Both Eyes Research Articles

Ocular hypertension in a child of acute lymphoblastic leukemia

Abstract To highlight the case of ocular hypertension in a 9-year-old male who came with fever and swelling in the left eye (LE) for 3 days. He was a known case of acute lymphoblastic leukemia (ALL) on treatment with oral steroids. His best-corrected vision was 6/6 in both eyes (BES). The anterior segment was normal in BES except for mild periorbital edema in the right eye (RE). On applanation tonometry (AT), intraocular pressure (IOP) was 42 mmHg in RE and 36 mmHg in LE. Gonioscopy showed open angles in BEs. Fundoscopy and optical coherence tomogram–retinal nerve fiber layer were normal in BES. He was diagnosed with steroid-induced ocular hypertension in BES and was started on both topical and oral antiglaucoma medications (AGMs). IOP was normal after 2 weeks of treatment. He came after a month of discontinuation of AGMs against medical advice but was still on oral steroids. He was asymptomatic, but his IOP was 28 mmHg in RE and 26 mmHg in LE. Parents were counseled about the disease and need to restart AGMs. Regular follow-up was also emphasized.

Acquired vitelliform lesion: A lesser diagnosed entity

We report a case of 56-year-old female patient who came to our retina department with diminution of vision in both eyes (BE) for three years. She was treated with anti-vascular growth factor injections in BE for choroidal neovascular membrane (CNVM) at another medical facility three months back. Her best corrected visual acuity (BCVA) was 6/24, N18, and 6/9, N8 in the right and left eyes, respectively. Fundus showed vitelliform lesions and subretinal deposits in BE. We could not find any evidence of CNVM on optical coherence tomography (OCT) angiography. We made a provisional diagnosis of adult-onset foveomacular dystrophy (AOFVD). After the literature review and investigations, we made a clinical diagnosis of acquired vitelliform lesion (AVL). The lesion is usually located between the retinal pigment epithelium and photoreceptors, which may occur as an isolated entity or in conjunction with other comorbidities. Hence, it is very important to differentiate AVL from CNVM to avoid unnecessary treatment.

Cataract Surgery After Keratoplasty: How Should We Prepare?

Introduction : Cataract surgery following corneal transplantation demands special attention to corneal graft stability and optimization to allow for excellent IOL selection, as well as corneal graft preservation since lens removal damages the corneal endothelium. This study aimed to determine how we should prepare for cataract surgery after keratoplasty.
 Case Illustration : Case 1: A 34-year-old male has phacoemulsification in his right eye (last eye). He had a history of eye surgery, including, keratoplasty for RE in 2019, and vitrectomy for RE because of endophthalmitis. The pre-operative visual acuity is 0.5/60 with PAS and an irregular pupil. Post-operative VA 3/60 with BCVA 6/40. Last follow-up, the grafted cornea was still clear with normal IOP. Case 2: A 50- year-old female underwent phacoemulsification for both eyes (BE). She had histories of keratoplasty in 1986, 1989, and 1997 for BE. She also had extreme myopia for BE (RE S -17.00, LE S-14.00). Pre- operative VA was 1/60 of BE, and BCVA was 6/20 a month after surgery. During the last check-up, both transplant corneas were clear with normal IOP. Last visit, her both grafts remained clear.
 Discussion : 
 Conclusion : IOL calculations are challenging due to inaccuracy in corneal measurements, astigmatism, or corneal pathology. The best time to perform surgery is at least 2 years after keratoplasty. We suggest using total keratometry in the K-6 formula or Haigis for the IOL formula. Good dispersive viscoelastic, operating away from the corneal endothelium, and employing low phaco-energy/fluids will help to deliver a clear cornea after surgery. Last, steroid treatment will enhance graft survival rate.

