Hypopyon Uveitis Research Articles

Etiology of hypopyon in patients presenting acutely to the emergency eye department and characteristics of hypopyon uveitis

ObjectiveTo examine the etiology of undifferentiated hypopyon presenting acutely and to better characterize hypopyon uveitis. MethodsPatients with hypopyon were retrospectively identified from presentations to the emergency eye department between January 2015 and 2022 and also from a uveitis database of 3,925 patients seen between January 2008 and January 2022. A total of 426 episodes of hypopyon occurred in 375 eyes in 359 patients, and medical records were reviewed for each patient. ResultsIn all, 222 hypopyon episodes were due to uveitis, and 204 were due to nonuveitic causes. The most common cause of hypopyon was HLA-B27-associated uveitis in 146 patients (34.3%). The next most common causes were infectious keratitis in 125 patients (29.3%) and endophthalmitis in 63 patients (14.8%). Compared with those presenting with nonuveitic hypopyon, patients with uveitis tended to present younger (p < 0.001), were more likely to be male (p < 0.0001), had better initial and final visual acuities (p < 0.001), and had lower intraocular pressures (p = 0.030). ConclusionAbout half of the cases of hypopyon were secondary to uveitis, most of them being associated with HLA-B27 conditions with a good prognosis, and the other half were secondary to infectious keratitis and endophthalmitis with a poor prognosis.

A clearer vision: insights into juvenile idiopathic arthritis–associated uveitis

The aim of this narrative review is to synthesize existing evidence-based knowledge on juvenile idiopathic arthritis–associated uveitis (JIA-U). We highlight epidemiology, pathophysiology, causes and genetics, risk factors, clinical features, diagnosis and screening, laboratory biomarkers, treatment options, trials with recent advances, and research challenges pertaining to JIA-U. The prevalence of JIA-U varies with different JIA subtypes, most frequently associated with the oligoarticular subtype. The risk factors involved in the development of JIA-U include younger age, antinuclear antibody (ANA) positivity, and the oligoarticular subtype of JIA, along with some specific major histocompatibility complex genes. Certain laboratory biomarkers, such as ANA, rheumatoid factor, interferon-λ, erythrocyte sedimentation rate, and transthyretin, have been used in JIA-U diagnosis, progress monitoring, and prognostication. Clinical features of JIA-U can range from asymptomatic to ophthalmic symptoms like redness, blurred vision, decreased visual acuity, hypopyon, and posterior uveitis, which can lead to retinal detachment and macular edema. The management protocol involves topical and systemic steroids, cycloplegics, disease-modifying antirheumatic drugs, biologic drugs, and surgical options. Early detection combined with prompt treatment is crucial to preventing irreversible vision loss in JIA-U.

Bilateral hypopyon uveitis in carcinoma of breast: Masquerade syndrome and review of literature

Maquerade syndromes are a group of ocular diseases that mimic inflammation but are due to neoplastic or less commonly non- neoplastic diseases. Metastatic choroidal disease is the most frequent clinical feature in carcinoma breast. We report a rare presentation of simultaneous uveal and orbital involvement in a 60- year-old lady with invasive ductal carcinoma. She had masquerade syndrome with acute hypopyon uveitis, angle closure glaucoma and panophthalmitis due to breast carcinoma. Anterior uveitis was due to an immune response which rapidly progressed to panophthalmitis because of orbital metastasis.

Hypopyon uveitis as a presenting manifestation of biopsy-proven sarcoidosis – A case report

A 68-year-old lady was referred for evaluation of bilateral hypopyon uveitis by her ophthalmologist. She had a history of bilateral cataract surgery 8 months ago and had received intravitreal dexamethasone implants for recurrent bouts of anterior uveitis with cystoid macular edema (CME) in both eyes 4 months ago. Systemic history was significant for diabetes mellitus and recurrent skin lesions. Aqueous tap was negative for infection on culture and polymerase chain reaction (PCR). Skin biopsy showed non-necrotizing granulomas, negative for Mycobacterium tuberculosis and fungi, suggestive of sarcoidosis. She received oral steroids and methotrexate, which resulted in resolution of ocular and skin lesions. This case highlights a rare presentation of hypopyon in ocular sarcoidosis.

