Background: Surgically induced astigmatism is the cause of poor postoperative vision even after uneventful cataract surgery. Aim: The aim of study was to compare the incidence, amount, type, and course of surgically induced astigmatism and visual acuity in temporal 5.5-mm clear corneal phacoemulsification and 6-mm superior scleral incision in Small incision cataract surgery (SICS). Materials and Methods: A total of 200 eyes of 200 patients with a mean age of 62 years were included in the study. Cases were randomly divided into two groups. Group A had undergone 5.5-mm temporal clear corneal phacoemulsification and group B had undergone 6-mm superior scleral SICS. Surgically induced astigmatism was analyzed by SIA software. Results: Mean age in group A was 61 (±8) years and in group B was 63 (±10) years. Mean surgically induced astigmatism in group A was 1.05 (±0.58) D, 1.13 (±0.52) D, 1.13 (±0.56) D, and 1.08 (±0.52) D on 1 ^st , 7 ^th , 21 ^st , and 45 ^th postoperative days, respectively. The change from 1 ^st to 45 ^th day was not significant. The same in group B was 0.75 (±0.58) D, 0.81 (±0.54) D, 0.88 (±0.49) D, and 0.91 (±0.47) D on 1 ^st , 7 ^th , 21 ^st , and 45 ^th postoperative days, respectively. Surgically induced astigmatism was comparable on all days between the groups. We found significant with the rule and against the rule type of astigmatism post-operatively in the temporal clear corneal incision in phacoemulsification group and in superior scleral incision in small incision cataract surgery group respectively. Conclusion: Surgically induced astigmatism was higher in the 5.5-mm temporal clear corneal group than in the superior scleral group. Clinical outcome of both surgeries was same, as there was no significant difference in the uncorrected postoperative visual acuity in between the groups.

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Background: To evaluate the role of cryotherapy of anterior retina in preventing vitreous hemorrhage in patients with proliferative diabetic retinopathy (PDR). Materials and Methods: The patients were divided into two groups: (1) retinal cryotherapy without sufficient retinal laser treatment and (2) anterior peripheral retinal cryotherapy (ARC) in addition to sufficient panretinal laser treatment. The history and management of vitreous hemorrhage were recorded. Ocular examination and fluorescein angiographic findings for recovery of vision and presence of recurrent vitreous hemorrhage and neovascularization in the two groups were compared to determine the effectiveness of adjunct cryotherapy in PDR. Results:The rate of clearance of vitreous hemorrhage in groups 1 and 2 was 11 out of 13 (85%) and 15 out of 17 (88%), respectively (P = 0.717). In patients with cleared vitreous, the complete regression rate of neovacularization in groups 1 and 2 was 2 out of 11 (18%) and 8 out of 15 (53%), respectively (P < 0.05). Frequencies of the neovascular categories at different ocular sites in each group were similar, and no statistically significant difference was found (group 1, P = 0.884; group 2, P = 0.43). Comparison of corrected visual acuity on the last follow-up to corrected visual acuity before ARC gave the following results: 19 eyes had improved visual acuity of at least two lines, and visual recovery had similar distributions (group 1, P = 0.05; group 2, P = 0.085). Conclusions:It seems that ARC combined with photocoagulation might be a helpful adjunct procedure in PDR and to prevent recurrent vitreous hemorrhage.

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Background: There has been a growing concern that trainees are infrequently observed, assessed, and given feedback during their workplace-based education. This has led to an increasing interest in a variety of formative assessment methods that require observation and offer the opportunity for feed. Mini-clinical evaluation exercise (mini-CEX) is an observation tool that facilitates the assessment of skills that are essential for good clinical care and provision of immediate feedback. The aim of this article is to sensitize academician-clinician in developing countries to mini-CEX. Materials and Methods: This observational study was conducted on 10 postgraduate students who were assessed on clinical skills, communication skills, professionalism and ethics in different clinical settings using a validated mini-CEX global rating scale. Data analysis was done. Student's scores in the first encounter and last encounter were compared to see an improvement in their performance. Results: A total of 216 encounters was observed and rated on a nine-point Likert scale. Mean score and maximum improvement were seen for Humanistic qualities/professionalism. About 100% residents found mini-CEX exercise useful. Faculty feedback was more useful than multiple encounters being observed. Over 90% patients were highly satisfied with resident behavior. The mean score for faculty satisfaction with mini-CEX was 5.33, and for the students, it was 5.48. Conclusion: Mini-CEX is an examination tool which permits evaluation based on a much broader set of clinical settings and patients. It also gives an opportunity to observe and communicate with the students in real life settings. It can be used as a tool to identify and highlight deficient areas in individual performance for further improvement.

