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Purpose: To compare the efficacy, safety, and tolerability of lifitegrast 5% versus carboxymethylcellulose (CMC) 0.5% in adult patients with dry eye disease (DED). Methods: A total of 370 eligible patients with DED were randomized equally to receive twice-daily doses of a single drop in each eye of either lifitegrast 5% or CMC 0.5% for 12 weeks. Follow-up at weeks 2, 6, and 12 evaluated changes from baseline in primary [eye dryness score (EDS), ocular discomfort score (ODS), ocular surface disease index (OSDI), and tear film break-up time (TFBUT)] and secondary [Schirmer tear test (STT) score and corneal fluorescein staining (CFS) score] endpoints. Global improvement, safety, and tolerability were also assessed. Results: At week 2, values of ocular discomfort score, OSDI, and conjunctival redness were significantly more favorable in patients treated with lifitegrast compared to CMC. At week 6, values of all study variables were better in patients treated with lifitegrast compared to CMC; differences between the groups were statistically significant for all except photophobia. This trend was also maintained at week 12. Global improvement and tolerability were found to be better with lifitegrast than with CMC. No serious safety concerns were reported in any treatment group. Conclusion: To our knowledge, this is the first active-controlled trial informing on the efficacy, safety, and tolerability of lifitegrast 5%. Significantly more favorable values for EDS (except photophobia), ODS, OSDI, TFBUT, STT score, CFS score, and conjunctival redness score were achieved at week 12 with lifitegrast 5% compared to CMC 0.5%.

Introduction: Screening for ROP and its severity require optimum pupillary dilatation. Mydriatics that allow good dilatation often have systemic side effects. Topical tropicamide is considered safest but does not dilate pupils optimally. A combination of phenylephrine and tropicamide is a good mydriatic but has adverse effects. The study aims to compare the mydriatic efficacy of phenylephrine (P 2.5%) plus tropicamide (T 0.4%) versus tropicamide (T 1%) alone for ROP screening. Methods: Preterm neonates due for ROP screening were randomized to one of the two groups. One drop was instilled in the eye thrice every 15 mins. Pupillary diameter was recorded as a primary outcome measure using the Schirmer’s strip at baseline, 15, 30, and 45 minutes after drop instillation. Oxygen saturation, heart rate, and respiratory rate were measured at similar intervals. Adverse effects like apneas, vomiting, and feed intolerance were documented. Ophthalmologist comments on the visibility of different retinal zones were also recorded. Data were analyzed by t-test and Chi-square test as appropriate. Results: Fifty-four preterm babies were included (27 in each group). The birth weight (1130 ± 300g, 1220 ± 460 g) and gestation (34.40 ± 2.26 and 34.74 ± 3.24) weeks were similar in both groups. The pupillary size after 45 minutes in group 1 (7.56 ± 1.12 mm) was significantly greater (P < 0.001) than that of group 2 (5.92 ± 0.90 mm). The visibility of retinal zones was better in group 1 compared to group 2, which was statistically significant (P < 0.01). There was no significant difference between the two groups in saturation, heart rate, and respiratory rate at 30 mins and 45 mins. Conclusion: A combination of phenylephrine and tropicamide is a more effective mydriatic with no increase in adverse effects.

Purpose: Amidst the ongoing coronavirus disease 2019 (COVID-19) pandemic, India experienced an epidemic of COVID-19–associated rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to describe the epidemiology and elucidate the risk factors for developing COVID-19–associated ROCM, comparing the risk factors among COVID-19 patients with and without ROCM. Methods: This case–control study included all COVID-19–associated ROCM patients treated at our hospital from May 1 to July 30, 2021. Controls included age- and sex-matched COVID-19 patients without ROCM, who were treated during the same time (exact matching, in 1:2 ratio). Matched pair analysis using conditional logistic regression was performed to examine the association of various risk factors with the development of ROCM in COVID-19 patients. Results: The study included 69 patients with COVID-19–associated ROCM and 138 age- and gender-matched controls. Epidemiologically, COVID-19–associated ROCM predominantly affected males (59/69, 85%), in their early 50s (mean 52 years), with 48% (33/69) of patients being from medical resource-constrained settings. On multivariate conditional logistic regression, elevated serum glycated hemoglobin (HbA1c) (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.03–1.78), blood glucose (OR = 1.008, 95% CI: 1.003–1.013), and C-reactive protein (CRP) (OR = 1.07, 95% CI: 1.02–1.17) were associated with increased odds of developing COVID-19–associated ROCM. Patients with undetected diabetes mellitus with increasing HbA1c (OR = 3.42, 95% CI: 1.30–9.02) and blood glucose (OR = 1.02, 95% CI: 1.005–1.03) (P = 0.02) had a higher probability of developing COVID-19–associated ROCM than patients with established DM. Conclusion: Uncontrolled DM evidenced by elevated HbA1c and blood glucose levels, exacerbated by COVID-19–induced proinflammatory state indicated by elevated CRP, is the principal independent risk factor for COVID-19–associated ROCM. Middle-aged males with undetected DM, from a resource-constraint setting, are particularly at risk.

Orbital Rhabdomyosarcoma is a lethal malignancy of childhood. It commonly presents in the first decade of life as a rapidly progressive proptosis that can mimic orbital inflammatory disorders. We present a case of a 13-year-old boy who presented with a diffuse right upper lid swelling progressing over 10 days. The detailed evaluation revealed an immobile, firm, and eyelid mass adhering to underlying tissues, not adherent to the skin. The provisional diagnosis of an orbital inflammation was performed. Neuroimaging suggested a preseptal cystic lesion. Intraoperatively, a solid bosselated mass arising from orbicularis oculi, extending into the anterior orbit was excised in toto. Histopathology revealed Stage-1 embryonal rhabdomyosarcoma, confirmed on immunohistochemistry. Postoperatively, the patient underwent systemic chemotherapy. The patient was tumor-free at 2 years follow-up.