Purpose: To analyze the profile of patients visiting the ophthalmic emergency department during coronavirus disease-2019 lockdown and analyze its impact on a tertiary eye care center in South India. Materials and Methods: Retrospective analysis of Electronic Medical records of all patients presenting in the period from March 24, 2020 to May 3, 2020 (lockdown group) and the same was compared with the data of patients from the same period in the previous year (prelockdown group). Data regarding their demographic details, presenting complaints, final diagnosis, medical treatment, and surgical interventions undertaken if any were scrutinized. Results: The total number of patients seen in the emergency services during the lockdown phase was 591. The number of patients coming to the emergency showed a decline of 35% compared to the previous year. The most common presenting complaint was defective vision (n = 112, 18.95). Review checkup was done in 128 patients (21.65%). The most common ocular diagnosis was conjunctivitis (n = 78, 13.19%). Emergency surgical interventions were advised in 30 patients (5.07%). Conclusion: A significant decline in the number of visits to the emergency in the lockdown period was observed probably due to the various constraints and hardships faced by patients.

Context: In general anesthesia, intubation/extubation and use of succinylcholine elevate intraocular pressure (IOP). Elevation of IOP during anesthesia may be detrimental to patients with preexisting ocular conditions such as glaucoma and uveitis. Regional anesthesia (spinal) lowers mean arterial and may lead to hemodynamic changes. Aims: We aimed to study changes in IOP and mean arterial pressure (MAP) in patients undergoing abdominal and lower-limb surgery following general and regional anesthesia. Setting and Design: A prospective comparative nonrandomized study was done. One hundred and twenty patients were randomly allocated to receive either general (Group A, n = 60) or regional anesthesia (Group B, n = 60), respectively. An independent investigator recorded MAP and IOP (Perkins handheld tonometer). Statistics: A one-way repeated measures analysis of variance (ANOVA) was done to determine whether there are any significant differences between the means of three or more levels of a within-subject factor (IOP and MAP) over time. Results: In Group A, there was a significant rise in IOP (ANOVA, P = 0.007) after general anesthesia over time. In Group B, the change in IOP (ANOVA, P = 0.219) was not statistically significant over time. However, there was a significant reduction in MAP over time. Between the groups, the mean change in IOP was significantly higher in patients in Group A and mean MAP significantly lower in Group B, respectively. Conclusion: Patients with glaucoma, uveitis, and cardiovascular diseases should have IOP monitoring prior to deciding the type of anesthesia and after anesthesia for lower-limb and abdominal surgeries. Sudden loss of vision after anesthesia needs immediate attention.

Context: Neonatal retinal hemorrhage (RH) is a condition occurring in newborns within 1 month of birth. Long-standing, dense hemorrhages obscuring the macula may lead to severe vision deprivation amblyopia. Aims: This study aimed to estimate the incidence of retinal hemorrhages (RHs) in full-term newborn babies in a medical college tertiary care hospital over a period of 1 year and to determine the association between RH and the mode of delivery. Settings and Design: This was a prospective observational study. Subjects and Methods: Screening was done in 469 full-term newborn babies within a week of delivery. Pupils were dilated with 0.4% tropicamide and 2.5% phenylephrine. Retinal evaluation was done with indirect ophthalmoscope and 20D lens. Statistical Analysis Used: Data analysis was done using SPSS software version 21. Chi-square test was used to assess the association between sex of the baby, mode of delivery, birth weight, and RH. P < 0.05 was considered statistically significant. Results: Out of 469 babies screened, 27 had RH on fundus examination. Of the 266 babies who were born spontaneously through vaginal route, 20 babies had RH. Eleven babies were delivered through vacuum-assisted vaginal delivery, of which 5 had RH. Babies weighing >2.5 kg had a higher incidence of RH (6.3%). There was no significant association between sex and RH. Conclusion: The incidence of RH in newborn babies was found to be 5.8%. Incidence of RH was found to be high among vacuum-assisted delivery followed by spontaneous vaginal delivery. Babies weighing >2.5 kg had a higher incidence of RH. By 2 weeks after birth, RH resolved in 96.29% of eyes.

