Kawasaki disease (KD) is the self-limited and multisystem vasculitis which accompanies many complications. Ophthalmic findings in KD are bilateral conjunctival injection, iridocyclitis, superficial keratitis, vitreous opacities and subconjunctival hemorrhage. Optic disc swelling is a rare ophthalmic complication in KD. We describe a 3-year-old boy who presented with 7 days of fever, both conjunctival injection without discharge, and right cervical lymph node enlargement of more than 1.5 cm. He was diagnosed as incomplete KD. He had no ocular symptom except bilateral conjunctival injection. On ophthalmic examination, he was diagnosed by anterior uveitis with optic disc swelling. The brain magnetic resonance imaging was performed and revealed no evidence of increased intracranial pressure. Echocardiography revealed the dilated right coronary artery up to 3.4 mm. Fever subsided and optic disc swelling was completely improved after intravenous immunoglobulin (2 g/kg) treatment. Optic disc swelling is a rare ophthalmic complication in KD.
Brain ; Child, Preschool ; Coronary Vessels ; Echocardiography ; Fever ; Hemorrhage ; Humans ; Immunoglobulins ; Intracranial Pressure ; Iridocyclitis ; Keratitis ; Lymph Nodes ; Magnetic Resonance Imaging ; Male ; Mucocutaneous Lymph Node Syndrome* ; Papilledema ; Uveitis* ; Uveitis, Anterior ; Vasculitis

PURPOSE: To report a case of corneal failure after implantation of the Ahmed glaucoma valve occurring in a patient diagnosed with Fuchs' heterochromic iridocyclitis. CASE SUMMARY: A 53-year-old male who complained of ocular pain and suddenly decreased visual acuity in his right eye visited our clinic. His visual acuity was 0.15 and intraocular pressure (IOP) was 55 mm Hg. The slit-lamp examination revealed edematous cornea, fine round or stellate keratic precipitates connected with fine filaments on the endothelium and depigmentation of the iris. The corneal endothelial cell density was 2,958 cells/mm2. There was no specific finding in his left eye. The IOP did not improve with medical treatment, therefore, an Ahmed glaucoma valve was implanted in his right eye. At every follow-up exam the tube was well positioned and the IOP was maintained between 8 and 13 mm Hg. Eight months postoperatively, the patient complained of decreased visual acuity and the cell density was decreased to 1,408 cells/mm2. Posterior subcapsular cataract opacity was observed as well as progression of depigmentation and distortion of the iris. Seventeen months after the surgery, the cell density was 700 cells/mm2. On follow-up examination, his visual acuity was decreased to FC10 cm with the cataract progressing, therefore cataract surgery was performed. One month postoperatively, his vision improved to 0.1. However, the visual acuity deteriorated due to progression of the corneal edema and penetrating keratoplasty was performed. CONCLUSIONS: Aggravation of the corneal complication after Ahmed glaucoma valve implantation should be considered in patients with Fuchs' heterochromic iridocyclitis-induced glaucoma.
Cataract ; Cell Count ; Cornea ; Corneal Edema ; Corneal Endothelial Cell Loss* ; Endothelial Cells ; Endothelium ; Follow-Up Studies ; Glaucoma ; Humans ; Intraocular Pressure ; Iridocyclitis* ; Iris ; Keratoplasty, Penetrating ; Male ; Middle Aged ; Visual Acuity

PURPOSE: To investigate the clinical manifestations, management, and ophthalmologic complications of orbital roof fractures and zygoma fractures. METHODS: A retrospective survey of 119 patients who visited Korea University Medical Center from June 2009 to June 2010 was performed. The sex, age, causes, fracture characteristics, neurologic injury, ocular injury, and combined facial bone fractures of patients who were diagnosed with orbital roof fracture and zygoma fracture were statistically analyzed. RESULTS: The mean age of patients with orbital roof fracture was 33.0 years old. The most common cause of orbital roof fracture was traffic accident (36.1%) with 6 patients receiveing surgical treatement (9.8%). Among the ophthalmologic diagnoses of the patients with orbital roof fracture, traumatic iridocyclitis was the most common (7 eyes) followed by eyeball rupture (2 eyes). The mean age of patients with zygoma fracture was 36.6 years old. The most common cause of zygoma fracture was traffic accident (32.8%), with 51 patients receiving surgical treatement (87.9%). Among the ophthalmologic diagnoses of the patients with zygoma fracture, traumatic iridocyclitis was the most common (6 eyes), followed by commotio retina (4 eyes). CONCLUSIONS: The present study regarding clinical characteristics and treatment of orbital roof fracture and zygoma fracture is helpful for ophthalmologists regarding the treatment of accompanying ophthalmologic complications.
Academic Medical Centers ; Accidents, Traffic ; Facial Bones ; Humans ; Iridocyclitis ; Korea ; Orbit ; Retina ; Retrospective Studies ; Rupture ; Zygoma

