|Year : 1980 | Volume
| Issue : 2 | Page : 85-87
Internal ophthalmoplegia following measles (morbilli)
M Mathew, DK Mathew, PS Sandhu
Department of Ophthalmology, Ladv Hardinge Medical College & S.K. Hospital, New Delhi, India
D K Mathew
Department of Ophthalmology, Lady Hardinge Medical College, New Delhi-110001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mathew M, Mathew D K, Sandhu P S. Internal ophthalmoplegia following measles (morbilli). Indian J Ophthalmol 1980;28:85-7
In India measles is still one of the very common exanthematous lesions of childhood, although its vaccine has reduced its frequency in the developed countries. Ophthalmologists are familiar with its after effects in the eyes, but serious complications affecting vision are rarely encountered. Miller considers catarrhal and kerato-conjunctivitis as common ocular lesions. Rarely, gangrene of one or more lids has been encountered,,. Tyler has mentioned transient dilatation of pupil due to encephalomyelitis with other findings like paresis of VI nerve and convergent strabismus. Internal ophthalmoplegia (accommodational palsy) due to measles is a very rare complication reported by Dreisch. We could trace only one case report in the literature. Hence this case is being published.
| Case report|| |
A boy, aged nine years, was admitted on 11th Nov. 1976 in the eye ward of Lady Hardinge Medical College & S.K. Hospital, New Delhi, with the complaint of diminution of vision in the left eye for the past three and a half weeks. A week earlier, the child had suffered from moderate fever and rash all over the body. Earlier, the patient was being treated by a private practitioner for intermittent high fever, productive cough and dimness of vision. There was no history of any injury over face or skull in the past. On examination the patient showed healed spots on the skin due to the earlier rash, a patch of pneumonitis in the right lung and dilatation of the left pupil. A diagnosis of post morbilli pneumonitis with internal ophthalmoplegia was made [Figure - 1].
Fever came down and chest infection cleared with procaine penicillin. Eye examination revealed that the patient had blurring of vision and difficulty for near work. Right eye vision was 6/6 and near point of accommodation was 10 cms. Accommodation was normal in range and amplitude. Right pupil was normal in size and shape, showed direct and consensual light reactions [Figure - 2]. Vision of the left eye was 6/18 and improved to 6/6 with + 0.50 D. Sph. Near vision was J3 with near point of accommodation at 30 cms. Pupil was dilated to 7 mm in size [Figure - 3]. Direct, consensual and near reflexes were absent. Slit-lamp examination was normal except for a tiny pigment dot at the back of cornea in left eye, while fundus and field of vision were normal in both eyes. There was no effect of local pilocarpine 2%, 4% and eserine 0.5% thrice daily on the left pupil. The pupil of right eye reacted normally to the above miotics. The child was discharged on Dec. 6, 1976 after twenty five days of stay in the hospital, with the advice to attend Eye OPD. D.F.P. was not tried because of non-availability. Follow up for more than one year showed no improvement.
| Discussion|| |
Internal ophthalmoplegia following measles without recovery is extremely rare. So far only one case has been reported in the literature to the best of our knowledge. Cycloplegia in diseases like mumps and herpes zoster has been reported. Accommodational palsy due to ocular varicella though uncommon has been reported by Ross.
The mechanism of palsy can be muscular or neurogenic or both. The lesion may be located in the nucleus or in the course of nerves that supply the sphincter pupillae and ciliary muscles. The two are not always easily distinguished. As the nuclei for the extraocular muscles are separate from those of the sphincter pupillae and the ciliary muscles, the extraocular muscles need not be involved when the internal ophthalmoplegia is of nuclear origin. The uniocular internal ophthalmoplegia, not responding to pilocarpine, an acetyl choline like drug, and eserine, a cholinesterase inhibitor, indicates that ophthalmoplegia is most likely due to the inability of muscles to contract, thus suggesting that the virus produces its effect on the iris and ciliary muscles directly or at myoneural junctions. If the muscles were not involved, there should be retention of the normal effect with eserine (Manz).
| Summary|| |
A nine year old boy with unilateral internal ophthalmoplegia after an attack of measles is being reported. To the best of our knowledge only one such case has been reported so far in the literature. Absence of any response of the pupil to pilocarpine and eserine indicated that the defect could be at the myoneural junction or in the ciliary muscle itself, possibly as an aftermath of virus affection.
| References|| |
Miller, D.L., 1964, Brit. Med. Jour.: 2, 75.
Axenfeld, K.T., 1904, Munch. Med. W., 51: 779, cited by Duke-Elder', S.S., Text Book of Ophthalmology, Vol. XIII, 137 Kimpton, London, 1974.
Fieuzal, 1887, Bull. Clin. Nat. Opht. Hosp Quinze-Vingts, 5, 198, cited by Duke Elder S.S., Text Book of Ophthal., Vol. XIII, 137, Kimpton, London, 1974.
Saint-Martin, 1884., Bull. Clin. Nat. Opht. Hosp. Quinze-Vingts, 2, 145, Cited by Duke-Elder S.S , Text Book of Ophthal., Vol., XIII, 137. Kimpton, London, 1974.
Tyler, H.R., 1957, Med. Bull., 36: 147.
Dreisch, 1898, Munch. Med. Wschr., 45: 627, cited by Duke Elder, S.S., System of Ophthalmology, Vol. XII, 705, Kimpton, London, 1971.
Ross J.V.M, 1961, Amer. J. Ophthalmol, 51: 1307.
Manz, 1870, Klin. Mbl. Augenheilk., 8: 245. cited by Duke Elder S.S., System of Ophthalmology, Vol. XII, 705, Kimpton, London, 1971.
[Figure - 1], [Figure - 2], [Figure - 3]