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Netarsudil is a novel Rho-kinase (ROCK) inhibitor approved for the reduction in intraocular pressure (IOP). Reticular epithelial edema (REE) is a side effect commonly noted in patients on netarsudil with pre-existing corneal edema. We report a case of netarsudil-associated REE in a corneal ulcer with secondary glaucoma. The patient had a recurrence of REE even after debridement, and the resolution was seen only after discontinuing the drug. Netarsudil-associated REE is a side effect previously reported in patients with corneal edema and decompensation. To the best of our knowledge, there are no previous case reports of REE in a corneal ulcer. ROCK inhibitors have additional anti-inflammatory and antifibrotic action, which can lead to delayed healing and scarring in corneal ulcers. In conclusion, ROCK inhibitors should be used judiciously in corneal ulcers.

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A 39-year-old woman on palliative chemotherapy for pancreatic carcinoma presented with painful bilateral vision loss. On examination, she had large bilateral corneal ulcers with hypopyon, with corneal and conjunctival xerosis. She was extremely malnourished. Investigations revealed macrocytic anemia with pancytopenia and hypoproteinemia suggestive of pancreatic enzyme insufficiency (PEI). Microbiology reported Pseudomonas aeruginosa infection that was sensitive to ceftazidime. Treatment with topical ceftazidime and oral vitamin A and B12 supplementation (therapeutic doses) led to rapid resolution of the ulcers in 4 weeks. Xerophthalmia with secondary keratitis due to malnutrition from pancreatic carcinoma is hitherto unreported but can be treated successfully with timely identification.

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We report a rare case of bilateral advanced keratoconus presenting with acute hydrops in a 5-year-old child with no known syndromic association and frequent eye rubbing. Pediatric consultation revealed delayed milestones and hypothyroidism with occasional seizures. Acute Hydrops was managed conservatively since fitness for intracameral perfluoropropane injection was delayed. Subsequently, the patient underwent deep anterior lamellar keratoplasty in both the eyes with good surgical outcome. Initial presentation of keratoconus with acute hydrops in a 5-year-old patient is rare. As this case was associated with hypothyroidism, global developmental delay, and seizures, it requires further investigation for any association with keratoconus.

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We report the optometric management of a 27-year-old female diagnosed with Adie's tonic pupil who was otherwise systemically stable. This case report is an effort to understand how tonic pupil management with iris tinted clear pupil contact lenses helps to resolve quantitative and qualitative visual disturbances similar to pharmacological treatment (diluted pilocarpine). The case report shows that it is an effective alternative management to overcome visual symptoms for patients with Adie's tonic pupil compared to pilocarpine (0.1%).

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A 21-year-man male patient presented for a regular eye check-up. He was a known case of bipolar affective disorder and was on the antipsychotic drug, olanzapine, for 12 years. Slit-lamp examination showed peripheral anterior-mid stromal, bilateral, whitish, diffuse pigmentary deposition. Olanzapine is a second-generation atypical antipsychotic used in the treatment of schizophrenia and bipolar disorders. In this case report, we describe a case of corneal deposits related to another new generation atypical antipsychotic agent, olanzapine.

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A patient with well enclaved retropupillary iris-claw intraocular lens (IOL) presented 3 months later with spontaneous diminishing of vision to counting fingers at 3 m. On slit-lamp examination, the cornea was clear, the anterior chamber was normal in depth and the IOL was found to have rotated by 90° and was now vertical, perpendicular to the iris and pupillary plane, and the superior site of enclavation was kinked. The edge of the IOL optic was seen protruding out of the pupil; however, not touching the cornea and a fibrosed posterior capsule was noted nasally. The patient was taken for anterior vitrectomy with repositioning of the IOL. The lever effect of the remnant posterior capsule can be the cause of the tilt.

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We describe a novel technique to manage silicone oil (SO) migration into the anterior chamber (AC) in a phakic eye. A 57-year-old female patient underwent right lens-sparing pars plana vitrectomy for diabetic tractional retinal detachment with SO tamponade. Postoperatively, a large bubble of SO was detected in the AC. The case was managed with the intraoperative displacement of the SO bubble using an ophthalmic viscoelastic device, phacoemulsification, and insertion of a capsular tension ring with an opening directed toward 6 o'clock position. The insertion of the capsular tension ring in this particular position prevented further migration of SO into the AC.

