Rajendra Prakash Maurya

Rhino-orbital mucormycosis is a rare life threatening invasive fungal infection that has recently shown a very high mortality rate in India during COVID-19 pandemic. We have designed the present study to find out associations between COVID-19 induced rhino-orbital mucormycosis and concentrations of inflammatory markers, i.e. D-dimer, Ferritin, IL-6, CRP and PCT, in blood serum of Indian population.There were four groups in the study, viz. control group with healthy subjects, treatment group-1 with patients suffering from SARS-COV-2 infection, treatment group-2 with patients suffering from both SARS-COV-2 infection and rhino-orbital mucormycosis, and treatment group-3 with patients suffering from rhino-orbital mucormycosis after SARS-COV-2 infection recovery. Inflammatory markers were quantified with standard protocols, and recorded data were subjected to statistical analyses.We found that patients suffering from SARS-COV-2 infection were more susceptible to rhino-orbital mucormycosis, as they had higher concentrations of inflammatory markers in their blood than the other subjects. Diabetes mellitus, hypertension, cardiovascular diseases and renal disorders were the associated comorbidities with the patients. We also found higher concentrations of inflammatory markers in males than the females, indicating towards their higher susceptibility in developing rhino-orbital mucormycosis than females. Present study therefore suggests that the frequent occurrence of rhino-orbital mucormycosis in India during second wave of COVID-19 was possibly due to indiscriminate use of corticosteroids by COVID-19 patients. Subjects with previous history of comorbidities like diabetes mellitus, hypertension, cardiovascular disorders and renal diseases are the most susceptible population groups for developing infection. Moreover, males are at higher risk of developing mucormycosis than the females.   Keywords: Fungal infection, SARS- Cov -2, Mucormycosis, Inflammatory markers.

Pterygium is an ocular surface disorder associated with fibrovascular growth and elastotic degeneration of the collagen in conjunctiva and cornea. It has high incidence in tropical countries like India especially in males because of abundance of UV light exposure. It does not hamper vision until in later stages when visual axis is involved. But the burden of disease has increased due to recurrence rates post surgery which is considered to be mainstay of pterygium treatments. Recently there have been advances regarding understanding of pathophysiology and management of pterygium. This article aims to review the recent developments in pathophysiology including genetics, various treatment modalities available beside surgery e.g. adjunctive therapies and management of recurrence pterygium.   Keywords: Pterygium, Recurrence, Adjuvant therapy, Pathophysiology, Conjunctival auto graft, Mitomycin C

The hormone melatonin plays a role in our natural sleep-wake cycle. Natural levels of melatonin in the blood are highest at night. Aqueous flow has a distinctive circadian rhythm, being lower at night than during the day. IOP fluctuates in a rhythmical diurnal pattern and this fluctuation is greater in eyes with glaucoma. Sleep apnoea is a type of sleep disorder breathing that causes intermittent pauses in breathing during sleep, leading to transient nocturnal hypoxia and hypercapnia. Obstructive sleep apnoea (OSA) is one of the systemic risk factors for glaucoma which causes irreversible visual field (VF) damage.   Keywords: Melatonin, Glaucoma, Intraocular pressure, Obstructive sleep apnoea (OSA), Visual field defect.

Intraorbital foreign bodies can be metallic, non metallic and organic in their composition. Organic foreign bodies especially wooden, can act as a nidus of infection if left in situ. The diagnosis of a wooden foreign body is quite difficult radiologically because of their radiolucent nature so, they require high degree of suspicion. We report this case of a patient who presented with non healing persistent discharging sinus from left eye lateral part of the upper lid just above the eye lid margin following trivial trauma 6 months back. Based on the clinical evaluation and radiological evidence we made a diagnosis of retained wooden intraorbital foreign body. LE orbit surgical exploration and removal of wooden foreign body was done and the patient responded well postoperatively.   Keywords: Intraorbital foreign bodies

Ocular surface squamous neoplasia (OSSN) is a diverse range of neoplasm arising from squamous epithelium of conjunctiva, limbus and cornea. OSSN is considered as a low grade malignancy but may be locally invasive and require exenteration. It has relatively high recurrence rate. It has multifactorial etiology and specific pathogenesis of lesion has yet to be attributed. Histopathology with immunohistochemistry is a gold standard diagnostic tool.This mini review highlights the pathogenesis, risk factors, various clinical manifestations, latest diagnostic tools and recent development in treatment of OSSN.   Keywords: Ocular surface squamous neoplasia, Xeroderma pigmentosum, Histopathological

