Vernal keratoconjunctivitis is diagnosed mainly on the basis of typical signs and symptoms of allergic conjunctivitis such as conjunctival papillae, limbal gelatinous thickening, peri-limbal Horner–Trantas dots, and shield ulcers. Limbal hyperplasia can be a rare finding in such patients, which mimics an ocular surface neoplasm and is difficult to diagnose clinically unless a histopathological examination is done. We report a case of a young boy with a longstanding history of allergic conjunctivitis refractory to topical corticosteroids who presented with a giant isolated limbal conjunctival nodule and was successfully managed without any recurrence.

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Presentation of conjunctival tumors ranges from benign lesions like pinguecula and pterygium to highly malignant tumors of melanocytic, lymphoid, and stratified squamous epithelium origin. A 30-year-old female presented with two brown-colored conjunctival lesions in her left eye extending from medial canthus to limbus. Lesions were excised and subjected to histopathologic examination (HPE), which came out to be pigmented squamous cell papilloma, a rare conjunctival lesion having potential to convert to malignancy. Another 50-year-old female presented with pinguicula-like lesions in both her eyes along with maculopapular rash on her forehead. Conjunctival lesions were completely excised HPE, revealed Spiegler–Fendt sarcoid, also known as lymphocytoma cutis, along with conjunctival tumor of lymphocytic origin. Spiegler–Fendt sarcoid is usually a benign lesion with potential for systemic involvement requiring holistic approach for the management of such patients.

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Mucous membrane pemphigoid (MMP) is a subepithelial blistering disorder affecting multiple mucous membranes, with ocular involvement in 70% of cases. A 50-year-old man had complaints of gradual and painless diminution of vision associated with redness since three months and had been diagnosed and managed as corneal ulcer outside. The patient did not improve clinically and presented to us with the above complaints. On systemic evaluation, he was found to have multiple skin lesions along with oral and genital ulcers. Punch biopsy of the lesions was suggestive of MMP. The patient was started on topical antibiotics and steroids along with systemic steroids and azathioprine. After one-month follow-up, there was improvement in both the ocular and skin lesions. MMP is a common cause of chronic cicatrizing conjunctivitis. One must be vigilant to diagnose and treat MMP before it presents as a blinding complication.

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Ecthyma Gangrenosum (EG) is a cutaneous infection occurring mainly in immunocompromised patients with very rare ocular involvement. We report a rare case of an immunocompetent, 16 year old female with bilateral pseudomembranous conjunctivitis preceded by dermatological lesions. Timely intervention and appropriate treatment helped salvage globe in both eyes with improvement of vision in right eye. Only 2 cases have been reported till date of Ecthyma Gangrenosum with ocular involvement. In both the case reports, the globe could not be salvaged.

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Fusarium keratomycosis is a disastrous fungal infection of the eye, can affect healthy individuals, is cumbersome to treat, and has a poor prognosis. Herein, we present a case of a healthy 40-year-old female patient, who presented with chief complaints of pain, redness, and watering of the left eye since 15 days along with the diminution of vision. She had a history of trauma to the left eye by fingernails, followed by the development of symptoms. KOH wet preparation of corneal scrapings revealed fungal elements with the growth of culture on Sabouraud's dextrose agar confirming the etiological agent as Fusarium oxysporum. This case is reported for its rarity.

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Fibroepithelial polyp, one of the most common benign cutaneous lesions, was seen as a conjunctival mass, which, to the best of our knowledge, is the second ever reported case of fibroepithelial polyp involving conjunctiva, although it can have atypical presentation and has been reported at sites like ureteropelvic junction, genitals, bronchi, tonsils, and outer ear canal. The common benign and malignant conjunctival lesions are pterygium, pingecuela, pannus, pyogenic granuloma, limbal dermoid, papilloma, squamous cell carcinoma, lymphoma, Kaposi sarcoma, and malignant melanoma. Therefore, the possibility of fibroepithelial polyp affecting uncommon sites cannot be negated.

