Background: Understanding the clinical profile of keratoconus is important in the diagnosis and management of the disease. Aim: This study aimed to investigate the clinical characteristics of keratoconus patients in Sudan with respect to age and gender. Materials and Methods: Clinical records of keratoconus patients were retrospectively reviewed in a period between April and June 2015. Records were collected from Makkah Eye Complex, Alwaledain Eye Charity Hospital and Sudan Eye Center, Khartoum City. Parameters investigated included patient's demography, keratometric readings, visual acuity, and manifest refraction. Classification of keratoconus was based on Amsler-Krumeich grading system. Results: A total of 208 patients' record was found diagnosed with keratoconus. The mean age of subjects was 21.43 ± 8.91 years. Around 78% of subjects were found with bilateral keratoconus. Analysis showed that keratoconus is more common in males (55.8%) than in females (44.2%) and manifest in young age (late teenage and early 20s). Age was not correlated with disease severity (P > 0.05). No significant difference was found between both genders in term of age, visual acuities, and severity of keratoconus (P > 0.05). Conclusion: Clinical profile of Sudanese keratoconus patients looks similar to that reported earlier worldwide.

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Objectives: (1) To review progress in the prevention of blindness in Sudan compared to Vision 2020 targets. (2) To show gaps and shortfalls. Materials and Methods: Reports of national Vision 2020 program covering the period 2003-2010 are reviewed, including data generated from six RAAB surveys conducted in 2009-2010. Results: Prevalence of blindness is 1% compared to 1.5% in 2003. Cataract surgical out-put, cataract surgical rate (CSR), and IOL implantation rate increased steadily. It is estimated that 70% of the population are covered with refractive errors services. Low vision services are provided by four centers. Trachoma mapping completed for Northern Sudan except Darfur. SAFE strategy is implemented. Prevalence of childhood blindness is not known. Two centers provide specialized pediatric eye services. There is community-directed treatment with Ivermectin (CDTI) in 3 out the 4 onchocerciasis foci. Ophthalmologists tripled in number. Optometists exceeded 1000, compared to less than 500 in 2003. Secondary and tertiary level facilities increased in major cities. There is no primary eye-care program. Conclusion: Northern Sudan shows good progress in most of the components of Vision 2020, namely cataract, trachoma, onchocerciasis, refractive errors, and low vision. However, scaling up and attention to diabetic retinopathy and glaucoma are still needed to reach all the targets by the year 2020.

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Objectives: To determine the magnitude and causes of avoidable blindness in 50 years and older population of Amran and Lahj governorates, Yemen. Materials and Methods: Using the RAAB manual, 78 clusters were randomly selected, 50 people aged of 50 ≥50 years were examined in each cluster. Visual acuity (VA) was measured with a tumbling "E" chart. Ophthalmologists examined people with <6/18 in either eye. A software program for RAAB was used for data collection and analysis. Results: In Amran and Lahj, 1789 (91.8%) and 1836 (94.3%) people were examined, respectively. The prevalence of blindness (VA < 3/60 in better eye, with available correction) in Amran was 9.33%, while in Lahj it was 10.84%. The principal cause of blindness was unoperated cataract in both governorates. The three main barriers to cataract surgery were unaware of treatment, destiny /God's will and cannot afford in both Amran and Lahj governorates. Conclusion: The prevalence of blindness, severe visual impairment and visual impairment in people aged ≥50 years in Amran and Lahj governorates were relatively higher than WHO's estimate in the sub region and the principal cause of blindness was untreated cataract in both governorates.

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Aim: The aim of this study is to evaluate the corneal endothelial changes before and after neodymium:yttrium-aluminium-garnet (Nd:YAG) laser posterior capsulotomy in patients with posterior capsular opacification (PCO) among adults. Materials and Methods: This prospective non-comparative study was carried out in 200 eyes of 200 adult patients with clinically diagnosed PCO. Eyes were later subjected to Nd:YAG laser capsulotomy and followed up at 1-12 weeks to evaluate the damage caused by laser on the corneal endothelium. Computerized morphometry was used to evaluate the central corneal thickness, size, shape and cellular density, coefficient of variation and hexagonality of the endothelial cells using non-contact specular microscopy before and after laser capsulotomy. Data was analyzed using Chi-square and t-test and P < 0.05 were considered significant. Results: Endothelial cell density (ECD) varied from 1659 to 2792 cells/mm ² with a mean of 2298.7 cells/mm ² before laser treatment. At 1 week, the mean ECD was 2178.1 cells/mm ² (P < 0.0001) and 12 weeks was 2121.3 cells/mm ² (P < 0.0001). The difference between pre-laser ECD and ECD at 1-12 week was 120.6 cells/mm ² and 177.4 cells/mm ² (7.78%) respectively which was found to be highly significant. Hexagonality of corneal cells varied from 49% to 84% with a mean of 72.22% pre-laser. At 1 week, hexagonality was 71.42% (P < 0.005) and at 12 weeks was 70.22% (P < 0.0001). The difference was clinically significant. 90% patients had two or more than two Snellen's line visual improvement. Conclusion: In our study, although there was a dramatic improvement in visual acuity after laser capsulotomy, we found a significant reduction of ECD. Although Nd:YAG laser capsulotomy presents the advantage of being non-invasive and effective method to treat PCO, the corneal endothelium may be damaged by laser radiation.