Eye injuries constitute a significant cause of avoidable global blindness. Animal-related injuries are an increasing public health issue worldwide. The interaction of a man with animals occurs in various situations, and the danger associated with it are underestimated and also there are underreported wounds. Animal-induced ocular injuries are often severe and may lead to visual impairment, blindness and cosmetic disfigurement. Animal-related ocular injuries are classified according to the geographical distribution, type of animal, its behavior and availability in the community. This article reviews current literature and discusses the mechanism and severity of animal inflicted ocular and adnexal injuries in humans and various management techniques.   Keywords: Ocular injury, Animal, Cow, Bull horn, Dog bite, Cat scratch, Globe rupture

Purpose: The tumor protein p53 (or p53) gene plays a major role in the maintenance of normal cell growth and differentiation. Alteration in p53 gene is responsible for carcinogenesis. In this study, we evaluated the frequency of p53 mutation and clinicopathological findings in various eyelid malignancies. Materials and Methods: We reviewed a cohort of 20 patients with various eyelid malignancies over one year. The expression of p53protein was analyzed by amplifying the exons 5-9 of p53 gene by conventional Polymerase Chain Reaction (PCR) followed by sequencing to identify mutations. Results: The commonest eyelid malignancies was sebaceous gland carcinoma (SGC;50%) followed by basal cell carcinoma (BCC;45%) and squamous cell carcinoma(SCC; 5%). Study population/patients were mostly elderly (60 %, > 50 years of age) and female (75%). A total of 14 mutations were identified in the p53 genes in 9/20 (45%) patients at different intron or exon. Amongst them 6 patients (66.7%) had SGC and 3 (33.3%) had BCC. Out of the total 14 mutations identified, 8 intronic variation and 6 exonic mutations were identified. Out of 6 exonic variations, 5 caused frame shift mutations due to insertion or deletion of bases and one case was of substitution mutation (D281Y). Conclusion: Sebaceous gland carcinoma (SGC) was found to be most prevalent eyelid cancer in the present study and it most frequent displayed mutation inthe p53 genes among the all eyelid tumors investigated.   Keywords: p53protein, PCR, Eyelid tumor, Mutation, Polymorphism, Sequencing, Sebaceous gland carcinoma, Basal cell carcinoma, Squamous cell carcinoma

Dry eye disease (DED) is a multifactorial disorder of the ocular surface that results in ocular discomfort, visual disturbance and damage to the ocular surface. It is one of the most common complaints in daily ophthalmic practice. The greater prevalence of dry eye in women compared to men suggests that sex hormones may have a role in this condition. Sex hormones; estrogen and androgens influence production of all components of the tear film including aqueous layer, lipid layer, and mucin layer. Various mechanisms such as decrease in hormonal levels, shift in feedback mechanisms, and changes in receptor receptivity interplay to alter the ocular surface homeostasis and subsequently result in DED. The purpose of this review is to briefly outline current scientific evidence on the influence of androgen and estrogen on the lacrimal and meibomian glands as well as on the ocular surface epithelia including conjunctival goblet cells during reproductive and menopausal periods. This article also outlines the updates regarding role of gonadal hormones in the treatment of dry eye.   Keywords: Dry Eye, Sex hormones, Estrogen, Androgen, Testosterone, Progesterone, Tear film, Meibomian gland, Lacrimal gland, Ocular surface, Menopause, HRT, Schirmer’s test.

Recently there has been upsurge in the cases of Obstructive Sleep Apnea (OSA) with increased prevalence of obesity in the general population. It has been continuously proved that OSA and metabolic syndrome go hand in hand and hence OSA predisposes an individual to a series of cardio-vascular disorders like ischemic heart disease, myocardial infarction, arrhythmia etc. In this article we have emphasized the possibility of ocular involvement in OSA patients. Several studies have shown ocular associations like floppy eye lid syndrome, glaucoma, dry eye syndrome, papilledema, keratoconus, non-arteritic anterior ischemic optic neuropathy etc. Through this review, we would like to highlight the ophthalmological associations of OSA, their pathogenesis and outcome with the treatment of OSA. Keywords: Obstructive sleep apnea, Ocular disorders, Floppy eyelid syndrome, Glaucoma, Keratoconus.

