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All Cornea 36 Cataract 17 Glaucoma 13 Retina & Vitreous 72 Neurophthalmology 8 Oculoplasty 15 Uvea & Inflammatory Diseases 24 Miscellaneous 20 Oncology 9 Pediatric Ophthalmology 15

5 Apr 2022 7 min read

Ten Facts Every Ophthalmologist Should Know About Lubricating Eye Drops

Introduction Artificial tear substitutes lubricate and protect the ocular surface and provide relief from ocular dryness, irritation, and burning sensation. They play a major role in providing symptomatic relief and are widely used for all types of dry eye diseases and nonspecific causes of ocular fatigue as well. Choosing the right kind of lubricating drops is of utmost importance. A number of reasons including lifestyle changes, increased computer and digital screen usage, and awareness of dry eye have resulted in an increase in the utilization of these eye drops. It is important to understand a few simple features of these drops to optimize their beneficial effects.[1] Commercially available lubricating eye drops have varying composition, viscosity, duration of action, preservatives, osmolarity, and pH. This article discusses the composition of tear substitutes and the mechanism of action on the ocular surface. 1. Role of lubricating eye drops on the ocular surface The main purpose

Dr. Sharon DSouza, MS, FCE
29 Mar 2022 8 min read

Corneal Ulcer Simplified for the Postgraduates: Ten Points

An ulcer is a breach in the continuity of corneal epithelial. However, a corneal ulcer is an epithelial breach with superficial tissue loss (subepithelial or stroma) having variable grades of inflammation. The causes can be infectious (bacterial, fungal, viral, Pythium) and autoimmune (marginal keratitis, peripheral ulcerative keratitis). Here, we discuss ten essential clinical key points for diagnosing a corneal ulcer. 1. History A detailed and meticulous history is essential in each case. The patients commonly present with pain, redness, photophobia, and defective vision. The history of trauma (vegetative matter, stick, mud, clay, insect bite, etc.), onset, presentation, and progression should be noted. Sudden onset and rapid progression are associated with Pseudomonas, Pneumococcus, and Staphylococcus ulcers. Gradual onset and slow progression are seen in Acanthamoeba, Nocardia, and Mycobacterium. A detailed history of ocular (Contact lens, adnexal infections, ocular surface disease

Dr. Bharat Gurnani, MBBS, DNB, FCRS, FICO, MRCS Ed, MNAMS · Dr. Kirandeep Kaur, MBBS, DNB, FPOS, FICO, MRCS Ed, MNAMS
22 Mar 2022 5 min read

Polymerase Chain Reaction in Ocular Infections

Newer technological progressions in molecular science have paved the way for a better understanding of infectious diseases. DNA-based molecular diagnostic techniques which are specific, sensitive, and rapid in the identification of the pathogen in the clinical specimen has been developed extensively over the past decades The rapid identi?cation of speci?c infectious agents is very important for the diagnosis of an ocular infection because the course of treatment and disease prognosis could be different from non-infectious diseases. Despite the availability of a wide variety of antimicrobial agents to treat these infections, specific treatment is delayed due to the inability to identify ocular pathogens quickly and accurately. PCR has emerged as an essential powerful rapid laboratory diagnostic technique complement the conventional gold standard “culture “, with special reference to difficult to grow or slow-growing microbial agents like viruses, Mycobacterium tuberculosis, anaerobic ba

Dr. Janani Madhuravasal Krishnan
9 Mar 2022 12 min read

i-File: Pigmentary Glaucoma

A 30-year-old male presented to the glaucoma clinic with complaints of gradually progressive diminution of vision in both eyes, left eye more than right, since 5 years. The visual disturbance was not associated with redness, pain, photophobia, or colored haloes. Past Ocular History: He was diagnosed with glaucoma elsewhere 5 years ago and started on anti-glaucoma medications(AGM). His baseline intraocular pressure (IOP) according to the old records was 52 mmHg In both eyes. At the time of his visit to the hospital, he was using 3 AGMs which he had stopped using for the past 7 days. No history of trauma or laser in the past Past Medical history: No history of any systemic illness Family history: No family history of glaucoma Systemic Examination: All vitals and systemic examination was within normal limits Ocular Examination Best Corrected Visual Acuity (Snellens) Right Eye (OD) 6/9 Left Eye (OS) 3/60 Ocular Motility/Alignment Full, free and painless in all gazes Intraocular pressure (I

Dr. K. Sugepriya · Dr. Rathini David
12 Jan 2022 8 min read

Seven Tips for Sideport Construction

Sideport might appear as a small and trivial step in SICS but it has great significance. Improperly constructed side port will give rise to a cascade of events which will complicate the further steps. You can make an ideal side port by employing the following tips. 1. Size Width: A very small side port will pose a lot of problems while instrumentation. It will force multiple attempts to enlarge the side port throughout surgery, which itself poses the risk of injury to intraocular structures. Conversely, a very big side port will lead to wound leak and instable AC intra-operatively. It may end up in needing a suture at the end. So assessment of apt width is imperative. The size of side port is largely dependent on the gauze of simcoe cannula being used. It needs a bit of experience to adequately size the side port and after doing a few cases one will be able to judge how much the blade needs to be inserted and how much extension is required. Fig 1 a. Very Big Sideport and b. Small Sidep

