Ixodidae ticks are vectors of Lyme borreliosis, Rocky Mountain spotted fever, tick-borne encephalitis, and relapsing fever. We present a case of eyelid tick infestation in a 49-year-old patient for 1 week. A slit-lamp examination suggested it to be a tick tethered on the patient's skin. Complete removal of the tick was done with 2% lignocaine infiltration locally around the swelling. The tick fell off from the periocular skin without any further manipulation. On entomology evaluation, it was categorized to be a hard tick Rhipicephalus sanguineus belonging to the Ixodes family. The patient was put on topical moxifloxacin and chloramphenicol eye ointment. The patient was followed up after 5 days and after 2 weeks and was found to be normal.

Eccrine acrospiroma are benign skin tumors of sweat duct origin which are occurring in eyelids. They present as small solid or cystic lesions that are confused clinically with other lesions. This is a case of eccrine acrospiroma with malignant potential of a 90 year-old female with mass over the ventral aspect of the left upper eyelid with bleeding, ulceration, and discharge. This is a rare presentation of histopathological that confirmed eccrine acrospiroma so as to alert the clinician about the differential diagnosis of mass over eye lids. By careful examination, meticulous wide excision and rigorous follow-up potential vision can be restored.

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare adnexal tumor of the skin with immunoexpression and neuroendocrine differentiation. It can be easily misdiagnosed as a meibomian gland tumor due to its prevalence in the Indian subcontinent over EMPSGC. It has a predilection for the skin of the eyelid and elderly females. It is histologically and immunohistochemically analogous to solid papillary carcinoma of the breast/endocrine ductal carcinoma in situ with a nodular, solid, papillary, and/or cribriform architecture, neuroendocrine differentiation, and mucin production. We describe a case of EMPSGC clinically mimicking meibomian gland carcinoma which was confirmed on immunohistochemistry and histopathological diagnosis.

We report ocular changes following accidental injection of distilled water into the anterior chamber during cataract surgery. We have documented eight eyes that had an accidental distilled water exposure in the anterior chamber following which they developed corneal edema, raised intraocular pressure (IOP), and pigment dispersion into the anterior chamber. We treated all the patients with topical steriods and sodium chloride 5% solution and anti-glaucoma medications as required. All of them had pigment dispersion and deposition into the anterior chamber and onto the corneal endothelium and the intraocular lens surface. All the patients had resolution of edema and good vision postoperatively after a month. Thus, patients who were exposed to accidental injection of distilled water into the anterior chamber during cataract surgery had a toxic reaction in the postoperative period. However, the corneal transparency was restored completely without complications with adequate treatment. A strict protocol must be followed by the OT staff and the members at various stages of surgery to prevent such mishaps from happening.

Nodular corneal invasion in xeroderma pigmentosum is rare. The depth of clinical involvement can be deceptive. Anterior segment optical coherence tomography/ultrasound biomicroscopy can aid in surgical planning. We reviewed the clinical features, surgical details and long-term outcomes of three patients who underwent superficial keratectomy, lamellar keratoplasty, and penetrating keratoplasty for invasive corneal neoplasia. The histopathology revealed squamous cell carcinoma in all three eyes. No recurrence was noted over a minimum follow-up of 4 years. Early surgery is recommended in view of the risk of deeper penetration. Besides surgery, options include plaque therapy. Comorbid conditions are best addressed sequentially, and long-term follow-up is mandatory.

Human dirofilariasis is a rare but known zoonotic infection with a worldwide geographical distribution. Ocular dirofilariasis is rare but more and more cases are being reported from all over India. Despite the southern states being endemic for this disease, cases are being reported from different Indian states due to better transport facilities, better infrastructure, and increased awareness among healthcare workers regarding this zoonosis. We present a series of three cases that focuses on the epidemiology of the disease and compares cases reported from various states, which indicates a northward shift of the disease to non-endemic states.

A 21-year-old female presented with a stick injury in her right eye 6 months after an uneventful laser in situ keratomileusis (LASIK). Diffuse lamellar keratitis which responded well to the initial treatment with topical steroids, progressed rapidly within the next 3 weeks to develop corneal perforation. A microbiological examination revealed a rare fungus Scedosporium prolificans. The patient was successfully managed with topical voriconazole 1% and cyanoacrylate glue for corneal perforation. At the end of 7 weeks, keratitis healed with a best-corrected visual acuity of hand movements. Hence, a strong suspicion of infectious interface keratitis is warranted while treating post-LASIK keratitis.

A 30-year-old female presented to our emergency room for the first time with reduced vision in her right eye (OD) after gentle rubbing. Her ocular history revealed laser-assisted in situ keratomileusis in both eyes (OU) 10 years back. Five years later, she developed ectasia OU where only the right eye was cross-linked. Both procedures were performed at another center. Isolated corneal stromal bed perforation with severe surrounding stromal thinning was evident. Sole glue application either at the bed or the flap edge was not successful. The patient underwent Penetrating keratoplasty (PKP) with a good outcome.

A 39-year-old male with prior history of having undergone laser-assisted in situ keratomileusis (LASIK) in both eyes was referred for management of refractive surprise of +5.0 diopter following phacoemulsification with intraocular lens (IOL) implantation in the left eye. The IOL power was re-calculated using post-LASIK IOL power formulae, but it did not differ significantly from that of the implanted IOL. Topography in the left eye showed decentration of the laser ablation zone and mild ectasia. An IOL exchange was performed in the following steps: IOL extraction, postoperative aphakic refraction to calculate IOL power, and IOL implantation. Postoperatively, there was no refractive surprise. In the right eye, the IOL power was calculated using post-LASIK IOL power formulae, which did not result in postoperative refractive surprise. Our experience highlights the efficiency of aphakic refraction over post-LASIK IOL power formulae in predicting IOL power in eyes with decentered laser ablations.

