Eye Care Center In Nepal Research Articles

Prevalence and Pattern of Ocular Trauma in a Secondary Eye Care Center in Nepal: A Descriptive Cross-sectional Study.

Ocular trauma stands as the leading preventable cause of monocular blindness worldwide. The aim of the study was to calculate the prevalence of ocular trauma and the circumstances, causes, and types of ocular injuries at emergency department of Community Eye Hospital. This was a descriptive cross-sectional study conducted retrospectively on patientsvpresenting to the Emergency Department in the year 2020. Ethical clearance was received from the Institutional Review Board with reference number 12/2021. Data collection commenced in April 2021, following the approval in March 2021. Descriptive statistics with mean and frequency were used for analysis. Among the 6526 emergency cases visiting the emergency department of Hetauda community eye hospital the prevalence of ocular trauma was 2143 (32.83%; 95% CI: 31.69%-33.97%). The mean age among the 2143 trauma cases was 33.55±15.63 years. Among them, 1851 (86.40%) fell in the working age group. The male-to-female ratio was 3:1. Occupational injuries due to welding, agriculture and industries were in 604 (28.19%) of all ocular injuries. The prevalence of ocular trauma in our study was higher than other studies. Occupational ocular trauma mainly welding injury, cement factory injury and agricultural injury are common cause of ocular trauma.

Insights into ocular syphilis in Nepal.

This study aims to elucidate the demographic characteristics, clinical features, diagnostic approaches, and medical management of patients with ocular syphilis, known as 'the great masquerader,' at a tertiary eye care center in Nepal. We conducted a retrospective review involving 15 eyes from ten patients with ocular syphilis treated at a uveitis referral center between 2020 and 2022. Lumbar puncture was performed if neurosyphilis was suspected. Treatment success was defined as the absence of ocular inflammation in both eyes and a decrease in Veneral disease research laboratory (VDRL) titres after completing therapy. A total of 15 eyes of 10 patients were diagnosed with syphilitic uveitis based on positive treponemal and non-treponemal serological tests. The mean age of the patient was 39.9years (range 22-54years) with an equal distribution between males and females. HIV coinfection was not found in any of the patients. Syphilitic uveitis was the primary presentation in nine patients (90%), while one patient presented with recurrent nodular scleritis. Ocular involvement was bilateral in 50% (5 patients). The mean duration between the initial symptom and the first presentation was 8.7weeks (range: 4days to 24weeks). The most common ocular findings was panuveitis (6 eyes). Eight patients with early syphilis received weekly intramuscular injections of benzathine penicillin G for 3 weeks whereas 2 patients with neurosyphilis were treated with intravenous ceftriaxone 1 gm twice a day for 14 days. Signs and symptoms of majority of patients improved with systemic therapy for syphilis. Syphilitic uveitis should be included in the differential diagnosis of any form of ocular inflammation.

Indications and Outcomes of Repeat Keratoplasty for Graft Failure at a Tertiary Eye Care Center in Nepal.

Graft failure is a common complication following keratoplasty requiring repeat keratoplasty (re-KP). To determine the indications and outcome of repeat keratoplasty at a tertiary eye care centre in Nepal. This was a retrospective study of 78 patients who underwent re-KP for graft failure in Tilganga Institute of Ophthalmology from Jan 2015 to Dec 2020. Indications for the primary keratoplasty, causes of graft failure and outcomes of re-KP in terms of vision acuity, graft clarity and secondary glaucoma were evaluated. Cases of regraft with less than one-year follow-up period were excluded. A total of 78 re-KPs had been performed in 78 patients during the study period. Seventy eyes had undergone single corneal regraft and 8 eyes had undergone multiple (second or third) regraft surgery. Most common indication of primary keratoplasty was infectious keratitis (n=36; 46.2%). On follow up, 36 eyes (46.2%) were clear at the last visit, of which 31 eyes were single regraft cases and 5 were of multiple regraft cases. Most common cause of graft failure was graft infection (n=34; 43.6%) followed by corneal scarring (n=12; 15.4%). Of 42 eyes with failed regrafts, recurrence of the preoperative infection was commonest cause (n=15, 35.7%) followed by secondary glaucoma (n=11; 26.2%). Of 36 eyes with clear regraft, only 4 eyes (11.11%) achieved best corrected vision of ≥6/18 and remaining 32 eyes had BCVA <6/18 due to associated cataract, secondary glaucoma and high astigmatism. The most common cause for re-KP includes graft infection followed by secondary glaucoma. Outcomes of corneal regrafts in the form of graft clarity and visual acuity are suboptimal.

