Bilateral Granulomatous Anterior Uveitis Research Articles

Palpebral sarcoid nodules

ABSTRACT Herein, we report a case of systemic sarcoidosis confirmed by a eyelid biopsy in a 47-year-old North African female with a past medical history of a bilateral granulomatous anterior and intermediate uveitis. She presented to the ophthalmological department for bilateral palpebral painful discomfort. An examination revealed the presence of bilateral, rounded, well-limited, subcutaneous, nodular lesions on the upper and inferior lid. A cutaneous biopsy confirmed the presence of a non-caseating granulomatous inflammation. The diagnosis of a definite ocular sarcoidosis was made and she was treated with local steroid ointment associated to hydroxychloroquine. A skin examination of the patient with granulomatous uveitis cannot be stressed enough. A biopsy allows us to make the diagnosis and to treat the patients appropriately. Key words: Inflammation, Granulomatosis, Eye, Skin Biopsy

Ocular Syphilis: A Case of Progressive Bilateral Panuveitis

Significance This report outlines a case of progressive bilateral granulomatous panuveitis secondary to syphilis. Purpose To describe the management of a case of progressive uveitis secondary to syphilis. Case Report A 60-year-old male with a three-month history of redness and floaters presented with bilateral chronic granulomatous anterior uveitis. He was started on difluprednate emulsion four times a day in each eye. The patient’s clinical course improved until he tapered off the drops, upon which he presented with a progressive bilateral panuveitis. A diagnostic work-up in collaboration with the hospital infectious disease department led to a diagnosis of neurosyphilis. The patient was treated with intravenous penicillin with eventual resolution of his ocular inflammation. Conclusions This case report underscores the importance of obtaining a detailed case history and taking a multi-disciplinary approach to patients with progressive uveitis. CE Notification This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/ocular-syphilis-a-case-of-progressive-bilateral-panuveitis) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Ocular sarcoidosis: a case report

Introduction: Sarcoidosis is a chronic granulomatous disorder which affects almost all parts of the body. It is usually idiopathic. Ocular involvement is noted in 25%–60% of patients with systemic sarcoidosis. It is very essential to rule out ocular tuberculosis as both can have similar presentations. Case report: A 26 year old patient presented with blurring of vision in left eye for nine months at Mongar regional referral hospital. Previously he was treated with topical steroids and cycloplegics for anterior uveitis. There were no systemic symptoms like dry cough, fever, chest pain and loss of weight. He had anterior chamber inflammation with iris nodule, vitritis and disc edema in left eye.The right eye had minimal anterior chamber reaction with only subtle iris nodule. Posterior segment examination was normal in right eye. He underwent blood investigations, chest X ray and contrast enhanced computed tomography of chest(CECT). The blood reports were normal. The chest X ray showed radiopaque lesions at both hilar region and multiple tiny radiopaque lesions in both lung fields.CECT chest showed significant paratracheal lymph nodes.Lymph node biopsy was not attempted due to extreme location. Based on clinical presentations and investigation findings a diagnosis of Presumed ocular sarcoidosis was made by using the criteria based on Revised International Workshop on Ocular Sarcoidosis.The patient was treated effectively with oral steroids for six months. Currently he is on low maintenance dose of oral steroids. Conclusions: Ocular sarcoidosis is a potentially blinding condition if not treated on time. There should be high suspicion of ocular sarcoidosis if patient presents with bilateral granulomatous anterior uveitis with hilar lymphadenopathy.However it is crucial to exclude ocular tuberculosis as both are mimickers of chronic granulomatous uveitis.

Severe Hypotony Maculopathy in Anterior Uveitis Associated with Hodgkin Lymphoma

ABSTRACT Purpose: To describe the clinical course and management of anterior uveitis complicated by ocular hypotony associated with Hodgkin lymphoma. Design: Case report. Methods: Chart and multimodal imaging review, including ultrasound biomicroscopy, widefield fundus pictures, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. Results: A 44-year-old female with progressive visual deterioration and history of low-grade fever developed bilateral granulomatous anterior uveitis complicated by severe hypotony maculopathy, not improving with systemic and topical steroids. After starting ibopamine 2% eye drops, ocular hypotony progressively resolved with visual recovery. Histologic examination of a biopsied enlarged lymph node of the neck revealed the presence of Hodgkin lymphoma, for which the patient underwent systemic chemotherapy. Conclusion: Severe hypotony maculopathy complicating anterior uveitis can be associated with Hodgkin lymphoma. Topical ipobamine 2% was safe and effective in the treatment of ocular hypotony in this case.