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To report three cases of late presentations of forceps birth trauma leading to DM tear and their management. Forceps delivery has become a rare method of child delivery in the modern clinical era. However, in the clinics, we still see patients with Descemet's membrane (DM) tear who have had ocular birth trauma with forceps. Most of the time, it is an incidental finding. Forceps injuries are usually unilateral and affect the left eye as the most common fetal head position is left occiput anterior. In the immediate postpartum period, the rupture in the DM leads to corneal edema, which eventually disappears, leaving the visible edges of the break. In the late presentations, patients can have high myopic astigmatism (steep cornea) and secondary amblyopia, which can mimic unilateral keratoconus and, later in life, can lead to corneal endothelial decompensation leading to bullous keratopathy. Here we report three cases of DM tear due to forceps injury with three late presentations. Patient 1 came with bullous keratopathy; patient 2 presented with high myopic astigmatism, amblyopia, and beaten metal appearance in between the torn edges; and patient 3 presented as keratoconus. To conclude, this case series highlights the various clinical features and signs of forceps induced birth injury to the cornea. In this report, the clinical history, ocular examination, and optical coherence tomography scan confirmed the diagnosis. Early rehabilitation with glasses or contact lenses can prevent the development of deep amblyopia. Corneal decompensation can be a presentation later in life; thus, these patients should have a close follow up. Endothelial keratoplasty helps in visual rehabilitation in cases where bullous keratopathy has developed, which can be up to the preoperative amblyopia state.

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A patient developed pseudoexfoliative glaucoma and hyphema syndrome with an appropriately placed, in-the-bag single-piece lens. Ultrasound biomicroscopy showed a Soemmering ring, extensive fibrotic bands tethering the capsule to the ciliary body, and localized ciliary body traction. An anterior chamber washout, peeling of the fibrotic bands, and capsular phimosis correction were performed. Uveitis-glaucoma-hyphema syndrome may be caused by a nontilted in-the-bag lens, precipitated by the formation of tractional fibrotic bands, a Soemmering ring, and a predisposition to zonular laxity from pseudoexfoliative syndrome. Surgical peeling of the capsular fibrosis may be the most important factor in preventing recurrent hyphema.

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Giant conjunctival nevi are considered congenital in origin, with the youngest case reported at 12 years. We describe an 11-month-old baby presenting since birth with a giant conjunctival nevus in the right eye involving inferior 9 o'clock hours of bulbar conjunctiva. Intralesional cysts were noted both on clinical examination and anterior segment optical coherence tomography (ASOCT). Gonioscopy revealed increased trabecular pigmentation. Parents were advised periodic review. Our case highlights that this can occur at birth and emphasizes the need for careful documentation and periodic review considering the rare risk of malignant transformation in these eyes.

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Carbonic anhydrase inhibitors are frequently prescribed in topical and oral forms in various types of glaucoma. Dorzolamide eye drops are frequently associated with ocular side effects but systemic side effects are rare with its use. We report a case of dorzolamide-induced giant cell thrombocytopenia in a patient with post uveitic angle-closure glaucoma. After discontinuation of dorzolamide eye drops, the thrombocytopenia reversed.

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Tamoxifen citrate is an antiestrogen agent used in the treatment of breast carcinoma. Incidence of ocular toxicity, in the range of 0.9–-11%, has been reported following its use. Since the clinical picture, especially crystals and cavitation, seen in tamoxifen maculopathy resembles type-2 macular telangiectasia (MacTel-2), differentiating them requires detailed multimodal imaging. We present a rare case of tamoxifen maculopathy mimicking MacTel-2 in an Indian patient. A 55-year-old female with a history of breast carcinoma had been taking tamoxifen 20 mg once daily (cumulative dose of 57.6 g) for 8 years. Color fundus photo showed crystals in foveal and parafoveal region. Further multimodal imaging with confocal blue reflectance, spectral domain optical coherence tomography, fundus autofluorescence, and OCT-angiography demonstrated close resemblance to MacTel-2 features. Thus, it is important to elicit a detailed history in female patients with a history of breast carcinoma and seek oncology consultation once tamoxifen toxicity is seen.

