Cyclodamia is a technique used for the determination of accommodative spasms. A 20-year-old healthy female presented a complaint of frontal headache for 1 month. In a previous checkup performed elsewhere, she was diagnosed with unilateral high myopia associated with amblyopia. In routine practice, the classic fogging technique is performed during the procedure of subjective correction. In the case of accommodative spasms, there are different techniques of fogging that can be used. The cyclodamia fogging technique should be used in routine practice to differentiate between the cases of excessive accommodation.

An 18-year-old girl presented to us with complaints of redness and photophobia in her right eye. She has been on irregular treatment since 6 years of age but never got completely relieved. We did a thorough examination and relevant investigations. On magnetic resonance imaging (MRI), right side lacrimal gland agenesis was present with normal left lacrimal glands, and a diagnosis of isolated congenital unilateral lacrimal gland agenesis was made.

Mustard seeds have been reported to cause contact dermatitis and even second-degree burns over the exposed skin. However, there have been no previous case reports on mustard seed-induced toxic endotheliitis. Mustard seeds have toxic compounds such as glycosides. There have been few reports on insect sting causing ocular changes. However, there have been no case reports on toxic endotheliitis caused because of rubbing of the eye containing a small insect. We report two such cases of toxic endotheliitis with rare presentation. Both the cases presented with intense photophobia and blurred vision in the affected eyes. The first case had a history of rubbing of an insect inside the eye. The other case had a history of husking mustard harvest a few hours prior to the occurrence of symptoms.

Spontaneous and sequential corneal perforation is rare in pellucid marginal degeneration (PMD) in the seventh decade of life. Hence, the importance of repeated follow-up, clinical examination along with serial corneal topography even in the seventh and eighth decades of life is of utmost importance in PMD. We report a case of spontaneous corneal perforation in a 64-year-old male patient with PMD having normal corneal thickness in the right eye which was managed with primary suturing and compression sutures. The other eye was absolutely normal with normal topographic findings. Over a period of four years of follow-up, the patient developed progressive diminution of vision in both eyes and was diagnosed with cataract. Temporal phacoemulsification with toric IOL implantation was done in both eyes, following which the left eye developed spontaneous perforation after a period of two months which was also managed with primary suturing and compression sutures.

To report evaluation and management of graft-host interface keratitis post-Descemet's membrane endothelial keratoplasty (DMEK). A 70-year-old lady with pseudophakic bullous keratopathy who underwent DMEK and developed interface interstitial keratitis on the first postoperative day. Cultures of corneal button revealed gram-negative bacilli (Pseudomonas aeruginosa). Prompt surgical intervention in the form of removal of donor Descemet's membrane and targeted antibacterial therapy helped in the complete resolution of infection. Descemet's stripping endothelial keratoplasty (DSEK) was performed postresolution of infection which yielded a good visual outcome for the patient. Donor rim culture helps immensely in identifying organisms in cases presenting in the early postoperative period.

We report an atypical presentation of a corneal graft suture-related abscess. An 80-year-old female with a history of Moraxella and herpetic keratitis successfully treated with penetrating keratoplasty was noted to have a semi-circular pigmented line of keratic precipitates straddling a single suture during a routine follow-up appointment. After 48 hours of oral anti-viral and topical steroid therapy for presumed graft rejection, she developed a suture abscess with hypopyon. Treatment with intensive topical antibiotics was commenced, and the case resulted in complete resolution. Semi-circular endothelial keratic precipitates could be an early sign of suture infection.

Trabeculectomy is considered as the gold standard for surgical treatment of glaucoma. The use of conjunctiva to create a filtering bleb limits future surgical options. Gonioscopy-assisted transluminal trabeculotomy (GATT) is an ab interno trabeculotomy technique that has the advantage of reducing the intra-ocular pressure (IOP) in a conjunctiva sparing manner. Ten eyes of eight patients underwent GATT and were followed up for a minimum period of 6 months. Eight eyes were not on any glaucoma medication till the end of their last follow-up, which ranged from 6 months to 1 year. Two eyes were advised to undergo additional glaucoma surgery. All eyes except one retained their visual acuity in the post-operative follow-up period. GATT is a promising technique for the treatment of mild to advanced open-angle glaucoma with an added benefit of sparing the conjunctiva for future interventions.