Primary Sjögren’s syndrome (pSS) is a chronic, multisystem autoimmune disorder, characterized by mononuclear infiltration of exocrine glands and other organs, resulting in dry eye, dry mouth and extra-glandular systemic findings. Primary Sjögren syndrome is of particular interest to ophthalmologists as it constitutes an important differential diagnosis in conditions with dry eye disease. The ocular tests are of great importance for diagnosis and monitoring of primary sjogren’s syndrome. Also a better understanding of immunological mechanisms and molecular pathways have resulted in discovery of new therapeutics for local and systemic treatment. This article illustrates an update regarding pathogenesis, diagnosis, investigative procedures and treatment options for dry eye related to Sjogren’s syndrome. Keywords: Dry eye disease,Sjogren syndrome.

Malignant melanoma of ciliary body is rare in Indian -Asian population. Its incidence is about 0.02-0.06% in India. Since it is in a hidden location behind the iris, patients of ciliary body melanoma usually present late in advanced stage. We intend to report an asymptomatic case of ciliary body melanoma identified during the pre-operative cataract assessment of a patient at a tertiary care eye center of North India. It emphasizes the importance of detailed slit lamp examination and fundus examination beforesurgery in camp cases. Early diagnosis is very important as this tumor has very poor prognosis. Keywords: Ciliary body tumor, Malignant melanoma, Poor prognosis, Indian population.

Purpose: To study the epidemiology, clinico-radiological pattern and visual outcome in patients having ocular injuries following road traffic accident and also compare various risk factors associated with it.  Materials and Methods: A prospective, hospital based, observational study was performed at a teaching hospital of North India. Various parameters including demographics, time, place and session of injury, type of road, vehicle & collision, type of injury, severity & location of injury, radiological findings and initial & final visual acuity were analysed. The association between ocular trauma and characteristics of the accident were evaluated. Results: Out of 402 patients of ocular trauma, 101 eyes of 95(23.63%) patients had injuries due to road traffic accidents. It was observed that males were affected predominantly (88.40%).The ratio between men and women was 7.6:1, age ranged from 1 year to 67 years. The most vulnerable age group was 21-30 year (25.30%) followed by 31-40 year (24.20%) and 11-20 year (21.10%).Maximum injury victims were illiterate (33.68%) or had primary education only (29.47%). The majority were married (68.42%) and belonged to rural background (42.10%). Most of the road traffic accidents occur in summer season (47.37%). Majority of the victims sustained injury in the afternoon between 12.00 -17.59 hrs (29.47%) and in evening between 18.00-23.59 hrs (27.33%). 57.89 % victims were not using any protective gear at the time of injury. Driving under influence of alcohol (42.11%) and sleepiness or drowsiness of victims (21.05%) were found to be an important risk factor in ocular injury. 43.61% of the accidents took place at highway. Two-wheeler occupants (30.53%) were more prone to ocular trauma than pedestrians (13.68%), three-wheelers occupants (5.26%) and car occupants (21.05%). However 29.47% victims were travelling in heavy vehicles like bus/ truck. The most common mode of road accident was collision with other stationary objects like a tree, pole, milepost and other vehicle (51.58%) followed by swerved / skidded vehicle (26.32%) and run in the ditch (13.68%).  The commonest mode of injury was frontal impact or head-on collision (37.89%) followed by sideways impact (26.32%) and hit by projectile object (6.32%). However, in 29.47% cases the mode of injury was indeterminate. Conclusion: Road traffic accidents can cause severe ocular trauma. Victims are usually adult males of productive age group. Two wheeler occupants, driving under influence of alcohol and non-use of protective gear were found to be major risk factors. Frontal impacts posed the greatest risk of orbito-facial trauma. Open globe injury and multiple orbital wall fracture usually associated with poor prognosis. Use of helmet and seatbelt may reduce the frontal impact and hence vision threatening ocular trauma. Keywords: Ocular trauma polytrauma, Road traffic accident, Visual impairment, Orbital fracture, Helmet seat belt.