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Cataract surgery in lenticonus is challenging because of increased fragility of the lens capsule. In this case series, we report three different modes of cataract surgery in 15 eyes of ten patients with lenticonus. Six patients had Alport syndrome, out of which two were diagnosed after ophthalmic examination. Two patients had posterior lenticonus, among which one had persistent fetal vasculature. There was a significant improvement in visual acuity following cataract surgery. Therefore, cataract surgery can be safely performed in patients with lenticonus, and ophthalmologists can retard the progression of renal failure by early diagnosis.

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The case of retinal vasculitis in a one-eyed elderly diabetic female after use of brolucizumab injection (second dose) for neovascular age-related macular degeneration.

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Bony lesions of the sinuses can cause disfigurement or functional issues in orbit. Benign bony lesions of the para-nasal sinuses are collectively called as the fibro-osseous lesions. Osteoma, fibrous dysplasia, and ossifying fibroma (OF) are common among them. OF is a rare benign bony tumor occurring in the second to fourth decade. We present this case as juvenile OF is very rare and to discuss the differentials of the bony sinus pathologies.

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Neoscytalidium dimidiatum is a plant pathogen that rarely causes human infection. Very few cases of ocular infection have been reported. We report a case series of three patients who presented with keratitis caused by it. The culture showed effuse, white-to-grayish colonies with yellow-to-deep orange colony reverse. Chains of arthroconidia typical of Neoscytalidium were seen on staining with lactophenol cotton blue. Two patients responded to topical antifungal treatment while one needed therapeutic keratoplasty. Hence, early diagnosis and intensive antifungal treatment are essential for successful healing in mycotic keratitis caused by Neoscytalidium species.

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Management of sensory exotropias is often challenging. In this study, patients who had sensory exotropia >70 prism diopter (PD) were treated with true muscle transplantation. A total of 10 patients with vision <3/60 in one eye were included in the study. All patients underwent transplantation of the medial rectus to the lateral rectus along with a recess–resect procedure. The mean preoperative deviation was 77.5 ± 7.5 PD and postoperative deviation was 6.8 ± 3.2 PD at 1 year. No limitation of movements or lateral incomitance was noted. Thus, this procedure seems to be effective in treating large-angle sensory exodeviations.

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Primary intraocular lymphoma (PIOL) is a rare malignancy affecting primarily elderly patients. In this case report, we present a rare case of bilateral PIOL in a 24-year-old pregnant woman with hepatitis C. The patient presented with blurred vision and floaters in the right eye for a duration of at least 3 weeks and gradual visual loss in the left eye over the course of 14 months. Fundoscopy revealed mild vitritis in the right eye and severe vitritis in the left eye. Moreover, serological testing revealed that the patient was positive for hepatitis C. Due to high clinical suspicion, a diagnostic 23-gauge pars plana vitrectomy was performed in both eyes and cytologic evaluation of the aspirate confirmed the diagnosis of PIOL. Therefore, despite PIOL being of low prevalence, chronic persistent vitritis in young adults should raise suspicion about this malignancy.

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Parinaud's oculoglandular syndrome (POGS) is a rare condition characterized by unilateral granulomatous conjunctivitis and ipsilateral regional lymphadenopathy. Among all infectious agents, cat scratch disease (CSD), which is caused by Bartonella henselae, remains the commonest etiology agent of POGS. We present a case report of a 13-year-old boy who came to a tertiary center in Malaysia with left granulomatous conjunctivitis and subsequent necrotizing lesions involving left upper eyelid, left paranasal region, and left preauricular lymph nodes. With a poor initial treatment response and confusing investigation results, this interesting case describes the diagnostic dilemma in differentiating the etiological agents of POGS.

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It is commonly acknowledged that surgery for correction of strabismus associated with third nerve palsy can be very challenging for an ophthalmologist. Understanding the difficulties, we present modified Nishida, an innovative approach to tackle third nerve palsy. The exotropia with hypotropia in an 8-year-old child with RE congenital third nerve palsy was corrected by a single-staged surgery – LR recession + MR plication + modified Nishida, followed by correction of severe ptosis with frontalis sling surgery 2 months after squint surgery. This innovative, simple, and effective technique with no anterior segment ischemia, giving adequate alignment and good stereopsis, is worth bearing in mind while tackling third nerve palsy.

