This case report describes a 15-year-old male who presented to the clinic for the first time with long standing unexplained reduced vision of the right eye. Through a comprehensive ophthalmic evaluation, direct ophthalmoscopy revealed a well-demarcated chorioretinal lesion in the macular region of the right eye and in the peripheral retina of the left eye. The case illustrates the diagnostic challenges of identifying ocular toxoplasmosis when external signs are minimal or absent and emphasizes the critical role of a thorough ophthalmic evaluation in detecting underlying chorioretinal pathology. Early recognition of such lesions is essential to appropriate management, prevention of further vision loss, and timely referral for specialized care.
Purpose: To report an atypical case of primary meningococcal keratitis in a myopic contact lens wearer, with typical clinical features resembling acanthamoeba keratitis. This case report emphasizes the significance of early diagnosis, investigations, and management of primary meningococcal keratitis. Case-report: This is a single-patient case report describing an 18-year-old male, contact lens wearer, who presented with 1 month history of left eye redness, and discomfort. His initial exam showed a semi-ring-shaped infiltrate, and cultures confirmed the presence of Neisseria meningitidis. Results: Based on the initial clinical suspicion of acanthamoeba keratitis, the patient was managed by total superficial keratectomy, which was sent for corneal gram stain, culture and histopathology. Topical hourly moxifloxacin hydrochloride ophthalmic solution 0.5% and propamidine isotheonate 0.1% ophthalmic solution and chlorhexidine gluconate 0.02% ophthalmic solution. Following the culture confirmed pathogen, infectious disease team was consulted and a systemic treatment with 7 days of intravenous ceftriaxone 2 grams per day was given. He had persistent epithelial defect that resolved after 3 weeks from the initial visit on intense regimen of ocular lubrication. Conclusion: This case report highlights an atypical presentation of culture confirmed primary neisseria meningitidis keratitis presenting with a ring-shaped infiltrate. Misdiagnosis or inappropriate treatment, such as the use of steroids, can exacerbate the condition. When evaluating contact lens wearers presenting with a ring-shaped infiltrate, n. meningitidis may be considered as a potential causative pathogen. However, in view of both the potential ocular and systemic sequelae of n. meningitidis infection, it is important to investigate and treat these patients promptly and aggressively.
Purpose: To report a culture-proven, delayed-onset Cutibacterium acnes endophthalmitis following intravitreal dexamethasone implant (Ozurdex®) and to highlight diagnostic and therapeutic nuances that distinguish infectious C. acnes inflammation from sterile post-implant reactions. Case report: A 75-year-old pseudophakic man with proliferative diabetic retinopathy and neovascular glaucoma in the right eye presented with pain, redness, hypopyon, and vitritis seven weeks after Ozurdex. Initial management consisted of anterior chamber (AC) paracentesis and intravitreal vancomycin/ceftazidime, plus intensive topical therapy and systemic steroid taper. Because of an indolent but persistent course, a pars plana vitrectomy (PPV) was performed without IOL/capsular manipulation, combined with intravitreal vancomycin, triamcinolone, and aflibercept (for neovascular control). Prolonged incubation of the AC specimen grew C. acnes on day 11; other aerobic/fungal cultures were negative, and PCR was not performed. Inflammation resolved without relapse, and visual acuity improved to 20/30 at 18 months. A fluocinolone acetonide implant placed at 12 months for macular disease did not trigger recurrence. Conclusion: Delayed-onset C. acnes endophthalmitis can occur after intravitreal steroid implantation and mimic sterile inflammation. Microbiologic confirmation often requires extended anaerobic incubation (≥10–14 days), with PCR as a useful adjunct where available. In carefully selected eyes without demonstrable capsular involvement, PPV-based management with intravitreal antibiotics—without immediate capsulectomy/IOL exchange—can achieve durable cure and good visual outcomes, provided close follow-up confirms long-term quiescence.
Introduction: Orbital cellulitis is a rare but potentially life-threatening infection of the orbit, usually secondary to sinus, cutaneous, or dental infections. Methodology: This retrospective descriptive study analyzed 18 cases of orbital cellulitis managed at the Ophthalmology Department of the National Hospital of Niamey over an eight-month period. The objective was to describe the clinical presentation and management approaches in our setting. Results: The mean age of patients was 25.7 ± 12.4 years, with a predominance of children and adolescents (<20 years: 66.7%). Males were more frequently affected, with a male-to-female ratio of 2.03:1. Predisposing factors included diabetes mellitus, malnutrition, and prior use of non-steroidal anti-inflammatory drugs. Eyelid edema was present in all patients, while 50% had retroseptal involvement. Orbital computed tomography was performed in 55% of cases and confirmed the extent and severity of infection. All patients received systemic antibiotic therapy, occasionally combined with corticosteroids. Surgical drainage was required in 72% of cases. Clinical outcomes were generally favorable, with one case of panophthalmitis requiring enucleation. Conclusion: Although limited by the small sample size, this study emphasizes the need for early diagnosis and appropriate management of orbital cellulitis to prevent severe ocular complications. Further multicenter studies with microbiological confirmation are recommended to refine management strategies in resource-limited settings.
