Cyclopentolate is an anticholinergic, antimuscarinic tertiary amine which has been widely used as a topical cycloplegic and mydriatic agent by ophthalmologists. Systemic absorption of the drug can occur transconjunctivally or through nasolacrimal duct through highly vascular nasal mucosa. This can lead to central anticholinergic syndrome which includes restlessness, hallucination, psychosis, hyperactivity, seizures, incoherent speech, and ataxia. We report a case series of three patients developing central nervous system toxicity following instillation of cyclopentolate. This article lays stress on the judicious use of this drug and outlines the steps that can be taken to reduce systemic absorption and toxicity include using the lowest available concentration of the drug.

Purpose: Dry eye is major tear deficiency disorder affecting millions of people worldwide. Materials and Methods: A cross-sectional study was conducted in the Ophthalmology Department, Central Referral Hospital, Gangtok, Sikkim. Seven hundred random patients fulfilling the inclusion criteria were examined in the eye outpatient department after informed consent. Results: Eighty-nine patients (12.7%) were found to have dry eye based on McMonnies-HO questionnaire, Schirmer's test, and tear film breakup time. There were 62 females and 27 males with dry eye. Female to male ratio was 2.3:1. The age of patients with dry eye ranged from 31 to 79 years. Conclusion: On analysis of symptoms that the patients presented, most common symptoms seen were dryness and grittiness.

Purpose: To clinically correlate the various ocular findings with the neurological status in cases of closed head injury and between ocular involvement and mortality rate. Study Design: Prospective study. Methods: In 189 patients with closed head injury, the Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) were applied to grade the severity. A detailed ophthalmological examination was carried out within 12 h of sustaining injury. Ocular neurological signs, GCS and RTS were then used to prognosticate the outcome. Apart from suturing of laceration, patients were managed by a multidisciplinary approach. Conclusion: Ocular complications occurred in 129 of 189 (68.3%) head-injured individuals with 172 cases, (91%) male and 17 cases (9%) female in the age range 3-75 years with a mean of 28.68 years. Young adult males (16-30 years) were more vulnerable to head injury. Road traffic accident was the most common cause of head injury in 130 cases (68.8%) leading to soft-tissue injuries to the globe and adnexae in maximum no. of patients. The most frequently encountered neuro-ophthalmic manifestation was pupillary involvement, followed by papilloedema and optic nerve trauma. The association between ocular signs and the outcome was significant (P = 0.003). All the patients that died had ocular signs of neurological significance. There was a significant co-relation of the GCS, neurodeficit and the ocular signs with the outcome. Pupillary abnormalities, papilloedema and lateral rectus palsy pointed towards a poorer outcome. The GCS, neurodeficit and ocular signs contribute significantly to the prediction of outcome.

Purpose: To evaluate the effect of ulcerative colitis (UC) on the choroid by measuring the choroidal thickness (CT) and also to determine any difference between CT in the Montreal classification groups. Materials and Methods: We included 36 eyes of 36 UC patients and 36 controls in the study. The UC patients were classified as ulcerative proctitis, left-sided (distal) UC, and extensive UC (pancolitis) according to the Montreal classification. CT was measured using enhanced depth imaging optic coherence tomography at the foveal center and at 500 μm, 1000 μm, and 1500 μm from the foveal center for each eye. Results: CT was significantly thinner in patients with UC than controls at 500 μm temporal to the fovea (P = 0.026), at 500 μm nasal to the fovea (P = 0.019), at 1000 μm nasal to the fovea (P = 0.042), and at 1500 μm nasal to the fovea (P = 0.013). There was no statistically significant difference between these three groups regarding the CT value (P > 0.05). Conclusions: Perifoveal CT was significantly thinner in patients with UC than in healthy controls. There was no statistically significant difference between these three groups (ulcerative proctitis, left-sided UC, and extensive UC) regarding the CT value.

Aim: The aim of the study was to analyse the effect of various donor parameters on visual outcome after optical penetrating keratoplasty (OPK). Methods: Data were reviewed retrospectively for the patients who underwent OPK. Donor factors which included the age and sex of the donor, cause of death, death to enucleation time (DET), death-to-preservation time (DPT), enucleation to utilisation time (EUT), total time (TT) in hours and recipient factors like age, sex, intraocular pressure (IOP) and best corrected visual acuity (BCVA) were analysed from preoperative and postoperative visits at range of 7-9 months. According to BCVA patients were divided into three groups as group 1,2 and 3 with BCVA of ≥6/18 ,6/24-6/60 and <6/60 respectively. Results: Donor variables like gender, cause of death, EUT and TT did not show any effect on the BCVA. The difference between DET of ≤3, >3hours and DPT of ≤4, >4 hours showed significant effect on BCVA with p value of 0.024 and 0.050 respectively. Average logarithm of minimal angle of resolution (log MAR) BCVA at last follow up was 0.75. According to BCVA maximum patients 55 (60.43%) fell into group 2. BCVA improved from the pre operative status in 81 (89.01%) of eyes. Conclusions: Donor variables shows impact on the visual outcome during short span of post OPK follow ups till nine months. Both donor and eye bank variables influence quality of donor corneas, outcome and complications of PK.

Serous retinal detachment (RD) is a rare complication of pre-eclampsia in pregnancy. We report a case of a 23-year-old primigravida with pre-eclampsia in her third trimester of pregnancy developing bilateral RD at term. After delivery, there was spontaneous resolution of the serous RD. Her best-corrected visual acuity was 6/6 in the right eye and 6/9 in the left eye on 1-year follow-up. Management of pre-eclampsia-induced serous RD is conservative, and the prognosis is good.

Orbital cellulitis refers to infection of the ocular adnexal structures posterior to the orbital septum. The infection most commonly originates from the sinuses. Mucopyoceles are infected cysts of mucous content that affect the paranasal sinuses most commonly the frontal sinus. Many of these lesions have an intraorbital extension causing vision-threatening ocular complications such as orbital cellulitis and intracranial extension causing life-threatening neurological complication like meningitis. We treated a 12-year-old female patient of acute orbital cellulitis secondary to frontoethmoidal mucopyocele with combined surgical approach - transnasal endoscopic and open surgical drainage.

We report a case of posttraumatic corneal rupture with massive hyphema followed by extrusion of intraocular lens (IOL) and complete aniridia in a patient who underwent small incision cataract surgery with IOL implantation 2 years back. Repair of the corneal wound with removal of blood from anterior chamber was done. Once the media became sufficiently clear, iris ball was discovered floating in the vitreous cavity mixed with vitreous hemorrhage. Two months after the primary repair, vitrectomy with scleral fixation lens implantation was done. Best-corrected visual acuity in the right eye was 6/12 at 1-month follow-up. In pseudophakic eyes, extrusion of IOL with total aniridia after blunt trauma has rarely been reported in literature.