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This case demonstrates the utilization of a prosthetic type C contact lens to manage visual symptoms such as photophobia and glare in patients with cone-rod dystrophy. A 20-year-old female patient reported to our clinic with complaints of photophobia, glare, and impaired vision and was evaluated with different contact lens trials to improve her ability to use her remaining vision effectively. The patient was fitted with ACUVUE OASYS transitions, X-chrome red-tinted contact lenses, and tinted type C contact lenses. All the trials manifest optimal fitting and better comfort but only the tinted type C contact lens resulted in pronounced improvement in photophobia, glare, and vision both indoors and outdoors. Finally, a tinted type C contact lens is effective in relieving photophobia and glare and making a remarkable changeover in the quality of life. Thus, all contact lens practitioners should use these lenses to treat victims with glare and photophobia caused by cone-rod dystrophy.

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A 56-year-old male presented with diminished vision in his left eye since 6 months. Humphrey visual field examination showed monocular left eye temporal hemianopia extending onto inferonasal field. Right eye field was essentially normal. Computed tomography scan of brain and orbits showed enhancing sellar mass with extension into suprasellar area having solid and cystic components. This is a rare visual field presentation of a sellar mass.

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Herpes simplex virus (HSV) keratitis is a potentially blinding condition of the eyes. HSV can afflict any of the anatomical layers of the cornea, sometimes more than one layer at one time, and presents with a spectrum of clinical manifestations. Recalcitrant course, recurrences, and variable response to therapy can make managing these patients a true challenge, particularly in the pediatric age group and recipients of corneal transplants. Here, we report a series of five cases of HSV keratitis from our practice that presented with diagnostic and management dilemmas and were successfully managed with a combination of medical and surgical treatment.

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Myofascial pain syndrome associated with occipitofrontalis muscle most of the time undergo underdiagnosed after eye surgery, and the exact cause remain to be ascertained. The present study is a case report which indicates that it may be one of the reasons for eye pain and/or headache that is misinterpreted as glaucoma or increased intraocular pressure. A systematic study is warranted to avoid the use of medicine in similar cases.

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Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), although rare, is now recognized as a distinct demyelinating disorder. The entity differs from multiple sclerosis and neuromyelitis optica spectrum disorder in terms of clinical presentation, radiodiagnostic features, and prognosis. Here, we present a 5-year-old female who presented with bilateral, painless loss of vision since 3 days. There was optic nerve enhancement, but no brain parenchymal lesions. She tested negative for Aquaporin-4 antibodies, and CSF analysis showed no oligoclonal bands. Serum analysis revealed positivity for myelin oligodendrocyte antibodies. There was full visual recovery on treatment with systemic steroids. The report highlights the need for testing for MOG–IgG antibodies, especially in children with bilateral optic neuritis. It is essential to differentiate the entity from other demyelinating conditions. The prognosis is usually benign.

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Senile scleral plaques are common age-related degenerative changes quite often diagnosed on routine examination. We report a case of an elderly female, incidentally noted to have clinical findings suggestive of a senile scleral plaque. Anterior segment optical coherence tomography (AS-OCT) concurred with clinical findings. They are in general non-progressive or slowly progressive. Although the risk of progression is rare, considering the rare possibility of perforation, we recommend periodic review both clinically and with AS-OCT. Imaging may also be valuable in patients with senile scleral plaques undergoing scleral procedures and repeated intravitreal injections to understand the possible risks of perforation.

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A 25-year-old male presented with ciliary congestion, pigmented cells in the anterior chamber, and raised intraocular pressure (IOP) in both eyes (left > right) two weeks after photorefractive keratectomy (PRK). The patient was treated for acute anterior uveitis with topical steroids, moxifloxacin, cycloplegic, and antiglaucoma eye drops. Systemic workup was unremarkable except elevated IgG CMV levels. Despite treatment, inflammation increased and IOP became treatment-refractory (peaked to 50 mmHg), with florid pigment deposition on lens capsule, diffuse iris transillumination defects, and dilated distorted pupils. Suspecting bilateral acute iris transillumination (BAIT), topical moxifloxacin was withdrawn with gradual resolution of disease over four months.

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This case report describes a case of acute corneal hydrops (ACH) within 4 days following collagen cross-linking that was done to arrest the progression of keratoconus in a 15-year-old girl. She developed pain, redness, and watering in the left eye within 4 days of undergoing an uneventful bilateral corneal collagen cross-linking. The diagnosis of ACH was made and was managed medically with a course of topical steroids. A large fluid-filled stromal pocket with iris adhering to the posterior surface was observed that resolved with stromal scarring after the treatment. Thus, ACH may be precipitated by cross-linking and needs to be managed appropriately.