RE-INVENTING CYANOACRYLATE RETINOPEXY IN THE 21ST CENTURY: LITERATURE REVIEW AND CASE SERIES.

We report use of cyanoacrylate (N-butyl-Cyanoacrylate) in previously failed retinal reattachment surgeries for chorio-retinal colobomas. We report the surgical technique, its challenges, and long-term outcomes in three patients who underwent the surgery. A chart review of patients with chorio-retinal colobomas and retinal detachment repair with cyanoacrylate at a tertiary eye care center in Nepal. Cyanoacrylate was used to seal colobomatous retinal breaks in eyes which had undergone multiple retinal surgeries with failed outcome. Three eyes that were operated using cyanoacrylate were included. All three patients had attached retina and none of the patients required a long-term tamponading agent. None of the patients underwent head positioning following the surgery. All of the patients had a visual acuity gain of 3/60 or more at the end of 8 months. No adverse or inflammatory reactions were noted. We demonstrate that cyanoacrylate is safe and less resource-demanding without a requirement of second surgery to remove a tamponading agent. It could be helpful in eyes with persistent retinal detachment in colobomatous eyes. Because we were able to achieve favorable outcomes without head positioning, we believe it may also be helpful in patients who are not suitable for positioning because of bodily or bony deformities and in retinal detachment with other coexisting trauma.

Clinical Profile of Low Vision in Children

Introduction: Visual impairment in children is more common in developing countries like Nepal. A low vision service has been found to be effective in significantly improving their overall development and quality of life. The main aim of this study was to determine the causes of low vision in pediatric population along with their refractive error distribution and visual functions. Methods: A descriptive cross sectional study was carried out in Tribhuvan University, BP Koirala Lions Center for Ophthalmic Studies. A total of 50 low vision children were under went detail low vision examination. They were selected through purposive sampling. Data was analyzed by using the descriptive and inferential statistics with SPSS version 19.0. Results: The study findings showed, most common cause of visual impairment in low vision children was refractive error (20%), followed by congenital cataract (18%) and macular dystrophy (16%). The most commonly prescribed low vision device for distance was telescope and for near was spectacle magnifier. There was average acuity improvement of five lines in distance visual acuity with low vision devices. Conclusion: The study concluded that refractive error and congenital cataract being the commonest cause of low vision in children, which reflect poor accessibility of care service among Nepalese children. Refractive error, the major cause of visual impairment could have been managed even in primary eye care center in Nepal. Children with impairment have potential visual acuity that can be improved with low vision services.

Profile of Custom Ocular Prosthesis Users in a Tertiary Eye Care Centre in Nepal

Objective: To analyze the profile of custom ocular prosthesis users in Nepal. Methodology: This was a retrospective study done at Drishti Eye Care System, Nepal from January 2019 to June 2019. One eyed subject who used custom prosthesis for minimum of 6 months or above of any age group were recruited in the study. Information regarding laterality, cause of loss of eye, reason for opting ocular prosthesis and source of information regarding ocular prostheses were collected from the participants. A set of questions were asked to the participants through telephonic interview after the duration of 3 to 6 months wear of ocular prosthesis to collect information on any symptoms after the wear. Results: Mean age of subjects in the study was 31.35±16.59 years (range 1.5 years – 78 years), 46.7% (n=14) were male and 53.3% (n=16) were female. Trauma was the most common cause of loss of the eye in 43.3% (n=13), followed by congenital loss and eye infections in 16.7% (n=5). 43.3% (n=13) of the subjects had lost their right eye and 56.7% (n=17) subjects had lost their left eye. 33.3% (n=10) of the subjects didn’t have any symptoms with the use of prosthesis. Milder form of symptoms like small appearance, mild discharge and pain were major complaints after the wear. Conclusion: There is a need of best prosthetic rehabilitation for the anophthalmic patients.

Clinical profile and management of vitreous hemorrhage in tertiary eye care centre in Nepal.