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Intraretinal hyperreflective line (IHL) is a novel optical coherence tomography (OCT) observation corresponding to the linear or curvilinear pattern of intraretinal hyperreflective foci. A middle aged female complained of recent onset black spot in the right eye visual field and was diagnosed as acute retinal pigment epithelitis (ARPE). On spectral domain (SD) OCT, in addition to features suggestive of ARPE, a vertical linear hyperreflective line was noted. Such IHLs have previously been reported to be present in association with various inflammatory, degenerative, or tractional conditions of macula. This is the first description of IHL in association with ARPE in published literature.

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The various health benefits of physical exercise are well known. Regular, moderate exercise is included in every cardiovascular risk prevention program, as it has a protective effect on the cardiac vasculature. But intense, supramaximal exercise might have potentially adverse effects ranging from increased risk of vascular endothelial injury to sudden cardiac arrest. Acute bout of exercise at high-enough intensity can damage the endothelial cells in the systemic blood vessels. Exercise also affects the retinal and choroidal blood flow, but studies evaluating these effects are limited. Autoregulation, perfusion pressure, endothelial injury, hemoconcentration, and other systemic factors play a complex role in this. In a rare occurrence, we report two cases of sudden occlusion of retinal circulation involving the central retinal artery in one and the ophthalmic artery in the other, following acute, intense exercise in otherwise young, healthy persons. Extensive investigations revealed no other cause for the occlusion. Vision in the affected eye remained poor.

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Bilateral inferior visual field loss (BIVFL) is a rare entity, and rehabilitation of such patients can be challenging. Peli prisms are a good option for visual rehabilitation in horizontal homonymous hemianopias. Here we present an interesting case of BIVFL with macular sparing, successfully rehabilitated with a novel vertical orientation of Peli prism.

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A 52-year-old lady presented with a history of stab injury to both eyes due to assault with scissors by her son. Ocular examination showed no perception of light in the right eye and perception of light in the left eye. Under diffuse illumination, the eyes were appearing unsalvageable. Computed tomography (CT) scan was suggestive of loss of right globe architecture but intact left globe and no intracranial injury. Examination under anesthesia (EUA) was suggestive of multiple injuries in both eyes. The right eye was enucleated and underwent a primary ocular implant. The left eye underwent reconstruction of the upper lid and ocular surface. Postoperatively, the left eye had visual acuity of 20/60 and the patient was able to perform her daily activities independently. Non-accidental bilateral ocular trauma is underreported in ophthalmology journals. Optimum management with a multidisciplinary approach will establish better cosmesis in an eye appearing unsalvageable. Better management and prognostication can be done by incorporating such types of injuries into the international trauma classification systems.

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Adult orbital xanthogranulomatous disease is a rare disorder which may or may not be associated with a systemic involvement. Herein, we report a 60-year-old male who presented with periocular swelling around the eyes for six years with history of asthma and rhinosinusitis. The diagnosis was confirmed by biopsy which showed multiple foci of lymphoid follicles, foamy histiocytes, and macrophages suggestive of the xanthogranulomatous lesion. The findings correlated with adult-onset asthma and periocular xanthogranuloma. He was treated with systemic steroids along with immunomodulator. We report this case owing to rarity of its occurrence, to discuss its management and to create awareness among ophthalmologists about this rare entity.

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Second primary malignancies (SPM) are observed in up to 8.1% of cancer patients and are often overlooked. We present the case of a 58-year-old male with ongoing treatment for colon adenocarcinoma who was discovered to have a mass in the conjunctiva in his right eye. Other than his oncologic diagnosis, he had no other risk factors, such as a history of smoking, unusual exposure to ultraviolet radiation, fair skin, or other conditions, that could explain the lesion.