We report two cases with dense corneal arcus with abnormally low levels of serum high-density lipoproteins. One case with arcus senilis had a history of corneal clouding since youth but no systemic associations. The other case had an arcus juvenilis with anemia and hepatosplenomegaly but an absence of renal involvement. The genetic analysis of this case was performed and was suggestive of lecithin-cholesterol aminotransferase deficiency.

We report a case series highlighting clinical correlation of recurrence of Reis–Bucklers corneal dystrophy (RBCD) with histopathology (HPE), genetic analysis, and electron microscopy (EM). This was an interventional case series of three cases in three generations of one family. The index case was a 23-year-old male with bilateral recurrent RBCD following OD PTK and OS ALTK done 6 years earlier. His father had undergone OU PK. His 35-year-old sister and 9-year-old niece were also affected who underwent OU ALTK. Clinical examination, histopathological examination (HPE), and electron microscopy (EM) evaluation were done. The recurrence of RBCD was noted in one of the three members of the same family. Corneal examination showed a dense reticulate pattern of epithelial-stromal involvement. On HPE, disrupted Bowman's membrane and underlying abnormal subepithelial collagen staining positive with PAS and Masson's trichrome were noted. On EM, degenerated stroma with dense collagen fibrils in aggregates, dispersed among regular collagen fibrils, were noted. All four members showed TGFß1 mutation (chromosome 5q31) with Arg124Leu mutation. A trend toward more advanced presentation with increasing age of cases was noted. The clinical and pathological correlation was performed. Clinical correlation with HPE, EM with genetic analysis of RBCD is interesting with presentation severity varying in different generations.

Postoperative endophthalmitis is sight-threatening, severe inflammation in posterior vitreous cavity and anterior chamber. Marginal keratitis with infiltrates or ulcers following endophthalmitis can be infectious or sterile, but the etiologies related to intraocular infection have rarely been reported. Here we present an unusual case of severe marginal keratitis with sterile infiltrates concomitant with staphylococcal endophthalmitis after phacoemulsification. Creamy white ring infiltrates at the corneolimbal junction was found with severe vitritis. With antibiotics treatment, endophthalmitis improved while the corneal infiltrates progressed. After corneal specimens yielded negative results, the corneal infiltrates improved under proper topical corticosteroid without marked sequelae. In conclusion, noninfectious, immune-related marginal sterile keratitis may develop in patients with staphylococcal endophthalmitis after phacoemulsification.

A 35-year-old male presented with a 16-month history of left-eye recurrent redness, photophobia, and blurring in his left eye. Systemically, he suffered from irritable bowel syndrome and HLA-B27-negative spondyloarthropathy. The cornea showed multiple nummular epithelial and anterior stromal lesions. The aqueous sample was positive for herpes simplex virus-1 DNA (glycoprotein-D gene) by polymerase chain reaction. The lesions resolved with oral acyclovir and topical dexamethasone 0.01% in tapering doses; however, he continued to have recurrent periodic redness even at 1 year. We hypothesize that coexisting systemic immune-mediated conditions may have a role in altering the disease course leading to its prolongation in our case.

Fungal keratitis is an infection of the cornea which can lead to severe visual compromise if not diagnosed on time and managed appropriately. It may present with minimal symptoms and many signs. Likely to be overlooked by the patient, it results in a late presentation when substantial damage has already occurred. It is usually seen in patients with a severe immune compromise such as acquired immunodeficiency syndrome (AIDS), uncontrolled diabetes, transplant patients on immune-suppressants or long-term steroids, and in pre-existing ocular surface disorder. This is a case report of a 27-week primigravida who presented with extreme fatigue and a fungal corneal ulcer with no preceding history of trauma or any other immune compromised state.

We report a 16-year-old female patient with diagnosis of xeroderma pigmentosum (XP), previously treated for simultaneous conjunctival squamous cell carcinoma in the right eye (OD) and conjunctival melanoma in the left eye (OS), showing progressive keratoconus during follow-up. Considering the risk of cross-linking treatment due to UV exposure in XP patients, an intrastromal corneal ring segment was implanted in the right eye. The patient was fitted with mini-scleral lenses that would promote corneal lubrication and provide the patient with better visual acuity than glasses. The patient has been followed-up for 1 year with no tumor recurrence and good vision.

Stromal rejection is rare and uncommonly seen in its pure form. We report a case of hyperacute stromal rejection followed by endothelial rejection post-therapeutic penetrating keratoplasty (PK) done for fungal keratitis. The rejection episode responded to steroids with a clearing of the graft. Residual mid to deep intra-stromal crystalline deposits remained at the area of stromal rejection, which remained stationary for a follow-up period of 1 year. The patient underwent Anterior segment optical coherence tomography (AS-OCT) to demonstrate the condition objectively.

We report the management of a rare case of bilateral, symmetrical, and spontaneous anterior lens capsule rupture with total soft cataractous lens in a 7-year-old child. The patient had no other predisposing factors or systemic associations. Bilateral lens aspiration was done through the fibrosed capsular opening, which behaved like a stable capsulorhexis and hydrophobic intraocular lens was implanted. At 6 weeks follow-up, the patient had good visual outcome without any astigmatism. Although capsule rupture is reported in trauma, Alports syndrome or in hypermature cataracts, to our best knowledge this is the first case report of bilateral symmetrical spontaneous anterior capsule rupture in an otherwise normal child.

