After the outbreak of the disease COVID-19, it has reached pandemic proportions within a very short time. It is mainly transmitted human-to-human through direct contact with secretions from an infected person or through inhalation of droplets containing SARS-CoV-2. It is controversial whether the virus may be transmitted via tears. Exposed ocular surface can serve as a gateway in transmission and acquiring respiratory diseases. Considering the reported cases on healthcare workers indicating nosocomial transmission and the anatomical and physiological aspects it is perceived that ophthalmic healthcare professionals are at higher risk of contracting the virus by virtue of their job. In this narrative review we discuss current evidence around detection of SARS-CoV-2 in human tears and forms of transmissions reported to date. We also provide a comprehensive approach that may be implemented in an ophthalmic care facility to protect healthcare personnel, as well as patients, from contracting the virus. ARTICLE HISTORY

Background: Computer vision syndrome is a common global problem among millions of computer users including medical students. Medical students are preferring soft copies rather than textbooks. The aim of this study was to assess the knowledge, attitude, and practice of MBBS students about Computer vision syndrome, and to identify its ocular morbidity among them.Methods: A descriptive cross-sectional survey based on the questionnaire was conducted among 1st- 4th year MBBS students of the Institute of Medicine and 80 students underwent detailed ocular evaluation. Results: A complete survey response was received from 236 students out of 299 students (Response Rate 80%). The mean age of MBBS students was 21.38 years ± 1.328 years and the range were 19-22 years; 76.2% were male and 23.8% were female. The majority (37.2%) spent 2-3 hours/day on the computer and had a higher risk (p-0.0001) of developing Computer vision syndrome. About 69.5% students used a computer at the level of the eye but there was a significant reduction in Computer vision syndrome (p-0.0001) among those who had computer screen below the eye level. Association between taking breaks (p-0.0001) and frequent blinking (p-0.0411) during computer use and relief of symptoms was significant. Only 22.9% had pre-existing knowledge of Computer vision syndrome and only 25.5% of them were practicing the ideal viewing distance.Among 80 medical students randomly selected for detail eye examinations (63.7% male;36.2% female), the prevalence of Computer vision syndrome  was 71.6%. The commonest ocular complaint was a headache (50%) and dry eyes (45%). Myopia was the commonest refractive error (31.2%) and the orthoptic problem was prevalent among 17.5% students.Conclusions: The survey showed that Computer vision syndrome is relevant among MBBS students but the knowledge, attitude, and practice of Computer vision syndrome among them is poor.Keywords: Attitude; computer vision syndrome; eyestrain; headache; knowledge; practice; medical students.

Varicella zoster is known to be associated with vaso-occlusive pathologies, vasculitis, or optic neuritis, leading to profound visual loss. We report a case where a 13-year-old boy who initially presented to us with on and off diminution of vision in his right eye since 3 days and had normal ocular and OCT angiography findings followed up in 5 days with sudden painless diminution of vision in the same eye since one day this time revealing a pale macular region with rest of the retina being normal. Repeated OCT angiography showed loss of the capillary network around the perifoveal region suggesting cilioretinal artery occlusion.

Importance: An observant Chinese doctor Li Wenliang became the first physician to alert the world about COVID-19. Being an ophthalmologist himself, he has put the additional onus on us. The fact that the ocular manifestation could be the first presenting feature of novel coronavirus pneumonia should not be ignored and the possibility of spread of SARS-CoV-2 through the ocular secretions cannot be ruled out. However, with breakthroughs still evolving about this disease, the calls are now louder for closer examination on the pathogenesis of conjunctivitis associated with it. Hence, we conducted a scoping review of all available literature till date to fill in the "potential" gaps in currently available knowledge on ocular manifestations of SARS-CoV-2 infection in an attempt to establish continuity in the "chain of information" from December 2019 till April 2020. We also summarize a possible hypothesis on much less understood and highly debated topics on regard to the etiopathogenesis of ocular involvement in SARS-CoV-2 based on either presence or absence of ACE2 receptor in the ocular surface. Methods: We conducted a scoping review search of published and unpublished SARS-CoV-2-related English language articles from December 2019 till mid of April 2020 from the online databases. The findings were summarized using text, tables, diagrams, and flowcharts. Results: The commonest ocular manifestation in SARS-CoV-2 infection is follicular conjunctivitis and has been the first manifestation of SARS-CoV-2 infection in 3 reported cases till date. The ocular surface inoculated with the SARS-CoV-2 leads to the facilitation of the virus to the respiratory system via the lacrimal passage. RT-PCR analysis of the ocular secretions has shown the presence of the SARS-CoV-2 nucleotides indicating the possibility of infection of ocular secretions. ACE2 receptors and its expression on the ocular mucosal surface are linked behind the etiopathogenesis of conjunctivitis. Conclusion: Conjunctivitis can be the presenting manifestation but may go unnoticed due to its mild nature. The ocular surface could serve as the entry gateway for the virus and ocular secretions could play a role in virus shed. The eye care personnel, as well as the general people, need to be more vigilant and adopt protective eye measures.

