We report a case of a full-term newborn Caucasian girl presenting at 10 days of age with bilateral absence of upper eyelid creases, extremely short palpebral fissures, and mucosal tissue covering both globes. B-scan ultrasonography and magnetic resonance imaging revealed bilateral microphthalmia, more pronounced in the left eye, with hypoplastic optic nerves. No other systemic anomalies were detected. The patient demonstrated normal psychomotor development and responded to light stimuli at ten months. Differential diagnoses included anophthalmia, blepharophimosis, and microblepharon; however, clinical and imaging findings supported a diagnosis of incomplete bilateral cryptophthalmos. Given the poor visual prognosis, surgical intervention was deferred, with plans for future reconstructive consideration. This case underscores the diagnostic challenges of cryptophthalmos, the limitations of prenatal imaging, and the need for a multidisciplinary approach involving ophthalmology, radiology, genetics, and reconstructive surgery in managing complex congenital ocular anomalies.

The intraocular pressure (IOP) ranges of premature newborns are not the same as those in full-term newborns and adult population. The exact ranges and causes, however, differ depending on the measurement techniques used and analysis. Our study aimed to summarize and analyze available information in the up-to-date literature concerning IOP values in premature newborns. We performed a systematic literature review with meta-analysis. Our research showed the mean IOP in premature newborns to range from 10 to 29 mmHg according to different authors, and its mean values were higher in premature compared to full-term newborns. The most commonly analyzed factor that probably affected IOP measurement was central corneal thickness. Longitudinal studies showed that IOP and central corneal thickness declined with maturation of the newborn and both factors were probably correlated. Additional studies with larger sample sizes and better differentiated sample groups need to be performed.

Background: The intraocular pressure (IOP) ranges of premature newborns are not the same as those in full-term newborns and adult population. There are no unified standards for IOP in infants, much less premature newborn. Research on the topic is very conflicting and needs to be expanded upon. To assess IOP in premature and full-term newborns and factors influencing it. Methods: Using a hand-held rebound tonometer, IOP was measured in 548 eyes of 274 preterm infants (gestational age ranging from 26 to 32 weeks) shortly after birth and at weekly intervals for one month. Results: The mean gestational age for premature newborns was 30.23 +/- 2.34 weeks (25-35 weeks), for full-term newborn it was 39.19 +/- 0.91 weeks (37-41 weeks). Mean IOP values in preterm infants were 21.95 +/- 4.36 mmHg (ranging from 11.1 to 32 mmHg), while for full-term were 13.5 +/- 2.9 (from 10.5 to 25.1 mmHg). At the end of the first month the mean IOP decreased to 17.66 +/- 2.21 mm Hg (P < .001) for preterm newborns, while not changing in a statistically significant way for the full-term ones (P>0.5). Central corneal thickness was found to be among the major factors associated with increased IOP (P<.001). Conclusion: Measured values of IOP are well outside the normal range for newborns. There is a tendency for decreasing IOP observed during the first month screening which decreases the value of the initial findings. The exact causes of the decrease of IOP are not completely clear up to this point. Use of eyelid speculum needs to be avoided to prevent artificial increase of IOP.

Objective: Our study aimed to summarize and analyze the available information in the up-to-date literature, concerning intraocular pressure and central corneal thickness values in premature newborns. Material and Methods: We conducted a comprehensive literature review, gathering information from PubMed, Scopus, Embase, Google Scholar, and free-text searches on the topic. We chose only 14 of them to perform a meta-analysis. We used Review Manager 5.4 to compare the mean values of intraocular pressure and central corneal thickness between full-term and premature newborns. Results: The results of the mean value of intraocular pressure of premature infants varied significantly according to different authors-from 10 mmHg to 29 mmHg. Most of the research showed higher intraocular pressure and thicker corneas in premature infants compared to full-term ones. Many researchers looked for a positive correlation between the increased central corneal thickness in premature newborns and the increased intraocular pressure but showed conflicting results. Our meta-analysis showed that the intraocular pressure and central corneal thickness in premature newborns were significantly higher compared to full-term infants with mean difference of 1.95 mmHg [Confidence interval (CI) 0.62-3.28] and 57.82 μm (CI 34.46-81.18), respectively. Conclusion: Additional studies tracking changes in both intraocular pressure and central corneal thickness values, with larger sample sizes and in a longitudinal design with better-differentiated sample groups, are warranted.

