Bilateral Acute Anterior Uveitis Research Articles

Zoledronate-induced Anterior Uveitis: A Case Report and Literature Review

ABSTRACT Zoledronate is one of the treatments used for postmenopausal osteoporosis. Acute febrile reactions are common with zoledronate therapy. However, zoledronate-induced uveitis is rarely reported in the global literature. In this work, we report a case of bilateral acute anterior uveitis following zoledronate infusion. A 56-year-old, postmenopausal woman presented with symptoms of fever, bilateral periorbital swelling, watering from eyes, pain, photophobia, and blurring of vision 2 days after zoledronate infusion. On examination, there was conjunctival hyperemia, aqueous cells, fibrinous reaction, pigments in the anterior lens capsule, keratic precipitates, and posterior synechiae, suggestive of acute anterior uveitis. Her symptoms resolved completely over 2 weeks of topical administration of betamethasone and atropine. Uveitis is one of the rare complications of bisphosphonates, with zoledronate having a higher risk. The mechanism is not fully known. Knowledge about this adverse event is essential for prompt diagnosis and timely management.

Rare case of limbal nodules with anterior uveitis secondary to chickenpox: A case report

Varicella-zoster virus is a common childhood viral exanthematous fever that is usually benign and self-limiting. Ocular complications of varicella have been rarely described. This report concerns an 8-year-old male child with a six-day history of a typical varicella rash and redness in both eyes. He had acute limbal nodules and anterior uveitis in both eyes. We treated him with topical dexamethasone for 2 weeks until the inflammation resolved without any sequelae. Thus, we present the first case of bilateral acute anterior uveitis with limbal nodules following chicken pox that showed a good response to treatment.

Lofgren syndrome: Not an uncommon entity

Lofgren syndrome is a rare acute phenotypic variant of sarcoidosis characterized by short febrile illness associated with symptoms triad of polyarthritis, hilar adenopathy, and erythema nodosum (EN). We describe a patient who presented with migratory polyarthritis, bilateral acute anterior granulomatous uveitis, and EN on both legs. Chest imaging showed bilateral enlarged multiple mediastinal lymph nodes and paratracheal lymph nodes. Transbronchial lung biopsy revealed noncaseating granulomas. He was successfully treated with prednisolone and methotrexate. Prompt recognition of such classical clinical presentation of sarcoidosis leads to early diagnosis and treatment.

Bilateral Acute Anterior Uveitis and Corneal Punctate Epitheliopathy in Children Diagnosed with Multisystem Inflammatory Syndrome Secondary to COVID‐19

ABSTRACT Purpose: To report bilateral anterior uveitis and corneal punctate epitheliopathy in children with multisystem inflammatory syndrome (MIS-C) secondary to coronavirus disease (COVID-19). Participants and methods: Five patients who were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies and diagnosed with MIS-C were evaluated. Ophthalmologic examinations were performed in order to reveal ocular findings in MIS-C disease. Results: Slit lamp examinations showed bilateral non-granulomatous acute anterior uveitis in all patients and severe corneal punctuate epitheliopathy in three of the patients. These ocular findings mostly disappeared with treatment in about one week. Conclusion: Bilateral non-granulomatous acute anterior uveitis and dry eye can be detected in patients diagnosed with MIS-C secondary to COVID-19. Even if generally, COVID-19 is not a life threatening disease in children by itself, inflammatory ocular manifestations can be detected in MIS-C secondary to COVID-19.

Клинико-эпидемиологические особенности поражения органа зрения при системных заболеваниях соединительной ткани

