Phantosmia: A neglected symptom after Dacryocystorhinostomy with intubation (A case report).

A 62-year-old female presented with complaints of persistent phantosmia (foul smell) for the last 4 months. She has a past history of right-sided dacryocystorhinostomy (DCR) 18 months back and left-sided DCR 12 months back. In the initial follow-up period, the patient had frequent visits to her otolaryngologist and ophthalmologist. She experienced phantosmia often but was reassured. The patient presented to us and was examined in an operation theater. It was discovered that the foul-smelling foreign body was present in her right nasal cavity above the middle turbinate. It was removed. A retained gauze piece was revealed to be a cause of phantosmia. The purpose of reporting is to create awareness among ophthalmologists and otolaryngologists. Retained gauze piece following DCR surgery presenting as phantosmia is a new symptom after DCR surgery previously not reported in the literature. Repeated complaints of a postoperative patient, should be dealt with vigilantly and timely.

First Case Report Of Poppers Maculopathy With Cannabis (Charas) In Pakistan.

Poppers is a recreational drug common in gay communities often used for euphoria and myorelaxation. It causes yellow foveal discoloration with disruption of outer segments of the foveal photoreceptors called Popper's maculopathy. We present first case of poppers maculopathy with use of Charas (Cannabis) from Pakistan. A 32-year-old transgender presented with bilateral gradual decrease in vision over the last two years. He gave past history of smoking cigarette and Cannabis (Charas). His visual acuity was 6/60 unaided and 6/36 with the help of pin hole bilaterally. Near vision was N/18 and Color vision was 12/12 on Ishihara test plate bilateral. Fundus examination revealed a yellow foveal spot at the posterior pole bilaterally. Optical coherence tomography (OCT) showed disruption of inner outer segment of foveal cones. Patient was followed up at three months after prescribing oral leutins with no improvement in vision.

Impact of COVID-19 lockdown on quality of life in a literate population in Pakistan.

Background: Early in the COVID-19 pandemic in Pakistan, complete lockdown was imposed from 24 March 2020: offices, shopping malls, market places, etc. were affected. On 25 March, further restrictions were imposed: hospital outpatient departments were closed and there was a ban on public and private gatherings. The lockdown significantly slowed down economic activities, and halted recreational, educational and religious activities and social gatherings. Aims: To assess the impact of the COVID-19 lockdown on the quality of life of literate individuals in Pakistan. Methods: A cross-sectional, descriptive study was conducted from 25 April to 15 May, 2020 among literate Pakistani who understand the English language, aged 10+ years and had internet access. We selected 500 individuals to complete the McGill questionnaire online. Results: The response rate was 73% (n = 365): 49% males and 51% females. Around one third reported a moderate effect on overall quality of life. Financial life was moderately affected in 45% and both physical life and emotional life in 43% of participants. Spiritual life was excellent in 69%. However, social life was severely affected in 56%. Mild depression was felt by 47% of respondents and 48% felt strongly supported during the COVID-19 lockdown. Conclusion: The COVID-19 lockdown made little difference to the quality of life of the literate population of Pakistan. A few aspects were moderately affected and social life was badly affected. Spiritual life improved for most individuals.

An unusual rise in cases of assault in ophthalmic practice during COVID-19 lockdown in a tertiary care hospital.

OBJECTIVE: The objective of the study is to report an unusual rise in cases of assault with ocular injury and their medicolegal implications presenting in an eye department of a tertiary care hospital during COVID-19 lockdown. MATERIALS AND METHODS: A retrospective, observational case series was conducted in the Department of Ophthalmology, Abbasi Shaheed Hospital, Karachi. Data were retrieved from the medicolegal records of the patients from April 1, 2019, to July 31, 2019, and similar months in 2020. We included all the patients of assault with ocular injury as alleged, registered as medicolegal cases. Patients with accidental injuries were excluded from the study. RESULTS: There was 34.3% increase in cases of assault with ocular injury as alleged with 72.35% reduction in the outpatient department patients. The ratio of cases of assault in 2019 and 2020 is 1:4.62. The mean age of the patients in the lockdown year was 33.74 ± 11.9 standard deviation (SD) and in preCOVID year 2019 was 39.74 ± 15.9 SD. Blunt trauma was experienced by 57 (66.3%) and penetrating injury in 2 (2.3%) patients. Sixteen (18.6%) patients had no ocular involvement. Home was the place of assault in 32 (37.2%) and street in 27 (31.4%) individuals. Fist was the source of assault in 46 (53.3%) and rod or stick in 15 (17.4%) individuals. CONCLUSION: There is a fourfold increase in patients of assault during 4 months of COVID-19 lockdown in 2020 as compared to the same time period in 2019. Most of these patients were young age, male gender, and uneducated. The most common place of incident was home, and fist was the most common source of infliction. Most of the injuries were superficial and had minimum effect on visual acuity.

Frequency of Ocular Diseases in Infants at a Tertiary Care Hospital.

