Thyroid eye disease has been a well-recognized clinical entity related to thyroid gland dysfunction for more than a century. However, the last couple of decades devoted to specific clinical research regarding this entity has significantly contributed to understanding the etiopathogenesis of the disease that has directed further research towards true disease-modifying therapies. The authors wish to present a comprehensive review of the disease with focus on the recent advancements in management of the same.

Purpose: The purpose of this study is to assess the level of awareness about glaucoma and impact of short education among patients visiting ophthalmology outpatient department (OPD). Methods: A hospital-based cross-sectional study was carried at our institute. The patients were given a pretested questionnaire containing nine questions to assess the awareness level before and after the short education about glaucoma. Microsoft Office Excel and IBM SPSS version 21 were used for statistical analysis. Results: The study showed that only 40% and 38% of the participants were aware of the term intraocular pressure and glaucoma, respectively. It was observed that participants <40 years scored higher than those of >40 years in both pre-test and post-test. Awareness among urban population was 58.92%, while in rural it was 29.85% in pre-test. Of the population 39.89% with formal education while 14.28% patients with no formal education were aware of glaucoma. The mean pre-test score was 1.66 ± 2.35 before the short education programme and the post-test score was 8.49 ± 1.09; the difference was statistically significant with P value < 0.0001. Conclusion: In our study, the awareness of glaucoma in the population was low; however, it was slightly higher in the younger age group, in urban areas and in educated population. Improvement in the knowledge about glaucoma was observed following short education. This waiting period in ophthalmology OPD can be effectively utilized for educating the patients about glaucoma as it has a higher impact than the regularly observed methods of imparting glaucoma education to the masses.

Aim: This study is aimed to characterize the various clinical spectrum of ocular Tuberculosis. Methodology: It is a retrospective study of patients presented during January 2020 and January 2021 with tuberculosis and with a follow up period of one year. Results: A total of 676 patients have been included in the study. Pulmonary tuberculosis is 61% (413 patients) and extrapulmonary tuberculosis is 39% (263). Out of 263, 21 patients (8%) had ocular manifestations. The most common ocular presentation is posterior uveitis 43%, followed by panuveitis 24%, intermediate uveitis 19% and anterior uveitis 14%. 70% of the patients were commenced on a standard course of Anti tuberculosis treatment (ATT) as a primary treatment modality, of which two patients were started with ATT empirically given a high index of clinical suspicion, and 30% of the patients were treated with ATT and corticosteroids. Conclusion: Ocular tuberculosis though having a wide spectrum of clinical manifestations and baffling diagnostic methods is still a treatable cause of uveitis. The patient approach should be holistic and integrated with a high index of suspicion in an endemic country like India.

Introduction: Glaucoma is a progressive optic neuropathy associated with loss of retinal ganglion cells, visual field loss and may or may not be associated with raised intraocular pressure (IOP). Although glaucoma is a multifactorial disease, elevated IOP remains the only modifiable risk factor. The direct relationship between IOP increase and decrease in retinal nerve fiber layer thickness has already been established by various authors previously. Hence, it is imperative to control the IOP to prevent the optic nerve damage and progressive visual field loss. The IOP can be influenced by various systemic factors, viz., hypertension, atherosclerotic diseases, body mass index (BMI), and diabetes mellitus (DM). Methodology: This study was conducted in a tertiary care center located in hilly areas of Northern India. Patients were recruited from out patient department (OPD). Design: Prospective, cross-sectional and case-control study. Sample: Patients attending medicine and ophthalmology OPD in Government Doon Medical College Hospital, Dehradun, were included in the study. Subjects were recruited as per selection criteria. This study included 25 patients with type 2 DM and 25 patients with the control group. Inclusion criteria (Group 1:Diabetic patients):

• Patients with diagnosed type 2 DM.

Inclusion criteria (Group 2: Non-diabetic patients):

• Healthy subjects without any history of raised blood sugar levels in the last 2 years.

Exclusion criteria:

• Diagnosed cases of glaucoma,
• Diagnosed ocular hypertension,
• Patients with corneal opacity, posterior segment diseases, or non-cooperative for eye examination,
• Refractive error greater than ± 5D spherical, or cylindrical refractive error greater than ± 2.5D.

