Presentation
At the last visit, both patients presented a quiet uveitis and stable BCVA: case 1 had 0.8 and 1.0 in the RE and the LE, respectively, while case 2 presented 1.0 in both eyes. No side effects were recorded during this time. [ncbi.nlm.nih.gov]
Panuveitis as a presenting feature of giant cell arteritis Statistics from Altmetric.com E ditor ,—It is unusual for bilateral panuveitis to be a presenting feature of giant cell arteritis. [bjo.bmj.com]
We present a case of severe bilateral panuveitis following phacoemulsification and intraocular lens implantation and discuss the importance of a correct diagnosis and management. [bmcophthalmol.biomedcentral.com]
Figure 4 Colour fundus photograph of the left eye 4 months after initial presentation shows new retinal infiltrates and haemorrhages. [nature.com]
Entire Body System
- Inflammation
Inflammation of all parts of the uvea (iris + cillliary body + choroid) is called panuveitis. Disorders in panuveitis are the same as in iridocyclitis, i.e. anterior uveitis. [optometry-today.com]
Synonym(s): panuveitis. panuveitis Inflammation of the entire UVEAL TRACT -the iris, the ciliary body and the CHOROID. panuveitis inflammation of all parts of the uveal tract. [medical-dictionary.thefreedictionary.com]
However, after 2 days, inflammation remained severe and unchanged. [bmcophthalmol.biomedcentral.com]
When compared to other anatomical sites of inflammation, panuveitis has poor visual outcome due to more widespread inflammation. [ncbi.nlm.nih.gov]
- Pain
It is also associated with painful enlargement of parotid glands. Cranial nerve palsy, fever, malaise and skin rashes are also seen. Ref: Comprehensive Ophthalmology, A. K. Khurana, 4th edition, p156, 157. Image credits: Jonathan Trobe, M.D. [pgblazer.com]
They may include blurred vision; seeing dark, floating spots ("floaters"); eye pain; redness of the eye; and sensitivity to light (photophobia). [rarediseases.info.nih.gov]
These make up the middle layer of the eye.[7538] The condition can also affect the lens, retina, optic nerve, and vitreous, causing reduced vision or blindness.[7539] Signs and symptoms may include eye redness and pain; blurring; light sensitivity; decreased [rarediseases.org]
History In addition to the right eye pain, the patient reported pain along her entire left leg and lower back for about one year. [retina-specialist.com]
- Fever
Cranial nerve palsy, fever, malaise and skin rashes are also seen. Ref: Comprehensive Ophthalmology, A. K. Khurana, 4th edition, p156, 157. Image credits: Jonathan Trobe, M.D. [pgblazer.com]
[…] of a 47 year old male who presented with panuveitis and disc oedema two weeks after an episode of dengue fever. [ijmedph.org]
“Bilateral Panuveitis Revealing Mediterranean Spotted Fever”. Ophthalmology and Vision Science 3.1 (2019): 1-5. Copyright: © 2019 Salem Bouomrani., et al. [scientiaricerca.com]
Recurrent bilateral panuveitis and rhegmatogenous retinal detachment in a patient with familial Mediterranean fever. Am J Ophthalmol 1990; 110 (6): 702–703. [nature.com]
- Malaise
Cranial nerve palsy, fever, malaise and skin rashes are also seen. Ref: Comprehensive Ophthalmology, A. K. Khurana, 4th edition, p156, 157. Image credits: Jonathan Trobe, M.D. [pgblazer.com]
He had experienced flu-like symptoms including fever, sore throat, myalgia, and malaise for 10 days before visual acuity decreased. [synapse.koreamed.org]
She gave a history of flu like symptoms with fever headache and malaise few days before onset of ocular symptoms. Fundus photographs shows classic picture of acute stage of VKH with multiple large serous RPE detachments and inflamed choroid. [imagebank.asrs.org]
He reported no respiratory symptoms, weight loss, genital sores, nausea or vomiting, decreased energy, malaise, neurologic symptoms or joint pain. He did admit to having a “bad back.” [aao.org]
- Pallor
Fundus examination OS showed hazy view due to dense vitreous exudates with disc pallor and sclerosed vessel [Figure 1]. Systemic examination was unremarkable. [ncbi.nlm.nih.gov]
Fundus photographs demonstrated multifocal scar lesions without pigmentation (yellow allows), white sheathing vessel (white allow), and pallor of the optic disc (blue allow). [journals.lww.com]
What’s Your Diagnosis. (1) In the right eye, epiretinal membrane, disc pallor, dilated veins, sclerosed and sheathed arterioles are still visible four years after initial presentation. (2) In the left eye, extensive epiretinal membrane, optic disc pallor [aao.org]
