|Year : 1980 | Volume
| Issue : 2 | Page : 67-68
Cholesterol crystals in Eales' disease
RK Mishra, M Ghosh, A Ghosh
Department of Ophthalmology, Medical College, Jabalpur, M.P, India
R K Mishra
Professor and Head of the Deptt. of Ophthalmology, Medical College, Jabalpur, M P
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mishra R K, Ghosh M, Ghosh A. Cholesterol crystals in Eales' disease. Indian J Ophthalmol 1980;28:67-8
Cholesterol crystals have been reported from human anterior chamber though they are considered to be of rare occurrence. The first case in literature was mentioned in 1828 by Parfait-Landrau. Thereafter about 55 cases have been reported. A case of cholesterol crystal in a microphthalmic eye of a girl aged 21 years was reported by Kumar. We are reporting a case of cholesterol crystal in a case of Eales' disease in a male adult. We could not find any reference of a similar case in literature.
| Case history|| |
A 26 year male attended the hospital on 6.4.78 with pain, redness and photophobia for one month and loss of vision in the right eye for 6 years. He first developed diminution of vision in 1971 and was diagnosed as Eales' disease in right eye. Within a year the vision of his right eye was reduced to P. L. only. The vision of left eye continues to be 619. From 1971 to 1978 he has been in and out of five Medical College hospitals. The diagnosis remained Eales' disease and was given the usual line of treatment. Now the right eye has developed a hazy A.C. with crystals, straw coloured fluid, lemon yellow cataract and multiple posterior synechiae with raised intra ocular tension. The eye is red and painful. Perivasculitis was seen in the left fundus. Routine investigations were done. Stool examination demonstrated E.H. cyst and the E.S R. was raised to 40mm first hour. Slit lamp biomicroscopy of right eye revealed haziness of corneal stroma, which had a luminous character. The A.C. was shallow and radiant with multiple shining crystals moving in A.C. Iris pattern was totally lost and there were wide multiple synechiae with lemon yellow coloured opaque lens. Gonioscopy could not be performed satisfactorily due to hazy A.C. and extensive ant. Synechia. Intra ocular tension was 42 m.m. of Hg. Schiotz. Paracentesis was performed. The aqueous was collected through a cannula for examination. Paracentesis reduced the pain of the patient quickly. Atropinization and corticosteroid therapy relieved the pain and redness of the right eye. Microscopic examination of aqueous smear showed multiple crystals typical of cholesterol along with few RBC's and bacterial contaminants [Figure - 1]. Chemical test showed strongly positive reaction to chloroform sulphuric acid and formaldehyde sulphuric acid test.
| Discussion|| |
Cholesterol deposits in ocular tissues is common, particularly in the lens, vitreous and retina. Cholesterol crystals in A.C. is considered uncommon. Degenerative changes, trauma, inflammation, haemorrhages and neoplasms have all been blamed to contribute to deposition of cholesterol crystals. Deposition of these crystals are seen at any age. It is considered to be dependent on the duration of causative factor rather than the age of the patient. In literature the youngest patient reported is of 5 years, the oldest being 83 years (Gruber). Studying the literature it appears that trauma, presence of blood and inflammation play a major role in formation of crystals in A.C. with hyphaema being the single most common cause in eyes which have been blind for many years, many of them being painful eyes associated with secondary glaucoma. The present case is interesting as no cholesterol crystals have been reported in Eales' disease. In this case the A.C. was filled with a polychromatic straw coloured fluid very richly impregnated by cholesterol crystals.
| Summary|| |
A young man with Eales' disease developed anterior chamber haemorrhage, severe iridocyclitis, and secondary glaucoma. Crystals were seen in A.C., confirmed to be cholesterol by microscopic examination and strongly positive chemical tests. The other eye with typical Eales' disease, retinal perivasculitis retains good vision.
| References|| |
Parfait-Landrau, 1828, Rev. Med. franc. etrang., 4: 203, (cited by Gruber, 1955).
Kumar, S., 1963, Brit J. Ophthalmol. 47:295.
Forsius, H., (1961) Acta Ophthalmol. (Kbh.), 39: 284.
Gruber, E., 1955, Amer. J. Ophthalmol. 40,817.
[Figure - 1]