Capillary glucose testing: IOP assessment: Immediately after the capillary glucose testing, IOP was measured in both eyes (i.e., fasting for exactly 10 hour and exactly 2 after breakfast) of each patient by Goldmann applanation tonometry. All readings were taken with the patient in a sitting position. Statistical analysis:All statistical analyses were performed with Statistical Package for Social Sciences version 21.0. Conclusion: We can conclude a significant relationship between glucose variation and IOP variation in the diabetic group with our results. The diabetic group exhibited higher values of fasting and post-prandial measurements than the control group. Hence, we recommend blood glucose testing in diabetic patients with glaucoma simultaneously with IOP monitoring. It should also include good blood sugar control. Though we are limited by a small sample size and time limit. A longitudinal study will help to get better and clearer results.

Aim: To compare the surgical outcome between anterior-posterior flap (APF) and anterior suspended flap (ASF) in external dacryocystorhinostomy (DCR). Settings and Design: This was a prospective, non-randomized, comparative, interventional, clinical study, done in J. P. M Rotary Club of Cuttack Eye Hospital and Research Institute, Cuttack. Materials and Methods: This was a single-centre hospital-based study on patients with primary nasolacrimal duct obstruction who underwent external DCR conducted during a period of 18 months. The patients were selected into either of the two procedures, that is, anterior-posterior flap external dacryocystorhinostomy (APF-DCR) or anterior suspended flap external dacryocystorhinostomy (ASF-DCR) and were reviewed at day 1, day 7, 1 month, 3 months, and 6 months postoperatively. Absence of epiphora was considered as the subjective success rate, whereas patent sac was considered as an objective success rate. Statistical Analysis Used: Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 13 software. Results: In our study, 131 patients underwent APF-DCR, whereas 133 underwent ASF-DCR. At the final follow-up, the subjective success rate was 88.3% and 87.7%, respectively, while the objective success rate at 6 months was 85.8% and 87.7% in the APF-DCR group and ASF-DCR group, respectively. However, there was no statistically significant difference between the groups, both subjectively and objectively. Intraoperative haemorrhage and other postoperative complications were very few in both the groups. Conclusions: We recommend performing ASF-DCR, as the suspension of anterior flaps prevents the possibility of granulation tissue formation at the rhinostomy site. Again, simultaneous suturing of the anterior flaps along with excision of the posterior flaps speeds up the procedure.

Aim: The aim of this study is to analyse the pattern of uveitis in a rural eye care hospital in Tamil Nadu. Understanding the shifting paradigm in uveitis, demographic differences in presentation, early diagnosis and treatment are very important in preventing ocular morbidity. Settings and Design: Retrospective Case study. Materials and Methods: Analysis of all the new cases of uveitis registered in our uvea clinic between December 2020 and April 2021 was done. Comprehensive eye examination and tailored investigations were done. Results: Among the 85 new cases of uveitis registered in the uvea clinic, 78 patients were included in the study. The mean age at presentation was 38.38 and ranged (4–77) years. The male: female ratio was 0.73. Anterior uveitis was the commonest type of uveitis (44.87%) followed by intermediate uveitis (24.35%), posterior uveitis (17.94%) and pan uveitis (12.82%). Aetiology was unknown in 30.76% (24/78) cases. HLA B27 association was noted in 22.8% of anterior uveitis cases. Sixteen patients had tuberculous aetiology. Ocular complications were noted in about 23.07% of patients and cataract was the most common complication. Conclusions: This study aims at analysing the pattern of uveitis in a rural area. Understanding the aetiology of uveitis whether infectious or autoimmune is of paramount importance to advice tailored investigations and to start early specific treatment. Delay in presentation and irregular follow-up, especially in patients from rural areas would result in permanent damage to ocular tissues and loss of visual function.

Vogt-Koyanagi-Harada (VKH) syndrome is a rare bilateral granulomatous panuveitis typically affecting the more pigmented races, and women more than men. VKH syndrome is theorized due to a T-cell-mediated autoimmune reaction against antigens related to melanin and melanocytes, that may happen due to cutaneous or viral triggers. Along with the clinical evaluation, it is mandatory to utilise additional investigative modalities such as fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT) and ultrasonography, which will help pick up pathognomonic signs, that can be missed on clinical evaluation. In this manuscript, we have reported striking multimodal images of a VKH patient with poor adherence; and have emphasized early detection, initiation of therapy without delay, aggressive therapy, good compliance, very slow tapering of oral steroids and use of immunosuppressants for a good visual prognosis.

