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| ARTICLE |
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| Year : 1966 | Volume
: 14
| Issue : 2 | Page : 87-88 |
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Intestinal infections and ocular lesions with particular reference to keratomalacia
R Tiwary
Gaya, Bihar, India
| Date of Web Publication | 12-Jan-2008 |
Correspondence Address:
R Tiwary
Gaya, Bihar
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Tiwary R. Intestinal infections and ocular lesions with particular reference to keratomalacia. Indian J Ophthalmol 1966;14:87-8 |
Eye manifestation in intestinal infestation by worms are not widely appreciated. We first got interested in this subject when in 1947, a lady patient aged 35 came to us suffering from pain in the eyes for the last five years which did not respond to any change of glasses. We failed to find any cause even after a fortnight's treatment. I remembered then the teaching of the late Dr. Muthaiya of Madras who often quoted in his lectures what Col. Verdon used to say, that while examining an eye never forget the abdomen. So, I sent her stool for examination and found that almost all varieties of worms were present in her bowel and the eradication of those cured her of her eye pain which had harassed her for 5 years.
Since then our interest was aroused and have got 6000 specimens of stools examined since 1947 for different eye diseases. I read a paper at the international ophthalmic conference at Delhi also where I had established the relation of intestinal worms with diseases like Keratomalacia, painful eyes, phlyctenular conjunctivitis, blepharospasm and diplopia.
Diplopia in helmenthiasis was mentioned to me by Dr. D. G. Patwardhan of Poona in the course of a talk at Aligarh in 1956 where a boy patient of his was cured of diplopia after passing 36 round worms. Since then I had 7 cases of dplopia without any definite cause, out of which 5 responded to treatment for worms.
In Delhi while I was coming out after reading my paper, a doctor from Yugoslavia met me and told me about a case he had reported nearly 10 years ago. While he was working in the army in Egypt, he got a case of optic atrophy which improved after eradication of round worms.
In this article I have shown the relation of Keratomalacia to intestinal worms. It struck me that if in a family of 10 if all are on the same diet but poor in vitamin A, why should one suffer from the disease and not the others. There should be some associated factor also. Further I found that most of them had some disorder of the bowels. The children and babies mostly had diarrhoea and dysentery. At the same time one man told me that his child had not been tolerating mother's milk for some time. I sent for the mother and finding some disorder of her bowels sent her stool for examination which was found to be full of Hookworms. A dose for hookworm was given and the child started tolerating mother's milk. Since then whenever I would get a Keratomalacia baby while on mother's milk, I would send the mother's stool for examination. To my surprise I did not find a single case in these 250 cases where intestinal worms were not found. Most of these mothers had conjunctival xerosis on examination or gave history of nightblndness some time before the child was born or had keratomalacia. In the majority of babies keratomalacia started with history of diarrhoea just preceding and on examination Giardia were present in more than 90% of cases.
Since 1947, I have kept on record 1500 cases of Keratomalacia whose stools were examined. In these 1500 cases 95% possessed intestinal worms. Expulsion of worms had hurried cures and checked recurrences. The worms found were hookworms, roundworms, Ent. hystolytica, Giardia and H. Nama etc. The worms act
1) By draining the vitamins.
2) By exerting their toxins.
3) By producing a sort of allergy. In cases of phlyctenular conjunctivitis, especially the recurrent type, we have found worms as a causative factor.
4) By changing the bacterial flora of the interestines due to which certain vitamins are not properly absorbed.
We have found Hookworm and Giadia more commonly than other worms in cases of Keratomalacia. Although not a worm, Ent. Hystolytica appears to me to be the most pathognomonic to the eye and we feel that ocular afflictions by it have not yet been fully investigated. In the course of one study, besides keratomalacia we had 5 cases of asthma, several cases of cardiac pain and a dozen cases of chronic headaches with varied histories, moving from physicians to Ophthalmologists and ophthalmologists to physicians who were relieved by eradication of Ent. Hystolytica. It plays major part in producing allergic ocular manifestations and keratomalacia.
The treatment of such cases will naturally require large doses of vitamin A as a supplement to the measures taken against the worms and entamaeba.
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