Corneal Problems Research Articles

Case Report: Conjunctivitis in Children

Conjunctivitis is an inflammation of the conjunctiva, the mucous membrane covering the back of the eyelids and the eyeball, which can be acute or chronic. This condition is characterized by conjunctival hyperemia, edema, and discharge. Causes of conjunctivitis include bacteria, chlamydia, allergies, viruses, and systemic diseases. The incidence of conjunctivitis varies by age, sex, and season. Although slightly more common in women in emergency departments, the seasonal pattern of conjunctivitis is consistent across regions. Allergic conjunctivitis, which affects 15-40% of the population, is most common in the spring and summer. Bacterial conjunctivitis is most common from December to April. Acute bacterial conjunctivitis is generally self-limited, with symptoms lasting 1-3 days if treated appropriately, but can last 10-14 days if left untreated. Staphylococcal and gonococcal conjunctivitis can lead to chronic complications or serious problems such as corneal perforation. Viral conjunctivitis usually gets worse in 4-5 days and resolves in 1-2 weeks. Complications are rare but can include corneal problems and life-threatening conditions such as meningitis or sepsis.

Mass cytometry reveals the corneal immune cell changes at single cell level in diabetic mice.

Diabetic ocular complications include sight-threatening consequences and decreased corneal sensitivity, characterized by decreased tear production, corneal sensitivity and delayed corneal epithelial wound healing. The pathogenesis of diabetic corneal disorders remains largely unknown. Growing evidence implies the participation of immune cells in the development of diabetic corneal diseases. Nonetheless, the immunological changes that result in diabetic corneal problems are largely unknown. Mass cytometry by time of flight (CyTOF) was used to investigate immune cell cluster alterations associated with diabetic corneal disorders. CyTOF test was performed on corneal cells at a single level from 21-week-old diabetic (db/db) and non-diabetic (db/m) mice. A panel of 41 immune-related markers monitored different immune cell types in diabetic corneas. To investigate the proportion of each immune cell subpopulation, an unsupervised clustering method was employed, and T-distributed stochastic neighbor embedding was used to visualize the distinctions between different immune cell subsets. Through CyTOF test, we identified 10 immune cell subsets in the corneal tissues. In a novel way, we discovered significant immune alterations in diabetic corneas, including pronounced alterations in T cells and myeloid cell subgroups in diabetic corneas linked to potential biomarkers, including CD103, CCR2, SiglecF, Ly6G, and CD172a. Comprehensive immunological profiling indicated remarkable changes in the immune microenvironment in diabetic corneas, characterized by a notable decrease in CD103+CD8+ tissue-resident memory T (TRM) cells and Tregs, as well as a dramatic increase of γδT cells and subsets of CD11b+Ly6G+ myeloid-derived suppressor cells (MDSCs). CyTOF analysis revealed significant alterations in the immune microenvironment during the development of diabetic corneal complications. This study mapped the immune microenvironment landscape of type 2 diabetic corneas, providing a fundamental understanding of immune-driven diabetic corneal disorders.

Netarsudil-induced reticular epithelial oedema: An uncommon side effect

Netarsudil ophthalmic solution 0.02% (Netalo) is a new drug in the armamentarium for lowering intraocular pressure in open-angle glaucoma or ocular hypertension. It is a rho-associated protein kinase (ROCK) and norepinephrine transporter inhibitor with multiple mechanisms of action at various cellular levels. Apart from its effect on glaucoma, it has been reported to be beneficial in acute corneal endothelial damage. Its reported common side effects are conjunctival hyperaemia, corneal verticillata and subconjunctival haemorrhage. Corneal oedema arising from its use has been infrequently reported from abroad. We have presented two cases of such oedema acutely induced by Netarsudil, in the absence of any pre-existing corneal problems and which resolved on discontinuation. Such incidences warrant further studies to understand their clinical significance, the mechanism of corneal oedema arising from ROCK inhibitors and the use of these drugs in patients with compromised corneas.

Using Alprazolam before phacoemulsification cataract surgery reduces complications and duration of the surgery.

