|Year : 1970 | Volume
| Issue : 3 | Page : 135-137
Post typhoid retinal detachment
JS Mathur, HV Nema, JN Char, KS Mehra
Department of Ophthalmology, College of Medical Sciences, Banaras Hindu University, Banaras, India
J S Mathur
Department of Ophthalmology, College of Medical Sciences, Banaras Hindu University, Banaras
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mathur J S, Nema H V, Char J N, Mehra K S. Post typhoid retinal detachment. Indian J Ophthalmol 1970;18:135-7
Typhoid fever is still common in many parts of the world, and it takes a heavy toll of manpower and occasionally even life. The prompt diagnosis and proper treatment of enteric fever seldom lead to any complication. Nevertheless, the disease is notorious for affecting the intestine, heart and joints. From the ocular standpoint conjunctivitis, metastatic uveitis, optic neuritis, retinal haemorrhages, accommodation paralysis, tenonitis, orbital cellulitis and even panophthalmitis have been mentioned as the complications of the disease (Agarwal  , Ballantyne and Michaelson  , Sorsby  , and Duke Elder). Pseudo-retinitis pigmentosa has also been reported (Schupfer and Santino).
During the last three years we have observed two cases of post-typhoid retinal detachment. The rarity of the complication has prompted us to report them.
| Case Reports|| |
Case I: K., 14 years female attended the out patients department of Bhuwalka Eye Hospital, Banaras Hindu University, Varanasi in April, 1966 with the complaints of gross diminution of vision in her left eye for the last 10 days. She had suffered from typhoid fever for a period of 27 days in March 1966 for which chloramphenicol, 250 rug q.i.d. was given for 17 days: Her Widal test was positive in dilutions 1:50. She had no previous inoculation against typhoid and there was no history of trauma.
On examination - Thee girl was of average build. Her right eye was normal with 6/6 vision. The left eye had dilated and sluggishly reacting pupil with 5/60 vision. Fundus examination of the left eye revealed vitreous floaters, hyperaemic disc with venous engorgement. The lower segment of the retina showed a big crescentic detachment extending from 9 to 4 O'clock position. The elevation of the retina ranged between 6-8 Dioptres. No fold or undulation could be seen. Repeated examinations failed to reveal any hole. She was diagnosed as a case of exudative retinal detachment. Her blood V . D . R . L . , blood sugar, total and differential W.B.C. counts, E.S.R., Mantoux-test, stool and urine examinations and X-ray chest were noncontributory. She had no septic focus in her body.
She was given retrobulbar Decadron injections - 0.5 ml every 4th day and Millicorten tablets (in graded dosage starting with 3.0 mg per day) and B 1 , B 12 injections intra-muscularly on alternate days for one month. It was supplemented with collosal iodine and Lederplex, one teaspoonful each, twice daily. She was advised absolute rest. Atropine and corticosteroid eye ointments were applied locally. The follow up examination showed some improvement in her vision from the 5th day onwards. After 31st day of hospitalisation, her visual acuity improved to 6/9. Funduscopy demonstrated complete flattening of retina but a few abnormal reflexes in the area of old detachment were still seen. The patient was rechecked in March, 1969. She had 6/6 partial vision in the left eye and the fundus picture showed no commentable abnormality.
Case II: Mrs. B. D., aged 24 years was admitted to the Indoor Section of our hospital in August, 1967 with gradual deterioration of her vision in the right eye for the last one and a half months. She also complained of dull pain in her left eye. The patient suffered from typhoid fever in May, 1967 with positive serology (Widal in 1: 100 dilution). Her continuous fever had lasted for 40 days and during the terminal phase of the disease she noticed blurring of vision in the right eye which was progressively deteriorating.
On examination - The patient was averagely nourished and moderately built. Her visual acuity in the right eye was hand movements and in the left eye 6/18. The right pupil was semidilated and was non-reacting to light stimulus, The vitreous was hazy and there was a massive detachment of retina extending from 2 O'clock to 11 O'clock meridians. It was encroaching on the macular and parapapillary areas. The detachment appeared to be of solid type and no retinal hole could be localised. The left eye had deep anterior chamber with active non-granulomatous uveitis. All the laboratory investigations were found to be within normal limits. No septic focus could be detected.
The patient was given treatment for her right eye on similar lines as in case - I, while subconjunctival injections of Decadron and mydricaine on alternate days were given in her left eye. Daily dressings with atropine and corticosteroid ointment were given in both the eyes. After 6 weeks of treatment the left eye showed improvement and visual acuity came to 6/6 partial. There was no significant improvement observed in the right eye. The retina remained elevated and visual acuity was 6/60. The patient left the hospital against medical advice.
| Discussion|| |
Typhoid fever is an acute infectious disease capable of producing toxic and degenerative changes in the tissues throughout the body. Therefore, involvement of the eye is not surprising in this disease. Complications are usually seen after the third week which is notoriously called as the "Week of complications". There can be two possible nodes of ocular involvement - firstly, through direct invasion of the ocular tissues by the bacteria and secondly, by way of allergic reaction, Direct invasion manifests usually in the form of orbital cellulitis or panophthalmitis. In some circumstances, a low grade chronic inflammatory reaction may appear as uveitis papillitis, arteritis or retinitis. Generally speaking, occurrence of retinal detachment points towards an exudative bacteriologically sterile reaction in the choroid. The detachment will correspond to the extent and amount of exudation. Although, this manifestation appears to be relatively benign, it may lead to serious visual damage, as in our cases. Therefore, the recognition of ocular complications of typhoid necessitates a close collaboration between a physician and on oculist at the earliest opportunity.
| Summary|| |
Two cases of unilateral exudative retinal detachment following typhoid fever are reported. One of them also had non-granulomatous anterior uveitis in the contralateral eye. The retiiral detachment in one case responded excellently to the treatment while, the other case did not show any improvement.
| References|| |
Agarwal, L. P.: "Eye diseases", Kitab Mahal. Alla-hebad, p. 511, (1963).
Ballantyne, A. I. and I. C. Michaelson: "Text Book of the Fundus of the Eye", Livingstone, London, p. 275, (1962).
Duke Elder, S.: "Parsons' Diseases of the Eye", 14th Ed., J. A. Churchill Ltd., London, p. 550.
Santino: Riv. Oto-neuro-oftal. 37: 441; (1962). Cited by Duke Elder, S.: "System of Ophthalmology", Henry Kimpton, London. Vol. X, p. 532, (1967).
Schupfer: Boll. Oculist, 30: 424, (1951). Cited by Duke Elder, S. - Ibid.
Sorsby, A: "Modern Ophthalmology", Butterworths, London, Vol. II, p. 105, (1963).