Keratitis–ichthyosis–deafness (KID) syndrome is a rare hereditary disorder caused by the gene GJB2 encoding connexin 26. Patients present the characteristic clinical triad of congenital bilateral sensorineural hearing loss, keratitis, and ichthyosis. Ocular manifestations are corneal neovascularization and severe Meibomian dysfunction associated with hyperkeratotic lid border. Treatments with ocular lubricants, autologous serum, tetracycline, and anti-inflammatory agents have been described. New therapies such as retinoids, gas-permeable contact lenses, or antiangiogenic agents may be indicated. However, sometimes surgical options such as keratoplasty and keratoprosthesis are needed. We report two cases of KID syndrome with different ocular manifestations and management.

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While mucocele of the lacrimal sac typical presents as a medial canthal lesion located below the medial canthal tendon, there may be an occasional simulating clinical condition. We present a 17-year-old patient with epiphora who had an orbital venous malformation masquerading as a lacrimal mucocele.

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Relentless placoid chorioretinopathy (RPC) is a relatively rare and more severe variant of acute posterior multiple placoid pigment epitheliopathy (APMPPE) and serpiginous choroidopathy (SC). The lesions can first involve the periphery and can recur in crops over months to years, causing atrophy in healed areas, thus the term relentless or ampiginous. Literature about RPC is limited to case reports and case series. The etiology and treatment of this condition are still unclear. In this illustrative essay, we demonstrate sequential clinical, autofluorescence (AF), and optical coherence tomography (OCT) imaging findings in a case of RPC that progressed over 8 weeks to cause bilateral severe vision loss.

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Bacterial keratitis is a common clinical condition that may lead to visual impairment if untreated. We report our clinical experience of treating bacterial keratitis with levofloxacin (LVFX) 1.5% ophthalmic solution in 10 patients. Eight patients with confirmed bacterial keratitis received monotherapy with LVFX 1.5% and two patients received an additional antibiotic. All patients demonstrated progressive improvement in keratitis and visual acuity over 1 to 2 weeks of treatment. There were no treatment-emergent adverse events. LVFX 1.5% solution is an effective and well-tolerated option for the treatment of bacterial keratitis.

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A 21-years-old female presented with pain, redness, watering, and diminished vision in right eye (OD). Slit lamp biomicroscopy revealed infective keratitis and microbiological tests revealed mixed infection of bacteria and fungus. The patient was treated with a combination of topical (antibacterial and antifungal) medication and oral itraconazole. The patient showed no response. Tab voriconazole was added. Observing no response after another week, collagen cross-linking was performed. On day two, sudden worsening of corneal infiltrates involving total cornea was observed. Topical colistin 0.19% drops were added. The patient did not respond to treatment and a therapeutic graft was performed. The postoperative period was uneventful and no recurrence was observed.

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The terminology of bacillary layer detachment (BLD) has been used vicariously to describe the splitting of the photoreceptor layers at the level of the myoids and has been discerned in multiple uveitic pathologies. To add to the existing literature, we report BLD in the acute stage of sympathetic ophthalmia presenting as an enclosed outer retinal cyst extending between the external limiting membrane and retinal pigment epithelium with disruption of the outer retinal layers and apparent splitting of the photoreceptor myoid zone at its margins. The cystic-appearing BLD collapsed following treatment with systemic steroids with improvement in vision.

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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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A thirty-five-year-old female patient presented with bilateral decreased vision and scotomas in her visual field in both eyes, two weeks after a second dose of human papilloma virus vaccination. After detailed ophthalmological examination she was diagnosed with APMPPE. Due to the visual deterioration shortly after the diagnosis, she was treated with oral prednisolone 1mg/kg. Her visual acuity improved to 20/32 in the right eye and 20/25 in the left eye in the first week, to 20/20 in both eyes in the first month of treatment. Despite rare, HPV vaccination may cause posterior uveitis in form of APMPPE.

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The development of retinal and choroidal neovascularization in posterior uveitis is attributed to the angio-inflammatory drive with/without ruptures in the retinal pigment epithelium-Bruch's membrane complex. We report a unique case of a 15-year-old Asian-Indian female who developed immune retinitis post-typhoid fever along with simultaneous retinal and choroidal neovascularization. After ruling out infectious etiologies, she was initiated on a course of systemic steroids considering that the retinitis had immune-mediated pathogenesis. Subsequently, the retinitis lesion and choroidal neovascular membrane healed with scarring while the retinal neovascular complex showed fibrotic regression.