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Context: Globally, there are 366 million patients living with Type 2 diabetes mellitus (DM), of which, 62.4 million are living in India alone. Thus, diabetic keratopathy is an important entity for all ophthalmologists. Aims: The study aims to identify variables associated with Type 2 DM, which correlate well with specular microscopy parameters. Settings and Design: This is a population-based case–control study aimed at determining the correlation between severity of DM Type 2 and corneal morphology. Subjects and Methods: After obtaining informed consent, detailed history of onset, duration, and treatment of Type 2 DM was ascertained. A comprehensive eye examination was done including specular microscopy using noncontact technique. Blood investigations were performed by the endocrine department for documenting whether disease was controlled or not. Statistical Tests: Unpaired t-test and linear regression analysis were used to determine the effects of multiple variables on the various specular microscopy parameters. Results: There were 100 eyes of diabetic patients with the mean age of 52.02 years, and 100 eyes of nondiabetic subjects with the mean age of 54.76. Short-term glycemic control parameter such as fasting blood sugar (FBS) and postlunch blood sugar (PLBS) showed no correlation with three specular microscopy parameters. However, HbA1c and severity of diabetic retinopathy influenced those parameters significantly. Conclusions: Corneal endothelium in diabetic patients was compromised, and it correlated well with the long-term glycemic control (HbA1c) but not with the short-term glycemic control (FBS, PLBS) or the duration of disease.

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Aim: To determine the prevalence of horizontal strabismus, the relationship between the family's socioeconomic factors and their attitude towards the child's eye health, its types, and to determine the attitude and compliance of the patients and their parents towards it among basic school children in Khartoum city between July and December 2010. Materials and Methods: A cross-sectional survey was conducted in Khartoum city among basic school children by questionnaire and eye examination. Sampling was with systematic random sampling for schools, probability proportional to size for children number in each school and systematic random sampling for children after obtaining a written consent from the ministry of basic education and parents. Results: 768 children were interviewed using questionnaire with a response rate of 100%. The questionnaires were analyzed using SPSS version 19 giving prevalence of horizontal squint of 2.8%, significant association between the father's educational level, socioeconomic status and their attitude towards eyes' health. Esotropia is the predominant type with a 2.2% and a slightly acceptable compliance towards regular eye follow up. Conclusion: Most of families didn't show good compliance towards the eye health unless they had a problem but almost all of them had the desire to know more.

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Background: Convergence insufficiency (CI) is one of the most common causes of ocular discomfort among students that it may have a negative effect on the student's school performance. Although various treatments are prescribed for patients with CI, there is a lack of studies regarding the most effective treatment. Aim: The aim of this study is to determine the efficacy of four home-based vision therapy (VT) techniques in the treatment of symptomatic CI. Materials and Methods: A Convergence Insufficiency Treatment Trial was conducted in Central Khartoum North (Central Bahri) in Sudan. A total of 273 students with mean age of 15.5 ± 2.5 years with symptomatic CI were assigned to one of the four TV groups: Pencil push-Up (n = 66), Cat card (n = 65), Brock string (n = 66), Dot card (n = 66) against placebo control group (n = 66). Data were collected using three outcome measurements: Convergence Insufficiency Symptom Survey score, Near Point of Convergence (NPC), and Positive Fusional Vergence (PFV) at near. Data were collected at baseline, after 3 weeks and at the end 6 weeks of treatment. The participants were advised to do this exercise at home 10 min per day, for 5 days a week for 6 weeks. Results: After 6 weeks of treatment, Dot card therapy group showed the best result in eliminating CI symptoms score by the mean value of 13.59 points (P < 0.001). Pencil push-up therapy group showed the best result in improving NPC by the mean value of 5.60 cm (P < 0.001). However, Cat card therapy group showed the best result in improving PFV by mean value of 7.32 PD (P < 0.001). Conclusions: All four home-based VT techniques were significantly reduced symptoms and improved NPC and PFV. The home-based VT techniques are effective option for treating symptomatic CI. There is no unified treatment suitable for all patients with CI. Therapist should deal with each patient separately.