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A 72-year-old man presented with bilateral brunescent cataract with pseudoexfoliation syndrome and subtle phacodonesis. He underwent right eye phacoemulsification with a 5-mm continuous curvilinear capsulorrhexis and implantation of an acrylic hydrophilic intraocular lens (IOL) with a polymethyl methacrylate (PMMA) capsular tension ring (CTR). Six months postoperatively, anterior capsule fibrosis and complete closure of the capsulorhexis opening were noted. A neodymium: YAG (Nd: YAG) laser anterior capsulotomy was performed for visual recovery. The centripetal forces of capsular fibrosis after cataract surgery may exceed the centrifugal resistance of the standard CTR in patients with pseudoexfoliation. Such patients must be frequently monitored postoperatively. A Nd: YAG laser anterior capsulotomy is a safe and effective option to manage even thick membranous anterior capsular occlusion. This is a unique case report since anterior capsular fibrosis and complete occlusion despite CTR in situ are extremely rare (reported only once to the best of our knowledge).

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We report an easily missed diagnosis of the blood-stained cornea that can simulate crystalline lens in the anterior chamber (AC), especially when associated with low intraocular pressure (IOP), a rare occurrence. A 10-year-old boy presented with loss of vision in the left eye since 15 days following a cricket ball injury. Ocular examination revealed an amber-colored disciform appearance in the cornea and visual acuity of light perception. The eye was hypotonus. The patient underwent an ultrasound B-scan, which demonstrated an infero-posterior displacement of the lens. The empirical diagnosis of crystalline lens in AC was then revised and a rare association with low IOP was picked up.

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A 13-year-old girl presenting with mucopurulent conjunctivitis (left > right) was diagnosed with Behçet's disease. Intraoperatively, the left eye had 360° culture-negative marginal corneal ulcer with scleral necrosis, managed with a scleral patch graft. Postoperatively, the right eye also developed a peripheral corneal lesion that resolved with immunosuppressants along with the skin lesions. Subsequently, wound gaping and uveal prolapse were noted in the left eye and was managed with a lamellar corneal graft and later with a corneoscleral patch graft. Following this, the patient improved very well in terms of visual acuity. Peripheral ulcerative keratitis can be a clinical presentation in pediatric Behçet's disease despite the unusual occurrence. Hence, any pediatric case with peripheral ulcerative keratitis should be thoroughly investigated for Behçet's disease, for which immunosuppressants may prove to be beneficial.

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We report a case of a 52-year-old man with diminution of vision in both eyes at night for 15 days with mild retinal pigment epithelium changes at the macula and a tessellated background on fundus examination. Given his history of chronic alcohol consumption and jaundice two weeks back, vitamin A deficiency was contemplated. Electroretinogram (ERG) showed diminished responses. Serum retinol was 17 μg/dl. On supplementation with vitamin A, symptoms improved and ERG was normal; however, serum retinol levels were still low at 8.98 μg/dl. Thus, serum retinol does not necessarily indicate response to treatment, and ERG is necessitated in such cases.

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A 32-year-old man had undergone small incision lenticule extraction (SMILE) that was complicated by intraoperative epithelial detachment in the right eye. Corneal epithelial erosion reoccurred at two and four months after surgery. At the third time of epithelial erosion, slit-lamp examination revealed dense white infiltrates throughout the corneal cap-stromal interface. The patient was initially managed with high-dose topical antibiotics. After the negative culture and Gram staining results from the interface washout, diffuse lamellar keratitis was confirmed and topical steroids were administered. The inflammation resolved, and corneal transparency was achieved after treatment. Timely diagnosis and appropriate treatment are highly critical for prognosis.

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We report a case of scleritis following micropulse transscleral laser therapy (TLT) in an elderly female with medically uncontrolled primary open-angle glaucoma. She had completed antitubercular treatment (ATT) for pulmonary tuberculosis 20 years ago. Along with scleritis, there were vitritis and macular edema post laser. Systemic blood investigations for connective tissue disorders were negative. She had latent tuberculous infection with positive Mantoux test and quantiferon TB gold. She responded favorably to topical steroids with no vision loss. Though TLT, with its pulsed laser delivery, is considered safe, caution must be exercised in patients susceptible to inflammation.