To evaluate the effect of preoperative Alprazolam on complications of phacoemulsification cataract surgery, duration of surgery and early reoperation rate. Records of 1026 eyes of 1026 consecutive patients underwent phacoemulsification with topical and intracameral anesthesia between 2016 and 2020years were retrospectively reviewed. Patients were divided into two groups, with or without using Alprazolam before surgery. Patients with planned first-time surgery for senile cataract and at least three months follow-up postoperatively were included. Those who had pseudoexfoliation, small pupil, zonular weakness, corneal and hearing problem as well as traumatic, brown, mature, hypermature, and posterior polar cataracts were excluded. Main outcome measures were duration of surgery, posterior capsule rupture, rapid posterior capsule opacification (PCO) formation requiring the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser and reoperation rate in early postoperative periods. Alprazolam and control groups included 490 and 536 eyes, respectively. Mean surgical time was shorter in Alprazolam group (10.2 ± 3 versus 12.2 ± 4min; < 0.001). Rate of posterior capsule rupture was higher in control group (4 versus 15 eyes; = 0.02). Four eyes (0.8%) in control group underwent unplanned secondary surgical procedures in early postoperative period (P = 0.126). Rate of rapid PCO formation was higher in control group (1 versus 9 eyes; = 0.027). Using Alprazolam before phacoemulsification can lead to less posterior capsule rupture, short operation time and prevent repetitive surgery. It also reduces rapid PCO formation and, thus, early Nd:YAG laser intervention due to better cleaning the posterior capsule during surgery. We conclude that Alprazolam not only reduces intraoperative complications, but also facilitates their management.

Anterior Corneal High-order Aberrations in Fuchs' Endothelial Corneal Dystrophy Classified by Scheimpflug Tomography.

Visual acuity may be limited after endothelial keratoplasty in Fuchs' endothelial corneal dystrophy. This may be due to increased anterior high-order aberrations that persist after endothelial keratoplasty. It is not clear at what stage these aberrations begin. We aimed to evaluate how subclinical corneal edema affects anterior corneal high-order aberrations. We aimed to evaluate anterior corneal high-order aberrations according to the presence of subclinical corneal edema in Fuchs' endothelial corneal dystrophy using Scheimpflug topography. All the patients underwent corneal topography (Sirius Scheimpflug-Placido disc camera; CSO Ophthalmic, Scandicci, Italy). Fifty-two eyes of 31 patients with Fuchs' endothelial corneal dystrophy and 52 eyes of 35 patients without corneal problems were included. In addition, patients with Fuchs' endothelial corneal dystrophy were divided into two groups according to subclinical corneal edema as with Fuchs' endothelial corneal dystrophy-edema and Fuchs' endothelial corneal dystrophy-nonedema. Subclinical corneal edema was defined based on the presence of at least two of three findings of the loss of regular isopachs, displacement of the thinnest point of the cornea, and posterior depression. High-order aberrations were expressed as Zernike polynomials in the 4- and 6-mm optical zone. We found that subclinical corneal edema in Fuchs' endothelial corneal dystrophy caused a larger 4-mm trefoil II and a smaller 6-mm spherical aberration II measurements than the nonedema group. The 6-mm total high-order aberrations, 6-mm coma aberration, and 4- and 6-mm trefoil II aberration measurements were larger, and the 6-mm spherical aberration II was smaller in Fuchs' endothelial corneal dystrophy patients with edema compared with the healthy eyes. The presence of subclinical corneal edema in Fuchs' endothelial corneal dystrophy results in larger 4-mm trefoil II and smaller 6-mm spherical aberration II measurements. More patients with intermediate values are needed to evaluate the effect of these aberrations on visual acuity.

Endoscopic Anatomy of the Zygomatic Nerve: Implications for the Endoscopic Transmaxillary Approach.