Purpose: The purpose of this study is to describe the clinical and topographical features of keratoconus in children and to emphasize the role of corneal topography in early diagnosis of keratoconus in eyes with astigmatism. Materials and Methods: It was a prospective study done to screen children below 18 years with astigmatism of 1.50 Diopter or greater for presence of keratoconus. Ophthalmic evaluation included retinoscopy, cycloplegic refraction, and detailed slit lamp examination for clinical diagnosis of keratoconus. All eyes underwent corneal topography and tomography. Eyes were followed up for progression with both refraction and corneal topographic imaging. Progressive cases later underwent Accelerated Collagen Crosslinking (ACXL). Results: 700 eyes of 350 patients with astigmatism were screened for keratoconus. 44 eyes of 28 patients were diagnosed with keratoconus. Mean age of the diagnosed children was 11.7 years (6–18 years), 18 boys and 10 girls. Overall, most common clinical association was allergic conjunctivitis. Twenty-five eyes (57%) had clinical evidence of keratoconus while other 19 eyes (43%) required corneal topography to establish the diagnosis. Based on the Amsler-Muckenheim tomographical classification, 22 of 44 eyes (50%) were grouped in prestage level followed by 13 eyes (29.5%) in Stage 1, 5 eyes (11.4%) in Stage 2, and 4 eyes (9.1%) in Stage 3. Thirty-five eyes of 21 patients showed progression and underwent ACXL. Conclusion: Early detection of keratoconus in children with astigmatism is of utmost importance to avoid visual impairment and surgical intervention. Even in the absence of clinical signs, corneal topography and tomography should be performed as a screening tool to rule out keratoconus in these children.

Aims and Objective: To analyze the various ophthalmic presentations among the Corona warriors-front line workers during the COVID-19 pandemic. Materials and Methods: This was a cross-sectional observational study conducted at a medical college hospital in the ophthalmology department. All the front-line workers including doctors, postgraduates, interns, staff nurses, Hospital staff, health-care workers (HCWs), Police personal were involved in the study after obtaining informed consent. Twenty-five front-line workers were examined after taking necessary safety precautions. A thorough history was taken regarding ocular symptoms. Best-corrected visual acuity was recorded using Snellen's visual acuity chart. Anterior segment evaluation was done using a slit-lamp examination, fundoscopy done. Medical management was done in 23 patients, and emergency surgeries were performed in two patients who required surgical management. Results: Among 25 front line workers mean age was 34.5 years, males were 15, females were 10. There were 20 HCWs among whom 8 were doctors, 2 postgraduates, 4 interns, 6 nurses. The other 3 were accredited social health activist worker, Bruhat Bengaluru Mahanagara Palike workers, hospital cook, and 2 police personal. Twenty-one workers had varied ocular manifestations which were managed medically. Two workers had retinal pathology and underwent retinal barrage laser. Two policemen had road traffic accidents and underwent emergency surgery. Conclusion: Corona warriors-front line workers are leading the battle against COVID-19 from the front, putting their own lives at risk with selfless determination for the sake of saving lives, they truly are our heroes in these challenging times. During this tough phase, they were working relentlessly and faced spectrum of the ophthalmic issue. It is, therefore important to monitor these front-line workers for any eye problems and ensure that timely treatment is given. Hence their safety is our responsibility. This is a tribute to all the front-line workers working tirelessly during the uncertain pandemic.

Purpose: The purpose of this study is to determine the common ocular manifestations in diabetes and their relation to the duration and severity of the diabetes. Methodology: This is a prospective, observational study of patients attending the outpatient department and those referred to the tertiary eye care hospital in Bagalkote district of Karnataka from October 2012 to March 2014. Type 2 diabetic patients were recruited on the basis of history, clinical examination, and blood investigations. Along with detailed demographic history, all participants underwent complete slit-lamp anterior segment, posterior segment examination and intraocular pressure measurement was done. Estimation of random blood sugar at admission and fasting blood sugar and postprandial blood sugar second day of admission along with urine sugar, albumin, and microscopy. If necessary based on the indication, fundus fluorescein angiography was also performed. Results: Out of 350 patients evaluated, 211 were male (60.3%) and 139 (39.7%) were female. Diabetic retinopathy (DR) was the most common complication (36.8%), followed by cataract 35.4%, glaucoma (4.6%), and other pathologies such as conjunctivitis, recurrent hordeolum, and dacrocystitis. The strongest predictor for the prevalence of retinopathy in persons with Type 2 diabetes is the duration of diabetes and was proven statistically significant. Both prevalence and severity of retinopathy correlate with HBA1C level in our study group. The most common type of cataract found was cortical type (41.2%) followed by senile posterior cortical (29.8%). Diabetes predisposes to infection in different body parts, and ocular structures are not an exception. Conclusion: DR was the most common ocular complication of diabetes, followed by cataract and primary open angle glaucoma. The prevalence and severity of DR were higher in patients with the longer duration of diabetes.

