Akshay Gopinathan Nair, Indumati Gopinathan, Vandana Jain
Ocular surface squamous neoplasia (OSSN) encompasses a variety of conjunctival and corneal epithelial tumors including dysplasia, carcinoma in situ, and invasive carcinoma. OSSN commonly affects the interpalpebral conjunctiva and typically arises from the nasal limbus as a solitary growth. It is generally believed that these tumor cells originate from dysfunctional limbal stem cells that have been altered by various mutagenic agents, such as UV radiation; however, these lesions can also be seen to extend across the limbus to involve the cornea. Rarely, OSSN may be seen to arise from atypical locations such as the palpebral conjunctiva.,, In addition, there have been documented cases of squamous cell carcinoma of the lacrimal sac and canaliculus presenting as punctal masses and canaliculitis as well.,, To the best of our knowledge, there has been no previous documented case of conjunctival squamous cell carcinoma presenting as an isolated peri-punctal mass with no involvement of the lacrimal sac. This study was adherent with the tenets of the Declaration of Helsinki.
Nandini Bothra, Kavya Madhuri Bejjanki, Mohammad Javed Ali
“Gossypibioma” is a Latin word, “gossypium” meaning cotton and “boma” meaning place of concealment and is used to describe a retained surgical sponge or surgical gauze. It is also referred to as “Textiloma” or “retained foreign object” (RFO). A retained surgical sponge in the nasal cavity is rare, as the nasal cavity is visible to the naked eye. A 67-year-old man presented with a foul-smelling discharge and bleeding from left nostril since 3 months. Past history revealed that a left-sided endoscopic dacryocystorhinostomy (DCR) was performed elsewhere, 3 months ago. On endoscopic evaluation, retained gauze with discharge [Figure 1]a and diffuse granulation tissue in and around it was noted [Figure 1]b. The granulation tissue along with the retained gauze [[Figure 1]b inset] was removed under endoscopic guidance followed by triamcinolone acetate injection into the base of the residual granuloma [Figure 1]c. Postoperatively, nasal steroids and decongesants along with oral antibiotics and anti-inflammatory agents were used. After 1 month, repeat endoscopic evaluation revealed a total cicatricial closure of the ostium and synechiae between the septum and the lateral nasal wall along the expected lines in such clinical scenarios [Figure 1]d.
Mohmad Uzair, Deepak Varma
A 46-year-old female presented with a small yellowish lesion since 3 weeks on the lateral aspect of right upper eyelid margin [Figure 1]a. Slit lamp examination revealed live tick attached [Figure 1]b. Tick was successfully removed using toothless forceps [Figure 1]c and was sent to the Microbiology lab and identified Dermacentor variabilis (American dog tick). Ticks must be removed as soon as possible, as animal and human studies have shown that the risk of disease transmission increases after 24 h of attachment and significantly increases after 48 h. The careful, mechanical extraction of ticks using blunt, curved, medium point forceps is recommended as safe and effective.
Ritika Mukhija, Neiwete Lomi, Akash D Saha, Radhika Tandon
An 11-year-old boy, who was a known case of bilateral chemo-reduced intraocular retinoblastoma, presented to our center with sudden onset diminution of vision, whitish discoloration, photophobia, and watering in the right eye for past two days. On examination, he had bilateral periocular fat atrophy, deep superior sulcus, and horizontal jerk nystagmus along with diffuse corneal edema, grossly visible corneal ectasia, and Munson’s sign in the right eye and esotropia in the left eye [Figure 1]. He was provisionally diagnosed as acute hydrops and planned for examination under general anesthesia, during which a diagnosis of bilateral keratoconus with right acute hydrops was confirmed using microscope-integrated Optical Coherence Tomography [Figure 2]. Intracameral gas injection was performed in view of severe edema and to provide early visual rehabilitation in the only seeing eye, following which hydrops resolved, and since then, the ocular condition has remained stable.
Akshay Gopinathan Nair, Ronnie Jacob George, Sundaram Natarajan, Vandana Jain
Purpose: To report the clinical outcomes of 0.5% timolol maleate eye drops for the treatment of conjunctival pyogenic granuloma (PG) and its effect on intraocular pressure (IOP). Methods: In this retrospective study, consecutive patients with conjunctival pyogenic granuloma between January 2019 and September 2019 were prescribed 0.5% timolol maleate eye drops twice a day and followed up for 8 weeks. IOPs were measured before treatment, while on treatment and 6 weeks after treatment. Results: A total of 12 patients with conjunctival PGs were treated with 0.5% timolol maleate eye drops. Patients ranged from 7 to 72 years with a mean age of 31.1 years. Eleven (11/12; 91.6%) patients had complete resolution of pyogenic granulomas after a mean duration of treatment of 4.4 weeks (range: 3–6 weeks). One patient had a persistent PG, which showed sub-optimal resolution at 6 weeks of treatment and was surgically excised. The mean IOP of the affected eye at presentation was 15.1 mm Hg (range: 10 to 20 mm Hg; SD: ±2.9 mm Hg). One week after initiating therapy, the mean IOP was 12.1 mm Hg (range: 8–16 mm Hg; SD: ±2.4 mm Hg). The mean reduction IOP compared to the baseline IOP was statistically significant (p = 0.02). No adverse events were noted in any of the patients. Conclusion: Topical timolol is effective in the treatment of conjunctival pyogenic granulomas with no major side effects. There is a significant reduction in IOP while on treatment which is reversible and returns to baseline following completion of therapy.
