Santanu Das

Abstract

Aim: To compare the Intraocular Pressure (IOP) measured by Non-contact tonometer (NCT), Rebound tonometer (RBT) and Goldmann Applanation tonometer (GAT) and their correlation with central corneal thickness (CCT) and true IOP. Reliability of each tonometer. Materials and Methods: 500 random patients aged 18 years and above were taken up for the study. Patients with anterior and posterior segment pathologies like corneal ulcer, leukoma, staphyloma, corneal lacerations, ectatic corneal conditions, corneal dystrophies, oedema, perforations, acute angle closure glaucoma, retinal detachments, vitreous haemorrhage and unwilling patients were excluded from the study. IOP was recorded using NCT, RBT and GAT after assessing the patient’s visual acuity. Following IOP measurement, central corneal thickness (CCT) of each patient was measured using pachymetry. All the data were collected and tabulated for statistical analysis to obtain results. Results: The mean CCT in males was 0.5350 mm and in females 0.5340 mm respectively. The mean IOP measured by NCT is 16.43 mm hg whereas the mean IOP measured by GAT is 15.43 mm hg. IOP measured by NCT is significantly higher than the IOP measured by GAT (p RBT are compared NCT values are significantly higher than that of RBT(p RBT IOP 15.83 mm hg is higher than the mean GAT IOP of 15.42 mm hg the values are not statistically significant. When correlated with CCT all the tonometers showed significant correlation with GAT showing the strongest correlation. NCT overestimates IOP in normal, thin and thicker corneas when compared to GAT and are statistically significant. RBT also overestimates in the normal and thick corneas when compared to GAT but their values are much closer to GAT values in thinner corneas. The IOP measured by all the 3 tonometers correlated with corrected IOP with NCT showing the best correlation followed by GAT. Conclusion: From the present study we can conclude that IOP measured by NCT and RBT is higher than GAT. NCT values are significantly higher than GAT values in thin and normal corneas whereas it overestimates more in thicker corneas. RBT values are significantly higher than that of GAT in normal and thick corneas. So, it is always advisable to measure the corrected IOP for each patient after considering the CCT. Keywords: Central corneal thickness, Goldmann applanation tonometer, Intraocular pressure, Non-contact tonometer, Rebound tonometer, True IOP.

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Abstract

Purpose: To describe the pattern, causes and management of eyelid and adnexal injuries in a tertiary care hospital. Materials and Methods: A prospective study of 64 patients presenting to the emergency and outpatient department with eyelid and adnexal injuries from June 2017 to June 2019 with or without any globe injuries was carried out. Thorough ophthalmic evaluation was done for all. Wound was thoroughly washed with saline and broad-spectrum antibiotics were started for all patients. They were divided into only eyelid, canalicular and periocular injuries with or without globe injuries and orbital fractures. All the data were then analysed. Results: Out of 64 patients 49 patients (76.5%) with eyelid and adnexal injuries were due to road traffic accident (RTA).1was due to a bull horn injury.7 were due to dog bite, 6 were due to self-fall and 1 was due to injury with cricket ball. 51(79.6%) patients were male and 13 were female. Amongst the RTA cases 2 patients had avulsion injury.1 patient had foreign body (glass pieces) inside the wound.2 patients had associated ocular injuries. 26 patients had associated orbital fractures. 2 patients had associated ocular injuries. 27 patients had eyelid injuries. 40 patients had adnexal injuries whereas 7 patients had canalicular injuries. The most common complication encountered during the post-operative period was wound site scarring in 11 patients. They were treated with 5 fluoracil and triamcinolone injections. 1 patient had MRSA infection. Primary repair was the most common surgery performed. All the surgeries were performed within the first 72 hours of admission. Conclusion: From our study we concluded that RTA is the most common cause and men were most commonly affected. Such injuries have varied presentations and management must be well planned and thought out to achieve good anatomical apposition as well as good cosmesis to avoid multiple surgeries. Keywords: Adnexal injury, Birmingham Trauma Score, Canalicular injury, Eyelid injury.

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