Opacification of intraocular lens rare phenomenon occurs and causes extreme diminution of vision in patients even after uneventful cataract surgery. Several reports of wrong diagnosis and delayed diagnosis of an opacified IOL leads to delayed treatment. The opacified IOL needs to be removed and exchanged with another PCIOL. This case report describes the electron microscopic analysis of an explanted intraocular lens and also gives details of the chemical composition. This is the first case report where presence of potassium has been noted in the opacified IOL as was detected by Scanning electron microscopic analysis.

Breakage of an intraocular lens (IOL) haptic during implantation is a rare complication of cataract surgery. We report here a case of a broken fragment of a trifocal IOL playing hide and seek and causing corneal edema repeatedly after an uneventful phacoemulsification and preloaded trifocal IOL (AT LISA tri 839MP) implantation. It was ultimately removed successfully and the patient achieved good vision. It is postulated that the broken piece of IOL migrated to and fro, from sulcus to anterior chamber. The breakage of IOL should also be kept in mind in the case of postoperative corneal edema when other causes have been ruled out.

Uveitis-glaucoma-hyphema (UGH) syndrome is a rare complication usually seen with anterior chamber intraocular lens. We report the occurrence of sudden-onset blurred vision and pain 1 year after an uneventful sutureless scleral fixated intraocular lens (SFIOL) implantation. Despite initial conservative management, the symptoms persisted. A recurrence of VH, uncontrolled IOP, and an irritable painful eye led to the diagnosis of UGH syndrome, and the SFIOL was explanted. We postulate a floppy iris secondary to previous trauma with resultant iris chaffing as the cause for the occurrence of UGH syndrome.

A 60-year-old Indian male presented with diminution of vision in the right eye for 3 months duration. Subsequent evaluation showed signs of granulomatous anterior uveitis, scleral thinning and brown colored pigmented hypopyon in the right eye. Patient was thoroughly evaluated for all possible associations of pigmented hypopyon. He was found to have positive mantoux test, QTB Gold test, positive culture for Mycobacterium tuberculosis on Middlebrook 7H9 medium and positive MPT64 antigen test confirming the diagnosis of intraocular tuberculosis. He was treated with anti-tubercular treatment and oral steroids and subsequently with dexamethasone intravitreal implant. He had complete resolution of pigmented hypopyon with improvement in visual acuity. This case highlights an approach to management in cases of pigmented hypopyon and also highlights that an aggressive management in such cases is pertinent to saving the eye and vision.

We report a case of pseudophakic malignant glaucoma who was managed with laser capsulo-hyaloidotomy through the dialing hole of the optic of the nonfoldable intraocular lens (IOL). Our case presented with sudden, painful decreased vision in the left eye since 15 days, 3 years after cataract surgery. There was a uniformly shallow anterior chamber with a high intraocular pressure (IOP) of 52 mm Hg and glaucomatous disc damage. After performing laser capsulo-hyaloidotomy through the optic hole of the IOL, we noticed deepening of the anterior chamber, improvement in vision, and good IOP control on antiglaucoma medication, thus showing complete resolution of aqueous misdirection and obviating the need for surgical management.

Minimally invasive glaucoma surgery (MIGS) is usually preferred as it causes less complications in glaucoma surgery. XEN Glaucoma Gel Microstent (XEN-GGM, Allergan Plc., Parsippany, New Jersey) is one of the MIGS used in glaucoma surgery. Different complications of XEN-GGM that developed during or after the operation have been reported. In our case, anterior capsule perforation occurred and a cataract consequently developed during the XEN-GGM application. For this reason, the measures that must be taken during XEN-GGM application in phakic patients are discussed.

Peritubular leak after glaucoma drainage device implantation causing hypotony can occur with the use of needles with a bore larger than 25 G for creating an entry track for the tube. We report a patient who developed persistent hypotony probably due to peritubular leak after Aurolab Aqueous Drainage Implant implantation using a 22-G needle. The hypotony spontaneously resolved 7 months after surgery due to fibrous ingrowth. High intraocular pressures due to tube blockage were treated with Nd: YAG laser to clear the fibrous ingrowth. Surgeons should be aware of fibrous ingrowth as a complication of using a large-bore needle track for tube insertion.

Glaucoma implant tube exposure and corneal endothelial decompensation are complications of implant surgeries in eyes with glaucoma. We describe a surgical method of managing these complications by relocation of the existing anterior chamber implant tube into the pars plana, after a three-port pars plana vitrectomy. We studied eight eyes of eight patients, four with perilimbal tube exposure and four with endothelial decompensation, who underwent the procedure. Four eyes of the four patients had resolution of tube exposure without recurrence and maintained stable intraocular pressure (IOP); visual acuity and IOP remained stable in the endothelial decompensation group.

Necrotizing scleritis can be a diagnostic and therapeutic challenge. We present a case of a 51-year-old female, who had necrotizing scleritis treated for 9 years with intermittent corticosteroid therapy. In view of its recalcitrant nature, she underwent scleral biopsy, which revealed histopathological features suggestive of IgG4- related disease. This case report highlights the importance of including IgG4-related disease as a differential diagnosis of scleritis and the role of scleral biopsy as a diagnostic tool in unresponsive cases.