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Aim: This study aimed to determine the prevalence and causes of childhood blindness and visual impairment among Quranic boarding schools children in Al-Gazira state of Sudan. Materials and Methods: A total of 822 children were screened, and they distributed in 8 traditional Quranic schools. The study divided into two phases, the first one was designed to detect the visually impaired children, and in the second one, the affected children were investigated deeply through inner eye, refraction, and cover test examinations. Results: The findings indicated that the prevalence of childhood visual impairment (6/12 and worse binocularly) with the best correction was 12 (1.5%) in children of traditional Quranic boarding schools in Al-Gazira state of Sudan. The prevalence of visual impairment among children was increased with the age of children (P ≤ 0.001). The uncorrected refractive errors was the main cause of visual impairment which represented (36%) of impaired children followed by cataract (21.5%), corneal opacities (21%), optic nerve lesion (10.7%), retinitis pigmentosa (3.6%), glaucoma (3.6%), and squint (3.6%). Conclusion: The study concluded that the most causes of childhood visual impairment in traditional Quranic boarding schools in Al-Gazira state of Sudan were avoidable. Uncorrected refractive errors was a major cause of visual impairment among children; this pointed out the need for urgent a comprehensive childhood eye care plan to deliver eye care services for them, through cooperation between governmental, community stakeholders, and nongovernmental organization working in the prevention of childhood blindness.

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Only few cases of Eptopic cilia have been reported in literature. Anterior ectopic cilia cause no apparent ocular symptoms and can be surgically excised for cosmetic improvement. We report a case of a 28-year-old male with anterior ectopic cilia in association with hypermetropic anisometropic amblyopia. Only 15 cases of anterior ectopic cilia have been reported in literature. Few of them were associated with some conditions such as choristoma, aberrant lacrimal glands, atopic eczema, nail–patella syndrome, and hypochromic nevus. To the best of our knowledge, this is the first reported case of anterior ectopic cilia associated with hypermetropic anisometropic amblyopia. No underlying common causative disorder became evident. The observed association was considered as coincidental.

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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.

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Aim: The aim was to study the knowledge, awareness, and practice of computer vision syndrome (CVS) in digital device users. Materials and Methods: This was an observational study conducted on 504 healthy students of a medical college. The students underwent an interview in the form of a preset questionnaire. Results: The present study comprised a total of 188 (37.3%) males and 316 (62.7%) females with the mean age of 21.98 ± 4.61 years. Awareness about CVS was poor, i.e., only 32% had ever heard of the term CVS of which around 65% could correctly define it. It was noted that more than half of the participants resorted to incorrect methods for relief of ocular symptoms. Social media was the largest source of information (15.1%). The association of age with awareness, knowledge with respect to definition, blink rate, and source of information was highly significant (P = 0.003, 0.001, 0.001, and 0.01, respectively). The association of profession of the participant with knowledge about blink rate and practice of taking a break was found to be highly significant (P = 0.002 and 0.01, respectively). Awareness about the blink rate and practice of closing eyes was significantly associated with the sex of the participant (P = 0.03 and 0.01, respectively). Conclusion: This study shows that the younger generation has significant knowledge about CVS, but there is a gap in practice. A program studying and addressing the barriers to practice needs to be developed for younger generation.

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Purpose: To evaluate the risk factors and treatment outcome of microbial keratitis in a tertiary eye care centre. Methods: A hospital based prospective study in clinically diagnosed cases with microbial keratitis were enrolled. Corneal scrapes taken and subjected to direct microscopy and culture. Empirical treatment initiated following smear report and definitive treatment commenced after culture and sensitivity report. Patients were followed up for 3 months. Treatment outcome was assessed on the basis of signs of healing, scar formation, necessity of surgical intervention and severe complications. Results: A total of 95 patients were included. Microbial keratitis was common in the age group of 51-60 years with male preponderance. It was common in people involved in agricultural works, and frequent during the agricultural season of monsoon and spring. Among the predisposing factors, history of ocular trauma with vegetative matter is common. Majority presented before 14 days of onset of symptoms and also had history of prior treatment. Organisms were identified under direct microscopy in (38.9%) of cases and isolated in (51.6%) in culture medium. Streptococcus pneumoniae (22.1%) and Aspergillus (7.3%) were the most common bacterial and fungal isolate respectively. In vitro antibiotic sensitivity demonstrated bacteria were most sensitive to ofloxacin. A total of (75.8%) patients achieved complete healing whereas (10.5%) required surgical intervention. Conclusion: Early presentation, medication compliance and timely intervention can lead to good clinical and visual outcome in patients with microbial keratitis.