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Recently, a new variation of transepithelial PRK, called TransPRK, was introduced, in which both the epithelium and stroma are removed in a single step, in one ablation profile. In this report, we present a case of a 31-year-old male patient who was prepared for laser-assisted in-situ keratomileusis (LASIK) surgery but switched to TransPRK combined with mitomycin C (MMC) application following intraoperative flap complication in one eye. As a result of the timely and on-site intervention, no haze was seen. TransPRK may be considered as an alternative with the advantages of reduced risk of postoperative pain and haze formation in intraoperative incomplete flap formation.

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Neurosensory retinal detachment (NSD) is a component of diabetic retinopathy. It is associated with other features like diffuse retinal thickening and cystoid macular edema (CME). The present report describes imaging features and the outcome of disproportionately large NSD in the left eye of a 61-year-old lady having proliferative diabetic retinopathy. The NSD was accompanied by minimal intraretinal edema and a choroidal filling defect on fluorescein angiography. There was near complete resolution of NSD with intravitreal ranibizumab. Disproportionately large NSD with minimal intraretinal cystic changes may be considered as a sign of diabetic choroidopathy.

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Traumatic subconjunctival dislocation of the lens (phacocele or lenticele) is of relatively rare occurrence. We report an unusual case of subconjunctival dislocation of the cataractous lens following blunt ocular trauma by cow horn in an elderly patient without having any previous ocular surgery or trauma. Blunt trauma resulted in indirect scleral rupture with subsequent dislocation of the crystalline lens in the subconjunctival space. The pathophysiological mechanism, clinical presentation, and management are discussed in this case report.

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Ectopic eyelid, an extremely rare entity, is a congenital disturbance in embryogenesis in which lid tissue is present in an abnormal position near the eyelid. We herein report a case of a six-year-old child with a soft mass near the lateral canthus of the left eye having cilia overlying it, with a similar family history in her father. A surgical excision biopsy was performed under general anesthesia. A histopathology report revealed stratified squamous epithelium with numerous dermal pilous units consisting of a central hair shaft and clusters of Moll's glands, suggesting eyelid tissue. Therefore, an ectopic eyelid tissue can be considered a differential diagnosis for any congenital, non-progressive, soft tissue mass near the eyelid with overlying cilia. However, histopathology is required to confirm the diagnosis.

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The cherry-red spot in typical central retinal artery occlusion occurs because of the reddish color of the vascular choroid and retinal pigment epithelium seen through the foveola while the adjacent inner retina is opacified. We report a case of a bilateral pseudo-cherry-red spot in association with conjunctival telangiectasia and corneal posterior stromal clouding.

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A 48-year-old female underwent a Tenon's patch graft for a perforated ulcer done during coronavirus disease 2019 (COVID-19) times. Five months later, the patient presented to us with Tenon's graft melt due to the infection of the graft and the corneal stroma with Curvularia. The patient was successfully treated with appropriate topical, commonly used antifungal therapy with a good outcome. To our knowledge, this is the first documentation of case describing the predisposing factors, clinical features, and the management of autologous Tenon's graft infection with Curvularia fungus, a rare occurrence in literature.

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Corneal endotheliitis and ocular surface neoplasia are known to be associated with altered immune status especially in the elderly. We reviewed an interesting case where endotheliitis occurred for the first time while on topical chemotherapy for ocular surface neoplasia in a patient with glaucoma. We have addressed the practical concerns in decision-making given multiple ocular comorbidities and highlighted a successful outcome with no recurrence of both the tumor and the endotheliitis for over 16 months.

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A middle-aged female with previous history of being treated as herpes keratitis, presented with a central deep stromal ulceration and overlying neurotrophic epithelium. On re-scraping, the culture grew Pseudomonas aeruginosa and Aspergillus flavus. Due to the aggressive nature of the organisms, during follow up, a central perforation was noted, for which emergency therapeutic keratoplasty was done and post-operatively medicated with topical eye drops as per culture and sensitivity. Hence, we are presenting this rare case report of Pseudomonas aeruginosa in a non-contact lens user, along with a co-infection of Aspergillus flavus in a previously compromised cornea with herpetic keratitis.

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We report a case of 50 year old female patient who underwent vitreo-retina surgery in left eye for retinal detachment and presented with branch retinal artery occlusion (BRAO) one month post surgery. Surgical procedures included scleral buckling, pars plana vitrectomy and silicon oil injection. Her best corrected visual acuity (BCVA) was 1/60 and intraocular pressure was 46 mm of Hg. Partial SOR was done which resulted in reperfusion and improvement in visual acuity. Early intervention is the key in managing such complications.