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An 81-year-old gentleman with a vague history of dust falling into the eyes presented with a white lesion in the left eye for 5 months. Both eyes showed two foci of central dense stromal infiltrates with keratic precipitates. Suspecting herpes simplex virus (HSV) keratouveitis, topical steroids, and antiviral eye ointment were started. A month later, he developed unilateral microsporidial keratoconjunctivitis with persistent bilateral deep stromal keratitis. The corneal scrapings revealed microsporidial spores on 10% Potassium hydroxide (KOH)with Calcofluor White Stain. Topical 1% voriconazole eye drops for 4 months in the right eye, a combination of 1% voriconazole and Natamycin eye drops for 9 months in the left eye and oral albendazole 400 mg twice daily for 3 weeks resulted in complete resolution. There were no recurrences over 1 year. We present a literature review of the medical management of microsporidial stromal keratitis highlighting our case with bilateral disease successfully managed medically with antifungal therapy.

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A diabetic and asthmatic patient was planned to undergo femtosecond laser-assisted cataract surgery in his left eye. At the end of femtosecond procedure, he developed breathlessness due to noncardiogenic pulmonary edema. The second procedure was postponed for 3 weeks till he received fitness for undergoing further ocular surgery. The second surgery was uncomplicated. There was no corneal decompensation, exaggerated inflammation, intraocular pressure spike, diabetic retinopathy progression, or postoperative cystoid macular edema till 6 months of follow-up. Although not recommended, such a delay may be unavoidable. The delayed surgery is unlikely to compromise the surgical outcome or increase the chances of intra- or postoperative complications.

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In the current times, scleral-fixated intraocular lens (SFIOL) has become the treatment of choice for the management of cases of aphakia without capsular support. In this retrospective case series, we describe the risk factors and management of three cases of scleral thinning with haptic exposure following SFIOL. Medical records of cases with scleral thinning with haptic exposure following SFIOL over the last 1 year were reviewed for demographic factors, type of surgery, and outcomes. Out of 116 eyes that underwent SFIOL, 3 cases developed scleral thinning within 1 week of surgery. The indication of SFIOL was aphakia with operated penetrating keratoplasty (2 eyes) and complicated cataract surgery (1 eye). Surgical records revealed that all cases had undergone SFIOL with conjunctival closure using fibrin glue without any intraoperative complication. Post-operative day 1 findings showed conjunctival mound formation due to excessive fibrin glue in all cases. Scleral thinning was noted on follow-up (day 7, 2 cases and day 5, 1 case). Cases were managed with conjunctival advancement (n = 1) and amniotic membrane graft (n = 2). Thinning resolved within 1 week of follow-up.

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Steroids are known to cause glaucoma in certain predisposed people (steroid responders). We present three cases where patients developed refractory steroid induced glaucoma following the use of skin whitening creams.

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A 11-year-old immunocompetent boy presented with a painful loss of vision due to panophthalmitis in the left eye. The eviscerated specimen showed invasive mucormycosis, for which he was treated with topical and systemic antifungals. The child presented later with recurrent episodes of redness in the right eye. During hospitalization, we found that the eye drop vials were perpetually contaminated with an acidic agent. Based on a detailed review of history and examination, a factitious disorder was suspected and confirmed by a psychiatric evaluation.

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A 27-year-old male, with a history of bilateral Laser in situ keratomileusis (LASIK) followed by photorefractive keratectomy, presented with complaints of disturbed quality of vision, the right eye worse than the left eye. Uncorrected distance visual acuity (UDVA) was 20/20 in both eyes. Corneal topography and wavefront aberrometry revealed slightly decentered ablation and increased higher-order aberrations in the right eye, respectively. A topography-guided femtosecond-assisted LASIK was performed for the right eye successfully reducing his visual symptoms and conserving UDVA at 20/20.

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A 31-year-old woman who had undergone bilateral small incision lenticule extraction (SMILE) surgery developed visually significant epithelial ingrowth in her left eye. She then underwent epithelial removal without lifting the cap. No corneal haze or irregular astigmatism was observed through follow-up. The patient had a medical history significant for hyperthyroidism, suggesting that epithelial basement membrane degeneration in patient with hyperthyroidism may be a risk factor for epithelial ingrowth after SMILE.