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Purpose: The study aimed to determine the effect of various donor factors on utilization pattern of donor corneal tissue. Methods: This was a cross-sectional, retrospective study. Data of 509 donors with 1007 eyes details from eye bank (EB) were reviewed from December 2012 to June 2017. Donor data was analyzed including the age, sex of the donor, cause of death, source of tissue, death to enucleation time (DET), death to preservation time (DPT), type of tissue collected, grades of the tissue, serology reports and various utilization parameters. Results: Tissue utilization of EB was 356 out of 1007 which made 35.35% with cumulative utilization to the tune of 512 out of 1007 (50.84%). 82.50% tissues utilized for surgical use were from donor>65 years of age. Type and grading of tissue influenced the utilization of the tissues significantly (P = 0.00) each. Maximum keratoplasties 179 (50.28%), 202 (56.74%) were done with DET>3 hrs and DPT ≤4 respectively. DET, DPT and serology showed significant influence on the utility of the tissue (P = 0.00) each. Major cause of exclusion of the tissue for utilization was poor quality of the tissue which was C grade. Grading of tissue was significantly affected by DET, DPT and mode of tissue procured. Donor age >65 years showed higher surgical utility. Conclusion: Various donor factors like DET, DPT, tissue grade and type and serology results affects the utility of harvested corneal tissue. Potential modifiable donor factors needs to be addressed such as attention must be paid to the cause of death, contraindications and time factors related to donor.

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Background: Visual evoked potential (VEP) is a useful noninvasive neurological diagnostic tool affected by certain physical and physiological parameters, age being the major of all. However, only few baseline studies have been conducted in India and none in Gujarat. Materials and Methods: Monocular pattern reversal VEP (PRVEP) was carried out using a standard protocol in medical students of same age group. Latencies of various waveforms were calculated and effects of gender, body mass index (BMI), and head size were studied. Results: Observations revealed normative VEP latencies in line with other studies. Difference observed for only N70 wave, head size were statistical significant and that for BMI, gender, and between eyes were not. Conclusion: Normative VEP data of age, BMI-matched healthy medical students showed no ethnic variation; disproved gender influence on VEP latencies and slight sex difference observed is due to head size.

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Aim: This hospital-based study was conducted to identify common bacterial organisms and the antibiotic susceptibility of these organisms and to study the demographic profiles of patients with chronic dacryocystitis. Materials and Methods: A total of 100 patients above the age of 40 years were examined. Patients complaining of epiphora and nasolacrimal duct block on syringing were selected. Demographic factors such as age, sex, occupation and social status were recorded. Samples were collected by applying pressure over the lacrimal sac and allowing the purulent material to reflux through the lacrimal punctum, or by irrigating the lacrimal drainage system with sterile saline and collecting the refluxing material. Samples were sent for microbiological investigation and antibiotic sensitivity pattern. Results: One hundred patients were included in the study, of which the majority of patients were in the age group of 50-60 years (43%); female (52%) were more commonly affected. Majority of the patients belong to low socioeconomic status (64%) and majority were housewives (39%), and the left eye was more commonly involved (56%). All patients presented with epiphora (100%), and majority of them had mucopurulent regurgitant (71%) on sac-syringing. Of 100 clinical samples, 83% were culture positive and the remaining were reported as having no growth (17%). Among the Gram-positive organisms isolated, Staphylococcus aureus (41%) was the most common organism (1%). Most of the isolates of S. aureus were sensitive to ciprofloxacin (82.9%). Conclusion: It is important to know about microbial organisms responsible for chronic dacryocystitis as it is one of the important predisposing factors for postoperative endophthalmitis, especially due to the large volume of cataract surgery performed nowadays. Knowledge of common bacteria causing chronic dacryocystitis and their antibiotic sensitivity may help in deciding the appropriate antibiotic coverage for ocular surgery.