Une étude transversale des effets des écrans numériques sur la vision des adolescentsIntroduction.La fatigue oculaire numérique est un nouveau syndrome clinique qui touche toute personne passant une longue période devant les écrans.L'objectif de l'étude a été d'analyser les effets de l'utilisation de différents appareils numériques avec un écran, sur le système visuel des adolescents.Matériel et méthodes.100 questionnaires ont été distribués dans deux cliniques ambulatoires d'ophtalmologie à Stara Zagora et Kazanlak, en Bulgarie, à des écoliers âgés de 13 à 18 ans.Au total, les résultats de 82 questionnaires étaient suffisamment exploitables et ont servi pour notre étude.Nous avons utilisé SPSS 19 pour l'analyse statistique.Résultats.Les résultats ont montré que seulement 3,7% des adolescents n'utilisaient pas de smartphone et que 75,6% d'entre eux passaient plus de deux heures par jour à en utiliser un.Mais également, 72% des participants présentaient au moins deux symptômes de fatigue oculaire numérique.Parmi les symptômes les plus fréquemment constatés, étaient les maux de tête (65,9%), la fatigue oculaire (54,9%) et la vision floue (53,7%).Le temps passé à utiliser un smartphone était fortement associé à la rougeur des yeux et présentait ABSTRACT Introduction.Digital eye strain is a new clinical syndrome that affects any person who spends a large period of time fixed on multiple screens, for work or leisure.The objective of the study was to analyze the effects of using different digital devices on the visual system of adolescent school children.Material and methods.One hundred questionnaire were handed out in two outpatient ophthalmic clinics in Stara Zagora and Kazanlak, Bulgaria, to high school students aged between 13 and 18 years.From these questionnaires, 82 were fit for analysis and were used in our study.SPSS 19 was used for statistical analysis.Results.The results showed that only 3.7% of adolescents did not use a smartphone and 75.6% of them spent more than two hours a day using one.72% of the participants had at least two or more symptoms of digital eye strain.The most commonly reported symptoms were headache (65.9%), eye strain (54.9%) and blurred vision (53.7%).The time spent using a smartphone was strongly associated with eye redness and had positive correlation with the frequency and severity of burning, eye strain, blurred vision, double vision, photophobia, heavy eyelids, eye pain and difficulty focusing.Females had more symptoms of digital eye strain compared to male participants.Mild headaches

Context: The contemporary workplace creates a challenge toward physicians and their teams. They are forced into a situation, in which to be competitive they must have skills outside of their medical specialty, such as health management, pedagogy, and information and communication technologies. Aim: To analyze the level of stress and burnout among the medical employees in the hospital care. Settings and Design: Healthcare professionals from three private, municipal, and regional hospitals filled a questionnaire in the time period January-March 2021. Methods and Material: An adapted Maslach Burnout Inventory 55 question questionnaire was used and analyzed. Statistical Analysis Used: One-way ANOVA, correlation, and multiple regression analysis in SPSS. Results: We identified high levels of emotional exhaustion (>62% report high signs or above), high levels of depersonalization (>70% report signs of depersonalization), and low levels of personal accomplishment (<39% have below average sense of achievements). Conclusions: Despite the physicians and their teams reporting high levels of workload and stress, the satisfaction from work has not diminished and the evaluation for the quality of provided work is still high. Additional research into the topic is required with focus on comparison between hospital physicians and primary care physicians.

The aim is to present a unique clinical case of a 62-year-old male with an ossifying fibroma (OF) in the left orbit. He presented with a slow-growing mass with bone consistency which easily shifted with palpation. After removal, it was given the histopathological diagnosis of osteoma. However, the lesion grew back rapidly and it became even larger 4 months later. After a computed tomography scan with a contrast medium, another surgery was performed. The histopathological diagnosis of the recurrent lesion was an epidermal cyst with secondary degenerative changes. As both diagnoses did not fit the clinical picture, we sent the material from both surgeries for a secondary assessment. The final histopathological diagnosis was OF. OF should be included in the differential diagnosis of benign lesions in the orbit with aggressive behavior.