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Duane retraction syndrome is a congenital miswiring of the medial and lateral rectus muscle. We reported a case of 12-year-old female child having left eye abduction limitation with normal adduction, widening of interpalpebral fissure of left eye on attempting abduction. She has 5 ∆ exotropia for distance and orthophoria for near in primary gaze. She has pendular nystagmus also.

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Diabetes Mellitus (DM) is an important health problem affecting wide population band globally. According to the World Health Organization (WHO) considerable numbers of individuals were diagnosed with DM, however, notable numbers are still undiagnosed due to diverse reasons. All diabetics are at risk of developing pathological complications in particular ocular complications seemed to appear early and might lead to blindness at late stages. The screening and routine medical eye care programs helped in detecting early the ocular problems allowing best possible remedy. Monitoring of such ocular problems has significant role in reducing advance stages that might lead to blindness. In an attempt of listing possible ocular problems due to DM, the author reviewed what would be most seen in practice across the ocular and visual components structurally and functionally. Assuming the article might be used as a quick reference by the clinicians involved in seeing diabetic patients.

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A chalazion is caused by an obstruction of excretion channel of the meibomian gland due to the accumulation of its own secretions. It can be ovoid, lobed, but most often it is a round nodule, variable in size, usually painless. Conservative treatment is the rule. When this fails, surgery is the only alternative, especially for nodules located far from the inner canthus due to the risk of seeing the section of lacrimal organs. This surgery is simple, with local anesthesia in adults and sometimes general anesthesia in children. It is exceptionally the cause of complications that can compromise the visual and/or vital prognosis. We have only found three cases in the literature, one apex orbital syndrome, an eyelid necrosis and one severe orbital bleeding. This observation reports a case of an eyelid gangrene associated with endophthalmitis due to Pseudomonas aeruginosa, which occurred after surgery for Chalazion in a healthy patient.

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Human vital organ systems may be affected by diabetic microvascular complications (DMC), lead to public health difficulty. Recent evidence shows genetic factors provide to the genetic and structural variants, and/or variability in disease severity play important roles in the development of DMC among the patients with similar risk factors. Several genetic loci have discovered that figure the risk of DMC as detected by genetic linkage studies. Genetic variants demonstrate for susceptibility to DMC as detected by genetic association studies. Copy number variation and interactions of gene Χ environment have been discovered by compelling analysis of structural variants. Mitochondrial DNA also acts a definite role in the development of DMC. Sequencing technologies have light important horizon on detecting rare and common genetic loci. This review focuses on the common science of the genetic context of DMC. Finally, recognition of genes or genetic loci and structural variants providing to risk of or guarding from DMC will help intuition the underlying mechanism of DMC, with conclusive suggestions for the evolvement of new medicine for diabetes mellitus complications.

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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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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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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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Pellucid marginal degeneration (PMD) is a rare ectatic corneal disease involving the inferior part of the cornea. It is difficult to differentiate between keratoconus (KCN) and PMD by slit lamp, especially in the detection of early and subclinical stages of the diseases. Corneal topography is the main diagnostic tool of PMD with characteristic diagnostic patterns “crab-claw” or “butterfly.” PMD could be mistaken as KCN, keratoglobus, and other peripheral thinning conditions such as Terrien marginal degeneration and Mooren's ulcer. Spectacles, soft and rigid gas permeable contact lens are the main visual correcting method in early stage of the disease. Different surgical techniques are available for PMD management; however, none of them were found to be effective, so further studies will be needed in the future.