LOW VISION IN RETINITIS PIGMENTOSA: HOW TO ENHANCE FUNCTIONAL VISION IN PSEUDOPHAKIC PATIENT

Introduction : Retinitis Pigmentosa (RP) could lead to various visual impairments, including decreased visual acuity, poor dark adaptation, decreased contrast sensitivity, poor color vision, visual field constriction, leading to low vision (LV). LV in RP decreases patient’s quality of life (QoL) and Independence. We aim to report a successful case of LV management in a bilateral pseudophakic patient with RP.
 Case Illustration : A 33-year-old man came with progressively blurred vision in both eyes (BE) that worsen 6 months ago. Ophthalmologic examination revealed his uncorrected visual acuity for right eye (RE) and left Eye (LE) was 6/60 and 4/60. The patient had cataract surgeries and IOLs implantation on BE in 2021. Funduscopic examination revealed the bone spicule appearance, blood vessel attenuation, and waxy disc pallor on BE. Humphrey's examination showed a peripheral visual field defect. Decreased contrast sensitivity and poor color vision were also found.
 Discussion : The patient was managed by LV aids and rehabilitation. Spectacle clarified distant and near vision with best corrected visual acuity (BCVA) 6/21 and 0.8 M on BE, photochromic lenses aided in adapting to various lighting levels and as a UV protection, and the addition of illumination and color contrast enhancement improved vision in dim light. A convex mirror to be used as a field- enhancement spotting tool. Rehabilitation enhances his head tracking, scanning, and habitual spotting skills. Improvement of QoL has been recorded using LVQoL questionnaires.
 Conclusion : LV management are vary based on an individual’s level of functional vision and personal preferences. Optimal LV management could enhance patient QoL and Independence.

A snake venom ophthalmia: A case – report

Introduction : Snake venom ophthalmia is caused by venoms of spitting snakes. Delayed treatment may result in corneal ulcer, corneal perforation and blindness. We aim to report a fortunate snake venom ophthalmia case.
 Case Illustration : A-54-year-old male complained of burning eye pain, watery, and redness of the right eye (RE) after being spat by a snake 3 hours before admission. The snake was identified as a cobra-snake, spitted at a distance of 1 meter without body bite. He rinsed his eyes with tap water and irrigated at a nearby hospital before referred. During the admission, the pH of both eyes (BE) was 8. The patient was irrigated with normal-saline. The visual acuity (VA) of the right eye was 6/12 and left eye 6/6. There was RE conjunctival and ciliary injection. Other examinations were unremarkable. The patient was discharged and treated with levofloxacin eye-drop, sulfas-atropine 1%, EDTA 1%, artificial tears, and vitamin C. He did self-eye irrigation. Two days later, he presented with VA of 6/6 for BE with normal ocular examinations and pH of 7 for BE.
 Discussion : The general principle is prompt and copious irrigation of the eyes in chemical contact. The snake venom mixture of chemicals was washed out, which local necrosis can be prevented. Managing snake venom as a chemical splash injury with considerable irrigation, lubricants, and topical antibiotics, resulted a good outcome and prevented sequelae in this patient.
 Conclusion : Urgent irrigation of the affected eyes and other mucous membranes is the key in treating snake venom ophthalmia

Hybrid Contact Lenses in Children: a Case Series

Introduction : Refractive errors in children have experienced a significant increase in recent years. Contact lenses are a therapeutic option when spectacles can no longer provide maximum results. One of the most advanced design than suitable for children is Hybrid Contact Lenses (HCL). HCL feature a Rigid Gas Permeable (RGP) center surrounded by a soft ridge or skirt. This design enable the hard center to provide clear vision while the soft skirt offers the comfort and ease of a soft lens. However, this type of contact lens has not been widely used in Indonesia.
 Case Illustration : Three patients were prescribed HCL to correct their high refractive errors and amblyopia; 1. 5 years old female: OD: S-14.50 C-3.25x180 6/24 OS: S-12.5 C-3.50x10 6/24; 2. 5 years old female with anisometropia: OD: S-6.00 C-2.50x180 6/12 OS: S-0.75 C-2.000x170 6/6; 3. 8 years old male with pseudophakic eyes: OD: S-9.00 C-2.00x180 6/30 OS: S-8.00 C-2.00x175 6/30. Visual Acuity after 1 month of HCL average from 6/9 to 6/6 both eyes (BE).
 Discussion : In this study, we can notice several advantages of using HCL. The main outcome are significantly increased visual acuity and reduced amblyopia. HCL also has a higher comfort level compare to RGP Lenses, the soft hydrogel skirt really help the neophyte patient to ease their initial adaptation.
 Conclusion : Contact lenses are a mainstay of optical correction options for children with special refractive needs. Due to it's design and comfort, HCL is one of the most suitable contact lenses for children. Therefore, socialization and further introduction about this contact lens is needed.

