A Case of Recurrent Uveitis in Autoimmune Liver Disease

PURPOSE: To report a case of recurrent uveitis associated with autoimmune liver disease. CASE SUMMARY: A 50-year-old female with severe fatigue and arthritis visited the ophthalmology department due to decreased visual acuity and discomfort in her right eye for ten days. She had intermittent injection and blurred vision in both eyes for 30 years. Slit lamp examination of her right eye showed keratic precipitates, pigment deposits on the anterior capsule of the lens and anterior chamber cells; fundus examination was normal without any sign of chorioretinitis. Inflammatory reaction was improved after steroid and cycloplegic eye drop treatment. Two months later, her left eye developed anterior uveitis. Inflammation was well controlled with steroid and cycloplegic eye drop treatment. To evaluate the cause of uveitis and associated systemic disease, serological testing was performed, and abnormal elevation of liver enzymes was detected. The patient was referred to the Gastroenterology Department and diagnosed with autoimmune liver disease. Oral ursodeoxycholic acid was prescribed. Liver function profile improved to normal range, and the patient is currently under routine follow-up with no sign of recurrent uveitis. CONCLUSIONS: When a patient with recurrent uveitis presents symptoms such as nausea, fatigue, abdominal pain, jaundice or abnormal liver profile, association with autoimmune liver disease should be considered.

Eye Fixation in Patients with Dissociated Vertical Diviation

PURPOSE: To clinically determine the proportion of people with a fixed dissociating eye in patients with dissociated vertical deviation (DVD). METHODS: Medical records of 86 patients diagnosed with DVD in our department of ophthalmology from 2001 to November 2011 were retrospectively analyzed. RESULTS: Of the 71 patients, 25 (35.21%) showed a higher degree of dissociation in the fixating eye, 26 (36.62%) had higher dissociation in the non-fixating eye; 20 of 25 patients with a higher level of dissociation in the fixating eye and 22 of 26 patients with a higher level of dissociation in the non-fixating eye received surgical correction for DVD, such as superior rectus muscle recession or inferior oblique muscle anterior transposition. CONCLUSIONS: In DVD, the proportion of patients showing a higher level of dissociation in the fixating eye was significant. Patients with DVD require thorough evaluation; measurement of the level of dissociation and determination of the fixating eye is beneficial for management and surgical intervention.

Acute-Onset Vertical Strabismus in Adults

PURPOSE: To define the clinical characteristics of acute vertical strabismus in adults strabismus without known ocular and cranial external factors. METHODS: We performed a retrospective study of 72 adult patients who developed acute vertical strabismus without known ocular and cranial external factors such as trauma or operation and were followed up for at least 6 months. RESULTS: Undetermined cause (n = 41, 57%) was the most common etiology of acute vertical strabismus, followed by fourth cranial nerve palsy (n = 15, 20.8%), myasthenia gravis (n = 7, 9.7%), third cranial nerve palsy (n = 6, 8.3%), brain tumor (n = 2, 2.7%), and carotid-cavernous fistula (n = 1, 1.3%). The average vertical deviation at primary position was 7.2 prism diopter at initial visit. Thirty-eight (62.3%) patients recovered to orthophoria and 13 (21.3%) patients showed decreased level of diplopia. The average recovery period was 2.9 months. Ten cases remained as strabismus and 5 underwent surgery upon patient's request. CONCLUSIONS: Unknown cause was the most common diagonosis of adult acute vertical strabismus without known ocular and cranial external factors. In the present study, 62.3% of patients recovered to orthophoria and 83.6% recovered without surgical procedures.

The Effects of Stress on Intraocular Pressure and Lacrimal Secretion

PURPOSE: To evaluate the effects of psychosocial stress on intraocular pressure and lacrimal secretion. METHODS: Twenty normal adult volunteers (40 eyes) who had no history of systemic or ocular disease such as dry eye syndrome or glaucoma were recruited from clinical research participants. Heart rate, intraocular pressure and lacrimal secretion were measured after the Trier Social Stress Test (TSST) which induces psychosocial stress. The same measurements were taken 1 week later and the recorded measurements were considered as the control group. RESULTS: Heart rate was elevated significantly after the TSST, indicating psychosocial stress was induced by the TSST. Compared to stress resolution status, intraocular pressure and lacrimal secretion were increased after the TSST (p = 0.027, p = 0.011). Elevation of intraocular pressure and lacrimal secretion was statistically significant in males (p = 0.031, p = 0.007), but not significant in females (p = 0.336, p = 0.554). CONCLUSIONS: Psychosocial stress can increase intraocular pressure and lacrimal secretion.