Introduction Understanding the anatomic features of the zygomatic nerve is critical for performing the endoscopic transmaxillary approach properly. Injury to the zygomatic nerve can result in facial numbness and corneal problems. Objective To evaluate the surgical anatomy of the zygomatic nerve and its segments from an endoscopic endonasal perspective for clinical implications of performing the endoscopic transmaxillary approach. Methods The origin, course, length, and segments of the zygomatic nerve were studied in four specimens from an endonasal perspective. Results The zygomatic nerve arises 4.1 ± 1.7 mm from the foramen rotundum of the maxillary nerve in the superolateral pterygopalatine fossa (PPF). According to its anatomic region in endonasal endoscopic surgery, we divided the zygomatic nerve into two segments: the PPF segment, from origin to the point of entry under Muller's muscle, which runs superolaterally to the inferior orbital fissure (IOF) (length, 4.6 ± 1.3 mm), and the IOF segment, starting at the entry point in Muller's muscle and terminating at the exit point in the IOF, which travels between Muller's muscle and the great wing of the sphenoid bone (length, 19.6 ± 3.6 mm). In the transmaxillary approach, the zygomatic nerve is a critical landmark in the superolateral PPF. Conclusion The zygomatic nerve travels in the PPF and the IOF; better visualization and preservation of this nerve during endonasal endoscopic surgery are crucial for successful outcomes.

Causes of Blindness and Visual Impairment Among Children Studying in Schools for the Blind in Central Development Region of Nepal

Introduction: This study was done to find out the causes of visual impairment in students studying in schools for the blind in the central development region of Nepal. Materials and Methods: The study was done in six schools for the blind in the central development region of Nepal. It was conducted by a team of Eye care professionals using standard eye examination protocols of the World Health Organization Prevention of Blindness Program in the year 2009. Results: A total of 133 students (5 - 21 years age group) enrolled in six schools for the blind were examined. 52.6% of children were visually impaired at birth and 12% developed vision impairment within one year of age. Twenty-one students (15.8%) had mild visual impairment, 5 students (3.8%) had severe visual impairment and 101 students (76%) were blind. The main cause of vision impairment was found to be lens-related anomaly 23.3% and retinal diseases, 18% followed by corneal lesions, 16.5%, and problems with the whole globe, optic nerve, and glaucoma accounting for 12.03%, 11.3%, and 7.5% respectively. The etiology could not be identified in 48.1% followed by hereditary causes (31.6%) and childhood factors (12%). Of the total students examined, 37.6% were visually impaired due to avoidable causes; preventable in 22.6% and treatable in 15% of cases. Conclusions: A high proportion of childhood blindness in schools for the blind in the central development region of Nepal is avoidable.

Ideal esthetic and functional full-thickness lower eyelid “like with like” reconstruction using a combined Hughes flap and swing skin flap technique

A goal in ideal lower eyelid reconstruction is to achieve not only an esthetic recovery of the shape of the eyelid but also to obtain satisfactory eyelid function without damage to the corneal surface. In this report, we introduce our "Like with Like" reconstruction technique using a combined Hughes flap and swing skin flap. The Hughes flap is a tarsoconjunctival pedicled flap from the upper eyelid, and the swing skin flap is a kind of transposition flap based on the orbicularis muscle pedicle. Eight patients who had more than 25% of the lower eyelid affected by a full-thickness defect were included. There were five men and three women, and the average age was 68.4years old. All patients had undergone wide tumor excision of the lower eyelid due to a malignant tumor and had also had primary two-stage eyelid reconstruction with a combined Hughes flap and swing skin flap. The average reconstructive time was 1:20, and no postoperative severe complications such as flap necrosis or wound dehiscence were observed. The follow-up period was an average of one year, and there were no functional problems such as ectropion, lower eyelid retraction, lid margin hypertrophy, lacrimation disorder, or corneal problems observed in any cases. Esthetically, no reconstructed eyelid bulging or asymmetry in the lid margin was observed in any of the cases. Combining the Hughes flap and skin swing flap technique might be the best choice for a full-thickness lower eyelid defect with regard to the esthetic and functional results.

Bandage Contact Lens

Purpose: Bandage contact lenses are fabricated hydrogel lenses, effective in many corneal problems, most commonly in the healing of incisions occurring after refractive surgery and traumatic corneal abrasions. They promote healing, improve vision and act as a delivery mechanism for drugs. The principle therapeutic aim of these lenses is to provide relief from pain, provide mechanical protection and seal corneal perforations by acting as a splint for the underlying weaker tissue. This study was planned to evaluate therapeutic efficacy of bandage contact lenses in cases of non healing corneal ulcer, impending perforation and perforated corneal ulcer cases. Methods: It was a single centre prospective study. 65 corneal ulcer cases were selected in whom BCL was applied from 1 week to 3 months. Cases were divided in 2 groups; Group A, with descemetocele or small corneal perforation, in whom BCL was applied at 1st day and group B with non-healing corneal ulcer cases, in whom BCL was applied after 20-30 days. Results: Out of 65 patients 36 were males and 29 were females. Group A had 34 cases and Group B had 31 cases. The healing time of corneal ulcer was 12.80±6.48 days in group A and 10.24±4.59 days in group B. No serious complication was noted in any case. 85% cases reported visual recovery. Conclusion: 90-97% relief was noted post BCL application without undue complications. Timely BCL application, broad spectrum antibiotic and antifungal treatment and proper monitoring helped to salvage these eyes.

