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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.

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Rubella is a viral disease that affects human particularly pregnant females and causes transplacental spread to affect the fetus in utero. Congenital rubella in a child can manifest from mild to severe involvement. We report a case of a young boy with bilateral blindness and sensorineural deafness. Enucleated eye revealed the evidence of rubella eye disease. TORCH titer showed increase of IgG antibody in the serum. An extensive systemic examination and investigations by physician did not show any other signs of extended rubella syndrome.

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Morning Glory Syndrome (MGS) is a well-established association of basal encephalocele and usually presents with midline cranio-facial anomalies. 45-year-old female presented with Secondary Acquired Nasolacrimal Duct Obstruction (SANDO) in left eye. She had a broad nasal bridge, hypertelorism and a swelling inferomedial to medial canthus. Fundus examination in right eye showed Morning Glory disc anomaly. CT of the orbit and brain disclosed left naso-ethmoidal encephalocele. CT Dacryocystography showed partial dehiscence of nasolacrimal duct bilaterally. The patient underwent surgical repair of encephalocele followed by resolution of epiphora. The association of MGS with contralateral naso-ethmoidal encephalocele and SANDO is presented for its rarity.

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A 30-year-old man presented to the ophthalmology clinic with a 1-week history of right eye blurred vision. He reported application of massage gun over bilateral periocular regions for 3 months. The best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. Slit-lamp examination revealed bilateral iris atrophy at the inferonasal region. In the right eye, there was anterior subcapsular and cortical cataract at the visual axis, associated with mild phacodonesis. There were dot opacities in the left eye lens without lens subluxation. The patient received right phacoemulsification with a multifocal intraocular lens implanted. To the best of our knowledge, this is the first case of bilateral traumatic cataract with symmetrical iris atrophy after repetitive periocular massage with a massage gun reported in the literature.

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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.

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We report a case of progressive childhood myopia who developed rebound myopia and convergence excess esotropia after switching from 1% atropine eye drops to 0.01% atropine eye drops. The esotropia recovered and myopia progression was arrested after stopping 0.01% atropine drops and resuming 1% atropine eye drops.

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High levels of iron may be toxic and cause various pathologies in the human body, including the eye. Studies have shown increased iron concentration in certain subtypes of senile cataracts. High serum levels of its non-reactive depot form, ferritin, has also been associated with juvenile cataracts in hereditary hyperferritinemia-cataract syndrome. Whereas this form of hyperferritinemia is inherited, there is no report on cataract formation in iatrogenic hyperferritinemia. Herein, we report a 43-year-old case who was diagnosed with bilateral cataracts a few years after she received intensive intravenous iron replacement therapy for severe iron deficiency anemia.

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Managing large-angle exotropia (>70 PD) can be challenging with the various techniques available. In this case series, we present “True Muscle Transplantation"––a simple technique––to manage large-angle sensory exotropia as a possible alternative. Seven patients (four women and three men) of mean age 39.71 ± 17.38 years with sensory large-angle exotropia (>70 PD) underwent proposed surgery after detailed preoperative workup. The stump resected from MR was transplanted to LR and recessed. The mean preoperative deviation of 77.14 ± 4.52 PD base-in reduced to mean postoperative angle of 4.71 ± 4.42 PD at 6 months with good ocular alignment, no lateral incommittance, and no limitation of ductions in all patients. Stable results were maintained beyond 6 months. True Muscle Transplantation, therefore, has the potential of being a possible alternative.

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A 58-year-old female diabetic patient with keratinization of the gray line, areas of linear scar traction, and forniceal shortening was evaluated. Cicatrizing conjunctivitis was diagnosed. Conjunctival biopsy was performed and the histopathological study revealed a prominent band-like lymphocytic infiltrate. Direct immunofluorescence (DIF) showed a heavy fibrinogen deposition which was irregular in the basement membrane consistent with lichen planus (LP). A full dermatological evaluation was unremarkable. The final clinicopathologic diagnosis was isolated conjunctival lichen planus. As cicatrizing conjunctivitis may have different etiologies with differing treatment strategies, it is important to diagnose this entity and start treatment with anti-inflammatory drugs to avoid vision loss.

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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.

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To our knowledge, assessment of striate keratopathy (SK) is subjectively done with slit-lamp bio-microscopic examination, which is the most common practice. In this manuscript, we have reported the role of objective scheimpflug imaging modality, in decoding the healing and repair process of SK, post prolonged cataract surgery. The quantitative and qualitative framing of this pathology with hyperreflective and hyporeflective hot spots (optical blooming) has never been reported in the literature before. In addition to the imaging of the cascadic events of SK in default colour, the role of digital calipers in the measurement of corneal thickness in SK (in inverse colour) is also highlighted. This manuscript throws light on the unique features of scheimpflug imaging technology, for the possible consideration of it as a routine post-operative investigation in patients undergoing prolonged or complicated cataract surgery, in quantifying their SK.

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