tuck technique" for fixation of lacrimal bypass tube in conjunctivodacryocystorhinostomy.

CONTEXT: Conjunctivodacryocystorhinostomy (CDCR) is the procedure of choice for proximal canalicular blocks. However, the complications of tube migration and extrusion limit its widespread practice. AIM: The aim of this study is to evaluate the efficacy and complications of the new "mirror tuck technique" for fixation of lacrimal bypass glass tube without holes in proximal canalicular blocks in laser CDCR. MATERIALS AND METHODS: A prospective interventional study was conducted in forty consecutive eyes of adult patients, undergoing 980 nm diode laser CDCR for proximal canalicular blocks. After creating the tract under endoscopic guidance, the collar of the glass tube was fixed to the conjunctiva with 6-0 prolene suture by "mirror tuck technique." Success was defined as the absence of extrusion of tube with patent tract and relief in epiphora at 1 year of follow-up. RESULTS: Both anatomical and functional success was achieved in 39 (97.5%) cases. Tube displacement occurred in one patient suffering from allergic conjunctivitis in which the tube had to be removed. A temporary heaviness was reported by 5 (12.5%) patients till about 2 weeks. Conjunctival overgrowth over the tube occurred in 1 (2.5%) eye at 5 months which was excised and treated with application of 0.02% mitomycin C with no subsequent recurrence. There were no cases of suture abscess or suture intolerance warranting tube removal. CONCLUSION: "Mirror tuck technique" is an effective method for tube fixation (for tube without holes) in CDCR. However, it is important to position the conjunctival opening so as to leave sufficient space for passage of sutures for anchorage medially.

Comparison of Goldmann applanation tonometer, Tono-Pen and noncontact tonometer in children.

BACKGROUND: To evaluate the agreement of Goldmann applanation tonometer (GAT) with Tono-Pen and noncontact tonometer (NCT) for measurement of intraocular pressure (IOP) in pediatric age group and to evaluate the correlation between central corneal thickness (CCT) and IOP measured with the tonometers used. MATERIALS AND METHODS: IOP was measured in 200 eyes in a group of Indian children, aged between 8 and 18 years using three different tonometers: NCT, the Tono-Pen and GAT. All IOP readings were made in the office settings by the same examiner. Readings obtained were compared between the instruments and with the CCT for each tonometer. Tonometer inter-method agreement was assessed by the Bland-Altmann method. The relations of CCT with absolute IOP values and inter-tonometer differences were analyzed by linear regression. RESULTS: The mean age was 13.37 ΁ 3.51 years. The mean IOP values recorded with NCT; Tono-Pen and GAT were 14.38, 15.63, and 12.44 mmHg, respectively. Both Tono-Pen and NCT recorded statistically higher IOP values than the GAT (P = 0.00) regardless of the CCT. The percentage increase of IOP measured over GAT was 15.66% for NCT and 25.70% for Tono-Pen which was also statistically significant. A correlation was found between CCT and IOP values obtained with all the three tonometers. CONCLUSION: IOP measurements on children vary significantly between instruments and correlations are affected by the corneal thickness. Further studies on children are needed to determine which instrument is most appropriate and to derive a normative IOP scale for the growing eye.

A rare case of delayed onset capsular block syndrome managed using 25-gauge vitrector.

We report a case of delayed onset capsular block syndrome in a patient 6 years after undergoing cataract surgery. Ocular examination revealed marked diminution of vision accompanied with a collection of milky fluid between the intraocular lens and posterior capsule. To treat and to understand the pathology of the condition, aspiration of fluid using 25-gauge vitrector through pars plana was done, and contents sent for microbiological analysis which did not reveal any growth. Postoperative period was uneventful with the absence of intraocular inflammation and excellent visual recovery.