|Year : 1962 | Volume
| Issue : 2 | Page : 47-49
A case of glaucoma with facial nevus
KN Mathur, TP Agarwal
From the Department of Ophthalmology, S. N. Medical College, Agra, India
|Date of Web Publication||29-Mar-2008|
K N Mathur
From the Department of Ophthalmology, S. N. Medical College, Agra
|How to cite this article:|
Mathur K N, Agarwal T P. A case of glaucoma with facial nevus. Indian J Ophthalmol 1962;10:47-9
The co-existance of facial nevus with glaucoma is well known for almost hundred years. The first case recorded was by Schirmer in 1860. The association of glaucoma with facial nevus accompanied in some instances by symptoms of intracranial disturbances of the opposite side because of the angiomatous involvement of the meninges is the Sturge-Weber syndrome.
Till 1950, about 150 cases have been recorded in literature. We therefore are dealing with a rare disease and the report of another typical case is worthwhile, particularly because of the association of the unilateral facial nevus with bilateral glaucoma of adult type and because of the presence of tortuosity and engorgement of Retinal veins.
| Case Report|| |
Patient named R. C., 18 years, Hindu male was admitted in this hospital on 20th November, 1960 with the complaints of gradual diminution of vision of right eye for the last three years and that of left eye for the last one and a half years. The diminution of the vision was precipitated last year, after an attack of fever which lasted for 15 days. No familial incidence could be found as enquired from the patient himself.
He was a young, dark coloured man of average build with normal pulse, temperature and blood pressure. Scalp hair were scanty but uniform in distribution. [Figure - 1] shows of facial nevus on the right side of the face. It was present since birth. The nevus was not much prominent because of the dark colour of the patient. It was distributed in the Ophthalmic and the Maxillary divisions of the Trigeminal nerve on the right side, more so in the Maxillary division. The mandibular division was unaffected. The nevus did not cross the mid-line. The skin in the area of the nevus was neither raised above the surface level nor was uneven. No such changes were present in the other parts of the body.
Right Eye :-As seen in [Figure - 1], the palpebral fissure was narrower as compared to the left eye. The nevus extended on to the skin of the lids and its margins. Pigmentation of the episcleral tissue could be seen in patches through the conjunctiva round about the limbus as seen in [Figure - 2]. The conjunctival vessels were normal. The cornea was hazy and edematous. The iris was dark coloured as compared to the left eye (Heterochromia Iridis). The fine markings of the iris pattern were not clearly seen because of the thickened iris stroma. There was no tortuosity of the blood vessels in the iris. Pupil was circular, dilated and sluggishly reacting to light. Fundus examination revealed--hazy media due to corneal edema, pale excavated disc because of the marked glaucomatous cupping, fulness and tortuosity of the retinal veins and generalised dark colour of the fundus. Vision was reduced to perceiving finger movements at one foot. Peripheral and central fields could not be recorded. Tension: 82 mm. of Hg. (Schiotz).
Left Eye:-Fundus examination revealed the same findings as in the right eye except that the disc was less pale and not so much excavated Vision : 6/18 on Snellen's chart. There was contraction of the field of vision as shown in [Figure - 3]. Tension : 40 mm. of Hg. (Schiotz). No definite scotoma could be found. Rest of the eye was normal. No pigmentation of the episcleral tissue was seen.
General Blood picture was normal. V. D. R. L. was negative. X-Ray skull did not reveal any pathology. Urine was normal.
Both the eyes were trephined with a 2 mm. trephine for the right eye and 1.5 mm. one for the left eye. The post-operative results are tabulated below:-
| Comment|| |
Glaucoma is usually of infantile type (Buphthalmic type) in 70 per cent of the cases. The adult type of glaucoma without enlargement of the eye ball is seen in 30 per cent of the cases and may occur at any age. The glaucoma as a rule is unilateral. There are very few cases of bilateral glaucoma, these too are the cases who had bilateral facial nevus. Only two cases are on record who had an association of unilateral facial nevus with bilateral glaucoma (One case in Anderson's series). The glaucoma in this case is bilateral but is more marked on the side of the facial nevus. It is rare to have such high intro-ocular tension (82 mm. of Hg.) with corneal edema in cases of chronic glaucoma, which got reduced to 11 mm. of Hg. alter 2 mm. trephine operation with improvement in vision and field. The real cause of glaucoma is not known, however, it is reasonable to assume that the two factors vascular and drainage anomalies are simultaneously acting, the one or the other predominating in different cases. In this case it is probably the vascular factor which is responsible for glaucoma as is evidenced by the engorged and tortuous retinal veins and generalised red colour of the fundus in both the eyes, while the pigmentary disturbances are only unilateral.
| Summary|| |
A case of glaucoma with facial nevus is reported. He had an association of unilateral facial nevus with bilateral glaucoma of adult type and the presence of tortuosity and engorgement of retinal veins. There was marked reduction in the tension of both eyes after the operation of trephine with improvement in vision and field in the right eye.
| References|| |
Berliner, M. L ., and Breinin, G. M.: (1951), Arch. Ophth. 46, 39-48.
Bock, R. H.: (1950), Amer, J. Ophth. 33, 1121-1126.
O'briens, C. S., and Porter, W. C.: (1933) Arch. Ophth., 9 :715-728.
Walsh, F. B.: Clinical Neuro-Ophthalmology. P. 945. The Williams and Wilkins Company. Baltimore, 1957, II Edition.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1]