Leber's disease is a form of primary retinal telangiectasia characterized by the presence of abnormalities in the retinal vasculature. It is an idiopathic, unilateral condition with male predilection. It is not associated with any other systemic or ocular disease. The disease has a very slow progression and can be complicated by vascular dilatations, neovascularizations, thromboses, retrovitreal hemorrhages, and macular changes. We present a case of Leber's miliary aneurysms in an asymptomatic 22-year-old male patient. His fundus examination showed aneurysmal dilatations with lipid exudation. Intravenous fluorescein angiography showed early and late leakage as well as capillary dropout with late hypofluorescence. In this case, the patient was treated with laser photocoagulation of the retina.

Purpose To study the demographics and clinical presentation of biopsied lacrimal gland lesions in a tertiary eye center and determine the accuracy of radiological imaging and blood investigations in reaching the diagnosis. We also studied the histopathological outcome of different lacrimal gland biopsy approaches. Materials and Methods A retrospective review of patients’ charts from 2014 to 2021 who underwent lacrimal gland biopsy. The data collected included demographics, clinical presentations, surgical approaches used, blood workup done, and histopathological and radiological diagnoses. The accuracy of radiological imaging in diagnosing lacrimal gland pathologies was evaluated by comparing radiological interpretation to the final pathological report. Results In a total of 48 cases, the most common lacrimal gland lesion was nonspecific inflammation of the lacrimal gland (34%, n=17) followed by lymphoproliferative lesions (25%, n=12). Females (62.5%, n=30) were more affected than males (37.5%, n=18). Other lesions included pleomorphic adenoma, angiolymphoid hyperplasia with eosinophilia, and IgG4 disease. Complete blood investigations were performed in 45.8% of patients and a systemic disease was found in only 18.2%. The initial assumptive diagnosis based on MRI and CT scan images was congruous with the histopathological diagnosis in 42% and 12%, respectively. Three surgical approaches were used for incisional biopsy in this study, including sub-periosteal, trans-septal, and palpebral lobe biopsy. Lateral orbitotomy was done in all excisional biopsy cases. We found no statistical difference in the histopathological outcome between the different surgical approaches used. Conclusion Nonspecific inflammation and lymphoproliferative disorders are the most common causes of lacrimal gland lesions. Blood work-up should not be used to waive off the need for lacrimal gland biopsy, and the diagnosis should preferably be based on histopathology results. The MRI is a useful tool to diagnose lacrimal gland lesions; however, histopathology remains the gold standard method.

Objective: Evaluate the knowledge, attitudes, and practices of surgical loupes among ophthalmologists and determine the relationship between this tool and musculoskeletal disorders. Methods: An anonymous, internet-based survey via Google forms was distributed among ophthalmologists (trainees and consultants) working in Saudi Arabia between December 2020 and January 2021. Results: 93 surveys were completed, and 82% reported pain with operating during the past 12 months. Neck pain was reported in 87%, shoulder pain 81%, and lower back pain 73%. 68% chose to rest without seeking professional care. 47% of participants exercise regularly. 69% attributed the pain to “bending or twisting your neck.” 55% of surgeons owned loupes, only a third used loupes regularly. 40% indicated limited field of vision as the main limitation. Chi-Squared analysis showed that musculoskeletal (MSK) pain is a risk among all ophthalmic surgeons. It was more prevalent among surgeons with longer experience. Higher rates of pain noted with increased surgical volume and prolonged operating time. Additionally, more frequent loupe use was associated with an increased prevalence of pain. None were found to be statistically significant. Finally, the activity level was significantly associated with a lower prevalence of pain (P = 0.028). Conclusion: We established that the majority of participants experienced occupational MSK pain. Most participants owned loupes. Only a third used loupes regularly. This is most likely due to prolonged operating time, static positioning, and neck flexion, producing the “head forward” posture. Young ophthalmologists should be encouraged to apply ergonomic principles to safeguard against future MSK injuries.

Objective To determine the preference for dacryocystorhinostomy (DCR), patient selection criteria for endoscopic DCR, endoscopic DCR technique, and barriers to adoption of endoscopic DCR. Method Cross-sectional study conducted from May-December 2021. A survey was sent to oculoplastic surgeons. Questions on demographic characteristics, type of clinical practice, technique preferences, barriers and facilitators to adoption of endoscopic DCR were included. Results 245 participants completed the survey. Most respondents were located at an urban site (84%), were in private practice (66%), and had been in practice for more than 10 years (58.9%). Sixty one percent perform external DCR as the first line procedure for treating primary nasolacrimal duct obstruction. The most common factor influencing the surgeon's decision to perform endoscopic DCR was the patient's request (37%) followed by endonasal exam (32%). The most common barrier for not performing endoscopic DCR was the lack of experience and lack of training during fellowship (42%). The most worrisome complication for most respondents was failure of the procedure (48%), followed by bleeding (30.3%). Eighty one percent believe surgical mentorship and supervision during initial cases would facilitate endoscopic DCR learning. Conclusions External Dacryocystorhinostomy is the preferred technique for treating primary acquired nasolacrimal duct obstruction. Learning endoscopic DCR early during fellowship training and high surgical volume to improve the learning curve dramatically impacts the adoption of the procedure.

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