Nanophthalmos is a rare eye condition characterized by short axial length (<20 mm), high lens-to-eye volume ratio, thick sclera, angle closure, and high hypermetropia. Cataract surgery in nanophthalmic eyes is associated with a higher rate of complications compared to routine cataract surgery. We discuss a case of a nanophthalmic patient (axial length (AL) of 15.80 mm) who presented with angle closure glaucoma, underwent uneventful cataract surgery with in-the-bag intraocular lens (IOL) implantation. The patient developed postoperative uveal effusion followed by malignant glaucoma that was managed effectively by 25 G capsulo-zonulo-iridectomy with anterior vitrectomy. Timely management resolved the episode.

Scleritis is a chronic destructive inflammatory disorder. It has various systemic associations, including granulomatosis with polyangiitis (GPA). However, anterior nodular scleritis being the initial manifestation of GPA is rare. Being in an endemic country of tuberculosis (TB), it is imperative to exclude any possibility of active or latent TB before institution of immunosuppressive agents. Similarly, the vice versa should be kept in mind. We present three cases of persistent anterior nodular scleritis even after treatment with antitubercular treatment (ATT). Subsequent recurrences led to the evaluation and diagnosis of GPA with multisystem involvement. Treatment with immunosuppressive therapy led to successful recovery.

Cataract extraction with intra-ocular lens (IOL) implantation is the most common sight-restoring surgery performed in the elderly. Blunt trauma is usually associated with severe ocular damage and grave consequences in post-operative eyes. Here, we report a case of a 70-year-old male, who suffered from blunt ocular trauma following one and a half month of phacoemulsification in the right eye. Phaco-tunnel wound was healthy, the iris was crumpled and settled at the bottom of anterior chamber, and the IOL was in the bag. There was no wound dehiscence. This is a rare presentation as the majority of reported cases had wound dehiscence and iris expulsion.

The purpose is to report a rare case of letrozole-induced bilateral acute intermediate uveitis (IU) with cystoid macular edema (CME). A 29 years old female undergoing infertility treatment came with complaints of progressive diminution of vision in both eyes. Clinical evaluation and optical coherence tomography (OCT) revealed IU with CME in both eyes. Intravitreal steroid injections and discontinuation of oral letrozole led to the resolution of IU with CME. Thus, all patients who are treated with letrozole should undergo periodic ophthalmic screening for timely diagnosis and treatment.

A 30-year-old Chinese woman presented to the ophthalmology department with bilateral blurry vision.; she was diagnosed with incomplete Vogt–Koyanagi–Harada (VKH). The treatment consisted of prednisolone infusion followed by a change of oral hormones. However, adalimumab subcutaneous injection was used instead because of the ineffectiveness of hormone therapy and the patient's reluctance to take oral hormones. After effective monotherapy with adalimumab, the inflammation was stable and inactive without recurrence at follow-up.

Tofacitinib, a Jannus kinase inhibitor, is used in the treatment of rheumatoid arthritis and recently has been used to treat polyarticular juvenile idiopathic arthritis (JIA). In this case report, we report the resolution of refractory anterior uveitis (OS) in a 5-year-old girl with polyarticular JIA. She had failed conventional immuno-modulation (methotrexate, mycophenolate mofetil, and oral steroids). As she could not afford adalimumab, tofacinitib was added, resulting in resolution of anterior uveitis. During the last follow-up (after 8 months), her best corrected visual acuity is 6/9 (OD) and 6/12 (OS). Tofacitinib may be considered as a cost-effective option for refractory JIA-associated uveitis in the developing world.

A 35-year-old lady presented with headache and diminution of vision in both eyes for 30–35 days. She was being treated for idiopathic intracranial hypertension with documented high intracranial pressures. In view of the past history of positive blood RPR and the current picture of peripapillary hemorrhage along with papillodema and telltale vitreous cells, we suspected neurosyphilis and repeated Blood-CSF TPHA, both of which were positive. She was treated with a single dose of benzathine penicillin G 1.2 MIU I.M and tablet doxycycline 100 mg twice a day for 14 days, with oral acetazolamaide, to achieve resolution of symptoms and improvement of vision.

Bilateral (B/L) simultaneous severe loss of vision and a lack of pain are indicative of an inflammatory optic neuropathy, which has been reported mostly in the systemic auto-immune disorders and defines as 'atypical' optic neuritis. The cause of inflammation in atypical optic neuritis can be an immune-related or infection or vitamin B12 deficiency. Here in this article, we report a 31-year-old male with a known case of psoriasis presented to us with complaints of sudden severe bilateral vision loss diagnosed as bilateral atypical optic neuritis because of psoriasis. This study emphasizes to recognize and monitor patients with auto-immune disorders such as psoriasis for possible development of atypical optic neuritis.

