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

CRAO with BRVO

Posterior scleritis
Lab investigations






Routine blood
Mantoux test
RA, ANA
HIV
Sickle cell Test
Normal
Negative
Negative
Negative
Negative
Past Treatment

Oral & topical steroids
Clinical Presentation


BCVA
 OD 6/6
OS – HMCF
SLE
 Live worm in the corneal
stroma
 AC cells 2+, flare +,
vitreous cells+
Fundus
Blot retinal hemorrhages, sub retinal heme, worm tracts, old vitreous hemorrhage
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
Gnathostoma spinigerum
Follow up – Day 1
Corneal stromal scar
 AC cells+, flare+, Iris holes
 IOP – 44mmHg

Follow up – Day 1 - Treatment


Oral
 Acetazolamide 250mg
Topical
 Prednisolone acetate - 10/d
 Homatropine – 2/d
 Combigan – 2/d
 Dorzolamide – 3/d
Final Diagnosis
Panuveitis induced by intraocular
Gnathostomiasis
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.
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