|Year : 1975 | Volume
| Issue : 1 | Page : 25-26
Amaurosis in toxaemia of pregnancy
M Mathew1, CK Rajani2, N Gulati2
1 Department of Ophthalmology, Lady Hardinge Medical College and Hospital, New Delhi, India
2 Department of Gynaecology, Lady Hardinge Medical College and Hospital, New Delhi, India
Department of Ophthalmology, Lady Hardinge Medical College and Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mathew M, Rajani C K, Gulati N. Amaurosis in toxaemia of pregnancy. Indian J Ophthalmol 1975;23:25-6
Of the many complications of toxaemia pregnancy, changes pertaining to the eye, deserves attention, as it can produce the temporary or permanent blindness. The comparative rareness of amaurotic eclampsia these days, prompted us to publish these cases.
R. R. 28 years old 5th gravida, of 34 weeks pregnancy was admitted with history of sudden and severe, throbbing headache along with vomiting followed by complete loss of vision. Her previous pregnancies were uneventful. She had oedema of feet one month prior to this event. Fundus showed marked narrowing of the arteries and slight pallor of both the discs. After 4 hours of admission she had an eclamptic fit and her blood pressure was 180/120mm Hg. She was given the usual regime of diuretics, sedatives, and hypotensive drugs. After 8 hours she could perceive light, and after 24 hours her vision was counting of fingers at 6 meters. Her blood pressure ranged from 150/110 to 170/120 mm Hg. Patient had a normal delivery. The female baby was cyanosed at birth, weighed 3 pounds 9 ounces only and died after 24 hours. Patient's vision and blood pressure returned to normal within 24 hours of delivery.
K. K. 28 years old was 3rd gravida, full term, when admitted with history of sudden complete loss of vision preceded by oliguria and severe headache. She had no toxaemia in the earlier pregnancies. Patient noticed oedema of feet 3 weeks prior to this episode. According to the patient she had complete blackout lasting for about 2 hours. On admission her vision was counting fingers at one foot with both the eyes. She was given diuretics, sedatives and hypotensive drugs. Her vision improved to finger counting at 6 feet after 48 hours. Her blood pressure was normal on admission but rose to 200/110 mmHg. Pregnancy was terminated and she delivered a baby boy weighing 6 pounds and 12 ounces. Both her vision and blood pressure came back to normal after delivery within 48 hours.
S aged 26 years, 6th gravida had 5 premature still births and came to hospital for lack of foetal movements at 32 weeks. During her third pregnancy she had sudden loss of vision at 30 weeks of gestation. This was followed by eclamptic fits, became unconscious and recovered after one day. She lost even perception of light abruptly and after 15 days could see quite well with the right eye but with the left eye she could perceive things at close quarters only. During this period she had ocular pain and headache on the left side. Her blood pressure was 160/100 mm Hg and she had albuminuria. Her vision was counting of fingers at 3 feet with the right side and hand movements only with the left eye. Pupil on the left side was dilated and reacted sluggishly to light. Fundus examination showed marked retinal arterial spasm. Discs were pale, margins were hazy and physiological cup was full. She was diagnosed as optic atrophy more so on the left side. She had another still birth after 4 days of admission. Her vision on the left side remained the same where as the right side vision improved to 6/18 with 1.50 Dsph glasses.
| Discussion|| |
Before the days of antenatal care reports on amaurosis were frequent. Agnello  quotes a report of Schiotz on 158 cases of amaurosis pregnancy. Radford  could not get any record of amaurotic eclampsia in English literature for over decade and he published one case.
The incidence of amaurosis with eclampsia is variously reported from I to 4% , Somerville  reported one case of permanent blindness in 150,000 births. However Dieckmann  mentioned that he had not seen any case since 1941. Amaurosis occurs in the last trimester of pregnancy in 90% of cases and is accompanied with hypertension in all cases  . In the present series second case did not have high blood pressure to begin with, though she developed it later. Where amaurosis precedes it, the onset of eclampsia is imminent as seen in all the three cases.
Optic neuritis has been reported in toxaemia of pregnancy  . Eross and Tarjan  reported peripapillary and papillary oedema associated toxaemia with of pregnancy, which causes amaurosis and disappears without leaving a trace within 24-48 hours of termination of pregnancy. Carpenter et al  reviewing amaurosis of pregnancy lists thrombosis and less commonly embolism as causes. Small visual defects, to blindness is mainly due to arteriolar spasm in toxaemia of pregnancy. It affects either the arterioles of the retina or the visual centre in occipital cortex or both with or without the accompanying oedema. ,10], As there is only loss of vision in first two cases with recovery, spasm affecting the retinal vasculature is the most probable cause. Repeated toxaemia of pregnancy must have resulted in the optic atrophy in the third case. Duke Elder  mentions that a certain degree of optic atrophy or permanent macular change remain as a lasting disability in more than 50% of cases and occasionally the visual disability is progressive.
Dieckmann  noted that visual disturbances like diplopia, dimness of vision, scotomata, though not indicative of toxaemia in the normal patients, but are prodromal symptoms of eclampsia in patients with preeclamptic toxaemia and occur in 20% of such cases.
Regular check up of blood pressure and albuminurea could perhaps avert the catastrophe in young patients (26-28 years) as in this series. All pregnant patients should have an ophthalmoscopic examination done and patients showing arterial spasm should be picked tip and should be treated for preeclamptic toxaemia.
| Summary|| |
Three cases of amaurosis with toxaemia of pregnancy are reported as this is a rare condition.
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