Background. microbial keratitis which is also known as corneal ulcer, is a common ocular infection that can result in debilitating monocular visual impairment. identifying the prevalence and the latest trend of the causative agents will be useful in the management of corneal ulcer. Objectives. To evaluate the demographic and epidemiology factors of microbial keratitis at a tertiary hospital in a rural state of malaysia. Material and methods. This is a retrospective review with a total recruit of 137 patients who were admitted to the ophthalmology ward in hospital Universiti Sains malaysia. a retrospective review of the demographic data and results of corneal tissue sampling were documented. Results. Demographic data showed similarity to other studies where it affected most commonly in the productive age. it was also more commonly seen in male patients than in female. Bacterial keratitis (51.1%) was found to be more common than fungal keratitis (24.8%). in cases of bacterial keratitis, Pseudomonas spp. was the commonest causative agent, while in cases of fungal keratitis, Fusarium spp. was the commonest fungus microbial agent. Conclusions. With the knowledge of the demographical and epidemiological factors of microbial keratitis of a region, clinicians will be able to initiate prompt treatment at the early stages of the disease. Thus, less complications will arise from the disease and a better visual outcome provided.

Background: Acute lymphoblastic leukaemia (ALL) is the commonest childhood malignancy and ocular manifestations are uncommon in ALL. Patients may present with non-specific systemic symptoms which are overlooked and life threatening symptoms of leukostasis often present late. Here, we present a rare case of ALL where ocular symptoms preceded constitutional symptoms. Materials and Methods: A case report. Result: A 11-year-old girl presented with a syncopal attack during the fasting month to a primary health center. She was investigated at a tertiary center and diagnosed to have ALL. Further history revealed she had sudden painless severe reduced vision in the right for one month prior to this. Ocular assessment noted her right visual acuity was 5/60 and left visual acuity was 6/6. Her right fundus had a large subhyaloid haemorrhage over the macula and multiple large white-centered haemorrhages (Roth's spot); while the left fundus showed multiple large Roth's spots and some intraretinal haemorrhages. Chemotherapy was instituted after immunophenotyping was reported as precursor B-cell ALL. Ocular condition was managed conservatively. There was total resolution of the subhyaloid haemorrhage and retinal haemorrhages in both eyes and she regained full vision bilaterally while on induction therapy over 5 months. Conclusion: Life threatening conditions such as ALL should be considered in children with sudden, painless, reduced vision and urgent ophthalmology assessment is important for early detection. Blurry vision could be the earliest symptom in ALL. Awareness on eye health must be emphasized in school by the educators for early detection of both sight and life threatening condition among children.