Priyam Gupta

Abstract

Purpose: To evaluate the clinical profile and visual outcome of optic neuritis patients presenting to a tertiary eyecare centre. Materials and Methods: It is a retrospective hospital-based study carried out over a period 5 years between 2013 to 2018 in a tertiary eyecare centre in South India. Case records of 20 patients diagnosed and treated for optic neuritis were evaluated based on clinical profile, type of presentation and visual outcome. Results: Patients had a mean age was 34.713.5 years. 60% presented in age group of 20-40years. Male preponderance was seen (65% of cases). Papillitis (65% of eyes) was more common than retrobulbar neuritis (35% of eyes). Unilateral involvement was seen in 85% of cases with Bilateral presentation seen in only 15% cases. Baseline visual acuity in 10(43%) patients was in the range of Counting fingers to = 6/60, 5(22%) patients had Hand movements positive and 5(22%) had Perception of light positive. Periocular pain was seen in 8(40%) of the cases. 13(56%) patients had defective colour vision. 16(70%) patients had Grade 3-4 RAPD while the remaining had grade 1-2 RAPD. One patient was diagnosed with multiple sclerosis (MS). Recurrence was seen in 1 patient (5%). After treatment with 3 doses of 1gm IV Methylprednisolone 15 patients (74% of eyes) showed improvement in vision, 7 eyes (35%) had improvement in colour vision, 4 eyes (20%) had improvement in pupillary reaction after 3 doses of IV Methylprednisolone. Conclusion: Optic neuritis is idiopathic in nature. Papillitis is the commonest presentation when compared to Retrobulbar neuritis. Keywords: Multiple sclerosis, IV Methylprednisolone, Optic disc swelling, Optic neuritis, Optic neuritis treatment Trial Papillitis, Retrobulbar optic neuritis.

Open full article page

Abstract

Purpose: We describe the clinical presentation of a 65yr old male patient with orbital pseudotumor of the right eye with secondary Ocular Surface Squamous Neoplasia, not responding to conventional steroid therapy. Observation: Reporting a case of Pseudotumor of the right orbit with secondary Ocular surface Squamous Neoplasia in a 65yr old diabetic male presenting with painless proptosis and redness of the right eye since 6months. CT orbit scan was suggestive of a Thyroid orbitopathy. Patient initially responded well to steroid therapy along with oral thyroxine and proptosis decreased, but relapsed in few months. Patient was readmitted and a Contrast enhancemed MRI of orbit was done-suggestive of right eye Orbital pseudotumor. A detailed blood investigation and whole-body workup, Fine Needle Aspiration Cytology studies were done to rule out secondaries to the eye and confirmed to have orbital pseudotumor. Patient was started on immunomodulators Oral Methotrexate 7.5mg once a week, after obtaining clearance. Excision biopsy of the proptosed exposed conjunctiva was done and on histopathological examination diagnosis of Orbital pseudotumor tumor was confirmed with Ocular surface squamous neoplasm due to chronic conjunctival exposure secondary to the proptosis. Conclusion: Patients with orbital pseudotumor typically respond to steroid therapy. However, in patients who are unresponsive or have recurrences, diagnosis should be revised or reconfirmed. Radiotherapy and immunomodulators are modes of treatment of unresponsive cases. Diagnosis and management of atypical cases pose a major clinical challenge. Keywords: Biopsy, Steroids, Methotrexate, Orbital pseudotumor, Proptosis, Thyroid ophthalmopathy

Open full article page