INTRODUCTION:Occupational eye injuries comprise a major source of ocular trauma. Knowledge of the epidemiology of occupational eye injuries is essential to formulate viable safety strategies.OBJECTIVES:To evaluate the demographics, patterns of protective eye wear use, and patterns of occupational eye injury among workers in Hetauda, Nepal.MATERIALS AND METHODS:Community based cross-sectional prospective survey was carried out from September 2010 to July 2011. Survey included all workers irrespective of their age and those who are willing to participate in survey by filling details on structured questioners and comprehensive eye examination at community level.RESULTS:1236 surveys were collected. 38.3% (473) of workers surveyed reported experiencing a work-related eye injury. Over two-thirds [68.3% (844)] of workers surveyed reported never wearing safety eyewear while at work. There was a positive correlation between male sex (P<0.001), reported previous work-related injury (P<0.001), and attending school (P=0.016) and use of personal protective equipment (PPE).CONCLUSIONS:The population studied demonstrates a significant level of work related injury. There are potentially modifiable factors that could lead to increased use of eye protection.

P eriorbital rejuvenation is a topic of particular interest to aesthetic surgeons, as aging changes often occur first around the eyelids, and periorbital surgery can improve both function and cosmesis. Ahead, the authors describe an approach to the periorbital aesthetic unit to treat the eyebrow, upper eyelid, lateral canthus, lower eyelid, and midface through a single upper eyelid blepharoplasty incision. We recommend combining internal SINGLE INCISION REJUVENATION OF THE PERIORBITAL AESTHETIC UNIT

Purpose: To evaluate the long-term transformation of lateral eyebrow soft tissue in a group of patients with known thyroid eye disease. Methods: A retrospective review of all patients with a known diagnosis of thyroid eye disease with clinical photos available from both their initial diagnosis visit and at least 7 years following their initial visit was performed. Age at diagnosis, sex, disease activity, previous orbital, and eyelid surgery were noted, as was history of treatment with radioactive iodine, steroids, and external beam radiation. The area between the upper eyebrow and upper eyelid crease was evaluated in standardized photographs by a panel of 4 expert, independent, masked observers utilizing a previously published visual grading key. Results: One hundred and four patients met inclusion criteria. Fifteen participants were male and 89 were female. The mean patient age was 50.6 years (±1.21 years), and the mean follow up duration was 10.0 years (±0.23 years). The mean initial photo grade (1.24) was significantly higher than the mean follow up photo grade (1.00; p < 0.01). In logistic regression analyses, only the initial photograph grade was significantly associated with improvement in eyebrow soft tissue appearance (p < 0.01). Medical and surgical treatments were not significantly associated with changes in eyebrow soft tissue appearance (all p > 0.05). Conclusions: Expansion of eyebrow soft tissue may improve over time in patients with thyroid eye disease. This change was not affected by age, sex, disease activity, surgery, or medical therapy.

Introduction: Orbital inflammatory disease (OID) represents a spectrum of conditions that can be placed into two groups, specific orbital inflammatory disease (SOIS) and nonspecific orbital inflammatory disease (NSOIS). This manuscript aims to systematically review the therapies for the different types of OID.Areas covered: The therapy for OID has evolved significantly with the advent of biologic medications, although certain mainstays are still widely used. The authors conducted a review of literature published in the last 20 years with the use of PubMed. This article is organized according to disease syndrome. Specific diseases and their associated treatments are addressed.Expert commentary: Although corticosteroids are still the mainstay of treatment in most OID, a focus on disease specificity combined with increasing understanding of inflammatory pathways has allowed utilization of inflammatory modulatory medications. Investigating these therapeutics in prospective trials will likely be the vital link to improving patient care in orbital inflammatory disease.