Vitreous hemorrhage is one of the most common diseases presenting to emergency department and leading cause of painless vision loss. To determine the profile of vitreous hemorrhage in patients presented to Outpatient Department (OPD) and emergency Department of Tilganga Institute of Ophthalmology (TIO). This is a hospital based observational non interventional descriptive study. Total 198 patients were enrolled who visited OPD and Emergency department of TIO from August 1st 2012 to July 30th 2013. Total 198 patients (201 eyes) were enrolled for the study, out of which 144 were male and 54 females. 195 were unilateral and 3 bilateral cases. Most common age group of presentation of vitreous hemorrhage was 51-60 years (24.75%). Most common presenting complaint was sudden onset of decreased vision (95%). Most common etiology of vitreous hemorrhage was branch retinal vein occlusion (22.38%). Among the total subjects, 57.7% of the patient were managed with medical therapy, 35.8% surgically and 6.47 % with combined medical and surgical treatment. Branch retinal vein occlusion (BRVO) is the most common cause of vitreous hemorrhage. Diabetes and hypertension are the most commonly associated systemic illnesses.

Pattern and Presentation of Vitreo-Retinal Diseases: An Analysis of Retrospective Data at a Tertiary Eye Care Center in Nepal.

Purpose:We examined patients presenting in a tertiary eye hospital in Nepal, focusing on information relevant to screening and management programs for vitreo-retinal (VR) disease.Design:Retrospective, cross-sectional study.Methods:We reviewed all patients presenting for the first time to the VR-clinic over 1 year. We quantified patient demography, symptoms and duration, systemic diseases, ophthalmological examinations, diagnostic investigations, and final diagnoses.Results:Of the 1905 cases, 1148 were male (60.3%). The 25th percentile of ages was 29 and 38 years for male and female, respectively; thus, female presented later (P < 0.0001). Hypertension was the commonest systemic disease (40.8%), followed by diabetes (32.5%). Age-related macular degeneration (AMD) and diabetic retinopathy (DR) affected 447 eyes (11.8%) and 416 eyes (10.9%), respectively. Male and female AMD and DR patients did not differ in age or disease duration. Similarly, age or disease duration for DR did not correlate with severity. Asymmetry of disease severity between eyes with AMD and DR was largest in patients with 1 normal eye. Presenting acuity was asymmetric between eyes (P < 0.0001) with people more often reporting once their right eyes had acuity of 6/18 or worse.Conclusions:The screening of blood pressure and glucose levels combined with fundus photography could prevent many from progressing to life-changing visual impairment and blindness. Later reporting by females began at childbearing age; therefore, education and ocular screening could be usefully coupled in reproductive health programs. Clubbing VR disease screening with other established health programs like diabetes control program, hypertension clinics, school health program, and so on, would provide economical and sustainable approach.

Biometry characteristics in congenital cataract patients before surgery in a tertiary eye care centre in Nepal

PurposeTo evaluate the anterior segment biometry characteristics in congenital cataract patients before undergoing surgery in a tertiary eye care centre. MethodsWe retrospectively reviewed the charts of congenital cataract patients aged less than 15 years who had undergone the congenital cataract surgery from Jan-Dec, 2015. 451 eyes of 351 patients were reviewed. The eyes were examined using an autorefract-keratometer, applanation A-scan and parameters like keratometry, axial length, corneal astigmatism were noted. ResultsThe mean age at the surgery was 92.4 ± 4.13 months (range 6 months to 15 years). The ratio of boys to girls was 2.34:1. The mean axial length was 21.94 ± 1.94 mm. Girls had shorter axial length than boys (21.53 mm vs 22.11 mm, p = 0.01). The axial length in the cataractous eyes in bilateral cases was significantly smaller than that in the unilateral cases (21.46 mm vs 22.55 mm, p < 0.0001).The mean keratometry was 44.12 ± 2.6 D. Girls had larger mean keratometry value than boys (44.71 vs 43.88, p = 0.0032). Keratometry values were higher in cataractous eyes in bilateral cases than in the unilateral cases (44.61 D vs 43.51 D, p < 0.0001). The mean corneal astigmatism was 1.49 ± 1.13 D. The prevalence of the corneal astigmatism of 2.0 D or more was 25.5%. The with-the-rule astigmatism was the most frequent type (62.53%). Girls had higher mean astigmatism than boys (p = 0.0122). The mean corneal astigmatism was higher in the cataractous eyes in bilateral cases than in the unilateral cases (p = 0.0094). ConclusionsThe axial length, mean keratometry and corneal astigmatism in congenital cataract patients varied with age, gender, and laterality. The data on biometry characteristics of Nepalese pediatric patients provided in the present study are of clinical significance and hence greatly enhance the guidelines for treatment decisions, IOL power calculations and management of congenital cataract patients.

