BACKGROUND:Healthcare information is easily accessible on YouTube; however, it is unregulated and the quality varies considerably. This study evaluates the causes for variation in the quality of corneal transplantation patient information videos on YouTube. METHODS:YouTube was searched using "corneal transplant" and the variations for penetrating and lamellar transplants. The results were deduplicated and screened for inclusion by two independent reviewers. A modified DISCERN tool was used to evaluate the quality of each video by two observers independently. Differences in quality were assessed by production location and legality of direct-to-consumer (DTC) advertising. RESULTS:Twenty-two videos were included in this study and the mean overall DISCERN score was 2.05 out of 5 (standard deviation = 1.09). Videos scored the highest in relevance to corneal transplant (mean 4.05) and lowest in explaining which patients are unsuitable (mean 1.00) and supporting shared decision-making (mean 1.05). The video with highest viewer engagement was created by McMaster University students. Videos produced in the United States (US) discussed uncertainty and risk less frequently (49% and 43% less, respectively [P < 0.05]) than videos released outside the US. CONCLUSIONS:Quality of YouTube content is variable and the lack of clarity over corneal transplant subtypes can be confusing for patients. There is considerable scope to improve visuals within videos to supplement verbal information in clinic, alongside tailoring information to the relevant age demographic. Essential components frequently lacking include risk, especially where DTC advertising is legal. While videos may be a useful supplement they should not be relied on for comprehensive material.
CONTEXT:Uncorrected refractive errors are the most common cause of visual impairment and global blindness. AIMS:This study aims to assess the accuracy of refractive error measurements using streak retinoscopy and autorefraction, both with and without administering cycloplegics, in children aged 4-10 years. SETTINGS AND DESIGN:This study is an analytical observational research with a cross-sectional design. SUBJECTS AND METHODS:This study was conducted at an eye clinic from January 2020 to August 2020, with 90 subjects. The examination utilized 1% cyclopentolate cycloplegia administered twice within 1 h, along with retinoscopy and autorefractors. STATISTICAL ANALYSIS USED:The data were analyzed using the Wilcoxon signed-rank test. RESULTS:The study results indicate that (1) there was no significant difference in the mean spherical equivalent (SE) before cycloplegia between the two instruments (P = 0.630); (2) a significant difference in mean SE after cycloplegia was observed for both instruments (P < 0.001); (3) significant differences in mean SE after cycloplegia were noted for both instruments in cases of compound myopic astigmatism (P < 0.001), compound hyperopic astigmatism (P = 0.007), and mixed astigmatism (P = 0.001); and (4) examination of all subjects showed undercorrection of autorefractometry results compared to those of retinoscopy. CONCLUSIONS:Retinoscopy and autorefractors yield different results for refractive error correction after cycloplegia. Therefore, autorefractor examination with cycloplegia cannot be considered a substitute for retinoscopy with cycloplegia.
This article describes a rare case where a patient developed Adie's pupil after recovering from Bell's palsy. Adie's pupil, caused by parasympathetic involvement, presents as a dilated, poorly reactive pupil with reduced accommodation; Bell's palsy involves facial nerve dysfunction leading to facial paralysis, usually resolving within 6 months. The patient, with a prior history of fully resolved Bell's palsy, presented with right-sided Adie's pupil and absent deep tendon reflexes. Diagnosis was confirmed with 0.125% pilocarpine. While Adie's pupil has been linked to other conditions, its occurrence post-Bell's palsy is unusual, underscoring the importance of long-term follow-up in such patients.