Rifabutin is a known-drug prescribed for prophylaxis and treatment of Mycobacterium avium complex (MAC) and causes dose-related anterior uveitis in immunocompromised individuals, particularly, those infected with HIV. Previous studies have reported rifabutin-induced uveitis with high doses. It is infrequent with 300 mg/day or less; moreover, it takes weeks to months to develop. We report three HIV cases that on treatment with low-dose 300 mg rifabutin presented with anterior uveitis with early occurrence. Furthermore, one of the cases had rifabutin-induced panuveitis, another rarity. Thus, although rare, low-dose rifabutin-induced uveitis with early presentation should be kept as a differential diagnosis of unusual presentation of uveitis in HIV, early management of which prevents visual morbidity.

We report a pediatric case of unilateral acute idiopathic maculopathy (UAIM) associated with West Nile virus (WNV) infection. A 10-year-old child with a 15-day history of presumed acute viral encephalitis, complained of blurred vision in the right eye. Clinical and multimodal imaging findings, including disruption of the foveal ellipsoid zone (EZ) with preservation of the external limiting membrane on Swept Source OCT (SS OCT), were consistent with UAIM. The finding of associated curvilinear chorioretinal lesions in the setting of encephalitis led a diagnosis of WNV infection to be considered and subsequently confirmed by serology. The EZ spontaneously restored over a few weeks with near complete visual recovery. This is a unique pediatric case of UAIM associated with serologically proven WNV infection.

Paradoxical worsening of ocular syphilis after initiation of antimicrobial therapy is rare, however it is important for the clinicians to be aware of this occurrence, as prompt recognition and timely intervention with corticosteroids can lead to restoration of vision. Alteration/discontinuation of antimicrobial therapy may not be indicated. Our case highlighted the role of dexamethasone implant to control such paradoxical worsening in a young patient with ocular syphilis.

A 31-year-old female was diagnosed with active placoid tubercular serpiginous-like choroiditis (TB-SLC) in the right eye. Serial swept-source optical coherence tomography angiography (SS-OCTA) of deeper choroid revealed unique dilated, tortuous, and disorganized tangled network of medium-sized choroidal vessels (MCV) at presentation (mimicking bag-of-worms) with increased compactness on paradoxical worsening and significant reorganization on resolution. SS-OCTA of choriocapillaris (CC) revealed extensive flow void at presentation, which increased on paradoxical worsening and its reversal with minimal CC atrophy on resolution. Visual acuity improved from 20/200 to 20/30. Serial changes from presentation till resolution provide hypothesis about unique appearance within choroid in TB-SLC lesion.

We report a case of a 7-year-old girl presenting to the Neuro-Ophthalmology OPD with only complaints of chronic headache who was found to have malignant (grade 4) hypertensive retinopathy. Visual acuity was 20/400 in the right eye and 20/80 in the left eye. Blood pressure was 220/120 mm Hg. The patient was not a known hypertensive. Fundoscopy revealed bilateral optic disc swelling, macular stars, and serous retinal detachment in both eyes. The patient was urgently referred to pediatrician for detailed evaluation and systemic control of hypertension. This emphasizes the need for checking blood pressure in children presenting with chronic headache.

We report a case of using synthetic cannabinoids (Bonzai) with hypertensive choroidopathy with bilateral multiple inkblot fluorescein leakage similar to acute central serous chorioretinopathy (CSC). The systemic blood pressure of the patient was 210/140 mm Hg. In fundus fluorescein angiography (FFA), there were multiple inkblot hyperfluorescent areas and an enlarging spot of fluorescein in the early phases and increased in the late phases similar to acute CSC in both eyes. All of the multiple focal hyperfluorescence areas in the FFA had disappeared, and hypofluorescent areas remained in their places at second month with systemic blood pressure regulation.

A 69-year-old female presented with right eye vision of 20/120 Snellens. Ultrawide-field fundus imaging showed old vitreous hemorrhage with superotemporal sclerosed vessels post venous occlusion. Spectral-domain optical coherence tomography revealed degenerative lamellar macular home (LMH) with lamellar hole-associated epiretinal proliferation (LHEP). The patient underwent surgery using vitrectomy with the embedding technique. Post surgery, good recovery of the foveal contour was achieved with vision improving to 20/40. LMH with LHEP can be a sequela of chronic macular edema in RVO.

Fundus autofluorescence (FAF) is a noninvasive imaging tool helpful in various retinal and choroidal diseases. In this series, we report the utility of FAF in two cases of retinal artery occlusion (RAO). Cholesterol embolus was seen as a bright hyper autofluorescent foci on FAF in a case of branch RAO. Platelet fibrin embolus exhibited minimal hyper autofluorescence in another case of multiple RAO in contrast to bright hyper autofluorescence of cholesterol embolus. Fundus autofluorescence may be helpful in easier identification of cholesterol embolus in RAO and helps in differentiating it from platelet fibrin embolus.

This case report describes a diabetic patient with nonischemic central retinal vein occlusion who developed findings suggestive of proliferative diabetic retinopathy in the same eye, with a normal retina in the right eye 3 years after presentation.

