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.

Aetiology of headache in clinical ophthalmic practice at a tertiary care hospital of Karachi.

OBJECTIVE: To determine the aetiology of headache in patients seen for an ocular examination. METHODS: This cross-sectional, descriptive study was conducted at Ophthalmology Department of Karachi Medical and Dental College, Abbasi Shaheed Hospital, Karachi, from January to December 2014, and comprised patients with headache. Patients were registered through non-probability consecutive sampling technique. A predesigned proforma was used to collect data. Complete ocular examination and investigations were conducted along with neuro-ophthalmological examination. Data analysis was done using SPSS 16. RESULTS: Of the 379 patients, 225(59.4%) were female and 154(40.6%) were male. The mean age was 35.12±16.387 years (range: 6-75 years). Conditions associated with headache were divided as ocular, non-ocular and combined pathologies. Among ocular causes, asthenopia was a major entity as 62(16.36%) asthenopic patients presented with refractive errors. These were followed by presbyopics who presented with complaint of headache 56(14.78%). The number of computer users with similar complaint was 18(4.76%). Among other ocular causes of headache, the number of patients with corneal ulcers was 22(5.80%), glaucoma 15(3.96%) and endophthalmitis 4(1.06%). Among the non-ocular causes were hypertension 59(15.57%), sinusitis 41(10.82%) and migraine 47(12.4%). CONCLUSIONS: The majority of patients had associate ocular causes such as refractive errors and anterior segment pathologies.

A one-year follow-up study of ocular and systemic complications of intravitreal injection of bevacizumab (Avastin).

OBJECTIVES: To report systemic and ocular complications within a year of intravitreal injection of bevacizumab (Avastin) in ocular neovascularisation. METHODS: The quasi-experimental (randomized without control) study was carried out at the Eye Department of Abbasi Shaheed Hospital, Karachi, from July 2008 to June 2010. It comprised 150 patients selected from the outpatient department with ocular neovascularisation through non-probability purposive sampling. After detailed history and examination, the patients were counseled for intravitreal injection Avastin (bevacjzumab) which was injected into the vitreous cavity in sterile environment in the operation theatre using fully aseptic technique. The injection site was compressed for several seconds to avoid reflux when the needle was removed. Paracentesis was done following the injection as soon as possible. Patients were discharged on moxifloxcin eye drops and steroid antibiotic combination ointment at night time. They were followed up the very next day, after 2 weeks, 6 weeks, 3 months, 6 months and 1 year. Injection was repeated after 6 weeks if required and further repetition was done again after 6 weeks according to the need of the patient. RESULTS: Of the 150 patients, 93 (62%) were males and 57 (38%) were females. Most commonly presenting age group was between 50-60 years (n=51; 34%) followed by 41-50 years (n=41; 27.4%). Most common indication for intravitreal injection Avastin (bevacizumab) was proliferative diabetic retinopathy in 134 (89.33%) patients, followed by age-related macular degeneration (wet type) in 5 (3.3%) patients. Most frequently presenting ocular complication was subconjunctival haemorrhage seen in 35 (23%) patients, followed by regurgitation of drug from the site of injection in 8 (5.3%) patients, transient rise of intraocular pressure in 7 (4.7%) patients, mild uveitiS in 4 (2.7%) patients, lens injury in 3 (2%) patients, conjunctival chemosis and iatrogenic vitreous haemorrhage in 1 (0.7%) patients. Among the systemic complications were acute rise of blood pressure in 4 (2.7%) patients, and mild irritation and allergic reaction on skin in 1 (0.7%) patient. CONCLUSION: Avastin is generally a safe drug for treatment of ocular neovascularization. The complications reported were more associated with the technique of the procedure and not the drug itself and were easily manageable. Drug-related complications were limited, transient and easily managed with treatment.

Comparison of Schirmer's test and tear film breakup time test to detect tear film abnormalities in patients with pterygium.

OBJECTIVE: To compare tear film breakup time test with Schirmer's test in patients with pterygium. METHODS: The case-control study, involving 86 patients with unilateral primary pterygium aged between 30 and 70 years, was conducted at the Department of Ophthalmology, Karachi Medical and Dental College, Abbasi Shaheed Hospital, from May 2009 to December 2010. The eye with pterygium was taken as the case, and was compared with the other eye without pterygium which was taken as the control in these patients. All patients underwent routine ophthalmic examination. Tear film tests such as Schirmer's test and tear film breakup time test were performed on all these eyes. Results of tear function test between the eyes with pterygium (cases) and the eye without pterygium (control) were compared. SPSS 17 was used for statistical analysis. Chi square test was used for comparing the results of the cases and the controls. RESULTS: Of the 86 patients, 63 (73.3%) were men, while 23 (26.7%) were women. The median age was 41 years. There were 62 (72.1%) patients with pterygium in the right eye, while 24 (27.9%) had it in the left. Among the involved eyes, decreased tear breakup time (<10 seconds) was observed in 65 (75.6%) eyes, while 21 (24.4%) eyes did not show decreased tear breakup time i.e.>10 seconds. On the other hand, 8 (9.3 %) eyes with pterygium had Schirmer's test positive and 78 (90.7 %) eyes had it negative. CONCLUSION: Tear film breakup time test has better diagnostic value compared to Schirmer's test in detecting tear film abnormality in patients with pterygium.

Frequency of primary open angle glaucoma in Abbasi Shaheed Hospital.

OBJECTIVE: To determine the frequency of Primary Open-Angle Glaucoma in different age groups. Early diagnosis of Primary Open Angle Glaucoma can prevent irreversible damage to vision. METHODS: This cross sectional study was conducted at the Abbasi Shaheed Hospital, Karachi from 2005 to 2006. A total of 149 glaucoma patients between the age groups of 30 to 70 years were included. Primary Open Angle Glaucoma was diagnosed on the basis of glaucomatous optic nerve damage, abnormal visual fields and optic disc cupping with or without elevated intra ocular pressure with open-angle on gonioscopy SPSSv.8 was used for data entry and descriptive analysis. RESULTS: The total patients in less than 40 years of age group were 2 (1.34%), in 41-50 years age group were 29 (19.46%), in 51-60 years of age group were 47 (31.54%), and in 61-70 years age group were 71 (47.65%). CONCLUSION: The results show that there is a high frequency of primary open angle glaucoma among people over age of fifty years. Therefore this population in particular, should be monitored carefully for open angle glaucoma, as early diagnosis and therapy may decrease visual morbidity.