kjo_24_20R1_PE

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2 Photo Essay 2
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5 This Descemet’s membrane has a story! Birth trauma 5
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ABSTRACT
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We report a case of a 27‑year‑old male presenting with blurred vision in one eye which was discovered at an army recruitment camp. He was
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examined and subsequently diagnosed to be having Descemet’s membrane tears, due to forceps‑induced birth trauma with amblyopia. His
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vision improved with a rigid gas permeable contact lens to 20/60.
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Keywords: Astigmatism, Descemet’s membrane tears, forceps‑induced birth trauma
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15 CASE 15
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17 A  27‑year‑old male  presented with blurred vision in 17
18 the left eye, discovered when he appeared for an army 18
19 recruitment screening camp. Best‑corrected visual acuity 19
20 was 20/20 in the right eye and 20/300 in the left eye. 20
21 Examination revealed multiple vertically oriented tears a b
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22 in the Descemet’s membrane (DM) with rolled edges and 22
23 clear and compact intervening cornea [Figure 1a, b and d]. 23
24 Posterior‑segment evaluation revealed no abnormality. There 24
25 was a definitive history of forceps‑assisted delivery. A scar 25
26 on the left maxillofacial area [Figure 2b] further affirmed the 26
27 diagnosis of a birth injury due to forceps‑assisted delivery. 27
28 Specular microscopy revealed marked pleomorphism and c d 28
29 polymegathism [Figure 2a], with a peripheral cell density of Figure 1: (a) Slit lamp photograph (×10) of the left eye in diffuse illumination 29
30 1575. A rigid gas permeable (RGP) contact lens trial improved showing multiple vertically oriented tears in the Descemet’s membrane. 30
31 (b) A slit section of the same eye with glassy ridge‑like appearance of the 31
his vision to 20/60. tears and clear and compact intervening cornea. (c) Significant topographical
32 astigmatism (Cyl − 4.85 D), note the axis of astigmatism is parallel to the 32
33 DISCUSSION axis of the tears. (d) Slit lamp picture taken in retroillumination highlighting 33
34 rolled edges of the Descemet’s membrane 34
35 Breaks in the DM due to birth trauma can be easily 35
36 Pooja Shukla1,2, Nitu Kumari3, 36
distinguished from the horizontal random breaks of
37 Palak Jugal Chirania3, Balmukund Agarwal3 AQ8
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congenital glaucoma, which are concentric to the limbus. 1
iTek Vision Centre, Sector 51, Noida, Uttar Pradesh,
38 Left eyes seem to be affected more commonly than right eyes 38
Departments of 2Cornea and 3 Refractive surgery, Sri
39 because neonates usually present in the left occiput‑anterior 39
Sankaradeva Nethralaya, Guwahati, Assam, India
40 position.[1] It is hypothesized that the tip of the forceps slips 40
41 over the anterior orbital rim causing vertical compression Address for correspondence: Dr. Pooja Shukla, 41
iTek Vision Centre, Sector 51, Noida, Uttar Pradesh, India.
42 E‑mail: pooja.amc2004@gmail.com
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43 Submitted: 29-Feb-2020 Accepted: 30-Apr-2020 Published: *** 43
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This is an open access journal, and articles are distributed under the terms of the Creative
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www.kjophthal.com
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49 For reprints contact: reprints@medknow.com 49
50 DOI:
How to cite this article: Shukla P, Kumari N, Chirania PJ, Agarwal B.
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51 10.4103/kjo.kjo_24_20 This Descemet’s membrane has a story! Birth trauma. Kerala J Ophthalmol 51
2020;32:XX-XX.
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© 2020 Kerala Journal of Ophthalmology | Published by Wolters Kluwer - Medknow 1
 Shukla, et al.: Birth trauma

1 increasing  Caesarian Section rates. As visual problems 1

2 go undiagnosed until the child realizes or secondary 2
3 complications develop, it also adds to the existing burden 3
4 of amblyopia. 4
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6 Declaration of patient consent 6
7 The authors certify that they have obtained all appropriate 7
8 patient consent forms. In the form the patient(s) has/have 8
9 given his/her/their consent for his/her/their images and other 9
10 a b clinical information to be reported in the journal. The patients 10
11 Figure 2: (a) Polymegathism on specular microscopy. (b) A deep scar in the understand that their names and initials will not be published 11
left maxillofacial area and due efforts will be made to conceal their identity, but
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13 anonymity cannot be guaranteed. 13
and horizontal distension of the globe, thus elevating the
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15 intraocular pressure acutely and resulting in tears of the Financial support and sponsorship 15
16 nonelastic DM.[1,2] The young endothelium resurfaces the Nil. 16
17 DM defect and the postnatal corneal edema clears. The 17
18 tears are seen as clear, glassy ridges in the posterior cornea Conflicts of interest 18
19 evident on retroillumination.[1] A large proportion of cases There are no conflicts of interest. 19
20 have high Degrees of astigmatism [Figure 1c] contributing 20
21 to poor vision.[1,2] Management options include spectacles, REFERENCES 21
22 RGP lenses, and keratoplasty. 22
1. Mannis MJ, Holland EJ. Cornea. 4th ed. Philadelphia,USA: Elsevier;
23 2017. p. 211‑3.
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24 DM tears due to birth injury are quite uncommon in the 2. Ruba A, Sathish S. Forceps‑induced birth injury to the cornea. BMJ 24
25 present era, owing to good prenatal care, planning, and Case Rep 2014;2014:Bcr‑2013‑201786. 25
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30 AQ8: Please note this author signature missing in copyright form. 30
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2 Kerala Journal of Ophthalmology / Volume 32 / Issue 2 / May-August 2020