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Lipid keratopathy (LK) is a disease in which fat deposits accumulate in the cornea, leading to opacification and decrease of visual acuity. It can be idiopathic, i.e. without signs of previous corneal disease or secondary to ocular or systemic diseases. It is usually associated with abnormal vascularization of the cornea, and the lipid classically deposits adjacent to these vessels. There have been case reports of annular LK in literature, but to the best of our knowledge, familial association has not been reported with it. In this case series, we thus present a family of six patients with bilateral annular LK.

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Pediatric ocular chemical injuries constitute a true ocular emergency and require urgent evaluation and treatment. We report a case of ocular chemical burn in an 11-month-old infant following contamination of ophthalmic eye drop vial with trichloroacetic acid. The child developed superficial corneal burn which was managed successfully with a favorable outcome.

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Sural nerve transplantation is an established procedure for neurotization in patients with corneal anaesthesia. In a child presenting with corneal anesthesia and maculo-leucomatous opacity, a combined deep anterior lamellar keratoplasty (DALK) and sural nerve transplant procedure was done. Under general anesthesia, a sural nerve graft was obtained from the child's own foot and co-apted with contra-lateral supra-orbital nerve. Simultaneously, lamellar dissection of host corneal bed, followed by the apposition of the graft was done. At 1 year follow up, visual acuity had improved, the graft was clear,avascular and the corneal epithelium was healthy.The corneal sensations were appreciated in all quadrants.The child was started on amblyopia therapy. Combined keratoplasty with neurotization surgery is a feasible alternative to staged surgical procedure. It helps achieve faster visual and anatomical recovery.

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Microbial keratitis is a potentially sight-threatening complication of contact lens (CL) wear. Microbiological investigations, close follow-up, and culture-guided treatment are mandatory to achieve a favorable outcome. Poor CL hygiene and exposure to contaminated water, associated with severe ocular pain, are hallmarks of Acanthamoeba keratitis (AK). However, AK is characterized by an insidious onset. We report a case of an acute onset CL-related keratitis associated with L. aquatica, a Gram-positive bacterium. A history of river water exposure and disabling ocular pain, which resembled AK but with unusual slit-lamp findings, made the diagnosis challenging.

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Patients with tubercular uveitis can present in a myriad of clinical findings. Tubercular retinal vasculitis (TRV) mimicking frosted branch angiitis (FBA) is sparsely reported in literature. However, TRV in the background of benign familial fleck retina simulating FBA is never reported. We report a patient of TRV from a tubercular endemic region, supported by ancillary investigations like fundus fluorescein angiography and fundus autofluorescence. The patient was diagnosed as a case of “possible intraocular tuberculosis.” She was managed with systemic and topical steroids along with antitubercular therapy and had a favorable outcome.

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Biological drugs, especially anti-TNF-α agents, have revolutionized the treatment of chronic immune-inflammatory diseases, however complications include reactivation of tuberculosis and increased incidence of other infections. We report a 28-year-old male, on biological agents for HLA B27 positive spondyloarthropathy, inflammatory bowel disease and psoriasis, who presented with occlusive retinal perivasculitis. Following a thorough clinical examination and ocular and systemic investigation, a diagnosis of probable ocular tuberculosis (POTB) with tubercular retinal vasculitis (TRV) was made. Biologics were temporarily withdrawn and anti-tubercular therapy (ATT) initiated with good response. Patients on biologics need close monitoring, for ocular and systemic infections especially TB.

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An 11-year-old female on treatment for miliary tuberculosis presented with decreased vision. Examination revealed bilateral disc edema, granulomatous uveitis, and multiple choroidal tubercles. Oral steroids were added. She was lost to follow-up, and 3 months later she had further visual loss due to optic atrophy. Repeat imaging of the CNS showed regression of the brain parenchymal lesions. This is a rare presentation of ocular tuberculosis in the setting of disseminated TB. While the mainstay of therapy is antitubercular therapy, this case highlights the importance of systemic corticosteroids to decrease both ocular and CNS inflammation and halt further vision loss.