BACKGROUND: Orbital exenteration is a destructive procedure performed by removing all or part of the orbital contents along with entire eyeball. It is a procedure reserved for life threatening malignancies and some nonmalignant disorders which are not controlled by conservative management.METHODS: This is a retrospective study done on patients who underwent orbital exenteration at Tilganga Institute of Ophthalmology from1 January 2006-30 in December 2014.RESULTS: The mean age of patients was 30 years (range 1-78), with male preponderance of 15(55.6%. Overall presenting duration of eye morbidity was 18 months (2 months-8.5 years). The most common presenting complaint was protrusion of eyeball1, 4(50%), primary site of tumor being intraocular in 10 patients (35.7%,) and total orbital exenteration was the most commonly performed type of surgery in 16(57.1%) out of 27 patients. The most common etiology responsible for orbital exenteration, in pediatric age group of 9/27 patients (64.2%), was retinoblastoma whereas conjunctival squamous cell carcinoma (SCC) accounts for 5 patients (38.4%) in adults. Overall, the most common cause of orbital exenteration was retinoblastoma 9(32.1%).CONCLUSION: The most common etiologies requiring orbital exenteration were retinoblastoma (in children and overall) and conjunctival squamous cell carcinoma (in adults), both diseases that could be addressed with less invasive treatment modality if detected earlier in the disease process. Designing strategy is important for early detection and treatment of these conditions, which would decrease disease morbidity and prognosis, potentially sparing sight and life.

To determine the effect of concurrent blepharoplasty and Mueller's muscle conjunctival resection (MMCR) surgery on eyelid position and eyebrow height.Clinical data from 274 eyes that met inclusion criteria for this study were reviewed. Mueller's muscle conjunctival resection surgery was performed alone in 198 eyes and was performed with concurrent blepharoplasty in 76 cases. In this study blepharoplasty consisted of only skin removal, leaving the muscle, fat, and tarsus intact. Preoperative and postoperative pupil to eyebrow, and eyelid margin to eyebrow distances were calculated and compared.Preoperative margin reflex distance 1 (MRD1) was similar for both groups of patients (p > 0.05) as was the postoperative MRD1 (p > 0.05). The change in MRD1 was similar between patients undergoing MMCR alone versus those undergoing MMCR with blepharoplasty (1.5 mm vs. 1.3 mm, respectively, p = 0.36). For similar amounts of tissue resection, the postoperative change in MRD1 was similar for patients undergoing MMCR-only surgery and MMCR with blepharoplasty (p > 0.05). Eyebrow height significantly decreased following both MMCR with blepharoplasty (0.73 mm, p < 0.05) and MMCR-only surgery (0.87 mm, p < 0.05), and this change in eyebrow height was not significantly different between the 2 groups.Combining MMCR surgery with skin-only blepharoplasty does not significantly alter eyelid height when compared with MMCR surgery alone for the correction of upper eyelid ptosis. This may assist in preoperative planning for combined MMCR with skin-only blepharoplasty.

We report the case of a 6-year-old boy with Sturge-Weber syndrome and unilateral glaucoma in his left eye. He was born with a port wine mark involving his upper left eyelid. On ultra-widefield fluorescein angiography, he was found to have several vein-to-vein anastomoses in his left retina. To our knowledge, this is the first documentation of retinal vein-to-vein anastomoses in Sturge-Weber syndrome.

Purpose: To determine the effect of concurrent blepharoplasty and Mueller's muscle conjunctival resection (MMCR) surgery on eyelid position and eyebrow height.Methods: Clinical data from 274 eyes that met inclusion criteria for this study were reviewed. Mueller's muscle conjunctival resection surgery was performed alone in 198 eyes and was performed with concurrent blepharoplasty in 76 cases. In this study blepharoplasty consisted of only skin removal, leaving the muscle, fat, and tarsus intact. Preoperative and postoperative pupil to eyebrow, and eyelid margin to eyebrow distances were calculated and compared.Results: Preoperative margin reflex distance 1 (MRD1) was similar for both groups of patients (p > 0.05) as was the postoperative MRD1 (p > 0.05). The change in MRD1 was similar between patients undergoing MMCR alone versus those undergoing MMCR with blepharoplasty (1.5mm vs. 1.3mm, respectively, p = 0.36). For similar amounts of tissue resection, the postoperative change in MRD1 was similar for patients undergoing MMCR-only surgery and MMCR with blepharoplasty (p > 0.05). Eyebrow height significantly decreased following both MMCR with blepharoplasty (0.73mm, p < 0.05) and MMCR-only surgery (0.87mm, p < 0.05), and this change in eyebrow height was not significantly different between the 2 groups.Conclusion: Combining MMCR surgery with skin-only blepharoplasty does not significantly alter eyelid height when compared with MMCR surgery alone for the correction of upper eyelid ptosis. This may assist in preoperative planning for combined MMCR with skin-only blepharoplasty.

