Peripheral primitive neuroectodermal tumor of the orbit in Graves' ophthalmopathy - A rare presentation.

Graves' ophthalmopathy is the most common cause of both unilateral and bilateral proptoses in adults. Peripheral primitive neuroectodermal tumor (pPNET) is a small round cell malignant lesion of neuroectodermal origin which very rarely affects the orbit. In this case report, we have discussed about a young woman with existing Graves' ophthalmopathy who presented with worsening proptosis; computed tomography imaging revealed an irregular mass lesion in the right orbit without bone erosion. Biopsy and immunohistochemistry of the mass lesion revealed features of primitive neuroectodermal tumor (PNET). The tumor was MIC-2 gene positive, and on follow-up, no recurrence was noted after successful surgical resection. PNET of the orbit is very rare, and to our best knowledge, this is the first case of peripheral PNET in patent with Graves' ophthalmopathy.

Traumatic Optic Neuropathy: Analysis of Demographic and Clinical Parameters Over Three Years in a Tertiary Care Hospital in India.

Background Treatment options for traumatic optic neuropathy (TON) are limited and the role of steroids in the treatment of TON is still controversial. Hence this study was planned to highlight the role of steroids in the treatment of TON. Purpose The study aims to highlight the epidemiological and clinical characteristics, as well as the role of steroids, in TON cases seen during a three-year period at a tertiary care center in India. Methods This was a retrospective study that reviewed records of all cases of TON between January 2018 to January 2020. Results Twenty-three cases of TON were seen representing 1.26% cases of head injuries. The median age was 18 years. One patient (4.34%) had bilateral TON and 18 patients (78.26%) were referred from accident and trauma care. None of the patients presented directly to an ophthalmologist. The most common cause of injury was automobile accident (69.56%). Visual acuity at presentation was 20/80-20/100 in six (26.08%) cases. Fifteen (65.4%) patients had associated closed globe injury. Seven (30.43%) patients had ocular adnexal involvement and 10 (43.47%) patients had orbital fractures. Seventeen (73.91%) received steroid treatment and six of these patients showed visual improvement. Conclusions The study showed that there was no significant association between presenting visual acuity and treatment. The presence of significant ocular injury and orbital injury increased the likelihood of treatment. There was no difference between the treated and untreated groups with respect to final visual acuity.

Effect of chronic alcohol and tobacco use on retinal nerve fibre layer thickness: a case-control study.

OBJECTIVE: To identify the effects of chronic alcohol and/or tobacco use on retinal nerve fibre layer (RNFL) thickness and to find the association between severity of addiction with RNFL thinning. METHODOLOGY: A case-control study was performed in 200 eyes of cases and 200 healthy control eyes. Cases were recruited from deaddiction clinic having history of alcohol and/or tobacco use for at least 5 years. Severity of alcohol and tobacco was graded by Alcohol Use Disorders Identification Test (AUDIT) and Fagerstorm Nicotine Dependence (FTND) scale, respectively. Age-matched and gender-matched individuals attending ophthalmology outpatient department without addiction were recruited as controls. RNFL thickness was measured using Stratus optical coherence tomography (OCT). RESULTS: Statistically significant RNFL thinning was noted in all quadrants except nasal quadrant in the cases. Statistically significant thinning was seen in all quadrants except nasal with increased FTND scale. Thinning was noted in all quadrants with higher AUDIT scale, but this was statistically not significant. CONCLUSION: Chronic alcohol and tobacco use are likely to cause RNFL thinning. OCT can be used as a screening tool to suspect visual morbidities in chronic tobacco and alcohol users.

Ocular Manifestations of Venomous Snake Bite over a One-year Period in a Tertiary Care Hospital.

PURPOSE: Ocular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center. METHODS: This is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes. RESULTS: Twelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%). CONCLUSIONS: Bilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.

Retinal nerve fiber layer thickness analysis in cases of papilledema using optical coherence tomography ­ A case control study.

BACKGROUND: Papilledema is defined as an optic disk swelling that is secondary to elevated intracranial pressure. Early diagnosis of papilledema can help in early intervention thus preventing visual loss and even death. Optical coherence tomography (OCT) is a non-invasive imaging technique which can detect and quantify diffuse thickening of the retinal nerve fiber layer (RNFL) in eyes with optic disk edema. AIMS: To assess the difference in the RNFL thickness in patients with papilledema from controls using OCT and to correlate the RNFL thickness with the degree of papilledema. SETTING AND DESIGN: A case control study was conducted from August 2011 to July 2013 in a tertiary care medical college of south India. METHODS AND MATERIALS: All adult patients diagnosed or suspected to have papilledema were included in the study. Disk photographs were graded according to modified Frisen criteria. Fast RNFL protocol on time-domain OCT was used. Cases and controls were compared. STATISTICAL ANALYSIS: RNFL thickness was compared using an independent samples t-test. Correlation between RNFL thickness and modified Frisen scale of papilledema was done using Spearman correlation. GraphPad InStat 3 version was used. RESULTS: A total of 100 cases and 126 controls were studied. Statistically significant thickening of retinal nerve fiber layer (RNFL) was seen in all quadrants in patients with papilledema as compared to controls. A positive correlation was found between Frisen grading of papilledema RNFL thickness measurements. CONCLUSIONS: RNFL thickening was mainly in the inferior and superior peripapillary region and was greater in higher grades of papilledema. A strong positive correlation was found between RNFL thickness and the Frisen scale for grading of papilledema. OCT can be included as a routine non-invasive quantitative tool for detection of early papilledema.

Hirsutism following the use of bimatoprost eyedrops for glaucoma.

Prostaglandin F2 alpha (PGF2α) analogues including bimatoprost are often the first line drugs used in the treatment of glaucoma. We present a case of a 62-year-old female patient who was started on bimatoprost in both the eyes for primary open angle glaucoma. The intraocular pressures reached the target level but she developed hair growth over the chin and upper lip after six months of commencing of the treatment. The regional hypertrichosis did not reduce much after stopping the drug. Hirsutism is a potential side effect of prostaglandin analogues which has rarely been reported. Doctors and patients need to be aware of this noticeable and unwanted side effect. The effect seems to occur in patients already having few non-vellus hairs in these areas.

Bilateral acute anterior uveitis and optic disc edema following a snake bite.

The authors wish to report a case of bilateral acute anterior uveitis and optic disc edema following a hemotoxic snake bite, in order to highlight the concomitant occurrence of these conditions and the potential adverse effects of anti-snake venom (ASV). A 35-year-old male was bitten by a viper at seventeen thirty hours, and was started on ASV. Two days following treatment he experienced sudden onset redness and painful diminution of vision in both eyes (OU). On examination, the patient's visual acuity (VA) in OU was 20/200. Examination revealed fresh keratic precipitates, cells, and flare in the anterior chamber (AC), posterior synechiae, sluggish and ill-sustained pupillary reaction, and hyperemic, edematous disc with blurred margins in OU. He was started on topical steroids, cycloplegics and intravenous methylprednisolone. Following treatment, the patient showed improvement and was continued on topical medications and oral prednisolone tapered over 3 weeks, after which VA OU improved, the AC showed no cells and flare and disc edema resolved. Uveitis and optic disc edema in snake bite can either be due to the direct toxic effects of the venom or the effect of ASV. Steroids have a beneficial role in the management of these symptoms.