CONTRIBUTION II zyxwvutsrqponmlkihgfedcbaYXWVUTSRPONMLK Anterior uveitis and multiple sclerosis DAVID M. MEISLER, MD; ROBERT L. TOMSAK, MD, PHD; SAMIA KHOURY, MD; MAURICE R. HANSON, MD; IVAN R. SCHWAB, MD; RICHARD M. RANSOHOFF, MD • Three patients with clinically definite multiple sclerosis and uveitis were studied. The uveitis presented as inflammation of the anterior segment of the eye (iridocyclitis) and was characterized by large keratic precipitates and posterior synechiae, consistent with a granulomatous iridocyclitis. Clinical and labora- tory evidence militated against other central nervous system diseases often associated with uveitis includ- ing neurosarcoidosis, Behcet's syndrome, Vogt-Koyanagi-Harada disease, neurosyphilis, and tuberculosis. Further attention should be directed to the possibility of granulomatous anterior uveitis in patients with multiple sclerosis. • INDEX TERMS: IRIDOCYCLITIS; MULTIPLE SCLEROSIS; UVEITIS DCLEVE CLIN J MED 1989; 56:535-538 TRPMHFBA M ULTIPLE sclerosis (MS) is a central nerv- ous system (CNS) disorder in which tissue injury appears to be mediated in part by au- toimmune mechanisms. 1 The most com- mon form of ocular inflammation associated with multi- ple sclerosis is optic neuritis. 2 Another form of ocular inflammation, uveitis, has less commonly been as- sociated with MS. 3-7 In clinical series to date uveitis in- volving the anterior segment of the eye (iridocyclitis) in MS has been uncommon and usually mild. We report on three patients with multifocal neuro- logical disease fulfilling the Poser criteria for clinically definite MS. 8 All had signs of anterior uveitis. In addi- tion the inflammation had the clinical appearance of a chronic "granulomatous" iridocyclitis. From the Departments of Ophthalmology (D.M.M.), Neurology (M.R.H., R.M.R.), and the Mellen Center for Multiple Sclerosis Treatment and Research (R.M.R.), The Cleveland Clinic Founda- tion; Division of Neuro-Ophthalmology (R.T.), Department of Neu- rology (S.K.), University Hospitals of Cleveland; and Department of Ophthalmology (I.R.S.), West Virginia University Medical Center, Morgantown. Submitted July 1988; accepted Oct 1988. Address reprint requests to D.M.M., Department of Ophthal- mology, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195. PATIENTS Two patients (Cases 1 and 2) were examined in the Ophthalmology Department of The Cleveland Clinic Foundation (CCF) and the third (Case 3) in the Oph- thalmology Department of West Virginia University Medical Center. Case 1 A t age 18, a black woman presented with quadripare- sis and bilateral visual disturbance; further details were not available. She was told that she had multiple sclero- sis. Her condition then improved considerably over months. Over the next several years, she had relapses, which included gait disturbance and sensory abnormali- ties; at age 28, generalized seizures developed, for which she was treated with phenytoin. She consulted us in 1976 at age 31 because of an exacerbation of neurologi- cal symptoms. A t that time she had dysarthria, a visual acuity of 20/ 25 OD and 20/ 800 OS, optic atrophy bi- laterally, horizontal nystagmus worse on gaze left, ataxic gait, and spastic quadriparesis. Her condition improved partially over several months. A t age 38 she complained of decreased visual acuity and ocular tearing and burn- ing. Visual acuity was 20/ 30 OD and light perception JULY • AUGUST 1989 CLEVELAND CLINIC JOURNAL OF MEDICINE 535 on October 18, 2022. For personal use only. All other uses require permission. www.ccjm.org Downloaded from