Punita Kumari Sodhi

Mumps-induced corneal endotheliitis.

Objective: To report two cases of corneal endotheliitis following mumps parotitis. Methods: Observational case reports of two patients presenting with sudden unilateral diminution of vision while they were in the resolution phase of mumps parotitis. Results: Central corneal edema with no associated epithelial involvement or iridocyclitis was confirmed on slit-lamp biomicroscopy. Specular microscopy confirmed an increased corneal thickness with corneal endothelial abnormalities. The diagnosis of mumps virus infection was established through detection of IgM antibody in serum samples of the patients using enzyme-linked immunosorbent assay (ELISA). The routine investigations for other systemic diseases were negative. Conclusions: Corneal endotheliitis as a sequela to mumps is a new reported association. Timely treatment with topical steroids led to resolution of the disease with full visual recovery without any residual symptoms or signs.

Subconjunctival Hemorrhage: The First Presenting Clinical Feature of Idiopathic Thrombocytopenic Purpura

BACKGROUND Subconjunctival hemorrhage as the first presenting clinical feature of idiopathic thrombocytopenic purpura, to the best of our knowledge, has not been reported earlier. CASE A 60-year-old woman presented with an isolated finding of subconjunctival hemorrhage. She later developed hemorrhage from retinal vessels and had a single episode of hematuria. OBSERVATIONS Her blood cell count showed an extremely low platelet count. Her medical history and clinical examination for any other systemic or ophthalmic pathology were negative. Even after treating the patient with blood and platelet transfusion and maintaining her on high doses of systemic steroids, she did not respond well. CONCLUSION The appearance of spontaneous subconjunctival hemorrhage in a patient should be thoroughly investigated as it can be an initial sign of a grave systemic disorder.

Experience with bicanalicular intubation of the lacrimal drainage apparatus combined with conventional external dacryocystorhinostomy

AIM The aim of this study was to assess the success rate of bicanalicular intubation of lacrimal drainage apparatus in chronic dacryocystitis patients who were at high risk of failure of surgery of dacryocystorhinostomy. MATERIAL AND METHODS A total of 24 patients with chronic dacryocystitis (25 eyes) including 11 males and 13 females (age range 3-80 years) having high risk factors of failure of dacryocystorhinostomy were enrolled. Factors such as previous attacks of acute dacryocystitis, trauma in lacrimal sac region, previously failed dacryocystorhinostomies, formation of false passages in the lacrimal drainage apparatus were considered. Conventional dacryocystorhinostomy followed by bicanalicular intubation of the lacrimal drainage apparatus with Jain metal silicone the lacrimal intubation tube (20-23 gauge) was performed in all these patients. The patients were followed up at weekly intervals for two months, at 6 months and at 1 year post surgery. RESULTS A total of 25 eyes in 24 patients (including 11 males and 3 females) were operated upon using the technique of bicanalicular intubation of lacrimal drainage apparatus with conventional external dacryocystorhinostomy. The procedure was successfully performed in 22 out of the 25 eyes. Perioperative complications included punctual damage due to recurrent attempts at passing these probes in 2 patients and mild damage to nasal mucosa in 5 patients. The majority of patients did not experience any untoward symptoms from these silicone tubes. However, in three eyes there was felt a mild foreign body sensation and two patients had chronic conjunctival erythema. The tubes could not be retained in two of these three eyes. Additionally, in one eye there was spontaneous extrusion of tubes whilst sneezing 3 months after surgery. All these three eyes had a recurrence of symptoms due to non-retention of the tubes and needed re-operation. On average the tubes were retained for a period of six months before they were spontaneously extruded or removed. Fifteen patients retained the silicone tubes for more than 1 year. The procedure gave a success rate of 76% (19/25 eyes) and these were the eyes in which the tubes had been retained for more than 6 months. The success was not influenced by the age or sex of patient, laterality of eye, aetiology of chronic dacryocystitis, or evidence of bony deformity or abnormality of the sac. CONCLUSIONS Bicanalicular intubation for lacrimal drainage system is a simple, inexpensive and straight forward adjunct to conventional external dacryocystorhinostomy. The procedure is strongly indicated for patients with chronic dacryocystitis who are at high risk of surgical failure. Carefully performed, it gives a 76% success rate and is not influenced by the different variables examined.

