Purpose: The purpose was to highlight the potential dangers of the air gun loaded with carbide commonly used by the farmers, causing injury to the eye. Scare airguns are used to prevent the birds from destroying the crops in their fields. Method: This was an observational study. Results: A 44-year-old Indian male presented to us with redness, diminution of vision, and mucopurulent discharge in his right eye (RE). On evaluation, it showed lid edema, excoriations, conjunctival congestion, corneal epithelial defect, anterior chamber inflammation, and hyphema in his RE. On his last follow-up a month later, hyphema and anterior chamber inflammation had resolved in his RE with an improved visual acuity. He was also educated about the dangers of using illegal air guns. Conclusion: Eye protection should be used when using devices that are inflammable. Ocular air gun injuries can range from some causing minor corneal abrasions to potentially serious ones. Due to the timely evaluation and treatment of our patient, the patient did not suffer significant visual morbidity.

The m.3243A>G variant in the MTL1 gene is a DNA point mutation which has been shown to cause a variety of diseases including retinal abnormalities. We report on the ophthalmologic phenotype and systemic findings in a new patient with this mutation, presenting with sensorineural hearing loss, diabetes and macular dystrophy. We characterized the retinal phenotype with a multimodal approach and throughout the follow-up period we observed sustained centripetal progression of the areas of chorioretinal atrophy.

The simultaneous occurrence of an infectious and an autoimmune systemic disorder associated with bilateral panuveitis is always feasible but improbable. While Vogt-Koyanagi-Harada requires prompt systemic corticosteroids and immunosuppressives, ocular tuberculosis (TB) requires multiple antibiotic therapies, and to a certain extent, corticosteroids to avoid inflammatory damage to crucial intraocular structures. We report a patient with granulomatous bilateral panuveitis, in which VKH and ocular TB were diagnosed simultaneously. This case emphasizes the importance of ruling out TB in the presence of a granulomatous panuveitis, despite the lack of pulmonary manifestations, especially in an endemic country. The hindmost because both diseases require different treatments.

Epibulbar choristomas are benign congenital ocular tumors characterized by abnormal growth in the epibulbar tissue, eyelids, and choroids. Two cases of epibulbar choristomas are described; the first one is a 39-year-old woman who presented a temporally conjunctival mass that had progressed in size accompanied by foreign body sensation and epiphora. Optical coherence tomography (OCT) and surgical resection were performed with a histopathological diagnosis of dermolipoma. The second case is a 7-year-old boy with a congenital corneal lesion in the nasal sector, elevated, vascularized, and with decreased visual acuity. In both cases, OCT showed a thinned epithelium with hyporeflective subepithelial fusiform lesions. OCT is an auxiliary method for the diagnosis of conjunctival lesions, such as epibulbar choristomas.

Objective: There is value in understanding the common etiologies of epiphora within different patient populations as well as identifying barriers to adequate treatment and symptom relief. The primary goal of the study is to report common etiologies of epiphora and the impact of treatment in patients of a large, inner-city hospital. Methods: This is a retrospective review of 10 years of data from the charts of 516 adult patients. The most common diagnoses and interventions linked to this symptom were evaluated. Subjective symptom improvement and adherence to follow-up were also analyzed. Results: Three hundred (58.1%) patients carried a diagnosis of dry eye syndrome and, of these, 40.1% did not have other ocular findings to explain their epiphora. Conservative management (CM) was recommended to the majority (86.4%) of the study population. 27.5% of the 357 patients who received CM as the only intervention reported symptom improvement. 90.1% of patients who underwent DCR reported symptom improvement. Nearly half of the patients were lost to follow-up. Conclusion: Epiphora is a common symptom that may be multifactorial in etiology, making effective treatment a challenge. Reflex tearing secondary to ocular surface dryness was the most common etiology linked to epiphora in this study. Low rates of follow-up limit the ability to fully assess the impact of current interventions on symptoms. Addressing the socioeconomic barriers that lower patient adherence to follow-up should allow more effective treatment of epiphora.

Purpose: The use of ergonomic practices and ergonomic environment should be encouraged to combat digital eye strain (DES) symptoms. Objectives: The objective of the study was to assess the effect of online classes on ocular health of school-going children during COVID-19 crisis. Materials and Methods: An online pretested, self-reported questionnaire with relevant details was generated through Google Forms and sent to participants. Results: The most common symptoms associated with DES in our study were eyestrain, 27.4% (N = 82), and headache, 26.8% (N = 80) (P = 0.001). There was a positive correlation of number and frequency of symptoms with increasing age and class standard of participants (P = 0.001), usage of multiple screens as well as smartphones (P = 0.004), the time spent on digital screen (P = 0.00), and continuous screen time (P = 0.004). Increasing screen distance had a negative correlation to number and frequency of symptoms (P = 0.03). Conclusion: COVID-19 pandemic has bought DES once again into limelight due its implications on overall physical, mental, and social health of adults as well as children. It is high time for a coordinated approach to spread education and promotion of ocular health in the community with emphasis on reduction of screen time, inculcation of ergonomic practices, and role model behavior of parents. This survey also gives an insight on the measures needed to be taken for safety of our children's ocular health, and therefore, it would reduce the stress faced by their parents.

Takayasu's arteritis (TKA) is a chronic, granulomatous, systemic vasculitis affecting the aorta and its branches. Ocular manifestations in patients with TKA play an important role in determining the visual prognosis. We describe a case of a young female with complaints of painless, progressive loss of vision in both eyes for 6 months who was clinically diagnosed with TKA. Her laboratory and radiological investigations confirmed the diagnosis. She had a bilateral cataract and operated for cataract in the right eye with guarded visual prognosis. This case report highlights the importance of creating awareness among ophthalmologists for early diagnosis and multidisciplinary management in cases of TKA for the prevention of blindness.

