Aims: To evaluate the effect of myopia on peri-papillary retinal nerve fiber layer (RNFL) thickness in various quadrants and clock hour positions. Also, to evaluate the effect of myopia on the location of superotemporal and inferotemporal peak positions of peri-papillary RNFL. Setting and Design: Observational cross-sectional study from November 2011 to March 2013. Myopic patients between age group of 20-30 years were evaluated by spectral domain optical coherence tomography (SD-OCT). Materials and Methods: Myopic eyes were classified into three groups based on refractive error - Group 1: myopia up to 3 D (Diopter, D), Group 2: myopia of 3-6 D, and Group 3: Myopia > 6 D. OCT scan was done to measure peri-papillary RNFL and to locate superotemporal and inferotemporal peak positions. Statistical Analysis Used: Data was analyzed using one way ANOVA and post hoc analysis using Tukey's test. Results and Conclusion: A total of 118 myopic eyes were evaluated. Eyes in Group 3 show significant thinning in 360 degree average RNFL thickness and in all quadrants except temporal as compared to Group 1 and 2. Correspondingly, in eyes with myopia > 6 D (as compared to Group 1 and 2), decrease in RNFL thickness is seen in all clock hour positions except 4, 8, 9, and 10. Also, in high myopia (>6 D), there is a significant shift in inferotemporal RNFL peak to temporal side while no significant change is noticed in superotemporal RNFL peak when compared to Groups 1 and 2. No significant difference was noted between Groups 1 and 2 in RNFL thickness profile and RNFL peak positions. While analyzing RNFL thickness in subjects with highly myopic eyes, this difference in topographic profile of RNFL thickness should be taken into consideration.

Aims: To study the prevalence of pseudoexfoliation syndrome (PEX) in patients scheduled for cataract surgery in eye camps in Kashmir. Materials and Methods: This was a prospective study conducted by the Mobile Ophthalmic Unit holding eye camps in rural areas of Kashmir from December 2010 to July 2011. Total of 1117 patients from 11 areas with age-related cataract scheduled for surgery underwent complete clinical examination. The PEX was diagnosed by the presence of gray flakes on the anterior lens capsule or at the pupillary margin or both. A Chi square test was used for statistical analysis. Results: The prevalence of PEX was 26.32%. The prevalence from the different areas varied from 4 to 36.36%. Males comprised 64.62% of the patients with PEX ranging in age from 49 years to 89 years. Increasing age was associated with increase in prevalence of PEX (P value < 0.001). Prevalence of PEX was higher in patients involved with outdoor activities (P value < 0.001). Most common type of cataract seen in patients with PEX was nuclear sclerosis. Patients with PEX had visual acuity (VA) significantly lower than patients without PEX (P value = 0.0013). Conclusion: The prevalence of PEX in Kashmir is relatively high. This is important from the perspective of mobile eye camps considering the increased frequency of cataract and the surgical complications associated with PEX, and thus the surgery mandates a thorough preoperative clinical examination to ensure good surgical outcome.

Aim: To determine the pattern of ocular injuries presenting to the accident and emergency department of a large zonal level hospital in a non operational area. Material and Methods: This retrospective study was conducted from July 2009 to June 2012 in a large, 580 bedded, zonal level military hospital. This hospital caters to serving soldiers, ex-servicemen, and their dependants as well as several large premier military training establishments. It is by far the largest service hospital in its state, and its eye center is the only military eye care facility available for the above-mentioned group of patients. Ocular trauma in our study was defined as any eye injury requiring medical attention. Results: Of the 177 patients included in the study, 153 (86.4%) sustained a closed globe injury while 24 (13.6%) had open globe injuries. One hundred and forty-eight (83.6%) of them presented within 24 hours of injury. One hundred and fifty-one (85.3%) patients required hospital admission. Finally, none of the patients involved were wearing any kind of protective eyewear at the time of injury. Conclusion: This study is unique for the fact that it involves both the military personnel as well as civilians and its analysis provides an insight into the pattern of ocular trauma in our set up. To the best of our knowledge, this is the only study which has been done combining both these entities. The findings indicate that ocular trauma is a significant cause of visual morbidity in this segment of population.