Rajat D Maheshwari, Maanvi Maheshwari
Purpose: Pigtail probe as a procedure of choice for canalicular laceration. Methods: Retrospective, consecutive interventional case series of patients with eyelid laceration involving the canaliculus undergoing repair. All patients were subjected to repair with pigtail probe as first choice and only if this was not possible, they were repaired by other method. Outcome was analyzed in terms of cosmetic, functional, and anatomic success. Results: A total of 35 patients (mean age, 10.88 years) underwent eyelid and canaliculus repair by a single surgeon (RM). In all, 32 (91.42%) canalicular lacerations were repaired by annular intubation using a pigtail probe, while the remaining 3 (8.58%) lacerations in which pigtail probe intubation was not possible, were repaired by an alternative method. Upper canaliculus was involved in 6 (17.14%) and lower canaliculus in 29 (82.86%) eyes. Mean follow-up was 8.2 months (range 3–13 months). Intubation tubes were removed after at least 3 months (range 12–20 weeks). None of the patients had complaints of epiphora. All the patients had good cosmesis, anatomic alignment and functional success as assessed by dye disappearance test in younger children and lacrimal irrigation in older children and adults. Conclusion: Bicanalicular annular repair with pigtail probe achieved excellent functional and cosmetic results. The loop minimizes the chances of extrusion of the tube, maintains natural anatomic alignment of the cut ends of the canaliculus and thus retains the integrity of the delicate canalicular system. Pigtail probe intubation can be considered as the first choice in canalicular lacerations.
Kasturi Bhattacharjee, Sripurna Ghosh, Shoaib Ugradar, Ariel M Azhdam
Of the two common techniques of lower blepharoplasty, the transconjunctival approach is limited to young patients with prominent herniation of lower fat pad without skin excess and the transcutaneous approach to patients requiring skin excision. However, the current trends not only highlight the traditional sculpting of the three orbital fat pads in lower lid blepharoplasty but also additional relocation of the intraorbital fats for correcting the inferior orbital hollowing. The purpose of this review is to analyze the published literature on common types, techniques, indications, and outcomes of the multiple surgical variants of lower lid blepharoplasty often aimed at treating the redundant skin, steatoblepharon, tear trough deformity, lid laxity, and dermatochalasis, thereby to correct the negative vector and inferior orbital hollowing along with effacement of the lid cheek junction. An extensive survey of peer-reviewed literature published in English in electronic databases, as well as bibliographies from cited articles, was conducted. Databases such as MEDLINE PubMed, the Cochrane Library, and Embase were scanned using relevant medical subject heading (MeSH) terms. Clinical studies with a minimum of five study cases were included. Level III evidence, case reports, letters, editorials, and case series with fewer than five eyes were excluded. This article provides a concise overview of available literature and as such no meta-analysis was done due to the narrowed scope of the involved studies and the variety in surgical approaches and techniques of lower lid blepharoplasty.
Subina Narang, Meenakshi Sindhu, Suman Kochhar, Awadesh K Pandey, Priya Goyal
A 3-year-old female with unilateral Group D retinoblastoma as per international classification, was injected periocular topotecan (1 mg in 0.1 ml) owing to persistent vitreous seedings after high dose chemotherapy. At 3-weeks follow-up, there was a marked decrease in vitreous seedings and topotecan was repeated intravitreally in the dose of 20 μgm in 0.1 ml. The patient developed fever and lid swelling within 24 hours of the injection, which worsened over the next three days. She also developed target lesions on skin consistent with erythema multiforme and exudation on both eyelids, oral ulcerations, and hemorrhagic crust formation on lips [Figure 1]. The cornea revealed total epithelial defect with a stromal haze [Figure 2]. The systemic work-up was unremarkable.
The skin rash responded to oral wysolone (10 mg/kg) and topical steroids, antibiotics, and antihistaminics for 1 week. The cornea re-epithelized at 2 weeks. Her fundoscopy at 4 weeks showed the resolution of vitreous seeds…..