To this date, uveitis associated with connective tissue diseases remain relevant due to serious complications that significantly reduce vision and thus worsen the quality of life of patients. Aim. To study the frequency and prevalence, as well as clinical manifestations of ophthalmopathology in connective tissue diseases. Material and methods. A retrospective and prospective study of 534 patients (144 men and 390 women) with connective tissue diseases was conducted, in which ophthalmological disorders were detected. The patients underwent standard rheumatological examination in the department. And also, ophthalmological examination with the determination of visual acuity, intraocular pressure and the use of biomicroscopy, ophthalmoscopy (or cycloscopy). If necessary and possible, additional studies were performed such as: ultrasound B-scan, optical coherence tomography, perimetry. The study examined the type of common disease, age of onset and gender of the patient. Of particular interest were patients with uveal inflammation, in which the localization and nature of the course of inflammation were evaluated. Results and discussion. The most common diseases with eye damage were rheumatoid arthritis (RA) – 129 (24.1%), systemic lupus erythematosus (SLE) – 92 (17.2%), inflammatory bowel disease (IBD) – 95 (17.8%), systemic scleroderma (SDS) – 54 (10.1%) and spondylarthritis (Spa) – 41 (7.8%). In a small percentage of cases, other connective tissue diseases were diagnosed, such as: mixed connective tissue diseases (MCTS) – 24 (4.5%), Overlap syndrome – 21 (3.9%), systemic vasculitis – 23 (4.3%), Behcet's syndrome -18 (3.4%), Sjogren disease – 14 (2.6%) and juvenile idiopathic arthritis - 7 (1.3%). All ophthalmic disorders were divided into four general groups and distributed as follows: inflammatory 27.7%, degenerative 4.9%, vascular 48.7%, side effects of glucocorticoids 18.7%. Uveitis accounted for 52 (9.7%) of all ophthalmopathology, occurring in connective tissue diseases. Unilateral acute anterior uveitis (AAU) was diagnosed in 13 (25%) patients with ankylosing spondylitis, of which 4 (7.8%) had a relapse in the paired eye. Simultaneously, bilateral AAU was detected in 3 (5.7%) patients with Behcet's syndrome. Chronic, recurrent posterior uveitis was diagnosed in 13 (25%) patients with Behcet's systemic vasculitis. All patients with Behcet's syndrome were male at the age of 31±3.1 years. The uveal process approximately started 3.2±1.16 years after the onset of systemic disease. Generalization of inflammation in all departments of uvea was detected in patients with PSA-5 (9.6%), AC – 3 (5.7%), DS – 2 (3.8%) and SLE – 2 (3.8%). In 5 (9.6%) patients, the process was bilateral. Inflammation of the paired eye by the type of AAU was observed in 1 patient and posterior uveitis - in 2 patients. Conclusions. Ophthalmic disorders in the structure of systemic diseases make up 20.2% and vary widely in their clinical manifestations. Chronic blepharoconjunctivitis, combined with rheumatoid arthritis (46%) is a common inflammation of the accessory structures of the eye. About 20% of patients have complications from general immunosuppressive therapy, leading to impaired visual function. The frequency of uveitis in the structure of ophthalmopathology associated with connective tissue disease is 9.7%. Uveitis associated with ankylosing spondylitis and systemic vasculitis of Behcet occurs in men at a younger age and is 31%. More than half (63%) of patients with uveitis have a severe course with the development of panuveitis and neuropathy. An increase in the thickness of the choroid (up to 2 mm) according to two-dimensional ultrasound is an early diagnostic criterion for the development of uveitis and the underlying disease of connective tissue. Keywords: inflammatory eye diseases, uveitis, connective tissue diseases, spondyloarthritis, Behcet's syndrome, complications.

Bilateral Acute Anterior Uveitis during Chemotherapy with Cytosine Arabinoside with a Total Cumulative Dose of 24 000 mg for Myelodysplastic Syndrome.

Bilateral Acute Anterior Uveitis during Chemotherapy with Cytosine Arabinoside with a Total Cumulative Dose of 24 000 mg for Myelodysplastic Syndrome.

Tubulointerstitial nephritis and uveitis syndrome: An atypical case

Tubulointerstitial nephritis and uveitis syndrome is an uncommon clinical entity. Usually, renal involvement is moderate, and uveitis is acute, bilateral, anterior, and nongranulomatous (revised). We present the case of a 55-year-old female patient who went to the emergency department with complaints of asthenia, myalgia, and paresthesia. One week later, she complained of photophobia and was diagnosed with bilateral nongranulomatous acute anterior uveitis. The next day, due to hypotension and acute kidney injury, the patient was hospitalized. Renal biopsy showed tubulointerstitial nephritis. The patient was started on oral prednisolone, achieving uveitis resolution and renal function stability. After slow corticoid reduction, the patient presented uveitis recurrence complicated with bilateral optic disc (revised) edema and cystoid macular edema (CME) in the left eye. After oral prednisolone reduction, the patient suffered another relapse with CME worsening. We decided to initiate methotrexate 7.5 mg/week, achieving ocular and renal function stability.