Introduction: Dry Eye Disease (DED) is a prevalent ocular condition characterized by insufficient tear production or excessive tear evaporation, leading to discomfort and visual disturbances. The widespread use of electronic devices has raised concerns about their potential association with DED. Aim: The study aimed to investigate the association between digital screen usage and DED among Orotta Collage of Medicine and Health Sciences students in Asmara, Eritrea. Methods: An observational cross-sectional analytical study was conducted and a total of 294 students were sampled using stratified random sampling. A pre-developed self-administered questionnaire and clinical evaluation methods were used. The data were directly entered into SPSS (version 26), and cleaned. Descriptive analysis of the socio-demographic was presented using frequencies (percentages) as appropriate – using graphs and tables. Chi-square test was used for the categorical variables. A bivariate and multivariable logistic regression analyses were used to determine predictors of dry eye. Crude Odds ratio (COR) and Adjusted Odds ratio (AOR) with 95% CI were used to measure the direction and strength of association between explanatory variables and the outcome variable. P-values less than 0.05 was considered statistically significant. Result: The median age of the participants was 21 years, with 86.7% of them being 25 years or less years.The distribution of students by sex was even, with 52% males and 48% females. Regarding the department, 38.1% were nursing students, while 21.8% were from the medicine department. Third-year students comprised the largest proportion (47.6%), followed by freshmen (20%). The frequency and intensity of symptoms of DED were also assessed, revealing that 25.5% of students reported problems with their eyes when watching screens often or always. Moreover, the study examined the duration of electronic device usage, finding that almost half of the students (50.3%) spent 6 to 10 hours per day using electronic devices. The prevalence of DED was computed with 29.9% of students identified as having DED. Spending 6 to 10 hours per day using electronic devices increased the likelihood of DED by 14 times compared to spending less than 5 hours. Additionally, spending more than 10 hours per day increased the likelihood by more than 45 times. However, age, sex, year of study, and department were not associated with DED. Tear film parameters were compared between students with and without DED, revealing significant differences (p<0.001) in Schirmer’s test and tear breakup time. Conclusion and Recommendation: This study concluded that the dry eye was prevalent as near one student in every three and directly linked to excessive use of electronic devices. Given the established link between excessive screen time and DED, implementing educational programs specifically aimed at college students becomes crucial. Implication to the field of nursing: Primarily, the research provided an opportunity for nurses to contribute to the growing body of knowledge in this area. Furthermore, Nurses could have played a pivotal role in raising awareness among patients about the potential risks and implementing preventive measures to minimize dry eye symptoms.
Purpose: The purpose of the study was to measure the effect of dioptric power on choroidal thickness in myopic subjects. Methods: A comparative cross sectional study design was conducted in myopic subjects. Fifty-one patients were included (20 female and 31 male). Purposive sampling technique was used to collect the data. Data was gathered by using instruments Optical coherence tomography and data was analyzed by using statistical test one-way anova in SPPS version 22. Result: Fifty-one myopic patients were examined. Out of which17 individuals were mild myopic with dioptric power of (-1 to -2D), 17 was moderate myopic with dioptric power of (-3 to-4D) and 17 were high myopic with dioptric power of (-5to -6D). Choroidal thickness was measured by enhanced depth optical coherence tomography. There was a statistically significant correlation between choroidal thickness and dioptric power. Choroidal thickness at fovea with decreased significantly (p value 0.001) with the increase in dioptric power. Conclusion: While calculating the retinal choroidal thickness, dioptric power has been considered as an important variable. There is a significant decrease in the choroidal thickness as dioptric power increases.