Patterns of Uveitis among Nepalese population Presenting at a Tertiary Referral Eye Care Centre in Nepal

Patterns of Uveitis among Nepalese population Presenting at a Tertiary Referral Eye Care Centre in Nepal

Anatomical and Visual Outcome of Rhegmatogenous Retinal Detachment Managed with Scleral Buckling at a Tertiary Eye Centre in Nepal.

To study the anatomical status and visual outcome of scleral buckling surgery in rhegmatogenous retinal detachment (RRD) at tertiary eye care center in Nepal. This is a prospective, noncomparative, consecutive, interventional study of rhegmatogenous retinal detachment managed with scleral buckling surgery performed in Lumbini Eye Institute, Nepal. All the patients underwent surgery by a single experienced surgeon and had at least 3 months follow up. A total of 50 patients (50 eyes) were operated, 38 males and 12 females, with a mean age of 39.46. Retinal reattachment was achieved in 46 (92%). Improved best corrected visual acuity (BCVA) was seen in 84%, whereas in 8% BCVA was same and deteriorated in another 8%. Rhegmatogenous retinal detachment is one of the common causes of visual impairment and blindness. Timely surgical management with scleral buckling surgery can give good anatomical and visual outcome.

Etiologies of Optic Disc Edema in Tertiary Eye Care Centre in Nepal.

Optic disc edema is a common clinical finding that can be caused by benign to vision and or life-threatening conditions. To investigate the etiologies of optic disc edema among patients presenting to Tilganga Institute of Ophthalmology, Kathmandu, Nepal. A retrospective chart review of patients with optic disc edema presenting to Neuro-ophthalmology department of Tilganga Institute of Ophthalmology from May 2012 to May 2014, was made. 98 patients were diagnosed with disc edema. Females (64%) were frequently affected. It was noted more in the 21 - 50 age groups. Papilledema was the most frequent cause (35.7%) of disc edema followed by papillitis (28.6%), pseudopapilledma (18.4%) and ischemia (17.3%), respectively. Brain tumors (13%) were the most common etiology for papilledema. Papilledema along with other causes, are common etiologies for disc edema. A detailed history and careful evaluation are necessary as the treatment strategy highly depends on it's underlying etiologies.

Pattern of presumed tuberculous uveitis in a tertiary eye care centre of Nepal

Purpose: To evaluate the pattern of presumed tuberculous uveitis and its various clinical presentation. Methods: This hospital based, cross-sectional descriptive study was conducted in B.P. Koirala...

Demographic pattern and clinical characteristics of optic neuritis in a tertiary eye care centre.

To study the demographic pattern and clinical characteristics of optic neuritis cases in a tertiary eye care centre in Nepal. Descriptive, cross-sectional study. Complete ocular examination was done in all the newly diagnosed cases of optic neuritis presenting from January 1st 2012 to June 30th 2013. Demographic pattern, clinical features, visual acuity, colour vision, contrast sensitivity and visual field defects were studied. Sixty seven eyes of 50 patients (28 females and 22 males) with optic neuritis were included in the study. The mean age was 34.32 years ± 13.72 years. The male: female ratio was 1:1.27. All the cases presented with complaint of blurring of vision. Painful ocular movement was noted in 58%. On ophthalmoscopic examination around 2/3rd of eyes suffered from papillitis (72%) and 1/3rd from retrobulbar optic neuritis (27%). Only one case of neuroretinitis (1%) was seen in the study. The colour vision pattern was variable. Contrast sensitivity was reduced in 94%. Centrocaecal scotoma was seen in 10.5%. Females were predominantly affected. Unilateral involvement was the most common presenting as papillitis.

Pattern of Corneal Diseases in Paediatric Age Group at a Tertiary Eye Care Center in Nepal.