Carotid-cavernous fistulas (CCFs) are spontaneous or acquired abnormal connections between the cavernous sinus and the carotid arterial system. It can be a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or an indirect one between the cavernous sinus, and one or more meningeal branches of the internal carotid artery, external carotid artery, or both. Ophthalmologists are called to diagnose and manage the condition in cases that present with ocular features such as decreased vision, conjunctival chemosis, external ophthalmoplegia and proptosis. A high index of suspicion in a case without any history of trauma and collagen vascular disease is the key factor. Prompt diagnosis of intravascular malformations at initial presentation can prevent ophthalmological complications and vision loss. Conventional treatments include carotid ligation and embolization, with minimal significant morbidity or mortality. A team approach including neurosurgeons, emergency physicians and ophthalmologists is needed for the proper management of such patients. Ophthalmologists may be the primary attending physician; therefore, this review aims to help understand the diagnostic approach and possible modes of treatment with expected outcomes.

Background: With the rapid rise in COVID 19 cases and increasing fatality during the second wave, most of the states have resorted to lockdown. All eye bank activities have come to a halt, and even emergency corneal transplantation is not possible due to the shortage of donor corneas. There is also an urgent need of innovative wet lab keratoplasty training models for continuing the training of the fellows and residents. Aims and Objectives: The authors describe an innovative cost effective wet lab training model for practicing keratoplasty during the COVID 19 pandemic lockdown. Methods: In this innovative wet lab practicing model, we have used Indian gooseberry and thermocol for practicing penetrating keratoplasty in the wet lab. Results: The gooseberry having natural marking over it is marked with an ink pen for suture alignment, and the ink marked trephine is used to punch the gooseberry. The gooseberry button is cut 360 degrees with the help of scissors and then either the same button or donor button cut from thermocol can be used to practice keratoplasty suture in the wet lab. Conclusion: This innovation can be a boon in the COVID 19 era when eye bank practices have come to a halt, and only emergency keratoplasties are being performed requiring skill and expertise..

The coronicle (corona + cubicle) provides state-of-the-art features required for comprehensive ocular evaluation. Assembling this cubicle requires acrylic sheets, aluminum beading, fevicol, araldite paste, and a jigsaw cutting blade, which can be done in a do-it-yourself template. Dimensions of the cubicle are 16 × 16 × 8 feet with only a total area of 256 square feet; thus, restricting patient movement inside hospital premises. Social distancing norms with three feet distance between the machines were incorporated while installing the ophthalmic gadgets within the cubicle. The cubicle encompasses slit-lamps, auto refractometer, lensometer, fundus capture device, optical coherence tomography, optical biometry, manual keratometry, corneal topography, and noncontact tonometer. Customized openings in the cubicle were made in front of each device, for the patient's head and chin rest positioning during the examination, and can be closed with sliding doors during times of disuse. An acrylic groove was provided to accommodate the patient's feet. Coronicle has helped instil, both patient and medical personal safety during COVID-19 and has withstood the test of time since its inception in May 2020. In this manuscript, we have discussed the economics and validated the utility of the cubicle, in terms of the quantitative usage of ophthalmic gadgets present inside the cubicle versus outside the cubicle for the past 19 months, since the installation of the cubicle; along with the cubicle's additive highlights and its role after the pandemic is over.

Central retinal artery occlusion is an established and potentially blinding ocular condition. It is the most common presentation of the spectrum comprising retinal arterial occlusive diseases. The presence of a hemicentral retinal artery is an anatomical variation and few reports on its occlusion are noted in literature. Here, we present the case of a 45-year-old male who was diagnosed with hemiretinal artery occlusion occurring secondary to an embolus from the carotid artery. He was also noted to have systemic hypertension at presentation along with dyslipidemia. The visual acuity loss improved over a follow-up period of 1 week post presentation before the patient was lost to follow-up. This case report highlights the role of a thorough systemic evaluation and prompt referral to an internist of the patient presenting with retinal arterial occlusive disease. It also showcases an uncommon presentation retinal arterial occlusion that may occur as an anatomical variant much as the case of a hemiretinal vein occlusion.

