Medical Ophthalmology: Case six


Figure 1

Figure 2

The 36 year-old man had been treated for bilateral severe panuveitis and had this forehead appearance.

a. What is the most likely diagnosis?

Behcet's disease.

The patient has thrombophlebitis leading to dilatation of the superficial veins. Figure 1 shows dilatation of the veins on the forehead and figure 2 is the abdoman of the same patient showing dilated vein, the so-called caput medusa.

b. What other ocular signs may occur with this condition?

In addition to panuveitis, the following ocular signs may occur with Behcet's disease:
    Anterior segment:
    • conjunctivitis
    • episcleritis
    • keratitis
    • hypopyon from severe anterior uveitis
    Posterior segment:
    • occlusive vasculitis causing retinal vein and artery occlusion and retinal ischaemia
    • diffuse vascular leakage leading to retinal oedema and disc oedema
    • retinitis causing white infiltrates and intraretinal haemorrhage
c. What are the diagnostic criteria for this condition?
The following are the diagnostic criteria based on the International Study Group for Behcet's disease:
  • Recurrent oral ulceration
and the presence of two other criteria as follow
  • Recurrent genital ulceration
  • Eye lesions (this can include anterior and/or posterior uveitis, cells in the vitreous or the presence of a retinal vasculitis)
  • Skin lesions (this can include  erythema nodosum, acnelike lesions or follicullitis)
  • Positive pathergy test result (non-specific skin inflammatory reaction in response to needle pricks or intradermal saline.)
Click here for the questions Click here for the main page Click here for MRCOphth/FRCS tutorials