A 66-year-old male patient presented with the right eye (OD) decreased vision for 1 month duration. His best-corrected visual acuity (BCVA) was 6/36 in OD and 6/6 in the left-eye (OS). He had bilateral non-proliferative diabetic retinopathy (NPDR) changes with the presence of a large perifoveal aneurysmal lesion, which was diagnosed as perifoveal exudative vascular anomalous complex (PEVAC)-like lesion based on clinical evaluation, spectral domain optical coherence tomography (SD-OCT), and fundus fluorescein angiography (FFA). The patient underwent three intravitreal ranibizumab injections with minimal response. However, he showed excellent improvement in BCVA to 6/6 with complete resolution of fluid on SD-OCT after switching to intravitreal Ozurdex implant. This case highlights that an intravitreal dexamethasone implant can be considered as a viable option for the optimal management of PEVAC-like lesions, with good visual acuity outcomes and morphologic response on SD-OCT. Further studies are warranted to gain better insight into the pathogenesis of PEVAC-like lesions and the potential role and mechanism of action of intravitreal dexamethasone implant in its management.

We depict the novel use of wide-field swept-source optical coherence tomography angiography (SSOCTA) to image and longitudinally follow peripheral polyps in peripheral exudative hemorrhagic chorioretinopathy (PEHCR). A 65-year-old man with hemorrhagic mounds in the temporal mid-periphery of his left eye underwent wide-field en face and cross-sectional SSOCTA at the baseline and 3 monthly with a total follow-up of 10 months. We were able to image the peripheral polyps and branching vascular network (BVN) on wide-field SSOCTA and document its response to treatment. The SSOCTA findings correlated well to the gold standard indocyanine green angiography (ICGA).

This report describes a patient with redness in the left eye and normal vision. Routine fundus examination revealed bilateral macular sparing multiple yellow white retinal flecks situated beneath the retinal vessels. In the right eye, a torpedo-shaped hypopigmented lesion with a hyperpigmented temporal edge was observed temporal to the macula. There was mild thickening of retinal pigment epithelium on spectral-domain optical coherence tomography and retinal thinning and atrophy. Fundus autofluorescence showed multiple hyperfluorescent lesions around the posterior pole with a normal signal and a torpedo lesion of variegated autofluorescence in the right eye. The unusual coexistence of unilateral torpedo maculopathy with bilateral retinal flecks is being reported here.

Case of a 52-year-old schizophrenic female with uniocular retinopathy like presentation is described who was on aripiprazole medication for last fifteen years. This case report illustrates the multimodal imaging features of this rare case presentation.

Tamoxifen is an antiestrogen agent used as adjuvant therapy in breast carcinoma. Crystalline maculopathy due to tamoxifen toxicity, though rare, causes irreversible changes in the retina. High-resolution imaging like spectral-domain optical coherence tomography (SD-OCT) can detect early degenerating changes like crystalline deposits and cavitation in the retina. Early detection helps in the prevention of visual loss by prompt consideration in discontinuing or replacing the drug. Periodic screening with SD-OCT is essential as structural changes in the retina are noted even in asymptomatic patients receiving low-dose tamoxifen.

Eclipse retinopathy is a rare clinical entity occurring as a result of unprotected gazing at the solar eclipse. OCT features of eclipse retinopathy vary with time of presentation and degree of damage. The presence of hyperreflective foci (HRF) in acute solar retinopathy has never been described in past. We are reporting a case of eclipse retinopathy presenting very early with asymmetrical involvement of the right eye (RE) more than the left eye (LE). We demonstrated the presence of HRF on early OCT corresponding to the degree of damage and correlating with final visual recovery (LE complete recovery while RE incomplete visual recovery).

Photic damage occurs due to varied etiologies. In two cases presenting with acute onset symptoms, fundus exam in Case 1 (Welder's arc) showed foveal yellow spot in the left eye. In Case 2 (Solar eclipse), foveal yellow spot was noted bilaterally. Spectral domain Optical coherence tomography revealed disruption of ellipsoid zone and a hyperreflective track extending from outer to inner retina. This hyperreflective track resolved on follow-up and correlated with symptomatic improvement. The hyperreflective track possibly indicates acute photic damage to retina and can serve as a prognostic marker for clinical improvement.

Choroidal nevus is a benign melanocytic lesion of the posterior uvea. Visual symptoms in choroidal nevus are most commonly secondary to serous neurosensory detachment in upto 50% cases. Here, we describe a case of symptomatic perifoveal Choroidal Nevus with sub-retinal fluid, which was treated with Reduced Fluence Photodynamic Therapy.

A 5-year-old girl presented with penetrating ocular trauma associated with severe intraocular inflammation and hypotony persisting after globe repair. On re-exploration, intraocular eyelashes were found in the posterior chamber causing fibrosis and ciliary body traction. The child underwent membranectomy with anterior vitrectomy. Postoperatively, the inflammation subsided with steroids and cycloplegic therapy and vision improved to 6/24. This report describes a unique case of intraocular eyelashes that caused severe inflammation along with hypotony that were not found by routine slit-lamp examination but identified during membranectomy.

The authors report a case of a 64-year-old diabetic male patient with late-onset fulminant fungal endophthalmitis occurring 6 weeks following complicated cataract surgery. A pigmented, dimorphic fungus known as Exophiala dermatitidis was isolated from aqueous and vitreous samples of the patient. The patient underwent pars plana vitrectomy, followed by daily injections of intravitreal voriconazole, and eventually had marked improvement in the best-corrected visual acuity to 6/9. So far, eight cases of Exophiala endophthalmitis have been reported in the literature, of which six have had a poor visual outcome. This case report demonstrates a successful outcome in a case of E. dermatitidis endophthalmitis, tackled with an aggressive medical and surgical approach.