Optic Neuropathy and Macular Ischemia Associated with Neurosarcoidosis: A Case Report.

In this study, we present a case of bilateral optic neuropathy and macular ischemia in the right eye associated with neurosarcoidosis. A 26-year-old woman presented to our clinic with complaints of bilateral blurred vision. Bilateral granulomatous anterior uveitis, vitritis, optic neuropathy, and macular ischemia were detected in the right eye in slit-lamp examination. She also reported complaints of fever, weakness, sweating, arthralgia, and headache for 2 months. She was referred to the pulmonary diseases unit of our hospital due to hilar lymphadenopathy seen in her chest x-ray, and biopsies were taken for diagnostic purposes. Histological analysis of the mediastinal lymph node biopsies revealed chronic, non-caseating, granulomatous inflammation. Furthermore, the patient was referred to a neurologist due to concomitant complaint of intense headaches. She was diagnosed with neurosarcoidosis supported by findings on cranial magnetic resonance imaging and lumbar puncture. She received a 3-day course of high-dose (1 g/day) intravenous steroid treatment (methylprednisolone) followed by a tapering dose of oral prednisone. The patient began receiving oral methotrexate 15 mg/week as a steroid-sparing agent. Significant improvement in neurological and ophthalmological symptoms occurred in the first week of treatment. In this case report, we emphasized that neurosarcoidosis should be included in the differential diagnosis of patients with both bilateral optic neuropathy and macular ischemia. Furthermore, early diagnosis and timely treatment of neurosarcoidosis are important for favorable visual outcomes.

Uveitis and internuclear ophthalmoplegia as ocular manifestations of sarcoidosis

Sarcoidosis is a multisystemic granulomatous chronic disease of unknown etiology with a wide range of clinical presentations. Diagnosis of sarcoidosis in patients with ocular manifestations can be challenging.We first describe a case of sarcoidosis presented with pulmonary involvement and both uveitis and internuclear ophthalmoplegia as ocular manifestations.A 55-year-old caucasian woman with non-productive cough and weakness presented with bilateral granulomatous anterior uveitis. Few days later, the patient presented again complaining of horizontal diplopia due to internuclear ophthalmoplegia. The diagnosis of sarcoidosis was made as a result of clinical examination and systemic investigations. Particularly, high-resolution computed tomography scanning of the chest was able to identify bilateral hilar lymphadenopathy not previously detected by chest X-ray. Biopsy confirmed diagnosis showing classic non-caseating granulomas.

Behçet's disease, VKH, sarcoidosis

SummaryOcular involvement associated with Behçet disease is characterized by a relapsing remitting panuveitis with diffuse vitritis, retinal infiltrates, and occlusive vasculitis. Proper management relies on the early use of immunosuppressive drugs in combination with corticosteroids and administration of biologic agents in resistant and severe posterior segment involvement. VKH disease is a bilateral panuveitis that may be associated with extraocular manifestations. Exudative retinal detachment, associated with typical imaging findings, is the most specific feature to acute VKH disease. Sunset glow fundus is typical to chronic VKH disease. Complications are more likely to occur in the chronic recurrent phase. Treatment for acute VKH disease relies on systemic corticosteroids for at least 6 months. Immunosuppressive therapy is mainly used in chronic recurrent disease. Main ocular features of sarcoidosis include bilateral granulomatous anterior uveitis, vitritis with snowballs, multifocal chorioretinitis, and segmental periphlebitis. Diagnosis is challenging in the absence of apparent systemic involvement. Treatment of sarcoidosis relies on corticosteroids and immunosuppressive agents, in severe cases.

Behçet's disease, VKH, sarcoidosis

SummaryOcular involvement associated with Behçet disease is characterized by a relapsing remitting panuveitis with diffuse vitritis, retinal infiltrates, and occlusive vasculitis. Proper management relies on the early use of immunosuppressive drugs in combination with corticosteroids and administration of biologic agent in resistant and severe posterior segment involvement. VKH disease is a bilateral panuveitis that may be associated with extraocular manifestations. Exudative retinal detachment, associated with typical imaging findings, is the most specific feature to acute VKH disease. Sunset glow fundus is typical to chronic VKH disease. Complications are more likely to occur in the chronic recurrent phase. The mainstay of treatment for acute VKH disease relies on systemic corticosteroid therapy for at least 6 months. Immunosuppressive therapy is mainly used in chronic recurrent disease.Main ocular features of sarcoidosis include bilateral granulomatous anterior uveitis, vitritis with snowballs, multifocal chorioretinitis, and segmental periphlebitis. Diagnosis may be challenging in the absence of apparent systemic involvement. Treatment of sarcoidosis relies on corticosteroids and immunosuppressive agents, in severe cases.

