Aim: To describe the prevalence and incidence of iris atrophy in patients with multibacillary (MB) leprosy. Methods and patients: Prospective longitudinal cohort study. 301 newly diagnosed patients with MB leprosy were followed up during the 2 years of treatment with multidrug therapy (MDT) and for a further 5 years with biannual ocular examinations. Incidence of iris atrophy was calculated as the number of patients with iris atrophy per person-year (PY) of follow-up among those who did not have iris atrophy at baseline. Stepwise multiple regression confirmed the presence of specific associations of demographic and clinical characteristics (p,0.05) with iris atrophy, detected by univariate analysis. Results: Iris atrophy was present in 6 (2%) patients at enrolment. During MDT, with 445 PYs of follow-up, 9 patients developed iris atrophy (IR 0.02, 95% CI 0.01 to 0.04) that was associated with cataract (HR 15.13, 95% CI 3.71 to 61.79, p,0.001) and corneal opacities (HR 6.83, 95% CI 1.62 to 28.8, p = 0.009). After MDT, with 2005 PYs of follow-up, 60 patients developed iris atrophy (IR 0.03, 95% CI 0.023 to 0.039) that was associated with age (per decade; HR 1.40, 95% CI 1.10 to 1.78, p = 0.006), skin smear positivity (HR 3.50, 95% CI 1.33 to 9.24, p = 0.011), cataract (HR 3.66, 95% CI 1.85 to 7.25, p,0.001), keratic precipitates (HR 2.76, 95% CI 1.02 to 7.47, p = 0.046) and corneal opacity (HR 3.95, 95% CI 1.86 to 8.38, p,0.001). Conclusions: Iris atrophy continues to develop in 3% of patients with MB leprosy every year after they complete a 2-year course of MDT, and is associated with age, increasing loads of mycobacteria, subclinical inflammation, cataract and corneal opacity.

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A 40-year-old male presented with a history of caterpillar fall in his right eye with subsequent foreign body feeling, discomfort, and redness to a tertiary care facility in southern India. His best corrected visual acuity in both eyes was 6/6. The IOP in both eyes were within normal range. Multiple caterpillar hairs were seen during a thorough examination of the right eye, in the palpebral conjunctiva, the superficial and deep corneal stroma, and the anterior chamber. There was no anterior chamber reaction. The fundus examination were within normal limits. Under topical anaesthesia, caterpillar hairs in the conjunctiva were removed with the help of forceps. The patient was started on topical steroids and antibiotics. The patient was carefully monitored. The patient's symptoms had improved. During the next visit, caterpillar hairs in the superficial cornea was removed. Despite having hairs in the anterior chamber, this patient had no anterior or posterior chamber reactivity. Two hairs on the iris were visible during the next follow-up, but there were none in the cornea or conjunctiva. The patient is still being followed up on regular basis (9 months). Caterpillar hairs have the capacity to move intraocularly through the cornea and are known to elicit an inflammatory response in the eye. Therefore, it is important to be aware of the potential for intraocular inflammation following the quiescent stage.

We present a case series of late-onset Pseudophakic cystoid macular edema who presented 10 years to 4 years after cataract surgery with recent-onset diminution of vision. Their vision in the affected eye ranged from 6/24 with an OCT macular map showing multiple cystoid spaces suggestive of cystoid macular edema. Other causes for CME were ruled out. The central macular thickness ranged from 577 to 557 microns. All the patients received a single dose of 0.1ml of 4mg/ml intravitreal triamcinolone acetonide. On the first postprocedure day, all the patient's visual acuity had improved to 6/6 and OCT showed a significant reduction in central macular thickness to 387-301 microns. This improvement in vision and macular thickness persisted at 3 months follow up. Late-onset of pseudophakic cystoid macular edema is a rare cause of postoperative vision loss, economically and easily treatable with a single dose of intravitreal triamcinolone.

Pseudoexfoliation syndrome is seen commonly above 60 years of age. It can lead to various complications such as poor dilatation of pupil, increased IOP and intraoperative complications such as zonular dehiscence or capsular rupture, vitreous loss and subluxation of intraocular lens. Pseudoexfoliative glaucoma is one of the common types of secondary open angle glaucoma. Pseudoexfoliation syndrome can also cause ocular surface disorders due to tear film instability. Hence this study was done to assess the prevalence of dry eyes in patients with pseudoexfoliation. Materials and Methods: This was a descriptive study which involved 150 eyes with pseudoexfoliation syndrome. Tear secretion assessment was done using Schirmer's test I. Then the tear film stability was evaluated using Tear break-up time(TBUT). Ocular surface damage was assessed using Fluorescein staining and Lissamine green staining. Result: Schirmer's test I, 144 eyes out of 150 eyes had Schirmer's test value more than 15 mm (96%). 4 eyes (2.6%) had value between 10-15 mm .2 eyes (1.4%) had value between 5-10 mm. Six eyes with dry eye syndrome were identified by Schirmer's test I. Tear breakup time was decreased in 3 eyes (between 7-9 seconds). Three eyes with dry eye syndrome were identified by TBUT test. Fluorescein staining was positive in one eye. Lissamine staining was positive in 2 eyes with score of 2 and 3. In this study of pseudoexfoliation patients, there were 9 eyes(6%) with dry eye syndrome. Conclusion: Early recognition of dry eye syndrome in patients with pseudoexfoliation syndrome can reduce ocular morbidity and prevent a significant compromise in their quality of life.