m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 2 ( 2 0 1 6 ) 2 7 0 -2 7 6 a r t i c l e i n f o The use of these devices has made our life simple in household work as well as in offices.However the prolonged use of these devices is not without any complication. Computer and visual display terminals syndrome is a constellation of symptoms ocular as well as extraocular associated with prolonged use of visual display terminals. This syndrome is gaining importance in this modern era because of the widespread use of technologies in day-to-day life. It is associated with asthenopic symptoms, visual blurring, dry eyes, musculoskeletal symptoms such as neck pain, back pain, shoulder pain, carpal tunnel syndrome, psychosocial factors, venous thromboembolism, shoulder tendonitis, and elbow epicondylitis. Proper identification of symptoms and causative factors are necessary for the accurate diagnosis and management. This article focuses on the various aspects of the computer vision display terminals syndrome described in the previous literature. Further research is needed for the better understanding of the complex pathophysiology and management. #

Treacher Collins syndrome is a congenital disorder with bilaterally symmetric anomalies of the structures developing from the first and second branchial arches. The ocular and orbital features are an obligatory component for the diagnosis. We presented a case of typical, complete syndrome and also reviewed the varied ophthalmological manifestations of the disease in the literature. Antimongoloid slanting of palpebral fissures and lower lid colobomas are constant features of the syndrome. However, varied ocular and lacrimal drainage anomalies are also associated. TCS is a syndrome with multiple ocular and orbital features, a knowledge of which will help in the diagnosis of incomplete forms of the syndrome.

A 13-year-old male child presented to out patient services of Ophthalmology department with the complaints of muddy discolouration and irritation of both eyes. On clinical examination the child was having telecanthus, broad nose with extreme gaze nystagmus . His uncorrected visual acuity was 20/20 in both the eyes. Muddy discolouration of conjunctiva and papillary hypertrophy was visible in both eyes. Intra ocular pressure was 14mmHg and 16mmHg in the right and left eye, respectively. On slit lamp examination, cornea was clear and transparent in both eyes, but patient was found to have small multiple hypo-pigmented elevated lesions over the iris suggestive of Lisch nodule in both eyes . Pupillary reactions and fundus examination did not reveal any abnormality. Patient was also having multiple pigmented lesions over the trunk . Lisch nodule with multiple hyper-pigmented skin lesions prompted us to rule out a neurocutaneous syndrome. Therefore, patient was referred to the paediatric department for further evaluation.On paediatric evaluation, patient was found to have multiple pigmented flat lesions of 2mm to >5mm in size suggestive of cafeau-lait spots over the front and back side of the trunk and over the lower extremity [Table/ Fig-1c,d]. Two hyper-pigmented elevated lesions, rubbery in consistency one over the left hypochondrium region and another over the inner side of right thigh were present and suggestive of plexiform neurofibroma . One neurofibroma was noted over the left external auditory canal. Axillary and inguinal freckling was seen. No neurological deficit was noted. Magnetic Resonance Imaging (MRI) of brain was ordered to rule out any neurological lesion. MRI brain showed the abnormal hyperintense lesion on T2W image over the right side of brain involving basal ganglia region suggestive of Unidentified Bright Objects (UBO) [Table/ Fig-1f]. Sphenoid wing dysplasia was not noticed.Based on paediatric, ophthalmological and neurological examination, the diagnosis of Neurofibromatosis type 1 (NF-1) was made. He is the only child of his parents and family history was insignificant for such lesions. Patient was treated for allergic conjunctivitis with topical fluorometholone and carboxy-methylcellulose 0.5%, 4 times per day in both eyes. Patient was kept under observation and asked for an annual examination. CaSe 2A 15-year-old male child presented to Ophthalmology outdoor services with the complaints of huge swelling over the right upper eye lid, brow and forehead area covering the whole right eyeball externally. Patient had history of this swelling since birth which is gradually progressive in nature. The similar swelling behind the left ear pinna was also noted since five years which is gradually increasing in size. No other ocular complaints were noted.On clinical examination, a localized well defined mass extending from below the medial canthus involving the upper eye lid, bridge of nose, eyebrow area and forehead giving the appearance of S-shaped mechanical ptosis obscuring the right eyeball completel...

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