Glial Heterotopia of the orbit: A rare presentation

<p>Abstract</p> <p>Background</p> <p>Glial heterotopias are rare, benign, congenital, midline, non-teratomatous extracranial glial tissue. They may masquerade as encephalocoele or dermoid cyst and mostly present in nose. Herein, we present an unusual case of glial heterotopia of the orbit with unilateral blindness.</p> <p>Case presentation</p> <p>A 6 year-old-boy presented with a progressive painless mass over the nose and medial aspect of the left eye noticed since birth. On examination, the globe was displaced laterally by a firm, regular, mobile, non-pulsatile and non-tender medial mass. The affected eye had profound loss of vision. Computed tomography scan showed a large hypodense mass in the extraconal space with no intracranial connectivity and bony erosion. The child underwent total surgical excision of the mass and histopathological examination confirmed glial heterotopia of the orbit.</p> <p>Conclusion</p> <p>Though the incidence of this condition is rare, the need of appropriate diagnosis and management of such mass to prevent the visual and cosmetic deterioration is warranted. To our knowledge this is the first reported case of Glial heterotopia of orbit causing unilateral blindness.</p

Changing uveitis patterns in South India - Comparison between two decades

Purpose: Changing pattern of uveitis in a subset of a population is an important ocular health indicator. Methods: A comparative study was done between uveitis patients of 2013 and 1995 using two proportions Z-test. Results: In 2013, 352 new uveitis cases were examined. Males 56%, females 44%; unilateral 30.4%; bilateral in 69.6%. A specific diagnosis achieved in 66.2%. Anterior uveitis was seen in 35.22%, intermediate uveitis in 30.11%, posterior uveitis in 25%, and panuveitis in 9.65%. There was no significant difference in the incidence of new uveitic cases (1.04% vs. 1.8%). A decline in male preponderance from 64% to 56% (P = 0.0187) was observed. In both studies, anterior uveitis was the most common but human leukocyte antigen-B27 positivity uveitis had increased (29.83% vs. 14.5%; P < 0.05). Intermediate uveitis was the second-most common type instead of posterior uveitis (P = 0.0006). In posterior uveitis cases, etiology was established in 88.6% versus 56.06% cases (P < 0.05). The most common cause of posterior uveitis was tuberculosis (TB) (35.2%). Viral retinitis had increased to 6.81% from 0.76% (P < 0.05). However, a declining trend in cases of toxoplasmosis was observed (P = 0.0545). The cause of panuveitis was comparable in both studies. The prevalence of TB has significantly increased in the present era (22.5% vs. 0.64%; P < 0.0001) and was the proven etiological cause of uveitis in overall 22.5% of which 4.8% cases were of anterior uveitis cases, 7.1% cases of intermediate uveitis cases, 8.8% cases of posterior uveitis cases, and 1.8% of panuveitis cases. Conclusion: A shifting paradigm of uveitis over the past two decades was observed

Quantitative polymerase chain reaction analysis of serpiginous choroiditis with biopsy-proven testicular tuberculosis

We report a case of a 47-year-old male patient presenting with diminution of vision in the left eye. The left eye fundus showed yellowish lesions with indistinct geographical margin extending over the posterior pole just abutting the macula, suggestive of diffuse choroiditis. The patient gave a history of testicular swelling for the past 2 years. Aqueous tap for polymerase chain reaction analysis was positive for IS6110 mycobacterial tuberculosis (TB) genome, and a biopsy of testicular sac was suggestive of tubercular epididymitis. A diagnosis of TB-multifocal serpiginoid choroiditis was established and was managed with anti-tubercular therapy and systemic steroids

Ocular Manifestations in Patients with Extrapulmonary Tuberculosis

Introduction&nbsp;:&nbsp; The study was done to find out the ocular manifestation in patients with extrapulmonary tuberculosis visiting a tertiary eye centre. Methods: A hospital based descriptive observational study was done among newly diagnosed extrapulmonary tuberculosis cases after approval from the institutional review board. After a detailed ocular evaluation, findings including patient demographics, presenting complaints, best corrected visual acuity, colour vision, contrast sensitivity, Goldman visual field and Optical Coherence tomography Retinal nerve fibre layer analysis of the optic nerve head were recorded in a semi-structured proforma. Data were expressed in frequency and percentage. Results: Out of 50 eyes of 25 patients included in the study, the mean age was 26.92±14.2 years (11-73 years). Sixty four percent were female. Two cases had ocular findings at the time of diagnosis. One case of tuberculous lymphadenitis had phlyctenular conjunctivitis and one case of tubercular meningitis had diplopia with right lateral rectus muscle paresis secondary to raised intracranial pressure. All the patients had best corrected visual acuity better than 6/12 at presentation. Color vision was normal in 72% cases in both eyes. Goldman visual field done at presentation were normal in both eyes in 88% cases while retinal nerve fibre layer thickness and contrast sensitivity were normal in all cases. Conclusion: The prevalence of ocular findings in patients with extrapulmonary tuberculosis was 8% in this study. Ocular examination is important in cases with extrapulmonary tuberculosis since a significant number of cases have ocular findings

