Pigmented Lesions of the Eyelid Margin

The eyelid area poses a diagnostic and therapeutic challenge due to its specific anatomy. The eyelid is composed of skin, orbicularis muscle, tarsus, and the eyelid margin is continuous with palpebral conjunctiva. Among pigmented tumors, benign lesions such as epidermal or intradermal nevi, freckles, lentigo, or seborrheic keratosis are the most common. Melanoma is relatively rare in this location. A suspicious lesion may be biopsied or excised. Surgery in the eyelid area requires special considerations to maintain a safe surgical margin, vital function of the eyelid, and acceptable cosmetic effect due to the exposure of the eyelid region of the face.

Allogeneic Cultivated Limbal Epithelial Sheet Transplantation in Reconstruction of Conjunctival Sac After Chemical and Thermal Burns

The study aims to evaluate the effect of allogeneic cultivated limbal epithelial cell sheet transplantation (CLET) in reconstructing conjunctival sac for severe symblepharon after chemical and thermal burns. A retrospective, non-comparative case series. Thirty-six eyes (36 patients) underwent CLET for severe symblepharon and conjunctival sac stenosis or atresia. Symblepharon was separated, and pseudopterygium was preserved to replace the palpebral conjunctiva. Allogeneic cultivated limbal epithelial cell sheet using human amniotic membrane as a carrier was transplanted into the recipient's eye to reconstruct the conjunctival sac. The effect of conjunctival sac reconstruction, eye and eyelid movement, ocular surface restitution, and symblepharon recurrence were analyzed after surgery. Symblepharon was completely relieved in 30 of the 36 eyes (83.3%) by a single surgical procedure, with fornix reconstruction, as well as free movement of eye globe and eyelids. Strip-like symblepharon remained in 6 eyes (16.7%) and was completely relieved after the second CLET. Twenty patients without visual function received prostheses 3 months after surgery and the other sixteen patients underwent different corneal transplantation for visual acuity improvement. During the follow-up period, no one had symblepharon recurrence. The transplantation of cultivated allogeneic limbal epithelial sheets offers an effective and safe alternative in the treatment of symblepharon and reconstruction of conjunctival sac in eyes with severe ocular burns, which lays the foundation for subsequent treatments.

Synthetic Fiber Granuloma Misdiagnosed as Chalazion in an 8-year-old Child

Purpose: We report a case of conjunctival synthetic fiber granuloma, which was misdiagnosed as chalazion. Case summary: An 8-year-old female patient, without any previous medical illness or ocular trauma history, visited our hospital with a prolonged mass-like lesion in the left lower palpebral conjunctiva. In her detailed medical history, she said that she often played with her doll's hair. The conjunctival mass first occurred 1 week before her visit to the private clinic. At that time, eye drop treatment was initiated under the diagnosis of chalazion. The child showed no improvement; thus, incision and curettage were performed. The mass in the conjunctiva continued to persist, so she was transferred to the hospital for a biopsy. Slit-lamp examination revealed a patterned agglomeration of fiber strands inside the mass. Complete excisional biopsy was performed under general anesthesia. Histopathological examination revealed a fibrous foreign body in the birefringence, with granulomatous inflammation surrounding it. The patient was diagnosed with synthetic fiber granuloma. Conclusions: Conjunctival synthetic fiber granulomas are easily mistaken as chalazion. If specific fibrous strands are entangled inside the mass on slit-lamp examination, diagnosis and treatment through therapeutic excisional biopsy are required under clinical suspicion.

Prediction of anemia and estimation of hemoglobin concentration using a smartphone camera