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A 30-year-old woman presented to the OPD, and during the course of her retinal examination she was seen to have multiple drusen in both the eyes. Based on her age, drusen appearance, distribution, autofluorescence, star in the sky appearance on angiography, and sub-RPE location on SD-OCT, she was diagnosed as having Cuticular drusen also called Basal laminar drusen. The perifoveal drusen had clustering and confluence with intermediate-stage AMD features. Thus, we report a rarely seen phenomenon of macular degeneration in a young woman with Cuticular drusen phenotype, which has genetic and systemic implications.

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We report a rare case of subfoveal intrachoroidal cavitation secondary to full-thickness macular hole in case of retinitis pigmentosa. Intrachoroidal cavitation was typically described in myopic eyes in peripapillary region and North Carolina macular dystrophy previously. Many authors described hypothesis regarding its pathogenesis but conclusive evidence is not available. We are reporting subfoveal intrachoroidal cavitation associated with retinitis pigmentosa and myopia.

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We describe a case of myopic macular hole (MMH) associated with posterior pole staphyloma (PPS) and foveal detachment (FD) complicated by the presence of Retinitis Pigmentosa (RP). The patient underwent combined macular buckling (MB) and pars plana vitrectomy (PPV). Two month post-operatively, the optical coherence tomography (OCT) showed a closed macular hole with flattened posterior pole. The challenges posed by a FD due to a MMH complicated both by a PPS and RP have been elaborated. A significant anatomical and visual improvement was achieved, providing better central vision in a patient with already compromised peripheral vision.

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Corneal wound infection following cataract surgery is rare. We describe a case of wound infection at both the main wound and the side port wound following uncomplicated phacoemulsification. Candida albicans was isolated, and the condition worsened with progression to endophthalmitis. Vitrectomy was done, and the infection was controlled after 3 months of topical and systemic antifungal medications.

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We report an unusual case of asymmetric maculopathy in a patient with a 30-year history of monocular aphakia. An 82-year old man presented with unexplained visual loss in his right eye. Examination revealed loss of the ellipsoid zone, abnormal visual fields, and multifocal electroretinogram, all worse in the right eye. Suspecting a genetic predisposition to maculopathy that may have been exacerbated by the asymmetric media, we conducted genetic testing that revealed mutations in adenosine triphosphate-binding cassette, sub-family A, member 4 (ABCA4) and jagged canonical notch ligand 1 (JAG1). This case shows that a genetic predisposition toward maculopathy may be exacerbated by extraretinal factors, including the asymmetric phakic status of the eyes.

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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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Penetrating injury in children resulting in a corneal tear with associated complicated cataract can present in different ways. The presence of fibrovascular downgrowth on the posterior capsule is very unusual and has never been reported before with pediatric traumatic cataract. In this study, we describe surgical management of such a case along with its postoperative course to help achieve good visual outcome.

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Among foreign bodies involved in ocular trauma, three-fourths are accounted by iron, causing ocular siderosis. We report a case of total white cataract with golden-brown deposits over the anterior lens capsule. Clinical examination made us suspicious about a foreign body which was detected on a computerized tomography (CT) scan in the ciliary body. The patient underwent cataract surgery, and the anterior capsule was histopathologically proven to have siderotic changes. Caution is advised in cases when there may be a long time interval for the development of ocular siderosis. Siderotic changes in the lens may occur even when there is no intralenticular foreign body.

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Purtscher's retinopathy is a well-known finding post trauma. It is microangiopathy occurring due to occlusion of peripapillary terminal arterioles that supply the superficial capillaries. There are numerous reports in literature describing this entity, but seldom any report describing its course and nature of resolution supported with imaging. We present a case of a 21-year-old young male who developed Purtscher's retinopathy post head trauma, with sequential follow-up imaging over a period of 3 months, till near complete resolution of the condition. The supportive imaging also aids in understanding the pathology in a simplified way.

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Optic nerve head avulsion is a rare complication of ocular blunt trauma usually seen in outdoor sport. The case reported is a 19-year old male presented due to sudden loss of vision in right eye following injury by jumped off dice while playing carom board. On examination visual acuity was light perception and fundus showed vitreous hemorrhage and deep seated optic nerve head. As visual recovery was unlikely, he advised to follow up after one month after explaining prognosis. We emphasis to suspect optic nerve avulsion in indoor sport injury and early diagnosis to prevent unnecessary treatment.