The vitreous was clear and the fundus showed no exudates or bleeding, however,there was dilatation of retinal vascular and disc pallor of optic nerve head (Figure 6). [ijo.cn]
Cardiovascular
- Hypertension
The other patient developed ocular hypertension when the vision in the affected eye suddenly deteriorated. Both eyes demonstrated partial response to steroid therapy. [insights.ovid.com]
As many as one fifth of people with uveitis can develop ocular hypertension. Some of these individuals will develop glaucoma. [preventblindness.org]
Physical examination revealed a hypertensive panuveitis and a mild facial vitiligo. The right eye, of which fundus was albinos, presented no abnormalities. The left eye was eviscerated. [agris.fao.org]
Ocular hypertension was found in 38 patients (23.90%). Glaucoma surgery was performed in 18.24% of patients and cataract surgery in 21.38%. [dovepress.com]
Skin
- Macula
Namely, the closer the inflammation to the macula, the lower visual acuity, while the inflammatory focus on the distant periphery of the retina does not affect visual acuity. [optometry-today.com]
Vitreous Retina Macula Consultants of New York, New York. Reprint requests: Richard F. Spaide, MD, Vitreous Retina Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022; e-mail: [email protected] Richard F. [journals.lww.com]
The left macula had cystoid oedema (Figure 3). Figure 1 Black and white fundus photograph of the left eye shows atrophic pigment epithelial lesions in the mid-periphery at presentation. [nature.com]
Fluorescein angiography showed a marked filling delay in the nasal retinal and choroidal circulations with a definite watershed zone involving the peripapillary choroid and macula. [kci.go.kr]
- Skin Lesion
This association might also be defined as a recognized clinical pattern, similar to the association of papulopustular skin lesions with arthritis. [acrabstracts.org]
Behcet’s key features include uveitis, recurrent oral and genital ulcers, and vasculitic skin lesions. [aao.org]
Sir, Behçet's disease (BD) is a chronic disorder characterized by relapsing uveoretinitis, oral and genital ulceration, and skin lesions. [nature.com]
There can be vesicular skin eruptions, conjunctival pocks, conjunctivitis, and corneal involvement, and most of these lesions are known to heal spontaneously. [tnoajosr.com]
Principal clinical findings are hepatosplenomegaly, lymphadenopathy, serous effusions and skin lesions. No ocular presentation has been reported so far, they said. [healio.com]
- Erythema
He had a history of oral and genital ulcers, arthralgia, and erythema nodosum. Snellen visual acuity was 0.3 (OD) and hand motions (OS). Refractive error was low myopic astigmatism. [nature.com]
Associated features include arthritis, central nervous system involvement, erythema nodosum, intestinal ulcers and vascular lesions such as thrombophlebitis, arterial occlusions and aneurysms. The cause and pathogenesis is unknown. [aao.org]
In European patients, the most common clinical manifestation of the disease is erythema migrans (EM), followed by Lyme neuroborreliosis (LNB). 1, 2 Data on ocular manifestations of LB are scarce and predominantly restricted to adults. [journals.lww.com]
The disease is characterized by four major symptoms: ocular (panuveitis and occlusive vasculitis), aphthous ulcers, genital ulcers, and dermatological lesions (erythema nodosum and subcutaneous thrombophlebitis). [chanrejournals.com]
- Skin Rash
Cranial nerve palsy, fever, malaise and skin rashes are also seen. Ref: Comprehensive Ophthalmology, A. K. Khurana, 4th edition, p156, 157. Image credits: Jonathan Trobe, M.D. [pgblazer.com]
The evolution was rapidly favorable with apyrexia, total disappearance of the skin rash, of ocular complains, and progressive recuperation of vision. Ophthalmological exam with eye fundus was totally normal at two months, and without sequel. [scientiaricerca.com]
He had a classical presentation of VL with fever, fatigue, anorexia, weight loss, skin rash and splenomegaly. [joii-journal.springeropen.com]
- Eruptions
There can be vesicular skin eruptions, conjunctival pocks, conjunctivitis, and corneal involvement, and most of these lesions are known to heal spontaneously. [tnoajosr.com]
The term describes the skin eruptions that are frequently caused by the illness. See, also, GRANULOMATOUS, INFLAMMATION, IMMUNE SYSTEM, and AUTOIMMUNE DISEASE. [uveitis.org]
