Blepharophimosis, Ptosis, and Epicanthus Inversus Syndrome: A Simple Remedy for Challenging Cases.

A 14-year-old male presented to the outpatient department of ophthalmology with complaints of visual impairment. The patient was assessed with a detailed history and physical examination. Marked amblyopia was observed on inspection, and his best-corrected vision was 6/36 in both eyes with no further improvement. Both the anterior and posterior segments of the eyes were normal. A diagnosis of blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES) was suspected. Surgery was initiated in two stages, with the first stage utilizing Mustarde's double Z-plasty to correct the epicanthus inversus and telecanthus. The second stage was done three months later, involving a tarsofrontalis sling with prolene sutures to correct ptosis. The success of this operation speaks to the efficacy of a two-stage procedure for remedying a syndrome as complex as BPES.

Unilateral Anophthalmic Socket Reconstruction With Dermis Fat Graft.

A 15-year-old girl presented with the complaint of a cosmetically disfigured right eye since birth. The initial assessment was carried out by way of a history and physical examination. The patient's history revealed no significant findings. Physical examination revealed that the right ophthalmic socket was seemingly devoid of an identifiable globe and ocular tissue, which is described as an anophthalmic socket. The conjunctival fornices appeared short, a finding which was more noticeable in the inferior conjunctival fornix. The patient's orbital volume was decreased. To increase the orbital volume, a dermis fat graft (DFG) was carefully taken from the gluteal region. The graft was then transposed to the anophthalmic socket and sutured to the conjunctiva and Tenon's capsule. A prosthetic eye was placed in the socket. Later, a second surgical intervention was performed to deepen the inferior fornix, for which a mucous membrane graft was taken from the lower lip. As a result of these interventions, all cosmetic and medical concerns of the patient regarding the anophthalmic socket were addressed. The success of this procedure speaks to the efficacy of DFGs in the repair of an anophthalmic socket.

Ocular Neurofibromatosis.

A 14-year-old boy presented with a right orbital lid mass, which had slowly grown over the last 4.5 years, as well as some impaired visual acuity in the affected (right) eye. We assessed the patient by taking a detailed history and physical examination. A Snellen chart was used to assess visual acuity, which revealed decreased acuity in the right eye as compared to the left eye. Pupillary reactions, including relative afferent pupillary reflexes, were unremarkable; anterior and posterior chamber assessment was normal including that of the optic disc and macula. Additionally, the intraocular pressure was within acceptable limits. The mass was excised surgically as it had caused significant disfigurement and posed risk to the patient in terms of the possibility for the lesion to increase in severity. It was an approach utilizing a blepharoplasty incision, horizontal wedge resection, and a frontalis sling done under general anesthesia. A biopsy of the mass identified it as a plexiform lesion of the orbit such as that attributed to neurofibromatosis type 1.

Normal interpupillary, inner canthal distance and outer canthal distance in a normal population of Pakistan.

OBJECTIVE: This study was conducted to quantify the normal indices of anthropometric measures related to ophthalmology including Interpupillary distance (IPD), Inner canthal distance (ICD), Outer canthal distance (OCD) in a normal, healthy Pakistani population. METHODS: This is a cross sectional study. Total 500 patients were chosen randomly but 499 were included in this study. Patients were selected randomly in an outpatient department of Jinnah Post Graduate Medical Centre Karachi, over the period of five months. IPD, ICD & OCD all measurements were taken with the help of plastic rule by only one researcher to minimize chances of error as much as possible. IPD was reconfirmed from auto refractometer while ICD and OCD readings were taken twice by occluding one eye of researcher to reduce error. Participants were divided into four categories on basis of: Age, Gender, ethnicity and geographical location. Patients were further categorized on basis of Ethnicity to Urdu Speaking, Sindhi, Punjabi, Pathan, and others. Moreover, four age groups were drawn ranging from 15-24 years, 25-44 years, 45-64 years and 65 years and greater. RESULTS: Our study comprised a total of 499 patents of which 272(54.5%) were males, and 227(45.5%) were females. The mean age of the participants was 39.3 ± 14.5 years. The mean values for the IPD, ICD and OCD in mm were 61.8 ± 6.2, 30.9 ± 2.9 and 85.2 ± 6.6 respectively. A statistically significant difference was observed between IPD, ICD and OCD Indices among male and female study participants (p<0.001, p=0.043, p<0.001). While comparing the IPD, ICD and OCD indices amongst the different ethnic groups, we found no statistically significant difference (p=0.09. p=0.28, p=0.06). Overall, there was no correlation between the age and other variables i.e. IPD, ICD, OCD, (r = 0.07, p = 0.085), (r = 0.005, p = 0.906), (r = -0.08, p = 0.058). CONCLUSION: This work has recommended normative values of IPD, ICD and OCD in Pakistani population on the basis different variables including gender, age, and ethnicity.