Eye as a window to ICSOL- Ocular involvement in intracranial space occupying lesions (ICSOL)

Purpose: To study the demographic profile and neuro-ophthalmic manifestations of various ICSOLs.Materials and Methods: A hospital-based cross-sectional study was conducted on 60 patients who had been clinicoradiologically diagnosed with ICSOLs, and presented to the ophthalmology OPD at a tertiary eye care hospital. The study period was 6 months. After obtaining informed consent and their socio-demographic data, standardized ophthalmic evaluation was performed, along with neuroimaging.Results: The major age group affected ranged from 20-40 years, of which majority were females (male: female=2:3). Amongst ICSOL with ocular manifestations, major etiological factor was found to be frontal lobe tumors especially gliomas in 46.2%, followed by cerebellopontine angle tumors in 17%, and meningiomas in 10%. Most common ocular manifestation was papilledema, bilateral in 73%, and unilateral in 6.6% who also had Foster-Kennedy syndrome. Visual acuity was 6/60 in 80%. Pupillary reactions and colour vision were normal in all cases. There was loss of corneal sensation (ipsilateral to lesion) in 13.2%, abducent nerve palsy (ipsilateral) in 6.6%, coarse horizontal nystagmus in 3.3%, bitemporal hemianopia in 3.3%, diplopia (binocular) in 6.6%.Conclusion: Ocular symptoms and signs can be considered as a window to the brain through which we can detect ICSOLs. Since most of these patients present to an ophthalmologist with ocular involvement, sometimes even prior to visiting a neurologist/neurosurgeon, a detailed ophthalmic examination can aid in early diagnosis and prompt management of these lesions, and can even be life-saving at times.