|Year : 1984 | Volume
| Issue : 4 | Page : 229-230
Bilateral descemet's wrinkles in acute gastro-enteritis
Gyanam Murthy, SD Adrianwala
TN Medical College & B.Y.L. Nair Hospital Mumbai, India
Professor and head Ophthalmic unit. T.N. Medical College and B.Y.L. Nair Hospital Mumbai 400 008
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Murthy G, Adrianwala S D. Bilateral descemet's wrinkles in acute gastro-enteritis. Indian J Ophthalmol 1984;32:229-30
Wrinkless and folds in the Descemet's membrane of cornea are constant features of ocular hypotony. Acute bilateral ocular hypotony maybe associated with a number of systemic diseases, particularly those involving dehydration, acidosis and gross metabolic distrubances. Moreau et al, noticed ocular hypotony in extreme dehydration due to malnutrition. An interesting case of acute Gastro-enteritis with dehydration presented with sudden diminution of vision and bilateral Descement's wrinkles of cornea due to hypotony. Hypotony as the cause of these Descemet's wrinkles was confirmed by the disappearance of these wrinkles on correction of dehydration and building up of the intra-ocular pressure to normalcy.
| Case report|| |
A sixty years male, a case of acute gastroenteritis with dehydration of four days duration, presented with sudden- diminution of vision in both eyes. -There was no visual problem prior to this attack.
On examiation, both eyes showed marked corneal haze with prominent double contour lines, in the absence of ciliary congestion. [Figure - 1][Figure - 2]. The eyeballs were soft indicating ocular hypotony. Visual acuity was C.F. 6
inches in both eyes. Due to corneal haze anterior segment and fundus details were not visualised. I.O.P. as recorded by Schiotz tonometer was 8.4 mm. Hg. in both the eyes. Slit lamp examination of both the eyes showed folds and wrinkles in Descemet's membrane. There was no aqueous flare and pupils were reacting briskly with early senile lenticular changes.
On correction of dehydration and control of gastro-enteritis, corneal folds disappeared [Figure - 3]. The intraocular pressure improved to 17.3 mm. Hg. in the right eye and 18.9 mm. Hg. in the left eye and visual acuity improved to 6/ 12 with + 1.5 spherical lens in right eye and to 6/9 .(F) with + 1.0 spherical/0.5 cylinder at 180°sub axis in the left eye.
| Discussion|| |
Acute gastro-enteritis with dehydration is a systemic state of haemoconcentration leading to increase in the osmotic pressure of the serum. This affects the ultrafiltration and secretion of the aqueous with lowering of the intraocular pressure. The resultant acute ocular hypotony manifests as rucked, saucer shaped hazy cornea, deeply grooved sclera and papilloedema, macular oedema, with generalised retinal oedema.
In our case the marked systemic dehydration caused acute bilateral ocular hypotony with corneal changes alone in the form of Descement's wrinkles.
Ocular hypotony usually leaves behind residual changes in the eyes such as macular oedema, keratopathy and so on, with visual deterioration. The redeeming feature of our case was that, with the normal heamodynamics re-established with intravenous fluids, the Descemet's wrinkles disappeared and the intraocular pressure built-up to normalcy without any permanent visual derangement.
| Summary|| |
An interest ing case of acute gastro-enteritis with temporary bilateral Descemet's wrinkles ofcornea due to hypotony showing reversal of these changes on correction of systemic dehydration is thus presented.
| References|| |
Moreau, Cornihert and Mugieret. 1963: Bull. Soc. Ophtal. Fr., 63:23.
[Figure - 1], [Figure - 2], [Figure - 3]