PURPOSE: To determine the frequency of ocular diseases in infants visiting the ophthalmology department of a tertiary care hospital. METHODS: This was a cross-sectional descriptive study conducted in the department of ophthalmology, Abbasi Shaheed Hospital, from January 2015 to May 2016. The study included 377 infants ranging in age from 1 day to less than 1 year who were, selected by a nonprobability consecutive sampling technique. A detailed history was taken, and a complete ocular examination was performed. Descriptive statistics were used to calculate the mean and standard deviation for age. Frequencies were calculated for ocular diseases along with the percentages. Outcome variables included various congenital and acquired diseases such as conjunctivitis, congenital cataract, glaucoma, nasolacrimal duct blockage, squint, trauma, and fundus abnormalities. RESULTS: The mean age of infants was 5.0 ± 3.7 months. There were 196 (52%) males and 181 (48%) females. The sample included 330 (87.5%) full term infants. Acquired ocular diseases occurred in 230 (61%) infants; and congenital diseases, in 147 (39%). The most common ocular disease was conjunctivitis, which occurred in 173 (46%) infants, followed by congenital blocked nasolacrimal duct, which occurred in 57 (15 %) infants. Conjunctivitis was more common among neonates than infants. CONCLUSIONS: Acquired ocular diseases were more common than congenital ocular diseases. The most common ocular pathology was conjunctivitis, followed by congenital nasolacrimal duct obstruction, in infants. Conjunctivitis was more common in neonates than infants.

Musculoskeletal problems in frequent computer and internet users.

AIM: This study was carried out to see the frequency of musculoskeletal problems in frequent Computer and Internet Users. METHODS: This was a Cross Sectional Study performed in the community and we chose Office workers and students aged 18 to 50 years using Computers and Internet for not less than 3 hours per day. After a verbal consent, they were given a questionnaire in English. People having prior diagnosed musculoskeletal problems were excluded. RESULTS: Total number of participants were 150, out of which 80% were males, and 67 (44.7%) suffered from musculoskeletal problems, affecting at least one of the four anatomical sites (low back, neck, shoulder, wrist/hand). Common symptoms were Headache, which was seen in 46% and neck pain in 41.3% of subjects. Whereas wrist pain was least commonly seen in 16% of subjects. Independent t test was used to compare the musculoskeletal problems with duration of computer use which has a significant value i.e. less than 0.05. CONCLUSION: Musculoskeletal symptoms are quite common, headache and back pain being most common symptoms. These symptoms are associated with prolonged use of computer and internet and often left unreported and unrelated.

Anaesthesia in various anterior segment complications of sub-Tenon surgeries.

OBJECTIVE: The sub-Tenon's space is a potential space between the capsule and the sclera. This study evaluated complications from sub-Tenon's anaesthesia in different corneal and anterior chamber ophthalmic surgical procedures. METHODS: The prospective cross-sectional study was carried out at the Baqai Medical University, Karachi, from March 2010 to August 2011, and comprised 149 patients for various minor and major intraocular surgeries. All the patients were operated under sub-Tenon's anaesthesia, administered in the inferio-nasal quadrant with a 19G cannula.Their complications were noted on a specific proforma. Data was analysed for frequencies of complications. SPSS 13 was used for statistical analysis. RESULTS: There were 82 (55%) males and 67 (45%) females who underwent surgery. There were 89 (59.7%) right eyes and 60 (40%) left eyes. The commonest surgery was phaco-emulsification (n = 79; 53%), followed by extracapsular cataract extraction with intraocular lens implantation (n = 33; 22.1%). Subconjuctival haemorrhage (n = 75; 50.3%) was the commonest complication, and the least common was pain during injection (n = 9; 6%). CONCLUSION: There was no incidence of life-threatening or sight-threatening complications. The procedure was almost pain free and can be simply, safely and effectively given by the beginners with due precautions.

Effect of different eye speculums on intra ocular pressure.

OBJECTIVE: To measure the difference in intraocular pressure with use of two different types of eye speculums. METHODS: The study was conducted at the Department of Ophthalmology, Abbasi Shaheed Hospital, Karachi, from November 2011 to May 2012. Through probability convenience sampling, hundred patients were selected and divided into two equal groups. Complete history and ocular examination was done. Intraocular pressure was measured using Goldmann Applanation tonometer on slit lamp. It was again measured with Barraquer wire speculum inserted in the eyes of 50 patients, and Universal eye speculum in the other 50 patients with the help of Goldmann Applanation. SPSS 16 was used for statistical analysis. RESULTS: There were 63 (65%) males and 34 (35%) females with an overall mean age of 45 +/- 14.09 years. The mean age baseline intraocular pressure of the right eye without speculum was 15.04 +/- 3.83 mmHg and that of the left eye was 15.48 +/- 4.00 mmHg. With Barraquer wire speculum, the value for the right eye was 22.21+/- 4.99, and that of the left eye was 23.08 +/- 5.41. With Universal eye speculum, the value for the right eye was 25.51 +/- 3.02, and for the left eye it was 25.78 +/- 3.64.There was a statistically significant difference in baseline and post-speculum measurements (p < 0.0001). Paired sample t-test was also conducted for values of the two speculums and the result was statistically significant (p < 0.0001). CONCLUSION: Barraquer wire speculum caused less increase in intraocular pressure compared to the Universal eye speculum. It should be preferred for intraocular surgeries to avoid increase in pressure during surgery and prolapse of ocular contents. Not only the effect of speculum, but also the type of speculum should be kept in mind when measuring intraocular pressure during examination under anaesthesia.