Microbial keratitis is an infection of the cornea of the eye that is commonly caused by prolonged contact lens wear, corneal trauma, pre-existing systemic disorders and other ocular surface disorders. It can result in severe visual impairment if improperly managed. According to the latest World Vision Report, at least 4.2 million people worldwide suffer from corneal opacities caused by infectious agents such as fungi, bacteria, protozoa and viruses. In patients with fungal keratitis (FK), often overt symptoms are not evident, until an advanced stage. Furthermore, it has been reported that clear discrimination between bacterial keratitis and FK is a challenging process even for trained corneal experts and is often misdiagnosed in more than 30% of the cases. However, if diagnosed early, vision impairment can be prevented through early cost-effective interventions. In this work, we propose a multi-scale convolutional neural network (MS-CNN) for accurate segmentation of the corneal region to enable early FK diagnosis. The proposed approach consists of a deep neural pipeline for corneal region segmentation followed by a ResNeXt model to differentiate between FK and non-FK classes. The model trained on the segmented images in the region of interest, achieved a diagnostic accuracy of 88.96%. The features learnt by the model emphasize that it can correctly identify dominant corneal lesions for detecting FK.

Ocular surface disorders such as Lid Wiper Epitheliopathy (LWE), Superior Epithelial Arcuate Lesion (SEAL), and contact lens-induced Limbal Stem Cell Deficiency (LSCD) as well as Superior Limbic Keratoconjunctivitis (SLK) affect one’s quality of life. Hence, it is imperative to investigate the underlying causes of these ocular surface disorders. During blink, the undersurface of the eyelid tends to interact with the cornea and the conjunctiva. The presence of a contact lens can add to the biomechanical frictional changes on these surfaces. To estimate these changes with and without a contact lens, a finite element model (FEM) of the eyelid wiper, eyeball, and contact lens was developed using COMSOL Multiphysics. Biomechanical properties such as von Mises stress (VMS) and displacement were calculated. Our study concluded that (a) maximum VMS was observed in the lid wiper in the absence of contact lens in the eye and (b) maximum VMS was observed in the superior 1.3 mm of the cornea in the presence of the contact lens in the eye. Thus, the development of friction-induced ocular surface disorders such as LWE, SLK, SEAL, and LSCD could be attributed to increased VMS. FEA is a useful simulation tool that helps us to understand the effect of blink on a normal eye with and without CL.

Propionibacterium acneshas rarely been reported as the causative organism in acute endophthalmitis following penetrating ocular trauma. We report a 53-year-old man, who presented with best corrected vision of counting fingers at 2 m, <N36, in the right eye and clinical features suggestive of endophthalmitis following penetrating trauma with a tree branch 2 days earlier. Conjunctival swab, aqueous and vitreous tap were sent for aerobic, anaerobic and fungal culture. The patient was treated with intravitreal ceftazidime, vancomycin along with topical antibiotics and steroids. An aqueous anaerobic culture was positive forP acnes. At the fifth month follow-up, the best corrected vision had improved to 20/20, N6. Thus, a good visual outcome was achieved, following appropriate treatment of a rather unusual causative organism.

Fungal granuloma of the sino-orbital region is uncommon. Although imaging modalities like CECT and MRI scans are usually helpful, a pre-operative diagnosis may still be difficult because of subtle overlapping clinical features and a rather indolent disease course. Due to the anatomical relations of the orbit, FNAC is generally difficult and has a high incidence of complications and false-negative results. We report a case of a middle-aged woman, who presented with a painless, progressive swelling below her right eyebrow with difficulty in looking upwards and to the right. Initial diagnoses of orbital dermoid cyst and frontal sinus mucocoele were made clinically. The origin of this lesion was unclear, was it a primary orbital pathology with secondary involvement of the frontal sinus, or vice versa? CECT and USG-guided FNAC aided in investigating, however, a definitive diagnosis of fungal granuloma was only established post-operatively, with the help of histopathological examination