Garima Agrawal

Abstract

Introduction: Congenital blepharoptosis is a common presentation to our out patient department. Congenital blepharoptosis may be myogenic, neurogenic, associated with misdirection of nerves. The study was designed to document the demography, clinical presentation and management of congenital blepharoptosis patients seen at our western regional institute of ophthalmology during the given study period. Aim: The study was designed to document the demography, clinical presentation and management of congenital blepharoptosis patients seen at our western regional institute of ophthalmology during the given study period. Materials and Methods: The study was carried out at our western regional institute of ophthalmology. The study was a prospective interventional study in an institutional cohort. The study period was one year from August 2018 to August 2019. Thirty five consecutive patients of congenital blepharoptosis seen at our western regional institute of ophthalmology were enrolled for the study. A thorough history and clinical examination was done. The type of blepharoptosis was identified and patients managed as per protocol. Results: Myogenic ptosis due to a dystrophic levator muscle included 23 cases (65.71%) followed by Marcus gunn jaw winking synkinesis in six (17.14%) cases. Congenital myasthenia was documented in three (8.51%) cases. Third nerve palsy was seen in two(5.71%) cases and blepharophimosis syndrome in one case (2.86%). Discussion: The results presented are similar to other studies. We report a predominant involvement of the right eye unilaterally (48.58%) as compared to the left eye unilaterally (25.71%). This finding is in sharp contrast to that reported from other studies. More studies would be required to determine the exact cause of this predominance. We also noted a higher incidence of congenital myasthenia gravis in our patients as compared to other studies. This enigmatic clinical entity is presented from our unique perspective. The study adds to and complements the world literature on the subject. Conclusion: The study highlights the demographics, clinical profile and management of congenital blepharoptosis patients seen at a centre of excellence in western India. Keywords: Congenital blepharoptosis, Demography, Clinical presentation, Management.

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Abstract

Introduction: Thyroid orbitopathy or Graves’ orbitopathy has been known since almost two centuries with the ocular changes associated with thyroid disease being first published by Graves in 1835. Thyroid orbitopathy is an autoimmune disorder. It is a life -long disease with systemic and ocular manifestations. Early diagnosis and appropriate management of this disorder are essential. The European group on graves orbitopathy has put forward new updated guidelines for the management of this disorder. We designed a study to document the demographics, clinical presentation and management of Thyroid orbitopathy patients at our institute as per the new guidelines. Aim: The current study aims to showcase the demography, clinical presentation and management of thyroid orbitopathy at a centre of excellence in western India. Materials and Methods: The study design was a prospective interventional study in an institutional cohort. The study was carried out over a period two years from August 2017 to October 2019. Thirty five consecutive cases of Thyroid orbitopathy presenting to the oculoplastics and ocular oncology clinic of our western regional institute of ophthalmology were studied. They were subjected to a thorough history taking, clinical examination. The thyroid ophthalmopathy was classified as mild, moderate to severe, sight threatening. Active or inactive orbitopathy was documented. The patients were managed as per the recent upadated globally accepted guidelines for the management of thyroid orbitopathy. Observation and Results: Thyroid associated opthalmopathy was found in all age groups. The age range was twelve years to seventy years. The maximum incidence was seen in the age group of thirty five to fifty five years (68.57%). It was more common in females (female: male ratio was 4:3). The most common clinical presentation was eyelid retraction(91.43%)followed by exophthalmos (77.14%). The patients had the whole spectra of the ophthalmopathy from mild (65.72%) ,moderate-to-severe (25.71%) to sight threatening ophthalmopathy (8.57%)though the latter cases were few. The disease activity was both active (31.43%) a n d quiescent (68.57%) with the latter dominating the scenario. The patients had the risk factors of active and passive smoke (45.71%) as well as thyroid dysfunction (97.14%). The patients were successfully managed as per the recent proposed updated guidelines of management of the disorder both medically as well as surgically. Conclusion: The study adds the demographic and clinical profile of thyroid orbitopathy patients seen at a centre of excellence, tertiary care centre in western India. The disease has been studied from our unique perspective and managed as per the globally accepted current guidelines. Keywords: Thyroid Orbitopathy, Demographics, Clinical presentation, Management, Western India.

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