Papers by malarvizhi raman
TNOA journal of ophthalmic science and research, 2023
Kerala journal of ophthalmology, 2024
TNOA Journal of Ophthalmic Science and Research
Marcus Gunn Jaw Winking Ptosis is a congenital ptosis associated with synkinetic movements of upp... more Marcus Gunn Jaw Winking Ptosis is a congenital ptosis associated with synkinetic movements of upper lid on masticating movements of the jaw. It is usually unilateral but rarely presents bilaterally. In this study, ten cases of unilateral ptosis since birth with moderate to severe degree movement of lids along movement of jaws (MGJW-Marcus Gunn Jaw Winking) presenting to Oculoplasty department were evaluated and managed according to the degree of jaw winking phenomenon and their outcomes were observed. The amount of jaw winking is the excursion of the upper lid in mm with the opening of the mouth. Ocular associations include strabismus (50-60%), anisometropia (5-25%) and amblyopia (30-60%). The cause for underlying amblyopia could be secondary to strabismus, anisometropia, or occlusion by the ptotic lid. It is graded into mild (maximum 2 mm), moderate (2 mm-5 mm) and severe (higher than 5 mm). Persistence of minimal jaw-winking phenomenon post-operatively after levator detachment. Frontalis sling is the most common procedure used to correct the ptosis following the obliteration of levator action. MGJWS mostly presented as moderate to severe jaw winking synkinesis of upper eyelid and accompanied by moderate to severe blepharoptosis. Eyelid excursion of jaw winking has direct correlation with ptosis and levator dysfunction. Unilateral levator aponeurosis excision with frontalis suspension is an effective surgical approach in the management of unilateral MGJWS, which achieved both satisfactory symmetrical outcome and resolution of jaw winking with eye movement.
TNOA journal of ophthalmic science and research, 2019
Aim: This study aims to evaluate traumatic eyelid injuries and assess functional outcome followin... more Aim: This study aims to evaluate traumatic eyelid injuries and assess functional outcome following treatment. Materials and Methods: A prospective study of 30 cases of lid injury was conducted at Orbit and Oculoplasty Department, Regional Institute of Ophthalmology and Government Ophthalmic Institute, Egmore, Chennai, Tamil Nadu, for 12 months from February 01, 2017, to February 01, 2018. Data collected were entered into Excel Spreadsheet and analyzed using STATA statistical software package release 11. Results: The incidence of lid injuries was more in males (63%) compared to females (37%). The most common mode of injury of the eyelid was accidental fall (36.7%) and assault (23.3%). Majority of the cases presented within 6 h of injury. Full-thickness involvement was seen in 20 patients (66.7%). Involvement of the eyelid margin was seen in 18 patients (60%) and was managed by three-layer margin suturing canalicular involvement in 8 cases (26.7%) underwent monocanalicular stent placement. About 40% of patients complained of epiphora and were not satisfied with cosmetic results. Conclusion: This study reveals that young adult males, most of whom were workers, were more prone to eyelid injuries. Timely meticulous management of the eyelid injury with minimal debridement of the wound and tension-free suturing gives better cosmetic outcome. Epiphora, notching of lid margin, or ectropion was the most common complication postoperatively.
TNOA journal of ophthalmic science and research, 2019
We report a rare case of probable Vogt–Koyanagi–Harada (VKH) syndrome in a 10-year-old child who ... more We report a rare case of probable Vogt–Koyanagi–Harada (VKH) syndrome in a 10-year-old child who presented with visual acuity of only perception of light present in both eyes. The anterior segment examination showed cells, flare (4+), fine keratic precipitates over back of the cornea, posterior synechiae, posterior subcapsular cataract, and fundus showing hyperemic disc with blurred margins. B-scan showed shallow retinal detachment and choroidal thickening. Bilateral panuveitis with normal serological and systemic screening was favoring a diagnosis of probable VKH syndrome. The patient was treated with intravenous methylprednisolone followed by oral prednisolone. Visual acuity improved to 6/24 BE.
TNOA Journal of Ophthalmic Science and Research, 2021
Intraocular lens (IOL) opacification can be one of the rare differential diagnoses for delayed de... more Intraocular lens (IOL) opacification can be one of the rare differential diagnoses for delayed decrease in postoperative vision in patients undergoing cataract surgery. A 73-year-old female presented with the complaints of diminished vision in her operated eye 4 years after a surgery for her cataract. After meticulous evaluation, the patient was diagnosed with opacification of IOL, and appropriate IOL exchange was done. The patient regained vision to 6/12. Hence, it is crucial to keep this cause of postoperative decrease in vision and manage accordingly to restore useful vision.