Dr. Rohit Rao · Dr. Bhavin Kumar Patel
3 Jan 2022 12 min read

i-File: Pseudophakic Bullous Keratopathy

A 60-year-old-male presented to the Cornea clinic with diminution of vision in the left eye for 4 months which was associated with intermittent photophobia and colored haloes around lights, especially on waking up in the morning. The patient also complains of pain and watering. No history of associated redness, itching, or discharge. Past Ocular History: H/o OD cataract surgery 6 years, OS cataract surgery 4 months back. No h/o trauma. Past Medical History/ History of Medication: No significant systemic history could be elicited. The patient was not on any medication. No addictions. Family History: No significant family history found Review of Systems/Systemic Examination: Systemic examination was within normal limits. All vitals were within normal limits. OCULAR EXAMINATION Best Corrected Visual Acuity (Snellen) Right eye (OD): 6/9 Left eye (OS): CF 2 m Ocular Motility/Alignment - Full, free, and painless in all gazes Intraocular Pressure (IOP) OD: 18 mm of Hg OS: 14 mm of Hg Pupils-

Dr. Hema Joshi, MBBS, DO, DNB · Dr. Akhilesh Yadav
16 Dec 2021 4 min read

Pearls for Indirect Ophthalmoscopy

Using the indirect ophthalmoscope proficiently is a difficult skill to master, nevertheless is an indispensable one. With adequate practice, you will eventually come to terms with it. Here are a few tips and tricks to help you with it. Important but often likely to be missed: Every day, check if the optics of the indirect ophthalmoscope is working properly and, if wireless- that the battery pack is charged. (Finding out that the optics is not working properly or the indirect ophthalmoscope switching off in the middle of the examination is not only embarrassing but may also undermine the impression that your patient will have about you). Have a dedicated switch to turn off the room light nearby your examination station. It is often easier to “do it yourself” than to command to others/assistant for the lights on and off. Ask them if they are driving or riding or have an important work immediately after the visit at your clinic. Defer the examination to a later time/date if any of the abo

Dr. Anadi Khatri · Dr. Gunjan Prasai
6 Dec 2021 5 min read

Ten Pearls of Phacoemulsification with PPC

Posterior Polar Cataract is associated with remnants of Tunica vasculosa lentis. (1) It presents as a white opacity situated on the posterior capsule appearing as a circular plaque with concentric whorls. (2) Surgical management of posterior polar cataracts is a challenge even for skilled surgeons due to high risk of posterior capsular rupture and vitreous loss during surgery. (3) 1. Preoperative Considerations: It has to be identified correctly on slit lamp examination – with its characteristic onion peel or bull’s eye appearance. Patient has to be counselled regarding increased surgical time, higher chances of posterior capsular rupture and even the possibility of posterior segment intervention and delayed visual recovery. (3,4) The fellow eye also needs to be evaluated. Image showing: Characteristic onion peel appearance of Posterior Polar Cataract (Courtesy of Rajan Eye Care Hospital). 2. The Preferred Anaesthesia: Peribulbar anaesthesia is preferred because of longer surgical time

Dr. Madhuvanthi Mohan · Dr. Sashwanthi Mohan · +1 other
30 Nov 2021 25 min read

Ocular Manifestations of HIV

Human immunodeficiency virus (HIV) disease is a pandemic of global concern, not only due to serious health issues affecting all organs of the body but also due to its huge economic burden.(1) The diagnosis is often associated with social stigma that includes changing sexual practices, lack of availability of a vaccine and the chronicity of the disease requiring lifelong treatment.(2) The disease runs a severe course, involving multiple organs. Ocular lesions are varied and can affect any structure, usually in the late phase of HIV infection. Rarely, these lesions can be the presenting manifestations of the disease. While a variety of cell types may be infected by HIV, the immunologic hallmark is the selective loss of the CD4+ T cells. CD4 is a cell surface marker that identi?es the helper/inducer subset of T cells. During the initial phases of infection, a majority of patients remain asymptomatic. With a decrease in the CD4+ T cell count (< 500 cells/µL) the immune system shows evidenc

Dr. Sharanya Abraham
17 Nov 2021 7 min read

Ten Pearls for Tunnel Construction in SICS

SICS is the most commonly performed cataract surgery by young budding surgeons. Young postgraduates are introduced to the world of ophthalmological surgery via SICS. Initially, every new surgeon struggles to make good scleral tunnel and capsulorhexis. These TOP TEN pearls will make young surgeons confident to achieve textbook tunnel. 1. Good Visualization: If you can see well, you can do well. Proper exposure of working field is a must. So, focus on to make adequate Conjunctiva and tenon’s dissection, avoid pooling of blood with judicious cautery and don’t let saline or visco to pool. Fig.1 Adequate Scleral exposure for tunnel construction 2. Superior rectus bridle suture: Mind the rectus It is probably one of the most important step in SICS. It is the first step any beginner surgeon learns, but it has not been given the due credit. It is a hidden player in tunnel construction. Furthermore, it provides the globe with sufficient traction and support to construct the tunnel seamlessly. 3

Dr. Rohit Rao · Dr. Patel Bhavin