Ashish Mishra

Purpose: To study clinical profile, causes, and outcome of optic neuritis. Material and Method: A total of 66 eyes of 33 patients were included in this prospective observational study, which was conducted at Ophthalmology Clinic of Tertiary Care Center of Western Maharashtra, during study period of August 2019 to September 2021. Study population included all patients clinically diagnosed of optic neuritis, except patients with ischemic optic neuropathy, para-infectious cause of optic neuritis, and postvaccinated optic neuritis. Result: Maximum patients belonged to age-group of 30–40 years. Fifty-two percent were male, while 48% were female patients. Fifty-five percent of study population reported with papillitis, 39% had retrobulbar neuritis, and 6% had neuroretinitis. 94.1% had improved visual acuity, post 3 months of the steroid therapy. However, 35% revealed improved color vision status, while 58.8% continued to have impaired color vision. Conclusion: Higher frequency of papillitis has been observed in various Asian studies. The present study accounts for 55% cases of papillitis and 39% of retrobulbar neuritis, in contrast to Western studies like ONTT which revealed predominantly higher cases of retrobulbar neuritis. Optic disk edema or swelling has been identified with lower risk to multiple sclerosis, thus explaining the increased frequency of papillitis among the Asian population with optic neuritis which seems compatible with lower rates of developing MS.

Diabetes is a major cause of ocular morbidity as multiple mechanisms play a role in inducing inflammatory changes in the eye. Diabetic retinopathy is the most common complication and is well-documented. However, in the era of modern medicine, attention is also being focused on ocular surface changes in diabetes. Therefore, this study aimed to determine the association between diabetes and ocular surface diseases. This is a cross-sectional study examining 320 eyes of 160 patients with diabetes who were grouped according to their duration of diabetes. The symptoms were evaluated using the ocular surface disease index (OSDI) questionnaire. Their recent hemoglobin (Hb) A1c value was recorded. Their external or internal hordeolum, blepharitis, meibomian gland dysfunction, and corneal sensitivity were also evaluated. The tear film was examined using tests, such as Schirmer's test, tear film breakup time (TBUT), tear film meniscus height (TFMH), fluorescein stain, and rose bengal stain. The results were correlated with the duration and control of diabetes. The mean age of the study population was 56.60 years comprising 56% (n=89) females and 44% (n=71) males. The mean OSDI scores were 7.9 ± 3.55 and 57 ± 19.22 in patients without dry eye and with severe dry eye, respectively. The study observed OSDI scores were consistently high with diabetes severity. About 67% (n=24) of patients with HbA1c of >8% had dry eyes. Dry eye was found in 68% (n=59) of patients with the duration of diabetes being >10 years. About 23.7% (n=38) had blepharitis, whereas only 4% (n=7) had external or internal hordeolum and 44% (n=86) had different grades of meibomian gland dysfunction. Corneal sensitivity was abnormal in only 12% (n=12) of patients. About 55% (n=86) of patients had varying degrees of dry eye. A statistically significant correlation was found between the severity of dry eye and TBUT, TFMH values, and grades of corneal staining (P < 0.0001). This study observed that the incidence of dry eyes was found to be higher when patients had uncontrolled diabetes and diabetes for a longer period. The OSDI scoring system is an important diagnostic tool while examining patients with dry eye. In an ophthalmology clinic, patients with diabetes should always be evaluated for any ocular surface changes when being screened for diabetic retinopathy, and proper guidelines should be implemented to detect changes in the ocular surface system as early as possible so that any long-term complications such as infectious or neurotrophic keratitis may be avoided at an early stage.