Title: A Clinical Study to Evaluate the Incidence of Ocular Manifestations in Patients with Nutritional Anemia

Authors: Dr Shazia Qayum, Dr Kunal Sharma

 DOI: https://dx.doi.org/10.18535/jmscr/v7i6.01

Abstract

Introduction: Anemia is a frequent haematological ailment presenting with diverse ophthalmic manifestations. It can involve  any  part of the eye and adnexa but principal features are conjunctival pallor and retinal haemorrhages retinal arteriolar and venous tortuosity, cotton wool spots, roth’s spots, macular star and papilledema. This study evaluates the incidence of ocular manifestations in anaemia, relation between incidence of retinal haemorrhages with degree of severity of anaemia and prerequisite for fundus examination in all patients with anemia.

Objective: To evaluate the incidence of ocular manifestation in anemia and to evaluate correlation between the incidence of retinal haemorrhages and degree of severity of anemia.

Methodology: This prospective observational study was done in the department of Ophthalmology at GMC Rajouri from January 2019 – April 2019. A total of 96 patients, age group 18-50 years, diagnosed with nutritional anemia were included in our study after gaining written informed consent. Comprehensive haematological work up was done to exclude patients with anaemia other than nutritional cause. Evaluation of anterior segment of eye was done by slit lamp bio microscope. Evaluation of posterior segment of eye was done the help of direct/indirect ophthalmoscope/slit lamp biomicroscopy with +90D lens after full dilatation of pupil with Tropicamide eye drops.

Results: Out of total 96 patients with nutritional anaemia iron deficiency was seen in 52(54.16%) patients, megaloblastic anaemia was seen in 16(16.66%) patients and dimorphic anaemia was seen in 28(29.16%) patients. In our study we found that conjunctival pallor was the commonest ocular manifestation in anaemia and was present in all the cases. Patients with severe anaemia showed retinal haemorrhages in 26 (68.4%) patients. In our study incidence and severity of retinopathy was higher with higher grades of anaemia.

Conclusion: Conjunctival pallor and flame shaped haemorrhages are most common ocular manifestations in patients with nutritional anaemia. Presence of conjunctival pallor needs evaluation for anaemia. Incidence and severity of retinal manifestations depends upon severity of anaemia.

Keywords: Anemia, Iron deficiency anemia, Conjunctival pallor, retinal haemorrhages.

References

  1. Duke -Elder S., Dobree J. H. “The blood disease”. Disease of Retina; l x. System of Ophthalmology C.V. Mosby Co 1967, Chapter IV, 373-381.
  2. Nusrat Shaheen, Junaid S. Wani, A.R. Nasti, M.I. Quadri: Ocular manifestations in anaemia – A clinical study. J K Practioner. 2005 July-Sept; 12(3): 128-130.
  3. Kalpana Suresh, Ramya sampath, Tanvi: Ocular manifestations in haematological disorders. Shri Ramchandra Journal of Medicine. 2011 Jan- Jun; 4(1): 1-4.
  4. Rosenthal AR. Ocular manifestation of leukemia. A review. Ophthalmology 1983;90: 899-905.
  5. Sethi A, Ghose S, Gujral S, Jain P, kumar R. Childhood proptosis: invaluable but overlooked peripheral smear. Indian J Ophthalmol 2001;49: 121-3.
  6. Anusha Venkataraman, Bijnya B Panda, Anupam Dey MD: Nutritional anemia as a cause of vision loss in developing countries: A case report. Kerala journal of ophthalmology. Dec 2013; 25 (4): 383-384.
  7. Lang GE, Spraul CW, Lang GK. : Ocular changes in primary hematologic disease. Klin Montsbl Augenheikd, 1998; 212(6); 419.
  8. Tarang N Sheth, Nitin K Chaudhary: The relation of conjunctival pallor to presence of anaemia. Journal of general Internal Medicine. 1997 Feb; 12 (2); 102-106.
  9. Marwaha RK, Singh S, Garewal G, Marwaha N, Walia BN, Kumar L. Bleeding manifestations inmegaloblastic anaemia. Indian J Pediatr 1989; 56:243-7.
  10. Lam S, Lam BL. Bilateral retinal hemorrhages from megaloblastic anemia: case report and review ofliterature. Ann Ophthalmol 1992; 24:86-90.
  11. Holt J.M., Gorden -Smith E.C. Retinal abnormalities in diseases of the blood. Brit. J. Ophthalmol,1963; 53; 145-159.
  12. Rubenstein R.A., Yanoff M., Albert D M: Thrombocytopenia, anaemia and haemorrhage. Am. J. Ophtholmol; 1968; 65; 435-439.
  13. Merin S., Freund M. Retinopathy in severe anaemia. Am. J. Ophthalmol, 1968; 66(6) 1102-1106.
  14. Ajit Babu Majji, Kapil Bhatia, and Annie Mathai: Spontaneous bilateral peripapillary, subhyaloid and vitreous haemorrhage with severe anaemia secondary to idiopathic thrombocytopenic purpura. Indian J Ophthalmol. 2010 May-Jun; 58(3): 234–236.

Corresponding Author

Dr Shazia Qayum

MS Ophthalmology DNB Ophthalmology, Assistant Professor, GMC & AH, Rajouri, J & K