Purpose The major drawback of an external dacryocystorhinostomy (ExDCR) is visible skin scar leading to poor patient satisfaction. In this study we have analyzed the skin scarring objectively after Curvilinear incision (CLI) and W shaped incision (WSI). Methods This is prospective trial done at Department of Ophthalmology at tertiary level hospital. All the patients with primary acquired nasolacrimal duct obstruction were included in the study. Patients were assigned to group A(CLI) or Group B (WSI). Cosmetic outcome was assessed by scar visibility at 1st, 3rd and 6th month postoperatively by two ophthalmologists separately, who were unaware of incision type. Results We studied 64 patients with median age 59.0 years (IQR [Interquartile range]: 50.0–66.8 years). Scar visibility was significantly (p = 0.001) more in WSI group at all follow-ups. None of the patients of CLI group showed visible scar at six months whereas ten patients (31.3%) of WSI group still had minimal scar (p < 0.001). Older patients had significantly less scar than younger patients. The time taken to perform ExDCR was significantly more with WSI (41.0 min, IQR: 40.0–44.0 min) than for CLI (33.0 min., IQR: 31.3–35.0 min); p < 0.05. Overall complication rates were similar in both the groups (p > 0.05) but extension of skin incision was more common in WSI group. Conclusions We found that CLI is more aesthetic, simpler, requiring less operative time and less incision related complications when compared with WSI.

Introduction Ocular injury is the commonest ocular emergency and can vary across geographical and socioeconomic regions. This study was conducted to determine the pattern of ocular injuries presenting to our tertiary care hospital located in Puducherry, Southern India. Methods A retrospective hospital-based study was performed and analyzed the records of the patients who presented with ocular injuries to the emergency department between January 2016 and December 2017. Data were collected using a structured format and noted the demographic profile and clinical profile of ocular injury. Results Of the 392 ocular emergencies, 318 (81.1%) were caused by ocular trauma. Mechanical trauma was most common (306; 96.2%). Males were more frequently affected (ratio; 3.7:1). Most cases of trauma belonged to the 21–30 years age group (86, 28.1%) and were caused by road traffic accidents (RTAs) (197; 64.4%). Adnexal injuries were commonest (285; 93.1%). The ocular injury was close globe type in 93 (30.4%) and the open globe in three (1.0%). Serious lid injury was present in 71 cases (23.2%). Serious injuries such as globe rupture and traumatic optic neuropathy were present in three (1.0%) and eleven (3.6%) cases, respectively. Conclusion Ocular trauma is the most common cause of ocular emergencies and RTA is the commonest cause of ocular trauma. We need to explore strategies to minimize ocular trauma as a priority.

To determine the prevalence of major systemic co-morbidities such as diabetes mellitus, systemic hypertension, chronic kidney disease and ischaemic heart disease among patients undergoing cataract surgery and to determine the demographic details of these co-morbidities among the cohort of cataract patients. Materials and Methods: A retrospective study of cataract surgery charts of those patients operated between Jan 2017 and Dec 2018 was undertaken. Assessment of age, gender, prevalence of above mentioned systemic comorbidities and their age wise frequency distribution among the cohort of cataract patients was done. Results: Among 2444 cataract charts analysed, 378 (15.47%) were found to have comorbidities. 88.6% of cataract patients with comorbidities were found to be between 50-75 years of age with a mean age of 63±8.997 years. 58.2% were females and 41.8% were males among the patients with comorbidities. Hypertension and diabetes were the highest contributors occurring in 78.1% of the comorbid patients with a mean age of 63 ± 8.2 years. Conclusion: An increasing prevalence of non-communicable diseases even in rural population, necessitates a thorough screening before cataract surgery to ensure fitness of the patients for cataract surgery.

Type 2 diabetes is the scourge of our times. Globally there are over 425 million diabetics which is projected to rise to 629 million by 2045, suffering devastating consequences resulting in significant morbidity and mortality.1-3Bringing blood sugars down can be challenging. Dietary control, lifestyle modifications and exercise can help but these can be difficult to implement.4 Medically, drugs are the usual method of bringing blood sugar levels under control but they come with their attendant risks and ongoing costs.5 Apart from drugs, the main arsenal against diabetes is exercise but due to one reason or another it is not very popular or practical. In the absence of antidiabetic medications and episodic exercises there seems to be no alternative left. So, when a person is unable to exercise or is not on hypoglycaemic agents, he is rendered defenceless against the deleterious effects of raised blood sugar levels. Regardless, muscles form the frontline defence against diabetes since muscles are the main modifiable factor in utilization of glucose by the body which they can do even in the absence of insulin.6,7 Hence, muscles need to be the first line agents to fight diabetes. However, the muscles need to be activated when the blood sugars are high, that is, within minutes or hours after meals rather than exercising in the morning or evening when the blood sugar may be relatively low. The question is ‘How do we get the muscles to start using up glucose right when it enters the blood stream?’ This is where the manoeuvres described below can help since these can be done almost anytime and anywhere. Following are the proposed manoeuvres:Calf contractions: Alternate contractions of calf muscles of each leg while sitting, giving a good squeeze to the calf muscles. Alternatively, one or both calves can be contracted and held for some time. This manoeuvre can be done even while lying in bed.Pectoral pressure: One or both pectorals can be contracted and held for 30-60 seconds-longer the better. The strength of contractions will depend on one’s motivation and ability. Alternatively, moderate contractions can be maintained for a longer duration.Shoulder squeezes: The back has some of the strongest muscles which can be used to ‘pulverise’ the sugars. In this method the person can sit slightly bent forwards and the shoulders are pulled back and held in that position for 30-60 seconds.These manoeuvres can be done either singly or combined with other manoeuvres described or with dietary modifications, regular exercises or medications for greater efficacy.Of course, like the antidiabetic medications, these manoeuvres need to be titrated, especially when combined with hypoglycaemic agents, otherwise they can lead to hypoglycaemia.8 Even without antidiabetic medication they have the ability to cause hypoglycaemia, if done excessively. Once the muscles get used to these manoeuvres it will be easier for them to use glucose and keep blood sugars down.

Hypertension is a leading cause of morbidity and mortality and is associated with the risk of cardiovascular, cerebrovascular disease, and target organ damage. The risk increases exponentially in individuals with diabetes. Hypertensive retinopathy is a marker for target organ damage, so screening for hypertensive retinopathy helps in cardiovascular risk stratification. This study was conducted with an objective to screen for hypertensive retinopathy among known diabetics using a portable non-mydriatic fundus camera to ascertain its prevalence. The study was conducted in three selected field practice areas of the Department of Community Medicine. A house-to-house survey was performed using a predesigned, pretested questionnaire among 302 known diabetics. The study participants were subjected to visual acuity examination using Snellen's chart and retinal fundus examination using a portable non-mydriatic Bosch Mobile Eye Care Solutions fundus camera. The fundus images were transferred to a laptop and were reviewed and graded by an experienced Ophthalmologist. Among the 302 participants studied, 60 were diagnosed with hypertensive retinopathy. The prevalence of hypertensive retinopathy among diabetic patients was 19.9 % (95% CI: 15.7% - 24.6%). The prevalence was found to be higher in ** (21.8%; 95% CI: 16% - 28.6%) as compared to ** (17.5%; 95% CI: 11.8% - 24.6%). Early detection of hypertensive retinopathy with cardiovascular risk stratification and initiation of prompt treatment among the high-risk individuals will help reduce the morbidity caused due to end-organ damage and premature mortality to a greater extent and will pave the way forward to achieving sustainable developmental goals.