Aim: The aim of the present study was to compare the central and peripheral corneal thickness before and after cataract surgery during three postoperative visits. Materials and Methods: Prospective, comparative study was carried out among 92 patients who underwent cataract surgery in right eye. The central and peripheral corneal thickness (nasal, temporal, superior, and inferior) was measured using anterior segment optical coherence tomography before and after cataract surgery. The mean value of the corneal thickness was compared between preoperative and postoperative. Results: The central corneal thickness (CCT) showed statistically significant differences between preoperative and postoperative measurement during all follow-up visits including 3 days. We also found statistically significant differences at all locations during a postoperative visit at 3 days. Superior, nasal, and inferior points on cornea were found to have significant differences when measured preoperatively and postoperatively at 1 month. A positive correlation was established between cataract grade and CCT during a postoperative 3-day visit using Pearson's correlation. Conclusion: CCT was found to increase significantly after cataract surgery. There was a significant increase in peripheral corneal thickness right after cataract surgery.

Introduction: Glaucoma is the most common cause of irreversible blindness in the world. Although smoking has an important vascular and oxidative role in cardiovascular diseases, the association of smoking with the development and evolution of glaucoma is still controversial. In this study, we aimed to correlate smoking with the incidence of glaucoma. Subjects and Methods: A retrospective study of 442 postmortem paired donor eyes obtained from the Minnesota Lions Eye Bank of Canada (Toronto, Ont.) between 2015 and 2019 was evaluated. All donors' eyes were collected with detailed clinical history, including the glaucoma diagnosis, gender, and smoking habits. A statistical analysis and correlation between these variables were performed. Results: No correlation was found between glaucoma and smoking when the total number of smokers of both genders were examined (P = 0.258). However, male patients demonstrated a significant positive correlation (P = 0.008). This correlation was not observed when only female patients were evaluated (P = 0.077). In addition, the eyes of patients, between 70 and 75 years of age (P = 0.04) and 76 and 80 years of age who were smokers, demonstrated an increased risk of glaucoma (P = 0.027). This relationship was even stronger for males between 76 and 80 years of age (P = 0.006). Interestingly, the duration of the smoking habit showed no correlation to the development of glaucoma. Conclusion: An association of smoking and glaucoma was found in patients between 70 and 80 years of age, particularly male patients. Further investigation will be conducted examining the histopathological features and other comorbidities to better elucidate these findings.

Intracranial tumors are known to have a broad clinical spectrum. Meningiomas are the second-most common benign tumors, usually affecting women in their sixth or seventh decade of life. The World Health Organization (WHO) classified them into three grades, and Grade 1 meningiomas are considered benign neoplasias. Despite being benign, they are usually located in noble areas of the brain, most frequently in the parasagittal area, followed by the falx, the sinus cavernosus, tuberculum sellae (5%–10%), lamina cribrosa, foramen magnum, and torcular zones, and are important causes of sequelae to the patient. We herein present the case of a young patient who experienced overnight visual loss. Literature shows that several factors are related to visual recovery, which is divided into phases and occurs in approximately 23%–80% of the cases. For the WHO grade 1 tumors, the standard treatment is complete excision of the mass, and it is possible to supplement treatment with stereotactic radiotherapy in atypical, malignant, or recurrent meningioma.

Objective: The objective of this study is to report a case of superior orbital fissure syndrome (SOFS), secondary to ocular herpes zoster, with a favorable evolution. Materials and Methods: Herpes zoster ophthalmicus (HZO) usually presents with ocular manifestations, being infrequent with the ophthalmoplegia. SOFS secondary to HZO is rare. We present the case of a 72-year-old man with dermatome involvement of the first left trigeminal branch, secondary to herpes zoster infection, who also developed herpetic keratitis in the left eye. After 8 days of antiviral treatment, he developed total left eye ophthalmoplegia that required steroid treatment. The evolution of the ophthalmoplegia was favorable with resolution at 3 months of follow-up. Conclusions: It is essential to make known one of the complications of HZO infection, although not as frequent, just as important, is to recognize this pathology when it occurs for prompt management and recovery.

Objective: This study aimed to examine the frequency of atypical features in conjunctival nevi in pediatric patients referred to the McGill University Health Center-McGill University Ocular Pathology and Translational Research Laboratory and to emphasize the importance of histopathological analysis to rule out malignant lesions, such as melanoma. Methods: Forty-four pediatric patients younger than 20 years of age previously diagnosed with melanocytic lesions of the conjunctiva were included in this study, and the database was analyzed for a 10-year period (2006–2015). Clinical information such as age, gender, location, type, size, and agreement between clinical and pathological diagnosis was also recorded and presented as means and percentages. Results: The mean age was 11.3 years, of which only 9.1% were older than 18 years. Gender predilection was found toward males (52.3%). An agreement was noted between clinical and pathological diagnosis in 77.2% of cases; only 22.72% showed atypia upon histopathological examination. The most common pathological diagnosis was compound nevus with different characteristics. The atypical lesions included conjunctival melanoma, junctional nevi with atypia, compound nevi with atypia, and cystic compound nevi. Moreover, 70% of the patients with atypical lesions were males and 60% of the specimens were from the right eye. Conclusion: An impressive number of 30% of all patients had some type of atypia after histopathological analysis. Therefore, based on these results, it is of extreme importance that all melanocytic lesions are sent for histopathological analysis, so an accurate diagnosis can be established.