Eyes
- Photophobia
Pupillary examination may reveal direct photophobia when the light is directed into the affected eye, as well as consensual photophobia when light is directed into the uninvolved eye; consensual photophobia is typical of iritis, whereas photophobia due [emedicine.medscape.com]
A 13-year-old boy who presented with a red left eye, painful eye movement, blurred vision, photophobia and increased lacrimation, was diagnosed with 1-sided panuveitis with optic disk edema. Diagnostic work-up revealed borrelial antibodies in serum. [ncbi.nlm.nih.gov]
Symptoms include decreased vision, ocular ache, redness, photophobia, and floaters. Although uveitis is identified clinically, identifying the cause typically requires testing. [msdmanuals.com]
Symptoms may include ocular redness, photophobia, blurred ... Access to the complete content on Oxford Reference requires a subscription or purchase. [oxfordreference.com]
These eyeglass lenses darken automatically in sunlight to reduce photophobia-related discomfort when going outdoors. Page updated April 2019 [allaboutvision.com]
- Blurred Vision
[…] wt 5 M 12 Blurred vision — 6 6 Wt/wt 6 F 57 Blurred vision Pain 54 3 R761H/wt 7 F 23 Blurred vision — 21 1.5 Wt/wt 8 F 19 Blurred vision — 15 4 Wt/wt 9 F 22 Blurred vision — 19 3 Wt/wt 10 F 7 Accidental — 5 2 Wt/wt 11 F 31 Redness Pain 21 10 Wt/wt 12 [hindawi.com]
A 13-year-old boy who presented with a red left eye, painful eye movement, blurred vision, photophobia and increased lacrimation, was diagnosed with 1-sided panuveitis with optic disk edema. Diagnostic work-up revealed borrelial antibodies in serum. [ncbi.nlm.nih.gov]
The main symptoms of panuveitis are eye pain, blurred vision, vision loss, light sensitivity, redness of the eyes, and seeing spots. [diseaseinfosearch.org]
Acute anterior uveitis presents as follows: [2] Pain, generally developing over a few hours or days except in cases of trauma Redness Photophobia Blurred vision Increased lacrimation Chronic anterior uveitis presents primarily as blurred vision and mild [emedicine.medscape.com]
Smith, M.D., assistant professor of ophthalmology at Mayo Clinic, discusses a case of unilateral panuveitis involving an 82-year-old white male who initially presented with several physical symptoms and blurred vision. [medprofvideos.mayoclinic.org]
- Eye Pain
A 13-year-old boy who presented with a red left eye, painful eye movement, blurred vision, photophobia and increased lacrimation, was diagnosed with 1-sided panuveitis with optic disk edema. Diagnostic work-up revealed borrelial antibodies in serum. [ncbi.nlm.nih.gov]
Symptoms may develop rapidly and can include: • Blurred vision • Dark, floating spots in the vision (floaters) • Eye pain • Redness of the eye • Sensitivity to light (photophobia) Anyone suffering eye pain, severe light sensitivity, and any change in [shileyeye.ucsd.edu]
Some other possible causes may include infections, tumors, bruises, and toxins in the eyes. The main symptoms of panuveitis are eye pain, blurred vision, vision loss, light sensitivity, redness of the eyes, and seeing spots. [diseaseinfosearch.org]
Uveitis is inflammation of the middle layer of the eye, called the uvea or uveal tract. It can cause eye pain and changes to your vision. Most cases get better with treatment – usually steroid medicine. [nhs.uk]
The symptoms of Anterior uveitis include light sensitivity, throbbing eye pain, and blurred vision. The eye will look very red and inflamed and some patients need to wear sunglasses to help with the light sensitivity. [opto.ca]
- Retinal Pigmentation
Acute lesions appeared as nodular collections under the retinal pigment epithelium. [journals.lww.com]
Indirect ophthalmoscopy showed vitritis with plenty of vitreous membranes, and subretinal yellow lesions in the peripheral retina along with retinal pigment epithelial tracts. [tandfonline.com]
It induces cell death by thermal coagulative necrosis of… Continue Reading The white dot syndromes are a heterogeneous group of rare inflammatory disorders affecting the retina, the retinal pigment epithelium, and the choroid. [semanticscholar.org]
- Lacrimation
A 13-year-old boy who presented with a red left eye, painful eye movement, blurred vision, photophobia and increased lacrimation, was diagnosed with 1-sided panuveitis with optic disk edema. Diagnostic work-up revealed borrelial antibodies in serum. [ncbi.nlm.nih.gov]
