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    Ocular sarcoidosis: a case report

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    Introduction: Sarcoidosis is a chronic granulomatous disorder which affects almost all parts of the body. It is usually idiopathic. Ocular involvement is noted in 25%–60% of patients with systemic sarcoidosis. It is very essential to rule out ocular tuberculosis as both can have similar presentations. Case report: A 26 year old patient presented with blurring of vision in left eye for nine months at Mongar regional referral hospital. Previously he was treated with topical steroids and cycloplegics for anterior uveitis. There were no systemic symptoms like dry cough, fever, chest pain and loss of weight. He had anterior chamber inflammation with iris nodule, vitritis and disc edema in left eye.The right eye had minimal anterior chamber reaction with only subtle iris nodule. Posterior segment examination was normal in right eye. He underwent blood investigations, chest X ray and contrast enhanced computed tomography of chest(CECT). The blood reports were normal. The chest X ray showed radiopaque lesions at both hilar region and multiple tiny radiopaque lesions in both lung fields.CECT chest showed significant paratracheal lymph nodes.Lymph node biopsy was not attempted due to extreme location. Based on clinical presentations and investigation findings a diagnosis of Presumed ocular sarcoidosis was made by using the criteria based on Revised International Workshop on Ocular Sarcoidosis.The patient was treated effectively with oral steroids for six months. Currently he is on low maintenance dose of oral steroids. Conclusions: Ocular sarcoidosis is a potentially blinding condition if not treated on time. There should be high suspicion of ocular sarcoidosis if patient presents with bilateral granulomatous anterior uveitis with hilar lymphadenopathy.However it is crucial to exclude ocular tuberculosis as both are mimickers of chronic granulomatous uveitis

    Bhutanese Teachers' Pedagogical Orientation in the Primary Classes: A Factor on Quality Education

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    In recent years, Bhutan has taken huge steps to provide education to all Bhutanese children. However, the poor performance of the high school graduates in the Call Centre interview and their failure to get selected for employment due to their poor communication skills in English ignited widespread debate amongst the general public on the quality of education in Bhutan. Educators believe that this claimed decline is a misperception rather than the reality. Thus, this paper attempts to study this issue by examining the pedagogical practices in primary schools through teaching observations and interviews with a sample of teachers from different schools in western Bhutan. The findings indicate that teacher dominated lessons generally prevail in the primary classrooms with detrimental student learning outcomes. This situation has implications about teacher education programmes and other stakeholders. Thus, it sends a message that there is a risk of declining quality in education if appropriate measures are not adopted
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