Acute Unilateral Hypopyon Uveitis in A Child with Post-BMT local Relapse of Acute Lymphoblastic Leukemia-Case Report

Relapse into the anterior ocular segment post bone marrow transplantation (BMT) for acute lymphoblastic leukemia (ALL) in a child is rare. We report this uncommon presentation as hypopyon uveitis in a patient in remission with complete chimerism after chemotherapy for ALL. The patient presented with red eye and slit lamp examination revealed hypopyon uveitis. The diagnosis of relapsed ALL was established by anterior segment aspiration followed by documentation of relapse with immunohistochemistry and flow cytometry of the fluid sample. Thus, a high index of clinical suspicion in uveitis cases post BMT, led to the early diagnosis of ocular relapse that prevented vision loss in the patient. Atypical unilateral hypopyon can therefore be an indication of relapsing ALL. Keywords: Acute Lymphoblastic Leukemia, ALL, Ocular Relapse, Hypopyon Uveitis

Intraocular lymphoma masquerading as unilateral hypopyon anterior uveitis: a case report

PurposeTo report an unusual case of unilateral anterior segment large B-cell intraocular lymphoma (IOL) presenting as a recurrent hypopyon anterior uveitis.Case presentationA 55-year-old female was referred because of recurrent unilateral anterior hypopyon uveitis with partial response to topical corticosteroid. All of the laboratory tests, review of systems and ocular sampling results were unremarkable. Given a high concern for masquerades syndromes, cytological specimens were obtained 3 times and the last sample showed large B cell lymphoma. First, it appeared confined to the eye and initially responded favorably to local chemotherapy (methotrexate and rituximab) but later went on to develop systemic involvement. CNS lymphoma was detected on the third brain MRI 6 months following ocular involvement. At this time, systemic chemotherapy was started. In the last 18 months’ follow-up, visual acuity was 20/30 in the right eye without posterior segment or fellow eye involvement.ConclusionUnusual presentation of intraocular lymphoma as a unilateral isolated anterior hypopyon uveitis should be kept in mind. This report emphasizes the importance of precise work-ups and multiple ocular biopsies to confirm the diagnosis of intraocular lymphoma.

Acute Unilateral Hypopyon Uveitis and Secondary Glaucoma in an Adult With Relapsing Acute Lymphoblastic Leukemia

Anterior segment infiltration in acute lymphoblastic leukemia (ALL) presenting as hypopyon uveitis in an adult is rare. We report this case as an uncommon presentation in a patient in remission after chemotherapy for ALL. In addition to the hypopyon, the patient presented with congested eye caused by secondary raised intraocular pressure. There is a need to maintain a high index of clinical suspicion in uveitis cases, as early diagnosis of ocular malignancy can save vision. Atypical unilateral hypopyon, even in adults, can be an indication of relapsing ALL.

Topiramate induced bilateral hypopyon uveitis and choroidal detachment: a report of two cases and review of literature

BackgroundTopiramate (TPM) is a drug commonly used by neurophysicians and psychiatrists for a plethora of indications. Topiramate has been reported to induce acute angle closure glaucoma as an adverse effect. However, there is limited literature on Topiramate causing hypopyon uveitis and intense ocular inflammation. It is imperative for ophthalmologists as well as physicians to be aware of the potential sight threatening ocular adverse effects of Topiramate. We report 2 rare consecutive cases of severe hypopyon uveitis and choroidal detachments after using Topiramate.Case presentationTwo patients presented with sudden onset of angle closure, bilateral hypopyon uveitis and choroidal detachments. On reassessing a detailed treatment history, it was found that both patient were taking oral Topiramate which had been started 2 weeks before the onset of ocular symptoms. The bilateral hypopyon and angle closure were considered to be induced by Topiramate and the drug was discontinued. The patients were started on oral and topical steroids which led to resolution of hypopyon uveitis and choroidal detachments. The visual acuity improved and the intraocular pressure also got normalised in both the cases.ConclusionsTopiramate can lead to a bilateral hypopyon uveitis and severe ocular inflammation. An urgent cessation of topiramate along with topical and systemic steroids is required to prevent serious complications.

Relapse of Acute Lymphoblastic Leukaemia masquerading as Hypopyon uveitis and disc edema

Relapse of Acute Lymphoblastic Leukaemia masquerading as Hypopyon uveitis and disc edema

Seasonal Hyperacute Panuveitis in Nepal: A Review over 40 Years of Surveillance

ABSTRACTPurpose: This review aims to provide a detailed update in Seasonal hypercute panuveitis (SHAPU) which is a blinding disease of unknown etiology reported only from Nepal, occurring every odd year since 1975 predominantly in children.Methods: Data sources were literature reviewed using PubMed, Medline, and ISI Databases (since 1975 to late 2017). Search items included SHAPU, seasonal endophthalmitis, hypopyon uveitis, caterpillar induced uveitis alone or in combination with white moth, panuveitis, and review.Results: Epidemics of SHAPU occur between August to December usually in odd years. Two thirds of the children present with unilateral blind eye which eventually becomes soft with shallowing of anterior chamber called as Malignant Hypotension. Hypopyon, fibrinous exudates in anterior chamber, difficult to dilate pupil and inability to visualize the retina because of massive exudation into vitreous producing a “White pupil in a Red eye” with little or no pain is its characteristic features. Contact with moths has been suspected. Because of presence of microbial agents in few cases, an infectious etiology has not been ruled out.Conclusions: Although SHAPU has been reported only from Nepal, lack of its report from ecologically similar terrain along Hindukush Mountains and possible association with moths remain intriguing.