(Lacrimal Apparatus Diseases) Arcus Senilis Arcus, Corneal (Arcus Senilis) Asthenopia Astigmatism Astrocytoma, Malignant, Optic Nerve (Optic Nerve Glioma) Atrophies, Gyrate (Gyrate Atrophy) Atrophies, Hereditary Optic (Optic Atrophies, Hereditary) Atrophy [provisu.ch]
When the disease manifests in the eye as IgG4-ROD, it typically presents with lacrimal gland, extraocular muscle, and, less commonly, eyelid, orbital bone, or scleral involvement [3]. [hindawi.com]
Psychiatrical
- Suggestibility
The positive deflection of the RPE-Bruch’s complex ultimately returned to a neutral position, suggesting normalization of intracranial pressure. [aaopt.org]
Cat scratch disease may manifest with angiographic features suggestive of Vogt-Koyanagi-Harada disease. [ncbi.nlm.nih.gov]
The pathogenesis of these two types of Neuro-Behcet’s Syndrome (NBS) are suggested to be different. The purpose of this study is to evaluate the association between the parenchymal Neuro-Behcet’s Syndrome and panuveitis. [acrabstracts.org]
Urogenital
- Metrorrhagia
Reported severe adverse reactions, some that differ from adults, include neutropenia, streptococcal pharyngitis, increased aminotransferases, herpes zoster, myositis, metrorrhagia, and appendicitis. [humirapro.com]
Neurologic
- Headache
He had complaints of headache with pain and defective vision in his right eye that had developed during his recovery from dengue fever. We treated him with topical steroid drops and subtenon steroid injections along with atropine eye drops. [ijmedph.org]
The panuveitis and bilateral serous retinal detachments resolved quickly after an initial aggressive treatment with topical difluprednate alone while the headaches resolved and vitiligo stabilized. [djo.harvard.edu]
Neurologic symptoms may be multiple and severe, including but not limited to, meningeal symptoms and signs, headache, confusion, cranial nerve palsies and inner ear disorders, although this is rare. [medscape.com]
The case of a 20-year-old woman is reported, who developed systemic illness (headache, nausea, vomiting, fever, diarrhea) and severe bilateral panuveitis with exudative retinal detachment about 2-3 weeks after several insect bites. [prohealth.com]
- Meningism
Few case reports document meningeal involvement and even fewer present with alternative ocular pathology. We report an atypical case of IgG4-ROD presenting as aseptic meningitis and panuveitis. 2. [hindawi.com]
VKH disease is broken into four phases, which may overlap: • Prodromal, in which the patients may often experience flu and/or meningitis-like symptoms. [medscape.com]
[…] optochiasmatic arachnoiditis, optic nerve tuberculoma or papilledema Vogt-Koyangi-Harada(VKH)Syndrome VKH Syndrome is an idiopathic multisystem autoimmune disease featuring inflammation of melanocyte containing tissues such as the uvea, skin, ear, and meninges [eyewiki.aao.org]
- Burning Sensation
The patient came with complaints of burning sensation of his left eye, and on examination, the presence of viral pocks over the face and trunk, anterior chamber cells and flare, and iritis were noted along with vitritis and retinitis and he was diagnosed [tnoajosr.com]
A 37-year-old Hispanic woman came to the Los Angeles County Hospital/University of Southern California emergency department complaining of a painful, burning sensation and redness in her right eye with blurry vision. [retina-specialist.com]
- Altered Mental Status
A 35-year-old male with no prior ophthalmic history presented with headaches, altered mental status, and fever of unknown origin. [hindawi.com]
Findings A 59-year-old man with history of multiple myeloma presented with altered mental status, bilateral eye redness, and blurry vision. [joii-journal.springeropen.com]
Workup
(eg, HIV, toxoplasmosis), depending on the presentation See Workup for more detail. [emedicine.medscape.com]
Systemic workup also revealed a new diagnosis of HIV, after which he was started on highly active antiretroviral therapy. Four months after presentation, the vitritis and retinitis were completely resolved. [aao.org]
[…] of any suspected underlying systemic condition Ophthalmoscopic examination Leukocytes in the vitreous humor and vitreous opacity Foci of inflammation of the choroid and/or retina Further workup of any suspected underlying systemic condition Complications [amboss.com]