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Ophthalmomyiasis is infestation of the eye by fly larva which leads to variable clinical presentations depending on the scale of penetration, species of the fly, and the involved ocular framework. A case of accidental external ophthalmomyiasis, who presented with symptoms mimicking of an acute catarrhal conjunctivitis, is being reported, which was managed with prompt mechanical removal of the larva under topical anesthesia along with supportive treatment. The patient had rapid recovery in the follow up with subsequent microbiological taxonomic identification of the retrieved larvae as of Musca domestica (housefly).

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To report a case series on the management of eight patients with complex orbitopalpebral neurofibromatosis that is inadequately addressed in the literature. All patients were managed surgically with full-thickness, transverse, or transverse-oblique resection of the upper eyelid neurofibroma along with canthopexies and ptosis correction. Presenting signs and symptoms include eyelid swelling, ptosis, canthal dystopia, and decreased visual acuity. These challenging cases were treated with a tailored surgical approach which provided functional and esthetic benefit that improved patient's social interaction and confidence.

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Wolfram Syndrome (WS) is a rare autosomal recessive progressive neurodegenerative disorder characterized by juvenile-onset diabetes mellitus (DM) and optic atrophy (OA), known as DIDMOAD (diabetes insipidus [DI], diabetes mellitus, optic atrophy, deafness). Patients present with DM and OA in the first decade, DI and sensorineural deafness in the second decade, urinary tract anomalies, and neurological manifestations later in life. We report two cases with late diagnosed WS in an asymptomatic young child and an adolescent with DI, DM, OA, and deafness to raise awareness regarding the identification of individuals with WS and provide them with immediate treatment and appropriate care.

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Phthiriasis palpebrarum is a rare cause of blepharitis in which Pthirus pubis infests the eyelashes. We report a case of bilateral Phthiriasis palpebrarum with crab louse. A 48-year-old woman presented with severe itching in both eyes for 4 days. Careful slit-lamp examination revealed multiple motile lice and nits in the eyelashes of both eyes with mild conjunctival hyperemia. Treatment was started by manually removing all the adult lice and eyelashes where nits were seen adhering and by the application of petrolatum jelly. After 2 weeks, she was symptomatically better with no louse or nit on her eyelashes on ocular examination.

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A 33-year-old male presented with progressive diminution of vision in his right eye for the past ten years following an alkali injury. Examination revealed diffuse, central, advanced, secondary lipid keratopathy (LK) with best-corrected visual acuity (BCVA) of counting fingers-one meter (CF-1 m). Anterior segment optical coherence tomography (AS-OCT) revealed a thin and scarred cornea. Due to the advanced stage of the condition, a manual deep anterior lamellar keratoplasty (DALK) with argon laser photocoagulation (ALPC) to feeder vessels (500 m, 200 ms, 300 mv) combined with intraoperative needle thermal cautery was performed. A reasonably clear cornea with a good visual outcome with complete surface epithelization was achieved postoperatively and documented on AS-OCT at follow-up.

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Here, we report a rare case of a 47-year-old man presenting with idiopathic retinal vasculitis, aneurysm, and neuroretinitis (IRVAN) syndrome combined with primary open-angle glaucoma (POAG). He was treated with retinal photocoagulation combined with intraocular pressure (IOP)-lowering therapy. At the 1-year follow-up, the patient's vision had not decreased and the IOP was well controlled. The abnormality of this case is the nonperfusion of macular deep capillary. Many studies support that POAG has no effects on the ischemia of deep capillary plexus. This case suggests that ischemia in the deep capillary plexus should be considered in IRVAN syndrome.

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We report an interesting corneal finding of sectoral, tongue-shaped posterior corneal stromal debris with adjacent episcleral inflammation in one case and scleral inflammation in the other case. With appropriate antibiotic treatment, the stromal debris consolidated, organized, and resulted in posterior corneal stromal scarring. The etiology was Pseudomonas scleritis in the first case and Mycobacterium tuberculosis–associated episcleritis in the second case. This case report highlights an atypical corneal finding and its clinical course. The need to rule out infections as a cause in such presentations, especially in the developing world, is emphasized through this report.