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Chondroid syringoma is a benign mixed tumor characterized by sweat gland elements in a cartilaginous stroma. A 34-year-old male patient presented with a slow growing mass since 2 yrs. A complete surgical excision was done for the same under local anesthesia which showed a significant improvement. Our report aims to raise awareness about this rare benign tumour of the eyelids and to study the histopathological aspects of it.

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Peripunctal tumors usually account for as low as 6.3% of all punctal lesions. Peripunctal nevus is benign in nature, but it can cause epiphora by its sheer mass effect or cosmetic blemish. Anterior segment optical coherence tomography has recently been used in various lower punctal pathologies. A 60-year-old lady presented with a painless, benign peripunctal nevus and underwent excision biopsy. Anterior segment optical coherence tomography was used for its in vivo assessment and defining features of the lesion. It showed a hyperreflective epithelial thickening and gradient hyporeflective layers with punctal occlusion.

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Juvenile xanthogranuloma (JXG) is a benign histiocytic disorder that belongs to the non-Langerhans cell group. Extracutaneous involvement in the eye usually involves the iris and presents as recurrent spontaneous episodes of hyphema or secondary glaucoma. A 3-year-old child presented with a subconjunctival mass in the left eye and concurrent scalp nodules. Ultrabiomicroscopic examination showed a moderately reflective episcleral mass with extension into cornea but no scleral involvement. Histopathology of the excised subconjunctival mass showed a dense infiltrate of polygonal/spindle mononuclear cells with moderate amounts of cytoplasm and scattered Touton giant cells, suggestive of JXG. Systemic evaluation did not reveal any other sites of involvement. Postoperatively, the patient was treated with topical steroids. At last follow-up 2.5 years, the patient is free on any recurrence.

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Verrucous carcinoma is a rare and indolent variant of squamous cell carcinoma. We report the first histopathologically confirmed case of verrucous carcinoma of the conjunctiva. An 85-year-old male presented with complaint of mass in interpalpebral region in the left eye. Examination revealed a single, sessile, pale-colored exophytic mass with a pebble surface approximately 15 mm × 10 mm in size. Patient did not respond to topical therapy and underwent complete excision of the lesion with biopsy. Histopathological examination of the excisional biopsy revealed a diagnosis of verrucous carcinoma. The patient was healthy with no signs of recurrence at 2 years follow-up.

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A 67-year-old male, presented with the complaints of itchy, painless, rapidly enlarging black colored mass arising from his left upper eyelid. Ocular examination revealed a dark colored nodule with overlying crust on the temporal aspect of the left upper eyelid. An excisional biopsy revealed a well-circumscribed tumor composed of anastomosing vascular channels of varying sizes. Lining endothelial cells revealed focal areas of hypercellularity, mild to moderate pleiomorphism. Immunohistochemistry revealed that tumor cells are diffusely immunopositive for CD34. A diagnosis of primary cutaneous angiosarcoma of eyelid was made. Systemic oncological workup for metastatic disease was negative. The patient thereafter underwent wide surgical excision with frozen section control of margins followed by free flap skin graft under general anesthesia to achieve complete surgical resection of the tumor. Thus, although extremely rare, angiosarcoma of eyelid should be considered in the differential diagnosis of unusual or atypical eyelid lesions; the early diagnosis and treatment of which improves the survival rate.

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Solitary fibrous tumor (SFT) is a rare spindle-cell neoplasm of mesenchymal fibroblast-like cells. A 47-year-old female, with complaints of watering with left medial canthal fullness and left failed dacryocystorhinostomy, on imaging showed homogeneous well-defined lesion extending into nasolacrimal duct with adjacent bone remodeling. Excisional biopsy showed spindle-cell tumor with cellular areas showing prominent vascular pattern. On immunohistochemistry, CD-34 was positive and Ki-67 was <5%. A diagnosis of SFT was suggested. At 6 months follow-up, the patient had no recurrences.

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A 42-year-old female presented with sudden diminution of vision in the right eye (RE) for 1 day. The vision was counting fingers with Relative afferent pupillary defect (RAPD) (RE) and 20/20 (LE). Fundus revealed dilated tortuous arteries and veins in all quadrants with premacular and submacular hemorrhage. Fundus fluorescein angiography (FFA) showed nonleaking vascular loops with hypofluorescence at the macula. Optical coherence tomography (OCT) revealed localized posterior hyaloid detachment with hemorrhage. We report this unilateral case of retinal racemose hemangioma with multilayered hemorrhage managed with pneumatic displacement and revealed retinal artery macroaneurysm in the background. On follow-up there was development of localized vitreomacular traction. It was treated with Yttrium Aluminium Garnet (YAG) hyaloidotomy, which improved vision to 20/80.