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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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Background: To compare the incidence of infection and damage caused by wooden stick with that caused by other objects and evaluate other objects causing ocular injury. Setting: Tertiary care hospital in rural part of central western India. Materials and Methods: This was a prospective observational cohort study designed in 2002. Patients with all open-globe injuries in either eye, diagnosed and managed between January 2003 and December 2009, were enrolled in our study. The injuries were grouped as those caused by wooden stick and injuries by other objects. Data were collected in International Society of Ocular Trauma initial and follow-up report form and were analyzed. Results: In our study, there were 687 cases of which 496 were open-globe cases. Wooden stick is one of the most common objects of injury in a rural setting. Wooden stick associated with any infection, the final visual outcome was significantly better than that of the injury caused by other objects. (P = 0.002). The outcome measures were final visual acuity and complications. Conclusion: Despite the wooden stick being a common object of injury, it is an important predictive factor for better visual recovery and is not associated with any infection.

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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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Objective: The aim of this study is to investigate the accuracy of prediction of different biometric methods for the calculation of intraocular lenses. Materials and Methods: We examined consecutive cataractous eyes with the IOL-Master-500 as well as with the acoustic biometry and keratometry. In all eyes, the intraocular lens to be implanted was chosen by means of the SRK/T formula, based on the measurements conducted with our standard method. The achieved postoperative refraction is obtained, at least 4 weeks after surgery, by the treating ophthalmologists. The results were compared and analyzed statistically using SPSS17. Results: We examined 156 out of which 72 female and 84 were male. Comparison of eye lengths as well as of the keratometric measurements showed good correspondence between the obtained measurements by both methods, acoustic biometry yielding significantly (P < 0.001) different axial lengths than the IOL Master, and the B and L yielding significantly (P < 0.001) different mean corneal refraction power than the IOL Master. The accuracy of the refraction obtained postoperatively compared to the preoperative aim was better with IOL Master compared to acoustic method. Conclusions: The predicted systemic differences in measurement results could be verified. Significant improvement in accuracy of our postoperative refraction prediction was achieved using IOL master. The other advantages of the IOL Master are the substantial gain in time, as well as the fact that performance of the measurements may be delegated. Only shortcoming was the use of IOL master in mature cataract.

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Aim: To investigate the dry eye syndrome (DES) among patients with red eye. Materials and Methods: This is hospital-based, cross-sectional, case control study. We selected about 100 patients with red eye and 100 patients without red eye (control group) from the same area. A complete eye examination was performed including Schirmer's test and fluorescein staining. Results: The study showed that symptoms and signs in the DES patients with red eye is greatly higher than in patients without red eye (P = 0.001). The prevalence of dry eye in patients with red eye is 32% and in patients without red eye is 40%. Conclusion: Red DES is an advanced stage of DES and it reflects the severity of the DES. Schirmer's test and fluorescein staining are important diagnostic tests for dry eye and hence, they should be included in the routine examination especially in red eye patients.

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Background: Recent reports suggest an association between deranged metabolism and age-related cataracts (ARC). Aim: This study was planned and carried out to evaluate some biochemical variables as possible risk factors for the different morphological types of ARC. Materials and Methods: We compared serum Na ⁺ and K ⁺ in 100 cases of ARC and 100 age- and gender-matched controls. The ARC patients were sub-grouped according to the WHO cataract grading system into posterior sub-capsular (PSC), nuclear (NC), cortical (CC) and mixed cataracts (MC). Statistical analysis was done using t-test, ANOVA, and post-hoc (Tukey) test. The 95% CI are reported; significance was set at P ≤ 0.05. Results: Although within normal range, the overall mean serum levels of Na ⁺ were significantly higher (P < 0.001; 95% CI for difference: 2.95 to 8.56) in the cases (145.39 (±3.04) mEq/L) as compared to controls (139.63 (±13.91) mEq/L). Except for the PSC group, sub-group analyses showed significantly higher Na ⁺ levels than controls (P < 0.05). There was no significant difference in serum K ⁺ levels. Importantly, serum Na ⁺ and K ⁺ levels were within the normal reference range in all the subjects. Conclusion: This study suggests that there is a tendency to have higher Na ⁺ levels in ARC as compared to non-ARC subjects, although within normal reference values.

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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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The case report of a 60-year-old man has been presented to report the treatment of alkali injury with labial mucus membrane graft. The patient presented with fall of cement in the right eye. He had perilimbal ischemia and corneal epithelial defect and his cornea was hazy. A diagnosis of severe alkali injury was made. The cement particles were removed. He was started on topical antibiotics, steroids, cycloplegic and lubricants. Later, he developed symblepharon and perilimbal ischemia, and the corneal epithelial defect was still present. A labial mucus membrane grafting was performed. An amniotic membrane was placed over the ocular surface and a conformer was placed and topical steroids, antibiotics and lubricants were continued. At follow-up, it was noted that the graft was taken up well and her best corrected visual acuity improved to 6/18.

