Hypopyon in Patients with Uveitis

Abstract

PURPOSE-To evaluate the risk of and risk factors for hypopyon among patients with uveitis, and to evaluate the risk of visual changes and structural complications following hypopyon. DESIGN-Retrospective cohort study.PARTICIPANTS-Patients with uveitis at four academic ocular inflammation subspecialty practices. METHODS-Data were ascertained by standardized chart review.MAIN OUTCOME MEASURES-Prevalence and incidence of hypopyon, risk factors for hypopyon, and incidence of visual acuity changes and of structural ocular complications following hypopyon.RESULTS-Among 4,911 patients with uveitis, 41 (8.3/1000) cases of hypopyon were identified at the time of cohort entry. Of these, 2,885 initially free of hypopyon were followed over 9,451 person-years, during which 81 (2.8%) developed hypopyon (8.57/1000 person-years). Risk factors Corresponding Author: John H. Kempen, M.D., Ph.D.; Center for Preventive Ophthalmology and Biostatistics; Department of Ophthalmology; University of Pennsylvania; 3535 Market Street, Suite 700; Philadelphia, PA 19104 john.kempen@uphs.upenn.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2011 February 1. Published in final edited form as:Ophthalmology. CONCLUSIONS-Hypopyon is an uncommon occurrence in patients with uveitis. Risk factors included Behçet's disease, HLA-B27 positivity, and diagnosis of a spondyloarthropathy. Intermediate uveitis cases (+/− anterior uveitis) had lower risk of hypopyon than other forms of uveitis. On average, post-hypopyon eyes were no more likely than other eyes with uveitis to develop structural ocular complications or lose visual acuity.Hypopyon-layering of white blood cells in the anterior chamber-signifies severe anterior segment intraocular inflammation. The frequency of hypopyon has been described in two small to moderate-sized series of patients with various types of uveitis. D'Alessandro et al retrospectively reviewed 155 cases of acute anterior uveitis and found 11 (7%) cases of hypopyon (duration of follow-up not reported), 9 of which were associated with HLA-B27. 1 BenEzra et al reviewed 49 patients with Behçet's disease, finding that 17 (35%) developed hypopyon over 6-10 years of follow-up.2 The incidence of hypopyon for other forms of uveitis is unclear.Data regarding the risk factors for hypopyon and regarding its prognostic significance are limited. Nussenblatt et al reported that the occurrence of hypopyon did not worsen the visual prognosis of patients with Behçet's disease. 3 However, the relationship betw...

Prevalence and aetiology of ocular hypertension in acute and chronic uveitis

“…However, since severe anterior inflammation reduces the function of ciliary body, IOP is often paradoxically lowered, especially in AAU 16. Therefore, it is logical that the causes of OHT in AAU or BD were steroid or pupillary block.…”

Practical diagnostic approach to uveitis

“…Several systems of cell grading on a 0-4+ scale have been reported, but the preferred method uses a narrow slit beam allowing for greater resolution of inflammatory cells. The presence of hypopyon does not differentiate the underlying etiology as this finding may be observed in patients with AAU associated with HLA-B27, Behçet's disease and patients with infectious endophthalmitis [29]. One should be aware of pseudohypopyons, which may be collections of neoplastic cells or fungal elements.…”

“…However, the differential diagnosis includes multiple infectious and other noninfectious etiologies [13,19,22,29,[46][47][48]. Cases associated with HLA-B27 are frequent and may be associated with seronegative spondyloarthropathies such as ankylosing spondylitis, reactive arthritis, IBD and psoriatic arthritis [19,49,50].…”

“…Oral and genital aphthous ulcerations are very common. Behçet's disease may initially present with AAU in 18-44% cases and may be accompanied by hypopyon [29,61]. Although initial ocular involvement may be unilateral and similar to other AAU syndromes, it is important to recognize this disease as it may become bilateral, severe and sight threatening with posterior segment involvement.…”

“…Intermediate uveitis refers to inflammation that primarily manifests in the vitreous, presumably due to inflammation of the pars plana and peripheral retinal vasculature [29,77,78]. Patients with IU may also demonstrate peripheral vascular sheathing and macular edema.…”