PURPOSE:To investigate the relationships between pre-operative marginal reflex distance (MRD), tissue resection length, phenylephrine response, and change in MRD with surgery for a cohort of individuals undergoing Muller's muscle conjunctival resection (MMCR) surgery. METHODS:All cases of MMCR surgery performed over a 13-year period at a single institution were screened for entry. Individuals with adequate photographic documentation and follow up were included. Patients with previous or concurrent upper eyelid, orbital or eyebrow disease of surgery were excluded. Marginal reflex distance (MRD) was calculated based on photographs utilizing public domain software. Data was plotted for inspection and appropriate statistical tests were performed. RESULTS:During the study period 198 eyes fit criteria for analysis. A loose association between tissue resection length and change in MRD with surgery was found (r = 0.176, p < 0.05); this relationship was not significant in ANOVA analysis (p = 0.367). There was a strong association between MRD change with surgery and pre-operative MRD (r = 0.498, p < 0.01). Approximately 28% of the sample responded to 2.5% phenylephrine drop instillation with a greater than 2 mm increase in MRD. The response to phenylephrine was strongly associated with pre-operative MRD (r = -0.441, p < 0.01). A regression on change in MRD with surgery with tissue resection, phenylephrine response >2 mm and pre-operative MRD as variables revealed a model with pre-operative MRD as the only significant predictor (p < 0.01). CONCLUSION:Tissue resection length and phenylephrine response play small roles relative to pre-operative MRD in the determination of change in MRD with MMCR surgery.

An 87-year-old man with a history of relapsing polychondritis presented to the emergency department after 4 days of worsening left periorbital swelling and erythema. On examination, he demonstrated clinical features consistent with orbital cellulitis and was treated with a trial of intravenous antibiotics. His condition did not improve over the next 36 hours and intravenous methylprednisolone was initiated. This led to rapid improvement in orbital symptoms and signs, and a diagnosis of specific orbital inflammation secondary to relapsing polychondritis was made. The patient was discharged on a tapering dose of prednisone. As a steroid-sparing measure, adalimumab was initiated; however, the patient developed Sweet Syndrome. Adalimumab was subsequently discontinued, steroid dose was increased, and anakinra treatment was initiated. This therapeutic course led to significant clinical improvement. Since initiating anakinra, the patient has had no recurrences of Sweet Syndrome. Anakinra may be a useful adjunct therapy for ophthalmic manifestations of relapsing polychondritis.

PURPOSE:To characterize the 24-hour pattern of intraocular pressure (IOP) in untreated ocular hypertensive (OHTN) patients.METHODS:IOP measurements were taken every 2 hours during a 24-hour period from 15 untreated OHTN patients (ages 41-77 years). Measurements were both sitting and supine (diurnal) and supine only (nocturnal). Mean diurnal and nocturnal IOPs in the OHTN group were compared to previously reported values in age-matched healthy and glaucomatous eyes. Post hoc analysis compared the 24-hour IOP pattern of the OHTN patients who converted to glaucoma and those who did not with that in the same healthy and glaucomatous eyes.RESULTS:Mean sitting and supine IOPs were significantly higher in the OHTN group than in the healthy control but not the glaucoma group. Similar to the glaucoma group, the OHTN group demonstrated significant differences from healthy controls in diurnal IOP variation and IOP changes upon awakening in habitual and supine positions. The 24-hour IOP curve acrophases and amplitudes for OHTNs were closer to those of the glaucoma than the healthy control group in the habitual position. Thirty-three percent of OHTNs developed glaucoma during a mean follow-up period of 4.3 ± 3.8 years. Similar to findings in the glaucoma group, habitual IOP curve phase delay, habitual IOP variation, diurnal-to-nocturnal IOP changes, and IOP changes upon awakening of the converters were significantly different from those in healthy controls. There were no differences between nonconverters and other groups.CONCLUSIONS:Baseline 24-hour IOP pattern in OHTN patients is similar to that in glaucomatous patients. In contrast to nonconverters, OHTN patients who converted to glaucoma are significantly different from healthy controls.