Introduction: Pterygium represents a significant cause of visual impairment and blindness in the Amazon and surgery is the only definitive treatment available. The cost of surgery and the need for prolonged postoperative follow-up have proved to be an obstacle to its management. The aim of this prospective study carried out in the southern region of the Amazon was to evaluate telemedicine in the pterygium surgery follow-up to help make pterygium surgery postoperative care feasible in places without ophthalmologic assistance. Materials and Methods: Postoperative follow-up care was done through teleconsultation. It involved capturing photographs from the corneal and conjunctiva by trained technicians and sending them to a reading center for an ophthalmologist's assessment based on an asynchronous (store-and-forward) model. Patients and ophthalmologists were inquired about their satisfaction regarding the postoperative follow-up. Results: All pictures were classified as adequate, allowing proper assessments of results and complications. It was possible to manage the postoperative and conclude there were no postoperative surgical complications during the 6-month follow-up. All patients reported satisfaction with the remote performed evaluation and considered that all their doubts and expectations were met. Conclusion: Teleophthalmology allows remote access and can significantly improve eye care quality, access, and affordability. It may represent an alternative to providing pterygium surgery postoperative monitoring in areas without the availability of an ophthalmologist, making it possible to combat one of the leading causes of reversible blindness in the equatorial region.

Open ocular trauma at the posterior segment can present with nonobvious scleral injuries, which represents a diagnostic challenge. The purpose of this article is to describe an atypical case of occult posterior scleral lesion. We present a clinical case of a 22-year-old man who consulted for a blunt trauma in his left eye. Physical examination revealed decreased visual acuity and vitreous hemorrhage without visualization of the posterior segment. Axial head computed tomography scan showed continuity solution of the posterior ocular wall, so the patient was taken to surgery with intraoperative atypical findings of loss of temporal retinal tissue with macular involvement, with good postoperative clinical course. In conclusion, high-energy trauma with both sharp and blunt mechanisms can generate posterior segment injuries such as occult posterior scleral rupture and even avulsion of retinal tissue in the macular area. Timely diagnosis and treatment of this type of injury is imperative for the patient's visual prognosis.

Objectives: To evaluate if the Weill Cornell Medicine (WCM) Ophthalmology Virtual Elective provided students with 1) an increased knowledge of ophthalmology, 2) an understanding of the residency program and department, and 3) an opportunity for the program faculty to become acquainted with the students. To determine how future virtual electives may be improved to increase efficacy of achieving these objectives. Methods: A 2-week virtual ophthalmology elective was offered to 4^th-year medical students. The curriculum included dedicated medical student lectures and assignments and supplemental resources from the American Academy of Ophthalmology. Students also participated in grand rounds, resident morning lectures, and delivered case presentations to the faculty. Pre- and postassessments were performed to evaluate medical knowledge, and a subjective experience survey was distributed to evaluate faculty and student experiences. Results: Seventeen, fourth-year medical students participated in the elective, and 12 students completed the voluntary pre- and postassessments of medical knowledge. Significant improvement in medical knowledge was noted. Median preassessment score was 80% (interquartile range [IQR]: 78%, 83%), and the median postassessment score was 100% (IQR: 90%, 100%), P = 0.0055. Sixteen students and four faculty members completed their respective subjective experiences in a Likert scale survey. Most students indicated they felt fairly confident or very confident that they had acquired knowledge, made relationships with faculty, and had become familiar with the program and departmental culture. All faculties indicated they agreed or strongly agreed that they were able to assess students' abilities and establish rapport with the students. Both students and faculty felt limited in the assessment of clinical skills due to a lack of in-person activities. Conclusions: Despite its inherent limitations, an ophthalmology virtual elective can effectively increase interest and knowledge within the field of ophthalmology, facilitate student–faculty relations, and serve as a tool for residency programs in the era of COVID-19 and thereafter.

Parinaud's Oculoglandular Syndrome (POGS) is a rare and atypical form of granulomatous conjunctivitis, classically composed of a triad: fever, unilateral granulomatous follicular conjunctivitis and preauricular satellite lymphadenopathy or ipsilateral submandibular, commonly related to cat scratch disease caused mainly by Bartonella henselae, or also caused, even if not tipically, by Sporothrix schenckii. In endemic areas, such as in South America, especially Brazil and Peru, ocular sporotrichosis, associated with POGS, should be considered a diagnostic hypothesis of ophthalmic diseases especially if this patient has a history of contact with cats . Itraconazole must be the first choice of medication for treatment and this patient would need assistance until complete clinical improvement, with family members oriented about possible sources of contamination, being important the early and appropriate treatment, due to the risk of eye sequelae . As a neglected public health problem in Brazil, where there has been a large increase in cases in the last decades, an accurate understanding of this disease is essential, with focus in the southeast region, mostly in the state of Rio de Janeiro.

Radial keratotomy (RK) was a popular refractive procedure in the 90s. However, more reproducible laser-assisted surgeries are currently preferred. Furthermore, RK patients who undergo cataract surgery experience variable refractive and keratometric changes during the early postoperatory period. Unfortunately, those post-RK patients currently require cataract surgery. A 58-year-old male with a history of RK in both eyes (OU) presented with a 2-year history of night glare and progressive vision loss due to a subcapsular cataract in OU. Using the double-K Holladay formula, bilateral phacoemulsification was performed. At 1 week, refraction was + 2.25/-1.00/27° (power [Pwr]: 39.25D) in oculus dextrus (OD) and + 3.00/−0.75/171° in oculus sinister (OS) (Pwr: 37.41D), achieving a best-corrected visual acuity (BCVA) of 20/30 OU. At 6 weeks, refraction was + 0.75/−0.75/18° (Pwr: 39.71D) in OD and + 1.00/−0.25/180° (Pwr: 38.33) in OS. BCVA remained 20/30 OU. The resulting transitory hyperopic shift after surgery demands a careful and comprehensive intraocular lens calculation preferably aiming toward myopic overcorrection.

