Neuro-ophthalmic manifestations in traumatic brain injury: a hospital-based study from Nepal.

Objective: Neuro-ophthalmic manifestations occur frequently in patients with a traumatic head injury which are often ignored, leading to late presentation with permanent visual disability and visual field defects. This study aimed to find the various neuro-ophthalmic manifestations of traumatic brain injury and correlate them with the neurological status and neuroimaging abnormality. Methods: A hospital-based cross-sectional study was carried out among patients admitted to our centre with a diagnosis of traumatic brain injury for a period of six months from August 2020 to January 2021. Glasgow Coma Score was used to grade the severity of the head injury. Detailed ophthalmological examinations were documented in predesigned proforma. Descriptive statistics were used to describe the outcomes. Results: A total of 377 head injury patients underwent neuro-ophthalmic examination-271 (71.9%) were males and 106 (28.1%) were females. The mean age in our study population was 38.6 ± 16.8 years, their age ranging from 3 to 85 years. Time from injury to ophthalmologic examination ranged from 30 min to 12 days post-injury, the mean duration being 24.2 ± 34 h. Road traffic accidents were the most common cause of head injury, with 203 cases (53.8%). 38 (10.1%) patients had neuro-ophthalmic manifestations-16 (42.0%) had afferent pathway deficits and 22 (57.9%) had efferent pathway deficits. The most frequently encountered neuro-ophthalmic abnormality was optic neuropathy in 14 (36.8%) followed by trochlear, oculomotor, abducens nerve, and chiasmal injury. The presence of brain contusion was associated with traumatic optic neuropathy while skull fractures were associated with trochlear nerve palsy, these associations being statistically significant (P<0.05). Conclusion: Neuroimaging abnormalities, particularly brain contusions and skull fractures were significantly associated with neuro-ophthalmic deficits.

Profile of Secondary Glaucoma in a Tertiary Eye Hospital of Eastern Nepal.

BACKGROUND: To determine the clinical profile and causes of various types of secondary glaucoma. MATERIALS AND METHODS: This was a hospital-based cross-sectional study conducted in a tertiary eye hospital of eastern Nepal from 1st June to 30th November, 2017. Patients who met the criteria for secondary glaucoma underwent detailed ophthalmic examination. RESULTS: Out of 7079 patients diagnosed with glaucoma or glaucoma suspects, 528 (7.4%) had secondary glaucoma. The mean age at presentation was 52 ± 17 years with male to female ratio of 1.5:1. The most common cause was lens induced 173 (32.8%) followed by neovascular 107 (20.3%), steroid induced 86 (16.3%), traumatic 76 (14.4%), post-vitrectomy 17 (3.2%), uveitic 11 (2.1%), pseudophakic 10 (1.9%), aphakic 8 (1.5%), post-keratoplasty 5 (0.9%) and miscellaneous included 35 (6.6%). Post-traumatic 31 (29.5%) was more prevalent below 41 years while lens induced glaucoma 86 (49%) above 60 years of age. At presentation, the average IOP was 40 ± 11 mmHg. 36 (6.8%) had no light perception in the presenting eye and a large number of participants 307 (58.1%) presented with visual acuity of <3/60 to perception of light. Glaucomatous optic atrophy was found in 22 (9.0%) cases. CONCLUSION: The causes of secondary glaucoma are diverse, lens induced glaucoma being most common. Most patients present late with poor vision, high IOP and even glaucomatous optic atrophy. So, early identification and treatment of the causes is important so that we can prevent the burden of blindness due to secondary glaucoma.

Primary Congenital Glaucoma among the Children Under 3 Years of Age in the Outpatient Department in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Primary congenital glaucoma is a rare vision-threatening condition of children. Primary congenital glaucoma though a rare disease it is the most common cause of childhood glaucoma with potency to cause blindness. This study was undertaken to find the prevalence of the children with primary congenital glaucoma under 3 years of age in a tertiary care hospital. METHODS: This was a descriptive cross-sectional study conducted at a tertiary eye center in Nepal in children (≤ 3 years) presented in the outpatient department of a tertiary eye hospital between June 2017 and June 2020. The study was approved by the hospital review committee and adhered to the declaration of Helsinki. A convenient sampling method was used. Point estimate at 95% Confidence Interval was calculated with frequency distribution. Data analysis was conducted using Statistical Package for the Social Sciences. RESULTS: Out of total children under 3 years who presented to the outpatient department, 46 (0.31%) at 95% Confidence Interval (0.30-0.32) had primary congenital glaucoma. Among them, 30 children (65.2%) had bilateral involvement. Mean intraocular pressure was 42.40±8.15mm Hg. The mean age of initial presentation, horizontal corneal diameter, and axial length were 12.07±8.9 months, 12.95±1mm, and 23.89±1.7mm respectively. Consanguinity was observed in 12 (26%) children. CONCLUSIONS: From the study, we conclude that there was a low prevalence of primary congenital glaucoma among children under 3 years of age who presented to the outpatient department in a tertiary care hospital.