BACKGROUND:Systemic hypertension and coronary artery disease (CAD) cause widespread vascular and neurodegenerative changes, including in the retina. Optical coherence tomography (OCT) offers a noninvasive means to visualise these changes, serving as a potential marker of systemic vascular health. Retinal layers like the peripapillary retinal nerve fiber layer (p-RNFL) and ganglion cell-inner plexiform layer (GC-IPL) are especially vulnerable to vascular damage, making them useful indicators of cardiovascular risk. This study aimed to evaluate and compare the p-RNFL and GC-IPL thickness among hypertensive individuals with and without CAD and healthy controls. MATERIALS AND METHODS:This prospective observational study included 140 participants divided into three groups: healthy controls (Group A, n = 40), hypertensives without CAD (Group B, n = 50), and hypertensives with CAD (Group C, n = 50). All subjects underwent comprehensive ophthalmic evaluation, including spectral-domain-OCT, to measure p-RNFL and GC-IPL thickness in both eyes. Data were analyzed using analysis of variance with a significance threshold of P < 0.05. RESULTS:Both p-RNFL and GC-IPL were significantly thinned in hypertensive subjects, especially those with CAD. Group A had the highest mean RNFL (114.11 ± 10.09 μm) and GC-IPL (85.07 ± 2.30 μm), whereas Group C showed the lowest (RNFL: 84.90 ± 11.81 μm; GC-IPL: 105.97 ± 11.72 μm). Differences were significant (P < 0.001). CONCLUSION:OCT can find early signs of retinal nerve damage related to high blood pressure and CAD, indicating it can be a helpful noninvasive method for checking and tracking heart health risks.
INTRODUCTION:Dacryocystorhinostomy (DCR) is a surgery in which a direct communication is made between the lacrimal sac and the nasal cavity through a bony ostium to bypass an obstruction in the nasolacrimal duct (NLD) and therefore facilitate tear drainage. There are two main types of DCR: external and endonasal. The external DCR is the gold standard procedure and the most preferred to treat primary acquired NLD obstruction (NLDO), with a reported success rate that reaches up to 97%. AIM:This retrospective cohort study was carried out to assess the functional and anatomical success rates of DCR done at a tertiary eye care hospital between 2017 and 2023, determined by patency on syringing and/or negative fluorescein dye disappearance test, and Munk's score of zero to one. MATERIALS AND METHODS:Clinical records of five hundred and one patients who underwent DCR surgery between 2017 and 2023 were reviewed, of which a hundred and seventy-seven records were included in this study. Children <12 years of age, patients with canalicular or common canalicular obstruction, patients who underwent repeat surgery in failed DCR, and patients with secondary NLDO were excluded. RESULTS:No statistically significant difference was found between the success rate of the anterior flap technique of DCR with or without silicone intubation. Overall, the functional success and the anatomical success of DCR were found to be 87.6% and 89.8%, respectively, which were similar to the other studies published in the literature. CONCLUSION:No statistically significant difference was found between the success rate of the anterior flap technique of DCR with or without silicone intubation.
Wildervanck syndrome, also called as cervico-oculo-acoustic syndrome. This is characterized by the triad of Klippel-Feil syndrome, Duane retraction syndrome, and congenital deafness. Other associations described are cardiovascular and musculoskeletal abnormalities. Some reports, in fact, state that nearly one percent of hearing-impaired females may be affected by Wildervanck syndrome. In our case report, a child who had the complete triad of the syndrome along with arachnodactyly (long slender digits), camptodactyly, short stature, and facial nerve paresis has been described.
CONTEXT:This study addresses the underexplored burden of ocular surface dryness in custom ocular prosthesis users and its impact on quality of life using a validated symptom assessment tool (Standard Patient Evaluation of Eye Dryness [SPEED]). AIMS:To investigate the extent to which ocular surface dryness influences quality of life (QoL) in individuals wearing custom-made ocular prostheses, using the SPEED questionnaire as a symptom assessment tool. SETTINGS AND DESIGN:The study design involves a cross-sectional observational study. MATERIALS AND METHODS:A cross-sectional observational study was conducted involving 60 adult users of custom ocular prostheses who had been wearing their prosthesis for at least 6 months. Participants completed the SPEED questionnaire, and dryness severity was categorized based on total scores. Patient-reported quality-of-life outcomes, including comfort during prosthesis wear, satisfaction with cosmetic appearance, and impact on social activities, were evaluated and analyzed in relation to dryness severity. STATISTICAL ANALYSIS USED:Data analysis was performed using SPSS software (version 26). RESULTS:The mean SPEED score among participants was 10.4 ± 4.2, indicating a high prevalence of dryness-related symptoms. Mild dryness was identified in 20% of participants, while 57% and 23% experienced moderate and severe dryness, respectively. Increasing dryness severity was significantly associated with reduced comfort, lower appearance satisfaction, and greater interference with social activities. Higher SPEED scores were also linked to more frequent prosthesis removal and increased use of lubricating eye drops. Multivariate regression analysis demonstrated that moderate-to-severe dryness independently predicted poorer overall QoL after adjustment for age, sex, and duration of prosthesis use. CONCLUSIONS:Ocular surface dryness is a common and clinically meaningful problem among users of custom ocular prostheses and has a substantial negative impact on multiple dimensions of quality of life. Routine symptom assessment using validated questionnaires such as SPEED may facilitate earlier identification and targeted management of dryness in this population.