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This report aims to describe the histopathological changes in the cornea following Tenon's patch graft. A 51-year-old male underwent Tenon's patch graft (TPG) for corneal perforation following Therapeutic penetrating keratoplasty which was performed twice for non-resolving microbial keratitis and graft infiltrate, respectively. The infection resolved following TPG resulting in formation of a vascularised scar. An Optical penetrating keratoplasty was performed six months after the TPG. Postoperative period was uneventful. Histo-pathological evaluation of the excised corneal tissue revealed excellent integration of the tenon tissue with the surrounding corneal stromal collagen. Histo-pathological evidence suggests that, tenon's tissue integrates well with surrounding corneal stromal collagen and is probably capable of regenerating new collagen and thus aid in corneal wound healing

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A 39-year-old male presented with painless diminution of vision in the right eye for 10 days, which was associated with drooping of the upper lid for 4 days. Vision was perception of light with 4 mm ptosis and mild proptosis and 3.5 mm pupil with grade 1 relative afferent pupillary defect (RAPD). Extraocular movements showed abduction and elevation limitation of -2, adduction and depression limitation of -1 in the right eye. Magnetic resonance imaging (MRI) showed right posterior ethmoidal mucocele causing optic nerve compression. Marsupialization of mucocele and optic nerve decompression were done. Post-surgery, vision, ptosis, and extraocular movements improved and pupil remained the same owing to the mechanical effect of the mucocele. Early identification and intervention of posterior ethmoidal mucocele is crucial in preventing visual compromise.

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Ocular motor mono-neuropathies frequently occur from micro-vascular ischemia to the nerve in the presence of atherosclerotic risk factors such as old age, diabetes mellitus, hypertension, and dyslipidemia. Other possible causes include trauma, intra-cranial neoplasm, aneurysm, inflammation, infection, and brainstem infarction. Recently, hyper-homocysteinemia has emerged as an independent risk factor for systemic and ocular vaso-occlusive disorders. Ocular pathologies such as retinal vascular occlusion and non-arteritic anterior ischemic optic neuropathy have been found to be associated with mild hyper-homocysteinemia. This case series describes four patients with isolated third and sixth cranial nerve palsy where hyper-homosysteinemia was the only risk factor.

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Keratomycoses are destructive, difficult-to-treat eye infections. A plant mold, Neoscytalidium dimidiatum, is an extremely rare cause of keratitis in humans. Direct microscopic examination and culture are essential for an early specific diagnosis and must be taken into consideration to establish the most effective treatment and avoid severe complications. Herein, we present a case of the first successfully treated case of N. dimidiatum keratitis in western India. Through this report, we wish to increase the awareness of this fungal species as a potential cause of keratitis and to provide the clinical, morphological, and microbiological features that might help in its treatment.

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A 30-year-old female presented with diminution of vision in the right eye for 2 months. She was a known case of macular corneal dystrophy and had undergone OD deep anterior lamellar keratoplasty 2 years back. The best corrected visual acuity (BCVA) was 6/18 at 6 months. At presentation, the BCVA was 4/60 and 6/60 in OD and OS, respectively. The graft was clear with no interface haze. An area of graft ectasia with thinning at the inferotemporal (7–9'o clock) graft–host junction was noted clinically and on tomography. Rigid gas permeable contact lenses showed a BCVA of 6/9 and were advised.

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A case of a 40-year-old female diagnosed with young onset Parkinson's disease with bilateral normal central fundus and normal subfoveal choroidal thickness associated with bilateral multiple peripheral pigment epithelial detachments and peripheral pachychoroid features in enhanced depth imaging-optical coherence tomography (EDI-OCT).

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A 33-year-old Asian man presented with redness, swelling, and blurring of vision in both eyes for 1 month associated with headache and pain. The patient had a history of allergic rhinitis with a progressive hearing loss for 3 months, followed by bell's palsy. Given his elevated serum cytoplasmic anti-neutrophil cytoplasmic antibody (C-ANCA) and erythrocyte sedimentation rate (ESR) levels as well as computed tomography head, orbit, and peripheral nervous system that showed marked bilateral mastoiditis with opacification of the right middle ear canal and enlargement of the bilateral lacrimal gland, the suspicion of small vessel vasculitis with ocular and ear involvement was high. Because there was no significant lung or kidney involvement, a conjunctival biopsy was attempted, which revealed small capillaries surrounded by eosinophils and plasma cells. Because there are no validated diagnostic tests for eosinophilic granulomatosis with polyangiitis (EGPA), a conjunctival biopsy can be valuable and minimally invasive in the early diagnosis and treatment of small vessel vasculitis.

