Ocular burns can have three origins: chemical (by acid or alkaline agents), luminous (by ultraviolet radiation) or thermal. We report the cases of eight patients with ocular burns (3 thermal and 5 chemical). Of these, one patient had a grade 2 burn according to the Dua classification, two had grade 3 damage and one had grade 4. One patient had grade 3 damage in the right eye and grade 4 in the left eye. Anterior segment optical coherence tomography (AS-OCT) was performed in two patients, showing corneal de-epithelialization, corneal thickening and a hyper-reflective line in the posterior stroma. All patients received medical treatment with topical antibiotics, topical corticosteroids, cycloplegics and wetting agents. Five patients had outpatient treatment with clinical improvement. Three patients were hospitalized, one of whom received an amniotic membrane graft (AMG), one had an AMG followed by a transfixing keratoplasty (TK), and the other is scheduled for a TK. Ocular burns are associated with significant functional risk, warranting prompt and effective management.

BACKGROUND: To describe a case of orbital spindle cell carcinoma which presented with limbal ischemia and briefly review the literature.
METHODS: Retrospective case report and brief literature review.
RESULTS: A 61-year old man presented with blepharoptosis, periorbital pain, decreased vision and limbal ischemia. He did not mention any previous illness and did not take any kind of drugs. Imaging revealed an orbital mass that was positive for SMA, Vimentin and CD99 and negative for S100. We treated the patient with chemotherapy and followed him for other complications that occurred throughout disease course.
CONCLUSIONS: Spindle cell carcinomas are a rare variant of squamous cell carcinoma (SCC) with dual malignant histologic differentiation of squamous and mesenchymal cells. Few cases of orbital spindle cell carcinoma have been reported, which have been either secondary to distant metastasis or regional spread. In this study, we have reported the first case of primary orbital spindle cell carcinoma presenting with limbal ischemia. Further studies are needed to describe the different clinical presentations and management strategies of this rare clinical entity.

BACKGROUND: Omnigen is a vacuum-dehydrated amniotic membrane transplant. It can be delivered to the eye pre-mounted on a special bandage contact lens (Omnilenz) that enables its application without the need for sutures or glue; the aim of this study is to evaluate the short-term clinical outcomes of Omnilenz-Omnigen complex in eyes with acute chemical injury (CEI).
METHODS: A prospective interventional study included patients with different grades of acute CEI attending the casualty between July 2021 and November 2022. All patients received first aid measures followed by the application of Omnilenz-Omnigen within the first 2 days. Patients were followed up for at least 1 month. Primary outcomes include epithelial defect and limbal ischemia. Secondary outcomes include best-corrected visual acuity (BCVA) and tolerability.
RESULTS: The study included 23 eyes of 21 patients with acute CEI mostly due to alcohol (34.8%). After the 1st application, the size of the epithelial defect showed a statistically significant reduction (p = 0.016) with improvement in BCVA (p < 0.001). Restoration of the limbal vascularity was obtained in 56.5% of the eyes. Repeated application of Omnilenz was required in 5 eyes (21.7%). The size of the epithelial defect was reduced after the second application (p = 0.504) with improved BCVA (p = 0.185). After 1st month, complete epithelial healing was achieved in all the eyes. Mild limbal ischemia persists in 3 (13%) of the eyes. Final BCVA showed statistically significant improvement (p < 0.001). None of the patients develops any serious complications.
CONCLUSIONS: Omnilenz proved to be easy to apply and well tolerated by patients, with promising clinical outcomes.

