Sahil Agrawal

Abstract

Purpose: Ocular trauma is an important cause of visual impairment worldwide. The reported annual incidence of severe ocular trauma is 9.75 per 1,000 adults. Ultrasonography (B scan) has emerged as a useful technique in ocular injury scenario. We aimed to evaluate role of B Scan ultrasonography in management of ocular injuries. Materials and Methods: All patients with ocular trauma attending the emergency department were enrolled for the study. Relevant history and demographic data was noted on the study proforma. Detailed ocular examination was done employing slit lamp biomicroscopy for anterior segment and direct and indirect ophthalmoscopy for posterior segment evaluation. All patients were necessarily subjected to B scan ultrasonography (USG) for additional clinical information. Results: A total of 50 cases were enrolled. The mean age of affection was 28 years. The most common mode of injury was agriculture related. The most common anterior segment finding was traumatic cataract as seen in 22(44%) cases while on USG posterior vitreous detachments seen in 36% cases, followed by retinal detachment in 24% cases and vitreous haemorrhage in 22% cases. Choroidal detachment was accurately localized in 2% cases. Conclusion: The study emphasizes the need for B-scan as a valuable tool in the diagnosis of posterior segment pathologies particularly when the media has become opaque as it can visualize and localize the position of the lesions which would not be possible by any other means. Keywords : Ocular trauma, B­scan, Traumatic cataract, Posterior vitreous detachment, Retinal detachment

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Abstract

Thyroid eye disease (TED) is a chronic debilitating condition which causes physical discomfort, oculo-facial disfigurement and compromised visual function. Around 25% of people with Graves’ hyperthyroidism are affected by TED, where 1 in 20 patients might report with moderate-to-severe, active disease that will require medical management for reducing both TED activity and severity. The mainstay of medical management involves intravenous corticosteroids for active moderate-to-severe TED. After accurate understanding of the mechanism and pathophysiology of this disease, investigations and randomised clinical trials have been conducted. The role of immunotherapy targeting and influencing different biomolecular pathways including that of T cells, B cells, cytokines and cell surface receptors have been investigated in various randomised clinical trials. This review article addresses the epidemiology, associated risk factors, recent advances in pathophysiology, newer diagnostic tools and current management options available for TED which include the use of immunosuppressive drugs like rituximab (RTX), tocilizumab, infliximab (IFX), etanercept ( ETN) and teprotumumab etc. Keywords: Thyroid eye disease, Graves' orbitopathy, Orbital fibroblast, Insulin like growth factor­1, Cytokine, rituximab, Tocilizumab, Teprotumumab

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Abstract

Tumors may occur in any part of the orbit. Their management demands either total excision or biopsy samples obtained through orbitotomy. The key to appropriate surgical management is a thorough knowledge of the anatomy and correct approach to reach the different spaces. The safest yet the most direct approach to access the tumors should be used. A multidisciplinary team may be required for deeply located lesions, close to the orbital apex, requiring advanced procedures. Here we give a brief review of the evolution of the various orbitotomy procedures and the surgical approach to the same. Keywords: Orbit, Orbitotomy, Proptosis, Ocular Oncology, Orbital Tumors.

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