Isolated hypopyon as an initial manifestation of relapsed acute lymphoblastic leukemia

The common sites of relapses of acute lymphoblastic leukemia are bone marrow, central nervous system and testis. When unusual sites like eyes are involved in extramedullary relapses, they may masquerade as hypopyon uveitis. We report a child who presented with isolated hypoyon as an initial manifestation of Acute lymphoblastic relapse, 3 months after his completion of chemotherapy. Leukemic involvement of the anterior segment of the eye should be suspected in all cases of uveitis that are refractory to treatment and particularly when a hypopyon uveitis develops in a child.

The Review of Behcet Diseases: A Case of Sub-acute Bilateral Hypopyonic Uveitis after 20 Years of Behcet Diseases

The current study was an attempt to report a case of subacute bilateral hypopionic uveitis and pan uveitis in a referral case of Behcet patient. Careful questioning of the patient and detailed examination of the eyes for other signs are necessary to guide the differential diagnosis and relevant investigations. In this study, a case of a patient with a 20 year history of Behcet disease and occular manifestation of bilateral hypopionic uveitis was presented in ophthalmic consultation. Hypopion resolved shortly after instating therapy but old scarified retinal lesion did not respond as well as long lasting posterior synchia. Hypopion uveitis is considered in the context of the associated ocular and systemic diseases causing it. If Steroid therapy, which leads to significant remission of symptoms, missed diagnosis, it could have serious consequences for the patient. A rational approach based on the understanding of the causes of hypopyon uveitis is imperative.

PO-0857 Central Nervous Thrombophlebitis And BehÇet Disease

Introduction Behcet’s Disease (BD) is manifested by a triad of relapsing hypopyon uveitis, aphthous stomatitis and genital ulcers. We present the case of a school-aged boy with a Behcet-related acute cerebral venous thrombosis. Material and method A 8 years old boy is admitted for acute and severe headaches with nausea. Clinical examination notes a febrile child with marked aphtous mouth (with a history of genital ‘burns’). ESR and CRP are mildly high, while cerebral angio-CT reveals a superior sagittal sinus occlusion. Steroids and palliative management completely resolve these symptoms, while angio-MRI confirms the isolated thrombophlebitis. Discussion The major manifestations of vascular Behcet Disease include venous occlusion, arterial occlusion and aneurysm formation. Cerebral venous thrombosis (CVT) results in signs and symptoms of increased intracranial pressure, like for our child. Steroids remain the mainstay initial treatment, with a particular attention to anticoagulation and adjunction/relay with colchicine. Conclusion Cerebral venous thrombosis may reveal BD is associated with a good prognosis when treated promptly, specially in paediatric patients.

An atypical case of HLA-B27-associated uveitis with hypopyon and posterior segment involvement

The presence of a hypopyon and posterior segment involvement are uncommon clinical findings in HLA-B27-associated uveitis. Furthermore, first-time attacks rarely occur in the elderly. This report highlights an atypical uveitis case involving an older patient, an evident hypopyon and severe intermediate uveitis in one eye.&#x0D; The 60-year-old Caucasian male was admitted for a painful, red eye with a sudden decreased vision to hand motion, in the affected eye. Ocular and systemic history were unremarkable. An anterior chamber examination of the eye revealed extensive cells and flare with a conspicuous hypopyon. An evaluation of the posterior segment revealed significant vitreous haze, obstructing all view to the retina. Despite the age and the atypical ocular findings of the patient, a diagnosis of HLA-B27-associated uveitis was made following an extensive clinical and laboratory evaluation. The inflammatory condition was successfully managed with a combination of intravenous, topical and oral corticosteroids tapered over the course of a few weeks, and visual acuity recovered to 20/30.&#x0D; This case is an important reminder that atypical signs, such as a hypopyon or intermediate uveitis, can occur and may be a significant sign of HLA-B27-associated uveitis. Clinicians should be aware of the diverse manifestations of HLA-B27-associated uveitis and be careful to include a comprehensive assessment of both the anterior and posterior segments of any presenting painful, red eye.