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Purpose: To compare two different methods of determining the post-operative position of the toric IOL and to calculate the alignment error with each method. Setting/Venue: Cataract and Intraocular Lens Implantation Service, Shroff Eye Center, New Delhi, India. Design: Case series Materials and Methods: Eighty-nine eyes of 61 patients with cataract and co-existing corneal astigmatism ranging from 1 to 4 diopters planned for toric IOL implantation were included. All eyes underwent pre-operative automated keratometry and biometry. Toric IOL cylindrical power, axis of implantation, and anticipated residual astigmatism were calculated using the web-based Acrysof Toric calculator. All eyes underwent pre-operative reference marking to denote the 0° and the 180° positions (using bubble marker) followed by digital slit-lamp photography. All eyes were operated by the same surgeon, at the same incision location. At 3 months, the achieved IOL alignment was analyzed by aligning the slit-beam of the slit-lamp with the pair of marks denoting the axis of the IOL after pupillary dilation. Additionally, the IOL position was determined after capturing a digital retro-illuminated slit-lamp photograph, which was superimposed on the pre-operative photograph using single prominent major episcleral vessel around the limbus as landmark. The axis of orientation of the toric IOL was determined using tools in Adobe Photoshop (version 7.0) by aligning a line through the marks denoting the IOL axis. The amount of alignment error (in degrees) by both methods induced with respect to the desired axis of alignment was calculated and statistically analyzed. Results: The mean pre-operative keratometry was 44.19 ± 1.51 D, and the mean corneal cylinder was 2.54 ± 0.90 D. The mean post-operative absolute cylinder was 0.57 ± 0.28 D. Toric IOL models used were T3(1.03 D): 28 eyes (31.5%), T4(1.55 D): 21 eyes (23.6%), T5(2.06 D): 18 eyes (20.2%), T6(2.57 D): 11 eyes (12.4%), T7(3.08 D): 4 eyes (4.5%), T8(3.60 D): 4 eyes (4.5%), and T9(4.11 D): 3 eyes (3.4%). Mean post-operative alignment error was 3.44 ± 2.60 D by the slit-lamp method and 3.89 ± 2.86 D by the Photoshop method with no significant difference seen between the two methods (P = 0.384). Fifty-six eyes (62.9%) by the slit-lamp method and 52 eyes (58.4%) by the Photoshop method had rotation error ≤ 5 degrees (P = 0.526), and 78 eyes (87.6%) by the slit-lamp method and 75 eyes (84.3%) by the Photoshop method had rotation error ≤ 10 degrees (P = 0.422). Conclusions: Both Adobe Photoshop method and slit-lamp observation were reliable and predictable methods of assessing IOL alignment. Although the sensitivity is more with the Photoshop method, the slit-lamp method is more accessible in an outpatient setup. The clinical outcome following toric IOL implantation can be refined by reducing the alignment error, which is dependent on an accurate keratometry and biometry, surgeon-specific SIA, reference and intra-operative marking, and finally, placement of IOL in the bag.

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Aim: To determine the barriers to cataract surgery as reported by those with cataract-induced visual impairment in Kassala state, eastern Sudan. Materials and methods: A cross-sectional, population-based survey of people aged 50 years and older. Around 2146 eligible people were identified and 2050 examined (95.5%). Participants with cataract-induced visual impairment (acuity <6/18 in better eye) were also invited to respond to a verbal questionnaire about barriers to cataract surgery. Results: Main barriers for not up-taking cataract surgery services were inability to afford (45.7%), unaware of treatment (14.2%), waiting for maturity (7.1%), contra-indication (7.1%) and unavailability of services (6.3%). Conclusion: Cost and lack of awareness are the most frequent barriers in Kassala state.

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Objective: To determine the clinical indications for destructive eye surgeries (DES) in Sokoto, North-Western Nigeria. Materials and Methods: A retrospective hospital-based study involving the review of the medical records of all patients that had DES in Usmanu Danfodiyo University Teaching Hospital and Specialist Hospital, Sokoto from January 2010 to December 2014. The age, sex, occupation, indications for surgery, and type of surgery done were recorded. Results: A total of 41 patients had DES during the study period. The mean age of the patients was 34.4 ± 17.7 years. The most frequent indication for DES was malignant neoplasms 41.4% (n = 17) followed by ocular infections 24.4% (n = 10) and trauma 24.4% (n = 10). Evisceration (n = 22) was the most common DES procedure. Conclusion: There is a need for educating the population on the dangers of late presentation, and since trauma and intraocular infections are largely preventable, public health education on safety measures is advocated.