Vogt-Koyanagi-Harada disease following BCG vaccination and tuberculosis.

Introduction To describe the characteristics, diagnosis, and treatment of the first documented case of Vogt–Koyanagi–Harada (VKH) disease following BCG vaccination (Patient 1) and the first documented case of both VKH disease and tuberculosis (Patient 2).Two patients were diagnosed with VKH disease and monitored using fundus photography, fundus autofluorescence, fluorescein angiography (FA), spectral-domain optical coherence tomography, and enhanced depth imaging optical coherence tomography (EDI-OCT).Case description A 39-year-old patient (Patient 1) had bilateral granulomatous anterior uveitis and serous retinal detachment. FA showed multiple punctuate hyperfluorescent lesions and multilobular pools of dye. EDI-OCT revealed serous retinal detachment, subretinal septa, and cystoid spaces. A 40-year-old woman (Patient 2) presented with a 3-week history of decreased vision, headache and tinnitus. Fundus examination showed bilateral disc swelling with serous retinal detachment and retinal folds. She had been diagnosed with tuberculosis. EDI-OCT showed fluctuation of the internal limiting membrane (ILM), retinal folds, retinal pigment epithelial (RPE)-Bruch membrane undulation, choroidal folds, serous retinal detachment. Both of the patients received high dosage of steroid treatment during the diagnosis. A fast recovery in VKH symptoms was observed following the treatment.Discussion and evaluationImmunological mechanisms and dysregulation of the immune system may play a significant role in the association between VKH disease and BCG.ConclusionsEDI-OCT imaging demonstrated structural changes in the photoreceptor layer, RPE-Bruch membrane, choroid, outer retina, ILM in acute VKH.

Behçet's disease, VKH, sarcoidosis

SummaryOcular involvement associated with Behçet disease is characterized by a relapsing remitting panuveitis with diffuse vitritis, retinal infiltrates, and occlusive vasculitis. Proper management relies on the early use of immunosuppressive drugs in combination with corticosteroids and administration of biologic agent in resistant and severe posterior segment involvement. VKH disease is a bilateral panuveitis that may be associated with extraocular manifestations. Exudative retinal detachment, associated with typical imaging findings, is the most specific feature to acute VKH disease. Sunset glow fundus is typical to chronic VKH disease. Complications are more likely to occur in the chronic recurrent phase. The mainstay of treatment for acute VKH disease relies on systemic corticosteroid therapy for at least 6 months. Immunosuppressive therapy is mainly used in chronic recurrent disease. Main ocular features of sarcoidosis include bilateral granulomatous anterior uveitis, vitritis with snowballs, multifocal chorioretinitis, and segmental periphlebitis. Diagnosis may be challenging in the absence of apparent systemic involvement. Treatment of ocular sarcoidosis relies on corticosteroids and immunosuppressive agents, in severe cases.

Behçet’s disease, VKH, sarcoidosis

AbstractOcular involvement associated with Behçet disease is characterized by a relapsing remitting panuveitis with diffuse vitritis, retinal infiltrates, and occlusive vasculitis. Proper management relies on the early use of immunosuppressive drugs in combination with corticosteroids and administration of biologic agent in resistant and severe posterior segment involvement. VKH disease is a bilateral panuveitis that may be associated with extraocular manifestations. Exudative retinal detachment, associated with typical imaging findings, is the most specific feature to acute VKH disease. Sunset glow fundus is typical to chronic VKH disease. Complications are more likely to occur in the chronic recurrent phase. The mainstay of treatment for acute VKH disease relies on systemic corticosteroid therapy for at least 6 months. Immunosuppressive therapy is mainly used in chronic recurrent disease. Main ocular features of sarcoidosis include bilateral granulomatous anterior uveitis, vitritis with snowballs, multifocal chorioretinitis, and segmental periphlebitis. Diagnosis may be challenging in the absence of apparent systemic involvement. Treatment of sarcoidosis is based on corticosteroids and immunosuppressive agents, in severe cases.

Sarcoidosis-associated granulomatous anterior uveitis

Purpose: Sarcoidosis is a chronic, multisystem granulomatous inflammatory disorder of unknown etiology. It is characterised by infiltration of tissues with macrophages and Th1/Th17-lymphocytes, which culminates in the formation of noncaseating (non- necrotizing) epithelioid cell granuloma in the affected organ. The author presents a case report of a patient who presented with bilateral granulomatous anterior uveitis as the presenting feature of ocular sarcoidosis.

