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Panuveitis

Panuveitis. Mamta Agarwal Senior Consultant Uveitis & Cornea Services Sankara Nethralaya Chennai. Ocular History. 22 year old woman OS – Decreased vision, pain, redness since 2 weeks Associated with headache & vomiting. No history of trauma, surgery, previous such episodes.

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Panuveitis

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  1. Panuveitis Mamta Agarwal Senior Consultant Uveitis & Cornea Services SankaraNethralaya Chennai

  2. Ocular History • 22 year old woman • OS – Decreased vision, pain, redness since 2 weeks • Associated with headache & vomiting. • No history of trauma, surgery, previous such episodes. • No systemic illness

  3. Past history • Diagnosed as • CRAO with BRVO • Posterior scleritis • Lab investigations • Routine blood Normal • Mantouxtest Negative • RA, ANA Negative • HIV Negative • Sickle cell Test Negative • Past Treatment • Oral & topical steroids

  4. Clinical Presentation • BCVA • OD 6/6 OS – HMCF • SLE • Live worm in the corneal stroma • AC cells 2+, flare +, vitreous cells+

  5. Fundus Blot retinal hemorrhages, sub retinal heme, worm tracts, old vitreous hemorrhage

  6. Treatment • Intraocular worm removal under local anesthesia Microscopic examination • Reddish brown body with transparent round globular head • Cephalic bulb showing four rows of hooklets & cuticular spines on the body Gnathostomaspinigerum

  7. Follow up – Day 1 • Corneal stromal scar • AC cells+, flare+, Iris holes • IOP – 44mmHg

  8. Follow up – Day 1 - Treatment • Oral • Acetazolamide 250mg • Topical • Prednisolone acetate - 10/d • Homatropine – 2/d • Combigan – 2/d • Dorzolamide – 3/d

  9. Final Diagnosis Panuveitis induced by intraocular Gnathostomiasis

  10. Conclusion Intraocular Gnathostomiasis (Ocular larva migrans) • Caused by Gnathostoma spinigerum • Definitive host – Cats, dogs, wild animals • Intermediate host – Fish, chicken, snails, frogs • Man is the accidental host. • Portal of entry into the eye – Posterior retina • Usually associated with retinal, choroidal or disc hemorrhage, artery or vein occlusion, macular scarring.

  11. Conclusion • Ocular manifestations • Lid edema, conjunctival chemosis, hyphema, anterior uveitis • Panuveitis, retinal hemorrhages, vasculitis, retinal artery & vein occlusion • Systemic involvement • Lungs, CNS, GIT, skin, ear, genitourinary tract. • Treatment • Oral Albendazole 400mg/day x 3 weeks

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