Lipofilling of the upper eyelid to treat paralytic lagophthalmos

Lagophthalmos is one of the most unpleasant and dangerous conditions that affect patients with facial palsy. The lack of ocular protection leads to corneal problems (such as conjunctival infections, acute and chronic keratitis, corneal ulcerations, and blindness). A dynamic reanimation of blinking eyelids is the therapeutic gold standard. However, success is not guaranteed with these dynamic techniques; even if results are good, blinking is usually restored within a year of the initial operation. Procedures that act more rapidly and have a higher success rate are needed. We proposed that lipofilling of the upper eyelid would improve eye closure, exploit the advantages of using autologous fat, and avoid the risks of exposure or migration associated with loading the lid with gold. Between 2012 and September 2018, we did upper eyelid lipofilling procedures for 75 patients with unilateral facial palsy. The main favourable result of lipofilling of the upper lid was the immediate improvement in corneal discomfort. Everybody described a partial to total increase in corneal comfort postoperatively. In the treatment of paralytic lagophthalmos, lipofilling of the upper eyelid produces favourable aesthetic and functional results, ocular health is restored, and the patients' quality of life is improved.

Preoperative clinical factors and visual outcomes following orbital decompression with dysthyroid optic neuropathy

BackgroundTo investigate preoperative clinical factors and visual outcomes of Japanese patients with dysthyroid optic neuropathy (DON) after urgent orbital decompression.MethodsThis retrospective, observational case series study investigated 44 patients who exhibited several preoperative clinical factors that might be associated with the need for urgent orbital decompression due to DON. Additionally, the visual acuity of DON patients was compared between the patients preoperatively and at 1 and 6 months postoperatively.ResultsAll 44 patients received steroid and with or without radiation therapy, with 27 patients able to avoid undergoing urgent surgery. However, the remaining 17 patients required urgent orbital decompression following a lack of response to the therapy. None of the patients who initially avoided surgery required additional surgery for DON. Factors significantly associated with the need for urgent orbital decompression surgery included: female gender, older age, long disease duration, unilateral significant DON, history of resistance to pulsed steroid therapy, unstable thyroid function, high TRAb (Thyrotrophin receptor antibody)value, poor visual acuity, presence of central diplopia, and presence of corneal problems (P < 0.05 each). The results also showed that postoperative visual outcomes of surgery for DON were acceptable.ConclusionThis study revealed several preoperative clinical factors for DON that appear to be associated with the need for urgent orbital decompression surgery in Japanese patients.

Anterior-Approach Versus Posterior-Approach Levator Advancement Surgery in Aponeurotic Ptosis.

To compare the effectiveness and complications of levator reinsertion in aponeurotic ptosis surgery using anterior and posterior approaches. Seventy-eight (36 females, 42 males) patients with acquired aponeurotic ptosis were evaluated. Pre- and postoperative margin reflex distance, symmetry of height, contour and skin crease, corneal problems, and lagophthalmus were evaluated and compared between the 2 groups. Independent and paired samples t-test, Pearson Chi-square, and Fisher exact test were used to evaluate the results. The anterior approach was performed on 43 eyelids and the posterior approach was performed on 35 eyelids. The mean age of the anterior-approach group was 62.1 ± 11 years, and posterior-approach group was 50.1 ± 15.1 years, respectively (P < 0.001). The male-female ratio was 28/15 in the anterior-approach group, and 14/21 in the posterior approach group (P = 0.027). The success rate of the anterior approach was 69.8% and the posterior approach was 57.1% (P = 0.248). The mean margin reflex distance change was statistically significant in both anterior- and posterior-approach techniques (P < 0.001, P < 0.001, respectively). Three (6.9%) patients in the anterior-approach group and 11 (31.4%) in the posterior-approach group required reoperation (P = 0.005). Lagophthalmus rates were similar (3 eyes in the anterior versus 7 eyes in the posterior group, P = 0.103). Both anterior- and posterior-approaches are effective and safe techniques for aponeurotic ptosis treatment. The posterior approach seems to be preferred by female and younger patients because there is no undesirable scar formation although it has the disadvantage of higher rates of reoperation.

