OBJECTIVE: The purpose was to study the safety and efficacy of sub-Tenon and subconjunctival anesthesia in manual small-incision cataract surgery (MSICS) in patients with hard-grade cataracts.
METHODS: The design of the study was a prospective, observational, and randomized control study.
METHODS: A total of 196 eyes, including 98 eyes in the subconjunctival anesthesia group (group A) and 98 eyes in the sub-Tenon anesthesia group (Group B), undergoing MSICS were enrolled in the study. A single surgeon performed all the surgeries. Intraoperative and postoperative pain scores, patient comfort, surgeon\'s satisfaction, and intraoperative complications were examined.
RESULTS: The mean age of patients in Group A was 66.64 ± 9.95 years and that of patients in Group B was 64.52 ± 9.46. No statistically significant difference was noted in the intraoperative (P = 0.54) and postoperative pain (P = 0.66) scores between the two groups. There was no pain (0 score) in 30% of patients in Group A and 35% of patients in Group B intraoperatively. The average surgical time (P = 0.66) and surgeon\'s comfort (P = 0.34) were not statistically significant. The mean corneal haze was 0.054 ± 0.12 in group A and 0.065 ± 0.22 in group B (P = 0.45). Two patients in group A required supplemental anesthesia. There were no surgical complications that could compromise visual outcomes. No patients in either group showed alterations in vital parameters or required intravenous sedation.
CONCLUSIONS: Both techniques of anesthesia are safe and effective for performing MSICS in hard-grade cataracts. However, it is prudent to choose a technique according to the surgeon\'s requirements.

Child physical abuse is a common cause of pediatric morbidity and mortality. Up to half of all children presenting with abusive injuries have a history of a prior suspicious injury, suggesting a pattern of repeated physical abuse. Medical providers are responsible for identifying children with suspicious injuries, completing mandated reporting to child protective services for investigation, and screening for occult injuries and underlying medical conditions that can predispose to injuries. Early identification of inflicted injuries appropriate evaluations may serve as an opportunity for life-saving intervention and prevent further escalation of abuse. However, identification of abuse can be challenging. This article will review both physical exam findings and injuries that suggest abuse as well as the evaluation and management of physical abuse.

Pterygium and subconjunctival hemorrhage are two common types of ocular surface diseases that can cause distress and anxiety in patients. In this study, 2855 ocular surface images were collected in four categories: normal ocular surface, subconjunctival hemorrhage, pterygium to be observed, and pterygium requiring surgery. We propose a diagnostic classification model for ocular surface diseases, dual-branch network reinforced by PFM block (DBPF-Net), which adopts the conformer model with two-branch architectural properties as the backbone of a four-way classification model for ocular surface diseases. In addition, we propose a block composed of a patch merging layer and a FReLU layer (PFM block) for extracting spatial structure features to further strengthen the feature extraction capability of the model. In practice, only the ocular surface images need to be input into the model to discriminate automatically between the disease categories. We also trained the VGG16, ResNet50, EfficientNetB7, and Conformer models, and evaluated and analyzed the results of all models on the test set. The main evaluation indicators were sensitivity, specificity, F1-score, area under the receiver operating characteristics curve (AUC), kappa coefficient, and accuracy. The accuracy and kappa coefficient of the proposed diagnostic model in several experiments were averaged at 0.9789 and 0.9681, respectively. The sensitivity, specificity, F1-score, and AUC were, respectively, 0.9723, 0.9836, 0.9688, and 0.9869 for diagnosing pterygium to be observed, and, respectively, 0.9210, 0.9905, 0.9292, and 0.9776 for diagnosing pterygium requiring surgery. The proposed method has high clinical reference value for recognizing these four types of ocular surface images.

Aim: To observe the factors affecting fibrovascular regrowth after pterygium excision and to compare the efficacy and complications of conjunctival autograft with sutures versus fibrin glue. Materials and methods: 65 consenting patients with primary pterygium attending the outpatient department having appropriate indications for surgery were enrolled. Data was collected using personal interviews. Routine pre-operative ophthalmic examination was done, including visual acuity assessment, slit lamp examination, and fundus evaluation. Pterygium excision surgery was done on all patients using either Fibrin Glue or 10-0 nylon sutures. Patients were followed up at weeks 1, 4, 12, and 24 and any complications were duly noted. Results: The fibrin glue group showed milder postoperative discomfort, symptoms, and signs compared to the suture group. Pyogenic granuloma (3.12%), corkscrew vessels (6.25%), and subconjunctival hemorrhage (24.99%) were more common in the fibrin glue group. FVG not crossing the limbus was observed in 6.25% of glue cases and 9.09% of suture cases, more in fleshy and large pterygia, while age and gender did not alter the incidence of FVG. No recurrences were observed in any group. Conclusion: The incidence of fibrovascular regrowth (FVG) was not affected by age, gender, smoking, and surgical technique, but was positively correlated with length and grade of pterygium. The complication rate between the two groups was not found to be statistically significant. Despite causing severe postoperative discomfort and requiring prolonged surgical time, suture-assisted pterygium surgery is a cost-effective method still being used with long-term outcomes similar to fibrin glue.