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Retinal hemangioblastoma is associated with Von-Hippel–Lindau syndrome. Here, we report the case of a 50-year-old man who had a retinal hemangioblastoma that penetrated the sclera and presented as an extra-ocular mass. Computerized tomography of the abdomen showed bilateral renal cell carcinoma, renal, and pancreatic cysts. A provisional diagnosis of Von-Hippel–Lindau syndrome was made. Enucleation of the eyeball was done, and the diagnosis of retinal hemangioblastoma was confirmed by histopathology and immunohistochemistry. Though rare, retinal hemangioblastomas can present with extrascleral extension. In such cases, enucleation may be the only alternative.

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Melanoma-associated spongiform scleropathy (MASS) is a non-inflammatory scleral degenerative change with a spongiotic morphology seen in the sclera associated with uveal melanoma. This degenerative change was seen in the inner side of the sclera in contact with the pigmented mass. It is usually seen in an elderly person with choroidal melanoma. We report a case of MASS in a large choroidal melanoma in a 58-year-old Indian man supported by histopathology, special histochemical stains, and immunohistochemistry.

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Ocular choristomas are uncommon. In the choroid, two types of ectopic tissues have been described, smooth muscle and osseous tissue, being the latter the most frequent. Choroidal osteomas are benign ossifying tumors, mostly unilateral, with unknown etiology. They are usually found in young women and are rarely diagnosed in infants. Herein we present an 8-year-old girl with congenital unilateral limbal dermoid who, over the years, developed bilateral choroidal osteomas outside the framework of systemic diseases.

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A 24-year-old male presented to us with a slow growing, painless mass lesion in his left eye. A dome-shaped, well-defined, nontender, nodulocystic, immobile, transilluminant subscleral mass was seen in the nasal quadrant. Infiltration of ciliary body, iris, choroid, and sclera by a suprachoroidal mass of variable echogenicity was noted on B scan ultrasonography (USG). Incisional biopsy hinted toward intraocular schwanomma. Considering the infiltration seen on USG B scan, progressive increase in size, and relatively good prognosis if intervened early, a transcleral local resection was performed. Histopathology and immunohistochemistry confirmed an ancient schwannoma. Patient recovered without complications.

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A teratoma is a tumor comprising three embryonic germ layers. Teratomas are classified as mature and immature teratomas based on their histological differentiation. Few teratomas, particularly immature teratomas, occur in the orbital cavity. We report a case of a 28-week-old fetus with an orbital immature teratoma. The parents terminated the pregnancy because of the rapid growth and unknown nature of the tumor. Owing to its relatively low incidence, no standard treatment for orbital teratomas has been devised. Generally, to preserve vision and for aesthetic reasons, surgery should be performed as soon as possible.

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To report a rare case of an orbital dermoid cyst combined with unilateral keratoconus. A 19-year-old female presented with a painless, progressive upper eyelid swelling of the right eye accompanied by decreased visual acuity. Keratoconus of the right eye was confirmed by corneal topography. After surgery, the lesion mass proved to be a dermoid cyst on pathological examination. To the best of our knowledge, this is the first report to describe an orbital dermoid cyst combined with unilateral keratoconus. This case suggested that the keratoconus of the right eye may be a secondary manifestation of the mechanical pressure exerted by the orbital dermoid cyst.

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An 18-year-old female with relapsed immune thrombocytopenic purpura presented with painful swelling and loss of vision in the right eye 2 days following treatment with systemic steroids and rituximab. She was diagnosed with orbital cellulitis and exudative retinal detachment in the right eye. Following cessation of systemic therapy and institution of broad-spectrum antibiotics, there was a prompt reversal of cellulitis and exudative detachment. Ocular complications can arise following treatment with rituximab. Venous congestion and reactive edema across the sclera can lead to exudative retinal detachment in orbital cellulitis. Early diagnosis and prompt treatment are associated with a good prognosis.