Fitting silicone hydrogel contact lenses with special diameters in a microcornea with micro and dislocated pupil

Purpose: Sarcoidosis is a chronic, multisystem granulomatous inflammatory disorder of unknown etiology. It is characterised by infiltration of tissues with macrophages and Th1/Th17lymphocytes, which culminates in the formation of noncaseating (nonnecrotizing) epithelioid cell granuloma in the affected organ. The author presents a case report of a patient who presented with bilateral granulomatous anterior uveitis as the presenting feature of ocular sarcoidosis. Method: A 40-year-old woman presented to the office with a chief complaint of pain, photophobia, tearing, redness, and cloudy vision in both eyes of 7 days duration. Clinical evaluation revealed bilateral granulomatous anterior uveitis with inflammatory ocular hypertension. Laboratory investigation demonstrated raised levels of serum Angiotensin-Converting Enzyme (ACE) and chest radiography revealed moderate bilateral pulmonary interstitial disease. The diagnosis was re-evaluated as presumed sarcoidosis-associated granulomatous anterior uveitis in line with the diagnostic criteria of the International Workshop on Ocular Sarcoidosis (IWOS). Result: A successful resolution of the granulomatous anterior uveitis with inflammatory ocular hypertension was achieved with topical therapy with corticosteroid, cycloplegia and ocular hypotensive agent. Theocular condition resolvedwithout any complications within 6 weeks. Conclusion: Sarcoid-associated anterior uveitis is an immunemediated sight-threatening eye condition. The inflammatory response in ocular sarcoidosis is characterised by an overexpression of proinflammatory cytokines and chemokines. Because Th1and Th17derived cytokines play a role in the pathomechanism of ocular sarcoidosis, early diagnosis and intervention with immunosuppressive therapy are vital to reducing ocular morbidity.

Behçet disease, VKH, sarcoidosis

AbstractOcular involvement associated with Behçet disease is characterized by a relapsing remitting panuveitis with diffuse vitritis, retinal infiltrates, and occlusive vasculitis. Proper management relies on the early use of immunosuppressive drugs in combination with corticosteroids and administration of biologic agent in resistant and severe posterior segment involvement. VKH disease is a bilateral panuveitis that may be associated with extraocular manifestations. Exudative retinal detachment, associated with typical imaging findings, is the most specific feature to acute VKH disease. Sunset glow fundus is typical to chronic VKH disease. Complications are more likely to occur in the chronic recurrent phase. The mainstay of treatment for acute VKH disease relies on systemic corticosteroid therapy for at least 6 months. Immunosuppressive therapy is mainly used in chronic recurrent disease. Main ocular features of sarcoidosis include bilateral granulomatous anterior uveitis, vitritis with snowballs, multifocal chorioretinitis, and segmental periphlebitis. Diagnosis may be challenging in the absence of apparent systemic involvement. Treatment of sarcoidosis is based on corticosteroids and immunosuppressive agents, in severe cases.

A case of systemic sarcoidosis with ocular presentation

Sarcoidosis is a chronic multisystemic granulomatous disorder thought to result from an exaggerated cellular immune response to a variety of self-antigens or non-self antigens.1 It is characterized by the formation of non-caseating granulomas in affected organs. Ocular involvement by sarcoid is common and has been reported in upto 78% of patients.2 However, among cases of uveitis, sarcoidosis is probably underdiagnosed depending on the extent of the work-up done for diagnosis. Although ocular involvement with generalized sarcoidosis is common, systemic sarcoidosis is diagnosed in a small percentage of patients with uveitis.3 Most retrospective studies of large numbers of patients with uveitis indicate that 5% of cases are associated with biopsy-confirmed systemic sarcoidosis.4–6 We report a case that presented with bilateral granulomatous anterior uveitis and was successfully diagnosed as a case of systemic sarcoidosis on work-up.

Travoprost Induced Granulomatous Anterior Uveitis

Purpose. To report a case of granulomatous anterior uveitis caused by travoprost. Methods. Single observational case report. Results. A 71-year-old who was fit and healthy presented with bilateral granulomatous anterior uveitis 2 months after he was started on travoprost in both eyes. There was no past history of uveitis. Blood test and radiological investigation were unremarkable. Travoprost was stopped. The uveitis resolved on topical steroid treatment. A rechallenge with travoprost was attempted in one eye. The inflammation recurred in this eye only. This subsided with the cessation of travoprost alone without topical steroid. Conclusion. This is the first case report of travoprost causing granulomatous anterior uveitis. The uveitis recurred with a rechallenge. Changing the prostaglandin analogue to another topical treatment may be adequate to cease the inflammation.