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Goldenhar syndrome or oculo-auriculo-vertebral is a rare abnormality affecting the craniofacial region having extracranial manifestations as well. First described by Maurice Goldenhar, its etiology still remains uncertain. We report here the case of a 7-year-old boy with the classic signs of Goldenhar syndrome in the form of accessory tragi, bilateral ocular dermoids, and mandibular hypoplasia (micrognathia).

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A 52-year-old female presented with a history of bull horn injury to the right eye. Examination revealed an avulsed flap of right lower eyelid starting from a point just lateral to the lacrimal punctum up to the lateral canthus without any other ocular or orbital damage. After a thorough assessment and cleaning, lid flap was sutured in layers. Postoperative antibiotic prophylaxis was given. Eyelid wound healed without complications.

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Background: Uncorrected refractive errors continue to remain a public health problem in the different population groups. Among children, it has a considerable impact on learning and academic achievement, especially in under-served communities. Optical correction of refractive errors in children is indicated when the refractive errors are sufficiently large to cause amblyopia or impairing the child's ability to function normally. Objective: The study aimed to investigate the distribution pattern of refractive errors and related visual impairment due to amblyopia in children. Materials and Methods: The recorded data of 183 children examined at optical center during the period (2007-2011) were reviewed and analyzed to show refractive status. The examination included visual acuity measurements, cover test, and noncycloplegic refraction (retinoscopy and/or autorefraction). The best-corrected visual acuity was noted. Results: The age range of children was 5-15 years, of whom 72 (39.3%) were males and 111 (60.7%) females. There was no significant difference in the correction of the two eyes and no gender associations. In this study, 97 (53.0%) were myopic, 17 (9.3%) hypermetropic, 42 (22.9%) pure astigmatic, and 27 (14.8%) normal. An adequate improvement of vision after correction in each eye reached 1.0 (6/6) achieved in 123 (67.2%) children (P < 0.0001) while binocular amblyopia found in 46 (25.2%) children and monocular amblyopia found in 14 (7.6%). Cover test mainly for near showed 126 (68.9%) children with associated exophoria, 7 (3.8%) with esophoria, and other 7 (3.8%) have manifest strabismus, and only 43 (23.5%) have orthophoria. Conclusions: Significant refractive errors revealed among children aged 5-15 years. Therefore, there is a need to have eye examination in school-age children at least at the commencement of school so as to early tackle disabilities due to amblyopia in children.

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Purpose: To study the compliance of contact lens (CL) wearers and the prevalence of CL-related ocular complications. Materials and Methods: This was a cross-sectional study conducted from December 2012 to May 2013 which included CL wearers coming to outpatient department or emergency department where these patients underwent ophthalmic examination. An interview was performed about the use and care of CLs. Results: The study included 102 patients, where 26 (25.50%) were men and 76 (74.50%) were women. Patient's ages ranged from 13 to 55 with an average (mean ± standard deviation) 29.48 years. Results showed myopia in 41 (40.19%), hyperopia 13 (12.74%), astigmatism 37 (36.27%), keratoconus 8 (7.84%), and others 3 (2.94%). More than 2/3 of the patients had, at least, one complication in their eyes. The average complication rate of gas permeable (GP) lenses was significantly (P < 0.04) lower than soft CLs (SCLs) (0.75). The most common complications were papillae, giant papillary conjunctivitis, conjunctival injection, corneal infiltrates, and corneal abrasions in both GPs and SCLs wearers. Silicone SCLs had a lower average number of complication rates per eye (0.73) than nonsilicone SCLs (0.76), but the difference was not statistically significant (P = 0.19). Extended wear CL use was associated with higher complication rate (86.84%) as compared to daily wear CL use (67.85%) and it was statistically significant (P < 0.03). Conclusion: Use of CL is associated with ocular complications. Most of these complications are minor and easily manageable. It is advised that patients should adhere with the recommendations of both manufacturer and optometrist to avoid complications.

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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.

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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.

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Thyroid eye disease (TED) is a heterogeneous autoimmune reaction typically occurring in the orbit of middle age group. The orbital inflammation of Graves' disease may parallel or remain isolated from a related inflammatory reaction in the thyroid gland. Development and severity of TED may dependent to both endogenous (genetic factors, increased age, male sex) and, or exogenous factors (smoking, thyroid dysfunction, and radioiodine treatment). Although rescue medical therapy for severe TED is often initiated with glucocorticoids, steroid-sparing medications may be an alternative area of efficient treatment.

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