Duanes retraction syndrome is characterised by restriction of ocular motility, changes in palpebral fissure width and globe retraction. Keratoconus is a bilateral, progressive non-inflammatory corneal ectatic disease characterised by central or paracentral thinning and steepening causing irregular astigmatism. We report a case of rare association of DRS with keratoconus in the contralateral eye in a thirteen year old male child. The ocular motility revealed left DRS with exotropia. Corneal topography, based on new Scheimpflug and placido-disk analyser, revealed the findings consistent with features of keratoconus in the right eye. There were no associated systemic abnormalities. This case gives evidence of the importance of cycloplegic refraction which provided a clue towards suspecting keratoconus. It also highlightsthe fact that a patient with DRS should be examined thoroughly to rule out any associated ocular anomalies.

BACKGROUND In paediatric group patients, management of Epiphora is a stepwise process starting with probing at the age of 9-12 months and it results in high cure rates. For persistent watering and discharge following repeated probing, more invasive procedures like Balloon Dacryocystoplasty or external and endonasal Dacryocystorhinostomy are required in older children. Our study was designed to evaluate the indications, intra operative events and surgical outcomes of external dacryocystorhinostomy in children. Design-A descriptive study was carried out in the Department of Paediatric Ophthalmology at Sarojini Devi Eye Hospital including children undergoing external Dacryocystorhinostomy in the year 2017 with a minimum Post Op follow up of six months. MATERIALS AND METHODS The children aged between 7-14 years attending the OPD of Paediatric Ophthalmology were recruited for study numbering 50. The data collected regarding age, sex of the patients, side of the obstruction, indication for surgery, intra operative events, follow up period, post-operative complications and post-operative results. In our study, follow up period was at least 6 months. Data of the 50 patients are statistically analysed and presented. RESULTS In our study, the mean followup period was 8.78 months and age of the patients ranges from 7 years to 14 years with a mean of 8.71 years. The complication rate is low as successful outcomes seen in 47 cases (94%) against failed patency in two cases (4%) and in 2% cases there is partial patency resulting in occasional watering. Incidence in males was slightly higher (60%) than in females (40%). CONCLUSION External DCR is a cost effective and efficient surgical treatment for Congenital NLDO or acquired lacrimal obstruction causing epiphora in children.

BACKGROUND Commonest cause for congenital dacryocystitis is obstruction at the lower end of nasolacrimal duct. It is due to an imperforate membrane at the lower end of nasolacrimal duct and usually affects the babies with permanent closure of the Hasner membrane. The aim of this study was to identify the organisms responsible and to determine the antibiotic sensitivity pattern in case of Congenital Nasolacrimal Duct Obstruction (CNLDO). MATERIALS AND METHODS This descriptive study was conducted on 183 eyes of 175 patients under the age of 2 years attending a Government Tertiary Care Eye Hospital from January 2017 to January 2018. In this study, infants and toddlers attending paediatric OPD with nasolacrimal duct obstruction problems, discharge was collected from the puncta with a moistened sterile swab without touching the lid margin or adjacent skin and sent for culture and sensitivity test. All the patients were kept on antibiotic drops depending on the sensitivity test reports and managed conservatively. Study Design-Descriptive study. RESULTS Out of 175 patients, Gram +ve cocci constituted the major bacterial isolate 97.0.1% with Staphylococcus epidermidis 73.88% predominating. Most effective antibiotic was Gatifloxacin. CONCLUSION The commonest organism found was Staphylococcus epidermidis sensitive to Gatifloxacin and the conservative treatment of congenital dacryocystitis shows excellent results, providing treatment based on antibiogram.

Background: The aim and objective of the study was to calculate intraocular lens power with IOL master in 100 eyes of 100 patients with long axial lengths between 25mm to 32mm.To analyse and compare the results of various formulae by postoperative auto refractometry and corrected distance visual acuity and to know the most accurate formula for highly myopic eyes (Axial length more than 25.00 mm). Methods: Patients coming to Sarojini Devi Eye Hospital from December 2012-September 2014 for cataract surgery were considered in this study. All patients with visually significant cataract having fundus findings within normal limits were included in this study and patients of complicated cataract due to trauma, uveitis, Glaucoma and any corneal pathology were excluded from the study. Results: The Mean AL was 27.25 ± 1.25 mm, the Mean keratometric value was 43.62 ± 1.45 D, and the Mean Absolute Error (MAE) calculated by the Haigis was 0.07 DD. Compared to the MAEs generated by the other formulae, the MAE generated by the Haigis was comparable to that by the SRK/T (0.231 D), and significantly lower than those by the Hoffer Q (0.481 D) and Holladay (0.864 D). Conclusions: The Mean post-operative refractive error (spherical equivalent) was found to be the least with Haigis formula followed by SRK/T for eyes with long axial length. The HAIGIS formula has a better predictability and accuracy. The postoperative hyperopic shift was comparable between HAIGIS and SRK-T formulae the least postoperative hyperopic shift with Haigis formula compared to other formulae.

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