Uveitis and immune checkpoint inhibition: when a blockage isn’t just a blockage

AbstractPurposeTo report uveitis triggered by immune checkpoint inhibition.MethodsRetrospective analysis of 5 charts of patients with metastatic cancer on immunotherapy.ResultsFive male patients, mean age 68.4 years, received immune checkpoint inhibition (pembrolizumab n =1, nivolumab n = 2, ipilimumab+nivolumab n = 2) with a mean duration of 2.05 months before onset of ocular symptoms. The primary malignancies were two cutaneous melanomas, a NSCLC, an oesophageal adenocarcinoma and an urothelial carcinoma of the bladder. Two patients presented with a bilateral acute anterior uveitis (AU) with fine keratic precipitates, anterior chamber (AC) cells grade 1+ (Standardization of the Uveitis Nomenclature), no posterior synechiae and no other abnormalities on dilated fundus examination and sd‐OCT. Two other patients presented with a bilateral panuveitis with AC cells 2+, vitreal cells and serous retinal detachments in the posterior pole. One patient showed serous retinal detachments in the posterior pole without AC or vitreal cells. The cases with AU responded to topical steroids with clinical remission within 4 weeks. Topical treatment failed to control the cases with panuveitis. Systemic steroids were successfully added. Nonetheless, checkpoint inhibition needed to be discontinued in all cases with serous retinal detachments.ConclusionsCheckpoint inhibition is a promising new treatment for metastatic cancer. Several adverse effects of immunotherapy have been reported, including uveitis. In the two cases with AU, immunotherapy was continued after therapeutic response to topical steroids. Checkpoint inhibition needed to be discontinued in the three cases with serous retinal detachment despite treatment with systemic steroids. Although AU is the most common ocular side effect, serous retinal detachment can be related to checkpoint inhibition in very rare cases.

39. Atypical presentation of giant cell arteritis confirmed on brain biopsy

39. Atypical presentation of giant cell arteritis confirmed on brain biopsy

Bilateral Acute Anterior Uveitis from Sinusitis Complicated by Optic Disc Oedema in a Child: A Case Report and Review of the Literature

Bilateral Acute Anterior Uveitis from Sinusitis Complicated by Optic Disc Oedema in a Child: A Case Report and Review of the Literature

Bilateral Acute Anterior Uveitis and Optic Disc Edema Following a Snake Bite

The authors wish to report a case of bilateral acute anterior uveitis and optic disc edema following a hemotoxic snake bite, in order to highlight the concomitant occurrence of these conditions and the potential adverse effects of anti-snake venom (ASV). A 35-year-old male was bitten by a viper at seventeen thirty hours, and was started on ASV. Two days following treatment he experienced sudden onset redness and painful diminution of vision in both eyes (OU). On examination, the patient's visual acuity (VA) in OU was 20/200. Examination revealed fresh keratic precipitates, cells, and flare in the anterior chamber (AC), posterior synechiae, sluggish and ill-sustained pupillary reaction, and hyperemic, edematous disc with blurred margins in OU. He was started on topical steroids, cycloplegics and intravenous methylprednisolone. Following treatment, the patient showed improvement and was continued on topical medications and oral prednisolone tapered over 3 weeks, after which VA OU improved, the AC showed no cells and flare and disc edema resolved. Uveitis and optic disc edema in snake bite can either be due to the direct toxic effects of the venom or the effect of ASV. Steroids have a beneficial role in the management of these symptoms.

THU0417 Uveitis Associated with Bisphosphonate Treatment: A Case Series of 18 Patients.

BackgroundClinical trials suggested that bisphosphonates (BP) were safe and well tolerated drugs, but post-marketing studies have shown their association with rare adverse events but potentially serious, including inflammatory ocular disorders,...

Gender and spondyloarthropathy-associated uveitis.

Spondyloarthropathies encompass a group of inflammatory diseases with arthritis and other features such as enthesitis and dermatologic and gastrointestinal involvement. Up to 37% of spondyloarthropathy patients may develop uveitis which is typically bilateral asynchronous acute anterior uveitis. Spondyloarthropathies with and without uveitis are more prevalent among males; the reasons for gender imbalance are unclear. This review will focus on gender differences in the prevalence, incidence, clinical manifestations, and prognosis of uveitis associated with spondyloarthropathies.