Melioidosis, a multi-system infectious disease caused by Burkholderia pseudomallei, has varied clinical presentations. The ocular manifestations though rare are often either infectious or inflammatory sequelae. We present a case of a 49-year-old fisherman, an alcoholic and diabetic, who presented with fever, breathlessness, and altered sensorium. The pus and blood culture showed Burkholderia pseudomallei. Clinically, the patient deteriorated over a few days and succumbed to septicemia. The fundus evaluation at presentation showed multiple cotton wool spots concentric to the disk bilaterally. Subsequently, the patient developed a solitary Roth spot in the right eye coinciding with his clinical deterioration. The association of melioidosis with this fundus picture is presented for its rarity.

A 37-year-old-man presented with the perception of wriggling movements in the left eye. The fundus revealed a highly motile nematode epiretinally. The location and plane of the movements were confirmed with optical coherence tomography (OCT), which also showed its intraretinal attachment. Multiple attempts of laser photocoagulation failed due to its incessant rapid movements in the antero-posterior axis. Immediate vitrectomy was deferred due to the risk of breakage. With combination therapies of peribulbar lignocaine and oral anti-helminthics for 2 days, a marked reduction in the motility, thickening, and swelling was noticed and it could finally be killed with laser. To the best of our knowledge, this is the first case report of a live intravitreal worm treated non-invasively.

We report the management of a case of inadvertent full-thickness scleral penetration during rhegmatogenous retinal detachment (RRD) surgery in a 14-year-old high myope while making partial-thickness scleral tunnel for the passage of the 240 silicone band. Sudden and gross hypotony with subretinal hemorrhage were noted post-penetration. Hypotony was immediately addressed by suturing the penetration site with a 7-0 vicryl suture. Subretinal blood was removed by performing 360° relaxing retinotomy and retinectomy and the retina was attached. This case report highlights the possible reasons for the full-thickness scleral penetration and one of the various methods to handle the same.

We present a case of a 19-year-old male with a history of right-sided orbital pseudotumor with suspected Burkitt's lymphoma. His best-corrected visual acuity (BCVA) was 6/36 in the right eye (RE) and 6/6 in the left eye (LE). On fundus examination, the patient had a large choroidal osteoma at the posterior pole with macular scarring, along with two additional satellite osteomas inferior and superonasal to the disc in OD, while OS was unremarkable. After conservative management with oral corticosteroids, the patient demonstrated an additional choroidal osteoma lesion nasal to the disc in the OD which had evolved over a period of merely 3 months. To the best of our knowledge, this is the first reported case to document such a rapid development of choroidal osteoma. This case highlights the need for frequent follow-up of these patients for early detection and monitoring of these lesions.

This is an atypical uniocular presentation of systemic diffuse large B-cell lymphoma. An 80-year-old Caucasian female presented with acute left visual loss, anorexia, headache, and jaw pain with disk swelling. Systemic steroids for giant cell arteritis were started despite negative temporal artery biopsy. Later, an inferior exudative retinal detachment developed. Lytic skull lesions were eventually seen on magnetic resonance imaging. Diffuse large B-cell lymphoma was diagnosed postmortem. This is the second documented case of unilateral serous retinal detachment with no uveitis/pseudouveitis or choroidal infiltrate due to lymphoma. It demonstrates pitfalls of pattern recognition when pieces of the jigsaw do not fit.

We report a rare case of vitreoretinal metastases from cutaneous malignant melanoma (CMM). A 76-year-old patient with CMM presented at our clinic complaining of floaters and blurred vision in his right eye. After conducting an exploratory vitrectomy, the diagnosis of vitreoretinal metastases from CMM was made. Histopathology of the enucleated eye demonstrated residual clusters of malignant cells in the vitreous and focal invasion of the inner retina. CMM metastatic to the retina and vitreous is very rare. A detailed ophthalmological examination in all patients with metastatic CMM and complaints of ocular symptoms is highly recommended.

Osimertinib is a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) used in the treatment of metastatic non-small-cell lung carcinoma (NSCLC) patients with targetable EGFR-T790M mutations. We describe the case of a 61-year-old Chinese female confirmed with multifocal uveal metastases from T790M-mutated NSCLC after developing acquired resistance to icotinib (a first-generation EGFR-TKI). Therefore, she was instituted on oral osimertinib. The uveal masses were reported to completely disappear on anterior segment examination, ultrasound biomicroscopy (UBM), and ocular color doppler flow imaging (CDFI) after 41 weeks. However, the patient got worse and eventually died from systemic metastases 4 months later.

A retinal infectious pathology, an acquired vertical nystagmus, and a suspicious neuroimaging result! Independently, these three entities are not uncommon. However, when they are consecutively observed in a young patient, it ramifies into an intriguing clinical scenario. A 17-year-old diagnosed case of diffuse unilateral subacute neuroretinitis presented to us with acute-onset vertical oscillations. On neuroimaging, she was found to have cerebellar dysgenesis. This case prompted us to revisit the pathogenesis of acquired vertical nystagmus and evaluate whether it resulted from disturbance of afferent (severe visual impairment) or efferent (cerebellar dysfunction) components of the neural integrator mechanism.

There is a diagnostic dilemma for pediatric Idiopathic intracranial hypertension (IIH), presenting rarely. Most clinicians use the Friedman et al. criteria. However, it is not appropriate because of the variability in the cerebrospinal fluid (CSF) opening pressure and other parameters between children less than 8 years and adults. We report two cases of IIH in children less than 8 years. Both indicate a chance of misdiagnosis using the Friedman et al. criteria in pediatric IIH. Based on our observation, a combination of Rangwala et al.'s recommendation and Friedman et al.'s criteria is suggested for diagnosing pediatric IIH in children less than 8 years of age.