Short course of oral prednisone was initiated once the infectious workup returned negative. Within 4-weeks, he had complete resolution of eye symptoms, with improvement of vision and ophthalmologic examination. [aspergillus.org.uk]
An extensive workup was ordered. CONCLUSIONS: Radiological tests were positive for nodular changes of the right and to a lesser extent the left hilum, indicative of sarcoidosis. ACE levels were moderately elevated. [aaopt.org]
Treatment
Steroids form the basis of treatment in the anterior and posterior uveitis. [optometry-today.com]
Oral prednisone, thalidomide and cyclophosphamide were attempted before any invasive treatment. After 5 days, the inflammation was markedly reduced (Fig. 2b). [bmcophthalmol.biomedcentral.com]
Second, with rifabutin dose adjustment and the use of topical steroids and mydriatic drugs, ocular inflammation resolved without any other changes in the treatment of tuberculosis or sporotrichosis. [scielo.br]
The mainstay of the treatment of uveitis is corticosteroids. Immunosuppressive agents are administered if the inflammation is not adequately controlled with corticosteroids. [ncbi.nlm.nih.gov]
or in whom corticosteroid treatment is inappropriate. [centerwatch.com]
Prognosis
However, typically the prognosis is guarded due to the entire eye being affected. The condition can lead to permanent blindness if early diagnosis and treatment is not provided Complications, such as glaucoma and cataract, can worsen the prognosis. [dovemed.com]
The long-term outcomes and prognosis of this condition are not well known. [ncbi.nlm.nih.gov]
Vision prognosis is often poor, even with early and appropriate treatment. Patients whose vision at presentation is count-fingers or worse should be considered for vitrectomy and use of intraocular corticosteroids. [merckmanuals.com]
Etiology
This could be due to better control of systemic and infectious etiologies, leading to decreased accompanying ocular complications. [iovs.arvojournals.org]
More patients with bilateral disease had a non-infectious etiology (n = 82, 50.9%) (p = 0.012). [tandfonline.com]
To describe clinical presentation and results of diagnostic and therapeutic procedures in seven children from an epidemic of panuveitis in the Brazilian Amazonia, as well as environmental analysis and etiological aspects involved. [ncbi.nlm.nih.gov]
Our suspicion of a herpetic etiology based on the lab results was growing. [retina-specialist.com]
Epidemiology
Keywords: 746 uveitis-clinical/animal model • 462 clinical (human) or epidemiologic studies: outcomes/complications • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials © 2014, The Association for [iovs.arvojournals.org]
Conclusion: In contrast to most epidemiologic studies of uveitis, the clinical and etiologic patterns of uveitis were different in a tertiary referral center in northeastern Iran. [jovr.org]
Uveitis epidemiology varies widely with geographic location; however, it remains a significant cause of vision loss throughout the world. [dovepress.com]
Pathophysiology
Du L, Kijlstra A, Yang P: Vogt-Koyanagi-Harada disease: novel insights into pathophysiology, diagnosis and treatment. Prog Retin Eye Res 2016;52:84-111. Wanat KA, Kim B, Rosenbach M: Multisystem diseases affecting the skin and eye. [karger.com]
PATHOPHYSIOLOGY Immunologic factors Genetic Factors Infectious agents 22. [slideshare.net]
[…] iris Etiology Vascular hypoxia (e.g., central retinal vein occlusion, central retinal artery occlusion, temporal arteritis) Neural diseases (e.g., diabetic retinopathy) Inflammatory (e.g., chronic uveitis) Neoplasms of the eye (e.g., uveal melanoma) Pathophysiology [amboss.com]
Despite the first description of this disease almost 50 years ago, many aspects of the condition remain a mystery, including the exact cause and pathophysiology. [thelancet.com]
Prevention
In the six patients with available follow-up, the optic neuropathy was corticosteroid-responsive, but required corticosteroid treatment to prevent recurrences of optic nerve inflammation and subsequent vision loss. [jhu.pure.elsevier.com]
Prevention and Prognosis of Panuveitis While it can be hard to prevent panuveitis uveitis, you can lower your risk by avoiding contact with people who have infections. [belmarrahealth.com]
A slow taper is essential to preventing the panuveitis from immediately returning. [patientworthy.com]
Prevention - Panuveitis Not supplied. [checkorphan.org]