Purpose: The contemporary work place creates a challenge towards physicians and their teams. They are forced into a situation, in which to be competitive they must have skills outside of their medical specialty, such as health management, pedagogy, information and communication technologies. Methods: An adapted 55 question questionnaire was used and analyzed with One-way ANOVA, Correlation and multiple regression analysis in SPSS. Results and conclusion: Despite the physicians and their teams reporting high levels of workload and stress, the satisfaction from work hasn’t diminished and the evaluation for the quality of provided work is still high. Additional research into the topic is required with focus on comparison between hospital physicians and primary care physicians.

Introduction. Ophthalmologists worldwide are reporting various ophthalmic manifestations of coronavirus disease 2019 (COVID-19). The most common ocular manifestation is conjunctivitis. Even a rarer complication, retinal vein occlusion may appear in patients with COVID-19. Case presentation. A 52-year-old man was admitted for retinal vein occlusion of the right eye. He had been complaining of blurred vision for several days. A complete clinical and paraclinical evaluation of the patient was performed, in search of associated diseases. The patient tested positive for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Conclusions. Retinal circulation is a potential site for thromboembolic complications in patients with COVID-19. Ophthalmologists should be aware of this possible association and maintain a high level of suspicion of COVID-19 in patients with vascular occlusive diseases of the eye.

BACKGROUND: Infertility is an increasingly common health problem which affects approximately 10% of the women in reproductive age. Artificial reproductive technology (ART), which is the modern solution to infertility, unfortunately has been linked to increased prevalence of prematurity and low birth weight (BW) in the newborn. That’s why ART infants make up a considerable portion of the retinopathy of prematurity (ROP) screening burden, which is likely to increase, as ART becomes increasingly available and utilized. AIM: The aim of the study was to assess the association between ART and the development of ROP. MATERIALS AND METHODS: Retrospective analysis of preterm infants screened for ROP at the Neonatal Intensive Care Unit in the University Hospital â€oeProf. Dr. Stoyan Kirkovich” Stara Zagora, Bulgaria, by single factor and multifactor logistic regression models. RESULTS: During a 4-year period (2016–2019), 419 infants, meeting the screening criteria, were admitted in the ward. Out of them, 265 were conceived naturally and 154 through ART. Thirty-two (7.6%) children required laser treatment for ROP, among which 15 (46.87%) were conceived naturally and 17 (53.12%) by ART. Multifactor analyses proves BW (odds ratio [OR] 0.99; confidence interval [CI], 0.98–0.99; p = 0.008) and gestational age (GA) (OR 0.296; 95% CI 0.09–0.88; p = 0.029) as significant risk factors for severe ROP, requiring treatment. CONCLUSION: ART is a risk factor for ROP due to its association with lower BW and GA of the newborn infants, rather than directly increasing the possibility for it. Nevertheless, there is a pronounced trend for more severe ROP to develop in ART children, when compared to naturally conceive in the same weight group.

INTRODUCTION:The refractive state of the eye changes as the eye's axial length increases and the cornea and lens flatten. In general, eyes are hyperopic at birth, become slightly more hyperopic until the age of 7, which at this point we see a myopic shift toward plano until the eyes reach their adult dimensions, usually by about the age 16.AIM:To determine the prevalence of refractive error in preschool children aged 3 - 6 in the city of Kazanlak, Bulgaria.MATERIALS AND METHODS:A cross-sectional study was conducted in a kindergarten based school within the city of Kazanlak, Bul-garia. Out of 15 kindergarten schools, 10 chose to participate in the study. The children underwent non-mydriatic refraction screening using a Plus-Optix S12с mobile camera. Myopia, hyperopia and astigmatism were defined as being a spherical equivalent (SE) ≤ -0.50 D, SE ≥ +2.00 D and cylindrical diopters ≤ -1.00 D.RESULTS:A total of 596 children were screened. Out of these 596 children; 526 were with ametropia (470 hypermetropia, 46 myopia) and 50 had astigmatism. Strabismus was found in 12 children, with a further 8 children suffering from amblyopia and finally 8 children were also found to be diagnosed with anisometropia. In 8 cases there were no results due to opacities or due to the small size of the pupil.CONCLUSION:The prevalence of refractive error in preschool children is similar to that found in other research in the field. While most cases fall into the category of emmetropia or mild hypermetropia, most of the children had never been to an ophthalmologist. A manda-tory checkup should be issued for all children below the age of seven.