Lyme disease is a multisystemic infection caused by the spirochete bacterium Borrelia burgdorferi, transmitted by the tick of the genus Ixodes sp. and has three stages: primary, secondary, and tertiary. Ocular involvement is possible in any of these stages. Neuroretinitis is a rare manifestation. It is recommended that the diagnosis be performed by serology using an immunoenzymatic test, and confirmed by the Western Blot test. The recommended therapy is doxycycline 100 mg 12/12 h or 200 mg once a day for 14 days to 21 days or amoxicillin 500 mg three times a day for 14–21 days. We herein present a patient who had neuroretinitis related to a previous diagnosis of Lyme disease. The presence of neuroretinitis in a setting of Lyme disease represents a very uncommon manifestation of this particular infection.

This is a case report of a 61-year-old woman who was referred to the PUC Campinas Hospital due to a femoral fracture. Ophthalmological evaluation was requested due to complaints of enophthalmos and low visual acuity, which showed signs suggestive of an orbital tumor. Physical and complementary examinations were important for the confirmation of metastatic orbital carcinoma. Knowing that breast cancer is the most common primary tumor site involved in orbital metastasis in women, this study aimed to highlight the importance of prompt recognition and appropriate diagnostic and therapeutic management in these cases.

The German pathologist Friedrich Wegener described granulomatosis with polyangiitis (GPA), formerly known as Wegener's Granulomatosis, in 1936. Lesions are inflammatory, and typically include vasculitis, necrosis, and granulomatous changes. Ocular symptoms may be the first manifestation of this disease in 16%–58% of cases. The ocular manifestations of GPA occur in the most diverse ways. Delayed diagnosis can have serious consequences for patients' vision, as can the preservation of the globe, in addition to other systemic involvement, which can be rapidly progressive in some cases, leading to long-term disability or mortality.

Aim: The aim of this study is to determine the magnitude and severity of dry eye disease (DED) in medical students as per assessed by the questionnaire Ocular Surface Disease Index (OSDI) and Schirmer's test. Materials and Methods: A cross-sectional study of a 2-month duration involving medical students was conducted to determine the magnitude and severity of DED. Dry eye was assessed through self-administered questionnaire, Schirmer's test, and OSDI scoring. Results: The most common symptom among the participants was eyestrain in 39% (N = 31) followed by headache in 33% (N = 26). Based on Schirmer's test, 75% (n = 60) of the participants were normal, 8% (n = 6) students had mild DED, 5% (N = 4) students with moderate DED, and 11% (N = 9) students had severe DED. Based on OSDI scoring, 59% (n = 47) participants were normal, 28% (n = 21) had mild DED, 11% (N = 9) had moderate, while 2% (N = 2) had severe DED. Conclusion: In this era of digitalization, DED has engulfed the younger population who are spending greater hours on different digital devices. The prevalence of symptomatic dry eyes in our study was 41% while it was 25% based on signs. This should raise concern among the caregivers to increase awareness regarding dry eyes and give strict guidelines restricting screen time. The use of ergonomic practices such as appropriate lighting in a room, adjusting digital screen parameters (resolution, text size, contrast, and luminance), and taking frequent breaks while using the screen should be encouraged.

World Sickle Cell Awareness Day is celebrated every June 19 to raise awareness for sickle cell disease (SCD). Access to health services remains unequitable in countries affected by the disease and stigma surrounding patients hinders access to therapies. SCD is the most common severe monogenic disease in the world and is characterized by abnormal hemoglobin production. Major complications include vaso-occlusive events, hemolytic anemia, and inflammation. Microvascular events in the eye are namely responsible for sickle cell retinopathy with or without vasoproliferative changes. Methods included the electronic search of peer-reviewed English literature published until 2021, which was screened, appraised in full version, and incorporated into the review as deemed necessary. This review provides a summary of disease mechanisms and ocular manifestations, and highlights the importance of early diagnosis, close management with imaging technology, and therapeutic avenues for patients with SCD. In addition to significant healthcare barriers encountered by patients and their families, early diagnosis for SCD must be posed by physicians. It is crucial for the healthcare community to become better familiarized with the disease manifestations for early recognition and prevention of chronic complications and morbidity.

This is a retrospective case report of a male patient referred to the PUC Campinas Hospital as a victim of blunt car trauma. On ophthalmological examination, the patient had bilateral retinal changes in the foveal region, causing low visual acuity in both eyes. Knowing that ocular trauma is the main cause of legal blindness in working-age people, this study aimed to highlight the importance of ophthalmological evaluation to provide the necessary treatment and follow-up to minimize the ocular sequelae resulting from trauma.

Retrobulbar hemorrhage (RBH) is an ophthalmological complication with the potential risk of irreversible blindness due to the compressive effect on the optic nerve. Cases of patients with a history of antiaggregation and/or anticoagulation therapy and RBH have been reported in the literature; ophthalmologists should keep this antecedent in mind and consider the risk–benefit of surgery while working in conjunction with the area of anesthesia to establish the times when medication is suspended or initiated. Similarly, early and timely identification of signs and symptoms related to this complication improves patients' visual prognosis. The following describes the case of a patient who had RBH associated with the use of antiplatelet therapy.