Purpose: The purpose of the study is to determine the degree of intereye asymmetry of optic disc topography and retinal nerve fiber layer (RNFL) thickness in healthy individuals of African descent (AD) and European descent (ED).Design: Observational, clinical study.Methods: Five hundred nineteen healthy individuals (AD, n=262, mean age=44.9 years; ED, n=257, mean age=47.1 years) from the African Descent and Glaucoma Evaluation Study and Diagnostic Innovations in Glaucoma Study were tested using Heidelberg retina romograph (HRT), GDx variable corneal compensation (GDx-VCC), and standard, automated perimetry within 6 months of one another. HRT-II measurements included cup area, cup volume, rim area, and rim volume. GDx-VCC measurements included average RNFL thickness. Intereye asymmetry was calculated as the absolute value of the differences in measurements between the right and left eye.Results: AD participants showed significantly higher median asymmetry in cup volume and rim volume (P<0.001 and 0.033, respectively) compared with ED participants. The effect of race lost significance after adjustment for mean disc area and disc area asymmetry in multivariable models. Axial length asymmetry was not correlated with increased asymmetry in any of this study's asymmetry parameters. Normal ranges of asymmetry for the HRT-II measurements of cup area (up to 0.39mm(2)), cup volume (up to 0.15mm(3)), rim area (up to 0.45mm(2)), and rim volume (up to 0.22mm(3)) were derived, as were asymmetry ranges for GDx-VCC-measured average RNFL thickness (up to 6.25 mu m).Conclusions: The effect of race was no longer significant after adjustment for mean disc area and disc area asymmetry. Individuals with asymmetries with magnitudes greater than those of the normal ranges could be considered as suspicious for glaucoma.

PURPOSE:To present and evaluate a new method of integrating event- and trend-based analyses of visual field progression in glaucoma. DESIGN:Observational cohort study. PARTICIPANTS:The study included 711 eyes of 357 glaucoma patients or suspects followed up for an average of 5.0 ± 2.0 years with an average of 7.7 ± 2.3 standard automated perimetry visual fields. An additional group of 55 eyes of 55 glaucoma patients underwent repeated tests over a short period to test the specificity of the method. METHODS:Event-based analysis of progression was performed using the Guided Progression Analysis (GPA; Carl-Zeiss Meditec, Inc., Dublin, CA). Trend-based assessment used the visual field index (VFI). A hierarchical Bayesian model was built to incorporate results from the GPA in the prior distribution for the VFI slopes, allowing the event-based method to influence the inferences made for the trend-based assessment. MAIN OUTCOME MEASURES:The Bayesian method was compared with the conventional ordinary least squares (OLS) regression method of trend-based assessment. RESULTS:Of the 711 eyes followed up over time, 64 (9%) had confirmed progression with GPA. Bayesian slopes of VFI change were able to detect 63 of these eyes (98%). An additional group of 49 eyes (7%) had progression by Bayesian slopes, but not by GPA. Slopes of VFI change calculated by the OLS method were able to identify only 32 of the 64 eyes (50%) with GPA progression. The agreement with GPA was significantly better for the Bayesian compared with the OLS method (κ = 0.68 vs. 0.43, respectively; P<0.001). Eyes progressing only by the Bayesian method had faster rates of change than those progressing only by the OLS method. When applied to the 50 eyes in the stable glaucoma group, both the Bayesian and the OLS methods had a specificity of 96%. CONCLUSIONS:A Bayesian hierarchical modeling approach for integrating event- and trend-based assessments of visual field progression performed better than either method used alone. Estimates of rates of change obtained from the Bayesian model had increased precision and may be superior to the conventional OLS method for providing information on the risk of development of functional impairment in the disease.