Case Study: Glaucoma and Epidemic Dropsy - A Past Possible Association Revisited

Case Study: Glaucoma and Epidemic Dropsy - A Past Possible Association Revisited

Swarna Biseria Gupta (Department of Ophthalmology, L.N. Medical College, Bhopal, India), Divya Verma (Department of Ophthalmology, L.N. Medical College, Bhopal, India) and D. P. Singh (Department of Ophthalmology, L.N. Medical College, Bhopal, India)
Copyright: © 2014 |Pages: 7
DOI: 10.4018/ijudh.2014070105
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Abstract

Epidemic dropsy is a multi-system disease involving the cardiovascular, hepatic, renal, ocular and other systems. Onset is usually subacute or insidious with watery diarrhea and vomiting. This lasts from a few days to more than a week. Bilaterally symmetrical pitting edema of the lower limbs extending from the ankles up to the scrotum and abdominal wall is a constant feature. It is a toxic disease caused by the unintentional ingestion of Argemone mexicana (prickly yellow poppy) seeds as an adulterant of wheat flour, or more commonly, of cooking oil such as mustard oil. Sanguinarine and dehydrosanguinarine are two major toxic alkaloids of Argemone oil. It is a rare phenomenon for practicing ophthalmologists to observe cases of epidemic dropsy, and the possibility of glaucoma should be kept in mind in cases of epidemic dropsy, when members of same family or village report with raised IOP, pedal edema and history of use of mustard oil for cooking or massage. Glaucoma is hypersecretory in nature; prostaglandin and histamine release may have significant roles in its pathogenesis. The disease has self limiting course but needs good control of intraocular pressure (IOP) medically till it returns to normal and visual field changes have stabilized. Its early diagnosis is very important to prevent grievous complications; hence, all cases should be followed up regularly for IOP measurement and visual field analysis up to 8-12 weeks, because, if ignored, optic atrophy may develop.
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Case Report 1

A 25-year-old female patient came to the Ophthalmology OPD for routine checkup of IOP as she was a known patient of glaucoma who had received the diagnosis prior to presenting at our facilities. She was asymptomatic.

On examination, she had visual acuity 6/6 in both eyes, clear conjunctiva, clear cornea, deep anterior chambers, normal pupils, intra-ocular pressure was 20mm Hg in both eyes on applanation tonometery, gonioscopy revealed both eyes had open angles, OD evaluation showed a vertical C:D ratio of 0.8 with superior and inferior NRR thinning in the right eye. The results from her carotid colour doppler studies were within normal limits.

She also had a history of difficulty in breathing, gastrointestinal distress, and a mild, but constant, heaviness in both eyes. On further probing, she provided a history of use of mustard oil for many years. There was a corroborative history of mass disease of swelling of feet in her village community, hence the patient was also investigated for epidemic dropsy. After initiating treatment to control IOP, the patient was referred to the Department of Medicine for further assessment and management of Argemone intoxication.

Figure 1.

Fundus photograph of right eye showing, VCD:0.7-0.8, nasal shifting of blood vessels along with, inferior thinning of NRR

Case Reports 2, 3, And 4

A female aged, 38 years and her two children, one boy of 12 years and a girl of 14 years, came with a history of blurring of vision in both eyes, with mild pain.

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