Objective: Pseudoexfoliation syndrome (PEX) is an age-related systemic disorder characterised by the deposition of extracellular fibrillar material in ocular tissues, particularly the lens capsule, pupillary margin, and trabecular meshwork. PEX is a major risk factor for glaucoma and elevated intraocular pressure (IOP), but its independent effect on corneal endothelial morphology remains uncertain. Previous studies have reported inconsistent findings regarding endothelial cell density (ECD), morphology, and central corneal thickness (CCT). This study aimed to evaluate the impact of PEX on endothelial morphology and CCT using non-contact specular microscopy in a Portuguese cohort. Material and methods: We conducted a retrospective cross-sectional study including 450 eyes: 250 with PEX and 200 age-matched controls without PEX. Eyes with pre-existing corneal disease, prior intraocular surgery, or contact lens wear were excluded. PEX was diagnosed by slit-lamp biomicroscopy, and IOP was measured by Goldmann applanation tonometry. Endothelial parameters were assessed with the EM-3000 specular microscope, including cell count, ECD, mean cell area, coefficient of variation (CV), hexagonality, and CCT. Group differences were analysed using parametric and non-parametric tests, with ANCOVA adjusting for age, sex, and IOP. Results: Baseline characteristics were comparable for age (PEX: 76.2 ± 6.9 years; controls: 75.9 ± 6.1 years; p = 0.289) and sex (female: 56.4% vs. 55.5%; p = 0.521). Glaucoma and ocular hypertension were more frequent in PEX (35.5% and 5.2%, respectively) compared with controls (3.9% and 0%; p < 0.001). On unadjusted analysis, ECD was lower in PEX eyes (2389.2 ± 305.7 vs. 2461.8 ± 274.1 cells/mm²; p = 0.042), though the difference attenuated after adjustment (p = 0.055). Mean cell area was larger in PEX (417.0 µm² [IQR 386.0–452.0] vs. 410.5 µm² [381.0–439.0]) and reached significance after adjustment (p = 0.036). CV was slightly lower in PEX (37.8% [35.0–42.5] vs. 40.9% [36.5–45.0]; p = 0.029), persisting after adjustment (p = 0.031). Hexagonality did not differ between groups. CCT was significantly greater in PEX (541.0 ± 35.9 vs. 530.2 ± 36.8 µm; p = 0.029), remaining significant after adjustment (p = 0.041). Conclusion: PEX was associated with subtle but clinically relevant corneal endothelial changes, including a trend toward reduced ECD, larger cell area, lower CV, and increased CCT. These alterations persisted for CCT, CV, and cell area after adjustment for age, sex, and IOP. The higher prevalence of glaucoma and ocular hypertension in PEX further reinforces the need for careful preoperative assessment. Specular microscopy should be considered routine in PEX patients to anticipate surgical risks and guide management.
Background: Despite the rising prevalence of evaporative dry eyes among young adults in Malaysia, the association between obesity-related factors like BMI, WHR and Meibomian gland loss (MGL) remains unclear. This study investigates the relationship between body mass index (BMI), waist-to-hip ratio (WHR) and Meibomian gland dysfunction (MGD) in young adults. Methods: A total of 66 right eyes of subjects were divided into underweight, normal weight, overweight, and obesity groups based on their BMI and WHR. Meibomian gland examinations of the upper eyelids were performed using Oculus Keratograph 5M corneal topographer (Oculus Optikgerate, Germany). MGL was calculated using ImageJ software (Version 1.51). Results: Among the 66 subjects enrolled, there were 29 males [44%] and 37 females [56%] with the mean age of 22.39 ± 1.98 years. The mean body mass index (BMI) was 23.40 ± 6.13 while the mean waist-to-hip ratio (WHR) was 0.79±0.06. Pearson correlation revealed no statistically significant difference in BMI and MGL (r(64)= 0.023, p= 0.857), BMI and MG tortuosity (r(64)= 0.124, p= 0.321), WHR and MGL (r(64)= -0.093, p= 0.457), WHR and MG tortuosity (r(64)= 0.151, p= 0.226). Conclusion: No significant association in BMI and WHR with either MGL or Meibomian gland (MG) tortuosity. These results suggest that targeting BMI and WHR alone may not be sufficient for addressing MGD, highlighting the need to explore other potential contributing factors.
Dry eye disease (DED) is traditionally diagnosed and managed using symptom scores and ocular surface tests. However, mounting evidence links serum inflammatory markers, including CXCL9/10, CCL19/20, and TNF-α, to disease severity, suggesting that a simple blood draw could soon complement conventional chairside evaluations. Meanwhile, many commonly used artificial tears still contain benzalkonium chloride and other “inactive” excipients that can enter the systemic circulation and exacerbate inflammation. This review synthesizes current evidence on blood-based DED biomarkers, highlights data regarding the systemic absorption and toxicity of ophthalmic inactive ingredients, and presents a clinical vignette in which a patient with polypharmacy intolerance experienced rapid symptom relief after switching to a preservative-free, organic eye drop. These findings support a paradigm shift toward integrating blood-based testing and excipient minimization for more personalized and biocompatible care.