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A rare presentation of bilateral refractory choroiditis due to presumed ocular tuberculosis with dramatic response to intravitreal moxifloxacin is described in this report. A 32-year-old lady with a past history of bilateral choroiditis due to presumed ocular tuberculosis and biopsy-proven tubercular lymphadenitis four years ago came to us with reactivation of inflammation refractory to antitubercular therapy, systemic steroids, vitrectomy and intravitreal anti-VEGF injections. The lesions responded dramatically to intravitreal injections of moxifloxacin and dexamethasone. Following this dramatic response, she also received oral moxifloxacin 800 mg/day along with ATT for a year. At two-year follow-up, she is doing well with no further recurrences. To the best of our knowledge, no cases of tubercular choroiditis responding to moxifloxacin have been reported (MEDLINE search). This case highlights the usefulness of intravitreal moxifloxacin in refractory tubercular choroiditis.

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Tarsorrhaphy usually reduces the palpebral aperture width and often requires reversal during cataract surgery and reformation. We present a case of phacoemulsification with intraocular lens implantation performed without reversal of tarsorrhaphy with the “push down technique” in a patient with cataract with left facial nerve palsy after surgical excision of acoustic neuroma. The phacoemulsification was performed in the small aperture by the push down technique, whereby the eyeball is manipulated by pushing down the phacoemulsification probe and the second instrument. The simple technique prevented an unnecessary additional surgical procedure and facilitated early rehabilitation.

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Ectopic cilia of the eyelid is a rare congenital anomaly. Here we report a case of a 22-year-old patient with an extra tuft of eyelashes with watering since birth. Excision of the tuft and histopathology revealed a “pilosebaceous unit with ectopic lacrimal gland.” Ectopic cilia are caused by the replacement of meibomian glands with skin glands. Associated lacrimal gland tissue is a choristoma. The typical site of occurrence of ectopic cilia is mostly in the junction of the medial two-third and lateral one-third of the eyelid. Proper preoperative planning with complete surgical excision provides gratifying cosmetic results with no recurrence.

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We report clinical features, culture-sensitivity profile and outcomes of infectious keratitis caused by Pseudomonas oryzihabitans. A 70 year-old male presented with acute pain, redness and diminution of vision in left eye since 6 days. Clinically, was diagnosed as infectious keratitis and microbiology revealed gram-negative bacilli. Culture showed Pseudomonas oryzihabitans growth. Initiation of appropriate antibiotics with steroids led to the resolution of keratitis. Pseudomonas oryzihabitans causes fulminant keratitis with rapid deep stromal involvement. However, timely intervention with appropriate topical anti-bacterials with steroids may lead to successful outcomes.

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A 38-year-old gentleman presented with bilateral ocular inflammation following fall of caterpillar hair. Examination revealed caterpillar hairs embedded in the palpebral conjunctiva, corneal abrasions, and anterior chamber reaction. The hairs were removed and topical antibiotics were initiated. Later, he presented with multiple scleral abscesses, retinal exudates, and sub-tenons fluid on B scan. The scleral abscesses were drained and treated with appropriate antibiotics and oral steroids. The abscesses and retinal exudates resolved with scleral thinning. This is the first report of ophthalmia nodosum presenting with scleral abscesses and panuveitis.

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A 47-year-old male reported a sudden diminution of vision in the left eye for 1 month. Fundus examination showed dense vitritis, retinal hemorrhages around the disc with subretinal precipitates. Peripheral examination revealed snowball opacities. Multimodal imaging indicated syphilitic retinitis with vascular leakage. A complete systemic workup was performed to support the diagnosis. Intramuscular benzathine penicillin injection along with oral corticosteroids showed an excellent response as confirmed by the multimodal imaging. Syphilitic retinitis with vasculitis is uncommon and can occur in immunocompetent patients. Multimodal imaging can be used to demonstrate the extent of involvement and to monitor treatment response.

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We report a rare case of cobalt toxicity resulting in a combined optic neuropathy and retinopathy. A 58-year-old woman with a recent revision of a hip implant presented with profound loss of vision. Although her initial exam was structurally unremarkable, she developed progressive outer retinal atrophy and optic nerve pallor. Abnormalities were also demonstrated in the full-field electroretinogram and optic nerve sheath on magnetic resonance imaging (MRI). Cobalt levels in the serum were severely elevated (734 μg/L) from the dysfunctional metal-on-metal (MoM) hip implant. Removal of the implant led to a rapid reduction in cobalt levels and stabilization of her declining vision.