To study the incidence of dry eye disease (DED) in head and neck cancer (HNC) patients undergoing external beam radiotherapy (EBRT), to find a correlation between tumor location and total radiation dose with DED, and to report various radiotherapy (RT) induced acute toxic effects on ocular and adnexal structures.
A prospective cohort study was conducted at a tertiary eye-care center on 90 patients of HNC undergoing EBRT from March 2021 to May 2022. All underwent a thorough clinical history and complete ophthalmological examination including an ocular surface disease index (OSDI) questionnaire, visual acuity, anterior segment, angle and posterior segment examination, dry eye workup including the Schirmer test, tear meniscus height, tear break-up time, corneal fluorescein staining and grading, and meibography by auto-refractometer and its scoring at each visit. Patients were evaluated before the start of RT and then at 1 week, 4 weeks, and 12 weeks post-RT. Radiation records of all patients were noted. Data were analyzed using percentage and Microsoft Excel.
Of the 90 patients, 66 were male and 24 female (M: F ratio of 2.75) with a median age of 52.5 years (range 24 to 80 years). The most common HNC was the carcinoma oral cavity and lip. Most patients received a total radiation dose between 46 to 55 Gy. DED developed in 48 (53.3%) patients. The incidence of DED increased with the increase in total radiation dose (r = 0.987). DED was also found to be correlated with tumor location (r = 0.983).
The incidence of DED positively correlated with the total radiation dose and tumor location.

Of the various manifestations of ocular chemical burns (OCBs), ischemia of the limbus and the peri-limbal sclera indicates poor prognosis and in severe cases threaten the integrity of the globe. Tenonplasty is a surgical procedure which involves advancing the Tenon\'s capsule over the ischemic areas to provide a vascular supply and to enable migration of the conjunctival epithelium. This review aims to provide an overview of the diagnosis of limbal ischemia and its management with Tenonplasty. A literature review was conducted using the keywords \"Tenonplasty,\" \"Tenon\'s capsule,\" \"ocular chemical injury,\" \"ocular thermal injury,\" \"Tenon advancement,\" \"scleral ischemia,\" and \"limbal ischemia,\" and outcomes were studied from seven selected articles. In addition to clinical evaluation, in vivo imaging techniques such as anterior segment optical coherence tomography angiography can provide an objective method of measuring and monitoring the ischemia and re-perfusion of the peri-limbal vasculature. Tenonplasty can be performed in eyes with acute OCBs with scleral or limbal ischemia by dissecting the Tenon\'s layer from the orbit and securing it to the limbus. The indications, mechanism of action, peri-operative considerations, surgical technique, and post-operative care of Tenonplasty are discussed in detail. The average time for post-operative re-epithelization ranges from 1 to 6 months with the formation of a symblepharon being the most common complication. In conclusion, Tenonplasty is a globe-salvaging procedure in cases with severe limbal and scleral ischemia because of OCBs and has good anatomical outcomes priming the globe for subsequent re-constructive and vision-restoring surgeries.

OBJECTIVE: To evaluate the limbal ischemia objectively in ocular surface chemical injuries by using anterior segment optical coherence tomography angiography (AS-OCTA).
METHODS: In this cross-sectional study, acute ocular surface chemical injury patients with less than 1 week injury history were enrolled. Demographic data of the patients were noted, and detailed ophthalmological examination with Dua classification was performed. AS photographs and AS-OCTA images were obtained and used for the assessment of limbal ischemia. To visualize the limbal vasculature, the device was focused manually to get a sharp image for all 4 quadrants of the limbus. The absence of vasculature was regarded as \"ischemia,\" and the amount of the ischemia was defined in clock hours. The limbal ischemia detected in clinical evaluation with biomicroscopy was compared with the AS-OCTA detected ischemia amount to make a conclusion for the correlation.
RESULTS: Nineteen eyes of 18 patients with acute ocular surface chemical injury were enrolled to the study (2 female, 16 male). The mean age was 35.1 ± 10 (18-55), and the mean best corrected visual acuity was 0.75 ± 1 (0.1-3.1) LogMAR. The causative agents were acid in 6 and alkaline in 12 patients. Limbal ischemia detected by using AS-OCTA was greater ((5.8 ± 2.6 (2-10) clock hours) than that detected in biomicroscopy (4.8 ± 2.4 (2-12) clock hours). The difference was statistically significant (p < 0.0005).
CONCLUSIONS: AS-OCTA has a significant importance on limbal vascularity visualization; therefore, its use for more objective and sensitive evaluation of limbal ischemia in ocular surface chemical injuries seems to have a crucial impact. AS-OCTA images may reveal the extension of limbal ischemia more precisely than clinical evaluation with biomicroscopy. However, future studies with higher number of patients are needed to come to a specific conclusion.