Background: This report discusses a case of bilateral optic disc edema associated with celiac disease which resolved after many months of a gluten-free diet. Case report: A 3-year-old white male, recently diagnosed with celiac disease, presented to our eye clinic for comprehensive exam after referral from plastic surgery due to craniosynostosis. Ophthalmic exam detected optic disc edema. Additional testing ruled out pseudo-papilledema, cranio- cephalic disproportion, and venous sinus thrombosis as the cause of the optic disc edema. After many months on a gluten free diet the optic disc edema resolved. Conclusion: This case highlights one of the extra-intestinal manifestations of celiac disease and showcases the importance of screening eye exams for all patients with systemic diseases that have ophthalmic implications such as celiac disease and craniosynostosis.
Simultaneous branch retinal vein and branch retinal artery occlusion can occur in healthy young patients without apparent cause, every attempt of treatment is made to save vision and proper assessment of the patient is mandatory.
Cerebral visual impairment (CVI) is a complex neurodevelopmental disorder that leads to visual impairment due to damage in the brain. The clinical features of CVI can include light gazing, preferences for certain movements, selective visual field preferences, inability to reach for objects using vision, and poor eye contact. In our presented cases, we observed the heterogeneity of CVI, which resulted in variable outcomes among the subjects. Out of the three cases, two demonstrated significant improvement. The one case that showed less improvement may be attributed to uncontrolled seizures despite treatment with multiple antiepileptic medications. Vision therapy, which utilizes colourful, high-contrast objects along with multisensory cues such as tactile and auditory stimuli, has been shown to enhance vision. These methods can promote visual interest, which is the engagement of the visual system and the development of attention. As a result, vision therapy can help children with CVI maximize their visual potential.
Migraine is considered a multifactorial disease, the irritant of which is unknown. Hypothesis of the occurrence of migraine: in genetically predisposed individuals, long-term negative factors (chronic stress) cause - through cortico-nuclear pathways - excessive constriction of the pupils, which is manifested by significant activation of the parasympathetic nervous system. Constricted pupils (reduction in light flux) through the optic-vegetative system irritant pathological biochemical processes in the body, which leads to a deterioration in the physical and psychological conditions of patients with migraine. It is proposed to introduce medical pupil dilation into the treatment protocol for migraine (and all somatic and mental illnesses) in order to eliminate the negative impact on the body of an overly activated parasympathetic nervous system.
Background: Herpes zoster ophthalmicus (HZO) is a reactivation of the varicella-zoster virus causing serious ocular and systemic complications, particularly in individuals with declining immunity. Case report: A 74-year-old male with a history of various chronic conditions was referred to an eye clinic due to herpes zoster affecting his right forehead and eye. Initial treatment included acetaminophen-hydrocodone, valacyclovir, and ofloxacin, with hypotensive agent added to manage elevated intraocular pressure. Follow-up visits showed improvement in lid swelling and eye pain, although his visual acuity initially worsened before eventually improving to near complete resolution, with corneal edema resolving with topical steroid and IOP stabilizing. The patient's treatment regimen was adjusted accordingly, with instructions to return for continued care until resolution. Conclusion: This case report highlights an unusual occurrence of HZO in an immunocompetent patient who had received Shingrix, emphasizing the need for awareness, early diagnosis, antiviral therapy, and tailored co-management approaches for effective care.
Graves' ophthalmopathy is associated with a reduced blinking frequency, eyelid retraction, proptosis, incomplete eyelid closure. Smoking significantly increases the incidence and severity of GO in patients with Graves' disease Objective: To assess the influence of smoking on the development of dry eyes in patients with Graves' ophthalmopathy (GO) and to determine the properties of tear secretion and ocular surface in these patients. Methods: A cross-sectional study was conducted at the outpatient department of the Eye Diseases Clinic of the Lithuanian University of Health Sciences. The study included 52 patients with a mean age of 47.3 (17.4–69.6) years. The study included 25 smokers and 27 non-smokers with Graves' ophthalmopathy (a total of 52 patients). Their mean age was 47.3 (17.4–69.6) years. Patients underwent ophthalmological examination, ocular surface disease index (OSDI) assessment, Schirmer test without local anesthesia (<5 mm was abnormal), slit-lamp biomicroscopy (tear break-up time (TBUT) under blue light illumination). Statistical analysis was performed using SPSS for Windows software (SPSS Inc., Chicago, IL, USA). Statistical significance was determined at p < 0.05. Results: The mean OSDI score in smoking GO patients was significantly higher (28.79 ± 15.29) compared to non-smoking patients (10.58 ± 7.41), (p < 0.05). The mean Schirmer test value in smoking GO patients was significantly lower (4.21 ± 3.07 mm) compared to non-smoking patients (11.74 ± 6.24 mm). The difference was statistically significant (p < 0.04), indicating insufficient tear production. The mean tear film break-up time (TBUT) was lower in smoking GO patients (7.04 ± 2.25 s) compared with non-smoking patients (10.93 ± 3.12 s), ( p < 0.04), indicating an unstable tear film. Conclusion: The study found statistically significantly increased OSDI scores, shorter Schirmer scale and tear film breakup time measurements in smokers with GO. These data may indicate a predisposition to dry eye syndrome in smokers.
