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Manifest synonym1/27/2024 ![]() ![]() Pigmented debris can deposit on the corneal endothelium, trabecular meshwork, iris or lens. Pigment Dispersion Syndrome (PDS) is an ocular disorder in which friction between the posterior surface of the iris and the lens zonules causes a release of pigment and cells into the anterior chamber. Furthermore, missed IOFB can have prolonged and atypical symptom presentation, including chronic anterior or posterior segment inflammation, often mimicking uveitis and further confounding the diagnosis. Sustained foreign bodies, particularly heavy metals of iron and copper, can lead to rapid retinal degeneration and severe visual loss. While occult, penetrating injuries are typically recognizable in a patient with a history of eye trauma, a high index of suspicion and early intervention of IOFB is crucial. These injuries vary widely in presentation based on the ocular region involved, type of foreign body, momentum of object and associated complications. Non-Malignant Masquerade Syndromes Intraocular Foreign Body This tendency to involve the choroid can thus mimic various ocular inflammatory conditions such as posterior scleritis and granulomatous diseases. Ocular metastases tend to effect the most high vascularized regions of the eye, most notably the uveal tract. Intraocular metastases is the most common type of intraocular malignancy, with an estimated incidence 20,000 cases per year in the United States. With the advent of innovative and successful treatments, there has been significant improvement in survival rates which have contributed to increased variability of presentation. This occurs by direct infiltration of neoplastic cells, secondary involvement by non-viable or dysplastic cells, or by complication arising from hematologic abnormalities and increased risk of opportunistic infection. Furthermore, ocular manifestation is highly variable, as leukemia can infiltrate almost any ocular tissue. Ophthalmic manifestation is extremely common, as up to 90% of leukemic patients have reported ocular involvement. ![]() Leukemia is an umbrella term that describes a group of several hematologic malignancies of white blood cell (WBC) origin, generally arising from either myeloid or lymphocytic cell lines. However this condition differs from vitreo-retinal disease as presentation is often low-grade and non-aggressive, rarely manifesting systemically. Much like PVRL, primary uveal lymphoma has a wide range of non-specific symptoms and can masquerade as multiple ocular conditions, including the various uveitides. Typically of B-cell origin, uveal lymphoma is classified as primary when the uvea is the initial or only site of neoplastic infiltration. Primary Uveal Lymphoma is an exceptionally rare type of intraocular lymphoma involving the choroid, iris, or ciliary body. PVRL is the most common intraocular lymphoma, and also constitutes the majority of neoplastic uveitic masquerading syndromes, representing 75% of the malignant UMS cases documented in the reports of Grange and Rothova (30/40). Primary Intraocular Lymphoma (PIL), otherwise known as primary vitreoretinal lymphoma (PVRL) is a subset of Primary CNS Lymphoma (PCNSL) where ocular symptoms represent the initial clinical findings. Herein we provide an overview of the conditions that can mimic uveitis, with a focus on clinical presentation, incidence, and clinical strategies for appropriate and timely diagnosis.Įtiology Neoplastic Masquerade Syndromes Intraocular lymphomas Masquerade syndromes can mimic more common ocular inflammatory conditions such as sarcoidosis, toxoplasmosis, syphilis, tuberculosis, intermediate uveitis, acute retinal necrosis, birdshot chorioretinitis and idiopathic retinal vasculitis. Awareness of the clinical conditions and presentations that mimic uveitis, and timely diagnosis of the underlying pathology, is essential to preserve visual acuity, and, in cases of neoplastic masqueraders, can be life-saving. While rare, Uveitis Masquerade Syndromes represent an important clinical entity. Similarly Grange reported a UMS prevalence of 2.5%, as 21/853 patients reporting to the National Eye Institute with uveitis between 20 were diagnosed with a neoplastic masquerade syndrome. In 2001 Rothova found that UMS was diagnosed in 5% of patients within a tertiary uveitis clinic (40/828 patients), and furthermore 48% of those UMS cases were found to have intraocular malignancy (19/40 patients). However, there have been two large retrospective studies within the literature that reported frequency of masquerading syndromes within large uveitis centers. The relative paucity of cases, in addition to common misdiagnosis and a dearth of published reports on UMS cases, has made it challenging to accurately report epidemiology and clinical characteristics of UMS. 1.2.2 Non-Malignant Masquerade Syndromes.
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