A simple technique of meibography for morphological and functional evaluation of meibomian glands in dry eye conditions.

Purpose: Dry eye disease (DED) is because of a decrease in the tear film's volume or a change in the composition of tears. Evaporative dry eye is the most common type, which is due to meibomian gland dysfunction (MGD). In this study, the morphology of meibomian glands was evaluated in all kinds of dry eyes to look for any loss of meibomian glands, assess the function of remaining glands, and investigate the relationship between anatomy, function, and severity of DED. Methods: A total of 300 patients were included in the study, with 150 eyes in the study group and 150 in the control group. Meibomian gland morphology was assessed by examining the tarsal plate after everting the eyelids. Tear film function was evaluated using tear film break-up time (TBUT) and Schirmer's test (SCH I and II). Meibomian gland morphology was examined with a slit-lamp under magnification, a transilluminator using a small light emitting diode (LED) bulb, and non-contact meibography using an auto refracto-keratometer (ARK). Results: Females had a higher prevalence of dry eyes in our study. In all, 103 eyes (68.6%) in the study group had evaporative dry eye, making it the most prevalent type. Among the 150 controls, 104 controls with 69.3% had no dry eye symptoms, and in those with symptoms, the evaporative type was the most common, with a 28% prevalence. Conclusion: TBUT should be performed in all patients with detectable MG abnormality. Meibography has high specificity and sensitivity to diagnose MGD and in turn dry eyes and should be considered a routine screening modality.

Dry eye symptoms and digital eyestrain - Emerging epidemics among university students due to online curriculum amid the COVID-19 pandemic. A cross-sectional study.

Purpose: Increased screen time has been a major concern among the students who have adopted the online curriculum amid the pandemic. The study was conducted to shed light on the changing trends of symptoms pertaining to dry eye disease and digital eyestrain due to the online curriculum and its negative implications on the ocular health of students. Methods: A cross-sectional study was conducted among students of Manipal Academy of Higher Education who are currently following the E-learning curriculum amid the COVID-19 pandemic the participants were surveyed using a pre-validated structured questionnaire. Results: The mean age of study participants was 23.33 ± 4.604 years. In total, 97.9% (321/352) of the respondents experienced at least three symptoms associated with the usage of digital devices. 88.1% of the participants were exposed to an average screen time of more than 4 hours per day. An increased number of hours of digital device usage was found to be associated with higher total symptom scores (P = 0.04). The total symptom scores were found to be considerably higher for those with continuous contact with the screen (P = 0.02). Headache (69.9%, n = 246) is the most commonly reported symptom followed by neck pain (65.3%, n = 230), tearing (44.6%, n = 157), eye pain (40.9%, n = 144), and burning sensation (40.1%, n = 141). Conclusion: This study highlights a tremendous increase in the prevalence of symptoms related to dry eye and digital eyestrain among students attending online classes during the COVID-19 pandemic. Eye care professionals need to be aware of this emerging public health threat and the appropriate measures for its prevention.

A comparison of sub-tenon block with peribulbar block in small-incision cataract surgery.

Purpose: To compare the efficacy and safety of sub-tenon block to peribulbar block with respect to analgesia, akinesia, and complications. Methods: It is an observational study conducted at a government hospital in Karnataka. Seventy patients who came to the ophthalmology OPD for small-incision cataract surgery (SICS) under local anesthesia were included in the study. The participants were divided into two groups of 35 as per the surgeon. The pain was evaluated at the time of administration of the block, during the surgery, and during the postoperative period of 4 h. Akinesia was noted in both the groups and the time of onset of akinesia was noted. Any complications associated with the block such as chemosis or subconjunctival hemorrhage were also noted. Statistical analysis was done using PSS version 25.0, where P < 0.05 was considered significant. Results: The baseline pain score was higher in the peribulbar group (1.57). The onset of akinesia was faster in sub-tenons (90.34 s). Complete akinesia was achieved in 82.9% of patients after peribulbar block. There was no significant difference in complications in both groups. Conclusion: Sub-tenons block is an effective and safer technique of ocular anesthesia for SICS. It can be considered as an alternative to the conventional peribulbar block for SICS.

Wolf in sheep's clothing: Primary orbital Ewing sarcoma in a child masquerading as internal angular dermoid.

Ewing sarcoma is one of the rare, highly malignant neuroectodermal tumors frequently involving bones. Primary orbital Ewing sarcoma is extremely uncommon. We report a rare case of a 5-year-old boy who presented to us with a painless, slow-growing mass above the medial canthus of the left eye, the clinical appearance of which was masquerading as an internal angular dermoid. The child was subsequently diagnosed to have primary orbital Ewing sarcoma. Primary orbital Ewing sarcoma is a rare tumor with poor prognosis, poses diagnostic challenges, and demands a high index of clinical suspicion.

Urine protein: Urine creatinine ratio correlation with diabetic retinopathy.

PURPOSE: To investigate the urine protein (UP) and urine creatinine (UC) ratio in diabetes mellitus and report its influence as a risk factor for the presence and severity of diabetic retinopathy (DR). METHODS: In total, 150 diabetic patients presenting to the outpatient department were included. Detailed history with informed consent and ophthalmic examination, including visual assessment, external ocular examination, anterior segment evaluation, dilated fundus examination by slit-lamp biomicroscopy, and indirect ophthalmoscopy, was done. The early morning spot urine sample was used to determine spot urine protein creatinine ratio. Association with hypertension, fasting blood sugar (FBS), and HBA1C (glycosylated Hb) were also noted. RESULTS: Urinary PCR increased with the severity of the diabetic retinopathy (P < 0.001). HbA1c, FBS, and duration of diabetes had a direct correlation with urine PCR. ROC curve analysis showed that the optimal PCR cut-off value for predicting the risk of onset DR was 0.65. Retinopathy progressed with increasing urine PCR. Spot urine PCR strongly correlates with stages of diabetic retinopathy and proteinuria measured in 24-h urine samples. CONCLUSION: The study showed that urine PCR can be a marker for risk and progression of diabetic retinopathy.

An Uncommon Case of Isolated Superior Rectus Palsy.

Head injury associated with orbital trauma is commonly encountered in day-to-day practice. We report a rare case of orbital trauma resulting in isolated orbital "roof blow" in fracture in a 14-year-old child. The patient presented to us with diplopia and limitation of elevation of right eye after orbital trauma. Computed tomography of the orbits (2 mm sections) did not reveal fracture of the orbital floor. However, there was orbital roof "blow in" fracture with fracture fragment impingement on the superior rectus muscle. Patient was treated conservatively and spontaneous recovery of ocular motility was noted after a month.