Human pythiosis keratitis is a rare but potentially sight-threatening infection. We report the case of an 8-year-old boy who developed a nonhealing corneal ulcer after finger nail trauma that did not respond to broad-spectrum antibiotics. Initial cultures identified Staphylococcus warneri and Streptococcus mitis. Worsening clinical signs prompted repeat investigations, which confirmed Pythium insidiosum through polymerase chain reaction. Despite intensive topical (natamycin and voriconazole) and systemic antifungals (voriconazole), the ulcer progressed with biofilm formation. Manual debridement and a revised regimen of topical linezolid 0.2% alternating with topical ceftazidime 5% led to significant clinical improvement. After 8 weeks of topical therapy and regular debridement, the infection eventually resolved with a paracentral scar and unaided visual acuity of 6/6. This case highlights the diagnostic complexity of Pythium keratitis and the crucial role of early microbial identification in pediatric ocular trauma. We attribute the successful management in this case to prompt diagnostic reevaluation, targeted antimicrobial therapy, and repeated scraping of ulcer biofilm.
Self-medication, over-the-counter medication, and injudicious use of eye drops are not uncommon in our society. Use of such over-the-counter drugs without proper knowledge may be a convenient or cheaper alternative in some scenarios but can have serious implications. With this case series, we intend to highlight one of the risks associated with inappropriate steroid use. We describe the case of three patients who presented with Fusarium keratitis after an episode of conjunctivitis and prolonged use of steroids. All three patients had varying outcomes, ranging from successful medical management to the needing a therapeutic penetrating keratoplasty. This study underscores the critical need for judicious prescription practices. Enhanced diagnostic vigilance and patient education on the risks of self-medication with steroids are essential to mitigate the incidence of this sight-threatening condition.
Janus kinases (JAKs) are a family of intracellular, non-receptor tyrosine kinases that play a crucial role in the JAK signaling pathway involved in the inflammatory process. Over the years, this pathway has garnered significant interest among researchers, leading to the development of various therapeutic agents aimed at blocking the pathway, thereby contributing to remarkable progress in the management of inflammatory diseases across multiple medical specialties. Although the use of JAK inhibitors in ophthalmology is still limited, evidence is gradually emerging on their role in managing uveitis and scleritis. One such agent is tofacitinib, a small-molecule pan-JAK inhibitor. Its therapeutic profile differs from that of biologics due to its partial and reversible inhibition of cytokines. Additionally, owing to its smaller molecular size, the drug is available in an oral formulation. In recent years, there has been a growing interest in JAK inhibitors, particularly tofacitinib, as a potential therapeutic option for refractory uveitis and scleritis in both adult and pediatric populations. Tofacitinib, either as monotherapy or in combination, has shown effectiveness in managing various uveitis cases that were unresponsive to conventional immunosuppressive therapies. It has also been explored in treatment-resistant scleritis. However, concerns persist regarding the potential adverse effects of tofacitinib, including cardiovascular events, thromboembolism, malignancies, and infections. This review aims to provide a comprehensive update on the role of tofacitinib in ocular inflammation, with particular emphasis on its clinical efficacy, safety profile, and the emerging literature surrounding its risks and side effects.