Autofluorescence findings in Vogt-Koyanagi-Harada disease

To report shortwave autofluorescence (SW-AF) and near infrared autofluorescence (NIR-AF) findings in a case of Vogt-Koyanagi-Harada (VKH) disease. A 22-year-old man presented with a 2-week history of headache, moderate hearing loss, discolored hair, and bilateral gradually decreased vision (20/800 bilaterally). Ophthalmologic examinations revealed bilateral granulomatous anterior uveitis and multiple patchy bullous retinal detachments. Fundus fluorescein angiography (FFA), SW-AF, and NIR-AF imaging were performed with a confocal scanning laser ophthalmoscope at the beginning and after resolution. The patient responded well to systemic prednisolone treatment. Visual acuity and hearing loss improved quickly (visual acuity 16/20 bilaterally). Multilobular dye pooling with a dark rim was observed in serous detached retinal areas on late-phase FFA. These areas were observed as hypoAF in SW-AF and NIR-AF mode due to the blockage. After resolution of serous detachment, numerous hypoAF granular dots were observed scattered over the previously serous detached areas in SW-AF and NIR-AF mode. These hypoAF granular dots were seen as window defect lesion in FFA and interpreted as retinal pigment epithelial damage or atrophy. SW-AF and NIR-AF imaging confirmed granular retinal pigment epithelium atrophy which corresponds to FFA findings. SW-AF and NIR-AF imaging methods are noninvasive and useful techniques for documentation of fundus changes in VKH disease.

Uveitis in a Patient Treated with Bacille-Calmette-Guérin: Possible Antigenic Mimicry of Mycobacterial and Retinal Antigens

To investigate the cellular immune response in uveitis developing after intravesical Bacille-Calmette-Guérin (BCG) applications. Experimental study. A 72-year-old HLA-B27-negative patient with bilateral granulomatous anterior uveitis that developed during the third cycle of intravesical BCG applications she was receiving for treatment of bladder carcinoma. The patient's peripheral T cell reactivity to ocular autoantigens was compared with the response to purified protein derivative (PPD) from Mycobacterium tuberculosis. T-cell proliferation and cytokine and chemokine secretion were measured in vitro. Anterior uveitis was treated successfully with topical corticosteroids and cycloplegics. The following were demonstrated: proliferation to PPD, interphotoreceptor retinoid-binding protein (IRBP), and IRBP-peptide R16, as well as secretion of proinflammatory cytokines in response to PPD, retinal soluble antigen (S-Ag), IRBP, cellular retinal-binding protein (CRALBP), and some S-Ag and IRBP peptides. These data indicate the generation of a polyclonal autoimmune reaction elicited by BCG. Amino acid sequence alignments revealed homologies between proteins from M. tuberculosis, BCG, and retinal antigens, suggesting antigenic mimicry as a potential cause of uveitis in this patient.

Granuloma Annulare Anterior Uveitis

Purpose: To present a case of bilateral granuloma annulare anterior uveitis. Design: Case report. Methods: Clinical case presentation and review of literature. Results: A 72-year-old woman with a history of granuloma annulare (GA) presented with acute bilateral granulomatous anterior uveitis. General physical exam revealed hypo- and hyper-pigmented punctate and annular skin lesions on both arms characteristic of GA. Infectious and autoimmune workup revealed a mildly elevated angiotensin converting enzyme (ACE) level. Her uveitis resolved with topical prednisolone and homatropine. Conclusions: Granuloma annulare is a rare cause of anterior uveitis that is diagnosed by characteristic skin findings and may be associated with sarcoidosis.

Focal Corneal Decompensation After Filtering Surgery With Mitomycin C

To report a case with focal corneal decompensation after filtering surgery with inadvertent inadequate irrigation of mitomycin C (MMC). Case report and review of literature. A 25-year-old man first referred with the complaint of photophobia. His ocular examinations revealed diffuse keratic precipitates and many iris nodules in both eyes. The primary diagnosis was idiopathic bilateral granulomatous anterior uveitis. The intraocular pressure (IOP) gradually increased in the left eye and was not controlled with a prescription of topical antiglaucoma medications. As the disease progressed, the left eye underwent filtering surgery with MMC 0.02%. The postoperative period was uneventful, and the anterior chamber was deep after surgery. The IOP was controlled without medications; however; the inferior third of the cornea was edematous because of severe endothelial dysfunction. Inadequate irrigation of MMC during filtering surgery can cause focal corneal decompensation.