A 33-year-old female presented with sudden painless blurring of vision in both eyes. She gave a history of dog bite and had received two doses of intradermal anti-rabies vaccination 2 weeks prior to the onset of symptoms. Ophthalmological evaluation showed bilateral retrobulbar neuritis, superior nasal field defects in the right eye and vasculitis, and temporal hemianopia in the left eye. Extensive laboratory investigations ruled out all underlying infections, connective tissue disorders, and systemic vasculitis. Good response to pulse steroid therapy was noted. To our knowledge, this is the first case report of retrobulbar neuritis with retinal vasculitis following chick embryo cell-derived anti-rabies vaccination.

Bilateral optic disc edema is usually a late manifestation of vestibular schwannoma. Raised intracranial pressure due to obstructive hydrocephalus or a large mass lesion are the known causes. We report a case of a 55-year-old female with decreased vision and bilateral hemorrhagic grade 5 papilledema. MRI revealed a small vestibular schwannoma (<2.5 cm) with mild communicating hydrocephalus. Intraoperative CSF pressure was high most likely due to raised protein level in CSF (1 g/L). Bilateral hemorrhagic grade 5 papilledema causing diminution of vision in a case of small vestibular schwannoma with communicating hydrocephalus prompted us to report this case.

This case demonstrates an acute case of internuclear ophthalmoplegia (INO) caused by cerebral metastasis from a small cell lung cancer, the only such case documented in the literature. A 54-year-old male presented to the emergency department for worsening headache and diplopia, secondary to INO. On further examination, a CT scan of the chest revealed a 6.1 × 4.8 × 6.8 cm solid mass in the right lower lung consistent with small-cell lung cancer. T2-weighted MRI exhibited bilateral supratentorial and infratentorial lesions interpreted as metastatic cancer. The patient's symptoms, including INO, were caused by the mass effect from the metastatic brain lesions.

We report a rare case of a 3-year-old female child with a severe degree of hypotropia and esotropia of the left eye secondary to presumed myositis from unknown etiology treated with systemic steroids. A magnetic resonance imaging (MRI) of the orbit revealed a bulky left inferior rectus muscle. With a working diagnosis of inferior rectus contracture, and presumed dense amblyopia in the left eye, a free tenotomy of the left inferior rectus muscle along with recession of the left medial rectus restored orthotropia from the locked-down position.

Osteogenesis imperfecta (OI) is well known to be associated with blue sclera due to thinning along with skeletal deformities. Not all cases of OI have blue sclera despite having a thinner sclera than in normal individuals. We are presenting a case report of a 28-year-old girl with intermittent exotropia and OI with no evidence of blue sclera. On AS-OCT, scleral thinning was noted at the level of medial rectus muscle insertion. The patient underwent successful recession-resection surgery for the same. The thin sclera and OI need not deter the decision to operate on squint, and a successful squint surgery is possible in eyes with some amount of scleral thinning with careful suturing.

A 2-year-old child with cerebral visual impairment (CVI) was brought by the mother to the pediatric ophthalmology clinic. She underwent a detailed functional vision and developmental assessment that revealed impairments in visual developmental skills, sensory, motor, and social skills. She was admitted into an integrated, parent-centered, structured early intervention program specifically designed for her for 3-months after which there were improvements noticed in visual developmental skills such as visual fixation, attention, and tracking; sensory skills such as tactile, olfactory, and gustatory; motor skills, including neck control and fine motor grasping; and age-appropriate social and communication skills. Through this case report, we aim to bring out the benefits of an evidence-based systematic early intervention approach in a child with CVI.

Cerebral (CVI)/cortical visual impairment is a decrease in the visual response due to damage or malfunction of the visual processing centers in the brain. While on the other hand, cerebral palsy (CP) is a permanent, nonprogressive disorder of movement and posture due to lesion of the infant's brain. This article presents a case study of a child with CP and CVI, and the strategies adopted in the Early Intervention program to that would work on the neuroplasticity. This in turn has demonstrated the improvement in the functional mobility, and the overall independence of the child.

A 4-year-old female child presented with a cystic swelling medially along the floor of the orbit with mild ipsilateral medial canthus dystopia on the left side. This swelling was present since birth with no significant orbital dystopia or any extraocular movement defects. During surgery, a trilobed yellowish cyst was found near the inferomedial wall of the orbit. Incidentally, the inferior oblique muscle was found to be originating from the medial lobe of the cyst. The cyst was removed completely, and the inferior oblique was reinserted to the inferomedial orbital margin. Histopathology was consistent with dermoid cyst. To the best of the authors' knowledge, the case of abnormal origin of inferior oblique muscle from an orbital dermoid cyst has not been reported before.

Lacrimal sac sarcoidosis is rare and reported in 7.7% of the cases of systemic sarcoidosis. Nasolacrimal duct obstruction, as the initial presentation of sarcoidosis, is very rare. A 50-year-old woman presented to us with complaints of watering and discharge from the right eye for the past 3 months. On examination, she was found to have a right-sided nasolacrimal duct obstruction and underwent external dacryocystorhinostomy (DCR). Intraoperatively, a biopsy was done because of the abnormally thickened sac wall. The histopathology examination was suggestive of granulomatous inflammation. After ruling out tuberculosis and fungal infection with the appropriate investigation, a diagnosis of pulmonary sarcoidosis with lacrimal sac involvement was made because of the mediastinal lymphadenopathy on computed tomography. She was treated with a course of oral steroids along with immunosuppressants for 3 months. There was no evidence of recurrence at 8 months of follow-up.

