Optic nerve sheath diameter measurements using ultrasonography to diagnose raised intracranial pressure in preeclampsia: an observational study

Objective: To estimate the incidence of raised intracranial pressure (ICP) as evident by enlarged optic nerve sheath diameter (ONSD) by ocular ultrasound among patients with preeclampsia and its relationship to severity of disease. Material and Methods: Sixty pregnant mothers with preeclampsia were compared to 30 normotensive, uncomplicated pregnant controls. For ONSD measurement, a 7-MHZ linear probe was used and three values from each optic nerve were taken and the mean of six values of both eyes was recorded. All study subjects were followed until seven days after delivery. Results: Two cut off values (5.8 mm and 4.6 mm) were used to compare ONSD in severe and non-severe preeclampsia with that of healthy pregnant individuals. The incidence of raised ICP among severe preeclampsia above 5.8 mm and 4.6 mm cut-off were 43.3% and 90%, respectively, before delivery. ONSD was significantly elevated among preeclampsia subjects at both cut-off values at pre-delivery (p=0.004 for ONSD >5.8 mm and p<0.001 for ONSD >4.6 mm) compared to controls. There a significant association between presence of neurological manifestations and enlarged ONSD (p<0.001 for ONSD >5.8 mm and p=0.04 for ONSD >4.6 mm) before delivery. Conclusion: Severe preeclampsia with neurological features was associated with increased ONSD, reflecting raised ICP. Further studies are needed to compare ONSD values with invasive ICP monitoring for better understanding of this relationship.

Frontal osteomyelitis presenting as upper eyelid ectropion: A cautionary tale.

Frontal osteomyelitis is a rare clinical entity that can occur as sequelae to frontal sinusitis, head trauma, as a postoperative complication following sinus surgery or due to haematogenous spread. It usually presents with a soft, fluctuant forehead swelling with pain and fever. Cicatricial ectropion is an extremely rare feature of frontal osteomyelitis. We present a young male patient presenting with cicatricial ectropion that occurred as the sole manifestation of an underlying frontal osteomyelitis. Extensive Medline search did not find any such reported case. We feel that frontal osteomyelitis should be kept in mind as a possible etiology when considering the differential diagnosis of cicatricial ectropion.

Diagnostic evaluation and surgical outcome of idiopathic isolated, acquired inferior oblique palsy: a rare presentation.

Isolated inferior oblique muscle palsy is the least common of all extra-ocular muscle palsies and very few reports are available in the literature. It can present a formidable therapeutic challenge to the ophthalmologist, as treatment options need to be titrated on an individual basis. A patient of 60 years old of idiopathic right inferior oblique palsy who underwent an adjustable superior rectus recession in his left eye, with a satisfactory surgical outcome and symptomatic resolution of diplopia is reported.

Solitary fibrous tumour of the orbit: an unusual presentation.

Solitary fibrous tumour is a rare tumour that usually arises from the pleura and very uncommonly from the orbit. This unusual unilateral orbital mass can be differentiated from the more common haemangiopericytoma by the use of histopathological and immunohistochemical studies. The tumour is strongly Immunoreactive for CD34, which supports its diagnosis.

Surgical outcome in monocular elevation deficit: a retrospective interventional study.

BACKGROUND AND AIM: Monocular elevation deficiency (MED) is characterized by a unilateral defect in elevation, caused by paretic, restrictive or combined etiology. Treatment of this multifactorial entity is therefore varied. In this study, we performed different surgical procedures in patients of MED and evaluated their outcome, based on ocular alignment, improvement in elevation and binocular functions. STUDY DESIGN: Retrospective interventional study. MATERIALS AND METHODS: Twenty-eight patients were included in this study, from June 2003 to August 2006. Five patients underwent Knapp procedure, with or without horizontal squint surgery, 17 patients had inferior rectus recession, with or without horizontal squint surgery, three patients had combined inferior rectus recession and Knapp procedure and three patients had inferior rectus recession combined with contralateral superior rectus or inferior oblique surgery. The choice of procedure was based on the results of forced duction test (FDT). RESULTS: Forced duction test was positive in 23 cases (82%). Twenty-four of 28 patients (86%) were aligned to within 10 prism diopters. Elevation improved in 10 patients (36%) from no elevation above primary position (-4) to only slight limitation of elevation (-1). Five patients had preoperative binocular vision and none gained it postoperatively. No significant postoperative complications or duction abnormalities were observed during the follow-up period. CONCLUSION: Management of MED depends upon selection of the correct surgical technique based on employing the results of FDT, for a satisfactory outcome.

Bilateral scleromalacia in a case of congenital erythropoietic porphyria.

A 25-year-old woman presented with gradual dimness of vision in the left eye with history of recurrent cutaneous bullae, photosensitivity and passage of red coloured urine. Examination revealed cataract and high intra-ocular pressure in left eye and symmetrical areas of scleral thinning in both eyes. Systemic features of the patient pointed towards congenital erythropoietic porphyria, which was established by laboratory investigations.

Traumatic pseudophacocele.

A 70-year-old man presented with blunt trauma to his pseudophacic eye, resulting in subconjunctival dislocation of the posterior chamber intra-ocular lens. This rare incidence of traumatic pseudophacocele, occurring 5 years after cataract surgery and how its management salvaged useful vision is reported here.