Long‐term response to idebenone treatment in a patient with advanced Leber hereditary optic neuropathy

Aims/Purpose: To present a case with advanced LHON and its response to 2‐year‐treatment with idebenone, which was prescribed 13 years after the onset of the disease.Methods: A 40‐year‐old Caucasian male patient with a history of bilateral painless visual loss since the age of 28 was examined at our Ophthalmology department. His brother had also suffered similar visual loss. At presentation ETDRS best corrected visual acuity (BCVA) was counting fingers (CF) in both eyes (BE). Fundoscopy revealed pale optic discs bilaterally. Visual fields (30‐2) showed central scotomas in BE. During OCT/OCTA imaging of the optic disc RNFL and GCC thickness were decreased bilaterally. In electrophysiological assessment with flash visual evoked potentials a reduction in amplitude was recorded in BE but with normal latency. Full‐field ERG was within normal limits in BE. At the genetic test, a mitochondrial point mutation m. 3460 G>A at MT‐ND1 gene was detected, which was compatible with LHON. The patient was prescribed 300 mg idebenone per os three times/day for 24 months. Follow‐up visits were scheduled at 6, 12, 18 and 24 months.Results: At 6‐ and 12‐month follow‐up visits visual acuity, fundoscopic findings and OCT‐RNFL imaging remained unchanged. However, the patient reported subjective visual improvement bilaterally, with greater improvement in the visual field of the left eye. At 18 months following initiation of treatment an improvement of the visual field was documented in BE. No change of the GCC thickness was noted. At 2‐year follow‐up his condition remained improved.Conclusions: Delayed treatment with idebenone in advanced LHON can lead to subjective visual improvement. Moreover, an improvement in visual fields can also be documented even after 18 to 24 months of the initiation of the treatment.

A Case Report of Axenfeld-Rieger Anomaly

Axenfeld-Rieger (AR) syndrome is an inherited Autosomal Dominant (AD) disorder with ocular, dental, and craniofacial defects, whereas AR anomaly presents only with ocular changes. Hereby, the authors present a case report of 40-year-old male patient who reported to the Outpatient Department (OPD) with complaints of diminution of vision in Both Eyes (BE) for three years. There was a significant family history. Visual acuity was limited to hand movements in both eyes. Both eyes showed prominent Schwalbe’s line, iris atrophic patches, and ectropion uvea. Intraocular Pressure (IOP) was high in the Right Eye (RE) and within normal limits in the Left Eye (LE). No craniofacial or dental anomalies were detected. Gonioscopy revealed a closed angle with broad peripheral anterior synechiae in both eyes. Fundus examination revealed a Cup Disc Ratio (CDR) of 0.5 in the RE and 0.9 in the LE. AR anomaly is a rare case. Long-term follow-up of these cases is as important as early diagnosis and treatment to prevent blindness.

