Unilateral diplopia and ptosis in a child with COVID-19 revealing third cranial nerve palsy.

We report the case of a 10-year-old boy with acute-onset diplopia and ptosis in the right eye. CR was positive for SARS-CoV-2. The patient was managed successfully with corticosteroids. We highlight the need for heightened suspicion of occult COVID-19 infection among children presenting with unusual III nerve palsy.

Plica semilunaris temporal ectopia: evidence of primary nasal pterygia traction.

PURPOSE: To study whether plica semilunaris (PS) temporal ectopia is associated with primary nasal pterygia and whether such hypothetical ectopia is linked to with-the-rule astigmatism so that a discussion of the clinical and surgical implications of such possible findings might take place. METHODS: Cross-section observational study of 208 consecutive eyes of 152 cases and 169 eyes of 109 control subjects enrolled for 6 months. Four PS position grades were designed. Grade 1 features a grossly vertical PS position. Grades 2 and 3 involve temporal displacement and an abnormal PS tilt. Grade 4 involves PS obliteration with possible associated temporal caruncle dragging. Pterygium corneal encroachment, pterygium fleshiness, and manifest refraction were recorded. RESULTS: PS position was significantly displaced temporally in pterygium-affected eyes (P = 2 x 10(-4)). Corneal encroachment (P = 2.1 x 10(-5)), pterygium fleshiness (P = 2.7 x 10(-5)), and age (P = 1.3 x 10(-2)) were positively correlated with PS position grades > 1. The presence of with-the-rule astigmatism was significantly linked to PS position grades > 1 (P = 0.01). CONCLUSIONS: Primary nasal pterygia result in PS temporal ectopia, and PS position grades (more than grade 1) are linked to the presence of with-the-rule astigmatism. These findings are consistent with the exertion of tractional forces at both pterygium ends. In eye abduction, medial canthus structures (PS, caruncule) may be dragged temporally. Thus, pterygium-related corneal traction may not always significantly increase in eye abduction. PS temporal ectopia may influence the decision to remove PS during pterygium surgical excision.

Alkali ocular burns in Martinique (French West Indies) Evaluation of the use of an amphoteric solution as the rinsing product.

PRECIS: During the 4 years of this study, we noted 66 cases of alkali ocular burns, or approximately 16 cases per year, nearly half (45.5%) of which are due to an assault. For grade 1 and 2 burns the time elapsed to reepithelialization appears to be shorter when rinsed with Diphoterine* versus physiological solution. PURPOSE: Comparison of the effectiveness of two rinsing solutions for emergency use: a physiological solution and an amphoteric solution (Diphoterine*, Laboratories Prevor, Valmondois, France). Description of the clinical and progressive characteristics of alkali burns treated at the University Hospital Center of Fort de France in Martinique (French West Indies). DESIGN: Prospective consecutive observational case series and nonrandomized comparative study. PARTICIPANTS: Sixty-six patients were included. The total number of burned eyes is 104. Forty-eight eyes (46%) were rinsed with physiological solution and 56 eyes (54%) with Diphoterine*. METHODS: All patients benefited from an ocular rinse with 500ml of physiological solution or Diphoterine*, followed by a complete ophthalmologic exam. The ocular injuries were classified according to the Roper-Hall modification of the Hughes classification system. The same standardized therapeutic protocol was applied and adapted to the seriousness of the burn. MAIN OUTCOME MEASURES: Demographic data, time to corneal reepithelialization, final best corrected visual acuity and complications were analysed. RESULTS: Twenty-eight (42.4%) patients have a unilateral burn and 38 (57.6%) patients have bilateral burns. In decreasing order of frequency, the circumstances surrounding the injury are: assaults in 45.5% of cases (n=30), work-related accidents in 32% of cases (n=31), and domestic accidents in 23% of cases (n=15). For grade 1 and 2 burns the time elapsed to reepithelialization appears to be shorter when rinsed with Diphoterine* versus physiological solution (respectively): 1.9+/-1 days versus 11.1+/-1.4 days (p=10(-7)) and 5.6+/-4.9 days versus 10+/-9.2 days (p=0.02). For grade 3 and 4 burns, there are complications in 11 cases (11.6%): 8 corneal opacities and 3 perforations. CONCLUSIONS: This study is the first conducted in humans that takes into account the type of ocular rinse product used in the progressive follow-up study of injuries. The time elapsed to reepithelialization is shorter with Diphoterine* for grade 1 and 2 burns. There are not enough cases of grade 3 and 4 burns to make a conclusion. Diphoterine* seems very effective in terms of its mechanism of action and the experimental and clinical results.

External ophthalmomyiasis caused by Dermatobia hominis. A retrospective study of nine cases and a review of the literature.

