J Korean Ophthalmol Soc.  2007 Nov;48(11):1588-1592.

Vogt-Koyanagi-Harada Disease Associated with Bilateral Tonic Pupils in a Pregnant Patient

• Park JS
• Park JM
• Lee JE
• Oum BS

Abstract

PURPOSE: We report a case of bilateral tonic pupils and decreased corneal sensitivity in a patient with Vogt-Koyanagi-Harada (VKH) disease during pregnancy.
CASE SUMMARY
A 33-year-old Korean woman in the sixth month of pregnancy presented with visual impairment in both eyes. Her best corrected visual acuity was 0.2 in the right eye and 0.125 in the left. Slit-lamp examination revealed cells in the anterior chamber and serous retinal detachments in both eyes. The patient was treated with topical corticosteroid in both eyes and posterior subtenon injection of triamcinolone acetonide in the left eye. The serous retinal detachment resolved completely at 2 months in the left eye and at 3 months in the right. As pigmentation of the retina developed, VKH disease was confirmed. The patient complained of photophobia, and both pupils were found to be enlarged to 8 mm without dilation. Light reflex was absent and near reflex was suppressed and slow. After instillation of 0.125% pilocarpine, the pupils were constricted to 3.5 mm and were diagnosed as tonic pupils. Though the patient's corrected visual acuity improved to 0.8 in the right eye and 1.0 in the left at 6 months, her pupils remained unchanged. Corneal sensitivity was decreased.
CONCLUSIONS
Tonic pupils may be complicated with VKH disease even during pregnancy. We recommend examinations of the pupils and corneal sensitivity in patients with VKH disease, especially those complaining of photophobia.

Keyword

Corneal sensitivity; Pregnancy; Tonic pupil; Vogt-Koyanagi-Harada disease

MeSH Terms

Adult
Anterior Chamber
Female
Humans
Photophobia
Pigmentation
Pilocarpine
Pregnancy
Pupil
Reflex
Retina
Retinal Detachment
Tonic Pupil*
Triamcinolone Acetonide
Uveomeningoencephalitic Syndrome*
Vision Disorders
Visual Acuity
Pilocarpine
Triamcinolone Acetonide

Figure

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  Figure 1. Fundus Photograph. Serous retinal detachment is seen at presentation (A, B). Serous retinal detachment is resolved at 3 months in the right eye (C), and at 2 months in the left eye (D). Depigmentation is noted around the optic disc of both eyes (C, D).

• 

  Figure 2. Optical coherence tomography demonstrates serous retinal detachment at presentation in the right eye(A), and in the left eye (B). Subretinal fluid is resolved at 3 months in the right eye (C), and at 2 months in the left eye (D).

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  Figure 3. Photography showing the pupil sizes. (A, B) Looking at the distance in the dark, both pupils are dilated (8 mm). (C, D) During near gazing, near reflex is slow and suppressed (6 mm). (E, F) In bright light, light reflex is suppressed (7 mm). (G, H) After instillation of single drop of 0.125% pilocarpine, both pupils are constricted (3.5 mm).

Reference

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