TNOA Journal of Ophthalmic Science and Research, 2020
Aims and Objectives: The aim and objective of this study was to assess the visual prognosis in op... more Aims and Objectives: The aim and objective of this study was to assess the visual prognosis in open globe injury patients using the “Ocular Trauma Score (OTS).” Methodology: A prospective study of 100 patients with open globe injury attending a tertiary referral eye care center, Chennai, was carried out for a period of 12 months from February 1, 2018, to February 1, 2019. Results: The mean age of presentation was 40 years. Males (75%) were more commonly injured compared to females (11%). The right eye (65%) was more commonly injured than the left eye (35%). Out of the 100 patients, 96 patients underwent surgical management and 4 patients were managed conservatively. Out of the 96 patients, 26% had globe ruptures, 11% had relative afferent pupillary defect, 10% had perforating injuries, 8% had retinal detachment, and 4% had endophthalmitis. OTS was 1 in 9% of patients, 2 in 30%, 3 in 35% patients, 4 in 15% patients, and 5 in 11% patients, indicating that most of the patients had poor visual acuity at the time of presentation with an OTS value of 1–3. At the end of 6 weeks, 18% of the patients had a vision of no perception of light, 21% had a vision of percentage of light/hand movements, 25% had 1/200–19/200, 18% had 20/200–20/50, and 18% had >20/40. Majority of the patients had a visual acuity between 1/200 and 19/200. The results were analyzed with the OTS value chart. Conclusion: OTS is a comprehensive score to predict final visual outcome in patients with open globe injury, which can be widely used for counseling ocular trauma victims. OTS calculated at the initial evaluation has predictive value in patients with open globe injury.
TNOA Journal of Ophthalmic Science and Research, 2020
We are reporting two cases of orbital hematoma, one who underwent surgical intervention and anoth... more We are reporting two cases of orbital hematoma, one who underwent surgical intervention and another case was observed. A 14-year-old boy presented to us with proptosis and features of optic nerve compression following trauma. Imaging revealed globe tenting, and the patient underwent hematoma aspiration with canthotomy. After 6 weeks, proptosis resolved with 6/6 vision and full extraocular rectus muscles (EOM). An 11-year-old girl presented to us with proptosis and diplopia following a trivial fall. Computed tomography orbit revealed a large variable dense lesion located at the intraconal and medial aspect of extraconal space. Since there were no features of optic nerve compression, the child was treated with oral steroids and was observed. After 2 weeks, proptosis resolved with full EOM.
TNOA Journal of Ophthalmic Science and Research, 2019
A 58-year-old male presented with injury in the left eye by falling over a cycle pedal. On presen... more A 58-year-old male presented with injury in the left eye by falling over a cycle pedal. On presentation to the casualty, the cycle pedal was found penetrating onto the superomedial aspect of the left orbit. The cycle pedal was removed in toto, and computed tomography brain with orbital cuts revealed fracture in the orbital floor, maxilla, and nasal bone. Upper-lid tear was sutured, and visual acuity was 20/30 no improvement in glass, no improvement in pinhole (NIG, NIP). Thus, immediate extraction of the foreign body resulted in better visual and cosmetic outcome.
TNOA Journal of Ophthalmic Science and Research, 2019
We report a rare case of probable Vogt–Koyanagi–Harada (VKH) syndrome in a 10-year-old child who ... more We report a rare case of probable Vogt–Koyanagi–Harada (VKH) syndrome in a 10-year-old child who presented with visual acuity of only perception of light present in both eyes. The anterior segment examination showed cells, flare (4+), fine keratic precipitates over back of the cornea, posterior synechiae, posterior subcapsular cataract, and fundus showing hyperemic disc with blurred margins. B-scan showed shallow retinal detachment and choroidal thickening. Bilateral panuveitis with normal serological and systemic screening was favoring a diagnosis of probable VKH syndrome. The patient was treated with intravenous methylprednisolone followed by oral prednisolone. Visual acuity improved to 6/24 BE.