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A girl was referred to our clinic for alternating esotropia. The angle of deviation was measured at +45 prism diopters (Δ). The esotropia gradually turned to exotropia over the last 9 years (about −15Δ). Fundoscopy revealed crystalline retinopathy and in combination with the additional clinical findings of ichthyosis, spastic diplegia, and genetic testing, the diagnosis of Sjögren–Larsson syndrome (SLS) was made. The esotropia in this case, which gradually turned to exotropia without any intervention, may reflect the change in the muscle tone and the neurological damage in SLS. Thus, early strabismus surgery should be avoided to prevent its unpredictable outcomes.

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A novel entity of optic nerve retraction following blunt trauma in a young boy is reported. Rotational injury of the globe following a fall from a bicycle resulted in optic nerve retraction within the scleral canal. On fundus examination, the scleral rim was visible, with peripapillary and vitreous hemorrhage and associated retinal detachment. Computed tomography of the orbit on axial section revealed an intact optic nerve at the posterior surface of the sclera.

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Leukemic infiltration of the optic nerve is considered as a neuro-ophthalmic emergency and may be indicative of systemic and/or central nervous system relapse of the disease. These patients have hyperleukocytosis characterized by increased viscosity of blood causing leukostatic retinopathy and retinal vascular occlusions. In this case report, we describe a young male with simultaneous infiltrative and leukostatic manifestations in the posterior segment of the eye, which was the initial sign of relapse of leukemia. The case highlights the importance of meticulous and early eye examinations in patients with hematological malignancies, as it may impact the long-term survival of the patient.

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A 24-year-old male with slowly progressing vision loss over six months came to our hospital. On clinical evaluation, his unaided visual acuity was 3/60, which improved to 6/60 with spherocylindrical correction. His lenticular status and posterior segment were within normal limits. On Pentacam evaluation, there was gross evidence of keratoconus. Over the next two months, his Pentacam scan showed a progressive increase in keratoconic parameters. Hence, he was scheduled for topography-guided photorefractive keratectomy (PRK) with full-threshold collagen cross-linking (CXL). After PRK with CXL, the inferior cone was obliterated, providing a stable corneal surface. His unaided visual acuity at three and six months was 6/12 and 6/9p, respectively. His visual acuity remained at 6/9p at the end of 2 years.

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Treatment of persistent macular holes is a challenge. Various techniques have been devised to reduce the surgical failure rate. We present a case of persistent macular hole treated with human amniotic membrane (hAM). We performed primary 23 Gauge pars plana vitrectomy surgery with internal limiting membrane peeling and perfluoropropane (C3F8) gas. Two weeks postoperatively, spectral domain optical coherence tomography (SDOCT) showed an open macular hole. A secondary surgery using hAM plug as scaffold and C3F8 gas was performed. Three weeks postoperative follow-up SDOCT showed anatomical closure of the macular hole. This suggests that hAM can be an effective substrate for persistent macular holes.

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Perioperative vision loss (POVL) is unilateral or bilateral, partial or complete loss of vision occurring in patients undergoing non-ophthalmic surgical procedures. They are commonly known to occur following cardiac, spine, and other orthopedic surgeries. The exact mechanism is not known and a variety of systemic and intraoperative risk factors including patient positioning, fluid loss, and use of vasopressors are implicated. The most common cause of POVL are ischemic optic neuropathies which occur due to disturbance in blood flow to the optic nerve. In this case report, we describe a case of perioperative ischemic optic neuropathy occurring following inner ear surgery and its management.

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Mucormycosis is an uncommon, rapidly progressive, angioinvasive fungal infection characterized by large areas of tissue necrosis. We report a case of a 25-year-old primigravida of gestational age 25 weeks with clinically and radiologically proven COVID-19-related rhino-orbito-cerebral mucormycosis (ROCM) stage 3c with gestational diabetes. She was treated with injection liposomal amphotericin B, but her condition rapidly progressed with impending intracranial extension. She was subjected to total exenteration of the left eye with extensive endoscopic sinus surgery and continued on systemic antifungals along with supportive therapy for four weeks after surgery.

