Original Article <136> J. Nepal Paediatr. Soc. Ocular Manifestations of Meningitis in Children Chaudhary M 1 , Shah DN 2 , Sharma PR 3 1 Dr. Meenu Chaudhary, MBBS, MD, B.P. Koirala lions Center for Ophthalmic Studies, 2 Prof. DN Shah, B.P.Koirala lions Center for Ophthalmic Studies, 3 Prof. Puspa Raj Sharma, Department of Paediatrics. All from the Tribhuvan University Teaching Hospital, Maharajgunj Kathmandu, Nepal. Address for correspondence: Dr. Meenu Chaudhary, E-mail: drmeenu67@gmail.com Abstract Introduction: Meningitis is the most common central nervous system disease affecting children leading to focal neurological deficits and various oculovisual anomalies including blindness in children. The objective of this study was to evaluate the oculovisual anomalies occurring in Nepalese children suffering from different types of bacterial meningitis. Materials and Methods: A Prospective, study was undertaken for 18 months at B.P.Koirala Lion’s Center for ophthalmic studies, TU Teaching Hospital to study the children suffering from bacterial meningitis admitted at Kanti Children’s Hospital for ocular involvement. A through history, anterior and posterior segment ocular examination and investigations like blood, CSF and CT scan were done. Results: A total of 182 cases of bacterial meningitis were screened. Tubercular meningitis cases were 40 (21.97%) and Pyogenic were 142 (78.02%). Oculovisual anomalies were seen in 70 (38.46%) cases. The ocular abnormalities included pupillary changes (34.28%), Cranial Nerve Palsy (22.86%), Fundus changes (35.72%), Cortical Blindness (4.28%), Panophthalmitis and Proptosis (1.43%). Third nerve involvement was seen in 17.14% cases, sixth nerve in 4.29% cases, Papilledema in 11.43 % and Optic atrophy in 22.86 %. Risk factors included late presentation; hydrocephalous and increased CSF cell count and protein level. Conclusion: Oculovisual anomalies formed an important group of clinical manifestations of bacterial meningitis. Incidence of oculovisual anomalies was more frequently seen in Tubercular meningitis (55%).Children with early presentation and intervention had better prognosis. Hence, timely intervention and health education is important. Key words: Bacterial Meningitis, Tubercular, Pyogenic, Oculovisual anomalies, Optic atrophy Manuscript Received: 28 th November 2011 Reviewed: 25 th March 2012 Author Corrected: 9 th April 2012 Accepted for Publication: 30 th April 2012 Introduction M eningitis is the most common central nervous system disease afecting children 1 leading to focal neurological defcits and various oculovisual anomalies including blindness in children. Commonly seen meningitis in children is of two types–Pyogenic and Tubercular. Both these types of meningitis can be associated with cranial neuropathies of II, III, IV, VI and VII cranial nerves due to focal or generalized infammation 2 . Optic neuritis, optic atrophy and papilloedema are the most important neurological sequelae of meningitis, mainly, tubercular. Meningitis may also be associated with lid retraction, gaze paresis, squint, tonic deviation of eyes, nystagmus, pupillary abnormality in size and reaction, panophthalmitis and exposure keratitis. According to the WHO meeting on childhood blindness in 1990 there are approximately 1.5 million blind children in the world of which 90% live in the developing countries 3 . In Nepal the prevalence of childhood blindness (0-14yrs. age group) is 0.63/1000 4 . Tubercular meningitis (TBM) is a more dreaded form of meningitis than pyogenic meningitis. Modern medical management has increased the number of survivors who live with neurological defcits. Cortical blindness is a rare and generally unexplained complication of bacterial meningitis. Patients who have high CSF protein content showed more chances of development of primary optic atrophy. Choroidal tubercles and papilloedema were found to be signs of grave prognostic signifcance. Thus, meningitis is an important cause of mortality and morbidity in the form of neurological sequelae and remains a serious global health problem in spite of potent antibiotics and improved treatment modalities. This prospective hospital based study was therefore May-August, 2012/Vol 32/Issue 2 doi: http://dx.doi.org/10.3126/jnps.v32i2.5534