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.  No systemic illness

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

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

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

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

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

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

Final Diagnosis Panuveitis induced by intraocular Gnathostomiasis

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

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