Leukemic Hypopyon in Acute Myeloid Leukemia

Leukemic hypopyon uveitis in acute myeloid leukemia (AML) is a very rare condition. We report this case of an unusual finding in a 2½-year-old boy in second remission after chemotherapy for relapsed AML. A young patient with an AML FAB M5 in second remission developed pain, photophobia, and conjunctival injections in the right eye. Recent bone marrow aspiration showed no blast increase and recent peripheral blood sampling presented no evidence of relapse. The patient showed a viscous hypopyon and a myotic pupil in the right eye that was refractory to corticosteroids. Anterior chamber aspiration revealed atypical blasts similar to the leukemic cells that were found in the bone marrow aspirate at the time of systemic relapse. Timely anterior chamber aspiration and subsequent cytology is useful in differentiating leukemic hypopyon from true intraocular inflammation in AML patients. This is the first report about a leukemic hypopyon uveitis in AML without systemic findings of malignant cells in a child.

Hypopyon Uveitis Following LASIK in a Patient With Ulcerative Colitis

To present a case of unilateral hypopyon uveitis that began 15 days after uneventful bilateral LASIK in a 24-year-old man with an undisclosed history of ulcerative colitis. Case report. The hypopyon uveitis completely resolved after treatment with aggressive topical and oral steroid agents in combination with topical antibiotic coverage. Although rare, visually significant hypopyon uveitis may arise after LASIK in the setting of ulcerative colitis and positive human leukocyte antigen (HLA) B27. Early recognition and treatment can result in an excellent outcome. The exact relationship between hypopyon uveitis and LASIK is impossible to ascertain.

Rifabutin-associated hypopyon uveitis and retinal vasculitis with a history of acute myeloid leukemia

PurposeThis study reports a case of bilateral rifabutin-associated uveitis in a child with a history of acute myeloid leukemia.MethodsWe utilized a clinical case description and brief discussion.ResultsA 17-year-old girl presented with acute bilateral anterior uveitis, a hypopyon in the left eye, and moderate bilateral vitritis. She had a history of acute myeloid leukemia status post-allogeneic hematopoietic stem cell transplant 5 years earlier. She was receiving rifabutin for a biopsy-proven Mycobacterium avium complex pulmonary infection. Work up for infectious and neoplastic etiologies was negative. The uveitis initially responded to topical corticosteroids, but recurred when the drops were tapered. Fluorescein angiography demonstrated diffuse vasculitis of small retinal vessels and cystoid macular edema. After rifabutin was discontinued, the uveitis and vasculitis slowly resolved.ConclusionFluorescein angiography demonstrated widespread retinal vasculitis which is a rare manifestation of rifabutin-associated uveitis.

Recurrent Anterior Uveitis with Hypopyon Revealing Relapsing Polychondritis

Relapsing polychondritis (RP) is a rare disease involving cartilaginous structures, predominantly the ears, nose and laryngotracheobronchial tree. The eyes, cardiovascular system, peripheral joints, skin, and central nervous system may also be affected. Involvement of all ocular structures has been described. Non-granulomatous uveitis is a common feature; however hypopyon is uncommon. We herein present the case of a 42-year-old man who had been diagnosed with bronchial asthma for a long period; and who presented with recurrent hypopyon uveitis as a revealing manifestation of relapsing polychondritis. We emphasize that RP should therefore be considered in the differential diagnosis of sterile hypopyon uveitis.

Relapsing acute myeloid leukemia presenting as hypopyon uveitis

Anterior segment infiltration in acute myeloid leukemia (AML) presenting as hypopyon uveitis is very rare. We report this case as an uncommon presentation in a patient on remission after bone marrow transplant for AML. In addition to the hypopyon, the patient presented with “red eye” caused by ocular surface disease due to concurrent graft-versus-host disease and glaucoma. The classical manifestations of masquerade syndrome due to AML were altered by concurrent pathologies. Media opacities further confounded the differential diagnosis. We highlight the investigations used to arrive at a definitive diagnosis. In uveitis, there is a need to maintain a high index of clinical suspicion, as early diagnosis in ocular malignancy can save sight and life.

Cataract Surgery Under Infliximab Therapy in a Patient With Behçet’s Disease

To report a case of a successful cataract surgery outcome in a patient with Behçet's disease (BD) without postoperative inflammation under infliximab therapy. A 40-year-old man who had frequent episodes of hypopyon uveitis despite immunosuppressive therapy underwent cataract surgery. Infliximab (5 mg/kg) was given intravenously to prevent inflammation during the perioperative period. After the initial administration, infliximab was given at 2 and 6 weeks, and then it was given at 8 weeks intervals thereafter. The patient underwent cataract surgery in both eyes at the midpoint of the 8 weeks duration schedule with an uneventful postoperative clinical course for up to 12 months except for the contraction of the anterior capsule in both eyes and posterior capsule opacification in 1 eye. Infliximab therapy may be effective when performing cataract surgery on BD patients who have uncontrollable uveitis.