Background: Computer vision syndrome is a common global problem among millions of computer users including medical students. Medical students are preferring soft copies rather than textbooks. The aim of this study was to assess the knowledge, attitude, and practice of MBBS students about Computer vision syndrome, and to identify its ocular morbidity among them.Methods: A descriptive cross-sectional survey based on the questionnaire was conducted among 1st- 4th-year MBBS students of the Institute of Medicine and 80 students underwent detailed ocular evaluation.Results: A complete survey response was received from 236 students out of 299 students (Response Rate 80%). The mean age of MBBS students was 21.38 years ± 1.328 years and the range were 19-22 years; 76.2% were male and 23.8% were female. The majority (37.2%) spent 2-3 hours/day on the computer and had a higher risk (p-0.0001) of developing Computer vision syndrome. About 69.5% students used a computer at the level of the eye but there was a significant reduction in Computer vision syndrome (p-0.0001) among those who had computer screen below the eye level. Association between taking breaks (p-0.0001) and frequent blinking (p-0.0411) during computer use and relief of symptoms was significant. Only 22.9% had pre-existing knowledge of Computer vision syndrome% and only 25.5% of them were practicing the ideal viewing distance. Among 80 medical students randomly selected for detail eye examinations (63.7% male;36.2% female), the prevalence of Computer vision syndrome was 71.6%. The commonest ocular complaint was a headache (50%) and dry eyes (45%). Myopia was the commonest refractive error (31.2%) and the orthoptic problem was prevalent among 17.5% students.Conclusions: The survey showed that Computer vision syndrome is relevant among MBBS students but the knowledge, attitude, and practice of Computer vision syndrome among them is poor.

PurposeTo report a modified technique of sutureless intrascleral fixation of a posterior chamber intraocular lens with use of instruments of anterior segment surgery and its outcomes.DesignProspective, noncomparative, interventional case series.ParticipantsNinety-two eyes of 92 patients with aphakia and subluxated lens who underwent surgery were evaluated.Materials and methods27-gauge needles were introduced transclerally and guided by the viscocanula to externalize via the main wound. The haptics were loaded into the lumen and externalized from entry points. The haptics were then fixed in a scleral tunnel made by a 27-gauge needle. The best-corrected visual acuity (BCVA) and complications were determined.ResultsNinety two eyes which were operated and completed follow-up of 6 weeks were included in the study. The most common indications for scleral-fixated intraocular lens (SFIOL) were subluxated lens – 55 eyes (59%), and surgical aphakia – 31 eyes (34%). Sixty-nine eyes (75.7%) had a postoperative vision of uncorrected visual acuity of 6/18 on day 1. There was an improvement in mean logMAR BCVA (0.086±0.18) at 6 weeks as compared to preoperative visual acuity (p<0.05). BCVA of 6/12 or better was attained in 94% of the cases at 6 weeks. Special mentions need to be made for 6 (7%) of our cases. Three of the patients were cases of fully treated postoperative endophthalmitis who lacked capsular support. Two of the other cases had undergone pars plana vitrectomy for retinal detachment. Both had silicon oil removal done 1 month before the SFIOL procedure. One of the patients had Marfan’s syndrome.ConclusionOur procedure is safe, easy, less traumatic, and less resource-demanding with good visual outcomes and can be performed even in low-resource settings of developing countries. It may also be considered in patients who have had posterior segment surgeries previously.

BackgroundPrimary open-angle glaucoma (POAG) is a progressive optic neuropathy with numerous risk factors. Its severity with associated risk factors remains a widely debated topic.AimTo evaluate the severity of POAG in patients with hypertension (HTN) and diabetes or both.Patients and methodsThis hospital-based, cross-sectional descriptive study was conducted for a period of 18 months from January 2016 to June 2017. Diagnosed cases of POAG were evaluated for severity with associated risk factors.ResultsA total of 221 patients were enrolled in the study. The mean age of the patients was 54.4 (SD ± 15.9) years with a male to female ratio of 0.93:1. Of the 221 patients, 68 (31%) had a family history of POAG. Mean intraocular pressure was 15.8±4.87 mmHg, and mean central corneal thickness was 535.4±34.9 μm. A total of 81 (36%) patients had HTN, 21 (9.50%) had diabetes mellitus (DM), and 15 (6.80%) had both HTN and DM. Analysis using SPSS version 20 was done. The severity of POAG was found to be significantly higher in patients with HTN, DM, or both when evaluated on the basis of anatomical and functional loss.ConclusionPOAG patients with HTN, DM, or both were found to have more severe POAG. Patients with these risk factors could represent “high-risk patients” with POAG. Patients with HTN and DM, or both may require evaluations on a more frequent basis to access the progression/severity of POAG.

A blunt trauma to a phthisical eye may elicit sympathetic ophthalmia. Non invasive imaging such as use of optical coherence tomography and angiography metrics of the retinal and choroidal vasculature can help monitor response to the treatment. K E Y W O R D Sangiography, autoantigens, imaging, ocular wounds, optical coherence tomography and angiography, phthisis, sympathetic ophthalmia, uveitis 150 | KHATRI eT Al.How to cite this article: Khatri A, Timalsena S, Khatri BK, et al. A rare entity: Sympathetic ophthalmia presumably after blunt trauma to the phthisical eye and optical coherence tomography angiography metrics to monitor response to treatment. Clin Case Rep.