Bilateral Simultaneous-Onset Nongranulomatous Acute Anterior Uveitis

OBJECTIVE To describe the etiology and outcome of patients with simultaneous-onset nongranulomatous bilateral acute anterior uveitis. METHODS The medical records of patients who presented to a single tertiary care center with simultaneous-onset nongranulomatous bilateral acute anterior uveitis between January 1990 and May 2010 were retrospectively reviewed; the clinical presentation, results of diagnostic testing, and outcome data are described. RESULTS A total of 4288 new patients with uveitis were evaluated by the Uveitis Service at the University of Illinois at Chicago Eye and Ear Infirmary between January 1990 and May 2010. Of these new patients, 44 (1%) presented with simultaneous-onset nongranulomatous bilateral acute anterior uveitis. The most common etiologies were postinfectious or drug-induced uveitis (23 of 44 patients [52%]) and idiopathic uveitis (15 patients [34%]). Tubulointerstitial nephritis and uveitis syndrome, HLA-B27-associated uveitis, inflammatory bowel disease, and Kawasaki disease each made up fewer than 5% of diagnoses. Overall, this group of patients was younger than the entire cohort of new patients with uveitis who were evaluated during the same time period (P=.002). For 14 of the 15 patients with at least a year of follow-up (93%), the disease duration was limited (<3 months). Of these 14 patients, 7 (50%) developed recurrent disease, with an average time to first recurrence of 20 months (range, 7.5-40 months) after resolution of the initial inflammatory episode. CONCLUSIONS Simultaneous-onset nongranulomatous bilateral acute anterior uveitis is a rare clinical entity that is more common in younger patients and is most frequently associated with recent infection and/or systemic antibiotic use. Tubulointerstitial nephritis and uveitis syndrome should also be considered as a diagnosis. Diagnostic evaluation should include serum antistreptolysin-O titers, HLA-B27 antigen, and urine β2 microglobulin levels because these may reveal systemic disease that requires therapy.

Slowly progressive corneal opacification in a patient with known mucocutaneous Leishmaniasis and HIV

AbstractPurpose To present a case of corneal opacification and anterior uveitis in a patient with systemic LeishmaniasisMethods Case reportResults A 40‐year old HIV‐positive patient was already followed for conjunctival involvement in systemic Leishmaniasis. Treatment with Glucantime was effective, but had to be stopped because of acute pancreatitis. A switch to Ambisome was made, but did not result in complete resolution. Slow appearance of corneal stromal opacities was also noted at this time. In January 2011 the patient consulted in emergency and was diagnosed with bilateral acute anterior uveitis as well as manifest progression of the stromal opacification. Regarding the inflammation, a good initial response was obtained with topical prednisolone acetate. However, a slumbering reaction remained present in the anterior chamber and an increase of the keratic precipitates was noted. On tapering of the steroids, several relapses occurred. The intrastromal opacities were still increasing, resulting in worsening visual acuity. An in‐vivo confocal microscopy of the cornea was performed and showed presence of cystic structures in the stroma, possibly related to intracorneal presence of the parasite. Because of insufficient response of the anterior chamber reaction to topical steroids, anterior chamber tap was performed and PCR showed positive for Leishmania. A tentative treatment with intrastromal and intracameral injection of Amphotericin B was initiated.Conclusion We report an atypical ocular presentation of Leishmaniasis, with proven presence of the organism in the aqueous humor, and presence of the cystic structures on in‐vivo confocal microscopy. A tentative treatment with intrastromal and intracameral injection of Amphotericin B was initiated.

Acute Anterior Uveitis and Optic Neuritis as Ocular Complications of Influenza A Infection in an 11-Year-Old Boy

The authors describe an 11-year-old boy developing bilateral acute anterior uveitis, papillitis in one eye, and neuroretinitis in the other eye after an upper respiratory tract infection of influenza A virus, possibly H1N1. Steroid pulse therapy resolved these conditions. The authors recommend alertness for visual blurring and ocular inflammation after influenza A infection.