TNOA Journal of Ophthalmic Science and Research, 2019
Aim: This study aims to evaluate traumatic eyelid injuries and assess functional outcome followin... more Aim: This study aims to evaluate traumatic eyelid injuries and assess functional outcome following treatment. Materials and Methods: A prospective study of 30 cases of lid injury was conducted at Orbit and Oculoplasty Department, Regional Institute of Ophthalmology and Government Ophthalmic Institute, Egmore, Chennai, Tamil Nadu, for 12 months from February 01, 2017, to February 01, 2018. Data collected were entered into Excel Spreadsheet and analyzed using STATA statistical software package release 11. Results: The incidence of lid injuries was more in males (63%) compared to females (37%). The most common mode of injury of the eyelid was accidental fall (36.7%) and assault (23.3%). Majority of the cases presented within 6 h of injury. Full-thickness involvement was seen in 20 patients (66.7%). Involvement of the eyelid margin was seen in 18 patients (60%) and was managed by three-layer margin suturing canalicular involvement in 8 cases (26.7%) underwent monocanalicular stent placement. About 40% of patients complained of epiphora and were not satisfied with cosmetic results. Conclusion: This study reveals that young adult males, most of whom were workers, were more prone to eyelid injuries. Timely meticulous management of the eyelid injury with minimal debridement of the wound and tension-free suturing gives better cosmetic outcome. Epiphora, notching of lid margin, or ectropion was the most common complication postoperatively.
TNOA Journal of Ophthalmic Science and Research, 2018
Intraocular cilium is a very rare intraocular foreign body. We report a middle-aged female patien... more Intraocular cilium is a very rare intraocular foreign body. We report a middle-aged female patient who presented with a cilium in the anterior chamber of the right eye with iritis, following an injury with a stick. In view of anterior chamber reaction, the eyelash was removed. Postoperatively, the iritis resolved in 2 weeks with periocular and topical steroids.
IP International Journal of Ocular Oncology and Oculoplasty
To study the incidence of cerebral visual impairment among children with history of perinatal neu... more To study the incidence of cerebral visual impairment among children with history of perinatal neurological insult and congenital brain anomalies and to analyze the outcome following visual intervention programme. A prospective interventional study, examining 100 children less than 7 years over a period of 1 year. All children with history of perinatal hypoxia, neonatal hypoglycemia, neonatal seizures, infantile spasm, epilepsy, congenital hydrocephalus, congenital brain anomalies, CNS infections, traumatic brain injury and post cardiac surgery, excluding children with ocular visual impairment. Of the 100 children studied, the incidence of CVI was 87%. The associated ocular problems were found to be low visual acuity seen in 85%, strabismus in 25%, refractive error in 39%, Nystagmus in 21% and oculomotor apraxia in 6%. The most common etiology was hypoxic ischemic encephalopathy, contributing to 30% of the cases and most common MRI findings were periventricular leukomalacia, seen in...
IP International Journal of Ocular Oncology and Oculoplasty
Electric current flows in the body between two contact points. The degree of damage caused by the... more Electric current flows in the body between two contact points. The degree of damage caused by the current is dependent on voltage intensity, tissue resistance, type of current, duration and area of contact and the route the current traveled within the body. Ophthalmic injuries are common with electrical damage to the body. Blepharospasm, keratopathy, uveitis, corneal opacities, cataracts, vitreous hemorrhage, retinal edema, macular hole and vascular occlusions are the frequently encountered ones. Here in this case, we report a very rare coincidence of optic neuropathy triggered by high voltage electrical injury (electrocution) and an occult pituitary macroadenoma which coexisted in the same individual causing compressive optic neuropathy. The patient was treated initially as optic neuropathy with steroids and later the macroadenoma was excised under neuro-surgical guidance. This case necessitates the importance of investigating temporal pallor in young individuals and arrival at a p...
IP International Journal of Ocular Oncology and Oculoplasty
Granular cell tumor (GCT) is a rare benign soft tissue tumor. They have been reported in several ... more Granular cell tumor (GCT) is a rare benign soft tissue tumor. They have been reported in several regions of the body but mostly in the skin and subcutaneous tissue of head and neck. It may involve the orbit, periocular skin, lacrimal sac, optic nerve, ciliary body, conjunctiva and caruncle. Here we present a rare case of intraconal GCT in a 45 year old woman who presented with unilateral proptosis. She presented with forward protrusion of right eye for the past 3 months,MRI orbit revealed a well defined T1/T2/FLAIR hypointense lesion in the inferolateral aspect of intraconal compartment of right orbit. Transconjunctival excision of the lesion was done. Histopathological Examination (HPE) and immunohistochemistry confirmed the diagnosis of Granular cell Tumor.
