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ARTICLE
Year : 1970  |  Volume : 18  |  Issue : 3  |  Page : 135-137

Post typhoid retinal detachment


Department of Ophthalmology, College of Medical Sciences, Banaras Hindu University, Banaras, India

Correspondence Address:
J S Mathur
Department of Ophthalmology, College of Medical Sciences, Banaras Hindu University, Banaras
India
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Source of Support: None, Conflict of Interest: None


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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

How to cite this URL:
Mathur J S, Nema H V, Char J N, Mehra K S. Post typhoid retinal detachment. Indian J Ophthalmol [serial online] 1970 [cited 2020 Oct 27];18:135-7. Available from: https://www.ijo.in/text.asp?1970/18/3/135/35079

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 [1] , Ballantyne and Michael­son [2] , Sorsby [6] , and Duke Elder[3]). Pseudo-retinitis pigmentosa has also been reported (Schupfer[5] and Santino[4]).

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 Top


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 Top


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 Top


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 Top

1.
Agarwal, L. P.: "Eye diseases", Kitab Mahal. Alla-hebad, p. 511, (1963).  Back to cited text no. 1
    
2.
Ballantyne, A. I. and I. C. Michael­son: "Text Book of the Fundus of the Eye", Livingstone, London, p. 275, (1962).  Back to cited text no. 2
    
3.
Duke Elder, S.: "Parsons' Diseases of the Eye", 14th Ed., J. A. Churchill Ltd., London, p. 550. (1964).  Back to cited text no. 3
    
4.
Santino: Riv. Oto-neuro-oftal. 37: 441; (1962). Cited by Duke Elder, S.: "System of Ophthalmology", Henry Kimpton, London. Vol. X, p. 532, (1967).  Back to cited text no. 4
    
5.
Schupfer: Boll. Oculist, 30: 424, (1951). Cited by Duke Elder, S. - Ibid.  Back to cited text no. 5
    
6.
Sorsby, A: "Modern Ophthalmology", Butterworths, London, Vol. II, p. 105, (1963).  Back to cited text no. 6
    




 

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