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Ocular trauma is an important cause of unilateral vision loss worldwide. In cases of perforating corneal injuries, immediate surgical intervention is imperative to prevent endophthalmitis; however, in cases of partial-thickness corneal tears, conservative management usually suffices. However, intervention in the form of compression sutures may be required later for astigmatism that may arise.

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Reversal of glaucomatous cupping is rare in adults. A case of pseudo-reversal of total cupping in an elderly gentleman with pseudo-exfoliation glaucoma who underwent combined trabeculectomy with cataract surgery is reported. Early laser suture lysis to control high post-operative intra-ocular pressure (IOP) led to sudden lowering of IOP with subsequent optic disc edema, which manifested as reversal of cupping, albeit temporarily. Eight months later, the visual field was stable, but the macula had developed an epiretinal membrane, probably secondary to hypotony-associated inflammation, thus highlighting the importance of timing the suture lysis and aggressive control of intra-ocular inflammation.

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Domestic ocular injuries are mostly caused by sharp objects such as needles or fists, balls, firecrackers, and bursting bottles; pressure cooker explosions constitute a relatively rare but largely under-reported cause of ocular trauma. We report here a domestic cooker blast injury in a 57-year-old lady who had an impacted nozzle and auto-eviscerated eyeball at the presentation that lead to permanent blindness. A careful evaluation and meticulous removal of the impacted foreign body (cooker whistle) prevented further damage to the surrounding structures. Pressure cookers are one of the most common kitchen appliances that need to be used with care and caution. We recommend stringent testing of the final product and complete adherence to the safety instructions on part of the users.

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We present a case of a 28-year-old male who was diagnosed with bilateral tubercular multifocal choroiditis with intraretinal neovascularization adjacent to an area of choroiditis in the left eye. We present OCTA features of the neovascular complex before and after 4 months of treatment with anti-tubercular therapy and oral steroids. We speculate that the intraretinal neovascular complex noted in our case may be due to VEGF released by the underlying ischemic choroid.

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Thyroid eye disease (TED) refers to the ocular symptoms and signs caused by an autoimmune pathology affecting the thyroid gland and the orbit. It is most commonly seen in patients with Graves' disease and rarely with Hashimoto's thyroiditis (HT). Upper eyelid retraction is the most consistent eyelid sign. Blepharoptosis in TED has been reported sparsely and is mostly associated with myasthenia gravis. Here, we report a case of blepharoptosis as a presenting sign of HT in a young girl.

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A 64-year-old gentleman presented with decreased vision, raised intraocular pressure, and anterior chamber reaction of 1+ with grade 3 vitreous exudates on day 5 after intravitreal Ozurdex® implant. Microbiological culture showed no bacterial or fungal growth. On suspicion of viral endophthalmitis, the patient was started on topical prednisolone, moxifloxacin, atropine, dorzolamide, and timolol eye drops and oral valacyclovir 1 g twice a day for 10 days. On day 9, a vesicular eruption was noted on the left forehead, confirming the diagnosis of herpes zoster-related shingles infection. Complete resolution of inflammation was noted on day 30. This is the first case report highlighting the occurrence of ocular zoster infection after an intravitreal Ozurdex® implant.

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Torpedo maculopathy is a rare, typically singular, asymptomatic, unilateral torpedo-shaped lesion located in the temporal macula. The pathophysiology of these lesions is currently unknown but is thought to occur during embryogenesis. Even rarer are cases of torpedo maculopathy with two lesions in the affected eye, with only one prior case identified in the literature. The authors present a case of double torpedo maculopathy with accompanying optical coherence tomography, fundus photos, and fundus auto-fluorescence imaging over a 1.5-year follow-up period. Although our case further establishes the non-progressive nature of this phenotype, the exact pathophysiology warrants further investigation.

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A 20-year-old woman presented with central scotoma in her left eye. Whitish retinal spots were observed mainly in the region nasal to the optic disk outside the major vascular arcade. Optical coherence tomography revealed subfoveal outer retinal disruption with hyperreflective material. Retinal spots coalesced into a larger lesion and progressed peripherally. Nasal retinal spots and foveal outer retinal lesion improved spontaneously, and her vision was completely recovered. The current case suggests that sequential sublethal infection of photoreceptors possibly via blood-borne pathogens and spreading to the nearby cells may be the possible alternative mechanism of multiple evanescent white dot syndrome pathophysiology.