We report a case of a 51-year-old gentleman who presented with diffuse conjunctival congestion, chemosis, and shallow anterior chamber only in his left eye (LE), with an intraocular pressure of 26 mmHg, and closed angles on gonioscopy. B-scan ultrasonography of the LE showed increased choroidal thickness with minimum suprachoroidal fluid effusion. A diagnosis of anterior and posterior scleritis with secondary angle closure was made. The patient showed a favorable response to oral and topical steroids with cycloplegics. Idiopathic scleritis can mimic an acute attack of angle closure. Prompt recognition of the same is vital to providing good clinical outcomes.

Myelinated retinal nerve fibers (MRNF) are a common developmental anomaly. MRNF is commonly associated with myopia. The association of MRNF with myopia, amblyopia, and strabismus is well documented. The amblyopia may be refractory to treatment. We report a case of a child with MRNF and amblyopia in the more hyperopic eye, a case of reverse Straatsma syndrome.

A 3-year-old female child presented to us with complaints of watering in the left eye since birth, along with swelling near the medial canthus of the left eye for 1 week. External examination revealed a burst lacrimal sac abscess. The child underwent left eye probing with intubation. Cultures of the lacrimal sac contents revealed Kocuria rhizophila, a Gram-positive bacterium, as the primary pathogen. K. rhizophila was identified based on phenotypic characteristics and the VITEK-2 system. On follow-up visit, she had a recurrence of nasolacrimal duct obstruction with discharge from the left eye and subsequently underwent dacryocystorhinostomy. This study reports the first case K. rhizophila dacryocystitis, its clinicomicrobiological correlation, and management.

Sixth nerve paresis is a rare presentation of intracranial aneurysms. We report an uncommon case of unilateral sixth nerve paresis in a young adult as the main presenting feature of an intracavernous aneurysm. The patient presented with pain and double vision in the right eye for 1 month. Computerized Tomography scan brain done elsewhere was normal. Examination showed right sixth nerve paresis with sensory loss in the first and second divisions of the trigeminal nerve. We suspected a cavernous sinus lesion and conveyed the same to the radiologist who therefore did additional and appropriate imaging, which revealed an intracavernous carotid aneurysm. This case is unique as to the best of our knowledge, it is the first case of its kind reported from India.

Blind eyes are left unattended. They present with unsightly large exodeviation, corneal degenerative changes such as band-shaped keratopathy and mature cataract. These have cosmetic as well as functional implications. It is an obstacle to social life as well as securing employment and betterment of career options. We need to address these patients for psychosocial well-being. We propose a novel surgical approach to address the exodeviation with a distance near disparity as well as to obviate the leucocoria due to mature cataract as the patient did not want to continue pupil occluding cosmetic contact lens any further.

The present case concerns what is best to our knowledge the rare case report of postoperative cilia in subtenon's space following subtenon injection of anesthesia, although many cases have been reported on intraocular cilia in the cornea, anterior and posterior chamber, lens, vitreous, and retina following penetrating injury.

A 10-year-old male child presented with blunt force injury to his right eye (OD), with best-corrected visual acuity of 20/200. Posterior segment evaluation showed vitreous hemorrhage, Berlin's edema, and choroidal rupture anterior to the equator, parallel to the ora serrata, associated with subretinal hemorrhages. In this manuscript, we have reported a rare traumatic manifestation of multiple direct choroidal ruptures in a child. According to our knowledge, this has never been reported in the literature before. This manuscript also highlights the importance of vigilant optical coherence tomography (macula) follow-up in such scenarios, despite the choroidal rupture not involving the macular region.