A patient with Takayasu arteritis (TA) with marked ischemia of the retina and choroid underwent successful treatment with stent implantation. The left common carotid artery was markedly narrowed. However, the left subclavian artery showed narrowing at its ostium and proximal segment with narrowing at the origin of the left vertebral artery. The patient underwent left subclavian balloon angioplasty with left vertebral artery stenting. This led to drastic resolution of micro-aneurysms and improvement of vision. Stenting for hypo-perfusion of ophthalmic circulation in cases of TA has rarely been reported, and to our knowledge, this is the rare case report of improved clinical and visual outcome following stent placement.

Ophthalmic artery occlusion is a rare, blinding condition seen in patients with disorders like hypertension, hyperlipidemia, and hypercoagulable state. We report a unique case of ophthalmic artery occlusion in a patient with sickle cell trait and hyperhomocysteinemia. A 23-year-old male presented with a complaint of loss of vision in the right eye for the last two days. There is a history of right-sided hemiparesis due to a thromboembolic event. He is a carrier of sickle cell trait. Fundus showed a pale disc, attenuated artery and vein. OCT revealed foveal thinning and thick posterior hyaloid. ERG showed an extinguished scotopic and photopic response.

It is well established that methanol poisoning induces commonly acute toxic optic neuropathy. Herein, we describe a case of unusual ocular manifestation. A 35-year-old male presented with painless, bilateral, and simultaneous sudden onset of severe visual loss following methanol poisoning. The visual acuity was 20/200 in the right eye and limited to a finger count in the left eye. Fundus color photography showed a bilateral sub-total central retinal artery occlusion (CRAO). A methanolemia carried out following the hemodialysis returned to 0.2g/l. To the best of our knowledge, this is the first case reporting CRAO after methanol poisoning. Our report under-scores the importance of early ophthalmic examination of patients with acute methanol poisoning and suggests that it could induce acute CRAO because of retinal artery vasospasm.

A 65-year-old man experienced sudden bilateral vision loss after rituximab infusion. Best corrected visual acuity was 1/10, and cystoid macular edema was identified. A bilateral rituximab-induced cystoid macular edema was diagnosed, and an intravitreal dexamethasone implant was applied. The exudative phenomena resolved, and the visual acuity rose to 8/10. Another rituximab infusion was followed by vision loss and recurrence of macular edema. A dexamethasone implant was reapplied, which showed great results. This is a rare case of rituximab-induced bilateral macular edema, which recurred after a second infusion. We also present an alternative treatment consisting of intravitreal dexamethasone implant.

We report an atypical central serous chorioretinopathy (CSCR) with pachychoroid disease and consequent recalcitrant neovascular glaucoma (NVG). A 45-year-old man with persistent subretinal fluid, pachychoroid and bilateral large areas of capillary nonperfusion exudative detachment, and CSCR presented with raised intraocular pressure (IOP) and neovascular glaucoma. Failure after trabeculectomy with mitomycin-C mandated the implantation of Ahmed glaucoma valve followed by two epiconjunctival MMC applications over the AGV plate/bleb in the hypertensive phase. He was also started on 25 mg oral eplerenone twice a day for the first month, followed by 25 mg once a day over the next two months, followed by intravitreal bevacizumab injection. The retinal neovascularization regressed along with normalization of IOP at over eight months follow-up.

A 58-year-old female presented with macular telangiectasia (MacTel) type 2 with proliferative diabetic retinopathy (PDR) and also showed vitreomacular traction (VMT) with epiretinal neovascularization (ERN) in both the eyes. Post-vitrectomy with anti-vascular endothelial growth factor (anti-VEGF) injection in the right eye, there was complete resolution of previously noted ERN, probably due to release of VMT, making this a compelling case of traction as one of the pathophysiology of ERN in MacTel type 2 in our case.

A 40-year-old gentleman with a history of repaired corneal perforation with anterior chamber hyphema was referred to the cornea clinic for suspected blood staining of the cornea. Diffuse corneal ocular siderosis and blood staining can present with a similar clinical picture. We describe the anterior segment optical coherence tomography features in our case which helped us differentiate between these presentations.

A 29-year-old male was incidentally diagnosed with amelanotic choroidal melanoma in the nasal quadrant of the right eye following an ocular examination due to accidental entry of an insect in the eye. The patient underwent right eye stereotactic Gamma Knife radiosurgery. The tumor mass showed regression six months after therapy. After 12 months, the patient presented again with diminution of vision with recurrence of choroidal mass and total retinal detachment. He underwent a right eye enucleation. Histopathological examination revealed spindle-shaped cells arranged in fascicles and immune stain positivity for S-100 and negative for HMB-45 and Melan-A—suggestive of schwannoma.