It is to study the pattern of corneal diseases (including injuries) in paediatric population in a tertiary eye care center. A descriptive, cross sectional study was carried out in a tertiary eye care center which included 176 cases. Out of 176 cases studied, 6 cases (3.4%) presented with congenital causes, 4 cases (2.27%) were of dystrophy and ectasia, 63 cases (35.79%) had infective origin, 17 cases (9.65%) had inflammatory cause, 9 cases (5.11%) had systemic association and 77 cases (43.75%) had traumatic causes. Trauma was noted to be the most important cause for corneal diseases in paediatric population followed by infective conditions. Viral keratitis was found to be the most common type of corneal infection in the paediatric age group.

The outcome of vitrectomy with internal limiting membrane peeling for chronic macular hole at Biratnagar eye hospital: A tertiary eye care center in Nepal

Background: A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Pars plana vitrectomy and gas tamponade is a recognised modality of treatment for macular hole.Larger holes are more likely to remain open after repair and late reopening after an initially closed macular hole is seen in macular holes larger than 400 μm.Aims and Objective: To evaluate the anatomical and functional outcome of pars plana vitrectomy with internal limiting membrane peeling for chronic stage 3 macular hole.Materials and Methods: Records of 15 patients with stage 3 chronic macular holes operated from 1st January 2013 to 30th June 2013 and completed 1 year of follow up were retrospectively evaluated and included in the study. Preoperative best distance corrected visual acuity (BCVA), preoperative macular hole size, final BCVA and macular hole status at 1 year follow up were recorded. Macular hole closure and visual improvement was calculated. Correlation of macular hole closure and visual improvement with various macular hole parameter was estimated.Results: Eleven (73.3%) macular holes closed at 1 year follow-up. Mean BCVA improved from 1.2 ± 0.27 to 0.89 ± 0.36 logarithm of minimum angle of resolution at 1 year (p&lt;0.001). Visual improvement was seen in only eight (53.3%) eyes. Both macular hole closure and visual improvement showed no correlation with minimum linear diameter, base diameter and hole height.Conclusion: Chronic stage 3 macular hole can be closed successfully in majority of patients with fairly good visual improvement. Macular hole parameters of stage 3 holes may not have any correlation with the anatomical and visual outcome.Asian Journal of Medical Sciences Vol.7(6) 2016 43-46

Surgical Outcome of Traumatic Cataract Following Corneal Perforation in Children in a Tertiary Eye Care Centre in Nepal

Introduction: Traumatic paediatric cataract is challenging and its management is difficult. It is associated with other distortion of ocular anatomy and subsequent post- operative complication poses more problems. It is mostly unilateral. The purpose of this study is to assess the outcome of traumatic cataract following corneal perforation in Nepalese children in a tertiary eye hospital in Nepal.Material and Methods: It was a retrospective review of medical records of children who developed cataract following perforating corneal injuries. The study included 69 cases diagnosed as unilateral traumatic cataract over a period of 70 months (January 2010 till October 2015) at Tilganga Institute of Ophthalmology (TIO). Traumatic cataracts caused by other than the perforating corneal injuries were excluded from the study.Results: Children between 6 to 10 years of age had highest percentage of ocular trauma. Boys were more commonly affected than girls. Forty two percentages of children had visual outcome of better than or equal to 6/18.Poor visual outcome was mainly due to anterior segment pathology- corneal scar (14.49%).Posterior segment pathology like macular scar, vitreous haemorrhage and retinal detachment contributed to 7.34% of the cause.Conclusion: Outcome of the traumatic cataract surgery varied. Visual outcome of post traumatic cataract after corneal perforation was dependent on multiple factors like co- existence of the anterior and posterior segment trauma, per –operative and post-operative challenges. Prompt and good management of traumatic cataract can result in good visual outcome.J Nepal Paediatr Soc 2016;36(1):50-55

Outcome of therapeutic penetrating keratoplasty in a tertiary eye care center in Nepal.

