|Year : 1982 | Volume
| Issue : 4 | Page : 307-309
Ocular manifestations of epidemic dropsy
Deptt. of ophthalmology, Gandhi Medical College, Bhopal, India
M K Rathore
Lecturer in ophthalmology, Gandhi Medical College, Bhopal (M.P)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rathore M K. Ocular manifestations of epidemic dropsy. Indian J Ophthalmol 1982;30:307-9
Epidemic Dropsy is an acute toxic disease which was recognised in 1877, when it appeared as an epidemic outbreak in Calcutta. However this drew the attention of ophthalmologists only in 1909 when Maynard' reported occurrence of Glaucoma in cases of Epidemic Dropsy.
| AETIO-PATHOGENESIS|| |
It is well established that contamination of the cooking oil with seeds of Argemona maxicana is the cause of this toxic state. The toxity was due to Sanguinarine Hydrochloride-an alkaloid of Benzphenanthrine subgroup of isoquinoline group isolated from oil of Argemone maxicana.
Mode of action of sanguinarine is not clearly understood. It appears to depress the action of sympathetic stimulation and of adrenaline. It also decreases to some extent the action of acetyl choline. It is also thought that sanguinarine in Epidemic Dropsy blocks the sulphhydryl radical of main enzyme (co-ASH) responsible for pyruvate oxidation, thereby increasing the amount of pyruvate in blood.
Pathologically sanguinarine hydrochloride gives rise to dilatation and engorgement of capillaries in various tissues of the body. Gross capillary dilatation is seen in the uveal tract particularly in the cilliary body.
| Materials and methods|| |
25 clinically proved cases of Epidemic Dropsy were studied in an outbreak in JuneJuly 1980. All of them belonged to Bengali Colony of Itarsi town of Madhya Pradesh, which was the only affected area. Bengalis who mainly consume mustard oil (which easily gets contaminated with the seeds of Argemone maxicana) suffered from this disease, while the rest of the city population remained unaffected. Oil samples taken from some of the affected families were positive for the presence of sanguinarine.
Ophthalmic examination carried out in the affected colony, included recording of visual acuity, external ocular examination, measurement of Intraocular tension with schiotz tonometer and fundus examination.
| Observations and discussion|| |
Out of 25 cases 13 were males and 12 were females.
(11) Age distribution
Adolescents and young adults were relatively more affected. No case was seen below the age of 4 years, and the incidence was again less above the age of 60 years. [Table - 1] Practically similar observations were made by Sainani.
(III) Visual Acuity
Ninety four percent of cases (47 eyes) had normal visual acuity without glasses or with pin hole. Six percent (3 eyes) had visual acuity of less than 6/60. Cause of defective vision in 2 of them was lenticular opacities and in one which had macular haemorrhage, visual acuity was reduced to finger counting at one foot.
(IV) Intra ocular tension
Intra Ocular tension in most of the eyes (96%) was within normal limit. Only one case had intra ocular tension of 64 mm. of Hg even with this tension there were no congestive features.
The incidence of glaucoma in cases of Epidemic Dropsy has been variable. In some of Epidemics, glaucoma has been dominating feature. (10 to 12% as reported by Chopra et al Meaker. While in other epidemics clinical findings other than glaucoma were found,,.
In our series relatively low incidence of glaucoma i.e. 4% only was observed.
Mechanism of production of glaucoma is still not clearly understood. Hakim in his experimental studies found ocular changes similar to those found in chronic simple glaucoma.
Leach fcur.d proliferation of endothelial lining of tra beculae in monkeys. While some other workers considers that the rise in ocular tension is due to the action of sanguinarine on C. N. S.
(V) Fundus Findings
Fundus examination showed venous engorgement in 84% of the eyes. 20% of them had superficial retinal haemorrhages of variable size scattered all over the fundus. [Table 5]
It was also observed that severity of Epidemic Dro psy (Generalised symptoms and signs) was fairly related to retinal venous engorgement, Cases with mild or low grade symptoms had no venous engorgement while acute and severe type of cases showed engorgement of the retinal veins and even haemorrhages.
In two eyes initially there was only venous engorgement but after two weeks, when they were admitted in the Medical College Hospital for the symptoms of toxic myocarditis. they further showed retinal haemorrhages.
Shah observed early venous congestion in 10 cases out of 67 (14.99%). A very high incidence of venous congestion was seen in our series (84%). Probably as a part of generalised telangiecatic dilatation of capillaries without inflammatory reaction, which may be due to histamine like action of sanguinarine hydrochloride.
Superficial retinal haemorrhages were seen in 20% of cases which appear to be due to toxic effect of sanguinarine.
Papilloedema has been reported in two out of 119 (1.7%) cases studied by Sainanis. However papilloedema was not seen in any of our cases.
| Summary|| |
Opthalmological study in 25 cases of Epidemic Dropsy in a recent outbreak in Madhya Pradesh was carried out. There was a low incidence of glaucoma in this series. High incidence of retinal vein congestion without and with haemorrhages was observed. Retinal haemorrhages observed in this series, to the best of our knowledge have not been reported so far in the literature.
| References|| |
Maynard, 1909, Ind. Med. Gaz. 44 :373
Sainani, G.S. Epidemic Dropsy. Progress in Clinical Medicine in India, Edited by M.M.S. Ahuja, Arnold Heinemann P.P. 92-98.
Chopra, R.N. and R.N. Choudhary Ind. Med Gaz. 70 : 481
Meaker, R.E., 1950, And. Med. Caz. 86: 280.
Shanbhag, 1968, Ind. Jr. Med. Sc. 27 : 226
Shah, M.J., 1969, Ind. Jr. Med. Res. 57 :1878.
Hakim, S.A.E., 1954, Brit. J. Ophthalmol 38 : 193
Leach, 1955, Trans. Ophthalmol. Soci. U.K. 75 425.
Duke, Elder, S., 1969, System of Ophthalmology Vol. XI. Henry Kimpton, London. P.P. 684:687.
[Figure - 1]
[Table - 1]