Rhino orbital mucormycosis: The new mimicker of neuro-ophthalmic lesions

It was always challenging to start steroids in a suspected optic neuritis case with rhino-orbital mucormycosis being the differentials in the COVID era. A 27-year-old female presented with headache and fever for 1 week, along with sinusitis and both eyes (BE) blurred vision for 2 days. There was history of tingling sensation in both lower limbs with urinary retention previously. History of COVID infection 1 month back. Vision in Right Eye (RE): 20/20 and Left Eye (LE): counting fingers (CF) CF with presence of relative afferent pupillary defect (RAPD) Grade 3. Humphrey Visual field gave a picture of Junctional scotoma with ganglion cell loss noted in BE. Magnetic resonance imaging (MRI) brain with orbit gave a picture of LE optic neuritis with right ethmoidal, sphenoidal sinusitis involving orbital apex making mucor a suspect. MRI spine showed focal myelitis. Patient underwent nasal endoscopy to rule out rhino-orbital mucormycosis following which she was started on intravenous methylprednisolone (IVMP) and vision improved drastically. Hence, a diagnosis of neuromyelitis optica was made. Three doses of IVMP along with a tapering dose of oral prednisolone were given and the patient is still in follow-up with no recurrence reported till now.

Toxic optic neuropathy and acute angle closure secondary to divalproex sodium – A rare case report

This study aims to report the side effects of oral divalproex sodium in a 55-year-old woman presented with a bilateral sudden painless decrease of vision and frontal headache and nausea, causing unique development of optic neuropathy and secondary acute angle closure (AAC). She gave a history of taking oral divalproex sodium for her migraine headache for 2 weeks. On examination, the patient was found to have secondary AAC, optic neuropathy with high intraocular pressure, and optic disc edema in both eyes (BE). The patient was treated with topical medications. The best-corrected distance visual acuity revealed an improvement of 20/30 from hand movement in BE within 2 weeks from the initial presentation. The ocular side effect, induced by divalproex sodium and possibly even after withdrawal from the drug, on time early detection of secondary AAC, and optic neuropathy will improve the management and give optimal results.

Nanophthalmos in a case of Alport syndrome: A unique presentation

A 20-year-old male having a positive family history of Alport syndrome presented to us with bilateral sensorineural hearing loss, hematuria, anterior central lenticular opacity in the right eye (RE), and anterior lenticonus in the left eye (LE). The patient had high hyperopia of +10 and +11 Diopter sphere in RE and LE, respectively. The anterior chambers (AC) were shallow (peripheral AC depth, Van Herick grade 1 and 0) with occludable angles on gonioscopy in both eyes (BE), which led us to suspicion of nanophthalmos. The axial length of ~15.35 mm and retinal–choroidal–scleral thickness of ≥2.20 mm in BE, on B scan, confirmed the diagnosis of nanophthalmos. We report this unique case presenting with phenotypes of two genetically diverse disorders, which, to our knowledge, has never been reported before.

Ocular involvement—An unusual initial presentation of chronic myeloid leukemia: A case report

ABSTRACT Chronic myeloid leukemia (CML) patients frequently exhibit systemic symptoms such as fatigue, abdominal discomfort, weight loss, and fever but rarely can have atypical initial presentation in the form of ophthalmic manifestations, which can precede the diagnosis of the primary malignancy. We describe a case of a 29-year-old male who presented in our ophthalmology out-patient department (OPD) with complaints of painless, diminution of vision, which was sudden in onset in right eye (RE) and loss of vision in left eye (LE) for four and seven days, respectively. There had been a history of loss of weight and appetite for the past 2 months. The visual acuity (VA) recorded was finger counting two meters in RE and perception of light in LE with an inaccurate projection of rays in both eyes (BE). The anterior segment evaluation of both eyes (BE) was normal. Fundus revealed multiple elevated yellow subretinal lesions with exudative detachment in the RE and no view in the LE. Ultrasound-Brightness (USG B) scan in the LE revealed multiple hyperreflective echoes likely vitreous hemorrhage. Optical coherence tomography (OCT) showed subretinal hyperreflectivity with surrounding edema in RE suggestive of leukemic infiltrates. On further systemic investigations, chronic myeloid leukemia-chronic phase (CML-CP) was detected; hence, the diagnosis of RE exudative retinal detachment (RD) and LE vitreous hemorrhage with CML-CP was made. Ophthalmic involvement is more often seen in acute than chronic leukemia, which makes the diagnosis challenging. We describe a unique case of a young patient with CML-CP who initially presented with ocular involvement preceding systemic diagnosis. This case report illustrates the importance of a primary care physician or an ophthalmologist in the early diagnosis and prompt management of hematological malignancy, as ophthalmic manifestations may be a rare initial presenting feature in CML-CP. These conditions require urgent referral to a hematologist by a primary care physician in the view of early commencement of therapy.