BackgroundCorneal ulcer is an important cause of blindness in developing countries. Therapeutic keratoplasty for infective keratitis is a frequently performed surgery in these countries.ObjectiveTo find out the outcome of therapeutic keratoplasty for infective keratitis.MethodsRecords of 5 years were reviewed of patients who underwent therapeutic keratoplasty from 2006 to 2010. Data collected included demographic parameters, indications for surgery, microbiology of the ulcers, type of surgery performed, and donor tissue details. In the follow-up period, ocular status was evaluated in terms of eradication of disease, anatomic success, graft clarity, visual acuity, and development of glaucoma and cataract.ResultsIn all, 180 eyes of 180 patients were enrolled in the study; 59.4% of the patients were male. Average age was 44.4±16.7 years. Overall, 71% of infective keratitis was perforated. A total of 101 (56%) eyes were positive for organisms of which 49 showed pure fungus and 49 showed pure bacteria. The commonest fungus and bacteria isolated were Aspergillus and Streptococcus, respectively. Average follow-up period was 29±23 months. Overall cure rate of infection was 88.8%, anatomical success rate was 89.5%, and graft clarity was 37.2%. Overall, 43.4% had secondary glaucoma. In the postoperative course, 65.8% of phakic eyes had developed cataract. In all, 38.6% of graft had endothelial failure and 24% of the graft failed due to late infective keratitis. Overall functional success with a visual acuity above 6/60 was 25.4%. Bacterial keratitis had a significantly higher cure rate, anatomical success, and graft clarity compared to fungal keratitis.ConclusionTherapeutic keratoplasty is an important procedure to save the eye and preserve vision in severe infective keratitis. There is a high incidence of postoperative glaucoma, cataract, and graft failure in such a surgery. Bacterial keratitis has a better outcome than fungal keratitis.

Kayser-Fleischer Ring evaluation in Wilson's Disease in a tertiary eye care centre of Nepal

Wilson’s disease is a hereditary disorder of copper metabolism which is characterized by neuropsychiatric and hepatic manifestations as well as appearance of Kayser-Fleischer ring. This is a retrospective review of the records of the patients of Wilson’s disease who attended Neuro-ophthalmic clinic for the identification of Kayser-Fleischer (K-F) ring from January2010 to June 2012. Detailed eye examination included visual acuity assessment, slit lamp biomicroscopy and intra-ocular pressure measurement. Data regarding clinical features, laboratory investigations and the status of K-F ring was recorded. Seven cases of Wilson’s disease with age range of 9-15 years were included in the study. Among them four (57.1%) had neuropsychiatric symptoms, two (28.5%) had hepatic disease and one (14.3%) was asymptomatic, diagnosed by positive family history and laboratory tests. Among four subjects having K-F ring, three (75%) subjects had neuropsychiatric symptoms and one subject had hepato-billiary disease. Besides K-F rings, other ophthalmic findings were sunflower cataract (14.3%) and vernal keratoconjuctivitis (14.3%). The identification of K-F ring is a simple and cost effective screening test for the diagnosis of Wilson’s disease. K-F is present in majority of the patients with neurological manifestations. DOI: http://dx.doi.org/10.3126/jcmc.v4i3.11934Journal of Chitwan Medical College 2014; 4(3): 17-20

A clinical approach to ocular myasthenia gravis

Myasthenia gravis is a common disorder of the neuromuscular junction characterized clinically by muscle weakness and fatigability. Ocular myasthenia is often misdiagnosed in the initial stages due to the fluctuating nature of ptosis and diplopia. Here, we describe the clinical characteristics of ocular myasthenia gravis along with the diagnostic difficulties in a tertiary eye care center in Nepal. We retrospectively reviewed the charts of the patients diagnosed as ocular myasthenia gravis in Neuro-ophthalmology clinic, BPKLCOS, from 2010 to 2013. The diagnosis of ocular myasthenia was based on the association of typical history and signs together with at least one of these features: unequivocal improvement of ocular signs after injection of neostigmine, positive response to electrophysiological tests and detection of serum antibodies to acetylcholine receptors. There were 24 cases of diagnosed ocular myasthenia gravis during the 3 years. Among them 11 cases (45.8%) were males and 13 cases (54.1%) were females. The mean age was 32.04±19.56 years with the age range from 9 years to68 years. The most common symptoms among patients were drooping of the lids (45.8%, n=11), followed by both double vision and drooping of the lids (37.5%, n=9) and only intermittent double vision in16.6% (n=4). In two patients (9.09%) CT-scan findings were suggestive of thymoma. The symptoms were resolved with anticholinesterases alone in 66.6% (n=16) and anticholinesterases were supplemented with immunosuppressive drugs in 33.3% (n=8) patients. Ocular myasthenia is often misdiagnosed in the initial stages due to its fluctuating nature. With a high index of clinical suspicion simple clinical tests accompanied by pharmacological tests can be useful in diagnosing the condition.DOI: http://dx.doi.org/10.3126/jcmc.v4i3.11931Journal of Chitwan Medical College 2014; 4(3): 5-8