|Year : 1983 | Volume
| Issue : 1 | Page : 27-29
Optic neuritis following panophthalmitis in the other eye
SC Karandikar, PT Lemade, NS Arvikar
Department of Ophthalmology, Medical College, Aurangabad, India
S C Karandikar
Deptt. of Ophthalmology, Medical College, Aurangabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Karandikar S C, Lemade P T, Arvikar N S. Optic neuritis following panophthalmitis in the other eye. Indian J Ophthalmol 1983;31:27-9
The establishment of aetiological diagnosis of optic neuritis is considerably difficult. Many a times it is by inference only. Number of inflammatory conditions were mentioned by Duke Elder, Walsh, and Kestenbaum as local causes of optic neuritis. Here a case of optic neuritis, is presented which resulted following panophthalmitis of the other eye.
| Case report|| |
A 30 years old, muslim, male sustained perforating injury with iron piece to his left eye. On the next day he was admitted with characteristic clinical picture of panophthalmitis. The iron piece got expelled out of it's own. The patient refused evisceration. The eye went into phthisis bulbi with medical treatment.
After 42 days of injury, he had rapid deterioration of vision of his right eye with frontal headache for which he was readmitted.
On local examination [Figure - 1] the head was turned towards left side. The right eye showed no congestion. There was no superior rectus tenderness. There were no posterior synechiae. The pupil was dilated and sluggishly reacting to light. The intra ocular tension was normal. The visual acuity was counting finger 1.5 meters, with no improvement with pin hole.
The right fundus showed clear media. The optic disc was hyperaemic with blurred margins and fullness of cup. There was retinal oedema around the disc extending upto the macula. The vessels were dilated and tortuous. There were no haemorrhages or exudates. The scotometry revealed centrocaecal scatoma. The perimetry was normal.
The left side had narrow interpalpebral fussure. The left eye was shrunken. There was no congestion. It was with difficulty that cornea could be made out. In the upper temporal quadrant there was blackish area 2 mm. in size. There was no perception of light.
On investigations the haernogram and urine were normal. The E.S.R. was 45 mm. at the end of first hour (Wintrobe). The blood sugar was 110 mg.%. The Rose Waller and V.D.R.L. tests were not suggestive. The blood culture for bacterial growth was sterile. The stool examinat.on did not show ova or cysts. There was no septic focus of infection anywhere.
The patient was kept on Injection Streptopenicillin and tablet prednisolone (40 mg.) alongwith nervine tonic. The patient was also given retro-ocular injections of Wymasone daily for four days. The left eye was enucleated.
The response to treatment was extremely good with improvement of vision to 6/12. The fields became normal. The reaction of the pupil to light turned normal. The fundus picture also changed to normal except for the pigmentary deposits at the macula.
The macroscopic examination [Figure - 2]a of the enucleated eye showed completely collapsed and distorted eye ball.
The microscopic examination [Figure - 2]b revealed replacement of corneal region with scar tissue. There were focal ectatic areas which incorporated descemet's membrane with pigment. The inner oeular structures could not be identified. There was total disorganisation. The sclera was extremely thickened. The diagnosis was optic neuritis right eye following panophthalmitis left eye.
| Discussion|| |
Even to this date, the diagnosis of internal eye diseases is speculative and the ophthalmologist has to deduce the conclusion by inference. On more than one occasion the diagnosis of sympathetic ophthalmitis is presumptive, it being usually based on clinical observations. Thus in the literature,, there are many cases on record with different aetiologies. From the clinical picture one may think of the present case to be a variety of sympathetic ophthalmitis, manifesting as simple optic neuritis, as has been described by many earlier authors, although Duke Elder has questioned this.
One cannot be certain of the diagnosis of sympathetic ophthalmitis, unless histopathological evidence is forthcoming. Woods (I956) stated that the absolute diagnosis depends on histological examination of the exciting eye. In our case, the histological examination was not suggestive.
As to the cause of optic neuritis in the present case, there was only one source of infection and that being the left eye. The nature of infection in the left eye was purulent.
The spread of Infection from one eye to the other is highly controversial. The route of spread by blood is ruled out by negative blood culture, but this cannot be very convincing evidence against blood spread. The spread can occur from one eye to the other along the optic nerves. But in purulent infection such route of spread is said to be not existing, as the lymph spaces are sealed. In the present case, it is speculated that the route of spread appears to be along the nerve. It is difficult to think of any other aetiological factor than panophthalmitis of the left eye.
| Summary|| |
A case of optic neuritis in right eye following panophthalmitis in the left eye is described.
| References|| |
Dake Elder S., 1971, System of Ophthalmology Vol, Xll, Neuro-Ophthalmology, Henry Kimpton, London, Page 83-84.
Walsh F.B.. Hioyt W.F., 1969. Clinical NeuroOphthalmology, Vol. 1, 3rd Edition, The Williams &. Wilkins Company Baltimore, Page 620.
Kestenbaum A., 1961, Clinical Methods of Neuro-Ophthalmologic examination, 2nd Edition, Grune & Stratton, Newyork, Page 131.
Duke Elder S., 1966, System of Ophthalmology, Vol. IX, Diseases of the Uveal Tract, Henry Kimpton London, Page 342.
Jain, I.S. and Sah Dev, 1970, Ind. J. Ophthalmol. 18:78.
Sood, G.C., Singh P., and Chappu B.A., 1972, Ind. J. Ophthalmol 20 : 139.
Woods, A.C., 1956, Endcgenous Uveitis, The Williams and Wilkins Company, Baltimore, Page 185.
[Figure - 1], [Figure - 2]