Vision Science and Eye Health Journal

Navigating Recurrent Corneal Injury: Addressing Challenges in Lawnmower-Related Ocular Trauma

Fitri Setyani Rokim — 2025-03-04

Introduction: Ocular trauma resulting from workplace accidents, such as those involving lawnmowers, can cause severe eye injuries, potentially leading to significant visual impairment. Case Presentation: A 42-year-old male presented with sudden vision loss, redness, and pain in the right eye following a workplace accident. Examination revealed a full-thickness corneal laceration, hyphema, and anterior chamber prolapse of the iris and vitreous. The patient underwent a surgical repair. However, recurrent injuries necessitated additional intervention, ultimately resulting in a corneal leucoma. Although postoperative symptoms initially improved, wound dehiscence led to recurrent vitreous leakage, complicating recovery. This case highlights the challenges associated with managing recurrent corneal injuries and underscores the importance of precise surgical techniques to optimize outcomes. Conclusion: This case emphasizes the complexity of recurrent ocular trauma, particularly in workplace-related injuries such as lawnmower accidents. A comprehensive patient history, individualized management approach, and multidisciplinary collaboration are essential for improving visual prognosis and surgical success.

Multifocal Keratitis in 23-year-old Woman with β-Thalassemia

Annisa Kinanti Asti — 2025-03-17

Introduction: Multifocal keratitis can result from infectious and non-infectious causes, and its etiology is often challenging to pinpoint. Ocular complications are common in β-thalassemia and can have serious consequences. This case highlights an unusual presentation of multifocal keratitis in a patient with β-thalassemia. Case Presentation: A 23-year-old woman with β-thalassemia, diagnosed 12 years ago, was referred by a hematologist for pain in her right eye persisting for the past two weeks. She reported redness, tearing, and light sensitivity. Six months prior, she experienced similar symptoms, which had left a white spot in her right eye. Recently, this spot had multiplied and spread across the ocular surface. Visual acuity (VA) was 6/40 in the right eye on examination. Findings included palpebral spasm, conjunctival and pericorneal injection, and multiple infiltrates on the anterior corneal surface. Fluorescein staining was positive for numerous infiltrates. Schirmer and break-up time (BUT) tests indicated an unstable tear film. Treatment included antibiotic eye ointment, preservative-free artificial tears, mucous membrane pemphigoid (MMPs) inhibitors, and oral ascorbic acid. Two weeks later, VA improved to 6/9, with a reduction in infiltrates and fluorescein staining. Conclusion: Prompt management is essential for preserving vision and preventing complications in ocular surface diseases while diagnostic procedures are underway.

Bilateral Pigment Dispersion Syndrome (PDS) in a Young Female Patient

Anindya Ramadian Karunika — 2025-03-17

Introduction: Pigment dispersion syndrome (PDS) is characterized by pigment accumulation in the anterior chamber and a concave peripheral iris. Many PDS patients are not diagnosed until the disease has progressed to pigmentary glaucoma or other visual problems. Since glaucoma is the primary cause of permanent blindness globally, it is crucial to perform a thorough examination on patients with PDS to identify early indicators of pigmentary glaucoma (PG). Case Presentation: A 17-year-old female presented to the ophthalmology outpatient unit with eye pain and headache. The intraocular pressure (IOP) in the right eye was 30 mmHg, while in the left eye, it was 20.5 mmHg due to the peripheral iris' concavity and heavy pigmentation in the trabecular mesh in both eyes. The patient was diagnosed with pigment dispersion syndrome in both eyes and was given timolol maleate 0.5% eye drops. A follow-up examination revealed a decrease in the IOP and pain. Conclusions: Many young PDS patients go undiagnosed, and those with glaucoma are misdiagnosed as having juvenile onset glaucoma or primary open angle glaucoma. When high IOP is seen in young myopic patients, a thorough evaluation of the anterior segment is required. The patient should be aware of the progression of PG, and regular follow-up is recommended.

Comprehensive Surgical Approaches for Paralytic Esotropia

Fredy Widayanto — 2025-04-16

Introduction: Paralytic esotropia occurs due to paralysis of the lateral rectus muscle due to sixth nerve paralysis. One of the etiologies of sixth nerve palsy is trauma. Examination and holistic management should be done in patients with sixth nerve palsy, as this condition will have a psychosocial impact on the patient. In this case series, the authors will report on the different approaches to comprehensive management in paralytic esotropia cases. Case Presentation: The first patient had 30Δ paralytic esotropia in the right eye for ten months after an accident, experiencing diplopia in the primary gaze worsening in the left gaze, with abduction limitation. He underwent a 7 mm medial rectus recession as the first step, followed by vertical rectus transposition with Foster modification after three months. This treatment successfully restored orthophoria with no diplopia in the primary gaze. The second patient developed paralytic esotropia (10) after a traffic accident one year prior, with minimal motility limitation. He underwent a 4 mm medial rectus recession, restoring binocular vision and allowing him to return to work. Conclusion: Sixth cranial nerve paralysis is the most common cause of eye-related nerve paralysis, leading to loss of lateral rectus muscle function, diplopia, and significant psychosocial impacts. Surgical treatment for chronic paralytic esotropia depends on the severity of muscle weakness, with different procedures recommended based on the ability of the lateral rectus to contract. Case studies showed that appropriate surgical interventions, such as medial rectus recession and vertical rectus transposition, effectively managed the condition and improved patient outcomes.