A case of chronic renal dysfunction following treatment with oral acyclovir.

Nephrotoxicity is a well-known side effect of intravenous acyclovir treatment but occurs rarely by oral treatment. A 76-y-old healthy male, with normal baseline renal functions (blood creatinine 0.6 mg%), received oral acyclovir at a dose of 800 mg five times daily for 10 days for treatment of herpes zoster ophthalmicus. He developed renal failure with blood creatinine levels of 3 mg% and his renal function failed to improve within eight months of end of treatment. Affection of renal function has to be considered also in relation to oral acyclovir treatment, especially in elderly subjects.

Exophthalmometric values in a normal Indian population

PURPOSE . The purpose of this study was to establish a set of exophthalmometric values in a normal Indian population and to compute a regression equation for calculating these values. METHODS . Twenty-five-hundred clinically normal Indians of both sexes in the age group of 3–80 years, who did not have local or systemic disease likely to affect orbital or ocular structures, were enrolled in this study. Hertels exophthalmometer was used to measure the degree of protrusion of the eyes. Statistical methods were used to calculate the mean values in the right and left eye in either sex and to compute a regression equation for calculating the exophthalmometric values. RESULTS . The range of exophthalmometric values in a normal Indian population aged 3–80 years was 7–19 mm for males and 7–21 mm for females. The exophthalmometric values were higher in the first decade, decreased in the second decade, and increased again in the third decade. They then remained stable for the next three to four decades. The peak was reached in the seventh decade in males and in the sixth decade in females. The lowest values in both sexes were attained in the eighth decade. The regression equations for the calculation of the exophthalmometric values are: In males for the right eye: Exophthalmometric value = 12.43 + 0.25 × age; In males for the left eye: Exophthalmometric value = 12.30 + 0.029 × age; In females for the right eye: Exophthalmometric value = 13.30 - 0.003 × age; In females for the left eye: Exophthalmometric value = 13.17 - 0.0003 × age. CONCLUSIONS . The trend of the normal exophthalmometric values for Indian subjects, by and large, was found to be similar to that quoted for other races. A knowledge of the normal values for this population subgroup can help clinicians in the early diagnosis and follow-up of patients with endocrine diseases, orbital tumors, craniofacial trauma and deformities and severe myopia.

Topical Mitomycin C as a Postoperative Adjunct to Endonasal Dacryocystorhinostomy in Patients with Anatomical Endonasal Variants

ABSTRACT Purpose: Unusual intranasal conditions may increase the rate of complications and affect success rate of endonasal dacryocystorhinostomy (DCR) surgery. The purpose of this study was to find the influence of endonasal abnormalities on outcome of endonasal DCR surgery and to find the role of topical mitomycin C (MMC) as a postoperative adjunct to endonasal dacryocystorhinostomy in these patients. Methods: A total of 23 patients (19 males and 4 females) of bilateral chronic dacryocystitis in the age range of 18–60 years, having endonasal anatomical variants were included in this study. After endonasal DCR, the right side of nasal cavity was packed with 0.05% MMC nasal pack and left side of nasal cavity was packed with normal saline pack for 48 hours. During postoperative visits, the patients were checked for improvement in clinical symptoms and watched for complications including formation of adhesions and/or synechaie. The statistical association between endonasal pathologies and 3 dichotomous outcome variables (clinical features, adhesions, synechaie) was assessed by applying Fishers Exact Test. Results: Postoperative retention of nasal packs for 48 hours after endonasal DCR, did not cause any side effect in our patients. An improvement in clinical symptoms (23/23 = 100%) was seen in all the patients on side with 0.05% MMC soaked nasal pack, while 10/23 i.e., 43.47% patients did not show improvement in symptoms on side of saline nasal pack. Postoperatively, the MMC nasal pack side nasal cavity had a healthy nasal mucosa during the entire follow up, while the saline nasal pack side nasal cavity had synechiae in 15/23 (65.2%) patients and adhesions in 15/23 (65.2%) patients. In our study, none of the anatomical endonasal variants had a statistically significant association with either formation of adhesion or formation of synechiae, as the p-value was > 0.05 in all these instances. Conclusions: The patients with endonasal anatomical variants have a higher incidence of complications like formation of adhesions and synechaie after endonasal DCR than other patients. Topical MMC is safe and effective agent to decrease the rate of complications when used as an adjunct in endonasal DCR in patients with endonasal anatomical variants.