Cataract surgery has advanced in techniques and instrumentation over the years, but complications such as cystoid macular edema (CME) do occur even after uneventful surgery. The incidence of pseudophakic CME (detected by optical coherence tomography) is 30%–40% after uncomplicated phaco cataract surgeries. Risk factors for the development of CME include prolonged duration of surgery, iris handling and diabetes. Corticosteroids are the mainstay of treatment of postoperative inflammation and CME. In certain situations where steroids are contraindicated anti-vascular endothelial growth factor (VEGF) agents are used as the second line agents for the treatment of CME. Here, we describe a case of postoperative uveitis with CME which showed good response with single dose intravitreal anti-VEGF injection-Bevacizumab.

Following the COVID pandemic, mucormycosis epidemic began as the next threat. A huge number of cases started accumulating. Although there is known pathogenesis and treatment for mucormycosis, several cases presented in uncommon ways causing a delay and dilemma in diagnosis and management. This case series is to highlight some of such presentations. Here, we present a series of nine cases which has deviated from the normal clinical progression of the sinus to the orbit. This case series depicts patients who had late signs of orbital cellulitis such as central retinal artery occlusion, papilledema, and optic neuritis as initial presentations. Furthermore, cases with superadded bacterial infection and aspergilloma are highlighted.

GCA is a granulomatous vasculitis of unknown origin and targets large vessels with predominance for the aortic arch and the cranial branches. The underlying etiology of GCA is complex and has been widely researched, yet is still not well understood. The average age of presentation is 72.5 years for women and 70.3 years old for men. Furthermore, women are affected between 2 and 6 times more often than men. With vision loss, ophthalmologists are on the front lines of diagnosing the disorder. In addition to vision loss, patients commonly note associated symptoms such as headache, jaw claudication, diplopia, myalgias, and constitutional symptoms. The most commonly feared sequel of GCA is permanent visual loss secondary to arteritic anterior ischemic optic neuropathy (AAION). Here we present a series of case reports of GCA with their various presentations.

Ethambutol hydrochloride (EMB) is one of the integral first-line antitubercular agents used in both intensive and continuation phase as per Revised National Tuberculosis Control Programme guidelines. Although usually well tolerated, reports of ocular toxicity secondary to ethambutol have not been rare. The toxicity is dose and duration dependent, and is reported to be usually reversible if detected early, followed by drug stoppage. The present case discusses ethambutol-induced optic neuritis in a male patient diagnosed with pulmonary tuberculosis.

Pheochromocytoma is an important cause of secondary hypertension that can lead to hypertensive retinopathy. In such cases, changes are often reversible and the condition remains stable once the required treatment is done at an early stage. In this case report, we present a case of pheochromocytoma-induced hypertensive retinopathy which regressed after adrenalectomy.

This study aimed to report the graft sequelae of retained host Descemet's membrane (DM) following Penetrating Keratoplasty (PKP). A 75-year-old male diagnosed with retained host DM with Anterior segment optical coherence tomography (ASOCT). Nd:YAG membranotomy resulted in graft failure. Later, DM stripping endothelial keratoplasty with removal of the host DM was done. Review of literature was done to discuss the best treatment modality.

We report a case of fungal keratitis in a patient with lattice dystrophy who underwent successful therapeutic keratoplasty. A 30-year-old female presented with advanced microbial keratitis in left eye, with lattice dystrophy in both eyes. Scrapping revealed fungal filaments and culture grew Aspergillus flavus. With limbus-to-limbus infiltrate, the patient was posted for emergency left eye therapeutic keratoplasty. At 6-month postoperative period, the patient had a good ambulatory vision with no recurrence. Here, we try to make a point that patients with lattice dystrophy are prone to corneal erosions, making them susceptible to microbial keratitis. Patients should be made aware of this fact and counseled for immediate medical help even after trivial trauma. Therapeutic keratoplasty will be inevitable if they present at an advanced stage.

An 8 year old girl was seen in our ophthalmology OPD who had come with complains of mild pain in both eyes since 1 month. Her unaided vision in both eyes was 6/6. Her weight was 20 kilogram. Cyclopentolate 1% was administered twice to the child at 5 minutes interval. Child became restless after 30 minutes of installation of eye drops; she started behaving abnormally and was not allowing to do retinoscopic examination. She had altered behavior, visual hallucination and difficulty in walking. She was disoriented with slurred speech. She had ataxia and frequent tightening of limbs with jerky movements and was plucking her hair. Her pulse rate was 90/minute and blood pressure was 120/90 mm of Hg. Her oxygen saturation was 94% in room air. Child was shifted to nearby hospital where a pediatrician and anesthesiologist were available and was kept under observation. Childs pulse, blood pressure and oxygen saturation were monitored for the next 5 hours. Child recovered completely over the next 8 hours.