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Atypical fibroxanthoma (AFX) is a rare tumor arising from conjunctival stroma, which mimics other malignancies leading to inadvertent aggressive management. We hereby report a case of an elderly male patient with a well-circumscribed mass in superior bulbar conjunctiva of 6 months duration causing corneal scarring in his left eye. He underwent excision biopsy and was suspected to have spindle cell carcinoma based on histopathological features. Immunohistochemistry (IHC) ruled out the epithelial tumors and confirmed the diagnosis of AFX, which usually follows a benign course. Thus, this case emphasizes the importance of IHC as a diagnostic tool for ocular surface tumors.

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A female aged 42 years presented to us for routine eye examination and was found to have a well-circumscribed, firm, smooth, oval nodule at the limbus of the right eye. It had increased slowly to the present size in 7 years. It is unique in being the first and largest limbal schwannoma to be reported from India. The patient had no visual or cosmetic concern. Excision followed by histopathologic evaluation revealed its nature. Special staining (S100 and reticulin) revealed it to be of neurogenic origin. Schwannomas of ophthalmic interest include those arising from the orbit. Within the globe, they have been reported to arise from the uvea. Conjunctival schwannomas are extremely rare. Role of gene mutation as a causal factor has been studied when schwannoma occurs as a part of Carney complex. Association with multiple neurofibromatosis is also documented.

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Macular coloboma is a rare and distinct entity thought to be a consequence of a developmental abnormality or a resolved inflammation secondary to intrauterine or postnatal infection. Acquired macular scars are usually post-inflammatory scars secondary to chorioretinitis usually caused by toxoplasmosis, cytomegalovirus, and, rarely, ocular Toxocara infection. We report a unique case of seronegative bilateral macular coloboma with multifocal choroiditis in the right eye. To our knowledge, unilateral multifocal choroiditis has not been reported in association with bilateral macular coloboma in the literature.

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To report a patient with choroidal hemangioma (CH) presenting in the third trimester of pregnancy, with visual symptoms and subretinal fluid. A 42-year-old 30-week pregnant woman presented to the ocular oncology service, with new-onset visual deterioration in her right eye. Fundoscopy revealed an orange elevated choroidal lesion in the macular region, with overlying subretinal fluid. The working diagnosis was a CH and a decision was made to monitor the patient until after delivery. Post-partum, the patient reported improvement in symptoms, and on examination, spontaneous resolution of the subretinal fluid was noticed, demonstrated also on optical coherence tomography (OCT). CH is a potentially sight-threatening lesion that may exacerbate during pregnancy. A watchful waiting approach should be considered, as a spontaneous resolution of subretinal fluid may occur after delivery.

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Domestic henpecking can cause serious ocular injuries. Here, we report a case of penetrating orbito-cranial injury along with lid laceration and orbital fat prolapse in a two-year-old girl following henpeck injury. The eye ball was spared. Prolapsed fat was relocated and the wound was repaired successfully. Neurosurgery consultation was done and conservative management advised.

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Breast cancer (BC) is a heterogeneous disease, both molecularly and histologically. The most common histological subtype of BC is that of no special type, followed by lobular carcinoma. Metastatic tumors of the orbit are relatively infrequent, and their primary sites can be the prostate, the gastrointestinal tract, and for women, the breast. The diagnosis and management of such rare cases are very challenging due to the limited data. We present two interesting cases of women initially diagnosed with BC characterized by different histological features who developed periorbital metastases. Orbital radiotherapy was the treatment of choice, and the outcome was successful.

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A 45-year-old man presented with history of painless, slow-growing mass in the medial aspect of right lower eyelid over 2 years. On examination, the mass was noted to be firm, mobile, and nontender. On excision biopsy, histopathologic and immunohistochemistry report was consistent with low-grade non-Hodgkin's B-cell lymphoma. He was then treated with local radiotherapy. Using 6 MeV electrons, a dose of 24 Gy was delivered in 12 cycles over a period of 2 weeks to the right lower lid, with a centimeter bolus. Though non-Hodgkin's lymphoma of the ocular adnexa is rare, it should be considered in differential diagnosis, as they have the potential for rapid systemic involvement and may need treatment that is different from that of other common diseases at the same site.

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