Association Between Dry Eye and Sleep Quality in an Elderly Chinese Population in Taiwan: The Shihpai Eye Study

Su-Ying Tsai — 2025-03-04

Introduction: Dry eye symptoms often do not align with test results, and discrepancies between symptoms and clinical signs are common. Interestingly, dry eye symptoms correlate more with non-ocular conditions than clinical signs. Purpose: Our study explored the link between dry eye symptoms, signs, and sleep quality among the elderly. Methods: This community-based cross-sectional survey targeted vision and eye diseases in non-institutionalized individuals aged 65 and older. It began with a structured questionnaire on dry eye symptoms and the Pittsburgh Sleep Quality Index (PSQI), followed by a standardized ophthalmic examination, including slit lamp and dry eye tests. Results: Frequent dry eye symptoms were significantly associated with poor sleep quality (OR: 1.92; 95% CI: 1.36-2.70). Positive dry eye symptoms with tear break-up time ≤ 10 sec (OR: 1.78; 95% CI: 1.25-2.52) and a Schirmer test ≤ 5mm (OR: 1.61; 95% CI: 1.10-2.34) were linked to poor sleep quality, as was having meibomian gland disease (OR: 1.60; 95% CI: 1.09-2.32). Dry eye symptoms were also associated with the use of sleeping medication (OR: 1.41; 95% CI: 1.01-1.95). Subjects with dry eye symptoms and tear break-up time ≤ 10 sec (OR: 1.59; 95% CI: 1.13-2.22) or a Schirmer test score ≤ 5mm (OR: 1.46; 95% CI: 1.01-2.08) were more likely to use sleeping medication. Conclusions: Our study showed dry eye, especially dry eye symptoms, significantly impacts subjective sleep quality and the use of sleeping medication in the elderly. The causal relationship between sleep quality and dry eye requires further investigation.

A Cross-Sectional Study of the Prevalence of Keratoconus in Patients with Astigmatism More than Two Diopters

Zinatus Sama — 2025-03-04

Introduction: Patients with astigmatism, especially those with more than two diopters, appear to have keratoconus as a co-morbidity. Understanding the coexistence of these two diseases may aid in these patients' early detection and management. Purpose: The purpose of the present study was to establish the rate of keratoconus among the patients with >2D astigmatism in Bangladesh. Methods: 80 astigmatic patients >2D among the age group 10-45 years old participated in this cross-sectional study between May and August 2024 at Noor Makka and Makka Eye Hospitals, Dhaka, Bangladesh. Keratoconus and subclinical cases were identified by using corneal topography, slit lamp, and corneal asymmetry, along with general visual evaluation by an ophthalmology consultant. Statistical package for the social sciences (SPSS) software was used as the data analysis tool. Results: This study analyzed the socio-demographic information and the eye characteristics of people with astigmatism. Out of 80 studied participants, keratoconus appeared in 65%, mainly from the age group 17-30 (56.25%). Among the study participants, males and females were 47.50% and 52.50%, respectively. The average astigmatism level was recorded at 4.697 diopters. The research established a significant statistical correlation between Keratoconus diagnosis and corneal biomicroscopy (p = .001) and corneal topography (p = .000), where most of the keratoconus patients showed thinning patterns in their stromal structure. The research also established a connection between age and gender to keratoconus. Conclusions: This cross-sectional study revealed a high prevalence of diagnosed keratoconus among astigmatic patients, particularly affecting younger individuals.

PEEK Acuity and its Potential to Improve Visual Acuity Screening

Pikasa Retsyah Dipayana — 2025-03-04

Introduction: Uncorrected refractive errors contribute to 43% of the leading causes of global visual impairment. Early screening is essential to detect visual impairment and to plan early intervention. Portable eye examination kit (PEEK) Acuity has the potential to help improve early detection; however, its validation needs to be studied. Purpose: To carry out a validation test of PEEK Acuity as a visual acuity examination tool compared to the Snellen Chart. Reviews: PEEK Acuity is a smartphone-based screening modality that can be used offline and has a low false positive rate. Several studies have been conducted to evaluate the accuracy of using the PEEK Acuity application. The duration of examination using PEEK Acuity is also said to be significantly shorter than that of using Snellen Chart in preschool-age children. Conclusions: The PEEK Acuity application can currently be considered a viable alternative for vision screening, especially for widespread screening in both the community and school-aged children who require a high level of specificity to avoid errors in identifying cases.