In recent years, more attention has been paid towards the research in the field of gender specific medicine. The purpose of this review article is to find out the gender alteration in the incidence and prevalence of diabetes and diabetic retinopathy and role of sex steroid hormones in the etiopathogenesis of diabetic retinopathy. Several studies suggest that, type-I diabetes is more common in men than women after puberty. Sex hormone receptors have been identified in the eye, but how sex hormones are involved in the development of diabetic retinopathy, is still not known well. In this article, we want to enlighten the reader about the sex hormone receptors in various eye tissues, gender based differences in diabetic retinopathy and the role of gonadal hormones in the development of diabetic retinopathy. Keywords: Gender, Sex hormones, Diabetic retinopathy.

The visual loss due to retained orbital foreign body may be associated with the ruptured globe, traumatic optic neuropathy, and orbital fracture. Metallic foreign body is more common than non-metallic foreign body. A young male are commonly affected by an orbital foreign body. Our aim is to describe a case report on retained orbital foreign bodies of a young male patient. The presenting feature was chronic discharging sinus. CT scan confirmed the organic foreign body in the orbit. MRI may be done as adjunct to CT scan of the orbit in the cases of wooden foreign body. Surgical extraction was made for two times. A high index of suspicion is mandatory for the suspected case of orbital foreign body. Multiple pieces of wooden foreign may be found. Keywords: Foreign body, CT scan of the orbit, Orbit, Organic, Surgical extraction.

Purpose: To compare the incidence of reflex(OCR) between hang-back and conventional method of muscle recession in horizontal. Materials and Methods: In this prospective, randomized, study, 40 consecutive patients of horizontal were evaluated. The patients were randomized into two groups based on the type of surgical recession technique employed for squint correction. Twenty patients were operated by Hang-back technique (group-1) and 20 by conventional muscle recession where the muscle tendon was sutured directly to the globe (group-2). All patients underwent evaluation which included refraction, and assessment of angle of deviation etc. ECG was monitored before surgery. During surgery heart rate (HR) was recorded as heart rate baseline (HRB), after 5 minutes of (HR5), during muscle traction (HRT), Minimum heart rate during traction of muscle (HRMin) Maximum increase in heart rate (HRMax). OCR was defined as > 20% reduction in HR during muscle traction as compared to baseline HR. Results: Out of total 40 patients 17(42.50%) were having and 23 (57.50%) had . The overall incidence of OCR in conventional recession was found to be greater than that in hang-back recession. The mean baseline HR was 72.00± 7.391 beat/min in conventional recession group and 77.55± 7.494 beat/min in hang-back recession group. The mean HR reduction in conventional procedure was 56.05± 8.787 beat/min. and that in hang-back procedure 61.80 ± 9.317 beat/min., which was statistically significant (p Conclusion: OCR is a common complication encountered during manipulation of muscle during surgery. Hang-back recession is a safe and effective method of muscle recession as it offers a shorter surgical time and better exposure along with lesser incidence of OCR with similar success rates when compared to conventional muscle recession. Keywords: Esotropia, Exotropia, Hang-back recession, Oculocardiac reflex, Rectus muscle, Strabismus.