This case focuses on a 16 years old male patient who was recently diagnosed with Marfan syndrome after his first comprehensive eye exam. Ocular manifestation like ectopia lentis, high amount of astigmatism and irregular cornea has been recorded in this case. The importance of careful oculo-visual examination and possible management options in such patients are highlighted.
Glaucoma is an optic neuropathy characterized by retinal ganglion cells (RGC) degeneration associated with visual field defects. Though conventional structural and functional assessments, such as optical coherence tomography (OCT) and perimetry, are essential for diagnosis, clinical electrophysiology of vision can offer a valuable understanding of the pathophysiology of the glaucomatous damage. This article highlights the role of electrophysiological testing in early detection of glaucoma and monitoring disease progression.
Objective: To describe the baseline characteristics of patients with diabetic macular oedema (DMO), both clinical and OCT biomarkers using AI and compare them at one-year follow-up. Methods: A descriptive cross-sectional and retrospective study was carried out on diabetic patients with a new diagnosis of DME and naive to treatment who consecutively attended our center over a period of two years. These patients were followed up during the year following their inclusion. Results: The study included 72 patients diagnosed with DME. No significant differences were found in age, visual acuity (VA) and glycosylated hemoglobin between sexes, except for dyslipidemia, which was more prevalent in men. At one year follow-up, there was a significant reduction in intraretinal fluid (IRF), but not in subretinal fluid (SRF) or pigment epithelial detachment (PED). In addition, there was a significant increase in the prevalence of epiretinal membrane (ERM) and geographic atrophy (GA). Conclusion: The study highlights a significant reduction of intraretinal fluid in patients with DME after one year of follow-up, but also an increase in the prevalence of epiretinal membrane and geographic atrophy. These results emphasize the importance of using advanced tools such as OCT with AI for better assessment and prognosis of DME in real clinical practice.
Purpose: The purpose of this study was to determine the association of dry eye disease in patients using antidepressants and also comparison of two antidepressants drugs escitalopram and sertraline among patients using these anti-depressants drugs. Methods: This descriptive cross sectional study was done from July 2019 to April 2020 at Capital Development Hospital Islamabad and Benazir Bhutto Hospital Rawalpindi. Data was gathered by using self-made proforma. Purposive sampling was done. After taking consent from the individuals using these two antidepressants Schirmer test and Ocular surface disease index results were recorded. Data analysis was done by the latest SPSS version 20. Data was analyzed by using chi square in SPSS version 20. Result: In 80 subjects aged between 20-40 years, both male and female gender using antidepressants escitalopram and sertraline, association of dry eye was assessed by Schirmer test and ocular surface disease index. Results of this study showed that dry eye was associated with duration of usage of antidepressants (p<0.001). Statistically there is no significant difference of dry eye between escitalopram and sertraline with p value (0.488). Conclusions: This study gives knowledge to Ophthalmologists and health care practitioners that long term use of antidepressants has association with dry eye. Antidepressant drug dosage history is important in dry eye disease. Dry eyes were checked in patients using these two drugs escitalopram, sertraline.
Allergy is considered to be a multifactorial disease with no known trigger. The hypothesis of allergy: in genetically predisposed individuals, long-term negative factors (chronic stress) cause excessive pupil constriction via the cortico-nuclear pathways, which is manifested by significant activation of the parasympathetic nervous system. Constricted pupils (reduced luminous flux) trigger pathological biochemical processes in the body through the optic-vegetative system, which leads to a deterioration in the physical and psychological conditions of patients. It is proposed to include in the protocol for the treatment of allergies (and all somatic and mental illnesses) the medical dilation of the pupils to relieve the negative effects of an over-activated parasympathetic nervous system on the body.