Isolated inferior rectus transection is a rare outcome of ocular trauma, leading to hypertropia and debilitating diplopia in primary and reading positions. The modified Nishida procedure is an easy-to-perform, minimally traumatizing, reversible, ciliary vessel sparing muscle transposition procedure that is ideal for post-traumatic scenarios. We report our experience with the modified Nishida procedure in a case of a lost inferior rectus after traumatic laceration.

The aim of this study is to report a case of hypertropia with severe globe retraction and innervational upshoot present in type III Duane retraction syndrome (DRS) and its management. We report a case of a 24-year-old male with type III DRS with large hypertropia and exotropia, 90° upshoot (grade 4) on attempted adduction, globe retraction on adduction and depression and significant face turn. MRI brain and orbit revealed absence of right abducens nerve with relative low position of horizontal rectus muscles, representing the bridle effect, with normal inferior rectus and superior rectus. The case was managed by performing right eye lateral rectus recession with Y-split for the severe upshoot and superior rectus recession for the hypertropia. Recession of the superior rectus muscle along with lateral rectus recession with Y-split is a safe and effective treatment of type III DRS cases with hypertropia and exotropia.

We herein present a case of a 14-month-old child presented in the pediatric ophthalmology clinic, who sustained a head injury and had unconsciousness and status epilepticus. The child was diagnosed to have cerebral visual impairment (CVI), hemiplegic cerebral palsy (CP), and global delay in developmental areas. After 167 center-based sessions and 120 home-based sessions of therapeutic intervention, a significant development in the child's functioning was noted and quantified using standard assessment tools like CVI range assessment and Developmental journal for babies and young children with visual Impairment (DJVI). At the age of 2.5 years, the CVI range assessment showed that the child from phase II has moved to phase III of visual development. On the DJVI scale, the child improved from performing 33% age-appropriate activities to 81% activities. This case is a clear example to show the importance of early intervention, an interdisciplinary team approach, and parental motivation and involvement in successful management.

Hereditary Sensory and Autonomic Neuropathy (HSAN) is a rare genetic disorder that usually begins in childhood. It is associated with sensory dysfunction (depressed reflexes, altered pain and temperature perception). We report a case of an orphan and adopted girl child with HSAN type IV masquerading as keratomalacia with normal developmental milestones, absent sensation to pain and temperature, bilateral absent corneal reflexes, corneal xerosis, anhidrosis, and trophic ulcers in both hands and feet.

Internal carotid-ophthalmic artery aneurysms (IC-OA) are rare lesions that become symptomatic only when they are quite advanced or when complicated by subarachnoid hemorrhage (SAH). We report a case of IC-OA aneurysm in a middle-aged lady who presented with relative afferent pupillary defect, optic disc pallor, significant color vision impairment, and rather preserved visual acuity in the right eye. Magnetic resonance imaging revealed a fuso-saccular aneurysm of the ophthalmic segment causing a pressure effect on the optic nerve. This case emphasizes the importance of careful ocular examination supplemented by neuro-imaging in cases of unexplained visual loss. Early detection can prevent a potentially fatal subarachnoid hemorrhage.

Gunshot injuries are a rising concern, which can have ocular involvement in almost 2% of cases. We present a case of a 35-year-old woman with accidental gunshot injury with no perception of light Oculus Uterque (OU). OD had disk pallor and OS, a repaired corneoscleral perforation. The bullet entered the left orbit perforating the left globe, crossed over to the opposite side, and exited through the right temple. Noncontrast computed tomography (NCCT) head revealed comminuted fractures of the roof, lateral and medial orbital walls. Multiple tiny bony fragments and foreign bodies were seen in the retrobulbar region of OD in relation to the optic nerve near the optic disk. This case highlights that gunshot injuries to the eye have high morbidity, but they are largely preventable as most injuries are unintentional, as was seen in this case. The priority should be to spread awareness and sensitize the masses regarding preventive factors.

A 7-year-old girl with bilateral cataracts, along with photosensitivity, was suspected to have xeroderma pigmentosum. Further dermatological examination confirmed the proband had dry skin, brittle hair, high-arched palate, and ichthyosis. The proband underwent bilateral cataract surgery. Her best corrected visual acuity (BCVA) improved to 6/9 in both eyes. Polarizing light microscopic observation of the proband eyebrow hair shaft resembled tiger tail-like stripes, which is an authentic clinical feature associated with trichothiodystrophy (TTD). Furthermore, on whole exome sequencing (WES) of the proband, mutations in the ERCC2 gene were found to be strongly associated with TTD1.