PURPOSE: To report nine cases of external ophthalmomyiasis caused by Dermatobia hominis. METHODS: Retrospective, non-comparative, interventional case series. Participants consisted of patients (n = 9) presenting at Cayenne Hospital between 1968 and 2003. The location and number of larvae, the larval stage, and the medical and surgical procedures applied were studied in each case. RESULTS: Seven patients had palpebral myiasis (including one with three larvae) and two had conjunctival myiasis. Every patient had palpebral oedema. The larval respiratory pore was located on the palpebral skin or free margin or on the conjunctiva. Movements were present within the lesion in at least three patients. Petroleum ointment or ivermectine solution was used in at least four patients to smother or kill the larvae. Extraction under local anaesthesia was possible in six patients, while three required general anaesthesia. CONCLUSION: Several larvae may be present in a patient. Topical ivermectine may help to kill the larvae before extraction is attempted.

Intraocular penetration of toxic substances

PURPOSE: The seriousness of ocular alkali burns has been linked to the rapidity with which the alkali enters the eye. The authors report the results of an experimental study on intraocular ammonia penetration. MATERIALS AND METHODS: 23 eyes of New Zealand albino rabbits were burned by applying for one minute 100 ul of a solution titrating 15.3 percent of ammonia. A pH meter probe was inserted into the anterior chamber beforehand to permit pH measurements every 5 seconds. Experiments were carried out after 1,3,5,10 and 30 minutes. The ammonia concentration was measured at the end of the experiment by puncturing the anterior chamber. RESULTS: The pH increased 1 to 3 minutes after applying ammonia on the cornea, reaching a maximum (mean) of 10 five to six minutes later, before an exponential decrease. After 30 minutes, the pH was always more than the physiological pH. The penetration ratio of ammonia through the cornea is about 11 percent. At 30 minutes, the concentration of ammonia is low. The pH observed differs from the calculated pH. DISCUSSION: The difference between observed and calculated pH indicates increases with an intervening plateau, showing the existence of two successive acid-base chemical reactions between ammonia and two types of acid. In addition, the amount of protein destroyed by ammonia can be calculated. CONCLUSIONS: These data show for the time the possibility of calculating the density of proteins destroyed in vivo by a base penetrating the anterior chamber. This opens the possibilty of interesting research work, because it is possible to relate the density of proteins destroyed in the eye to the pK of this base, and to forecast the potential danger of a base of biological tissues.(AU)

Ocular ammonia burns: treatment

PURPOSE: The authors present the results of an experimental study to support the proposal for a delay in ocular bathing in the treatment of severe ocular burns due to ammonia. This study compares two solution of ocular wash: physiological serum and Diphoterine. MATERIALS AND METHODS: 23 eyes of New Zealand albino rabbits were burned for one minute by 100 ul of a solution containing 15.3 percent ammonia. Then, each eye was washed by an ocular wash of 250 ml of physiological serum, or of 250 ml of Diphoterine, after a delay of 1,3,5,10 and 30 minutes. The effects were appraised by measuring the anterior chamber, the concentration of ammonia in the anterior chamber, and by the cytopathological analysis of these burned corneas. RESULTS: An ocular wash with Diphoterine in the first few minutes following an ocular burn induces an inflexion of the pH graph, contrary to an ocular wash with physiological serum. On the other hand, there is no inflexion of the pH graph at 30 minutes, and the concentration of ammonia in the anterior chamber is low at that time. The cytopathological analysis shows stromal oedema with the ocular wash by physiological serum, but not when Diphoterine ocular wash is used. DISCUSSION AND CONCLUSIONS: This study proves the importance of ocular bathing in the first minutes following an ocular burn by ammonia. The efficacy of an external ocular wash by Diphoterine features; the importanve of sequelae has been linked to the initial stromal oedema.(AU)

Ocular alkali burns: limbal autograft

The authors present five patients treated with limbal autograft for serious recent ocular alkali burns, in four of whom it has permitted healing of recurrent corneal ulcers or the reduction in the period of conjunctival recovery. Functional amelioration is also important and this intervention has permitted a useful visual acuity. One case was complicated by bacterial keratitis, but our experience has confirmed the efficacy of the technique for managing surface ocular disorders. However there have been few reports hitherto of the use of limbal autografts for serious ocular burns, and our study has demonstrated its usefulness in this setting and the appropriate timing. VIDEOTAPES(U-Matic or VHS): The authors report their surgical technique of limbal autograft use in recent and severe ocular burn, a modification of Kenyon and Tseng's technique. The physical signs used as indicators for surgery, the selection of the limbal region and methods of following the graft, are presented.(AU)