Anemia, defined as a low hemoglobin concentration, has a large impact on the health of the world’s population. We describe the use of a ubiquitous device, the smartphone, to predict hemoglobin concentration and screen for anemia. This was a prospective convenience sample study conducted in Emergency Department (ED) patients of an academic teaching hospital. In an algorithm derivation phase, images of both conjunctiva were obtained from 142 patients in Phase 1 using a smartphone. A region of interest targeting the palpebral conjunctiva was selected from each image. Image-based parameters were extracted and used in stepwise regression analyses to develop a prediction model of estimated hemoglobin (HBc). In Phase 2, a validation model was constructed using data from 202 new ED patients. The final model based on all 344 patients was tested for accuracy in anemia and transfusion thresholds. Hemoglobin concentration ranged from 4.7 to 19.6 g/dL (mean 12.5). In Phase 1, there was a significant association between HBc and laboratory-predicted hemoglobin (HBl) slope = 1.07 (CI = 0.98–1.15), p<0.001. Accuracy, sensitivity, and specificity of HBc for predicting anemia was 82.9 [79.3, 86.4], 90.7 [87.0, 94.4], and 73.3 [67.1, 79.5], respectively. In Phase 2, accuracy, sensitivity and specificity decreased to 72.6 [71.4, 73.8], 72.8 [71, 74.6], and 72.5 [70.8, 74.1]. Accuracy for low (<7 g/dL) and high (<9 g/dL) transfusion thresholds was 94.4 [93.7, 95] and 86 [85, 86.9] respectively. Error trended with increasing HBl values (slope 0.27 [0.19, 0.36] and intercept -3.14 [-4.21, -2.07] (p<0.001) such that HBc tended to underestimate hemoglobin in higher ranges and overestimate in lower ranges. Higher quality images had a smaller bias trend than lower quality images. When separated by skin tone results were unaffected. A smartphone can be used in screening for anemia and transfusion thresholds. Improvements in image quality and computational corrections can further enhance estimates of hemoglobin.

Ocular lesions in a domestic feline:

Sporotrichosis is a dermatozoonosis, caused by dimorphic pathogenic fungi of the genus Sporothrix. Although Sporothrix brasiliensis is the most frequent and pathogenic species identified from the Brazilian sporotrichosis hyperendemic, to the best of our knowledge this is the first report of its molecular diagnosis from a cat with ocular lesions. A 3-month old female, domestic feline presented an ocular manifestation with granuloma in the lower-left palpebral conjunctiva, in addition to mucocutaneous lesions in varied locations throughout the body. Samples were collected for subsequent cytopathology, fungal culture, serology, and molecular genotyping. Itraconazole was prescribed for the treatment of sporotrichosis and the animal was considered clinically cured at the end of 5 months of treatment and discharged. S. brasiliensis cat interactions can manifest with a multitude of clinical forms that resemble either infectious or noninfectious diseases. Both the need for meticulous cat physical evaluation by a veterinarian followed by accurate laboratory diagnosis are key Public Health measures in the Brazilian sporotrichosis hyperendemic area.

To Evaluate the Efficacy of Mukkadi Bidalaka and Patoladi Kashaya Parisheka in the management of Anjananamika (External Hordeolum) – A Single case study.

Anjananamika is a Raktapradhana Vartmagata Sadhya Netra Vikara caused by the vitiation of Rakta and Mamsa of Vartma due to improper Ahara and Viharas.1 The Lakshanas of Anjannamika appears to be similar to that of Hordeolum externum, acute suppurative inflammation of the eyelash follicles and its associated glands of Zeis or Moll.2 It is a Raktapradhana Vyadhi along with the involvement of other Doshas, Pittahara and Doshahara treatment can be done. All the drugs in Mukkadi Bidalaka and Patoladi Kashaya Parisheka are Chakshushya and have Pitta Shamaka properties. The case selected in this study, patient has been suffering from pain, foreign body sensation, discomfort, congestion, mild watering and photophobia in the upper palpebral conjunctiva of the left eye. Mukkadi Bidalaka and Parisheka was administered twice a day for 5 days, with follow up of one week in Anjananamika. Here a sincere effort is made to evaluate the effect of Mukkadi Bidalaka and Patoladi Kashaya Parisheka. Clinical data collected in 5 days course shows complete relief from the symptoms.

Effect of Kaulitika Varti-Madhu Ashchyotana in the Management of Kaphaja Abhishyanda with Special Reference to Vernal Keratoconjunctivitis (VKC) - A Case Study

Rationale: Vernal Keratoconjunctivitis (VKC) is a recurrent bilateral chronic allergic inflammatory disease of the ocular surface affecting mainly young children in first decade of life. As per Ayurveda, the disease VKC bears resemblance to the kaphaja abhishyanda which is one among four types of abhishyanda (conjunctivitis). The line of treatment of abhishyanda is langhana (fasting), lepana (anointing with medicated paste), swedana (causing perspiration), siravedhana (venesection), virechana (purgation), anjana (collyria application) and ashchyotana (guttae application) respectively. Based on this principle, the present case was managed with amapachanayoga and ashchyotana as per classical guidelines. Background: An Indian female aged 23 years presented in December 2020 with complaints of severe itching, watering, redness, papillae on upper palpebral conjunctiva, gelatinous opacification (approx. 2 mm in size) around the limbus and Tranta’s dots for 11 years. The patient had recurrent episodes of this illness since last 11 years. Intervention and Outcome: The patient was treated on prescribed line of treatment i.e. langhana (amapachana) and ashchyotana as described in Ayurveda for abhishyanda disease. Before treatment, the severity score determined by the 5-5-5 Exacerbation Grading Scale in VKC was 145. After the therapy, the severity score reduced to 0.00. Hence, 100% improvement in disease severity. Key words: abhishyanda, ashcyotana, amapachana, spring catarrah.

