Clinical Study of Ocular Manifestations of Thyroid Disease in Tertiary Eye Care Center

Introduction: Thyroid eye disease (TED), Graves’ ophthalmopathy, or Thyroid associated orbithopathy (TAO) are an immunemediated inflammatory disorder that produces expansion of the extraocular muscles and fat in the orbit. TED is most commonlyassociated with Graves’ hyperthyroidism but can also be noted in hypothyroid and euthyroid states.Aim: The aim of the study is to evaluate the ocular manifestation of thyroid dysfunction (TD).Materials and Methods: A prospective non-randomized observational study was carried out on 106 patients of TD. They wereexamined in detail for demography, systemic, and ocular examination and laboratory investigation. Period of study was 1 year.Results: In this study, average age of presentation of TD was 42.54 years. Female-to-male ratio was 3.1:1. Lid retractionwas the most common (82.4%) lid sign in patients of hyperthyroidism while in patients of hypothyroidism, it was lid edema(28.9%). The second most common lid sign was lid lag which was present 70.6% cases. Proptosis was present in 52.9%hyperthyroid patients. Three patients had unilateral proptosis. Corneal ulcer (due to exposure keratopathy) was present in17.6% of hyperthyroid patients.Conclusion: Females were more commonly affected. However, ocular manifestations were more severe in male. Hence, it isimportant to rule out TD in patient with other ocular symptom.

Golden half ring sign for identification of pseudophacocele.

Dislocation of intraocular lens (IOL) is a serious complication of blunt ocular trauma in pseudophakic eyes. Here, a 72‑year‑old male patient with subconjunctival dislocation of an IOL (pseudophacocele) secondary to bull horn injury was reported. In this case report, a new sign named as “golden half ring sign” was described for easy identification and localization of subconjunctival dislocation of IOL in patient with open globe injury (surgical wound dehiscence) associated dense subconjunctival hemorrhage.

Red eye: Rule out Ophthalmomyiasis too.

Ophthalmomyiasis is the infestation of human eye by the larvae of certain flies. Sheep botfly commonly manifests as Ophthalmomyiasis externa when there is conjunctival involvement or rarely as Opthalmomyiasis interna when there is larval penetration into the eyeball. It appears to be more common than what has been indicated by previously published reports. We present a report of seven cases of Ophthalmomyiasis by Oestrus ovis, from central India who presented with features of conjunctivitis varying between mild to severe. The larvae were seen in bulbar and palpebral conjunctiva and also entangled in lashes with discharge. Since the larvae are photophobic, it is prudent to look for them in the fornices and also in discharge. Prompt removal of the larvae from the conjunctiva helps in relieving the symptoms and also prevents serious complications. Taxonomic identification of the species is important to estimate the risk of globe penetration by the larvae.

Ocular manifestations in the Hutchinson-Gilford progeria syndrome.

The Hutchinson-Gilford progeria (HGP) syndrome is an extremely rare genetic condition characterized by an appearance of accelerated aging in children. The word progeria is derived from the Greek word progeros meaning ‘prematurely old’. It is caused by de novo dominant mutation in the LMNA gene (gene map locus 1q21.2) and characterized by growth retardation and accelerated degenerative changes of the skin, musculoskeletal and cardiovascular systems. The most common ocular manifestations are prominent eyes, loss of eyebrows and eyelashes, and lagophthalmos. In the present case some additional ocular features such as horizontal narrowing of palpebral fissure, superior sulcus deformity, upper lid retraction, upper lid lag in down gaze, poor pupillary dilatation, were noted. In this case report, a 15-year-old Indian boy with some additional ocular manifestations of the HGP syndrome is described.