PURPOSE: To investigate the frequency of significant intraocular sequelae (SIOS) in orbital blunt trauma and their association with blowout and facial bone fractures. METHODS: A retrospective survey consisting of 726 patients with orbital blunt trauma who visited Korea University Medical Center was performed. Patients were divided into three groups: blowout fracture only group (group 1), facial bone fracture group (nasal bone fracture, maxillary fracture, zygoma fracture without blowout fracture, group 2), and non-fracture group (group 3). SIOS (traumatic iridocyclitis, commotio retina, hyphema, retinal hemorrhage, eyeball rupture, vitreous hemorrhage, retinal detachment, lens dislocation, traumatic cataract) were surveyed in each group, and the association between the frequency of SIOS and the presence of blowout fracture or facial bone fracture was analyzed. RESULTS: The frequency of SIOS in the fracture groups was 83.8% in group 1 and 73.3% in group 2, which were both higher than the 67.9% in group 3, the non-fracture group (p = 0.000 by chi-square linear by linear association). Traumatic iridocyclitis and hyphema were also significantly higher in groups 1 and 2 than group 3 (p = 0.003, p = 0.008 by chi-square linear by linear association). CONCLUSIONS: SIOS was found significantly more often in the fracture group than the group without fracture, although the frequency of severe SIOS was lower in the fracture group than the non-fracture group. The results from the present study could help in the treatment and management of patients with orbital blunt trauma.
Academic Medical Centers ; Facial Bones ; Fractures, Bone ; Humans ; Hyphema ; Iridocyclitis ; Korea ; Lens Subluxation ; Maxillary Fractures ; Orbit ; Retina ; Retinal Detachment ; Retinal Hemorrhage ; Retrospective Studies ; Rupture ; Vitreous Hemorrhage ; Zygoma

PURPOSE: To report clinical features and optical coherence tomographic findings of presumed atypical ocular tuberculosis associated with tuberculosis lymphadenitis and encephalomeningitis. CASE SUMMARY: A 28-year-old female with lymphadenitis in the axillary area presented with a fever and headache of a one week duration. CSF study and MRI findings implied tuberculosis encephalomeningitis, and presumed tuberculosis uveitis manifested with visual disturbance after five days. Ocular symptoms were aggravated and showed anterior iridocyclitis, vitritis, macular edema, and multifocal retinitis with miliary granuloma that was distinct from choroiditis or typical tuberculosis granuloma. After the patient received anti-tuberculosis medication and systemic corticosteroids, significant improvements in visual acuity, ocular findings and OCT results were observed. CONCLUSIONS: Ocular tuberculosis can present with various clinical findings, and caution should be taken so as not to misdiagnose based on these characteristics. In the present case, anti-tuberculosis medication and systemic steroids resulted in the resolution of inflammation. In such cases, monitoring the posterior pole lesion via OCT may be helpful in determining improvement.
Adrenal Cortex Hormones ; Adult ; Choroid ; Choroiditis ; Female ; Fever ; Granuloma ; Headache ; Humans ; Inflammation ; Iridocyclitis ; Lymphadenitis ; Macular Edema ; Meningitis ; Meningoencephalitis ; Retinitis ; Steroids ; Tuberculosis ; Tuberculosis, Miliary ; Tuberculosis, Ocular ; Uveitis ; Visual Acuity

PURPOSE: To analyze ocular manifestations of herpes zoster ophthalmicus and evaluate risk factors and complications affecting visual acuity. METHODS: Ocular, cutaneous, and systemic findings were analyzed retrospectively from the medical records of 81 patients, admitted between 1994 and 2007, to the dermatology department of our hospital for the management of herpes zoster ophthalmicus. RESULTS: Herpes zoster ophthalmicus was manifested as eyelid eruption (93%), conjunctivitis (80%), keratitis (67%), iridocyclitis (36%), secondary glaucoma (20%), or extraocular muscle palsy (1%). Some patients had accompanying systemic illnesses, including malignancy, hepatitis, diabetes mellitus, chronic obstructive pulmonary disease, tuberculosis, and cerebrovascular disease. Patients with decreased vision during the follow-up period were statistically more likely to have presented with keratitis (p=0.032). However, 86% of these patients recovered vision over a 6-month period. CONCLUSIONS: Patients presenting with keratitis upon initial evaluation are at risk for decreased vision and require appropriate ophthalmic evaluation and management.
Conjunctivitis ; Dermatology ; Diabetes Mellitus ; Eyelids ; Follow-Up Studies ; Glaucoma ; Hepatitis ; Herpes Zoster ; Herpes Zoster Ophthalmicus ; Humans ; Iridocyclitis ; Keratitis ; Medical Records ; Muscles ; Paralysis ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors ; Tuberculosis ; Vision, Ocular ; Visual Acuity