We present an 18-month-old girl with strabismus and a variable esotropia of the left eye. Fixation of the affected eye was intermittent with a relative afferent pupillary defect. A fundus photography of the left eye displayed a combination of features of both morning glory disc anomaly and peripapillary staphyloma. A B-scan ultrasonography examination of the left eye showed a conical excavation of the posterior pole. Cycloplegic refraction measurements showed a large amount of anisometropia. Correction with glasses and part-time occlusion was prescribed and a strict follow-up routine was advised. No other systemic associations with the disease have been discovered so far in our patient. We support the theory that morning glory disc anomaly and peripapillary staphyloma may represent two different morphologies in the spectrum of the same disease.

Abstract Background and purpose: The occurrence of primary orbital lymphoma comprises approximately 1% of non-Hodgkin’s lymphoma and 8% of extranodal lymphoma. The vast majority of orbital lymphomas are of B-cell origin, of which extranodal marginal zone B-cell lymphoma is the most common subtype. The purpose of this paper was to present the diagnostic challenges in a case of orbital lymphoma. Case presentation: An 84-year -old woman with orbital tumour was operated on after a long period of inappropriate treatment. It was later diagnosed as B-cell lymphoma. Conclusion: Orbital lymphoma can be easily mistaken for another ocular disease due to the slowly progressing non-specific complaints of the patients. We should be alert to the possibility of this ocular diagnosis when we are presented with an elderly patient with proptosis.

Background: Orbicularis myokymia frequently occurs in young, otherwise healthy individuals. The intermittent muscle fasciculations are transient and generally disappear with time. Aims and tasks: to synthetise and analyse the causes, significance and treatment of eyelid myokymia Methods: a literature review; Data was collected from Pubmed, Scopus, Google Scholar, free search. Results: Eyelid myokymia, unlike myokymia of other facial muscles, is assumed to be a benign, selflimited disorder. It is associated with fatigue, anxiety, stress, exercise, physical exertion, cold weather, excessive use of caffeine, energy drinks, smoking, alcohol, female gender, and reduced sleep. Some authors reported it as a side effect of Topiramate. When it is chronic it might be considered as a separate disease entity of the facial nerve. In rare cases, the eyelid myokymia gradually spreads over several months to affect additional muscles on one or both sides of the face, producing benign essential blepharospasm, Meige syndrome, hemifacial spasm, or, rarely, spastic-paretic facial contracture. Rarely it might be the first sign of brainstem lesions like tumor or multiple sclerosis. Conclusion: If the myokymia is persistent or progressive, neurologic assessment and investigation may be necessary. Change of lifestyle is advised before invasive treatment. Botulinum toxin is the treatment of choice for chronic eyelid twitching.

Introduction: Telecommunications are becoming a part of every aspect of life – business, entertainment, medicine. As part of medicine ophthalmology is particularly amenable to the utilization of such applications. Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. While currently most efforts are concentrated on screening and referral to experts, it could be used as a research and clinical tool. Aim and tasks: To assess the spread and use of telemedicine in ophthalmology. Materials and methods: A structured literature search was done in search engines such as PubMed, Medline, and Google Scholar using the following keywords – teleophthalmology OR telemedicine OR teleophthalmology OR telediabetic screening OR teleglaucoma OR tele ROP OR telescreening AND Diabetic retinopathy OR retinopathy of prematurity OR macular diseases. One hundred and seventy five articles were reviewed. Results: Most current research is focused on screening for retinopathy of prematurity (ROP), diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sightthreatening conditions. Studies report only 2% of screened eyes requiring in-person examination due to ungradable images. Tele-screening required less time than its bedside counterpart, and while further research is needed most studies suggest high specificity and sensitivity. Conclusion: Teleophthalmology also allow for greater coverage of health care, providing access to an ophthalmologist even in distant and rural areas. At the same time it reduces time and travel costs, while providing high acceptance and satisfaction levels.

