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

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.