Vasu Narasimha Naik

Abstract

Aim: To know the efficacy of only conservative management without manual removal of adult parasite in treatment of pediculosis palpebrarum. Material and Methods: Seventeen patients with pediculosis palpebrarum underwent health education on personal hygiene, avoid overcrowding, counseling and psychotherapy. Deparasitisation of associated axillary and pubic area with Permethrin 1% cream application two courses at weeks gap. Washing clothes and linen in hot water. Face wash with shampoo lotion and simultaneously rubbing of the eye for 1-2 minutes thrice daily. Topically Antibiotic - steroid drops and ointment thrice daily for 6 weeks. No manual removal of adult parasite, epilation or trimming of the eye lashes was done. Results: The mean age of patient is 19.5 +/- 13.4 years. Male: Female ratio was 10:7. Mean duration of symptom is 13.+/-6.6 weeks. Commonest presentation was itching in all patients. 82.3% (14/17) patients had bilateral involvement of both upper and lower lids with associated pubic and axillary area infestation. By 1st week all had resolution of symptoms and on 3rd week 82.3% (14/17) free from infestation. (3 dropout) only discomfort was transient blurring of vision due to eye ointment. Conclusion: Conservative management without manual removal of adult parasite is equally effective in treating pediculosis palpebrarum. Acceptable to children, anxious and non cooperative patients. It wiil avoid the discomfort to patients, complications of sedation and local side effects of topical parasiticidal agents. Only side effect was transient blurring of vision due to eye ointment. Keywords: Conservative, Drops and ointment, Pediculosis palpebrarum.

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Aim: A prospective, randomised and comparative study to compare the efficacy and complications of triamcinolone acetonide (TMA)40mg/ml with TMA 10mg/ml in treatment of Chalazion.  Material and Methods: Sixty chalazion patients were randomly grouped into two groups. Group A patients received single intralesional injection of 0.2ml TMA 40mg/ml and group B 0.2ml of TMA 10mg/ml. The outcome and complications are evaluated at the end of 6 weeks. Results: There were 60 chalazion from 58 patients, two patients with bilateral chalazion. There were 28 chalazion in group A and 32 chalazion in group B.Over all cure rate was 68.3% (41/60) and comparable to earlier study (P=0.70). The success rate of 78.6%(22/28) in group A is significantly more than the success rate of 56.3%(18/32) in group B (P=0.05). The cumulative complications are marginally more in group A 14.3 % (4/28) (7.2% with raised intraocular pressure (IOP) of>15 mmHg and 7.2% with cosmetically blemish yellow white deposit in skin) compare to 6.3% (2/32) in group B (cosmetically blemish yellow white deposit in skin) (P=0.41). Conclusion: Single dose of intralesional injection of higher concentration of TMA 40mg/ml is more effective than TMA 10mg/ml. However vision threatening complication of raised IOP and Aesthetical dissatisfaction due to yellow white deposit in the lid skin are the disadvantages. Glaucoma comprehensive eye examination and repeated counseling sessions in cosmetically anxious young female patients to be kept in mind. Keywords: Chalazion intralesional injection, TMA, Yellow deposit.

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Purpose: To compare the Visual outcome, intraoperative and post operative complications following early and delayed Cataract surgery in Phacolytic glaucoma. Materials and Methods: A Prospective and interventional study in a district hospital. Confirmed cases of phacolytic glaucoma after medical control grouped into group A and group B. Group A patients under went small incision cataract surgery (SICS) within 7 days (early) and group B patients after 7 days(delayed). They were compared for complications and post operative distant corrected visual acuity (DCVA) at the end of 8 weeks. Results:There were 38 eyes from 38 patients. The demographic factors and clinical findings are comparable between two group. Cumulative intraoperative complications like difficulty in doing continuous curvilinear capsulorhexis (CCC), Zonular dialysis and posterior capsule (PC) tear with vitreous disturbance were more in group B 55.6%(10/18) compare to group A 35.0% (7/20). Postoperative DCVA of 6/12 or more was comparable between two group A and B 60.0% (12/20) and 55.6 % (10/18) respectively. Post operative persistent corneal edema in 5.0% (1/20) in group A, 5.5% (1/18) persistent uveitis and 5.5% (1/18) optic nerve damage in group B observed. Conclusion: Early surgical intervention is to be preferred choice in all cases of phacolytic glaucoma. However in patients with genuine personal, family and socio economical reasons delayed surgery will not alter final visual outcome. Adequate preoperative preparation are to be taken to reduce and handle intra operative complication. Keywords: Complications, Intervention, Phacolytic glaucoma, Visual outcome.

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Purpose: To compare the benefits and complications of External dacryocysto rhinostomy (EXDCR) with Silicone tube (ST) intubation in anatomical primary acquired naso lacrimal duct obstruction (APANDO)and functional primary acquired naso lacrimal duct obstruction(FPANDO) patients. Materials and Methods: Patients with epiphora/discharge/mucocele are grouped into group A (APANDO) and group B (FPANDO) based on diagnostic probe test, positive syringing and Fluorescein Dye Disapearance (FDD) test. Both group underwent EXDCR with ST intubation. Patients were evaluated for subjective and objective resolution of epiphora/discharge/mucocoele, complications and subjective satisfaction at the end of 6 months. Result: There were 23 patients each in group A and group B and no difference in demographic and laterality of eye involvement. Epiphora was common presentation in FPANDO (91%) and discharge in APANDO (57%). (P =0.01). The success rate is 78.3% (18/23) in group A and 86.9% (20/23) in group B and the difference is not significant (P=0.69). Tube related complications are high in group B 82.6% (P = 0.01) and inflammation related complications in group A 61.2% (P=0.49). In group A 82.6% (19/23) and group B 73.9% (17/23) were satisfied with the procedure (P =0.72). Tube related complication and additional financial burden are the main factors for dissatisfaction in group B (P= 0.72) Conclusion: Use of silicone tube does not alter the success rate of EXDCR in APANDO and FPANDO. Preoperative counseling and eye health educations are very important before doing such procedure on rural population. Keywords: Complications, EXDCR, PANDO, Silcone tube.

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