DAPSONE-INDUCED TOXIC MACULOPATHY IN LEPROSY PATIENT

Introduction: Dapsone has been widely used as a part of multidrug therapy for leprosy patients. Ocular side effects are rare. Ocular toxicity manifestations include retinal necrosis, optic atrophy, macular infarction, bilateral exudative retinal detachment, and choroidal detachment. We reported a rare case of dapsone-induced toxic maculopathy in a leprosy patient. Case Report: A 32-year-old male complained of blurred vision and a gray spot in central vision in the left eye (LE) for one month prior to admission. He had been treated with multidrug therapy (MDT) for leprosy for seven months. The MDT consists of dapsone, clofazimine, and rifampicin. The best-corrected visual acuity (BCVA) of the right eye (RE) and the LE were 6/6 and 6/12, respectively. A funduscopy of the LE showed decreased macular reflex. A color vision defect following the tritan axis was found in the LE. The Humphrey visual field (HVF) test of the LE revealed a central scotoma. Macular optical coherence tomography (OCT) showed intraretinal hyperreflectivity and subretinal fluid. Dapsone was then stopped in collaboration with a dermatologist. Two months after the discontinuation of Dapsone, the BCVA of the LE improved to 6/7.5, then 6/6 three months later. Color vision, macular OCT, and HVF tests revealed improvements. Multifocal ERG of both eyes (BE) also showed improvement in N1 and P1 wave amplitude in both eyes on 9-month follow-up after dapsone discontinuation. Discussion: Instead of direct drug toxicity, the mechanism of ocular side effects is thought to be ischemia caused by two distinct mechanisms. Macular ischemia is caused by acute, severe peripheral hypoxia and the physical effect of red cell fragmentation due to the hemolytic process. After discontinuation of dapsone, this case showed improvement in visual function and macular structure. Conclusion: Toxic maculopathy may be present in leprosy patients receiving dapsone treatment, although it is uncommon. Regular follow-up and evaluation of visual function and macular involvement are essential. Early detection of dapsone-induced toxic maculopathy and prompt discontinuation of dapsone may result in an improvement of visual functions.

Case Series of Ocular Injury with Firecracker During Diwali in North India

Objectives:- The primary aim of this case series is to evaluate and report the patients presenting at a tertiary care hospital with an ocular injury sustained due to firecrackers during the occasion of the Diwali festival and to report the pattern and severity of firecrackers associated ocular injury and to what extent this affects the visual acuity of these patients.
 Methods:- This study is a tertiary care teaching hospital-based prospective study that includes 14 eyes of 12 patients who suffered firecracker-associated ocular injuries. All of them were presented to the hospital’s emergency department within one week after the Diwali festival. A detailed history of all the patients was taken and their ocular examination was done. Out of 12 patients, 7 were admitted for further surgical management, and one patient who sustained a superficial facial burn, including periorbital area, without any eye injury was admitted to the department of plastic surgery 4 patients were given conservative treatment. The injuries were classified according to the ocular trauma scoring system (OTSS).
 Results:- Out of the 12 patients presented, all were males, all of age group 6 years to 42 years (mean age group 18 years). Eight of them sustained injuries from explosive firecrackers and four sustained injuries from bottle rockets. Six of them were involved in igniting firecrackers, while 5 patients were either bystanders or passersby. Out of 11 patients, the right eye (RE) was involved in 6, the Left eye (LE) was involved in 4 and both eyes (BE) were engaged in 1 patient. Out of 12 eyes, six eyes had open globe perforating injuries involving cornea or cornea and sclera both, two eyes had mild conjunctival congestion and superficial burn over the periorbital region, one eye had conjunctival injury and one eye had a vitreous hemorrhage, one eye had traumatic retinal detachment, one eye had optic nerve avulsion. The maximum number of affected eyes falls under OTSS score II, indicating poor prognosis regarding visual acuity.
 Conclusion:- Firecrackers may cause injuries in one or both eyes which may be grievous in nature resulting in an irreversible loss of vision in either or both eyes. Hence, it is a matter of serious concern. Directives should be formulated to register the ocular injury presented to the hospitals. The public should be educated regarding the safe handling of firecrackers. Firecracker manufacturing companies should be instructed to manufacture less explosive and safer firecrackers.