Presumed Vogt-Koyanagi-Harada (VKH) disease in Nepalese population: A rare entity

Vogt-Koyanagi-Harada (VKH) disease is a granulomatous inflammatory disorder affecting the eyes, auditory system, meninges, and skin. It typically affects those of more pigmented groups, such as Hispanics, Asians, Native Americans, Middle Easterners, and Asian Indians and is rare among Nepalese population. Hereby, we report a series of eight VKH cases with bilateral ocular involvement, of which six were females. The mean age of the patients was 38.13 ± 11.53 years. The acute uveitic stage was the commonest stage of presentation (4/8). Posterior segment involvement was in the form of disc edema (9/16), serous retinal detachment (5/16), and multifocal choroiditis (5/16). The extraocular manifestations were present in seven cases; neurological manifestations being the commonest

Outcome of polymerase chain reaction (PCR) analysis in 100 suspected cases of infectious uveitis

Abstract Background Polymerase chain reaction (PCR) analysis is an important tool in the diagnosis of infectious uveitis. A retrospective, interventional study of PCR analysis of ocular fluid in suspected infectious uveitis cases between January 2014 to July 2016 was done. Nested, real-time and broad range PCR was performed for detection of the genome of Mycobacterium tuberculosis, herpes virus family, Chikungunya virus, Toxoplasma gondii, fungus, eubacterium and propionibacterium acne. Results Total of 100 cases included, mean age was 39.2 ± 15.4 years. Uveitis was unilateral in 82% and granulomatous in 40%. Mean visual acuity at the initial visit and final visit was 0.73 logMar and 0.63 logMar respectively. PCR analysis confirmed the clinical diagnosis in 70.1% patients. The sensitivity, specificity, positive predictive value and negative predictive value of PCR analysis was 90.2%, 93.9%, 93.9% and 90.2% respectively. The quantitative value of real-time M. tb. Positive PCR ranged from 32c/ml to 2722 c/ml. Conclusions PCR assay is an accurate technique with high sensitivity and specificity to diagnose the DNA genome in infectious uveitis

Pattern of presumed tuberculous uveitis in a tertiary eye care centre of Nepal

Purpose: To evaluate the pattern of presumed tuberculous uveitis and its various clinical presentation. Methods: This hospital based, cross-sectional descriptive study was conducted in B.P. Koirala Lions Centre for Ophthalmic Studies, Kathmandu, Nepal from January 2013 to June 2014. All uveitis patients presenting to uveitis clinic were included in the study. A complete ophthalmic examination, systemic evaluation and tailored investigations were done for each individual patient and the findings were recorded. Results: Out of 1140 uveitis patients evaluated, 12 patients (1.05%) had presumed tuberculous uveitis. Panuveitis (five patients, 41.7%) was the most common form of uveitis, followed by posterior (four patients, 33.3%) and anterior uveitis (three patients, 25%). All patients showed signs of clinical resolution after the institution of anti-tuberculous therapy along with drugs for the control of intraocular inflammation. Conclusion: Panuveitis and posterior uveitis were the common forms of clinical presentation of presumed tuberculous uveitis in this study. Treatment with anti-tuberculous therapy along with drugs to control intraocular inflammation resolves presumed tuberculous uveitis

A Case of Orbital Myiasis in Recurrent Eyelid Basal Cell Carcinoma Invasive into the Orbit

Introduction. Orbital myiasis is the infestation of the orbital tissues by fly larvae or maggots. Compromise of periorbital tissues by malignant disease, surgery, ischemia, or infection may predispose the patient to orbital myiasis. Case Report. A 73-year-old male patient with neglected recurrent basal cell carcinoma of the eyelid invasive into the orbit presented with complaints of intense itching and crawling sensation with maggots wriggling and falling from the wound of left orbit. The patient improved following manual removal of the maggots along with oral Ivermectin treatment. Recurrence of the basal cell carcinoma was confirmed by punch biopsy from the wound and extended exenteration of the orbit followed by reconstructive surgery was done. Conclusion. Orbital myiasis is a rare and preventable ocular morbidity that can complicate the malignancies resulting in widespread tissue destruction. The broad spectrum antiparasitic agent, Ivermectin, can be used as noninvasive means to treat orbital myiasis. In massive orbital myiasis and those associated with malignancies, exenteration of the orbit must be seriously considered