PURPOSE: To report a case of intraocular cilium revealed by diagnostic vitrectomy in a case of stubborn uveitis that was unresponsive to steroid therapy. CASE SUMMARY: A 39-year-old man was referred to our hospital due to decreased vision in his right eye that started two months prior to presentation. He had previously been treated for a diagnosis of iridocyclitis. The patient's history revealed a blunt trauma to the right eye while wearing glasses after which he developed a microhyphema and was treated for traumatic iritis at another clinic 3 months ago. He was treated with topical and oral steroids after being diagnosed with iridocyclitis and had recently been prescribed additional oral cyclosporine because his condition had not improved. Ocular examination revealed inflammatory cells in the anterior chamber and vitreous cavity with hand motion vision. Ultrasonography revealed a hazy vitreous cavity but the retina was flat. Diagnostic vitrectomy with intravitreal antibiotic injection was performed and an intraocular foreign body presumed as a cilium was detected without an entrance wound on the exterior or interior surface of the eye. After removal of the foreign body, the patient's vision was completely recovered. CONCLUSIONS: In cases of chronic uveitis that do not respond to immunosuppressive treatment without a clearly definable cause, diagnostic vitrectomy should be considered, keeping in mind the possibility of intraocular foreign body.
Adult ; Anterior Chamber ; Cilia ; Cyclosporine ; Endophthalmitis ; Eye ; Eyeglasses ; Foreign Bodies ; Glass ; Hand ; Humans ; Iridocyclitis ; Iritis ; Retina ; Steroids ; Uveitis ; Vision, Ocular ; Vitrectomy

PURPOSE: Juvenile rheumatoid arthritis(JRA) is one of the most common rheumatic diseases of childhood and is an important cause of short- and long-term disability. The purpose of this study was to determine the disease course and outcome in childhood patients with JRA. METHODS: Fifty nine patients with JRA who were diagnosed and treated in the Department of Pediatrics, Asan Medical Center from August 1990 to November 2004 were enrolled in this study. Sex, age, type, affected joints, extra-articular manifestations, laboratory and radiologic findings, treatments, and outcomes of JRA patients were reviewed retrospectively. RESULTS: Among JRA patients, 32.2 percent had pauciarticular type, 30.5 percent had polyarticular type and 37.3 percent had systemic type. The ratio of boys to girls was 1.7:1 and the mean age at onset was 9.3+/-3.7(1.3-15.9) years. The most commonly affected joints were knee, ankle and wrist. The extra-articular manifestations observed were fever, rash, myalgia and lymph node enlargement, etc. The main laboratory findings observed were leukocytosis, anemia, thrombocytosis, elevated ESR, and elevated CRP. Rheumatoid factor and antinuclear antibody(ANA) were positive in 5.3 percent and 18.0 percent. Nonsteroid anti-inflammatory drugs(NSAID) were used most frequently and methotrexate with or without steroids was added in 27.1 percent of patients unresponsive to NSAID. 88.1 percent of patients were cured without functional disability and only one patient was in functional status IV. One patient, who had pulmonary involvement, died. CONCLUSION: Our results showed an even distribution in type of onset, male predominance, older age of onset, low incidence of iridocyclitis, and low positivity of ANA in JRA patients; this differs from occidental data. This study may suggest regional differences and variability in disease groups of JRA among different racies, but further multi-center trials and large scale epidemiological studies are needed to confirm our conclusion.
Age of Onset ; Anemia ; Ankle ; Arthritis, Juvenile* ; Chungcheongnam-do ; Epidemiologic Studies ; Exanthema ; Female ; Fever ; Humans ; Incidence ; Iridocyclitis ; Joints ; Knee ; Leukocytosis ; Lymph Nodes ; Male ; Methotrexate ; Myalgia ; Pediatrics ; Retrospective Studies ; Rheumatic Diseases ; Rheumatoid Factor ; Steroids ; Thrombocytosis ; Wrist

Sweet's syndrome, or acute febrile neutrophilic dermatosis, is an unusual disease characterized by fever, leukocytosis, and distinctive skin lesions. Common complications include arthralgia, arthritis, conjunctivitis, and iridocyclitis. However, the involvement of the central nervous system in this disease, termed `neuro-Sweet syndrome' is rarely reported. We present a patient with recurrent encephalitis for 15 years, accompanied with neutrophilic dermatosis, and characterized by HLA-B54 and Cw1, with good responsiveness to corticosteroid.
Arthralgia ; Arthritis ; Central Nervous System ; Conjunctivitis ; Encephalitis ; Fever ; Humans ; Iridocyclitis ; Leukocytosis ; Neutrophils ; Skin ; Skin Diseases ; Sweet Syndrome

Chickenpox (varicella) is caused by the varicella zoster virus and can be associated with noncutaneous complications, including encephalitis, pneumonitis, and ocular disease. Previously described ocular complications resulting from chickenpox were conjunctival and corneal lesions, iridocyclitis, glaucoma, chorioretinitis, and optic nerve lesions. Most of the reported cases were anterior uveitis with self-limited disease course and patients usually recovered good vision or had but a partial visual defect. We treated a patient who developed permanent visual loss after chickenpox. A 24-year-old female who developed the typical rash of chickenpox four days before she complained of a sudden loss of vision in her left eye. The exact cause of central retinal artery occlusion in our patient is not known, but its coincidence with chickenpox is interesting.
Chickenpox* ; Chorioretinitis ; Encephalitis ; Exanthema ; Female ; Glaucoma ; Herpesvirus 3, Human ; Humans ; Iridocyclitis ; Optic Nerve ; Pneumonia ; Retinal Artery Occlusion* ; Retinal Artery* ; Uveitis, Anterior ; Young Adult