Netarsudil is a rho-associated coiled-coil-containing protein kinase inhibitor and norepinephrine transporter inhibitor, which decreases the intra-ocular pressure by increasing the aqueous outflow and decreasing the aqueous production. However, netarsudil has been reported to cause adverse effects attributed to its vasodilator property. The common side effects associated with its use are conjunctival hyperemia, corneal verticillata, and conjunctival hemorrhages. This report describes a case of allergic contact dermatitis 3 months after initiating netarsudil eye drops in a 78-year-old man.

A 75-year-old female presented with swelling and redness on the left lower lid away from the lid margin since 10 days. The best corrected visual acuity in both eyes is 6/6 and N6. On examination, an erythematous ulcerative lesion with rolled edges and central necrosis on the left malar area was seen clinically mimicking basal cell carcinoma. Excision biopsy was performed, and the histopathology report revealed an inflamed follicle with intra-follicular demodex folliculorum with ulceration and suppurative abscess with necrotizing destruction of hair follicles. The patient was treated with topical ciprofloxacin ointment. Follow-up after 3 weeks showed complete resolution of the lesion with no recurrence at 3 months.

A 53-year-old gentleman, presented with an alleged history of seizures at home during which he suffered trauma to his left eye leading to prolapse of the globe. This globe luxation was associated with lid lacerations and active bleeding from the orbit. The lacerations were repaired, the globe was enucleated, and eventually, a prosthesis was fit for cosmesis. Autoenucleation usually occurs in patients with psychiatric illness or drug abuse and rarely in cases of accidental trauma. We present this case report to highlight the clinical presentation of such a trauma with complications, which might be overlooked while treating such patients.

This report highlights a rare case of a benign orbital intramuscular lipoma mimicking a malignant tumor with unusual sphenoid wing destruction. A 2-year-old female patient presented with proptosis of the left eye, left temporal fullness, and motility disturbance during abduction. Brain and orbital computed tomography revealed an inhomogeneous enhancing density partially circumscribed mass in the left extraconal space (36.6 × 34.4 × 34.2 mm) with bone erosion of the greater wing of the left sphenoid bone. The clinical and radiologic findings suggested rhabdomyosarcoma. Histopathology revealed diffuse infiltration of mature adipocytes in the striated muscle. An intramuscular lipoma, a rare subtype of benign lipoma, can mimic malignant orbital tumors due to adjacent bone erosion.

A 13-year child presented with protrusion of the left eye (LE) with redness, pain, and diminution of vision following blunt head trauma. The best-corrected visual acuity (BCVA) in the LE was hand movement. On examination, LE had abaxial proptosis with lagophthalmos and severe exposure keratopathy. There was a large corneal ulcer with feathery margins and superficial brown pigmentation, confirmed as Curvularia spp. on microbiological assessment. A computed tomography (CT) scan of the orbit and brain demonstrated superior subperiosteal hematoma of the orbit and frontal epidural hematoma. Aspiration of blood from subperiosteal orbital hematoma resulted in an immediate reduction of proptosis. The epidural hematoma resolved spontaneously. Treatment with topical and systemic antifungal agents resulted in complete healing of the keratitis with a residual leucomatous corneal opacity. Emergency treatment of subperiosteal orbital hematoma through needle aspiration helps in the early resolution of proptosis, exposure keratopathy, and visual loss.

A 66-year-old female presented with a swollen and itchy eyelid for 4 weeks. A computed tomography (CT) scan revealed a lesion epicentered in the greater wing of the sphenoid and anterior lateral and superior orbital walls, predominantly showing osteoblastic features. Magnetic resonance imaging (MRI) demonstrated further calvarial and pachymeningeal involvement. Biopsy of the lesion demonstrated a poorly differentiated carcinoma. A distant history of breast cancer (20 years) prompted specific immunochemistry that confirmed breast carcinoma metastases. Staging positron emission tomography-computed tomography (PET) revealed multisystem spread. This report highlights the fact that breast carcinoma metastasis may rarely present with a predominantly osteoblastic lesion in the orbit.

IgG4-related disease is a multisystem disorder characterized by tumefactive lesions comprising of IgG4-bearing plasma cells with fibrosis. We report a case of pediatric IgG4-related orbital disease that was diagnosed 12 years after its first clinical manifestation and we present sequential imaging findings of the case.