Soumen Chakraborty

Abstract

Background: Epiphora due to chronic dacryocystitis is extremely common in the ophthalmolmic practice across this country. The typical patient is often a female in her young or middle age, and the clinical pathology is usually obstruction of the naso lacrimal pathway located at the naso-lacrimal duct or beyond. Definitive treatment entails creation of an alternative pathway for fluid egress by a surgical procedure known as dacryocystorhinostomy (DCR). Aims and Objectives: To compare two commonly performed techniques of DCR – namely external and endonasal – in terms of surgical time, complications and outcomes. Materials and Methods: Seventy two patients were studied over a period of two years from April 2017 to May 2019 were divided in two equal groups. The first group (Group A, n=36) underwent external DCR which was done by an ophthalmic surgeon whereas the second group (Group B, n= 36) underwent endonasal DCR done by an ENT surgeon. All cases of both the groups were followed up for a period of six months. Both groups were compared in terms of surgical time, per and post operative complications and final surgical outcomes. Results: The study had 64 females and 8 males in total aged between 19 and 63 years. Mean surgical time in group A (31 females, 5 males) was 48 minutes whereas in Group B (33 females, 3 males) it was 44 minutes. Intra operative haemorrhage was seen in 16% (n= 6) patients of Group A and 11% (n= 4) of Group B. Patency at the end of six months was sustained in 91% (n= 33) patients in Group A and 86% (n= 31) patients in Group B. Conclusion: Both techniques offer viable surgical alternatives as far as correction of naso lacrimal obstruction is concerned. Keywords: Dacryocystitis, External DCR, Endonasal DCR.

View Article

Abstract

Background: Corneal edema following contact with plant extracts occur not only with horticultural workers but also with amateur gardeners. The condition causes reasonable visual debility but is reversible and self limiting. Till date, no established therapeutic protocol exists for management of this particular condition. Objectives: To re-examine the etiological factors behind this condition and to develop a definitive therapeutic prescript for this problem. Materials and Methods: Forty six patients suffering from this condition were randomly divided into two equal groups. Group A was treated with topical steroids (commercially available moxifloxacin 0.5% w/v + dexamethasone sodium phosphate 0.1% w/v), whereas Group B was treated with a placebo (carboxy methylcellulose 0.5% w/v). All patients were monitored on alternate days in terms of BCVA, non contact tonometry and slit lamp examination. Pachymetry was done on arrival and after complete resolution of corneal edema. Results: In both the groups, corneal edema resolved in all eyes by the fifth day without any residual clinical deficit. The mean pachymetry value on presentation in Group A was 626 microns and in Group B was 628 microns, and returned to 550 microns or below by day five in all patients. Visual acuity was restored to 6/9 or better in all patients of Group B and 96% (n= 22) patients in Group A, but this deficiency was not related to the disease process in question. Conclusion: Botanical toxin induced corneal edema was self limiting and resolved in a time bound pattern without any sequel. Topical steroids neither seemed to hasten the resolution of corneal edema nor affected the final outcome of this clinical condition in any way. Keywords: Calptropis gigantea, Na + K + pump, Corneal edema, Topical steroids, Cardiac glycosides.

View Article

Abstract

Aim: To find out an association, if any, between smoking and dry eye diseases and whether it has any relation to the number of cigarettes smoked. Materials and Methods: Patients attending the hospital outpatient department were enquired about smoking and then given the option to enrol in the study following a written and informed consent. Depending on the number of cigarettes they smoked, patients were divided in three groups, namely low, moderate and high smokers based on the heaviness of Smoking Index. They were labelled as Group A, B and C respectively. Symptomatic assessment of each group was done by the Ocular Surface Disease Index (OSDI) questionnaire, and a score greater than 12 was considered meaningful. Clinical evaluation was done by performing TBUT and Schirmer’s test. Respective cut off values were 10 seconds and 10 mm. Deviations from established normal values were observed and analyzed. Results: A total of 205 patients participated in this study of which 90.7% (n= 186) were males and 9.3% (n= 19) were females. 30.7% (n= 63) patients were low smokers (Group A), 42.9% (n= 88) were moderate smokers (Group B) and 26.3% (n= 54) were high smokers (Group C). The mean TBUT and OSDI scores showed progressive deterioration from Group A to C, whereas the mean Schirmer’s values across all groups remained relatively unaffected. Conclusion: Cigarette smoking had a deleterious effect on the health of the ocular surface, but the aqueous tear secretion remained unaffected. Keywords: Smoking, Dry eyes, OSDI, TBUT, Schirmer’s test.

View Article