The utility of retropupillary (RP) iris-fixated lenses, even when the iris support is deemed inadequate is portrayed in this case series. The case series emphasizes iris-claw lens as an effective alternative in cases where there is a disfigurement of the iris with meticulous surgical skills. A 58-year-old with diminution of vision in the right eye for 6 months had a vision of 6/60, iris coloboma inferiorly with zonule loss and cataractous lens. Manual small-incision cataract surgery (M-SICS) was performed with placement of iris-claw lens despite the presence of iris disfiguration. A 62-year-old male with diminution of vision in the left eye had a vision of counting fingers at 1 m. On slit-lamp examination, iris atrophy, an oval-shaped pupil with a maximum of 5 mm eccentric dilation, cataractous lens inferiorly subluxated and partially absorbed, a breach in the anterior capsule, and vitreous strands were noted in the anterior chamber. M-SICS with iris-claw lens was then performed. A 3-year-old female child with a history of trauma to the left eye had a vision of perception of light only. On anterior segment evaluation, she had radial, full-thickness corneoscleral tear with iris plugging the wound, iris trauma, and traumatic immature cataract. Left eye corneal tear repair with cataract extraction and iris-claw insertion was performed. Postoperative vision on follow-up after a month was 6/12p in all three cases. Iris claw lens being readily available, and surgical technique of insertion being easy and quick, serves as one of the effective alternatives for the intraocular lens in difficult situations.

We report a rare case of ocular cryptococcosis that presents as chorioretinitis in a patient with acquired immunodeficiency syndrome.

Ocular surface complications secondary to continuous positive airway pressure (CPAP) machines have been previously reported such as ocular irritation, dry eye disease, lid laxity, and floppy eyelid syndrome. No severe ocular complications have been specified in the literature. We report a serious ocular complication in a patient under helmet CPAP (hCPAP). A 68-year-old male with COVID-19 pneumonia required ventilatory support with hCPAP. Following 5 days, the patient started complaining of ocular discomfort, purulent discharge in his left eye, and ocular dryness upon awakening. Ophthalmological examination showed no light perception in the left eye and slit-lamp biomicroscopy revealed atalamia, loss of corneal transparency with superior infiltrates, and a total epithelial defect with iris herniation and a central perforation. Considering the patient's progressive worsening clinical condition, with a painful blind eye, left evisceration was performed. It is important to be aware of possible ophthalmological complications related to ventilation since prompt diagnosis and treatment can avoid poor visual outcomes. In this clinical case, we faced a serious ocular complication following hCPAP ventilation.

Exotropia is a cosmetically distressing strabismus with lasting negative psychosocial impact on the patient. Aim: The purpose of our study was to apply the Classification of Eye Movement Abnormalities and Strabismus (CEMAS) to the patients of exotropia (XT) in our study, identify the common types and causes of this cosmetically and psychosocially distressing strabismus, and to determine if any of these causes are preventable. Materials and Methods: A prospective, cross-sectional study was carried out in patients aged 6 months and more with exotropia attending the ophthalmology outpatient department of a tertiary care hospital from December 2016 to July 2018. Complete strabismus evaluation of the patients was done, the exotropia seen in the patients was categorized in types according to the CEMAS classification and possible causes of exotropia were studied. Results: Of the total 120 patients, 110 had comitant XT, whereas 10 had incomitant. Of the 110 comitant cases, intermittent XT was maximum – 54 (45%). A significant number of patients had XT due to sensory or neurological causes 46 (38.8%). The etiology of XT due to sensory or neurological causes included amblyopia due to uncorrected refractive errors, trauma, media opacities in cornea and lens, and posterior segment diseases. Other causes included developmental delay, congenital fibrosis of the extraocular muscles, isolated 3^rd N palsy, and basic XT. Conclusions: Our study shows that although majority of the patients had intermittent exotropia, a significant number of patients had exotropia due to visual or neurological causes, which may be preventable in many cases. Diagnosis of the cause of XT at the appropriate time may prevent unnecessary visual loss and reduce the negative psychosocial impact of squint.

Coronavirus disease (COVID)-19 is associated with ophthalmic manifestations during and after recovery from the disease and may be sight-threatening. A 54-year-old Asian Indian female patient presented to us with redness, pain, and blurred vision in her right eye (RE) of 2-day duration. In RE, the best-corrected visual acuity was 20/25, and she was diagnosed with anterior sclero-uveitis. Three days later, she had mild breathlessness and loss of taste. Nasopharyngeal swab for reverse transcription–polymerase chain reaction-COVID-19 was positive, and investigations for uveitis were negative. The systemic evaluation was also within normal limits. A month later, she had no evidence of ocular inflammation. There was no other attributable cause to her ocular inflammation. Her COVID-19 immunoglobulin G antibody was positive, confirming the previous COVID-19 infection. The case emphasizes the importance for eye care professionals to remain vigilant and considers SARS-CoV-2 as the causative agent in patients presenting with anterior segment inflammation.

Spherophakia is usually associated with systemic disorders but may also present as an isolated entity. Spherophakia patients often present in adolescence or before 50 years of age. Here, we describe a case of isolated spherophakia in a 61-year-old woman with bilateral angle closure and cataract managed by lens extraction and retropupillary iris-claw lens implantation.

