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Year : 1982  |  Volume : 30  |  Issue : 4  |  Page : 307-309

Ocular manifestations of epidemic dropsy

Deptt. of ophthalmology, Gandhi Medical College, Bhopal, India

Correspondence Address:
M K Rathore
Lecturer in ophthalmology, Gandhi Medical College, Bhopal (M.P)
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Source of Support: None, Conflict of Interest: None

PMID: 7166412

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How to cite this article:
Rathore M K. Ocular manifestations of epidemic dropsy. Indian J Ophthalmol 1982;30:307-9

How to cite this URL:
Rathore M K. Ocular manifestations of epidemic dropsy. Indian J Ophthalmol [serial online] 1982 [cited 2023 Feb 1];30:307-9. Available from: https://www.ijo.in/text.asp?1982/30/4/307/29458

Table 1

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Table 1

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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.


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 Top

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 Top

(I) Sex-distribution

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[2].

(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[3] et al Meaker[4]. While in other epidemics clinical findings other than glaucoma were found[2],[5],[6].

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[7] in his ex­perimental studies found ocular changes simi­lar to those found in chronic simple glaucoma.

Leach[8] 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[6] 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 Top

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.[9]

  References Top

Maynard, 1909, Ind. Med. Gaz. 44 :373  Back to cited text no. 1
Sainani, G.S. Epidemic Dropsy. Progress in Clinical Medicine in India, Edited by M.M.S. Ahuja, Arnold Heinemann P.P. 92-98.  Back to cited text no. 2
Chopra, R.N. and R.N. Choudhary Ind. Med Gaz. 70 : 481  Back to cited text no. 3
Meaker, R.E., 1950, And. Med. Caz. 86: 280.   Back to cited text no. 4
Shanbhag, 1968, Ind. Jr. Med. Sc. 27 : 226  Back to cited text no. 5
Shah, M.J., 1969, Ind. Jr. Med. Res. 57 :1878.  Back to cited text no. 6
Hakim, S.A.E., 1954, Brit. J. Ophthalmol 38 : 193  Back to cited text no. 7
Leach, 1955, Trans. Ophthalmol. Soci. U.K. 75 425.  Back to cited text no. 8
Duke, Elder, S., 1969, System of Ophthalmology Vol. XI. Henry Kimpton, London. P.P. 684:687.  Back to cited text no. 9


  [Figure - 1]

  [Table - 1]


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