Chronic canaliculitis is an uncommon disease with a protracted course. Its management is prolonged and difficult. An elderly lady was diagnosed to have left lower chronic purulent canaliculitis. Conserva- tive treatment alone did not effect a complete cure. Canaliculotomy with removal of sulphur granules and canalicular curettage also had to be performed to achieve a permanent cure. Unlike many cases of canaliculitis, this patient presented numerous complications confined to the canaliculus. To the best of our knowledge, this is the first report of Actinomyces naeslundii (A. naeslundii) causing chronic puru- lent canaliculitis and associated complications. A. naeslundii canaliculitis should be considered in the differential diagnosis of chronic conjunctivitis with epiphora.

Some species of venomous snakes spit venom in human eyes as a defence mechanism when threatened. If not detected and treated appropriately early, this can result in severe toxic ocular injury leading to potential blindness (snake venom ophthalmia). Not much is known of the clinical course and treatment guidelines due to the rarity of such occurrences. We present a case of isolated severe toxic ocular injury in one eye who reported to us with very poor vision following venom spit, which was promptly treated leading to a successful visual recovery. This is the first documented case of snake venom ophthalmia from Kuala Belait, Brunei Darussalam.
Elapidae ; Snake Venoms ; Corneal Opacity ; Blindness

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease that preferentially affects the optic nerves and spinal cord. It has a worldwide distribution and distinctive clinical, neuroimaging and laboratory findings that distinguish it from multiple sclerosis. In most cases there is a long interval be- tween the optic neuritis and myelitis but approximately 10 to 20% can have near simultaneous occur- rence of both. We report a case of NMO presenting with symptoms and signs of optic neuritis and transverse myelitis which was later confirmed by neuroimaging and laboratory findings. The acute at- tack was treated with pulse therapy of corticosteroid and subsequently the patient was maintained on Azathioprine and tapering dose of oral steroid. This case highlights a neurological disorder that is in- creasing in prominence and may become more relevant in our region with increased diagnostic utility of antibody testing.

Rheumatoid arthritis is a chronic auto-immune disease that leads to persistent symmetrical polyarthri- tis mainly affecting the hands and feet. Significant extra-articular involvements can occur including the eyes. However, most extra-articular manifestations usually occur in the presence of joints changes or symptoms. We report an interesting case of a 62-year-old Malay lady who was referred severe ocular presentation, peripheral ulcerative keratitis that led to the diagnosis of rheumatoid arthritis. Interest- ingly, she had typical changes of rheumatoid arthritis in the hand but was not troubled by them.

Introduction: A pterygium is an elevated, superficial, external ocular mass that usually forms over the peri-limbal conjunctiva and extends onto the corneal surface. It is more common in the tropics secondary to higher exposure to ultraviolet light. This study compares the various techniques of pterygium surgery including bare sclera, conjunctival autograft, and conjunctival mini-graft (with or without intraoperative Mitomycin C application) in terms of surgical outcome and recurrence rate and to identify the risk factors for recurrence and complications. Materials and Methods: 959 patients operated for pterygium were retrospectively studied to determine the complications and recurrence rate after pterygium excision using the above mentioned surgical techniques. 625 (65.7%) were males. The mean age was 44 ± 12 years. Risk factors for recurrence were also studied. Results: The recurrence rate of pterygium was 17.4%. There was no significant difference between the three surgical techniques in terms of recurrence rate (p = 0.28). Younger age was associated with higher recurrence rate (p = 0.001); There was no significant correlation between gender and recurrence of pterygium (p = 0.48). The bare sclera recurrence developed after a longer period of time compared to conjunctival grafts (p = 0.002). The commonest complication was granuloma (3.9%), followed by scleral thinning and/or melting (1.4%). Conclusion The study showed no statistically significant difference in terms of recurrence rate between the three pterygium surgical procedures studied. However, among cases of recurrence, those following bare sclera technique showed delayed recurrence compared to conjunctival autografts and conjunctival minigraft. The use of Mitomycin C adjunctive therapy was associated with significant reduction in recurrence rate. On the other hand, younger age group was associated with significantly higher recurrence rate.

The main medical indications for botulinum toxin type A injections is to treat certain spasmodic muscle disorders. A 40-year-old Malay lady presented with a right lower motor neurone facial nerve palsy, and associated exposure keratitis and hypopyon, following excision of schwannoma. The keratitis resolved after treatment with lubricants and lateral tarsorraphy. Two months later, she presented with corneal ulcer and hypopyon, which did not respond to topical antibiotics. Complete ptosis was induced in the right eye using Botulinum Toxin type A trans-cutaneous injection to the superior palpebrae superiosis. Following the injection, the ulcer recovered gradually over a period of five weeks. This report illustrates an important role of Botulinum toxin A in the management of refractory exposure keratitis.

A 55-year-old man presented with a five-day history of blurring of vision, pain and redness in the right eye. He had no significant past ocular or medical history, and gave no history of trauma. Ophthalmologic examination is shown above (Panel). What is the diagnosis? Answer: refer to page 235

(Refer to page 207) Answer: Hypopyon In this case, hypopyon is seen in the anterior chamber and posterior synaechiae can also be seen at the pupil margin. Hypopyon can be defined as layering of white blood cells in the anterior chamber of the eye following acute, subacute and chronic inflammatory reactions involving the aqueous humor and anatomical structures adjacent to it. It appears as a white milky layer at the bottom of the anterior chamber.

Orbital trauma and surgery are recognised aetiological factors of tonic pupil. Tonic or Adie's pupil is an efferent pupil defect in which light reactions to one or more segments of the iris sphincter are lost due to the postganglionic parasympathetic nerves damage from ciliary ganglion. There is loss of part or all of the light reflex and decrease in accommodative functions at near. We report a case of tonic pupil in a 42-year-lady after a successful surgical removal of an orbital cavernous haemangioma.
Tonic Pupil ; Haemangioma, Carvenous ; Adie Syndrome