Rajendra P Maurya

Orbital Myiasis: Due to Invasion of Larvae of Flesh Fly (Wohlfahrtia magnifica) in a Child; Rare Presentation

Wohlfahrtia magnifica larvae cause myiasis in mammals, mainly in sheep and rarely in human. In human it may infest the ear, eye, mouth or nose, damaging living tissues. We report a case of ocular myiasis in 1.5 years old child belonging to urban slum after history of minor injury on left upper lid due to fall from bed. The purpose of reporting this case is to highlight the ocular association of W. magnifica.

Immunoglobulin concentration in tears of contact lens wearers.

Purpose: To evaluate changes in the concentration of tear immunoglobulins in contact lens wearers. Methods: A total of 45 cases including 23 contact lens wearers (43 eyes) and 22 age and sex matched healthy controls having no ocular pathology were studied for immunoglobulins (IgA, IgG, IgM) in their tears by single radial immunodiffusion method. Results: Most of the cases used soft (56.6%) and semi-soft gas permeable (30.4%) contact lenses. Tear IgM was detected in only 17.4% and tear IgG in 43.6% of contact lens wearers, while in controls IgG was detected in 9.1% but none of the controls had IgM. There was a significant rise in total tear IgA (13.17 ± 4.44 mg/dl) in contact lens wearer as compared to controls (8.93 ± 3.79 mg/dl). Rise of tear IgA was more in symptomatic patients (15.38 ± 5.28 mg/dl) and in those wearing hard (19.73 ± 5.43 mg/dl) and semi-soft contact lenses (13.31 ± 5.43 mg/dl). A significant increase in tear IgA was noticed in subjects wearing lenses for >3 years (15.69 ± 5.39 mg/dl). About 43.4% of lens wearers were symptomatic and 80% of their lenses showed deposits and/or haziness. All cases with IgM in tear were symptomatic. Conclusion: The relation of immunoglobulin concentration with increasing duration of wear and material of contact lens shows that tear immunoglobulin rise accrues due to mechanical stimulation, hence contact lenses should not be used for a long period and lenses of hard nature should be discouraged. The maintenance, cleaning and deproteinization of the lenses are of high importance to avoid immunostimulation.

Non-steroidal immunosuppressive drugs for non-neoplastic ocular disorders

Introduction Immunomodulatory or immunosuppressive drugs have an ability to suppress the immune drive by producing certain soluble bioactive molecules like cytokines and chemokines thus decreasing the tissue damage resulting from the inflammatory mediators. The use of immunosuppressives in ophthalmology follow their extensive use as anticancer chemotherapeutic agents. Nonneoplastic use of immunosuppressive agents by ophthalmologists has greatly increased over the past three decades because of better knowledge of the immunopathology of immune mediated, noninfectious ocular inflammatory disorders, affecting conjunctiva, cornea, sclera, uveal tissue etc.. Most of the uveal disorders such as non-infectious uveitis associated with arthritis and collagen vascular diseases e.g. Vogt-koyanagi-Haradas disease, Behecets disease, sympathetic ophthalmitis, pars planitis etc are immune mediated and require immunosuppressive agents if corticosteroids fail or are not tolerated or contraindicated. Allergic eye diseases like vernal keratoconjunctivitis and atopic keratoconjunctivitis are characterized by complex immunopathology. Immunomodulating agents like cyclosporine A and tacrolimus can be used to inhibit T-cell activation among the patients with severe allergic eye diseases. Other immune mediated ocular conditions which require immunosuppressive drugs are thyroid associated ophthalmopathy (TAO), dry eye disease, necrotizing scleritis, moorener’s ulcer, limbal cell transplantation and peripheral ulcerative keratitis (PUK). Earlier, the use of immunosuppressives were limited to treatment of corticosteroid resistant, sight threatening ocular inflammation , but now a days these drugs are considered as first line of treatment for Wegeners granulomatosis, Behcetss disease etc. Most of the immunosuppressive agents are extremely potent and have significant adverse effects. The purpose of this review is to briefly summarize the management of various ocular inflammatory disorders by using immunosuppressive agents, with focus on use of newer immunosuppressive drugs. A review of the literature in the PubMed, MedLine, and Cochrane database was conducted to identify clinical trials, comparative studies, case series and case reports describing the use of immunosuppressive therapy.

Traumatic Subconjunctival Dislocation of Fractured Posterior Chamber Intraocular Lens by Cow Horn Injury

Traumatic sub-conjunctival dislocation of posterior chamber intraocular lens is a rare and emergency condition. This communication is to report a rare ocular trauma by cow horn. A 52 year old male farmer presented with history of cow horn injury to his right eye. He had pain redness and decreased vision in his right eye. His posterior chamber IOL which was implanted two years back,was found dislocated to superiotemporal sub-conjunctival space with one broken haptic in anterior chamber and was removed surgically. Such a dislocation has not yet been reported in Indan literature and rarely reported in international literature to the best of our knowledge.

Orbital Myiasis (Dermatobia Hominis)Complicating Secondary Squamous Cell Carcinoma of Medial Rectus Muscle

Background: Myiasis is an infestation of living tissue of human and other vertebrate animals by larvae of flies of the order Diptera. Aim: To present a case of destructive squamous cell carcinoma complicated by orbital myiasis. Case report: Here is a rare case report of ocular myiasis from the species sarcophaga in an elderly patient belonging to rural India having neglected secondary squamous cell carcinoma of medial rectus muscle, one month after excision of conjunctival intraepithelial neoplasia. Computerized tomography imaging of orbit and brain revealed multiple bony erosions with intracranial extension. The pathogenesis, clinical presentations, findings of investigations and treatment of orbital myiasis in squamous cell carcinoma are discussed here under.