Journal of Evidence Based Medicine and Healthcare, Oct 9, 2017
INTRODUCTION: Orbit is a sterile closed compartment surrounded by bony walls on all sides and ant... more INTRODUCTION: Orbit is a sterile closed compartment surrounded by bony walls on all sides and anteriorly by orbital septum. The orbit houses the eyeball and has the major function of protection of eyeball and helps in its motility in extreme degrees. Orbit has many potential spaces that make it a primary site of infections. It may present either as a secondary site for infections from the adjacent structures or intermediary site for infection to other vital sites. Orbital anatomy and its relation with other adjacent structures are important in the pathogenesis of orbital infections. These relationships also explain its devastating consequences and influence therapeutic decisions. Orbital and periorbital infections may be caused by variety bacterial, fungal and parasitic agents. Appropriate management depends on appreciation of topography of the process within the orbit and periorbital tissues using Radioimaging and identification of responsible organisms and its sensitivity to antibiotics using Microbiological study. Appropriate management by either medical or surgical treatment helps in prevention of complications.1e Integration of history, physical and ocular examination and ancillary testing allow achievement of these primary goals. AIM OF THE STUDY: To evaluate orbital infections and analyse the role of Radioimaging and Microbiological study in early diagnosis, management and outcome. OBJECTIVES: To analyse the prevalence, etiopathogenesis and various clinical presentations of orbital infections and role of Radioimaging and Microbiological study in its early diagnosis, treatment and outcome. METHODS OF EVALUATION: This prospective study was conducted at Orbit and Oculoplasty department, RIOGOH, Egmore, Chennai for a period of 12 months during when 30 patients with Orbital infections were evaluated RESULTS: Out of 30 patients, 16 patients (53.4%) were diagnosed to have Preseptal cellulitis, 8 patients (26.7%) and 4 patients (13.3%) were diagnosed with Orbital cellulitis and Orbital abscess respectively. Rest of the 2 patients were diagnosed with Subperiosteal abscess and Cavernous sinus thrombosis. Radiological and Microbiological investigations were done in patients according to their needs Out of the 20 medically treated with appropriate antibiotics, all patients improved. Out of the 10 surgically treated, 2 patients (20%) deteriorated. CONCLUSION: Orbital infections are more common in paediatric age group and preseptal cellulitis is the commonest infection encountered. Periocular infections are the most common causative factor for the orbital infections. Bacteria is the major causative organism for orbital infections. Among it, gram positive organisms predominate the cause. Fungi constituted the second major cause. Radioimaging like X Ray, B scan, CT Scan and MRI help in diagnosis, identification of complications and in assessment of response of treatment in orbital infections. They are complimentary to one another. Microbiological study with Gram Staining, Culture and Sensitivity and Fungal culture help in the identification of Strain of Organism and in Correct choice of antibiotics that is important in the complete cure of infections. Most of the orbital infections resolve with the prompt treatment. Surgical approach forms the treatment of choice in abscess and it should be followed by medical treatment according to the microbiological study. Radioimaging and Microbiological study play a significant role in the choice of treatment. Radioimaging is used to assess, response to treatment and to modify treatment for a better outcome.
Journal of Evidence Based Medicine and Healthcare, 2018
BACKGROUND Proptosis in children usually presents as a diagnostic dilemma. This study is to evalu... more BACKGROUND Proptosis in children usually presents as a diagnostic dilemma. This study is to evaluate the incidence, mode of onset, various clinical presentations in children up to 14 years. The various treatment modalities and the final outcome of treatment were also assessed. MATERIALS AND METHODS This prospective study was conducted at Orbit and Oculoplasty Services, RIOGOH, Egmore, Chennai for a period of 26 months from April 2014 to May 2016. Thirty patients presenting with proptosis were examined with detailed history taking, complete general examination and ocular examination, slit lamp biomicroscopy, ophthalmoscopy, Hertel's exophthalmometry, colour vision, refraction, intra ocular pressure, perimetry, laboratory investigations, radiological investigations and histopathological evaluation were done to aid in the etiological diagnosis and to plan the management. RESULTS Of the total 90 patients of proptosis who attended the hospital during the study period, 30 were children upto 14 years of age (33.33%). 18 cases (60%) of patients presented with axial proptosis and 12 cases (40%) were eccentric. 25 cases (83%) presented with unilateral proptosis and 5 cases (17%) with bilateral proptosis. The common aetiologies for proptosis in children were inflammatory (33%) followed by neoplastic (20%) commonly secondaries. Among the inflammatory causes orbital cellulitis was the most common cause (30%). Leukemic infiltration was the commonest cause of proptosis due to secondary orbital infiltration. Among all cases inflammatory lesions had better outcome. Out of 30 cases majority (40%) got cured and showed clinical improvement by medical and surgical methods of treatment. CONCLUSION This study reveals that in children inflammatory condition is the predominant cause. Most of the cases were unilateral and axial in presentation. Overall the most common aetiology of childhood proptosis is orbital cellulitis. Among the malignancies, secondaries were more common than the primary orbital tumours. Haematological malignancy accounts for the majority of cases of orbital secondaries in children. Imaging techniques are the best modality of investigation in all cases of proptosis to detect the early lesions within the orbit.
Uploads
Papers by malarvizhi raman