We attempt to describe the determinants and outcome of severe soft tissue infections affecting the eye (peri-orbital necrotizing fasciitis or PNF), a rare entity caused by toxin-producing, virulent bacteria. Our series of six adult cases of PNF included patients with and without co-morbidities. Minor trauma and adjacent focus of infection preceded the development of PNF in four cases. No source of infection could be identified in two patients. Patients with no apparent co-morbidities recovered rapidly with aggressive antibiotic therapy and surgical debridement. However, all the patients who had associated co-morbidities showed a protracted course, two of them with complications. Surprisingly, in majority (5 out of 6), culture grew group A beta-hemolytic streptococcus. Thus, our case series points to the importance of early detection and aggressive treatment of associated co-morbid conditions to avoid complications of this life-threatening, yet treatable disease.

Ectopic cilia is a very rare congenital anomaly. The authors present two cases of posterior ectopic cilia and review the literature. In both cases, the ectopic cilia presented as dark lesions under tarsal conjunctiva. The cilia were present in two tufts in curved manner, adherent to each other without protruding from the conjunctiva and embedded deeply in the posterior tarsal plate. This presentation is considerably different from previously reported cases of posterior variety and represents a distinct clinical entity of ectopic cilia.

A 52-year-old male presented with gradually progressive painless diminution of vision in both eyes since two years. There was no history of trauma, and family history was non-contributory. Ocular examination revealed a vision of 6/60 in both eyes improving to 6/36 with pinhole and bilateral colobomata of the crystalline lens along with nuclear cataract in both eyes. The edges of the colobomata were irregular and notched. The fundus examination was normal. A lens extraction was done by a temporal section small incision cataract surgery and an iris claw lens implanted after an automated vitrectomy. The post-operative vision was 6/18 improving to 6/6 in both eyes.

Posterior lenticonus is a rare progressive disease characterized by protrusion of posterior lens capsule along with lens cortex into the vitreous cavity. Posterior lenticonus is more common but present unilaterally unlike anterior lenticonus, which presents bilaterally. Posterior lenticonus is a common cause of unilateral infantile cataract but is a very rare cause of bilateral cataract. Diagnosis is mainly clinical but can be difficult in asymptomatic patients; oil drop sign (in mild posterior lenticonus) and fish tail sign (lenticular cortex hanging in vitreous cavity after posterior capsular dehiscence) are described in posterior lenticonus. We are proposing an atoll sign in advanced case of posterior lenticonus with intact posterior capsule on slit lamp examination. The positive atoll sign will have more favorable prognosis since posterior capsule is intact, hence posterior chamber intraocular lens implantation will be more feasible with better visual prognosis as was the case with our patient.

Orbital metastasis of osteosarcoma is rare with only few cases reported in literature. We report an unusual case of an eight-year-old female child who sustained injury to the left eye. Following injury, parents noticed swelling of the left eye. Computed tomographic (CT) scans showed a soft-tissue mass lesion involving the left frontal region and a biconvex extraconal high-density mass-lesion located in upper part of the left orbit pushing the eyeball downward. Also, a biconvex hyperdense intracranial lesion was noticed in left frontal region. Based on clinical and imaging findings, a left frontal extradural and orbital hematoma was suspected. At surgery, there was a highly vascular, firm tumor mass adherent to frontal bone extending into the orbit. There was erosion of and destruction of fronto-zygomatic bone. Histopathological examination of the tumor confirmed the diagnosis of osteosarcoma. In spite of radiotherapy, chemotherapy, and surgery, adequate local or regional control is not possible and the prognosis of osteosarcoma involving skull is poor and the treatment can only partially relieve the symptoms, but cannot eradicate the tumor.

Chronic dacryocystitis occurs usually due to obstruction of lacrimal passage at the junction of the lacrimal sac and the nasolacrimal duct or within the bony nasolacrimal duct. Reconstruction of the lacrimal passages in such cases can be achieved by several surgical techniques, although external dacryocystorhinostomy (DCR), proposed by Ohm and by Dupuy-Dutemps and Bourguet in 1921, is still the most successful operation. Despite ease and decreased morbidity of endonasal DCR, external DCR is procedure of choice as it is more successful. Several ophthalmologists fear performing DCR because of bleeding and unfamiliarity of structure. This article tries to provide few tips to make DCR easy and stress-free. Proper case selection, pre-operative workup and adequate exposure go a long way in making DCR stress-free and successful. Excessive bleeding, a common hindrance in DCR surgery can be successfully tackled by proper positioning of patient, use of adrenaline, suction, and adjustment of nasal pack.