A young male in his early 30s presented with spontaneous left eye redness for three months associated with blood-stained eye discharge. There was no history of trauma, blood dyscrasias, or anticoagulant intake. On examination, visual acuity was normal in both eyes. An anterior segment examination of the left eye showed subconjunctival hemorrhage with a fleshy bright red conjunctival mass hidden in the inferotemporal fornix. Other parts of the ocular examination including the contralateral eye were unremarkable. Upon further inquiry, the patient revealed a history of a retroviral disease diagnosed eight years ago but had not pursued treatment. Systemic examination revealed a raised non-pigmented lesion of the tongue and a painless purplish plaque at the back. Investigations showed a high viral ribonucleic acid (RNA) load and confirmed the Kaposi sarcoma of the conjunctiva, tongue, and skin; cryptococcal meningitis; smear-negative pulmonary tuberculosis; and late latent syphilis. He was comanaged by multidisciplinary teams. Highly active antiretroviral therapy (HAART) was commenced. Treatment was a challenge considering the simultaneous presence of malignancy and a serious fungal infection of the brain in an immunosuppressed patient. Fortunately, three months post treatment, he showed remarkable improvement as there was almost a complete resolution of conjunctival Kaposi sarcoma. This case revealed an unusual presentation of Kaposi sarcoma affecting the conjunctiva, which could have been mistaken for simple subconjunctival hemorrhage in a young patient without informed comorbidity.

Retrobulbar hemorrhage may result in sudden accumulation of blood in the retrobulbar space which can lead to an orbital compartment syndrome. This potentially blinding condition is characterized by a rapid increase in intra-orbital pressure. While most commonly associated with orbital trauma, it may rarely occur with Valsalva events in patients on anticoagulants. In this report, we present a case of a retrobulbar hemorrhage secondary to self-induced vomiting, occurring in a patient on no anticoagulation medication.

OBJECTIVE: The aim of this study is to determine the incidence and characteristics of newborns with subconjunctival hemorrhage (SCH).
METHODS: In our study, patient files of term infants referred to the study hospital\'s ophthalmology clinic in 2018-19 were analyzed. Demographic data of infants including gestational week, birth weight, gender, and head circumference were all recorded. The frequency of SCH detection was evaluated depending on delivery type. Demographic data of infants with and without retinal hemorrhage (RH) were compared.
RESULTS: A total of 172 eyes of 86 infants were included in study. Forty-two (48.8%) of 86 neonates were male, and 44 (51.2%) were female. Mean gestational week was 38.62±1.1. SCH was detected in 31.4% (27) in the right eye, 36% (31) in the left eye, and 32.6% (28) in both eyes. The diagnosis was made at the mean of 3.74 days (range 1-20). Mean birth weight was found as 3621.1±453.3 g, head circumference as 35.4±1.3 cm, height as 50.7±2 cm, and chest circumference as 33.6±1.4 cm. Mean Apgar score in 1st min was 7.1±0.4; 5th min was 9. About 11.6% (10) of the mothers were nulliparous, and 88.4% (76) were multiparous. It was found that 79 of the deliveries were vaginal and seven with cesarean section. RH was not detected in any of the infants born with cesarean section.
CONCLUSIONS: SCH and RH were more common in infants born vaginally. If SCH is detected, a fundus examination should be performed to not miss possible RH.

Hyposphagma or subconjunctival hemorrhage is extensive confluent bleeding located between the conjunctiva and episclera. It can develop after trauma or the Valsalva maneuver and hemorrhagic diathesis and vascular diseases, hypertension, arteriosclerosis, and diabetes are the predisposing causes. It may also appear as part of the so-called congestion syndrome of the face and neck in crush or mechanical asphyxia and ligature strangulation, as well as in head-down positional asphyxia. We present two cases of heavily intoxicated individuals who were both, at the time of death, in the position with their trunks bent at the waist over their thighs and their heads down between the legs. They both had severe facial congestion with pronounced hyposphagma. The formation of extensive subconjunctival bleeding or hyposphagma resulted in hemodynamic dysregulation, a consequence of the head-down position, with a decreased venous return of blood to the heart. Since it requires preserved circulation, this finding cannot be considered solely as a mere postmortem phenomenon. Thus, in the presented cases, and especially in other cases where the blood level of psychoactive substances alone may be insufficient to explain the death, positional asphyxia, including the head-down position, could be considered a contributing cause. In such cases, hyposphagma could prove to be a valuable marker of positional asphyxia.

Unilateral proptosis secondary to ectopic lacrimal gland tissue is rare. The most common site of ectopic lacrimal gland tissue is at the bulbar conjunctiva and limbal area. Although uncommon, intraorbital ectopic lacrimal gland tissue may mimic other ominous symptoms of intraorbital neoplasm in childhood. We present a rare case of intraconal ectopic lacrimal gland tissue in a 14-year-old girl with intermittent proptosis since childhood associated with subconjunctival hemorrhage and excruciating pain. She underwent lateral orbitotomy with orbital mass excision that resulted in good outcomes and no recurrence was seen at 6 months after the surgery.

A 15-year-old female patient presented with complaints of headache, blurring of vision, and redness of both eyes for 15 days and fever for 20 days. Her best-corrected visual acuity (BCVA) was 20/40 in both eyes. Anterior segment examination was normal except for subconjunctival haemorrhage in both eyes. Examination of the posterior segment showed disc oedema in both eyes. Her blood investigations revealed platelet count to be 1.5 lakhs per cubic mm, and leucocyte count to be10,700 per cubic mm. CSF culture showed seven cells per microlitre,76% lymphocytes and CSF samples negative for gram stain, acid-fast bacilli, and culture. Further investigation for IgM titre for scrub typhus was positive. She was treated with oral doxycycline. On follow up after three weeks, both the subconjunctival haemorrhage and bilateral disc oedema resolved with BCVA of 20/20 in both eyes. She was kept on follow up and has not presented with any fresh complaints until six months after the initial presentation.\"