Year : 1967 | Volume
: 15 | Issue : 2 | Page : 69--70
Eale's disease followed by granulomatous anterior uveitis
BS Jain, KN Srivastava
Willingdon Hospital, New Delhi, India
B S Jain
Willingdon Hospital, New Delhi
|How to cite this article:|
Jain B S, Srivastava K N. Eale's disease followed by granulomatous anterior uveitis.Indian J Ophthalmol 1967;15:69-70
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Jain B S, Srivastava K N. Eale's disease followed by granulomatous anterior uveitis. Indian J Ophthalmol [serial online] 1967 [cited 2023 Mar 27 ];15:69-70
Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1967/15/2/69/38684
Periphlebitis Retinae (Eale's Disease) characterised by recurrent intraocular hemorrhage in young males is quite a common condition in this part of the country. These patients are treated in two stages, once a diagnosis of Eale's disease has been arrived at and relevant investigations are come pleted, (1) for absorption of hemorrhages and (2) for prevention of recurrences.
Absorption of hemorrhage is attempted with rest, intravenous collosal iodine (Crookes) 0.40%, 10 c.c. mixed with 500 mg. of vit. C, given intravenously once a week along with general supportive treatment. In the mentime, all the routine laboratory, serological and clinical investigations are carried out, any functional or organic vascular disease (Raynaud's disease, Buerger's disease, or Raynaud's phenomenon etc.) and collagen disease are excluded.
Any evidence of septic foci, ankylostomiasis and ascariasis obtained during investigation is radically dealt with, while other cases are put on tuberculin desensitization therapy to check recurrence of hemorrhage in the second stage.
We are reporting here a case, who while on tuberculin desensitisation therapy, developed cyclitis with mutton fat K.P.'s.
A young male aged 26 came to us after having been under the observation and treatment of some other consultant for Eale's disease for more than 6 months with no improvement.
Examination : Vision of right eye was reduced to perception of light only. The fund us reflex was not visible by direct or indirect ophthalmoscopy. The left eye had 6/6 and Ji vision with normal visual field. Focal illumination and slit lamp examination showed no abnormality. X'Ray chest showed prominent hilar markings. E.S.R. was 42 mm Wester green 1st hour. Bleeding time, coagulation time were normal. Serological tests for syphilis-negative. Differential count showed relative lymphocytosis. Repeated stool examinations were normal. Mantoux test was 2 plus. Fundus examination showed vitreous hemorrhage. Tension was normal (20 mm schiotz).
He was put on desensitisation therapy by Tuberculin according to the Sarnae method, starting from a dose of 0.1 c.c. of 1 : 1,000,000 dilution subcutaneously once a week. The initial dosage prescribed was less than even the prescribed testing dose, to avoid the danger of any severe focal reaction, which is aimed to be kept minimal. After about six months of this treatment, while on 1/100,00 dilution and weekly check up, it was found that the right eye had become very soft almost like cotton wool. A traction detachment was suspected. On taking the patient for slit lamp examination, three spots of large greyish white waxy (mutton fat) K.P.'s were seen on the back of the cornea, while the eye was quiet with no circumcorneal congestion, pain or any sign of irritation. A diagnosis of granulomatous cyclitis in a case of Eale's Disease was made. Tuberculin therapy was stopped and the patient was put on local hot fomentation, mydriatic and corticosteroids combined with anti-tubercular chemotherapy (streptomycin, P.A.S. and I.N.A.) continuing general measures at the same time.
In the third week of this line of treatment, the tension started improving and in two months, the tension had returned to normal and the K.P.s had almost completely disappeared, but no improvement in vision could be achieved. The patient continues to be under observation and treatment. The left eye has been normal while he has started developing complicated cataract in the right eye.
The occurrence of granulamatous uveitis in this case of Eale's disease could be incidental, but it could more probably be due to a more than desired focal reaction of tuberculin in a patient with increased hilar shadows, raised E.S.R., 2 + Mantoux test and suspiciously tuberculous ocular lesion (Eale's disease). Tuberculin is known to produce a local reaction, which is partly specific and partly non-specific. It also gives rise to a focal reaction which is kept minimal for therapeutic purposes. The action is absolutely specific and occurs at the site of lesion, if tuberculous.
There is no fixed dose for tuberculin and however careful one may be, starting with the smallest possible dose, one is liable to overshoot the mark and cause a more than desired focal reaction. This is what could have happened in this case, resulting in clinical evolution of granulomatous anterior uveitis in the eye previously afflicted with Eale's disease and the fact that it was controlled by anti-tubercular treatment, further elucidates the etiology of this condition.
Eale's disease has a varied aetiology and more than one factor are responsible but there is enough clinical evidence in this case to label it as tuberculous.