Purpose: The purpose of this study is to compare analgesic, akinetic effects, and safety profile of sub-Tenon's and peribulbar anesthesia in manual small-incision cataract surgery (MSICS). Materials and Methods: In a hospital-based randomized, comparative study, patients who fulfilled inclusion criteria and who have been posted for elective surgery for uncomplicated cataracts were randomized to receive either sub-Tenon's or peribulbar block. Pain during anesthesia and surgery, akinesia, lid movements during surgery, and complications after anesthesia were assessed. Results: A total of 120 eyes of 120 patients were studied. Of which, 60 underwent sub-Tenon and another 60 had undergone peribulbar block. Pain during anesthesia was significantly less in sub-Tenon group (37/60, 61.6%) than peribulbar group (10/60, 16.6%), whereas pain during surgery was comparable in both groups, 40/60 (66.6%) in sub-Tenon group and 45/60 (75%) in peribulbar group. Peribulbar group has significantly Grade 0 akinesia (31/60, (51.7%) than 0% in sub-Tenon group. Mild complications such as chemosis 34/60 (56.7%) and subconjunctival hemorrhage (37/60, 61.7%) were more in sub-Tenon group than in the peribulbar group, 17/60 (28.3%) and 22/60 (36.7%), respectively. Conclusion: This study has shown that sub-Tenon's anesthesia provides adequate analgesia and akinesia for cataract surgery with minimal and less severe complications. Therefore, sub-Tenon's anesthesia is a relatively safe method with lesser learning curve, effective, and alternate to peribulbar anesthesia for MSICS.

Aim: The aim was to study the impact of COVID-19 pandemic on vitreoretinal practice in a tertiary care government hospital in Central India. Setting: This study was conducted at a tertiary care hospital in Central India. Design: This was a retrospective, cross-sectional, observational, comparative study. Patients and Methods: Records of all patients coming to the outpatient department of ophthalmology for vitreoretinal consultation from March 24 to September 30 in 2 consecutive years 2019 and 2020 were retrieved. Demographic profile and details of the diagnosis and treatment offered were noted and entered into the Excel sheet. Data were subjected to statistical analysis. Results: The number of patients presenting to the retina department from March 24 to September 30 came down from 1748 in 2019 to 836 in 2020, representing a 47.8% drop. Similarly, the number of major procedures was reduced from 178 in 2019 to 50 in 2020. Minor procedures such as intravitreal injections showed a reduction from 103 in 2019 to 38 in 2020 (37.2%). Conclusion: COVID-19 adversely impacted vitreoretinal practice in a tertiary care government hospital in Central India. This led to a severe loss of vision in several patients, affecting their quality of life.

Purpose: To evaluate the outcomes of our institution, the National Ocular Oncology Reference Center (Centro Hospitalar e Universitário de Coimbra) on Episcleral Brachytherapy (EBT) for the treatment of uveal melanoma (UM), since its beginning in November 2013, regarding local control, survival rates, metastatic rates, and side effects and to compare them with the international literature. Materials and Methods: Prospective study of patients referred to the Ocular Oncology Reference Center and treated with EBT between November 2013 and August 2020. Data were collected regarding local control, survival, distant metastasis, and treatment side effects. Data analysis evaluated treatment outcomes and radiation side effects. Results: A total of 150 patients underwent EBT but only 143 were considered for analysis. In 95.5% of cases local control was achieved and only 4.5% underwent secondary enucleation due to treatment failure and disease progression. Tumor initial maximum diameter was a predictor of time to melanoma-related death (Hazard ratio [HR] = 1.24 [95% confidence interval [CI] - 1.03–1.50] P = 0.018) and time to metastasis (HR = 1.43 [95% CI - 1.2–1.71] P ≤ 0.001). Among the 143 patients, the most common radiation side effect was cataract (58.33%) followed by the development of any form of radiation retinopathy (42,36%). One patient (0.7%) underwent secondary enucleation due to uncontrolled neovascular glaucoma. Conclusions: Our results demonstrate excellent clinical outcomes of local control with EBT, with satisfactory overall survival and metastasis-free survival rates, comparable to international literature. Considering the high rates of local control and globe preservation, this research validates de use of EBT as a mainstay treatment in UM.

Introduction: Trochlear apparatus calcifications can be found incidentally on computed tomography (CT) scans involving the orbit. The calcification often is misdiagnosed as intraorbital foreign body and vice versa. This study aims to find the prevalence of trochlear apparatus calcification and its association with diabetes. Methods: A cross-sectional study was conducted at a medical college hospital from January 2021 to March 2021. Two hundred and fifty-three patients undergoing CT of the brain and paranasal sinuses were recruited. The trochlear apparatus calcification is considered when attenuation is high at the point of angulation of the superior oblique muscle. Frequency and percentages were used, and Fischer's exact test was done for association. coGuide software was used for data analysis. Results: The participant's mean age was 49.16 ± 18.42 years. Out of 253 participants, 137 (54.15%) had diabetes. The prevalence of trochlear apparatus calcification was 3.95%. Out of 137 people with diabetes, 5 (3.65%) had trochlear apparatus calcification. Conclusion: The study shows that trochlear apparatus calcification prevalence was 3.95%. This benign calcification in CT should be differentiated from ocular foreign body and other pathological conditions.

Epithelial downgrowth (ED) after penetrating keratoplasty (PK) is a rare but troublesome complication, often leading to vision loss. We present a case of refractory ED and review of the literature on ED after keratoplasty. Case presentation and literature review was the study design. Intracameral 5-fluorouracil at the time of wound revision and placement of a tube implant for glaucoma control were successful in securing the closure of a fistulous wound after multiple transplant surgeries. In this case, the successful management of ED after PK was achieved with meticulous wound closure, adequate pressure control, and the mitigation of ED with chemoablation of the proliferating epithelial cells. More advanced cases may require repeated injections of antiproliferative medication, cryotherapy, or surgical excision of involved tissues.

