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   Table of Contents      
ARTICLES
Year : 1975  |  Volume : 23  |  Issue : 1  |  Page : 25-26

Amaurosis in toxaemia of pregnancy


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

Correspondence Address:
M Mathew
Department of Ophthalmology, Lady Hardinge Medical College and Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


PMID: 1158419

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How to cite this article:
Mathew M, Rajani C K, Gulati N. Amaurosis in toxaemia of pregnancy. Indian J Ophthalmol 1975;23:25-6

How to cite this URL:
Mathew M, Rajani C K, Gulati N. Amaurosis in toxaemia of pregnancy. Indian J Ophthalmol [serial online] 1975 [cited 2020 Jun 5];23:25-6. Available from: http://www.ijo.in/text.asp?1975/23/1/25/31335

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.

Case I

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.

Case 2

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.

Case 3

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 Top


Before the days of antenatal care reports on amaurosis were frequent. Agnello [1] quotes a report of Schiotz on 158 cases of amaurosis pregnancy. Radford [11] 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% [6],[14] Somer­ville [13] reported one case of permanent blindness in 150,000 births. However Dieckmann [4] 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 [12] . 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 [2] . Eross and Tarjan [7] 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 [3] 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. [8],[9]10],[14] 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 [5] 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 [4] 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 Top


Three cases of amaurosis with toxaemia of pregnancy are reported as this is a rare con­dition.

 
  References Top

1.
Agnello, F., 1960 Boll Occulist 39, 657.  Back to cited text no. 1
    
2.
Blagojevic M., Kostic, P. and Litricin O., 1963 Bull. Soc. Trans. Ophthal. 76, 165.  Back to cited text no. 2
    
3.
Carpenter, F. Kava, H. L. and Plotkin, D., 1953, Amer. J. Obst. Gynae. 66, 641.  Back to cited text no. 3
    
4.
Dieckmann, W. J., 1952. The Taxaemias of Pregnancy, 2nd Ed. 217. St. Louis. Mosby.  Back to cited text no. 4
    
5.
Duke Elder, S., 1967, System of Ophthalmology 10, 350, Henry Kimpton, London.  Back to cited text no. 5
    
6.
Eastman. N. J. (1950, Williams Obstetrics 10 Ed. 666, New York Appleton Century Crofts.  Back to cited text no. 6
    
7.
Eross, S. and Tarjan G. Z., BL 1964, Gynak 86, 35, 1229.  Back to cited text no. 7
    
8.
Green Hill. I. P., 1960, Obstetrics 12th Edn. 389, London & Saunders Philalelphia.   Back to cited text no. 8
    
9.
Inguilla W., 1949 Med. J. Ausr. 1, 145.  Back to cited text no. 9
    
10.
Palliez R. Delecour, M and Woillez. M. 1959, Gynae et Obstet 11, 364.  Back to cited text no. 10
    
11.
Radford A. J. and Ruth D. W. O., 1964, Aunt. N. Z. J. Obstet. Grnae. 4, 35.  Back to cited text no. 11
    
12.
Swift, B., 1931 Med. J. Aust. 1, 632.  Back to cited text no. 12
    
13.
Somerville, Large, L. 1950. Brit. J. Ophtlral. 34, 431.  Back to cited text no. 13
    
14.
Wagener, H. P., 1933, J. A. M. A. 101, 1380. 15. Wagener H. P., 1934, J. A. M. A. 103, 1910.  Back to cited text no. 14
    




 

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