Inflammation of sclera with involvement of uvea is an uncommon and underdiagnosed disease entity seen in an ophthalmological outpatient setting. A 34-year-old male presented with complaints of headache, redness, pain, photophobia, and blurring of vision in the left eye > right eye with associated tinnitus, decreased hearing, and recurrent severe headaches over 3 months. Detailed ophthalmological examination revealed signs of sclerouveitis. We thoroughly investigated the patient which revealed manifestations of incomplete VKH syndrome, along with strongly positive mantoux test hence, he was started on oral steroids under antituberculous treatment cover after physician consult. On follow-up, the patient was symptomatically better with resolution of inflammatory signs over a period of 3 months. The patient is being followed up by multispecialty approach to discern VKH manifestations of later disease.

We report an unusual presentation of spontaneous hyphema in a young male with Axenfeld − Reiger syndrome (A-R syndrome) and developmental glaucoma. This rare presentation of A-R syndrome with spontaneous hyphema and dilated iris vasculature has been reported in mice eyes with COL4A1 mutation, but not in human eyes.

We present the case of pineal gland arteriovenous malformation (AVM) with optic neuropathy in a 29-year-old male who presented to our hospital with diminished vision in both eyes associated with headache, dizziness, and generalized weakness for 3 years. Visual acuity was counting finger at 3 m in the right eye and counting finger close to the face in the left eye. Posterior segment examination showed papilloedema. Magnetic resonance imaging of the brain and orbit with angiography revealed AVM in the pineal gland area which was compressing over the cerebral aqueduct and floor of the third ventricle causing ventricular dilation.

A 70-year-old female with uncontrolled diabetes mellitus presented with complaints of defective vision in the left eye for 3 weeks. History revealed vigorous rubbing of LE followed by defective vision and use of self-prescribed antibiotic drops without ophthalmic consultation. The patient denied any history of trauma. She had undergone cataract surgery with posterior chamber intraocular lens (PCIOL) implantation 6 years back. Examination revealed poor ocular hygiene, blepharitis, and transcorneal extrusion of the PCIOL. The IOL was removed under strict aseptic conditions under antibiotic cover. Social neglect, repeated eye rubbing due to blepharitis and uncontrolled diabetes could have been the underlying cause for the painless extrusion of the PCIOL. Uncontrolled diabetes mellitus leads to corneal neuropathy characterized by decreased corneal sensitivity, recurrent erosions, corneal ulceration, and melting. This case signifies the importance of maintaining proper ocular hygiene, strict control of diabetes mellitus, and the use of appropriate ocular medications.

Acute lymphoblastic leukemia (ALL) is a disorder caused by the abnormal proliferation of immature lymphocytes. Of the varied ocular manifestations seen in ALL, infiltration of the optic nerve is a rare and serious complication that heralds a relapse of the disease. It requires a high index of suspicion for diagnosis. Urgent intervention may prove to be lifesaving. We describe a case of optic neuropathy in a 12-year-old boy with ALL and wish to emphasize the need to maintain a low threshold for diagnosing optic nerve infiltration in patients with a prior history of leukemia.

Exposure of the scleral explant is a rare complication of scleral buckling surgery. We report a case of a young male who presented to us with foreign-body sensation in his right eye for 1 month. He had undergone right eye scleral buckling surgery with an encircling silicon band 14 years back. On presentation, the right eye demonstrated an exposed segment of the silicon band medial to the limbus along with the torn off anchoring suture of inferonasal quadrant. The ocular movements were full and patient did not complain of diplopia. The band would have probably cheese-wired and migrated through the medial rectus muscle with slow reattachment of muscle to the sclera with scar formation.

Bietti crystalline dystrophy (BCD) is a rare autosomal disorder characterized by the presence of intraretinal crystalline deposits and later chorioretinal degeneration. We describe a case of BCD with macular cysts. Macular cysts have been reported in many retinal dystrophies such as Juvenile X-linked retinoschisis, Goldmann-Favre Syndrome, and fenetrated sheen dystrophy. BCD with macular cysts is rarely reported in the literature.