|Year : 1957 | Volume
| Issue : 3 | Page : 69-71
Glaucoma and thyrotoxicosis
Department of Ophthalmology, Irwin Hospital, New Delhi, India
|Date of Web Publication||9-May-2008|
N S Jain
Department of Ophthalmology, Irwin Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain N S. Glaucoma and thyrotoxicosis. Indian J Ophthalmol 1957;5:69-71
E. M., 28 years old, female, nurse, unmarried, came with the following history:- In December 1955 she developed congestion of the left eye. which got cured in three days with instillation of cortisone ophthalmic suspension 0.5%.
During August, September and October, 1956, she suffered from intermittent pyrexia, continuous anorexia. persistent nausea with occasional vomiting and loss of weight. Formerly her weight was 108 lbs.
Examination in November 1956 was made for persistent headache. Vision in the right eye was 6/12 and improved to 6/6 with -0.5 D Sph. -0.5 D Cyl. axis 90°. That in the left eye was 6/18, improving to 6/9 with -1.0 D Sph. - 0.5 D Cyl. axis 60°. The right eye was normal in all other respects, but the left pupil was irregular in shape and eccentric, and did not react to light nor dilate with mydriatic. Iris pattern was normal in each eye. Fundi showed bilateral papillcedema. Skiagram of the skull was normal. On lumbar puncture the cerebro-spinal fluid was found to be under a pressure of 220 mm. Hg.
Follow-up:- A week following lumbar picture, the patient had no headache. Papillcedema was absent and the vision in the left eye had improved to 6/6 with the same glass. A general medical examination did not reveal any systemic disorder.
The subsequent subjective and objective observations are described date-wise hereunder:-
1 st January 1957 - Attack of fever.
5 th January 1957 - Enlargement of thyroid, tremors of hands, staring appearance of the patient, pulse rate of a 120 to a 140 per minute, palpitation and a Basal Metabolic Rate of +32. The left eye was subjectively noted to be pink.
19 th January 1957 - Increased congestion of the left eye.
21 st January 1957 - Sudden partial loss of vision in the left eye.
23 rd January 1957 - Vision in the right eye with glass was 6/6 and the tension was 17 mm. Hg. (Schiotz).
The left vision with glass was reduced to 6/18; cornea was steamy; pupil was irregularly dilated eccentric and non-reactive to light; circumciliary injection was present; iris showed a marked patchy atrophy of the anterior layers and heterochromia; intraocular tension was 68 mm. Hg. (Schiotz). A drop of D.F.P. was instilled in the left eye and four hourly instillations of combined miotics (0.5% eserine with 1.0% pilocarpine) was advised.
25th January, 1957--Left eye showed - normal cornea; vision with glass improved to 6/6; tension 22 mm. Hg.; condition of the pupil unaltered.
Slit lamp examination revealed a complete absence of K.P., aqueous flare, pigment on anterior lens capsule or posterior synechiae. Cornea was normal. Iris showed a patchy destruction of the anterior layers with rudiments of irregular rings of anterior layers of iris near the pupil and the periphery. Strands of anterior layers seemed stretched across the front of posterior pigmentary layer and gave rise to a sieve-like appearance.
General condition of the patient showed a high pulse rate of 130 per minute. prominence of the thyroid and a weight of 90 lbs.
6th February. 1957 After miotics had been discontinued for the preceding week vision in the left eye with glass was reduced to 6/9 and the tension rose to 45 mm. Hg. (Schiotz).The patient has since been lost sight of.
| Discussion|| |
The case presents several features of unusual interest:- (a) the young age of the female patient, (h) the unilaterality and suddenness of the disease, (c) the height of the intraocular tension responding quickly to strong miotics, (d) the immediate recurrence on discontinuing miotics. (e) the rapidity with which the anterior layers of iris atrophied giving rise to heterochromia, (f) the total absence of inflammatory signs, and (g) the association of the ocular condition with thyrotoxicosis and raised intracranial tension in the initial stage.
Judging from these there can be no doubt as to the diagnosis of this case from other heterochromic conditions.
A strong intervention of the sympathetic nerve is evinced by (a) such a vasomotor instability as may produce a temporary rise in the intracranial tension. (b) the occurrence of a rapid heterochromia. and (c) the high degree of intraocular tension (Lagrange). The effect of thyrotoxicosis in the causation of glaucoma (Passow, 1930) indicates an important hormonal influence on the sympathetic system in this case.
| Summary|| |
A case of thyrotoxic glaucoma with heterochromia is described.
| References|| |
Lagrange, F. (1922), Du Glaucoma et de l'Hypotonie, Paris, 1922.
Passow (1930), Arch. of Aug., 103,111.
[Figure - 1], [Figure - 2]