Donor Profile, Tissue Evaluation and Comparison of Voluntary and Motivated Corneal Donation in Nepal Eye Bank.

PurposeCorneal problems is one of the major causes of blindness in developing countries like Nepal. This study intended to analyze donor and tissue profile of Nepal Eye Bank (NEB).Material and MethodsThis was a cross-sectional descriptive type study. Data of corneal tissues collected by NEB from January 2015 to December 2016 were used in the study. Data collected were demographic profile, cause of death, type of corneal donation (whether voluntary or motivated), quality and utilization of tissues. A comparison was made between voluntary and motivated donors.Results1244 corneal tissues were retrieved from 639 donors. Mean age of donors was 49.4 years. 57.7% of the donors were male. There were almost equal number of donor deaths due to cardiovascular disease, 27.2%, and respiratory disease, 26.7%, followed by hanging, 17.8%. Majority of donors were motivated (n = 561, 87.7%). Mean death to preservation time was 5.79 hours (hrs). Of the harvested corneas, 1040 (83.6.%) were suitable for transplant with a mean endothelial cell count of 2850 ± 520 cells/mm2; 16.4% were of poor tissue quality and 2.7% were seropositive. 76.2% of total tissues were of optical quality. Utilization rate of transplantable tissues was 97%. Tissues from motivated donors were significantly “younger” (p=0.0001), had better endothelial count (p=0.0001), and were of better quality (p=0.026) than those from voluntary donors.ConclusionMotivated eye donation is a major and effective source of cornea collection in the eye bank under study with “younger” and better quality corneas compared to voluntary donors.

Ophthalmic Outcome in a Belgian Cohort of Cystinosis Patients Treated with a Compounded Preparation of Cysteamine Eye Drops: Retrospective Analysis.

IntroductionTreatment of the anterior segment problems in cystinosis is challenging as oral cysteamine is ineffective in the treatment of corneal problems because of its avascular structure. Although cysteamine eye drops have been formulated to counter this issue, the stability of cysteamine in these off-licensed formulations and treatment compliance are major problems. The aim of this retrospective study was to determine the efficacy of a compounded preparation of aqueous 0.5% cysteamine eye drops in the management of corneal complications of cystinosis.MethodsData of patients attending the multidisciplinary cystinosis clinic at the University Hospitals Leuven, Belgium between January 2015 and December 2018 were analyzed. All cystinosis patients were treated with the compounded preparation of aqueous 0.5% cysteamine eye drops and oral cysteamine.ResultsA total of 12 patients were treated with the compounded preparation of aqueous 0.5% cysteamine eye drops, of whom 75% were aged > 18 years (n = 9). The mean instillation frequency of the cysteamine eye drops was 3.3 drops/eye per day, and the mean number of hospital visits was two per year. All patients showed photophobia, > 30% corneal infiltration, blepharospasm, eye pain and conjunctival hyperemia during the study period. None of these symptoms improved with treatment with aqueous compounded 0.5% cysteamine eye drops. The corneal cystine crystal score was ≥ 2 in all patients at the last visit.ConclusionTreatment with the compounded preparation of aqueous 0.5% cysteamine eye drops, combined with oral cysteamine, was not effective in reducing corneal cystine crystal deposition and other ocular symptoms in these patients with cystinosis.FundingRecordati Rare Diseases.

Graft rejection-like reactions in the early postoperative period after deep anterior lamellar keratoplasty for keratoconus: a retrospective study.