Purpose: The coronavirus disease (COVID)-19 pandemic put medical residency programs in a predicament, impacting clinical attention and surgical practice. This study aims to describe the adjustments applied in an ophthalmology residency program to overcome the COVID-19 pandemic restrictions. Materials and Methods: An observational, comparative, and descriptive study was performed in an ophthalmology residency program to analyze the adaptations and innovations implemented to overcome the medical attention and training restrictions enforced by the sanitary authorities due to the COVID-19 pandemic in the year 2020. The residents' record folders were analyzed yearly for academic, research, clinical, and surgical activities from 2018 to 2020. An online survey was applied to residents for congress attendance, research publications, time spent on classes, lectures, clinical cases, journal club, and surgical videos sessions during the pandemic. Results: Compared to years 2018 and 2019, during 2020, there was a significant increase in the hours destined per week to academic activities (6.04 vs. 16.42 h, P < 0.001); the monthly hours of journal club sessions (0.5 vs. 3.41 h, P < 0.001); and the number of published articles involving residents (0.4 vs. 2.52, P < 0.001). On the contrary, the hours of outpatient consultation (8 h/day vs. 4 h/day) and the number of cataract surgeries performed per resident decreased (48 vs. 15, P < 0.001) from 2019 to 2020. Conclusions: Prompt reaction and innovation were required to overcome the educational and training barriers imposed by the COVID-19 pandemic. While remote academic activities increased significantly, online patient consultation and surgical simulation were necessary to avoid hindering patient's attention and surgical training.

Purpose: To report the results of using human amniotic membrane (AM) as a bandage at the end of pterygium surgery to diminish its uncomfortable postoperative symptoms. Materials and Methods: Observational, descriptive retrospective study in which patients with bilateral primary nasal pterygia were operated on with a conjunctival-limbal autograft with conventional suturing, one eye receiving an AM bandage at the end of surgery and the other not. Results: There were 20 eyes of 10 patients, five men, and five women, with a mean age of 28.7 ± 6.4 years; general postoperative symptoms (pain, burning sensation, and tearing) and foreign body sensation were statistically lower in the AM group at the 4^th, 8^th, and 12^th postoperative day (P < 0.05). Conclusions: AM as a bandage at the end of pterygium surgery reduces the uncomfortable postoperative symptoms typical of such surgery.

Myopia, as the most common source of distance vision impairment in the world, is a serious global public health and socioeconomic crisis. Although more than half of the world population will be myopic by 2050, none of the myopia control strategies has been demonstrated to completely stop the development or progression of myopia. This is due to the fact that myopia is progressing faster than its management options. It should also be emphasized that none of the current myopia control strategies is practically in use for some reason except for research purposes. It is of critical importance to realize that without any effectual controls or therapeutic interventions, myopia crisis enlarges further.

Objective: The objective of this study was to report the characteristics and the bacterial microbiological frequency of the etiological agents and the antibiotic sensitivity of the isolated pathogens in infectious keratitis in Mexico between 2012 and 2016. Methods: This was a retrospective, cross-sectional, and observational study; medical records of all patients who presented in the cornea department in Mexico with infectious keratitis from 2012 to 2016 were reviewed. Demographic data, Gram stain, and microorganisms obtained in the culture and antibiotic sensitivities were evaluated by disc diffusion test. Results: In the studied period, a total of 639 (40.67%) cases that had a positive culture were included; 54.5% were male with an average age of 48.50 ± 20.43. Gram-positive agents were the most frequent with 80.66% of cases. The most frequent causative agent was Staphylococcus epidermidis (36.61%). The most frequent Gram-negative agent was Pseudomonas aeruginosa (7.55%). The antibiotic with the highest sensitivity was netilmicin (90.3%), followed by moxifloxacin (82.3%) and gatifloxacin (81.3%). Among fortified antibiotics, ceftazidime had a sensitivity of 78% while vancomycin 43.8% (for Gram positive). Conclusion: Bacteria are the most common cause of infectious keratitis, Staphylococcus and Pseudomonas as the most common isolates. There was low resistance to netilmicin and fourth-generation fluoroquinolones for these isolates.

To report the use of intravitreal dexamethasone implant and its short-term efficacy in a pediatric patient with Coats' disease. A 7-year-old patient was referred to the clinic because of decreased visual acuity in the right eye of 10-month duration. Best-corrected visual acuity was 20/400. Funduscopic examination showed evidence of Stage 2B Coats' disease. The patient underwent treatment with laser photocoagulation, intravitreal injection of bevacizumab, and intravitreal injection of dexamethasone implant. During the 10-month follow-up, there was no evidence of side effects. Anatomical resolution was evident on funduscopic examination and macular optical coherence tomography, with best-corrected visual acuity being 20/60. Intravitreal dexamethasone implant was effective during the 10-month follow-up; providing improvement in visual acuity without any side effects.

Summary: Diabetic retinopathy (DR) is the leading cause of blindness among working-age persons in high-income countries. A public system strategy was developed to improve screening, using telemedicine, automatic detection using artificial intelligence (A/I) and medical reporting. In the current work, we evaluated program efficiency. Material: We conducted a cross-sectional study using information from an institutional database of retinographies submitted to the A/I platform in 2019. With a positive test, a medical report was made using the international scale. Results: In 2019, 220,994 retinographies were reported, corresponding to 24.0% of diabetic patients. Around half (53.0%) of cases were discarded by A/I, being different in each regional health service. The medical analysis discarded diabetic retinopathy in 30.2% of exams, 11.5% had diabetic retinopathy, including 2.3% with risk of blindness, while 3.7% could not be evaluated. Discussion: The use of A/I allowed optimizing the medical resources, discarded 53% of cases, which helped in the screening of diabetic retinopathy. Coverage is still insufficient, and detection of macular edema must be improved.

