Orbital Tumors and Tumor like Lesions: A Hospital Based Study.

BACKGROUND: Orbital tumors have rare incidence, still they play a significant role in terms of morbidity and mortality. Orbital tumors may be primary, secondary or metastatic. These consist of benign and malignant lesions with extreme variations in pediatric and adult groups. These lesions can have acute or chronic onset, slow to rapid progression with or without bony destructions leading to vision loss, deformity and sometimes death. METHODS: This retrospective cross-sectional study was carried out in the Department of Ophthalmic Pathology and Laboratory Medicine in Biratnagar Eye Hospital. Fifty-one patients who underwent histopathological evaluation for their orbital lesions from June 2018 to December 2019 were included in the study. RESULTS: Orbital tumor and tumor like lesions comprised 27 cases (52.94%) in adults and 24 (47.06%) in paediatrics. Histopathologically, the most common pediatric benign tumor was dermoid cyst and malignant was secondary to orbital extension of retinoblastoma. Also, the most common adult benign orbital tumor was cavernous hemangioma and malignant was non Hodgkins lymphoma. The clinico-pathological accuracy for diagnosis was 68.63%. Association between age groups and nature of orbital lesions and between clinical and histopathological diagnosis was found to be statistically significant (p<0.05). CONCLUSIONS: Orbital tumors and tumor like lesions are uncommonly encountered. These masses showed significant variation in incidence in children versus adults. Combined efforts by different specialties help in early and prompt management of the orbital tumors.

Positive Microbiological Stains of Corneal Scrapings among Patients with Keratitis in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Keratitis, an ocular emergency, requires rapid and accurate treatment to prevent vision impairment. Wet mount direct microscopy examination of corneal scraping smear using gram and 10% potassium hydroxide stain helps in early diagnosis and treatment. The main objective of this study was to find out the prevalence of positive microbiological stains of corneal scrapings among patients with keratitis in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Department of Ophthalmic Pathology and Laboratory Medicine from January, 2018 to December, 2019. Data collection was done after taking ethical approval from the Institutional Review Committee of the hospital (Reference number: BEH-IRC-35/A). All corneal smear samples received in this department were included in this study. Case records with incomplete data were excluded. Whole sampling was done. The data were analyzed using Statistical Package for the Social Sciences version 22.0. Frequency and percentage was calculated for binary data. Results: Among 4631 corneal scrapings, microbiological stains were positive in 3538 (76.40%) patients. Conclusions: The prevalence of positive microbiological stains of corneal scrapings in our study was higher in comparison to other studies done in similar settings. This technique could be used where culture facilities are unavailable or unaffordable. Keywords: keratitis; microscopy; Nepal.

Orbital Myocysticercosis different Presentation and Management in Eastern Nepal.

INTRODUCTION: Ocular cysticercosis is a preventable cause of blindness. It is caused by parasitic infestation caused by the larval form of Taenia solium. Poor sanitation and improper management of food and meat products are the major causes for cysticercosis infestation. CASE: Two cases of myocysticercosis presented to our hospital differently. A 12 years boy, first case presented with drooping of right eye (RE) upper lid with recurrent swelling, pain, redness with mild headache and intermittent vomiting for 1 and half months. On examination swelling of RE upper lid, mild ptosis, abaxial proptosis with restricted motility in upgaze was noted. Orbital CT (computer tomography) scan and ocular ultrasound reports showed findings suggestive of myocysticercosis of superior rectus muscle of RE. Routine microscopic examination (RME) of stool demonstrated eggs of Taenia. Complete blood count (CBC) showed eosinophilia. As a suspected case of myocysticercosis and since the patient resided at an endemic zone, empirical therapy with albendazole and steroid was started to continue for 4 weeks. After one week the patient presented with features suggestive of RE orbital cellulitis. With proper counseling about medical therapy and cyst excision, the patient recovered well with only mild RE upper lid ptosis of 2mm. The histopathological examination (HPE) of the excised cyst was suggestive of inflammatory cystic lesion. A 55 years male presented as a second case to us with gradually increasing mass in the RE lower lid with a history of pain, difficulty in opening RE and intermittent swelling of RE 2 months back. On examination RE lower lid mass with exotropia of 15 degree, mild hypertropia was noted. CT scan showed presence of cystic mass 3.5x2x1.5cm in the right orbit involving the right inferior rectus muscle, abutting and displacing the globe superolaterally. CBC showed eosinophilia. Post cyst excision patient recovered well with remaining mild restriction in infraduction most probably due to fibrosis. HPE was conclusive of cysticercus cellulosae. Both the patients improved well with no recurrence until last visit 17 months in 12 years boy and 6 months in 55 years male after which he lost to follow. CONCLUSION: Myocysticercosis can occur at any age. There is equal importance of clinical, radiological, microbiological and histopathological support for proper diagnosis and management of cysticercosis. Medical therapy along with surgical excision of the cyst with it's content may be needed in the management of myocysticersosis.