BackgroundDeep anterior lamellar keratoplasty (DALK) is indicated to correct high astigmatism in patients with keratoconus (KC) and no evidence of Descemet’s membrane rupture. However, some patients with KC experience graft rejection-like inflammatory reactions within 2 months (usually in the first week) after DALK. The aim of this study was to identify the characteristics and influencing factors of these reactions by reviewing the records of patients who underwent DALK or penetrating keratoplasty (PKP) for KC or other corneal problems.MethodsWe retrospectively reviewed the medical records of patients who underwent DALK for KC (DALK/KC), PKP for KC (PKP/KC), or DALK for other corneal problems (DALK/non-KC) at Ban Buntane Hotokukai Hospital between January 2006 and December 2015 and who were followed for more than 1 year. We collected data on the characteristics and incidence of severe inflammatory graft reactions in the early postoperative phase (ie, within 2 months after keratoplasty) and visual outcomes after these inflammatory reactions.ResultsPostoperative inflammatory reactions characterized by persistent epithelial defects, loose suture with infiltration, and vessel invasion occurred in seven of eleven DALK/KC patients, three of 50 DALK/non-KC patients, and none of five PKP/KC patients. These reactions were nonresponsive to topical steroids, and suture removal was required. Although a clear corneal graft in the pupillary area was obtained and best-corrected visual acuity was good after the resolution of inflammation, a risk of corneal astigmatism remained.ConclusionThe incidence of these reactions in the early postoperative period is high after DALK for KC. These reactions do not respond well to topical steroids, and suture removal may be required, which may cause high astigmatism after the inflammation subsides. Lamellar keratoplasty should be considered carefully for patients with KC.

Microbial keratitis-induced endophthalmitis: incidence, symptoms, therapy, visual prognosis and outcomes

BackgroundTo evaluate symptoms, therapies and outcomes in rare microbial keratitis-induced endophthalmitis.MethodsRetrospective study with 11 patients treated between 2009 and 2014. Clinical findings, corneal diseases, history of steroids and trauma, use of contact lenses, number and type of surgical interventions, determination of causative organisms and visual acuity (VA) were evaluated.ResultsThe incidence of transformation from microbial keratitis to an endophthalmitis was 0.29% (n = 11/3773). In 90.9% (n = 10/11), there were pre-existent eyelid and corneal problems, in 45.5% (n = 5/11) rubeosis iridis with increased intraocular pressure and corneal decompensation, and in 18.2% (n = 2/11), ocular trauma. Specimens could be obtained in 10 of 11 samples: 33.3% of those 10 specimens were Gram-positive coagulase-negative Staphylococci (n = 3/10) or Gram-negative rods (n = 3/10) and 10.0% Staphylococcus aureus (n = 1/10). In 30% (n = 3/10), no pathogens were identifiable. 72.7% (n = 8/11) of all keratitis-induced endophthalmitis were treated with vitrectomy and 9.1% (n = 1/11) with amniotic-membrane transplantation. In 27.3% (n = 3/11) the infected eye had to be enucleated – 18.2% (n = 2/11) primarily, 9.1% (n = 1/11) secondarily. No patient suffered from sympathetic ophthalmia. The median initial VA was 2.1 logMAR (n = 11/11). At one month, median VA was 2.0 logMAR (n = 7/11), after three months 2.0 logMAR (n = 6/11), and after one year 2.05 logMAR (n = 6/11). The change in VA was not significant (p > 0.99). 36.4% (n = 4/11) of the cases resulted in blindness.ConclusionsThe overall outcome is poor. Enucleation should be weighed against the risk of local and systemic spread of the infection, prolonged rehabilitation and sympathetic ophthalmia.

Eye care in the intensive care unit.

Ocular surface disease is common in the intensive care population with 20-42% of patients developing corneal epithelial defects. The ocular surface is normally protected by the ability to produce tears, to blink and to close the eyes with rest or sleep. All of these mechanisms can be disrupted in the intensive care population, increasing the risk of developing ocular surface disease. Despite the scale of the problem, eye-care protocols are commonly not instigated and documentation of eye care is often poor. This review details the risk factors for developing ocular surface disease. It also provides evidence-based guidance on protecting the eyes in vulnerable patients, identifying diseases affecting the eye in intensive care patients and delivering the best treatment to the eye. There is growing evidence that adherence to a correctly performed eye-care guideline prevents the majority of corneal problems encountered in the intensive care unit.