We report an unusual presentation of paradoxical reaction (PR) with orbital signs in a case of possible intraocular tuberculosis (POTB). A 15-year-old boy presented with vitreous hemorrhage in the right eye (OD) and multifocal choroiditis in the left eye (OS) and progressed to develop bilateral proptosis, lid edema, chemosis, subretinal lesions, and progression of choroidal lesions following the rapid tapering of oral steroids with anti-tubercular therapy for POTB. The orbital reaction and progressing posterior segment lesions were managed with pulse steroid therapy, oral steroids, intravitreal anti-vascular endothelial growth factor (anti-VEGF), and steroid implant. The orbital involvement is rarely seen in POTB with PR.

Orbital cellulitis is a dreaded entity that can lead to an array of complications from visual loss to cavernous sinus involvement. Paranasal sinus (PNS) infection and trauma are the most common etiology. We report a case series of three patients who were victims of landslide and developed orbital cellulitis. Facial edema, proptosis, central retinal artery occlusion and hyperdense foci in the orbit, and PNS with proven growth of Clostridium perfringes were the common features in all these patients. Natural calamity leading to this fulminant infection led to mortality of all three patients. This is the first case series of sino-orbital gas gangrene in victims of heavy rainfall causing landslide.

We present a very rare case of fungal orbital cellulitis which presented to us as a pus-discharging fistula below the medial canthus. The patient presented with signs of orbital cellulitis along with a pus-discharging fistula below the medial canthus with positive mucopurulent discharge from the puncta and fistula on syringing. It started with swelling near the medial canthus. The patient responded well on broad-spectrum antibiotics but developed a necrotic patch on the hard palate. The Magnetic resonance imaging (MRI) showed intraconal and extraconal involvement. Diagnostic nasal endoscopy (DNE) was done and the tissue was sent for Potassium hydroxide (KOH) mounting, culture, and histopathology. After the KOH mount showed budding-like yeast cells, the patient was started on antifungals and discharged when the repeat culture report showed no growth. Therefore, a high level of suspicion should be maintained for a fungal cause even in the presence of the pus-discharging fistula.

Non-albicans candida infection is an emerging threat in immunocompromised patients like those with diabetes mellitus, bone marrow transplant recipients, or HIV-positive patients. We report a rare case of necrotizing preseptal cellulitis extending to the cheek caused by Candida orthopsilosis in a young diabetic patient. Fungal etiology must be considered as a possible cause of preseptal and facial cellulitis in the setting of uncontrolled diabetes mellitus, which is unresponsive to broad-spectrum antibiotics even in the absence of a local nidus of infection in the paranasal sinuses or oral cavity.

Isolated oculomotor nerve involvement in a posterior draining CCF is relatively rare. We present the case of a 70-year-old female with complaints of painful left-sided ophthalmoplegia and ptosis. She was detected to have a pupil involving third nerve palsy on the left side. We asked for neuroimaging in the form of MRI and MRA which showed a left-sided low-flow CCF compressing the cavernous and the extra-cavernous portion of the oculomotor nerve. This report stresses the importance of keeping low-flow CCF as a differential diagnosis as early detection can be life-saving.

Bilateral superior ophthalmic vein thrombosis (SOVT) being extremely rare requires diligent evaluation for a definitive diagnosis. A 19-year-old male presented with pain and swelling around both eyes for 5 days. He had bilateral proptosis with gross limitation of movements (extraocular movement) and visual acuity of 6/9 in both eyes. On palpation, no mass was found. Contrast-enhanced magnetic resonance imaging orbit demonstrated bilateral superior ophthalmic vein dilation. Keeping a clinical suspicion of bilateral SOVT, systemic evaluation revealed raised anticardiolipin antibody levels at two occasions 12-weeks apart. A diagnosis of antiphospholipid syndrome was made and anticoagulant therapy was commenced. At 2-week follow-up, there was marked improvement in clinical features.

Gun pellet injury is rare but devastating to the eye. Airgun pellets made of lead can ricochet between the orbital bony walls and can damage the intraocular structures, even causing loss of vision. These pellets can get displaced in the orbital fat during surgical manipulation. Intraoperative CT scan is not readily available in hospitals; however, C-arm fluoroscopy is readily available in most setups. We used a C-arm fluoroscope and three instruments (i.e., two malleable retractors and a periosteal elevator) for locating and removing the pellet successfully in two cases, which to the best of our knowledge has not been reported before.

Orbital injuries caused by foreign bodies are common among children and young adults and may cause ocular morbidity. We report a rare case of an 18-month-old child who sustained an injury with a large metallic keychain in the right medial orbital wall and bridge of the nose following a fall. Timely radiological imaging with X-ray and CT orbit helped in localization and planned removal of the metallic keychain in the most atraumatic way. Early surgical removal with a multidisciplinary approach played a pivotal role in preventing infection, salvaging vision, and anatomical integrity, leading to holistic recovery of the child.

Orbital foreign bodies are seen commonly, but the presence of an unusually large organic foreign body in-toto in the orbital cavity is rare. Here, we are discussing a case of the organic orbital foreign body following a fall. A 22-year-old gentleman with a history of fall presented to us with a large organic foreign body in his right orbit with the collapsed globe. Following thorough history and evaluation, the foreign body was removed and the globe was repaired. The eye became phthisical. A custom-fit prosthesis was applied a month after surgery. We are highlighting the importance of surgical intervention and follow-up to achieve good cosmetic outcomes and the importance of protective gear in the workplace.