Folie 1 - Springer

Folie 1 - Springer

Eales Disease Rowayda M. Amin Assist. Lecturer of Ophthalmology Ahmed Souka, MD Lecturer of Ophthalmology, Alexandria Univesity Ocular History

29-year-old male progressive decrease in visual acuity in both eyes over 2 weeks. had commenced oral steroids 5 days prior to presentation with only a marginal improvement in VA and intraocular inflammation.

Ocular History recurrent uveitis and argon laser treatment 5 years ago First Presentation BCVA was 4/60 in the right eye and 1/60 in the

left, bilateral panuveitis extensive retinal vasculitis complicated cataract posterior synechae in the left eye First Presentation - Right Fundus

VA: 4/60 2+ AC cell, mild flare 2+ vitreous cell, mild haze extensive retinal vasculitis Optic disc hyperemia

Peripheral laser scars Chorioretinal and retinal infiltrates First Presentation - Left Fundus VA 1/60 +2 AC cell, mild flare Poor view due to posterior synechae, complicated cataract and vitreous haze

Differential Diagnosis Behcets disease SLE Sarcoidosis Ocular tuberculosis/ Eales disease Syphilis Work-up

CXR

PPD Mantoux Tuberculin skin tests Routine blood work S ACE, ANA, FTA, RPR Meticulous review of systems All unremarkable PPD 18 mm induration despite oral steroids Supporting a diagnosis of ocular TB. Treatment standard course of antitubercular treatment

2 months of rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by 4 months of rifampicin and isoniazid and slow taper of oral steroid dose. Follow-up dramatic improvement of uveitis and VA over a 4 week period

6 months after completing ATT, eyes remained quiet VA of 6/36 RE and 3/60 LE Right and left Fundus 4 weeks after begin of treatment Conclusion

This case highlights the diversity of clinical presentations of TB uveitis which forms part of the differential of any chronic or recurrent uveitis. TB is one of the few causes of uveitis with a definite effective treatment and where standard treatment with steroids alone could be sight threatening.

The diagnosis of ocular TB is based on clinical findings consistent with TB, positive tuberculin skin testing and absence of any other systemic disease to account for the uveitis.

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