Ocular injuries in mid-facial fractures: A retrospective study

Purpose: Mid-face injuries are usually accompanied with loss of integrity of the orbital skeleton along with the subsequent affection of the visual apparatus. This study aimed to highlight the incidence of different eye injuries associated with mid-facial fractures and to accentuate the need of the maxillofacial surgeon to comprehend and approach the post-traumatic ophthalmic consequences.Patients and methods: A total of twenty five patients suffering from mid-facial fractures and orbital involvement were included in this study from the departments of oral and maxillofacial surgery, faculties of Dentistry, Cairo University and MSA University. They were 22 males and 3 females with a mean age of 37 years. All the patients were subjected to immediate clinical and radiographic examination to evaluate the extent of the injury and its implications. An ophthalmologist was asked to further assess the eye apparatus to determine the exact ophthalmic complications. The collected clinical, radiographic and ophthalmic findings were recorded and analyzed. Results: A dominating etiology of Road Traffic Accidents was found (64%) with a significant male predominance (88%). Mid-face trauma in the form of ZMC fracture was acquainted as the most common reason for ophthalmic problems (36%) followed by the direct orbital blow-out fractures (20%). A wide range of ophthalmic complications were recorded. Sub-conjunctival hemorrhage (92%) was the most common to occur followed by peri-orbital edema (84%) and lid ecchymosis and laceration (76%). A clinical complaint from sensory infra-orbital nerve paresthesia was documented (72%). Diplopia (48%) and Enophthalmus (24%) were encountered as the most severe types of complications with other non-significant occurrence of reduced vision (8%), retinal detachment (4%), corneal problems (8%) and traumatic hyphema (8%).Conclusion: We concluded that it is a must to extend the maxillofacial surgeon’s knowledge to include post-traumatic ocular injuries and their ophthalmic complications to complement an optimal patients’ treatment outcome and to prevent disastrous ophthalmic repercussions following mid-face injuries.

Childhood corneal blindness: a retrospective study in a tertiary eye hospital of eastern region of Nepal.

Studies from Nepal show that most of the cases of unilateral childhood blindness are due to corneal causes. It was also observed that these corneal causes were mostly preventable or treatable. to study the patterns of corneal diseases in a pediatric out-patient department of a hospital in the eastern region of Nepal. A retrospective study of the patients who presented to the pediatric department of our hospital in the year 2014 was done with the help of the data received from the hospital recording system. Detail examination of every case was done in the out-patient-department of the hospital by pediatric ophthalmologists. Patients with only corneal disease were included, and those with corneal disease along with other ocular disease were excluded from the study. Of 20,250 patients examined in the pediatric department over a one year period, 1911(9.4%) presented with isolated corneal problems. Keratitis and corneal ulcer were found in 47.8% of them. Corneal trauma was present in 5.6% and vitamin A deficiency leading to corneal opacity and keratomalacia was seen in 0.06% of the cases. Corneal blindness was observed in 66 eyes (bilateral in 3 cases). No case of trachoma or congenital corneal disease was observed. Childhood corneal blindness is mostly due to preventable and treatable causes.

Inflammation the good and the bad

SummaryInflammation at the ocular surface is the most commonly encountered pathology in Ophthalmology, irrespective of age, gender, race or geographical area. Inflammation in the form of primary keratitis of any origin represents a real threat for visual loss. The commonest way though to eventually have a vision‐threatening corneal problem is as a consequence of an inflammatory process initiated in the eyelid margin (i.e. meibomitis), in the conjunctiva (i.e. conjunctivitis that eventually develop into kerato‐conjunctivitis) or Dry Eye Disease (DED).DED serves as an example which explains the role of the lacrimal functional unit (LFU). The LFU, initially defined in 1988 and later expanded, comprises the ocular surface (cornea, conjunctiva, limbus, and tear film), all tear‐producing glands and cells (lacrimal glands, mucus producing system and Meibomian glands) and all the neuro‐hormonal controlling interactions. Thus, the LFU is a crucial concept to understand how inflammation in a tissue not belonging to the optic system (i.e. eyelids or conjunctiva) may end up causing visual disability by involving the visual axis in the cornea. Examples of inflammation in the LFU as well as their deleterious consequences will be presented.