Introduction: A chalazion is a common localized lipogranulomatous inflammation of the eyelid. Histopathological diagnosis of chalazia is essential to rule out malignancy in particular sebaceous carcinoma. Our aim is to understand and classify the histopathological findings of chalazia and to determine any association with a patient's demographics. Materials and Methods: H and E sections were reviewed and classified into four categories: (1) lipogranulomas only, (2) lipogranulomas with multinucleated giant cells, (3) lipogranulomas with abscess, and (4) fibrosis without lipogranulomas or granulomatous inflammation. Patients' sex, age, and location of the lesion were analyzed. Results: Five hundred and forty cases included men (54.6%) and women (45.4%) with the mean age of 45.3 (13–89; standard deviation, 16.8). Five hundred and eight had information regarding location: left lower eyelid, 21.1%; right lower eyelid, 19.5%; left upper eyelid, 30.5%; and right upper eyelid, 28.9%. Category 1 accounted for 44.6%; category 2, 41.5%; category 3, 7.0%; and category 4, 6.9%. There was no significant correlation between classification and sex (P = 0.210) or age group (0–50 and > 50) (P = 0.369) nor between presence of giant cells and/or abscess and location (P = 0.826). Mean ages of category 1 (47.0) and 2 (43.1) were significantly different (P = 0.011). Conclusion: Four histopathological subtypes were equally distributed across sexes and eyelid locations. Individuals in category 1 are older than category 2. Favoring a systematic way to analyze the histopathology of chalazia may result in fewer missed diagnoses of malignancy and other inflammatory or infectious diseases.

Purpose: The purpose was to study the proportion and risk factors for posterior capsular rent (PCR) in small incision cataract surgery in a teaching hospital. Methods: We conducted a retrospective observational study of all cases with PCR in small incision cataract surgery performed between November 2015 and May 2018. The medical records were analyzed and data were collected. Results: There were a total of 63 cases of PCR out of 4206 cases who underwent small incision cataract surgery with a 1.68% PCR rate. The mean age was 65.5 years and the male-to-female ratio was 2.15:1. There was no association between nuclear sclerosis, pupil dilatation, and pseudoexfoliation. Resident operated surgeries had a PCR rate of 1.96 compared to faculty operated surgeries which was 1.46. Three faculty surgeons accounted for 54.3% of the cases while the remaining ten surgeons accounted for 45.7% of the cases. Postoperative day 1 vision was low, with only 19% achieving >6/18 vision, and 54% of the individuals needed more than one topical drug and 61.5% were started on oral steroids. Conclusion: Surgeon- and patient-related factors are equally important in avoiding posterior capsule rent in cataract surgeries. Patient-related factors should be carefully assessed preoperatively on slit-lamp biomicroscope, so that surgeons are prepared for all the complications and visual morbidity limited. Surgeon factors also need to be looked into and efforts have to be made to limit them and thus ensure the right to vision to each patient.

Purpose: To compare the efficacy and safety of manual small incision cataract surgery (mSICS) versus phacoemulsification in a referral center from a low-to-middle-income country. Subjects and Methods: A retrospective cohort of 177 eyes with visually significant cataract and ≤1.0 diopter (D) of keratometric astigmatism was intervened during 2017 by four surgeons either by mSICS or by phacoemulsification. Last follow-up was at 4–6 weeks. Outcome measures included postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive cylinder, spherical equivalent (SE), complications, and re-interventions. Results: The mSICS group included 107 eyes; the phacoemulsification group included 70 eyes. UDVA was comparable between both groups; 89.6% in the mSICS group and 95.7% in the phacoemulsification group achieved a UDVA ≥6/18 (20/60) (P = 0.06). CDVA was comparable between both groups; 100% in the mSICS cohort and 98.6% in the phacoemulsification cohort had a CDVA ≥6/18 (20/60) (P = 0.26). Although the absolute difference in postoperative refractive astigmatism between both groups was small, it was statistically significant in favor of the phacoemulsification group (P = 0.02). Postoperative refractive SE was also comparable between both cohorts (P = 0.64). One intraoperative complication was found in the phacoemulsification group (1.4%), with no complications in the mSICS group. However, there were six reoperations in the mSICS cohort (5.6%) and no reoperations in the phacoemulsification one. Conclusions: Both mSICS and phacoemulsification achieved excellent visual outcomes with low complication rates. Phacoemulsification gives better UDVA and lower postoperative refractive astigmatism in a larger proportion of patients at 4–6 weeks.

Iridociliary melanoma represents a rare and aggressive variant of intraocular melanoma. We report the case of a 30-year-old male with iridociliary melanoma that started as a uveitis masquerade syndrome. Noninvasive, stereotactic radiosurgery with CyberKnife^® at a dose of 27 Gy to the 90% isodose line was promptly performed. Six months after treatment, no postoperative complications were observed. The patient achieved local tumor control, maintained a 20/20 visual acuity, and no signs of systemic metastasis were observed. The versatility and outpatient nature of CyberKnife^® make it an option to consider for the multidisciplinary management of these patients.

Objective: To describe a phacoemulsification technique to face chalenging situations such as hard and leathery nucleus. Methods: The present technique was successfully performed in 52 eyes of 48 patients, over a period of 3 months. Results: None of the patients had zonular dehiscence or posterior capsular rupture. In 40 eyes, the cornea was clear on the 1st postoperative day, while in 12 eyes, the cornea cleared on the 4th postoperative day. Visual acuity improved to 20/20 (corrected distance visual acuity) at the end of the 3-week follow-up. Conclusion: The flower petal chop technique is an effective and safe technique for phacoemulsification of hard and leathery cataracts.

Paraneoplastic optic neuropathy (PON) is a rare phenomenon that is associated with lung carcinoma. In addition, retinal metastasis is extremely rare, accounting for <1% of intraocular metastasis. We hereby report a rare case of synchronous metastases from lung carcinoma to the choroid of the right eye and the retina of the left eye complicated with presumed PON. The presence of intraocular mass and optic disc swelling should prompt investigations for systemic malignancies.