Importance of monitoring the ocular surface of patients with Kearns‐Sayre syndrome: a case report

AbstractPurposeKearns‐Sayre Syndrome (KSS) is a congenital mitochondrial myopathy initially described by the triad: Progressive external ophthalmoplegia, pigmentary retinopathy, heart block. Surgical procedures to alleviate ptosis can cause corneal injury from exposure. The lack of blinking can lead to a difficult contraction of the muscles responsible for squeezing the meibomian glands causing their dysfunction (MGD). Therefore, the follow‐up is of special interest in those cases where we suspect KSS due to the probable appearance of complications.MethodsWe present the case of a male of 9 years old who presented a sudden‐onset ptosis and bilateral internuclear ophthalmoplegia. Initially, he was diagnosed with Myasthenia. At the age of 12, resection of the elevator upper eyelid was performed in both eyes (BE). In the successive visits: negative Bell's sign, a progressive MGD and significant corneal thinning in the lower half of the BE were observed, and the right eye (RE) was affected with an infiltrated ulcer.ResultsTreatment with high hydration in BE and RE was treated with antibiotics eye drops and antibiotic ophthalmic ointment. After reviewing the history and given the high suspicion of KSS, genetic tests were requested to confirm it. Maintenance treatment was settled in BE with high hydration, 20% autologous serum and therapeutic contact lens. After a year of exhaustive monthly follow‐up, the patient remains stable and there is no progression of the corneal thinning.ConclusionsIt is important to take care of the ocular surface in these cases of KSS due to the corneal exposure after ptosis surgery. We must achieve stability in terms of symptoms and visual acuity without incurring other complications such as infections or perforation.

Multimodal imaging including optical coherence tomography angiography of benign familial fleck retina

A 44-year-old woman presented with complaints of pain in the right eye (RE). Fundus examination revealed disc edema in the RE along with retinal flecks sparing the macula in both eyes (BE). Fundus autofluorescence demonstrated a symmetrical pattern of white flecks in BE. Spectral-domain optical coherence tomography (SD-OCT) revealed the lesions at the level of retinal pigment epithelium with impingement onto the outer retina. SD-OCT angiography through the flecks revealed hyperreflective lesions at the level of avascular retina. RE B-scan revealed a T-sign. Based on these findings, she was diagnosed with BE benign familial fleck retina (BFFR) with RE posterior scleritis. We describe the multimodal imaging features in a middle-aged patient with BFFR and provide an insight into the probable pathogenesis.

Intraretinal and subretinal fluid in exudative nonproliferative macular telangiectasia type 2

A 62-year-old man presented with complaints of decreased vision in BE. His best-corrected visual acuity (BCVA) was 6/12 in both eyes (BE). Based on his fundus examination and imaging findings, he was diagnosed with BE Macular Telangiectasia type 2 (MacTel 2) and was advised of regular follow-up. Over the course of follow-up, he developed further reduction in vision in the right eye (RE) to 6/24. Spectral-domain optical coherence tomography (SD-OCT) showed the presence of a subfoveal detachment (SFD) with intraretinal cystoid edema. He was diagnosed to have an exudative variant of preproliferative MacTel 2 and underwent three intravitreal injections of bevacizumab in the RE following which there was an improvement in BCVA to 6/12 along with the complete resolution of SFD and IRF on SD-OCT. This report describes a rare case of exudative nonproliferative macular telangiectasia type 2 presenting with the presence of intraretinal fluid.