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A 73-year-old woman presented with vertical diplopia which was diagnosed as a trigeminal nerve sheath tumor. This case was unusual because the principal symptom was a vertical diplopia due to involvement of the trochlear nerve. Trigeminal function was preserved on initial presentation. The patient was advised neuroimaging along with baseline blood investigations. On subsequent follow-ups she developed trigeminal symptoms in the form of tingling and numbness along her left cheek and below her left eye. Eventually, radiodiagnosis showed a dumbbell-shaped necrotic lesion originating from the trigeminal nerve sheath suggestive of a schwannoma. The case was then referred to a neurosurgeon for appropriate management.

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Intermittent exotropia (IXT) usually presents with occasional outward deviation of the eye, asthenopia, headache, diplopia, or photophobia. We report here an unusual presentation of IXT in a 21-year-old man, with an anomalous head posture (AHP) of face rotation towards left as the primary symptom. On examination, there was lateral gaze incomitance, and improved fusion range in dextroversion explained his AHP.

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Tolosa–Hunt syndrome (THS) is a rare, idiopathic, inflammatory process of the cavernous sinus and remains a diagnosis of exclusion. It is characterized by unilateral orbital pain and is often associated with diplopia due to the involvement of one or more oculomotor nerves. Involvement of the cranial nerve V, cranial nerve VII, or the ipsilateral sympathetic pupillary pathway, has also been described. Bilateral cranial nerve involvement is very infrequent. Herein, we are presenting a case of unilateral THS with bilateral cavernous sinus involvement.

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Central nervous system (CNS) tuberculoma can have variable presentations depending on the site and number of tuberculomas. We report a rare case of a 48-year-old male presenting with ptosis and binocular double vision. Clinical examination revealed bilateral third-nerve palsy and fourth-nerve palsy with nystagmus. Magnetic resonance imaging (MRI) of the brain revealed ring-enhancing lesion in the dorsal midbrain, suggestive of tuberculoma. Radiological search for tuberculous foci in other internal organs proved pulmonary tuberculosis. Mantoux was positive, confirming the exposure to tuberculous bacilli. He was started on low-dose steroids along with antitubercular therapy (ATT). There was no improvement after continuing ATT for one-and-a-half years. Thus, the prognosis of CNS tuberculoma is related to the timing of initiating appropriate therapy. Delays in diagnosis and treatment will result in poor prognoses and severe neurological sequelae.

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Intraorbital foreign bodies should be thoroughly looked for and removed judiciously and timely in order to avoid sight-threatening complications. In this series of cases, three patients presented with various types of intraorbital foreign bodies secondary to trauma or iatrogenic causes. After confirmation of diagnosis using appropriate radiological investigations, the foreign bodies were retrieved with the help of suitable surgical techniques. Timely intervention prevented infection and other inflammatory processes such as siderosis and other serious complications like airway obstruction and chemical injury. Meticulous examination supported by radiological investigations is the mainstay of management in cases of orbital trauma.

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Orbital metastases from breast carcinoma presenting as enophthalmos are a rare occurrence and must be carefully investigated to stage the disease and initiate management, which can be lifesaving in such patients. We report our experience in diagnosing and managing a case of enophthalmos that, on histopathology, revealed orbital metastases from lobular breast carcinoma.

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A five-month-old child presented with complaints of watering from the left eye associated with swelling in the left lacrimal sac area, which was progressive. The swelling was noticed at 3 months of age by the parents. On examination, the swelling was tense and cystic in consistency. A provisional diagnosis of amniocele was made. A diagnostic/therapeutic probing was planned. However intraoperatively while probing was attempted, we encountered a hard stop distal to the canaliculus. Hence, after additional consent, the swelling was explored by an external dacryocystorhinostomy (DCR) incision. It was a solid and well-defined mass, which was found in the lacrimal sac region. The mass was excised in-toto and sent for a histopathology examination. A bicanalicular silicone intubation tube was passed and distally retrieved via the nasolacrimal duct (NLD) opening through the inferior meatus of the nose to maintain lacrimal outflow patency. The histopathological examination (HPE) features were suggestive of embryonal rhabdomyosarcoma (RMS). The child was then referred to a medical oncologist for systemic evaluation and adjuvant chemotherapy. The child underwent six cycles of chemotherapy and was followed up monthly for a period of 12 months.

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Colorectal carcinoma being one of the most common gastrointestinal carcinomas in humans has few metastatic sites. An unusual presentation of eyelid metastasis in a patient with rectal adenocarcinoma has been discussed in this case report. The patient presented with eyelid secondaries with no other secondaries elsewhere in the body.

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