Aim: To determine the prevalence and pattern of retinal vascular disorders in pregnant women. Materials and Methods: This hospital based, prospective observational study was conducted over a period of two years. Patients were selected from outpatient department and antenatal ward of Department of Obstetrics and Gynecology and outpatient department of Ophthalmology, SS Hospital, IMS, BHU, Varanasi. In all cases detailed obstetric history including age, gravida, gestational age, general and antenatal examination and relevant pathological investigations like blood sugar, blood urea, serum creatinine and urinary protein were carried out. After taking ocular history, detailed ocular examination including visual acuity and fundus examination under mydriasis with 1% tropicamide eye drop was carried out. All the findings were recorded on a data sheet and were analyzed using SPSS programme. The Chi-Square test was used to evaluate the association between the various antenatal factors and retinal vascular changes. Results: Of 210 patients 38.09% patients were primigravida and 28.57% were second gravida. 28.57% had pregnancy induced hypertension (PIH), 13.33 % had gestational diabetes mellitus, 12.38% had preexisting diabetes mellitus. Fundus abnormalities were observed in 110 (52.38%) cases among them commonest retinal pathology was hypertensive retinopathy 38 (34.55%) followed by diabetic retinopathy (32.73%), retinal vein occlusion (16.36%) and central serous chorioretinopathy (7.27%). Out of 60 cases of PIH 38 (63.33%) had retinal abnormalities. Retinal vascular disorders were seen in > 80% cases of severe pre-eclampsia and about 90% cases of eclampsia. Majority (68.42%) of PIH patient had grade I hypertensive retinopathy. The commonest retinal change was arterial attenuation (28.57%) followed by dot and blot hemorrhage (21.90%), A-V crossing changes (20.48%), hard exudates (19.05%), flame shaped hemorrhage (42.56%) and macular edema (18.10%). However in 5.71% cases papilledema and in 5.24% cases ischemic optic neuropathy was observed. Conclusion: The most common vision threatening retinal vascular disorders in pregnancy was hypertensive retinopathy (34.55%) followed by non proliferative diabetic retinopathy (32.73%), pregnancy associated venous occlusive disorders of retina (16.36 %) and central serous chorioretinopathy (7.27%). Other retinal abnormalities seen in pregnancy included optic neuritis, papilledema and macular edema. Pregnancy may be one of the risk factors for retinal vasculopathy and temporary visual impairment. Thus, ocular fundus examination may be a valuable and necessary routine investigative procedure in pregnancy. Keywords: Diabetic retinopathy, Eclampsia, Hypertensive retinopathy, Ophthalmoscopy, Pre-eclampsia, Pregnancy induced retinal disorders.  

An orbital apex syndrome (OAS) has been described previously as a syndrome involving damage to the ocular motor and sensory nerves in association with optic nerve dysfunction. Patients usually present with signs and symptoms derived from the involvement of structures within the orbital apex, the superior orbital fissure, and the cavernous sinus. Visual loss from optic neuropathy and ophthalmoplegia involving multiple cranial nerves are the hallmarks of orbital apex syndrome. Historically, superior orbital fissure, orbital apex, and cavernous sinus are being used to define the anatomical locations of a disease process. However, the diagnostic evaluation and management are similar for each of these entities. The authors reviewed the literature on evaluating disorders involving the orbital apex and it’s diagnosis.   Keywords: Orbital apex syndrome, Horner’s syndrome

Ocular sebaceous gland carcinoma (SGC) is a relatively rare, slow growing, but most aggressive and life-threatening tumor. It accounts for around 1% of all cutaneous malignancies. In Caucasians, SGCs are rare accounting for 1-5.5% of eyelid malignancies with a high incidence rate (28-60%) reported in the Asian population. In most SGCs no obvious etiology has been identified but few cases are associated with Muir-Torre syndrome. The dysregulation of several cell signaling pathways has been reported in tumorigenesis of SGC. Recently genome sequencing of periocular SGC revealed several gene mutations like TP53 and RB1 genes. Ocular SGC is known as the ‘great masquerader’ as it mimics several benign and inflammatory conditions like chalazion and chronic blepharitis/ blepharoconjunctivitis which may be responsible for delayed diagnosis and high mortality. Clinico-pathologically ocular SGC can be broadly categorized into nodular and pagetoid subtypes. The latter is more aggressive and associated with a high rate of lymph node metastasis and recurrence hence requiring aggressive multimodal treatment. More aggressive features associated with poor prognosis include involvement of both eyelids, infiltrative growth pattern, multicentric in origin with a pattern of spread to surrounding structures like pagetoid spread, vascular, lymphatic and orbital invasion. Although wide surgical excision with tumor-free margin is the gold standard treatment for the localized nodular type of ocular SGC, but the management of advanced-stage disease, invasive or aggressive lesions and recurrence is challenging and often needs a multidisciplinary approach that can reduce the mortality rate in patients with SGC. In this review article, we report recent research in molecular pathogenesis, clinicopathological features, the importance of TNM staging, sentinel lymph node biopsy, map biopsy and immunohistochemical evaluation of tumor markers like p,Ki-67, bcl-1, and p. We also emphasized the treatment of ocular SGC, i.e. surgical excision & reconstruction, topical therapy, neoadjuvant chemotherapy, targeted therapy, and radiation therapy.   Keywords: Ocular sebaceous Carcinoma, Masquerades, Therapeutic target, Biomarkers, Prognostic markers, Metastasis, Recurrence