Aim: In this study, we aimed to assess the importance and frequency of ocular complications of head trauma. Material and Method: This research paper presents a cross-sectional study of 77 children with head injury. The study was carried out at the University Hospital "Prof. Dr. Stoian Kirkovich", Stara Zagora, Bulgaria, Department of Neurosurgery. Participants were recruited consecutively into the study during the period from January 2016 to January 2018 and underwent a thorough ophthalmic and neurosurgical examination. The analysis included age, sex, the cause of head injury, and ocular findings. Results: The leading causes of head injury were domestic accidents (45.5%) and fall in playgrounds (33.8%). Ocular findings were observed in 56 (72.72%) cases of head injury. Most common complications were ocular adnexa damage (29.9%) and anterior segment damage (27.3%). Severe damage including orbital fractures was found in 1 patient. There is no statistically significant difference in gender, although males were more prone to sports activity related accidents. The main complaint of males was the pain in the ocular area, while females considered the swelling a primary concern. Age also plays a factor, with the highest frequency of incidences between 10 and 15 years. Discussion: Additional problems which require attention are head trauma due to child abuse, overprotective parents exacerbating the children's complaints and the need for emergency evaluation of visually asymptomatic patients with orbital fractures.

BACKGROUND:Retinopathy of Prematurity (ROP) is a potentially blinding vasoproliferative disease in premature babies. The presentation and course of ROP are determined by a complex interaction of a series of risk factors, including artificial reproductive technology (ART).AIM:To analyse and combine the information relating ART as an independent risk factor for retinopathy of prematurity.METHODS AND MATERIAL:The article is systematic review and meta-analysis using RevMan 5. Pubmed, Scopus and Medline were searched for articles from 1990 to 2018.RESULTS:Studies suggest that ROP is observed more frequently in ART children. They are more likely to be premature and of low birth weight than those conceived naturally. Results vary from just a tendency to a five-fold increase in risk to develop ROP in ART babies. At the same time, they might develop ROP later, and more mature newborns might be affected.CONCLUSION:The data relating ART as a risk factor for ROP is inconclusive, but most studies show at least a tendency. The ART newborns need to be considered as a risk group for ROP and observed with greater suspicion. Even more mature ART newborns might need to be screened in order not to miss any significant pathology.

Dermoid and epidermoid cysts are among the most common orbital tumors, comprising 3% to 9% of all orbital masses. We report a rare case of upper medial orbital epidermoid cyst of a 2-year-old patient. The patient was complaining of pain in the right eye and infrequent vomiting. The neurological and radiographic examinations showed no pathological findings, only after CT scan was performed a tumor formation was found. After the extirpation a histological examination was performed proving the diagnosis.

BACKGROUND: Alport syndrome is a progressive genetic disease which is characterised by glomerulonephritis, sensorineural deafness and ocular abnormalities.We aimed to present a clinical case of a patient with Alport syndrome with spontaneous anterior lens capsule rupture.CASE REPORT: A 16-year-old male with histologically proven Alport syndrome was hospitalised in the Department of Ophthalmology, University Hospital „Prof. Stoyan Kirkovich“, Stara Zagora with low vision, pain, redness, high IOP and rupture of the anterior lenticular capsule of the right eye. Phacoaspiration was successfully performed (Millenium, Bausch& Lomb, Rochester, New York, USA) with the bimanual irrigation-aspiration system (Geuder AG, Heidelberg, Germany) with excellent visual results.CONCLUSION: As the syndrome is quite rare and can lead to diagnostic difficulties for the ophthalmologist complications such as spontaneous or traumatic rupture of the capsule are not uncommon. In such cases, phacoaspiration is an efficient method for clear lens extraction after ruptures of the anterior lenticular capsule of young patients with Alport syndrome.

Aim: Retinal hemorrhages are frequently observed sights in healthy newborns examined hours after birth. A large percentage of them are resorbed in the first two weeks following delivery, with a single case reporting retinal hemorrhages after four weeks. Case Report: We present a preterm newborn weighing 690 g at birth, born at 26 g.w. A hemorrhage was found during screening for retinopathy of prematurity with no signs of retinopathy of prematurity. The screening was performed with indirect ophthalmoscopy, and a photo was taken with a welch-allyn ophthalmoscope adapted to an iphone. The hemorrhage had persisted for nearly 20 weeks before it was completely resorbed. Case documentation with retcam was possible after transportation to the Department of Ophthalmology. Discussion: Even though hemorrhages are less common in children born preterm and with C-section, infants with extremely low birth weight and those who underwent artificial ventilation are still at increased risk for retinal hemorrhages.