Elevated levels of anti‐endotoxin antibodies in patients with bilateral idiopathic acute anterior uveitis

Endotoxins have been proved to be responsible for acute anterior uveitis (AAU) in animals in a well-established experimental model of endotoxin-induced uveitis (EIU). The purpose of our study was the detection of antibodies against endotoxins of selected enterobacteria in the serum of patients with idiopathic AAU and searching for correlations between the levels of these antibodies and the presence of HLA-B27 antigen as well as characteristic signs of EIU such as bilaterality and the absence of spontaneous recurrences of the disease. Reactions of serum IgG antibodies with lipopolysaccharides (LPSs) of Escherichia coli O1, E. coli O10, E. coli O111, E. coli J5, and Klebsiella pneumoniae O3 were determined for 60 patients with idiopathic AAU and 40 healthy volunteers. The presence of HLA-B27 antigen in patients was determined. Documentation of the frequency of recurrences of AAU during a follow-up period of 8 years was collected. We have observed that the sera of patients with a first attack of AAU reacted stronger with the LPS of K. pneumoniae O3 than the sera of patients with relapse of the disease. Patients with bilateral AAU had markedly higher levels of antibodies against four of the five used LPSs than patients with one eye involved. A multiply comparison showed higher levels of IgG reacting with LPS of E. coli O111 in patients with bilateral eye inflammation admitted with the first attack of AAU comparing to controls. The incidence of recurrent form of AAU was significantly increased in HLA-B27-positive patients compared to HLA-B27-negative patients. However, we found in HLA-B27 carriers that those with the bilateral form of AAU had over three times smaller risk of recurrence and showed stronger immunization by endotoxins than patients with unilateral inflammation. Our results suggest a potential role of endotoxins in the aetiology of the nonrecurrent bilateral form of AAU. We suggest that not only HLA-B27 status but also determination of number of involved eyes may be useful to assess the risk of recurrence of the idiopathic AAU.

More Than Meets the Eye

A 27-year-old woman was hospitalized with fever and visual changes. She had been well until nine months earlier when she developed unilateral blurry vision in the left eye. Ophthalmologic examination revealed bilateral acute anterior uveitis. She was treated with topical steroids and her vision returned to baseline. However, over the next few months, she developed debilitating fatigue and experienced an unintentional fifteen pound weight loss. One month prior to presentation, she noted the onset of daily low grade fevers and chills. On the day of admission, she developed a temperature of 103°F and a severe frontal headache. Here we describe a case where the overlap of clinical features led to an initially broad differential diagnosis of seemingly unrelated diseases. Ultimately, the discovery of a key radiographic finding allowed us to more clearly define the diagnosis.

TINU-associated retinal pigment epithelium detachments: a possible novel posterior segment feature

To report a case of tubulointerstitial nephritis and uveitis syndrome (TINU) with novel posterior segment features of bilateral vitritis and retinal pigment epithelial detachments. This is an interventional case report with fundus photographs and fluorescein angiograms of a 9-year-old girl presenting with bilateral acute anterior uveitis 4 months after a diagnosis of acute tubulointerstitial nephritis. Visual acuities remained normal throughout the 6-month period of follow-up. The anterior and posterior uveitis settled, although retinal pigment epithelial detachments persisted and may be related to the underlying disease process in TINU or exogenous steroid treatment, or both. The idiopathic inflammatory response seen in TINU is traditionally associated with an anterior uveitis. This case demonstrates that there may be more extensive ocular involvement and that posterior uveitis and retinal pigment epithelial detachments may represent emerging features of atypical cases of TINU.

Metastatic lung and pleural malignancy presenting as bilateral acute anterior uveitis

AbstractAnterior uveitis is associated with a variety of underlying systemic diseases but the association between bilateral acute anterior uveitis (BAAU) and lung and pleural malignancy is not widely recognized. The case is described here of a 61‐year‐old woman presenting to an eye clinic with BAAU. A routine chest radiograph performed principally to exclude pulmonary sarcoidosis revealed an intrapulmonary mass and she was subsequently found to have widespread lung and pleural malignancies. Evidence is discussed that suggests a link and potential aetiology between BAAU and lung and pleural malignancies. The present case shows the virtue of requesting a chest radiograph in patients presenting with BAAU, even in the absence of other symptoms or clinical findings.