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Severe anterior uveitis associated with idiopathic dacryoadenitis in diabetes mellitus patient.

Takahashi Y, Kakizaki H, Ichinose A, Iwaki M - Clin Ophthalmol (2011)

Bottom Line: T1-weighted enhanced magnetic resonance imaging demonstrated left lacrimal gland enhancement with inflammatory spread to the left anterior ocular segment.Blood examination showed increased blood sugar but the other components were within normal limits.Resolution of the anterior uveitis and the dacryoadenitis was obtained after 2 months and there was no recurrence 1 year after the therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan;

ABSTRACT
A 38-year-old woman with diabetes mellitus complained of acute visual loss in the left eye (20/200) and swollen left upper eyelid. Slit lamp examination of the left eye revealed ciliary injection, posterior synechia iritis, numerous inflammatory cells, and fibrin exudates in the anterior chamber. T1-weighted enhanced magnetic resonance imaging demonstrated left lacrimal gland enhancement with inflammatory spread to the left anterior ocular segment. Blood examination showed increased blood sugar but the other components were within normal limits. The patient was treated with steroid pulse therapy (methylprednisolone 1 g/day × 3 days) under a blood sugar control regimen in consultation with an endocrinologist, after which additional peribulbar injection of triamcinolone acetonide (40 mg) was performed. Resolution of the anterior uveitis and the dacryoadenitis was obtained after 2 months and there was no recurrence 1 year after the therapy. This is a rare case of severe anterior uveitis caused by idiopathic dacryoadenitis in a patient with diabetes mellitus.

No MeSH data available.


Related in: MedlinePlus

T1-weighted enhanced magnetic resonance image. The spread of the lacrimal gland inflammation to the anterior segment of the left eye and the lateral rectus muscle is seen.
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f1C-opth-5-619: T1-weighted enhanced magnetic resonance image. The spread of the lacrimal gland inflammation to the anterior segment of the left eye and the lateral rectus muscle is seen.

Mentions: Two weeks after the initial examination, the patient noticed acute visual loss and conjunctival injection in the left eye, and left eyelid swelling. Her left visual acuity declined to 20/200 OS, and left intraocular pressure increased to 28 mmHg. Hertel exophthalmometry indicated 20 mm OS, ie, 3 mm more proptotic than the measurement taken 2 weeks before. Movement of the left lateral rectus was restricted. Swelling and tenderness occurred in the left upper eyelid (Figure 1A). Slit lamp examination of the left eye disclosed ciliary injection, posterior synechia iritis, numerous inflammatory cells, and fibrin exudates in the anterior chamber (Figure 1B), although no inflammatory sign was shown in the vitreous cavity. T1-weighted enhanced magnetic resonance imaging (MRI) illustrated enhancement of the left lacrimal gland and the anterior segment of the left globe (Figure 1C). The fasting blood sugar level was 201 mg/dL at the time, but blood tests for angiotensin-converting enzyme, rheumatoid factors, antinuclear antibodies, thyroid-related autoantibodies, antineutrophil cytoplasmic antibodies, anti-Sjögren syndrome A and B antibodies, soluble interleukin-2 receptor, and virus-associated immunoglobulins were all within normal limits or negative. The chest radiograph did not show hilar lymphadenopathies. The needle reaction was negative on physical examination. According to the findings, we diagnosed it as an idiopathic orbital inflammatory syndrome (lacrimal type).3 In addition, we judged that the lacrimal gland inflammation caused the anterior uveitis.


Severe anterior uveitis associated with idiopathic dacryoadenitis in diabetes mellitus patient.

Takahashi Y, Kakizaki H, Ichinose A, Iwaki M - Clin Ophthalmol (2011)

T1-weighted enhanced magnetic resonance image. The spread of the lacrimal gland inflammation to the anterior segment of the left eye and the lateral rectus muscle is seen.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3102595&req=5

f1C-opth-5-619: T1-weighted enhanced magnetic resonance image. The spread of the lacrimal gland inflammation to the anterior segment of the left eye and the lateral rectus muscle is seen.
Mentions: Two weeks after the initial examination, the patient noticed acute visual loss and conjunctival injection in the left eye, and left eyelid swelling. Her left visual acuity declined to 20/200 OS, and left intraocular pressure increased to 28 mmHg. Hertel exophthalmometry indicated 20 mm OS, ie, 3 mm more proptotic than the measurement taken 2 weeks before. Movement of the left lateral rectus was restricted. Swelling and tenderness occurred in the left upper eyelid (Figure 1A). Slit lamp examination of the left eye disclosed ciliary injection, posterior synechia iritis, numerous inflammatory cells, and fibrin exudates in the anterior chamber (Figure 1B), although no inflammatory sign was shown in the vitreous cavity. T1-weighted enhanced magnetic resonance imaging (MRI) illustrated enhancement of the left lacrimal gland and the anterior segment of the left globe (Figure 1C). The fasting blood sugar level was 201 mg/dL at the time, but blood tests for angiotensin-converting enzyme, rheumatoid factors, antinuclear antibodies, thyroid-related autoantibodies, antineutrophil cytoplasmic antibodies, anti-Sjögren syndrome A and B antibodies, soluble interleukin-2 receptor, and virus-associated immunoglobulins were all within normal limits or negative. The chest radiograph did not show hilar lymphadenopathies. The needle reaction was negative on physical examination. According to the findings, we diagnosed it as an idiopathic orbital inflammatory syndrome (lacrimal type).3 In addition, we judged that the lacrimal gland inflammation caused the anterior uveitis.

Bottom Line: T1-weighted enhanced magnetic resonance imaging demonstrated left lacrimal gland enhancement with inflammatory spread to the left anterior ocular segment.Blood examination showed increased blood sugar but the other components were within normal limits.Resolution of the anterior uveitis and the dacryoadenitis was obtained after 2 months and there was no recurrence 1 year after the therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan;

ABSTRACT
A 38-year-old woman with diabetes mellitus complained of acute visual loss in the left eye (20/200) and swollen left upper eyelid. Slit lamp examination of the left eye revealed ciliary injection, posterior synechia iritis, numerous inflammatory cells, and fibrin exudates in the anterior chamber. T1-weighted enhanced magnetic resonance imaging demonstrated left lacrimal gland enhancement with inflammatory spread to the left anterior ocular segment. Blood examination showed increased blood sugar but the other components were within normal limits. The patient was treated with steroid pulse therapy (methylprednisolone 1 g/day × 3 days) under a blood sugar control regimen in consultation with an endocrinologist, after which additional peribulbar injection of triamcinolone acetonide (40 mg) was performed. Resolution of the anterior uveitis and the dacryoadenitis was obtained after 2 months and there was no recurrence 1 year after the therapy. This is a rare case of severe anterior uveitis caused by idiopathic dacryoadenitis in a patient with diabetes mellitus.

No MeSH data available.


Related in: MedlinePlus