Bilateral laser peripheral iridotomy in a co-occurrence of unilateral iridocorneal endothelial syndrome and chronic angle closure glaucoma.

To report a case of unilateral Iridocorneal endothelial (ICE) syndrome- Progressive iris atrophy (PIA) with an overlapping chronic angle closure glaucoma (CACG) and to highlight the effect of bilateral Laser peripheral iridotomy (LPI) in such a co-occurrence. A patient presented to us with bilateral gradual painless progressive diminution of vision. Both eyes (BE) had a clear cornea, shallow peripheral anterior chamber depth, grade 2 nuclear sclerosis, raised intraocular pressure and glaucomatous optic neuropathy. In addition, the Left eye (LE) had an irregular anterior chamber, peripheral anterior synechiae (PAS) extending to cornea, patchy iris atrophy, subtle corectopia and a low endothelial cell count on specular microscopy. Indentation gonioscopy led to the diagnoses of CACG BE with ICE syndrome- PIA LE. LPI was performed bilaterally. On Anterior Segment Optical Coherence Tomography (ASOCT), there was evident widening of the angle away from PAS in the Right eye as well as in the LE with PIA post LPI. This is a unique case of unilateral PIA with an associated CACG in BE. It is the first case demonstrating the effect of bilateral LPI in such a case scenario. Though not indicated in ICE syndrome, LPI did show short term evidence of significant widening of the angle away from areas of PAS even in the eye with PIA having a limited high PAS and a concurrent primary (chronic) angle closure disease.

Bilateral multifocal choroidal metastasis as the presenting feature of non-small-cell lung carcinoma

A 46-year-old man was referred to our centre with blurring of vision in both eyes (BE) since 1 month and breathlessness for last 1 week. He was an active smoker...

English

BACKGROUND Glaucoma is a chronic, progressive optic neuropathy leading to irreversible blindness. Raised intraocular pressure is one of the modifiable risk factors of developing glaucoma. Regulation of intraocular pressure (IOP) is influenced by various factors and, systolic hypertension is one of them. The objectives of the study was to assess the relationship between systolic hypertension and IOP, also to see the effect of controlled and uncontrolled systolic blood pressure (SBP) on IOP in adults above 40 years of age. METHODS This study included a total of 230 known systemic hypertensive patients of age above 40 years. All the patients underwent detailed history taking, careful systemic and ocular examination. IOP was measured by Goldmann applanation tonometer, central corneal thickness (CCT) by anterior segment optical coherence tomography (OCT) and blood pressure (BP) was recorded after 5 minutes of rest. The data was recorded. RESULTS Correlation coefficient for SBP and IOP in right eye (RE) was 0.290 and for left eye (LE) was 0.354 with a probability value of P < 0.0001 which was statistically highly significant. Mean IOP for controlled SBP was 17.76 mmHg in both eyes (BE) which increased to 20.19 mmHg in RE and 20.64 mmHg in LE in uncontrolled SBP. The Z score value between controlled and uncontrolled systolic hypertensive patients in RE and LE was 6.11 and 7.06 respectively (P < 0.0001). There was an increment of IOP for every 10 mmHg in SBP by 0.56 mmHg in right eye and 0.73 mmHg in left eye. CONCLUSIONS Systolic blood pressure is significantly correlated with IOP. The uncontrolled SBP was related to higher mean IOP and mean IOP was found to increase with rise in SBP. Therefore, patients with known hypertension and glaucoma have to be regularly followed-up and should keep their BP in normal range to prevent disease progression. KEYWORDS Intraocular Pressure, Central Corneal Thickness, Systolic Blood Pressure, Adults Above 40 Years