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    CASE REPORT-2
    Discussion
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ARTICLES
Year : 1981  |  Volume : 29  |  Issue : 1  |  Page : 35-36
 

Acute haemorrhagic conjunctivitis-rare ocular manifestations


Department of Ophthalmology, Christian Medical College, Vellore, India

Correspondence Address:
T A Alexander
Department of Ophthalmology Christian Medical College Vellore- 633 001
India
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PMID: 7287123

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How to cite this article:
Alexander T A, Thomas A. Acute haemorrhagic conjunctivitis-rare ocular manifestations. Indian J Ophthalmol 1981;29:35-6

How to cite this URL:
Alexander T A, Thomas A. Acute haemorrhagic conjunctivitis-rare ocular manifestations. Indian J Ophthalmol [serial online] 1981 [cited 2014 Sep 2];29:35-6. Available from: http://www.ijo.in/text.asp?1981/29/1/35/30988


The various ocular manifestations of ocute haemorrhagic conjunctivitis so for reported are episcleritis, phlyctens, follicular conjunctivitis, superficial marginal keratitis, epithelial erosions and sub epithelial keratitis. During the last epidemic in southern India a few of our cases presented with rare ocular features. The aim of this article is to report two cases of optic neuritis and one case of palsy of the 6th nerve which developed following an attack of viral conjunctivitis.


   CASE REPORT-1 Top


M.G.K. male aged fifty years presented to us with complaints of sudden diminution of of vision in right eye of two days duration. A week prior to this he had developed acute viral conjunctivitis in both eyes. During the attack he had low grade fever lasting for two days. On examination his visual acuity was hand movements in the right eye and 6/6 in the left eye. Right eye showed ill sustained pupillary reaction and ocular movements were restricted to abduction. Fundus examination revealed blurring of the disc margins, tortuosity of the vessels and superficial haemorrhages around the disc. Slit lamp examination showed a few cells in the vitreous. There was no other neuro­logical deficit. A diagnosis of optic neuritis with 6th nerve palsy was made and the patient was put on systemic and retrobulbar injection of steroids. Within one week his visual acuity improved to 6/6 and ocular movements to full range. Central field examination done at 6/24 showed a central scotoma. Serum when tested against Coxakie A/54, Variant CH 24/1970 EV 70 viruses showed that antibody titre was signi­ficantly high (32) against CH 24/1970. All other investigations were normal.


   CASE REPORT-2 Top


P.D. female aged 53 reported with com­plaints of sudden diminution of vision in the right eye since one day. Her vision in the right eye was 6/24 with correction and left eye was hand movements (old retinal detachment). Four days prior to this the patient had acute con­junctivitis in both the eyes. The patient also had pain on moving the eye balls. Fundus examination revealed a normal aphakic fundus. A central scotoma was demonstrated on scoto­metry and a diagnosis of retrobulbar neuritis was made. Systemic and retrobulbar steroids and inj. Vitamin B complex were given. Two days later vision improved to 6/5. All investi­gations were normal sera tested against Coxakie A 24, Variant CH 24/1970, and EV 70. Neutralizing antibody titre was not high (less than 8) in all viruses.


   Discussion Top


Acute haemorrhagic conjunctivitis is a relati­vely new clinical entity whose entire clinical features are not fully elucidated. Constitutional symptoms mainly are headache, fever, malaise and abdominal pain. Neurological complications of lumbar Radiculomyelitis with incomplete recovery were first reported from India from Bombay during 1971 epidemic.[1],[2] All the above cases except one had developed viral conjunc­tivitis immediately prior to the spinal involve­ment. Following this report Kono[3] studied the neurotoxic effect of AHC virus in cyanomo­logous. He observed that following the inocula­tion of virus material into the spinal cord and thalamus, the monkeys developed paraplegia or monoplegia of the lower limbs. The frequent association of viral conjunctivitis and radiculo­myelitis and experimental evidence of neuroto­xicity suggests that AHC virus is capable of producing neurological complications.

Virological studies in our cases have shown that in case No. 1 there was high neutralizing antibody titre while case No. 2 did not have. Earlier observations in our laboratory have shown that there are cases of conjunctivitis with positive virus isolation and no significant neutralizing antibody. Hence one cannot rule out attacks of viral conjunctivitis even though there is no significant antibody titre.

The development of these ocular complications immediately following conjunctivitis suggests that the virus is likely to be responsible for these lesions. The ocular lesions recovered without any sequelae.

One must look for these ocular complica­tions in cases of viral conjunctivitis. These ocular complications are rare, when compared to the number of cases of viral conjunctivitis. The emergence of virulent neurotoxic mutant strains are possibly responsible for these lesions. Our series is small and hence more extensive studies are called for.


   Summary Top


Two cases of optic neuritis and one case of sixth nerve palsy immediately following an attack of viral conjunctivitis are reported.

 
   References Top

1.Bharucha, E.P., and Mondkar, V.P., 1972, Lancet, 2 : 970.  Back to cited text no. 1    
2.Kono, R., Uchida, N., Sanagawa, A., Akao, Y., Kodama, H., Mukoyama, J., and Fujiwara, T., 1973, Lancet, 1 : 61.  Back to cited text no. 2    
3.Wahida, N.H., Irani, P.F., and Katrak, S.M.1973, Lancet, 1 : 350.  Back to cited text no. 3    




 

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