A 70-year-old Omani male with a history of poorly controlled diabetes, hypertension, and dyslipidemia presented with a 6-month history of persistent right ear and temporomandibular joint pain, culminating in sudden painless vision loss in the right eye and jaw claudication. Despite multiple prior consultations and misdiagnoses, the diagnosis of giant cell arteritis (GCA) was only made after ophthalmologic assessment revealed arteritic anterior ischemic optic neuropathy. Bilateral temporal artery biopsies confirmed GCA. The patient was managed with intravenous methylprednisolone, oral steroids, methotrexate, and later Tocilizumab. While systemic symptoms improved, vision loss was irreversible. This case underscores the diagnostic challenges of GCA in regions with low prevalence and highlights the importance of early recognition to prevent blindness.
Diabetic retinopathy (DR) is a leading cause of preventable blindness, with the highest burden falling on populations living in urban slums and peri-urban settlements in low- and middle-income countries. These communities often remain outside the reach of conventional health systems due to systemic neglect, migratory lifestyles, and fragile infrastructure. Traditional facility-based screening models are often inaccessible, underscoring the urgent need for decentralized, community-embedded solutions. This review synthesizes global evidence on community and allied health worker (CAHW)-led DR screening initiatives in urban slum contexts, drawing from 22 studies conducted across Asia, Africa, Latin America, and Oceania. In addition, field experience from a DR screening program in Dharavi, Mumbai, one of Asia's largest informal settlements, is included to illustrate operational realities. Findings highlight the transformative potential of task-shifting DR screening responsibilities to CAHWs, many of whom are recruited from the communities they serve. These workers effectively carried out tasks including health education, visual acuity screening, portable fundus photography, referral navigation, and digital data management. With structured training and supervision, CAHWs were found capable of taking on responsibilities conventionally reserved for ophthalmic professionals. Their cultural familiarity and embedded presence also enabled them to overcome key barriers such as distrust, mobility, and language, improving screening uptake and follow-through in underserved populations. Despite clear benefits, challenges persist. Programs often lack standardized competency frameworks, adequate incentives, digital tools, and integrated referral systems. Addressing these gaps is essential for sustaining impact.
BACKGROUND:To evaluate retinal structural and vascular changes using optical coherence 15 tomography (OCT) and OCT angiography (OCT-A) in migraine patients and to explore 16 their associations with clinical and epidemiological characteristics. SUBJECTS AND METHODS:This cross-sectional, comparative study included 136 eyes from 68 subjects, divided into 68 eyes from migraine patients and 68 eyes from controls. Participants underwent full ophthalmological examinations, OCT, and OCT-A. RESULTS:Patients had a mean age of 35.8 years and a female-to-male ratio of 1.83. Migraine with aura was present in 47.1% of cases. A reduction in upper retinal nerve fiber layer thickness was found in migraine patients, with no other significant OCT or OCT-A differences compared to controls. Correlations were observed between OCT metrics and disease duration, severity, and attack frequency, though no correlations were noted with laterality. CONCLUSION:Optical coherence tomography and optical coherence tomography-angiography may serve as valuable biomarkers for diagnosing, monitoring, and predicting outcomes in both aura and nonaura migraines.
Eyelid and periorbital lesions encompass a wide range of etiologies and clinical presentations, often posing diagnostic challenges. We report a case of a right lower eyelid mass that was initially referred to as a nonresolving chalazion. Clinical suspicion suggested a vascular lesion; however, magnetic resonance imaging indicated a dermoid or epidermoid cyst. Definitive diagnosis was achieved through histopathological examination of the excised specimen, which revealed a vascular thrombus originating from a true aneurysm of an artery. In the absence of a clear history of trauma, infection, or a systemic illness, an unrecognized injury was considered the most plausible explanation. To the best of our knowledge, a vascular thrombus arising from a true arterial aneurysm involving the lower eyelid has not been previously reported. This case report underscores the importance of comprehensive clinical, radiological, and histopathological evaluation in the assessment of atypical eyelid lesions.