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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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Myopia, once seen as a simple refractive error where the image is focused in front of the retina, is now considered as an epidemic with projected estimates of half the world population becoming myopic by the year 2050. It has been shown that the prevalence of myopia is highest in Asian countries, while evidence in the Western world shows an increase in the prevalence of myopia, with a financial burden leading to uncorrected refractive errors including myopia being a major cause of avoidable vision impairment. Although no definite single cause of myopia has been proven, both hereditary factors and near work play a role in the development and progression of myopia. Inaccuracy of accommodation at near and hyperopic defocus at the periphery of the retina have been investigated as possible causes of myopia development, with research on animals providing an insight into the development of myopia in humans. Optical, pharmacological, and corneal reshaping strategies have been developed to control myopia progression with variable results. While undercorrection of myopes and correction with single vision lenses have not been proven to be effective in myopia management, other methods such as orthokeratology and use of atropine are showing evidence of controlling the progression of myopia.

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Introduction: Color vision examination is of great clinical interest in diabetes mellitus, since changes in color vision can be accepted as an indication of pathological condition. Color vision as a psychophysical measurement was performed with a view to providing an assessment of early neural functional integrity in the presence of no or minimal diabetic retinopathy. Materials and Methods: The investigation was carried out on a healthy visual system control group and a number of age and sex-matched non-insulin dependent diabetic groups with different levels of diabetic retinopathy. The psychophysical test used was the Farnsworth Munsell 100-Hue test. Results: The results were considered in terms of the presence of functional changes relative to the severity of retinopathy and the duration of diabetes. The color vision test differentiated between normal and those with diabetes but without retinopathy. Clearly the color vision score error mean is increased in the diabetic groups compared with the normal subjects and the level of the score error mean increases with the severity of retinopathy, but not to duration. Conclusion : C0 hanges in color vision are not strongly related to the duration of diabetes, but more to the severity of the retinopathy.

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Context: Globally, of 55 million ocular trauma cases occurring per year, 1.6 million are rendered blind. Intraocular foreign bodies (IOFBs) form a major subset (40%) of the penetrating eye injuries. Aims: To study the clinical presentations, visual outcomes, and the prognostic factors in penetrating eye injuries with IOFB. Settings and Design: This is a prospective cohort study conducted at a tertiary care center. Thirty-three eyes of 33 consecutive patients presenting to our center between March and December 2012 with IOFB injury were included in the study. Materials and Methods: After obtaining informed consent, detailed history and examination findings were noted at presentation. Computed tomography scanning was done in all patients. The details of the IOFB extraction procedure were noted and the patients were followed up for 3 months following the surgery. Statistical Analysis Used: All statistical calculations were performed in Stata (12.1) using the t-test. Results: Fifty-three percent were males between 15 and 30 years of age. Seventy-three percent had foreign body located in the posterior segment, whereas 27% were located in the anterior segment. The incidence of endophthalmitis was 16.67%. The final best corrected visual acuity appeared to be worse with poorer vision at presentation, larger foreign body size, scleral entry wound, and foreign body removal during a secondary surgery. Conclusions: Penetrating eye injuries with IOFB usually occurred in young males at work places. Factors leading to poor visual outcome were poor vision at presentation and larger foreign body size.

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Proptosis in childhood can be a diagnostic dilemma. We present a child who came with subacute onset, bilateral and asymmetric proptosis. He was diagnosed to have pseudotumor on the basis of imaging studies and started on systemic steroids. He responded partially, only to have a recurrence few weeks later. Baseline blood investigations showed a substantial drop in hemoglobin. Peripheral blood smear (PBS) showed atypical cells suggestive of leukemia. A bone marrow biopsy confirmed acute myeloid leukemia. The case illustrates an extra-ocular, systemic cause of proptosis, which was missed on initial presentation. The clue to the diagnosis was clinched on simple baseline tests such as hemoglobin and PBS. An extra-ocular cause, though uncommon, should always be considered in evaluation for every childhood proptosis to prevent delayed diagnosis.

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