Central retinal vein occlusion (CRVO) is a common diagnosis encountered in our clinic. Patients usually have predisposing factors and regular presentation but, in this paper, we present an extremely unusual incidence of bilateral CRVO in a young male. The patient had jumped from the second floor after consumption of poison and suffered bilateral pneumothorax that needed hospitalisation for 5 weeks. Though the patient had noticed blurring in both eyes, he presumed it to his myopic state and broken glasses. On reporting to us after 2 months of this misfortune, he had non-ischemic variant of bilateral CRVO with Cystoid macular edema (CME) as consequences of bilateral pneumothorax. He was treated with single dose of inj. Avastin and macular grid laser in both eyes. Patient responded well and his visual status improved and now he is in follow-up. This case is being presented for its rarity and unusual profile.

Vogt–Koyanagi–Harada (VKH) is a rare autoimmune multisystem disease. Here, we report a case of VKH with asymmetric involvement and the importance of patient counselling and a comprehensive approach. A 45-year-old female patient went to tertiary care with left-sided headache and sudden diminution of vision in the left eye (LE) since 1 day. She was advised lumbar puncture but became apprehensive and came to us with visual acuity (VA) 6/6 in the right eye (RE) and HMCF PL+, PR accurate in LE. LE showed lid oedema, mild conjunctival congestion, vitritis, disc oedema, choroidal detachment and exudative retinal detachment (ERD) involving the macula. The patient was suspected to have incomplete VKH. Neurologic, Ear, Nose, Throat (ENT) and dermatology consults were taken. The patient was counselled about the systemic issue, the possibility of other eye involvement later and the need for a team-based approach. The patient was started on steroids. At 6 months, VA in RE - 6/36 and in LE - 6/60, RE showed a pocket of ERD. Asymmetric involvement of both eyes is an infrequent presentation highlighting the necessity of a comprehensive approach along with diligent patient counselling for allaying fears.

Exogenous infective endophthalmitis is extremely rare after eyelid surgery. A 65-year-old lady presented with bilateral corneal infiltrates and severe anterior chamber exudation after bilateral senile entropion correction. There were multiple fluffy exudates in both the anterior chambers. The left eye was pseudophakic, with yellowish fundal glow. Ultrasonography revealed moderately reflective dot echoes in both eyes. Corneal scraping showed yeast in the right eye. Culture grew Pseudomonas aeruginosa resistant to all drugs except imipenem. Systemic tests for endogenous endophthalmitis were negative. She was started on 5% natamycin and 0.5% imipenem eye drops hourly in both eyes, as well as intravenous imipenem twice a day for five days with supportive treatment. Complete resolution of infection was achieved at one month. The rare bilateral presentation of extra and intraocular infection after entropion surgery, mixed and resistant causative organisms and anterior chamber exudates being disproportionately more than corneal involvement are the unique features of this case.

A report of a 66-year-old male with keratoconus presenting with an acute hydrops. The patient was managed with intracameral C3F8 gas injection. On postoperative follow-up, slit lamp imaging showed a large central Descemet's membrane tear taking the appearance of a leech, with such well-defined tears in cases of acute hydrops being a rare entity to image on a slit lamp.

The development of a lens in intrauterine life reacts to any insults by losing its clarity and developing opacity, which manifests as congenital or developmental cataract. Developmental mixed morphology cataracts are seen when there is occurrence of multiple forms of cataracts in a single crystalline lens. Although the prevalence of mixed morphology cataract is 23%, this combination of blue dot cataract with lamellar cataract has never been reported in the literature before, as per our knowledge. The blue dot and lamellar cataracts develop in childhood and progress throughout life. Cataract extraction is rarely necessary before adulthood and is mainly managed with periodic cataract progression assessment. In this manuscript, we have studied the morphology of this mixed morphology cataract with anterior segment imaging tools to throw more light on their optical properties and densitometry.

Benign familial fleck Retina is a rare inherited retinal disease first reported by Sabel Aish and Dajani in 1980. It is an autosomal recessive condition associated with a distinctive retinal appearance with no apparent visual or electrophysiological deficits. Fundus photography, autofluorescence and enhanced depth optical coherence tomography B-scan imaging modalities aid in the diagnosis. We present a case report of a 19-year-old female diagnosed with benign familial fleck retina which belongs to a heterogeneous group of flecked retina syndromes, and should be considered in patients with yellowish-white retinal lesions sparing the macula.