Vogt-Koyanagi-Harada disease presenting as acute angle closure glaucoma at onset

Abstract

VKH disease presenting with a bilateral increased IOP mostly occurs in older women. The strikingly decreased visual acuity associated with mild to moderate increased IOP is a clue to the diagnosis. The increased IOP responded well to corticosteroids but not to anti-glaucoma treatment.

Uveal Effusion

“…Inflammatory uveal effusions, such as those secondary to posterior scleritis and VKH syndrome are effectively managed with systemic corticosteroids and steroid-sparing drugs such as methotrexate and azathioprine. 7 Drug-induced uveal effusions gradually resolve on cessation of the causative drug in consultation with the patient's physician. Topical corticosteroids help reduce ciliary inflammation in these cases.…”

Uveitis and glaucoma

“…Mansouri and Ravinet reported that iridoplasty was successful in the treatment of a uveitic eye with acute angle closure which was resistant to medical treatment and repeated laser iridotomies (Yang et al, 2011). Besides this isolated report, there is little additional evidence for the efficacy of iridoplasty in the treatment of angle closure in eyes with uveitis, and it is often not possible to mechanically widen the angle with laser burns to the iris in uveitic eyes (Kok and Barton, 2002).…”

“…Detachment of the ciliary body occurs in eyes with severe ocular inflammation and has been associated with posterior scleritis (Heinz et al, 2013), Vogt-KayanagiHarada disease (Kishi et al, 1996;Yang et al, 2011;Yao et al, 2013), pars planitis, and uveal effusion syndrome (Saari, 1976). These patients can present with an acute increase in IOP (Kishi et al, 1996;Yamamura et al, 2008;Yang et al, 2011;Yao et al, 2013) and are easily misdiagnosed as acute primary angle closure.…”

“…These patients can present with an acute increase in IOP (Kishi et al, 1996;Yamamura et al, 2008;Yang et al, 2011;Yao et al, 2013) and are easily misdiagnosed as acute primary angle closure. Secondary causes of acute angle closure should be considered in the context of younger patients, bilateral simultaneous ocular involvement in the absence of pupillary changes, and severely decreased vision which is inconsistent with only moderately elevated IOP (Yang et al, 2011). A comprehensive examination of the posterior segment may reveal other signs of ocular inflammation, including disc swelling, exudative retinal detachment, and choroiditis (Yang et al, 2011).…”

“…Secondary causes of acute angle closure should be considered in the context of younger patients, bilateral simultaneous ocular involvement in the absence of pupillary changes, and severely decreased vision which is inconsistent with only moderately elevated IOP (Yang et al, 2011). A comprehensive examination of the posterior segment may reveal other signs of ocular inflammation, including disc swelling, exudative retinal detachment, and choroiditis (Yang et al, 2011). Topiramate ingestion is also associated with ciliary body detachment, choroidal effusions, and anterior rotation of the ciliary processes (Etminan et al, 2012;Kamal et al, 2014;Senthil et al, 2010).…”