A Study Of Orbital Fractures In A Tertiary Health Care Center

A retrospective study of patients with orbital fractures had 48% patients in the age group of 20 – 40 years with male : female ratio of 10:1. Road traffic accidents (71.43%) were the most common cause followed by injury due to fall (20%). Eighty five percent of patients had normal visual acuity at presentation and 65.57% patients had no ocular complaints. Diplopia was present in 14.2% of patients. Of the orbital fractures infraorbital rim was involved in 43.13%, floor in 19.6%, lateral wall in 13.7%, pure blow out in 14.28% and the roof in 2.9%. Important ocular findings were extraocular movements restriction in 9 (10.3%), infraorbital dysaesthesia in 3 (3.4%), enophthalmos in 2, RAPD and globe rupture in 1 patient each. 32 patients underwent surgical management. At the end of 4 months of follow up, 3 had restriction of EOM, 1 patient had vision loss due to globe rupture, 2 had RAPD (optic nerve compression), 1 had lagophthalmos, 1 had exotropia and 1 had atrophic bulbi

Idiopathic intracranial hypertension: Clinical profile and outcome

Background: It has been a long standing challenge to clinicians and investigators to explain the pathophysiology of Idiopathic Intracranial Hypertension (IIH).Therefore, the goal of this study is to delineate the clinical course of this disorder. Aim: To delineate the clinical course of Idiopathic Intracranial Hypertension with an emphasis on visual prognosis. Settings and Design: Prospective, observational study of 18 patients. Materials and Methods: Patients with unilateral or bilateral disc oedema; CSF pressure >25 cm H 2 O non- focal neurological examination, and normal CT/MRI/MRV scans were included in the study, while those with concurrent ocular disease were excluded .Ocular examination, visual acuity, fundus photography and visual fields evaluation was done at presentation and during follow up visits for a period of two years. Statistical analysis: Descriptive study. Results: Of the 18 patients, 16 were females. The average age of onset was 31.5 years. Hypertension was the most common systemic comorbidity, seen in 5 patients. Headache was the most common presenting symptom, seen in all 18 patients .Diminution of vision was seen in 16 eyes, out of which 14 improved while 2 showed progressive impairment of vision. Abnormal visual field tests included an enlarged blind spot in 11 out of 36 eyes and peripheral constriction in 14 out of 36 eyes .17 patients had a bilateral and symmetric disc swelling. A CSF opening pressure of more than 40 cm of H 2 O was noted in 6 patients. All the patients were managed medically with diuretics therapy (acetazolamide) and weight reduction. Conclusion: A strong suspicion of Idiopathic Intracranial Hypertension in chronic severe headaches and immediate investigations followed by proper treatment can salvage vision of patients even in cases with established papilledema

A Clinical Study of Blunt Ocular Trauma in a Tertiary Care Centre

Purpose: To analyze blunt eye injuries with respect to mode of injury, sites involved and outcome. Method: This was a retrospective study of 32 patients with blunt ocular trauma from 2010 to 2012 in a tertiary care centre. Patient data, mode and extent of injury, management and outcome was noted and analyzed. Result: The commonest age of presentation was 10-20 years (28.125%) and the commonest mode of injury was road traffic accident (28.125%). The most commonly involved structure was conjunctiva (84.375%), followed by lid and adnexa (62.5%). Anterior segment involvement included corneal epithelial defect (7 cases), hyphaema (4 cases), iritis (3 cases) and anterior dislocation of lens (1 case). Posterior segment involvement included vitreous haemorrhage (1 case) and commotio retinae (2 cases). Conclusion: This study reinforces that blunt trauma can cause any extent of damage to ocular structures and the final visual outcome is dependent on the structures injured

Malingering versus dissociative disorder: A clinical dilemma!!

Malingering and dissociation coincide with the mode of presentation. Dissociation and attention-deficit hyperactivity disorder (ADHD) can coexist due to their similar etiology. We report a case of dissociative disorder in a boy with ADHD presenting with sudden visual diminution. To our knowledge, though common, such case has not been reported in the literature. A 9-year-old boy, a case of ADHD on atomoxetine (25 mg) and risperidone (0.25 mg), was brought by his apprehensive mother, with sudden diminution of vision in his right eye for 1 week. On examination, his visual acuity was 20/120 in the right eye and 20/20 in the left eye, even on repeating with various charts. His anterior segment, fundus, and cycloplegic retinoscopy were normal. Visually evoked potential was normal in both the eyes. With a suspicion of malingering, +20D in front of the left eye. The test was positive for malingering, and the mother was reassured. The kid was sent to the psychiatry department for further counseling. They diagnosed it as a dissociative disorder. Simple tests for malingering still have an important role in ophthalmology. Children cannot be underestimated in their ability to malinger, but at the same time, dissociative disorder should be borne in mind before labeling a patient as a case of malingering. Because once the label of malingering is given, then it is a human tendency to form a prejudice idea about that patient and later that the patient would not get proper medical assistance