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Snake envenomation is a major public health challenge in the interior Sindh region of Pakistan. Ocular complications ensuing snake envenomation are comparatively scarce. A case report of bilateral proptosis and blindness in a 3-year-old girl presenting 5 days after a snakebite is a rare manifestation. Even antivenom and other medical/surgical management could neither reverse her visual loss nor save her life. This report has enlightened the eminence of problems related to snake envenomation in the interior Sindh, Pakistan, and highlights the need for early referral and that ocular manifestations must be treated as an emergency.

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Congenital orbital fibrosis with strabismus fixus is a very rare clinical condition. Although surgery is used to treat strabismus fixus caused by congenital orbital fibrosis, it does not improve ocular motility after removal of extraocular muscles. Here, we describe cases of congenital restrictive strabismus caused by orbital maldevelopment. Specifically, we describe the clinical characteristics and magnetic resonance imaging features of strabismus fixus caused by congenital orbital fibrosis.

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Herein, we report a case of acute, unilateral, painless visual loss in a middle-aged female. A 43-year-old female presented with rapid painless diminution of vision in the left eye with no history of any systemic disease. Anterior segment findings were within the normal limit in both eyes. Fundus examination revealed hemorrhages at the disc with pale disc and disc edema in the left eye and no remarkable change in the right eye. Ultrasound B-scan (USG) and computed tomography (CT) scan revealed optic nerve head drusen (ONHD). Diagnosis of nonarteritic anterior ischemic optic neuropathy (NAION) secondary to ONHD of the left eye was made.

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Pupillary abnormalities can be a potential cause of migraine with photophobia. A 32-year-old female developed Adie's pupil following concussion injury which triggered severe episodes of migraine with extreme photophobia. We used diluted Pilocarpine drops (0.125%) for treatment and the patient had significant improvement in MIDAS (Migraine Disability Assessment) score after treatment. This case highlights the importance of pupillary examination in cases of migraine.

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A 42-year-old male presented with complaints of pain in the left hypochondriac region and diffuse headache and gradual painless loss of vision in both eyes. Ocular examination revealed BCVA was 20/40 in the right eye and 20/60 in the left eye and Grade 5 Papilledema noticed in both eyes. Blood investigation revealed polycythemia and positive JAK2 mutation. Primary polycythemia was diagnosed. Immediate treatment with low molecular heparin was initiated, and regular phlebotomies were performed until the hematocrit dropped to 45%. This case reveals, papilledema as an important sign of polycythemia and as a guide to the diagnosis of cerebral venous sinus thrombosis (CVT).

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Bilateral optic disc swelling with bilateral abducens nerve palsy as the first presenting signs of sporadic primary Burkitt's lymphoma (BL) is very rare. We report this in a young immunocompetent individual. Initial misdiagnosis of idiopathic intracranial hypertension was made due to normal brain imaging with elevated opening pressure on lumbar puncture. After 2 months, he developed neurological deficits and neck swellings. Biopsy of swelling revealed BL. He received chemotherapy but succumbed before the second cycle. Signs of raised intracranial pressure warrant meticulous investigation. Multiple high-volume taps of lumbar puncture are advised if clinical suspicion of neurolymphomatosis is high.

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A 56-year-old female presented with bilateral progressive painless loss of vision. Examination showed a relative afferent pupillary defect in the left eye with temporal disc pallor and visual field loss. MRI (magnetic resonance imaging) brain revealed a suprasellar mass for which mass excision via frontotemporal craniotomy was done. Histopathology examination of the mass revealed foamy histiocytes with emperipolesis, S-100 marker was positive. Thus, a diagnosis of Rosai–Dorfman disease (RDD) was made. Our case describes a rarely found isolated intracranial RDD presenting as compressive optic neuropathy and vision loss in an elderly female.

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Tolosa–Hunt syndrome (THS) is a granulomatous inflammation in cavernous sinus or orbital apex. Recurrences are encountered ipsilaterally. Contralateral involvement is known as alternating THS. A middle-aged man presented with right sided headache and vomiting. Magnetic resonance imaging (MRI) revealed hyperintense lesion in right orbital apex with inflammatory changes in superior orbital fissure. A diagnosis of idiopathic hypertrophic pachymeningitis (IHP) was entertained. Within 48 h, there was complete ptosis and markedly restricted ocular movements. MRI done 3 months prior revealed similar features in left eye. A rare case of recurrent alternating THS with radiological evidence is portrayed here.

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