No abstract

Prevention and early management of post-burn cicatricial ectropion is the best strategy to avoid ocular complications, with poor visual prognosis in extreme cases. A 51-year old man presented with diminution of vision and absolute inability to close both eyes, three months after thermal burn injuries to face, upper limbs and trunk. His best corrected visual acuity (BCVA) was 1/60 in BE. He had bilateral extremely severe ectropion involving both upper and lower lids with complete inability to close the eyes. The ensuing exposure keratitis developed secondary infection by Methicillin resistant Staphylococcus aureus (MRSA) in the right eye and multi-drug resistant Pseudomonas aeruginosa in the left eye. His extreme ectropion prevented infection healing, so its release and full-thickness skin grafting was done when partial resolution of infection was noted. After three months, he had moderate residual ectropion in BE; vascularised corneal scar in the inferior part of the right eye (BCVA:20/40) and adherent leucoma in left eye (BCVA:HM). Prioritising ectropion surgery in our extreme case for infection control, facilitated corneal healing. Our case highlights the extreme consequences of not taking preventive measures or of managing incident ectropion following thermal injury to the face.

Ocular manifestations of anemia include conjunctival pallor, retinal hemorrhages, cotton wool spots, Roth spots, subhyaloid hemorrhage, venous dilatation, disc edema, and anterior ischemic optic neuropathy (AION). Retinal arterial occlusion is a very rare complication of iron deficiency anemia. We, hereby, report such a rare case of branch retinal artery occlusion (BRAO) occurring as a complication of iron deficiency anemia. A 49-year-old female presented with sudden painless diminution of vision in her right eye (RE) for 2 weeks with visual acuity of 20/120 in the affected eye and 20/20 in the left eye. Fundus examination of RE showed disc pallor, arteriolar attenuation, and retinal whitening at macula. Fluorescein angiography study demonstrated delayed filling of superotemporal branch of retinal artery, suggesting BRAO as the cause of vision loss. Thorough evaluation for underlying etiology revealed severe iron deficiency anemia (hemoglobin 3.9 g/dl). Her blood pressure, blood sugar profile, lipid profile, carotid Doppler, echocardiogram, coagulation profile, and immunological workup were all unremarkable. She was treated with packed cell transfusion and oral iron supplementation, and her vision improved to 20/40 at 1-month follow-up. Retinal vascular occlusions can occur rarely in iron deficiency anemia, and therefore anemia should be considered, while evaluation of vascular occlusion – specially in those with associated conjunctival pallor as in our case.