Clinical Observation of Allergic Conjunctival Diseases with Portable and Recordable Slit-Lamp Device

Background: The incidence of allergic conjunctival diseases (ACDs) is gradually increasing worldwide. Both ophthalmologists and non-ophthalmologists prescribe eye drops to treat ACDs; however, there are many cases which are treated without sufficient examination and diagnosis of the eyes. We have invented a portable, recordable, and smartphone-attachable slit-lamp device—Smart Eye Camera (SEC). The purpose of this study was to compare the diagnostic abilities of ACDs between the SEC and the conventional, non-portable slit-lamp microscope. Methods: This prospective observational study included 32 eyes of 17 Japanese patients (mean age: 21.5 ± 14.8 years; range: 11–51 years; female: 5). The severity of 10 objective signs in the palpebral conjunctiva, bulbar conjunctiva, limbus, and cornea were scored on a grading scale of 0 to 4 (0 = normal; 1+ = mild; 2+ = moderate; 3+ = severe), respectively. First, the conventional slit-lamp microscope was used to examine the grade of the ACDs. Second, another ophthalmologist filmed the eyes using the SEC and two other ophthalmologists evaluated the grades on another day. The correlation and inter-rater reproducibility in total scores among the two devices were determined. Results: Total scores of clinical signs, evaluated by the two approaches, correlated significantly (both eyes: r = 0.918 (95% CI: 0.839 to 0.959; p < 0.001)), with substantial inter-rater agreement (weighted κ value = 0.631 (95% CI: 0.601 to 0.661; p < 0.001)). Conclusions: The SEC is as reliable as the conventional non-portable slit-lamp microscope for assessing ACDs.

Amyloidosis in the Palpebral Conjunctiva Mimicking Lymphoproliferative Lesion

A 47-year-old Japanese woman presented with a 1-year history of foreign body sensation in the right eye. Upon examination, a linear soft tissue lesion in the lower conjunctival fornix was noted. The mass resembled a conjunctival lymphoproliferative lesion but was pinkish-yellow rather than salmon pink in color. Histopathology of the biopsy specimens revealed amyloidosis. Systemic workup showed no other lesions. The conjunctival lesion did not recur at 3 months postoperatively. Since conjunctival amyloidosis mimics conjunctival lymphoproliferative lesions, it is important to keep conjunctival amyloidosis as a differential diagnosis in the diagnosis of a pinkish conjunctival lesion.

Predominant role of Haemophilus influenzae in the association of conjunctivitis, acute otitis media and acute bacterial paranasal sinusitis in children

Haemophilus influenzae is a predominant pathogen for conjunctivitis, acute otitis media and acute bacterial paranasal sinusitis in children. We undertook this study to investigate the possible association among these diseases. Children younger than 18-year-old with a diagnosis of bacterial conjunctivitis plus acute otitis media and/or acute bacterial paranasal sinusitis during 2009–2018 were included. Sampling for bacterial cultures was obtained from the lower palpebral conjunctiva and/or ear discharge with cotton-tipped swabs. A total of 67 children were recruited and the age was 29.5 (± 22.4) months in average. Fifty-seven children had conjunctivitis–otitis media syndrome and eight of them had a concurrent diagnosis of acute paranasal sinusitis. Ten children had conjunctivitis and acute paranasal sinusitis simultaneously. Clusters in household were observed in 50.7% children. Most common isolates were Haemophilus influenzae (70%), Moraxella catarrhalis (18%), and Staphylococcus aureus (8%). Antibiotic resistance rate of H. influenzae was 80% for ampicillin, 18% for amoxicillin–clavulanate, and 11% for the second or third-generation cephalosporins. Apart from well-known conjunctivitis–otitis media syndrome, acute paranasal sinusitis may also be linked to conjunctivitis with a similar pathogenic process. Simultaneous presence of these infections may guide the choice of empiric antibiotics toward H. influenzae.