Acute ocular burns have varied manifestations which require prompt diagnosis and management to prevent chronic sequelae. Of these, the detection of limbal ischemia poses a challenge because of the subjective nature of its clinical signs. Anterior segment optical coherence tomography angiography (AS-OCTA) offers an objective method of assessing ischemia in these eyes. This review provides an overview of the technology of AS-OCTA and its applications in acute burns. AS-OCTA generates images by isolating the movement of erythrocytes within blood vessels from sequentially obtained b-scans. Limbal ischemia manifests in these scans as absent vasculature and the extent of ischemia can be quantified using different vessel-related parameters. Of these, the density of vessels is most commonly used and correlates with the severity of the injury. Incorporation of the degree of ischemia in the classification of acute burns has been attempted in animal studies and its extension to human trials may provide an added dimension in determining the final prognosis of these eyes. Thus, AS-OCTA is a promising device that can objectively evaluate limbal ischemia. This will facilitate the identification of patients who will benefit from revascularization therapies and stem cell transplants in acute and chronic ocular burns, respectively.

Changes in the limbal microvasculature following a chemical eye injury are essential for prognosis and management. At the slit lamp, it can be difficult to assess, here using fluorescein and indocyanine green angiography we show that anterior segment angiography may be informative to assess objectively the limbal microvascular changes over the follow-up period.

UNASSIGNED: To report a rare complication of herpes zoster ophthalmicus (HZO).
UNASSIGNED: A 27-year-old man with a history of graft-versus-host disease (GVHD) presented with pain and redness in his left eye along with vesicular eruptions on the same side of the forehead from 40 days earlier.
UNASSIGNED: In this case report, we present a case of HZO with severe limbal ischemia in a patient with ocular GVHD. The patient was administered with intensive topical preservative-free lubrication, topical preservative-free antibiotics, topical autologous serum 20%, topical non-preservative steroid (methylprednisolone 1%), and oral valacyclovir 1 g twice daily. The patient underwent amniotic membrane patch surgery on bulbar conjunctiva and cornea, lateral tarsorrhaphy, and punctal occlusion for the left eye.
UNASSIGNED: In this report, severe and extensive limbal ischemia caused by herpes zoster virus in an immunocompromised patient is reported.

BACKGROUND: To investigate the demographics, acute management and compliance rates of severe chemical eye burn cases that presented to the largest eye hospital in the United Kingdom (UK).
METHODS: All patients presenting to the Moorfields Eye Hospital emergency department are registered on the electronic patient administration system (PAS). A search of the PAS for patients assigned a preset diagnosis of \'chemical injury\' was performed for the period from 1 January to 31 March 2016. The results of the PAS search and handwritten clerking notes were reviewed. Eyes that were found to have ≥ 33% limbal ischaemia or limbal staining, or corneal haze that obscured the details of the iris, were recorded as having severe chemical injuries.
RESULTS: 55 patients had mild chemical eye burns, and 11 eyes of 10 patients had severe burns. Average patient age was 37 years (SD 22 years) and 22 years (SD 10 years) for mild and severe chemical injuries, respectively. 53% of the mild injuries and 90% of the severe injuries were in males. 7 (70%) of the 10 severe injuries were assault-related. In the severe chemical injuries group, first presentation to the emergency department was 24 h or more postinjury in 50% of the patients, 33% stopped ascorbate and citrate drops (ocular pain), 40% stopped attending clinical follow-up sessions, and 45% of the eyes had a final best corrected visual acuity (BCVA) of 6/18 or worse.
CONCLUSIONS: A significant proportion of the severe ocular chemical burns were assault-related. Delayed presentation and poor treatment adherence and follow-up attendance rates are significant challenges in patients with severe chemical burns. Patient education and public health awareness are important strategies. These findings also raise the question of whether these patients, who are mostly young males, should be admitted to improve treatment adherence rates and visual outcome.