Dermatological side effects of brimonidine: a report of three cases.

Brimonidine is a potential first line therapy for primary open angle glaucoma (OAG) and ocular hypertension (OHT). It is known to cause various ocular and systemic side effects. Being a newer drug, the whole spectrum of its adverse effects is not known. The dermatological side effects caused by brimonidine have rarely been reported before. We present three OAG patients who presented to us with contact dermatitis of periorbital skin and lichen planus of nail following the use of topical brimonidine (0.2% twice a day) for more than six months. These side effects slowly disappeared on discontinuing the drug but reappeared on reintroducing topical formulation. Such side effects from the use of brimonidine have not been reported before.

Efficacy of lamellar division for correcting cicatricial lid entropion and its associated features unrectified by the tarsal fracture technique.

OBJECTIVE : To determine the efficacy of lamellar division for correcting cicatricial lid entropion and its associated features unrectified by the tarsal fracture technique. METHODS : Fifty patients (92 lids) diagnosed as having cicatricial lid entropion were operated by the tarsal fracture technique. There was defective lid closure in 34/92 lids, irregular lid margin in 48/92 lids, distichiatic or metaplastic cilia in 28/92 lids and a history of previous entropion surgery in 34/92 lids. All patients were followed up for one year and the surgical failures at the end of this period were subjected to lamellar division. These subjects were further followed up for one more year./ RESULTS : An overall success rate of 28.26% (26/92 lids) was obtained with the tarsal fracture technique. A correction was achieved in all the 20 lids having cicatricial entropion without any associated features. However, this technique succeeded in only six of the remaining 72 lids (8.33%) with a history of previous surgery or the associated features stated above. Furthermore, it was not effective in correcting associated anomalies such as defective lid closure, irregular lid margin and distichiatic or metaplastic cilia. Reoperation using lamellar division gave good correction in 97% of the lids (64/66). CONCLUSIONS : Lamellar division is a better procedure for treating cicatricial lid entropion, especially in patients with associated complications or with a previous history of entropion surgery.

Comparison between the Role of Intraoperative Mitomycin C and Doxorubicin in Preventing the Recurrence of Primary Pterygium

Purpose: The purpose of this study was to compare the role of intraoperative mitomycin C (MMC) and doxorubicin in preventing the recurrence of primary pterygium. Materials and Methods: Fifty-six patients including 22 males and 34 females in the age range of 22–55 years (mean age 38.1 years ± 10.7) having primary pterygium of progressive type were randomly divided into two groups. The first group of patients was treated with intraoperative MMC (0.02% for 3 min) and in the second group intraoperative doxorubicin (0.02% for 3 min) was used. The patients were regularly followed until 1 year postoperatively for examining visual acuity, wound condition, adverse events and recurrence of pterygium. Results: The mean age of patients of MMC group was 37.4 ± 11.0 years and of doxorubicin group was 38.8 ± 10.8 years (difference statistically not significant). All these patients had pterygium on the medial side of cornea. The side effects experienced by our patients from the use of these agents were conjunctival hyperemia, conjunctival necrosis, corneal epithelial defect, subconjunctival hemorrhage, episcleritis, increased pain, foreign body sensation, lacrimation, irritation, diminution of vision and photophobia. Recurrence was seen in 4 patients of MMC group (14.3%) and 3 patients of doxorubicin group (10.7%) (difference statistically not significant; χ2 = 0.16, p = 0.68). The recurrence of pterygium was not associated with age of patients, laterality of eye involved, amount of encroachment of pterygium over cornea, width of pterygium, preoperative complaints and postoperative adverse events. Conclusions: The two antimitotic agents, MMC and doxorubicin, when used intraoperatively along with primary pterygium excision, had a comparable role both in terms of adverse events and prevention of recurrence of pterygium.

Fetus-in-fetu

Abstract Fetus-in-fetu (FIF) is a rare congenital condition first described in early nineteenth century. In this anomaly, a malformed parasitic twin is found within the body of its partner. Less than 100 cases have been described in the English-language literature.